ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Chlorhexidine Applications Improve Oral Health of Patients with Down Syndrome
Clinical Question In a patient with Down Syndrome and poor oral hygiene, will chlorhexidine applications prove more successful at increasing the patient’s overall oral health versus no treatment?
Clinical Bottom Line Chlorhexidine applications in a 2% sustained-delivery dosage form along with rinses with 0.2% chlorhexidine mouthwash and brushing with 1% chlorhexidine gel improve the oral health of patients with Down Syndrome. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 1838722Stabholz/199130 subjects with Down Syndrome; 10 received placebo, 10 received chlorhexidine solution, 10 received no treatment every 3 days for 21 days.Randomized Controlled Trial
Key resultsFor subjects receiving chlorhexidine treatment: Mean plaque index and gingival index reduction of 40%, bleeding papillae reduction of 20%, 85% reduction in bacteria colony-forming units.
#2) 18251655Cheng/200521 adult subject with Down Syndrome received non-surgical periodontal therapy and chlorhexidine mouthrinse and gel twice daily for 12 months.Case Series.
Key resultsPlaque sites decreased from 84.1% to 23.6%; bleeding on probing sites decreased from 82.1% to 29.6%; Reduction in clinical probing depths from 3.2 to 1.8 mm; average gain in clinical attachment level of 0.6mm.
Evidence Search Search "Chlorhexidine"[Mesh] Search ("Down Syndrome"[Mesh] Search down syndrome
Comments on
The Evidence
The evidence only consists of a randomized controlled trial and a small case series but the studies are very consistent with results and outcome.
Applicability It is well known that patients with Down Syndrome frequently have poor oral hygiene, often with worse conditions than patients of similar age without this syndrome. Such patients require additional treatments and more frequent visits to the dental office. Health practitioners need to determine which treatments, both mechanical and chemical, will be most beneficial for these patients in order to reduce the amounts of bone loss, plaque buildup and gingivitis they are often affected with. Both studies provide evidence that is applicable to the question of whether patients with Down Syndrome may experience improved oral hygiene results following the application of chlorhexidine. Although the evidence consists of only a small randomized trial and a small case series, the studies both demonstrate that patients with Down Syndrome may in fact, be treated with non-surgical periodontal therapies to improve the management of gingivitis. Additionally, chlorhexidine applications are not only advantageous at improving oral health conditions, but it is also beneficial that hygienists and even untrained professionals can administer such applications. The procedure is simple and does not require special equipment or training in order to see significant improvements.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Down syndrome, Chlorhexidine, Plaque, Oral health
ID# 466
Date of submission: 01/06/2010spacer
E-mail hogans@uthscsa.edu
Author Sheridan Bunch
Co-author(s) Steven Hogan
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Trey Patterson (San Antonio) on 04/02/2012
Completed a PubMed search and found a more recent article. However, the article doesn’t focus in on just chlorhexidine treatment but rather a combination of products. Therefore, I don’t think adding it to your CAT would be appropriate.
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