Chlorhexidine mouthrinse as an adjunctive treatment for gingival health
Information
- DOI:
- https://doi.org/10.1002/14651858.CD008676.pub2Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 31 March 2017see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Oral Health Group
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
Helen Whelton (HW) conceived the idea for the review. Patrice James (PJ), Carmel Parnell (CP), Philip Riley (PR), Thomas Lamont (TL) and Mairead Harding (MH) identified the studies to be included in the review. PJ, CP, PR, TL, MH and Andrea Cheung (AC) carried out data extraction. PJ, AC, PR and TL compiled the characteristics of included studies tables. PJ, CP, PR, MH and TL assessed the risk of bias for the included studies. Helen Worthington (HVW) statistically analysed the data. PJ, TL and AC drafted the background section. PJ, HVW and PR drafted the body of the review. HW, MH, CP and AC commented on and edited the draft review. HVW and PR provided advice and guidance throughout the review process.
Sources of support
Internal sources
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Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK
External sources
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Health Research Board Cochrane Fellowship Scheme, Ireland
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National Institute for Health Research (NIHR), UK
This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, the NIHR, the NHS or the Department of Health.
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Cochrane Oral Health Global Alliance, Other
The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (oralhealth.cochrane.org/partnerships-alliances). Contributors over the past year have been the American Association of Public Health Dentistry, USA; the British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; and NHS Education for Scotland, UK.
Declarations of interest
As former Director of the Oral Health Services Research Centre, Cork, Helen Whelton has conducted clinical trials of products for GlaxoSmithKline (GSK) and she received consultancy fees in relation to this research. Mairead Harding (Deputy Director of the Oral Health Services Research Centre) was involved in the development of educational materials with regard to tooth wear/dental erosion and has conducted epidemiological studies and presented the findings on tooth wear and dental erosion at conferences. Fees received from GlaxoSmithKline for this work were paid to the Oral Health Services Research Centre, Cork and not to Mairead Harding. Philip Riley is a salaried member of the Cochrane Oral Health editorial team. Editorial control of the review and final decisions about the content of the review were maintained by Helen Worthington who is Co‐ordinating Editor of Cochrane Oral Health. The remaining co‐authors declare no conflict of interest.
Acknowledgements
We wish to thank Ms Anne Littlewood, Information Specialist, Cochrane Oral Health, for developing the search strategy, conducting the database searches and writing up the 'Electronic searches' section of the review; and Luisa Fernandez Mauleffinch, Managing Editor and Copy Editor, Cochrane Oral Health, for her assistance with the editorial process. We thank Anne‐Marie Glenny and Jacopo Buti for their comments on the draft. We would like to thank Leyes Borrajo, Michel Brecx, Jack Caton, Eros Chaves, Dan Ericson, Thomas Flemmig, Peter Fine, Stuart Fischman, Per Gjermo, Michael Newman, Mariano Sanz, and Francesco Spadari for responding to our queries regarding their studies; and Magda Feres, Marcelo de Faveri, Jan Hase and Torgny Sjödin for providing additional outcome data from their studies. We would also like to thank Irene Halpin, Cork University Hospital Medical Library and the staff at the Interlibrary Loans Department in the Boole Library, University College Cork for their assistance in obtaining many of the studies for this review through interlibrary loans and stores requests. We would like to thank Makiko Nishi (Oral Health Services Research Centre) for her assistance with obtaining unpublished data and assistance with assessment of eligibility of Japanese and Chinese papers and the staff of the Oral Health Services Research Centre, Cork for their support and encouragement. Patrice James would like to thank Mark, Oisin, Aoife and Rian for their love and unfailing support.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Mar 31 | Chlorhexidine mouthrinse as an adjunctive treatment for gingival health | Review | Patrice James, Helen V Worthington, Carmel Parnell, Mairead Harding, Thomas Lamont, Andrea Cheung, Helen Whelton, Philip Riley | |
| 2010 Sep 08 | Chlorhexidine mouthrinse as an adjunctive treatment for gingival health | Protocol | Patrice James, Carmel Parnell, Mairead Harding, Helen Whelton, Helen V Worthington, Paul V Beirne | |
Differences between protocol and review
In Spring 2016, in conjunction with the editorial board of Cochrane Oral Health, the decision was made to address the comparison of chlorhexidine mouthrinse with placebo, control or mechanical oral hygiene alone in this review and to report the comparison of chlorhexidine mouthrinse with other active mouthrinses in a subsequent review. This decision will enable us to comprehensively report all of the results for the objectives set out in the published protocol (James 2010) across two reviews.
A number of additional changes were made in relation to the criteria for including studies in the review after the protocol was published but early in the review process.
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Types of studies
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It was decided to exclude cross‐over trials due to concerns that chlorhexidine could exert an effect beyond the washout period.
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When we wrote the protocol, we did not anticipate encountering split‐mouth studies meeting the inclusion criteria because it is not possible to conduct a split‐mouth study when using mouthrinse as the intervention. However, we encountered split‐mouth studies comparing different scaling and root planing regimens and different periodontal surgical techniques that incorporated a chlorhexidine and placebo/control comparison. Such study designs were considered inappropriate to answer the question posed by this review and were excluded.
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Types of participants
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Individuals no longer need to have undergone periodontal treatment and be in the maintenance phase to be included. This change was made to allow us to include studies where chlorhexidine was used as an adjunct to surgical and non‐surgical periodontal therapy. Individuals of any age, gender or race with periodontal disease (gingivitis or periodontitis) provided they are capable of performing mechanical oral hygiene procedures are included.
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Risk of bias
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Assessment of blinding for participants, personnel and outcome assessors was changed to allow for low and unclear risk of bias in these domains in certain situations.
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The following were not explicitly addressed in the protocol and required clarification.
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Types of intervention
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We clarified that the mechanical oral hygiene procedures must be the same in both the chlorhexidine mouthrinse and the comparison arms so that the chlorhexidine mouthrinse is the only difference between the arms to ensure that the groups are truly comparable.
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Studies where the chlorhexidine mouthrinse also contained fluoride were included.
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Studies where gum care or antigingivitis dentifrices (that do not contain chlorhexidine) are used for mechanical oral hygiene in both test and comparator arms were included.
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Studies where chlorhexidine mouthrinse formed part of a combined intervention with other agents (such as other chlorhexidine vehicles, dentifrice containing chlorhexidine, or other antigingivitis agents (e.g. cetylpyridinium chloride (CPC)) that the comparator arm/s did not receive were excluded because the effect of the chlorhexidine could not be separated from the effect of the other active agents.
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Types of outcome
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A hierarchy to guide data extraction of gingivitis and plaque data was developed to facilitate data extraction and analysis. The main analysis however, was based on the main prespecified gingivitis index: the Gingival Index of Löe and Silness (Löe 1967; Löe and Silness 1963).
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Notes
There is unlikely to be new evidence to include in this review that would change the results so it will not be further updated.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Chemotherapy, Adjuvant;
- Chlorhexidine [adverse effects, *therapeutic use];
- Dental Plaque [complications, *drug therapy];
- Dental Plaque Index;
- Dental Prophylaxis;
- Gingivitis [*drug therapy, etiology];
- Mouthwashes [adverse effects, *therapeutic use];
- Oral Hygiene;
- Publication Bias;
- Randomized Controlled Trials as Topic;
- Time Factors;
- Tooth Discoloration [chemically induced];
Medical Subject Headings Check Words
Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged;
PICOs
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 1: Gingival Index (0‐3) 4‐6 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 2: Gingival Index (0‐3) 6 months
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 3: Gingival bleeding 4‐6 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 4: Gingival bleeding 6 months
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 5: Plaque 4‐6 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 6: Plaque 4‐6 weeks PI (0‐3)
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 7: Plaque 4‐6 weeks TQH (0‐5)
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 8: Plaque 6 months
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 9: Plaque 6 months PI (0‐3)
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 10: Plaque 6 months TQH (0‐5)
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 11: Calculus 4‐6 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 12: Calculus 7‐12 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 13: Calculus 6 months
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 14: Tooth staining 4‐6 weeks dichotomous
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 15: Tooth staining 7‐12 weeks dichotomous
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 16: Tooth staining 4‐6 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 17: Tooth staining 7‐12 weeks
Comparison 1: CHX versus placebo/control mouthrinse or no mouthrinse, Outcome 18: Tooth staining 6 months
| Chlorhexidine mouthrinse compared with placebo/control mouthrinse/no mouthrinse for gingival health | ||||||
|---|---|---|---|---|---|---|
| Patient or population: adults and children with gingivitis Settings: any Intervention: chlorhexidine mouthrinse Comparison: placebo/control mouthrinse or no mouthrinse | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Chlorhexidine | |||||
| Gingival Index 4 to 6 weeks (Löe and Silness Gingival Index) (0 to 3 on an increasing scale) | The mean gingivitis scores ranged across control groups from 0.17 to 1.401 | The mean gingivitis score in the chlorhexidine group was 0.21 lower (0.11 to 0.31 lower) | 805 (10 trials) | ⊕⊕⊕⊕2,3 | The effect size at 6 months was similar Insufficient evidence for differences in effect size for different chlorhexidine concentration or frequency of use Insufficient evidence to determine the effect size in individuals with moderate or severe levels of gingival inflammation on average (mean GI scores 1.1 to 3) | |
| Plaque 4 to 6 weeks (various increasing scales including Plaque Index (0 to 3 scale) and Turesky Modification of the Quigley and Hein Index (0 to 5 scale)) | Plaque Index ranged from 0.75 to 1.06 Turesky Modification of the Quigley and Hein Index ranged from 1.2 to 3.3 | The SMD was 1.45 lower in the chlorhexidine group indicating a large reduction in plaque from 1.00 to 1.90 standard deviations | 950 (12 trials) | ⊕⊕⊕⊕2,3 | The effect for the Plaque Index (4 trials; 223 participants) was 0.58 (95% CI 0.39 to 0.78) lower The effect for the Turesky Modification of the Quigley and Hein Index (5 trials; 546 participants) was 0.78 (95% CI 0.70 to 0.85) lower There were also large effects for the plaque at 6 months | |
| Tooth staining 4 to 6 weeks (various increasing scales) | The mean tooth staining score was measured on different scales | The SMD for tooth staining in the chlorhexidine group was | 415 (8 trials) | ⊕⊕⊕⊝4 | Data have not been converted to original scale as many different scales are used. The SMD effect size is considered large There were also 2 trials presenting dichotomous data showing large significant effect RR 5.41 (95% CI 2.03 to 14.47) There was also a large effect for tooth staining for chlorhexidine at 7 to 12 weeks and 6 months | |
| Other adverse effects | 22 trials reported at least 1 adverse effect apart from extrinsic tooth staining and calculus formation in the chlorhexidine rinse arms. The adverse effects most commonly reported were taste disturbance/alteration (reported in 11 trials), effects on the oral mucosa including mucosal irritation, soreness, mild desquamation, mucosal ulceration/erosions, oral mucosal lesions (reported in 13 trials) and a general burning sensation and/or a burning tongue (reported in 9 trials) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1The mean gingivitis score for the control group was 0.93 (median is 1.0). | ||||||
| Characteristic | Number of studies | Slope estimate | 95% CI | Slope interpretation | P value |
|---|---|---|---|---|---|
| Adults versus children | 10 ‐ no studies with just children | ||||
| Gingivitis alone versus gingivitis with perio | 8 | 0.12 | ‐0.14 to 0.38 | Increase in GI effect estimate for gingivitis and perio | 0.30 |
| Prophylaxis or not | 9 | 0.05 | ‐0.22 to 0.32 | Increase in GI effect estimate for prophylaxis | 0.66 |
| Baseline gingivitis < 1 versus > 1 | 9 | 0.02 | ‐0.25 to 0.30 | Increase in GI effect estimate for higher baseline score | 0.84 |
| CI = confidence interval. | |||||
| Characteristic | Number of studies | Slope estimate | 95% CI | Slope interpretation | P value |
|---|---|---|---|---|---|
| Adults versus children | 13 | ‐0.17 | ‐0.42 to 0.09 | Increase in GI effect estimate for adults | 0.185 |
| Gingivitis alone versus gingivitis with perio | 9 | 0.15 | ‐0.14 to 0.44 | Increase in GI effect estimate for gingivitis and perio | 0.25 |
| Prophylaxis or not | 11 | ‐0.13 | ‐0.25 to ‐0.004 | Increase in GI effect estimate for no prophylaxis | 0.045 |
| Baseline gingivitis < 1 versus > 1 | 9 | ‐0.05 | ‐0.39 to 0.30 | Decrease in GI effect estimate for higher baseline score | 0.75 |
| CI = confidence interval. | |||||
| Outcome (index) | Time | Chlorhexidine concentration | Studies (participants) | MD/SMD 95% CI | Effect P value | Subgroup P value |
|---|---|---|---|---|---|---|
| Gingival inflammation (Gingival Index) | 4 to 6 weeks | 0.2 | 6 (552) | MD ‐0.27 (‐0.46 to ‐0.09) | 0.003 favours CHX | 0.41 |
| 0.1 and 0.12 | 5 (253) | MD ‐0.19 (‐0.27 to ‐0.10) | < 0.0001 favours CHX | |||
| Gingival inflammation (Gingival Index) | 6 months | 0.2 | 1 (86) | MD ‐0.12 (‐0.20 to ‐0.04) | 0.005 | Too few studies in subgroup |
| 0.1 and 0.12 | 10 (2352) | MD ‐0.22 (‐0.33 to ‐0.11) | < 0.00001 favours CHX | |||
| 0.05 | 1 (150) | MD ‐0.04 (‐0.11 to 0.03) | 0.28 | |||
| Gingival bleeding | 4 to 6 weeks | 0.2 | 4 (472) | SMD ‐0.71 (‐0.90 to ‐0.51) | < 0.00001 favours CHX | 0.18 |
| 0.1 and 0.12 | 3 (127) | SMD ‐0.32 (‐0.85 to 0.21) | 0.23 | |||
| Gingival bleeding | 6 months | 0.2 | 2 (155) | SMD ‐1.20 (‐2.48 to 0.08) | 0.07 | 0.34 |
| 0.12 | 6 (977) | SMD ‐0.57 (‐0.79 to ‐0.36) | < 0.00001 favours CHX | |||
| Plaque | 4 to 6 weeks | 0.2 | 8 (685) | SMD ‐1.75 (‐2.45 to ‐1.04) | < 0.00001 favours CHX | 0.04 |
| 0.1 and 0.12 | 4 (215) | SMD ‐0.95 (‐1.23 to ‐0.66) | < 0.00001 favours CHX | |||
| Plaque | 6 months | 0.2 | 2 (149) | SMD ‐1.26 (‐1.61 to ‐0.90) | < 0.00001 favours Chx | 0.65 |
| 0.1 and 0.12 | 8 (1898) | SMD ‐1.38 (‐1.75 to ‐1.00) | < 0.00001 favours CHX | |||
| Calculus | 4 to 6 weeks | 0.12 | 1 (52) | MD 0.01 (‐0.21 to 0.23) | 0.93 | |
| Calculus | 7 to 12 weeks | 0.2 | 2 (159) | SMD ‐0.03 (‐0.43 to 0.36) | 0.86 | 0.05 |
| 0.12 | 4 (266) | SMD 0.52 (0.13 to 0.91) | 0.10 | |||
| Calculus | 6 months | 0.2 | 2 (149) | SMD 0.41 (0.09 to 0.74) | 0.01 | 0.005 |
| 0.12 | 2 (174) | SMD 1.17 (0.76 to 1.59) | < 0.00001 favours control | |||
| Tooth staining | 4 to 6 weeks | 0.2 | 2 (116) | SMD 1.45 (1.04 to 1.87) | < 0.00001 favours control | 0.05 |
| 0.1 and 0.12 | 6 (299) | SMD 0.96 (0.68 to 1.24) | < 0.00001 favours control | |||
| Tooth staining | 7 to 12 weeks | 0.2 | 3 (181) | SMD 1.38 (1.05 to 1.71) | < 0.00001 favours control | 0.10 |
| 0.12 | 7 (361) | SMD 1.2 (0.96 to 1.45) | < 0.00001 favours control | |||
| 0.05 | 1 (39) | SMD 0.59 (‐0.05 to 1.24) | 0.07 | |||
| Tooth staining | 6 months | 0.2 | 2 (149) | SMD 1.79 (1.41 to 2.17) | < 0.00001 favours control | 0.08 |
| 0.12 | 2 (174) | SMD 1.33 (1.00 to 1.66) | < 0.00001 favours control | |||
| CHX = chlorhexidine; CI = confidence interval; MD = mean difference; SMD = standardised mean difference. Studies where the concentration of the chlorhexidine mouthrinse was not reported (Turkoglu 2009) and where data relate to a combination of different chlorhexidine concentrations (Flotra 1972) were excluded from this analysis. Therefore, in certain analyses, the number of studies and participants presented in the table are different from the data presented in the main analysis. | ||||||
| Outcome (index) | Time | Chlorhexidine frequency | Studies (participants) | MD/SMD 95% CI | Effect P value | Subgroup P value |
|---|---|---|---|---|---|---|
| Gingival inflammation (Gingival Index) | 4 to 6 weeks | Twice per day | 9 (785) | MD ‐0.22 (‐0.33 to ‐0.11) | < 0.0001 | Too few studies in subgroup |
| Once per day | 1 (20) | MD ‐0.13 (‐0.31 to 0.06) | 0.18 | |||
| Gingival inflammation (Gingival Index) | 6 months | Twice per day | 11 (1614) | MD ‐0.17 (‐0.20 to ‐0.13) | < 0.0001 | 0.56 |
| Once per day | 2 (1002) | MD ‐0.34 (‐0.93 to 0.25) | 0.26 | |||
| Gingival bleeding | 4 to 6 weeks | Twice per day | 8 (649) | SMD ‐0.56 (‐0.79 to ‐0.33) | < 0.0001 | ‐ |
| Gingival bleeding | 6 months | Twice per day | 8 (1132) | SMD ‐0.72 (‐1.02 to ‐0.42) | < 0.0001 | ‐ |
| Plaque | 4 to 6 weeks | Twice per day | 11 (930) | SMD ‐1.49 (‐1.97 to ‐1.02) | < 0.0001 | Too few studies in subgroup |
| Once per day | 1 (20) | SMD ‐0.92 (‐1.86 to 0.02) | 0.05 | |||
| Plaque | 6 months | Twice per day | 10 (1223) | SMD ‐1.34 (‐1.66 to ‐1.03) | < 0.0001 | Too few studies in subgroup |
| Once a day | 1 (852) | SMD ‐2.10 (‐2.27 to ‐1.93) | < 0.0001 | |||
| Calculus | 4 to 6 weeks | Twice per day | 1 (50) | MD 0.03 (‐0.11 to 0.17) | 0.70 | ‐ |
| Calculus | 7 to 12 weeks | Twice per day | 5 (373) | SMD 0.33 (‐0.11 to 0.77) | 0.14 | ‐ |
| Calculus | 6 months | Twice per day | 4 (323) | SMD 0.80 (0.33 to 1.26) | 0.0007 | ‐ |
| Tooth staining | 4 to 6 weeks | 3 times per day | 1 (33) | SMD 1.55 (0.76 to 2.34) | < 0.0001 | Too few studies in subgroup |
| Twice per day | 5 (310) | SMD 1.18 (0.93 to 1.44) | < 0.0001 | |||
| Once per day | 1(20) | SMD 0.39 (‐0.5 to 1.28) | 0.39 | |||
| Tooth staining | 7 to 12 weeks | 3 times per day | 1 (33) | SMD 0.77 (0.06 to 1.48) | 0.03 | Too few studies in subgroup |
| Twice per day | 9 (496) | SMD 1.26 (1.04 to 1.49) | < 0.0001 | |||
| Tooth staining | 6 months | Twice per day | 4 (323) | SMD 1.54 (1.22 to 1.86) | < 0.0001 | ‐ |
| CI = confidence interval; MD = mean difference; SMD = standardised mean difference. | ||||||
| Outcome (index) | Time | Chlorhexidine conc (%) | Studies (participants) | MD/SMD 95% CI | Effect P value | Heterogeneity |
|---|---|---|---|---|---|---|
| Results for studies with no rinse control arms | ||||||
| Gingival bleeding | 7 to 12 weeks | < 0.1 | 2 (196) | MD ‐0.07 (‐0.16 to 0.02) | 0.13 favours CHX | P = 0.19, I2 = 40% |
| Plaque | 7 to 12 weeks | < 0.1 | 2 (196) | SMD ‐0.77 (‐1.07 to ‐0.47) | < 0.00001 favours CHX | P = 0.61, I2 = 0% |
| Results for studies with placebo/control rinse arms | ||||||
| Gingival inflammation (Gingival Index) | 7 to 12 weeks | 0.2 and 0.12 | 4 (144) | MD ‐0.47 (‐0.76 to ‐0.18) | 0.001 favours CHX | P < 0.0001, I2 = 86% |
| Gingival inflammation (Gingival Index) | > 6 months | 0.1 and 0.12 | 2 (1124) | MD ‐0.50 (‐1.11 to 0.11) | 0.11 favours CHX | P < 0.0001, I2 = 99% |
| Gingival bleeding | 7 to 12 weeks | 0.12 and < 0.1 | 5 (182) | SMD ‐1.29 (‐1.85 to ‐0.72) | < 0.00001 favours CHX | P = 0.02, I2 = 64% |
| Gingival bleeding | Long term | 0.12 | 3 (99) | MD ‐0.12 (‐0.2 to ‐0.04) | 0.003 favours CHX | P = 0.33, I2 = 11% |
| Plaque | 7 to 12 weeks | 0.2, 0.12 and < 0.1 | 10 (423) | SMD ‐1.74 (‐2.51 to ‐0.98) | < 0.00001 favours CHX | P < 0.00001, I2 = 91% |
| Plaque | > 6 months | 0.1 | 1 (852) | MD ‐1.55 (‐1.79 to ‐1.31) | < 0.00001 favours CHX | N/A |
| Plaque | Long term | 0.12 | 4 (132) | SMD ‐1.10 (‐1.18 to ‐0.40) | < 0.002 favours CHX | P = 0.02, I2 = 71% |
| CHX = chlorhexidine; CI = confidence interval; conc = concentration; MD = mean difference; N/A = not applicable; SMD = standardised mean difference. There were no subgroup differences between the different chlorhexidine concentrations, therefore the overall effect for all concentrations combined is reported. | ||||||
| Time | Study ID | Comparison | Index | CHX mean (SD) | Control mean (SD) | Total n | Notes |
|---|---|---|---|---|---|---|---|
| 4 to 6 weeks | Anauate‐Netto 2014 | CHX 0.12% vs placebo | PBS | 0.9 (0.6) | 0.7 (0.4) | 40 | Did not report GI. Quote: "..no statistically significant differences were detected among groups" |
| 7 to 12 weeks | Anderson 1997 | CHX 0.12% vs placebo | GI | 0.345 | 0.895 | 28 | Reported mean GI by surface + SD. No overall SD. We calculated overall mean. Quote: "The means of the …gingival indices did not show any significant differences (P<0.05) 1 or 2 months after baseline. However there were significant differences (P<0.05) in the changes recorded at 30 and 60 days at all sites in…..the experimental group" |
| de la Rosa 1888b | CHX 0.12% vs placebo | PMGI severity (mean score of all sites graded) | 0.1413 | 0.2902 | 92 | Did not report GI or a SD. Quote: "..the effect of the chlorhexidine rinse on the occurrence and severity of gingivitis amounted to a 51% reduction of the disease compared to the placebo rinse…differences were statistically significant" | |
| de la Rosa 1988a | CHX 0.12% vs placebo | PMGI severity (mean score of all sites graded) | 0.2892 | 0.4526 | 99 | Did not report GI or a SD. Quote: "..the gingivitis reductions were 34% and 36% for occurrence and severity respectively…differences were statistically significant" | |
| Eaton 1997 | CHX 0.12% vs placebo | mGI | 0.42 (0.383) | 0.55 (0.382) | 98 | Did not report GI. Quote: "..the pooled mean mGI score improved by 25% from 0.56 at baseline to 0.42 at 12 weeks in the ChD (CHX) group but showed no change (0.54 to 0.55) in the placebo group" | |
| Ferretti 1987 | CHX 0.12% vs placebo | PMGI | 0.8 | 1.94 | 33 | Did not report GI and SD depicted in graph but not reported. Quote: "Significant reductions in …gingivitis scores were seen on days 33 (P<0.0001) and 60… (P<0.001) for those patients using chlorhexidine rinse" | |
| Segreto 1986 | 0.2% vs 0.12% vs placebo | GI | 0.4112/0.3640 | 0.5039 | 454 | Did not report a SD. Quote: "Gingivitis severity by the GI method was… significantly lower at 3 months for both chlorhexidine groups compared to the placebo group. Differences ranged from 28‐46% and averaged 37% for the 0.12% group. Differences ranged from 18‐40% for the 0.20% group and averaged 29%" | |
| Weitz 1992 | CHX 0.12% vs placebo | GI | 1.69 | 1.86 | 36 | Did not report a SD. Quote: "…the active (CHX) groups had significantly lower… gingivitis scores than the respective control groups. Overall, the active group had a 10.27% reduction in the gingival index…compared to insignificant changes in the control groups" | |
| 6 months | Fine 1985 | CHX+OH vs OH | Not clear. Quote: "a gingival inflammation Index" | NR | NR | 83 | Outcomes reported in graphs which are difficult to decipher. Quote: "Whilst there was a general improvement in all… groups of patients, no one group was statistically significantly different from the other…" |
| Hoffmann 2001 | CHX 0.1%, CHX 0.06%, CHX 0.06%+F vs control | GI | Median 0.15/0.29/0.34 | Median 0.45 | 58 | No SD. At 3 months "..only the 0.1% CHX was different from the control". At 6 months "…the 0.1% CHX showed significant differences…in the GI…when compared to the 0.06% CHX/F" (P = 0.043) | |
| Overholser 1990 | CHX 0.12% vs control | mGI | 0.81 (SE 0.065) | 1.166 (SE 0.063) | 83 | Did not report a SD. Quote: "PX (CHX) inhibited gingivitis development by 26.8% (P<0.001) at 3 months and by 30.5% (P<0.001) at 6 months, compared to the control" | |
| CHX = chlorhexidine; F = fluoride; NR = not reported; OH = oral hygiene; SD = standard deviation; SE = standard error. Total n is the number of participants analysed in the study arms relevant to the review. PBS (Papillary Bleeding Score, Loesche 1979) is measured on a 0‐5 increasing scale. GI (Gingival Index, Löe 1967; Löe and Silness 1963) is measured on a 0‐3 increasing scale. PMGI (Papillary Marginal Gingivitis Index, de la Rosa and Sturzenberger 1976) is measured on a 0‐3 increasing scale. mGI (modified Gingival Index, Lobene 1986) is measured on a 0‐4 increasing scale. | |||||||
| Time | Study ID | Comparison | Index | CHX mean (SD) | Control mean (SD) | Total n | Notes |
|---|---|---|---|---|---|---|---|
| 4 to 6 weeks | Axelsson 1987 | CHX 0.2% vs CHX 0.1% vs placebo | Mean % of gingival units with GI score 2 or 3 | 12%/11% | 25% | 64 | Did not report a SD. Quote: "In all…study groups, the % of gingival units scored GI 2+3 was reduced between baseline..and end of trial" |
| Graziani 2015 | CHX 0.2%+Alc vs CHX 0.2% no Alc vs CHX+ADS vs control rinse | FMBS /BOP | Not clear | 13.47% | 70 | Partial reporting of outcome data. Quote: "Statistically significant decreases in mean full‐mouth scores of gingival inflammation were noted for all experimental study groups at day 35 compared to baseline. Between‐group changes in FMBS…were statistically significant only when CHX2 (mean difference of 43.4 ± 22.4, P = 0.05) and CHX 3 (mean difference of 46.1 ± 23.1, P = 0.05) were compared to the CTRL group" (note: CHX 2 = CHX no Alc, CHX 3 = CHX + ADS) | |
| Sanz 1989 | CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | 18.78% | 31.31% | 38 | Did not report a SD. Quote: "Beginning at 4 weeks of rinsing, gingival bleeding was significantly lower in the CHX group compared to the placebo group by an average of 41.6% (P < 0.05). At 6 weeks that reduction was 40%, (P < 0.05)" | |
| 7 to 12 weeks | Corbet 1997 | CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | 27%(anterior) 42%(posterior) | 52%(anterior) 75%(posterior) | 36 | Did not report a SD. Quote: "The difference between the mean percentage of GB of the test and control groups at 3 months was highly significant (P < 0.001)" |
| Segreto 1986 | CHX 0.2% vs CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | Examiner A: 3.4%/2% Examiner B: 7.2%/6.2% | Examiner A: 3.81% Examiner B: 14.9% | 454 | Did not report a SD. O.2% Quote: "Bleeding was 31% lower (range 11‐52%) compared to the placebo group" (P > 0.05) 0.12% Quote: "..gingival bleeding was significantly lower by an average of 53% for both examiners (range 48‐59%)" (P ≤ 0.05) | |
| 6 months | Banting 1989 | CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | 2.41% | 4.12% | 383 | Did not report a SD. Regarding outcomes at 6 months to 2 years: Quote: "Subjects in the treatment group…displayed between 42% and 51% fewer sites with moderate to severe gingivitis (GI scores of 2 or 3) compared with subjects in the control group" (P < 0.0001) |
| Charles 2004 | CHX 0.12% vs control | Mean % sites GI score 2 and 3 | 11.01% | 20.65% | 1156 sites | % of bleeding sites in each group is presented. There is a unit of analysis error (number of sites rather than number of subjects). Quote: "There was a considerable reduction in percent bleeding sites in the chlorhexidine…groups at 6 months compared with both control and baseline" | |
| Lucas 1999 | CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | 1% | 4.2% | 20 | Did not report a SD. Quote: "Although the percentage of bleeding surfaces in the chlorhexidine group was less than in the placebo group on days 90 (33%) and 180 (76%), the differences were not significant" (P = 0.07) | |
| Sanz 1994 | CHX 0.12% vs placebo | % sites GI score 2 and 3 | Graph | Graph | 130 | % bleeding sites reported incompletely in text and also in a graph. Did not report a SD. Quote: "At 6 months…the positive control group had significantly fewer bleeding sites than the control group (.. 23%...)" | |
| Gingival bleeding > 6 months | Banting 1989 | CHX 0.12% vs placebo | Mean % sites GI score 2 and 3 | 4.41% | 8.88% | 272 | Did not report a SD. Regarding outcomes at 6 months to 2 years: Quote: "Subjects in the treatment group…displayed between 42% and 51% fewer sites with moderate to severe gingivitis (GI scores of 2 or 3) compared with subjects in the control group" (P < 0.0001) |
| ADS = antidiscolouration system; Alc = alcohol; BOP = bleeding on probing; CHX = chlorhexidine; FMBS = Full‐Mouth Bleeding Score; GI = Gingival Index; SD = standard deviation. Total n is the number of participants analysed in the study arms relevant to the review. | |||||||
| Time | Study ID | Comparison | Index | CHX mean (SD) | Control mean (SD) | Total n | Notes |
|---|---|---|---|---|---|---|---|
| 4 to 6 weeks | Sanz 1989 | CHX 0.12% vs placebo | PI | 0.452 | 0.9907 | 38 | Did not report a SD |
| 7 to 12 weeks | Anderson 1997 | CHX 0.12% vs placebo | PI | 0.3175* | 0.8425* | 28 | Mean GI by surface + SD reported. We calculated the overall mean. No overall SD |
| de la Rosa 1888b | CHX 0.12% vs placebo | TQH | NR | NR | 92 | Quote: "The reductions in dental plaque were not statistically significant.." | |
| de la Rosa 1988a | CHX 0.12% vs placebo | TQH | NR | NR | 99 | Quote: "The reductions in dental plaque were not statistically significant.." | |
| Segreto 1986 | 0.2% vs 0.12% vs placebo | TQH | 1.14/1.01 | 1.58 | 451 | Did not report a SD | |
| Weitz 1992 | CHX 0.12% vs placebo | PI | 1.84 | 2.21 | 36 | Did not report a SD | |
| 6 months | Banting 1989 | CHX 0.12% vs placebo | TQH | Graph | Graph | 383 | Data presented in a graph. Did not report a SD. Quote: "Subjects in the treatment group had significantly lower mean plaque scores than those in the control group at six months, and at one and two years. The difference between the groups ranged from 35% to 46%" |
| Hoffmann 2001 | CHX 0.1%/CHX 0.06%/CHX 0.06%+F vs control rinse | PI | Median 0.13/0.25/0.27 | Median 0.72 | 58 | Median only. Did not report a SD | |
| Jayaprakash 2007 | CHX 0.05%/ CHX 0.05%+F vs placebo | PI | 0.0813/0.0459 | 0.1189 | 100 | Did not report a SD | |
| Lucas 1999 | CHX 0.12% vs placebo | OHI‐S | 0.33 | 0.59 | 20 | Did not report a SD | |
| Sanz 1994 | CHX 0.12% vs placebo | PI | Graph | Graph | 130 | Data presented in a graph. Did not report a SD. Quote: "…reductions in Plaque Index...were statistically significant for the positive control group…compared with the reduction obtained with the control group.. These reductions were 41% (positive control)…after 3 months and 35%..after 6 months.." | |
| Plaque > 6 months | Banting 1989 | CHX 0.12% vs placebo | TQH | Graph | Graph | 272 | Data presented in a graph. Did not report a SD. Quote: "Subjects in the treatment group had significantly lower mean plaque scores than those in the control group at six months, and at one and two years. The difference between the groups ranged from 35% to 46%" |
| CHX = chlorhexidine; F = Fluoride; NR = not reported; SD = standard deviation. Total n is the number of participants analysed in the study arms relevant to the review. PI (Plaque Index, Silness and Löe 1964) is measured on a 0‐3 increasing scale. TQH (Turesky modification of the Quigley and Hein Index, Turesky 1970) is measured on a 0‐5 increasing scale. OHI‐S (Simplified Oral Hygiene Index, Greene and Vermillion 1964) is measured on a 0‐3 increasing scale. | |||||||
| Time | Study ID | Comparison | Index | CHX mean (SD) | Control mean (SD) | Total n | Notes |
|---|---|---|---|---|---|---|---|
| 4 to 6 weeks | Anderson 1997 | CHX 0.12% vs placebo | RI | 0.1075 | 0.0475 | 29 | Mean RI by surface + SD reported. We calculated overall mean. No overall SD |
| 7 to 12 weeks | Anderson 1997 | CHX 0.12% vs placebo | RI | 0.0875 | 0.0525 | 28 | Mean RI by surface + SD reported. We calculated overall mean. No overall SD |
| Charles 2004 | CHX 0.12% vs control | VM | 0.37 (SD NR) | 0.11 (SD NR) | 74 | Did not report a SD | |
| Sanz 1994 | CHX 0.12% vs placebo | VM | Graph | Graph | 130 | Data presented in graph. Did not report a SD. Quote: "All groups developed calculus after the initial cleaning at baseline. This increase was only statistically significant for the positive control group compared with the control group at 6 months" | |
| Calculus 6 months | Banting 1989 | CHX 0.12% vs placebo | VM | NR | NR | 383 | Results reported at 24 months only. See results at > 6 months below |
| Charles 2004 | CHX 0.12% vs control | VM | 0.45 (SD NR) | 0.21 (SD NR) | 73 | Did not report a SD | |
| Grossman 1986 | CHX 0.12% vs placebo | Not specified | NR | NR | 380 | Quote: "Supragingival calculus was higher in the group using chlorhexidine but this increase in calculus did not diminish the therapeutic effects of chlorhexidine since subjects with significant increases in calculus also had significant decreases in gingivitis" | |
| Sanz 1994 | CHX 0.12% vs placebo | VM | Graph | Graph | 130 | Data presented in a graph. Did not report a SD. Quote: "All groups developed calculus after the initial cleaning at baseline. This increase was only statistically significant for the positive control group compared with the control group at 6 months" | |
| Calculus > 6 months | Banting 1989 | CHX 0.12% vs placebo | VM | NR | NR | 272 | At 24 months subjects in the treatment group had higher mean supragingival calculus scores, but at the same time more subjects were free of subgingival calculus |
| CHX = chlorhexidine; NR = not reported; SD = standard deviation. Total n is the number of participants analysed in the study arms relevant to the review. RI (Retention Index, Björby and Löe 1966) is measured on a 0‐3 increasing scale. VM (Volpe‐Manhold Calculus Index, Manhold 1965; Volpe 1965) measures calculus present on the lingual surface of the lower 6 anterior teeth. Calculus is measured in 3 planes using a standard periodontal probe.The greatest value allowed for any 1 plane is 3 units, therefore the maximum score per tooth is 9 units or 54 units per subject. The mean per subject score is obtained by dividing the total calculus score by the number of lower anterior teeth. A mean calculus score for the group is then calculated. | |||||||
| Time | Study ID | Comparison | Index | CHX mean (SD/SE) or n (%) | Control mean (SD) | Total n | Notes |
|---|---|---|---|---|---|---|---|
| 4 to 6 weeks | Axelsson 1987 | CHX 0.2%/0.1% vs control | DI (Lobene) | 0.1171 (0.297) | 0 | 64 | Not included in meta‐analysis as control mean is 0. We combined data from the 0.2% and 0.1% CHX groups |
| Bhat 2014 | CHX 0.2% vs control | Reported number and proportion of participants with mild or moderate 'discolouration' in text | 20 (91%) | 0 | 44 | Not clear whether discolouration relates to teeth or oral tissues or both | |
| Flotra 1972 & 1971 (4‐month study that reports this outcome at 4 weeks) | CHX 0.2%/0.1%/0.1% (acetate) vs control | No index Reported narratively | 12% of tooth surfaces without fillings 62% of silicate fillings | NR | 48 (at 4 weeks) | Quote: "..12% of the tooth surfaces without fillings became discolored within the first 4 weeks of the experiment…this happened more frequently on the interproximal surfaces than on the labial surfaces (ratio2:1). Sixty‐two per cent of the silicate fillings in these areas were discolored.." | |
| Graziani 2015 | CHX 0.2% vs control | SI | 0.2228 (0.18) | 0 | 70 | Not included in meta‐analysis as control mean is 0. We combined data from the 3 CHX groups | |
| Hase 1995 | CHX 0.2% vs placebo | Subjective of participants regarding staining of teeth and/or tongue using VAS | 38 (SE 7) | 9 (SE 1) | 39 | Teeth and/or tongue staining reported together. Data estimated from a graph | |
| López‐Jornet 2012 | CHX 0.2% vs placebo | Registration of side effects including denture/dental staining (n and %) | 2 (5.71%) | 3 (8.57%) | 70 | Denture and dental staining reported together | |
| Turkoglu 2009 | CHX (conc not reported) vs placebo | No index Reported narratively | 14 (56%) | Assumed 0 | 50 | Quote: "Of the 25 subjects who rinsed their mouth with CHX mouthrinse..14 showed discolouration of teeth and/or tongue" | |
| Zimmer 2006 | CHX 0.06%+F+OH vs OH | Staining of teeth and tongue registered at final examination (n) | 4 | 0 | 78 | Stain on teeth/tongue reported together. If more than 1 side effect was present, only the most relevant was listed i.e. side effects were reported with no double counting | |
| 7 to 12 weeks | Charles 2004 | CHX 0.12% vs control | DI (Lobene) | 1.61 (SD NR) | 0.01 (SD NR) | 74 | Did not report a SD |
| Grossman 1989 | CHX 0.12% vs placebo | Not specified Quote: "Photographs of facial surfaces of the 12 anterior teeth (maxillary and mandibular, cuspid to cuspid) were graded for stain intensity and coverage" | 4.66 (SD NR) | 2.59 (SD NR) | 246 | Did not report a SD | |
| Sanz 1994 | CHX 0.12% vs placebo | Not specified | NR | NR | 130 | Data presented in a graph at 6 months only See 6‐month results below | |
| Zimmer 2006 | CHX 0.06% +F+OH vs OH | Staining of teeth and tongue registered at final examination (n) | 6 | 0 | 78 | Stain on teeth/tongue reported together. If more than 1 side effect was present, only the most relevant was listed i.e. side effects were reported with no double counting | |
| 6 months | Charles 2004 | CHX 0.12% vs control | DI (Lobene) | 2.08 (SD NR) | 0.01 (SD NR) | 73 | Did not report a SD |
| Grossman 1986 | CHX 0.12% vs placebo | Not specified | NR | NR | 380 | Outcome data not reported. Quote: "Some extrinsic tooth staining was observed in the chlorhexidine group" | |
| Grossman 1989 | CHX 0.12% vs placebo | Not specified Quote: "Photographs of facial surfaces of the 12 anterior teeth (maxillary and mandibular, cuspid to cuspid) were graded for stain intensity and coverage" | 5.15 (SD NR) | 2.75 (SD NR) | 246 | Did not report a SD | |
| Hoffmann 2001 | CHX 0.1%/ 0.06%/0.06%+F vs control | DI (Lang and Räber) | 1.13/1.02/1.06 (SD NR) | 0.38 (SD NR) | 58 | Median only. Did not report a SD | |
| Sanz 1994 | CHX 0.12% vs placebo | Not specified Quote: "Photographs of facial surfaces of the 12 anterior teeth (maxillary and mandibular, cuspid to cuspid) were graded for stain intensity and coverage" | Graph | Graph | 130 | Data presented in graph Did not report a SD Quote: "Statistically significant more overall staining, more intense staining and stain coverage per tooth were detected for the positive control group…compared with the control group" | |
| CHX = chlorhexidine; conc = concentration; F = fluoride; NR = not reported; OH = oral hygiene; SD = standard deviation; SE = standard error; VAS = visual analogue scale. Total n is the number of participants analysed in the study arms relevant to the review. DI (Discolouration Index, Lobene 1968): gingival and body regions of the tooth are scored for intensity (0‐3 increasing scale) and severity (0‐3 increasing scale). DI (Discolouration Index, Lang and Räber 1981) is measured on a 0‐3 increasing scale. SI (Staining Index): the buccal surfaces of the 8 central incisors were divided into 3 areas: incisal, approximal and gingival according to Lobene 1968 and Grundemann 2000 and a SI was used to record the dichotomous presence or absence of staining in each area and to calculate the percentage of the total area showing staining. | |||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Gingival Index (0‐3) 4‐6 weeks Show forest plot | 10 | 805 | Mean Difference (IV, Random, 95% CI) | ‐0.21 [‐0.31, ‐0.11] |
| 1.1.1 CHX versus no rinse | 2 | 339 | Mean Difference (IV, Random, 95% CI) | ‐0.13 [‐0.31, 0.05] |
| 1.1.2 CHX versus placebo/control rinse | 8 | 466 | Mean Difference (IV, Random, 95% CI) | ‐0.23 [‐0.34, ‐0.13] |
| 1.2 Gingival Index (0‐3) 6 months Show forest plot | 13 | 2616 | Mean Difference (IV, Random, 95% CI) | ‐0.20 [‐0.30, ‐0.11] |
| 1.2.1 CHX versus no rinse | 2 | 142 | Mean Difference (IV, Random, 95% CI) | ‐0.12 [‐0.18, ‐0.05] |
| 1.2.2 CHX versus placebo/control rinse | 11 | 2474 | Mean Difference (IV, Random, 95% CI) | ‐0.22 [‐0.33, ‐0.11] |
| 1.3 Gingival bleeding 4‐6 weeks Show forest plot | 8 | 649 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.56 [‐0.79, ‐0.33] |
| 1.3.1 CHX versus no rinse | 4 | 459 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.69 [‐0.89, ‐0.50] |
| 1.3.2 CHX versus placebo/control rinse | 4 | 190 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.36 [‐0.77, 0.06] |
| 1.4 Gingival bleeding 6 months Show forest plot | 8 | 1132 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.72 [‐1.02, ‐0.42] |
| 1.4.1 CHX versus no rinse | 2 | 142 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.49 [‐0.83, ‐0.16] |
| 1.4.2 CHX versus placebo/control rinse | 6 | 990 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.79 [‐1.16, ‐0.41] |
| 1.5 Plaque 4‐6 weeks Show forest plot | 12 | 950 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.45 [‐1.90, ‐1.00] |
| 1.5.1 CHX versus no rinse | 3 | 433 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.43 [‐2.39, ‐0.47] |
| 1.5.2 CHX versus placebo/control rinse | 9 | 517 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.48 [‐2.07, ‐0.89] |
| 1.6 Plaque 4‐6 weeks PI (0‐3) Show forest plot | 4 | 223 | Mean Difference (IV, Random, 95% CI) | ‐0.58 [‐0.78, ‐0.39] |
| 1.6.1 CHX versus no rinse | 2 | 114 | Mean Difference (IV, Random, 95% CI) | ‐0.59 [‐0.94, ‐0.24] |
| 1.6.2 CHX versus placebo/control rinse | 2 | 109 | Mean Difference (IV, Random, 95% CI) | ‐0.50 [‐0.97, ‐0.04] |
| 1.7 Plaque 4‐6 weeks TQH (0‐5) Show forest plot | 5 | 546 | Mean Difference (IV, Random, 95% CI) | ‐0.78 [‐0.85, ‐0.70] |
| 1.7.1 CHX versus no rinse | 1 | 319 | Mean Difference (IV, Random, 95% CI) | ‐0.83 [‐1.00, ‐0.66] |
| 1.7.2 CHX versus placebo/control rinse | 4 | 227 | Mean Difference (IV, Random, 95% CI) | ‐0.76 [‐0.85, ‐0.68] |
| 1.8 Plaque 6 months Show forest plot | 11 | 2075 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.43 [‐1.76, ‐1.10] |
| 1.8.1 CHX versus no rinse | 2 | 142 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.68 [‐1.35, ‐0.01] |
| 1.8.2 CHX versus placebo/control rinse | 9 | 1933 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.59 [‐1.89, ‐1.29] |
| 1.9 Plaque 6 months PI (0‐3) Show forest plot | 5 | 1108 | Mean Difference (IV, Random, 95% CI) | ‐0.62 [‐1.12, ‐0.12] |
| 1.9.1 CHX versus no rinse | 2 | 142 | Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐0.42, ‐0.18] |
| 1.9.2 CHX versus placebo/control rinse | 3 | 966 | Mean Difference (IV, Random, 95% CI) | ‐0.86 [‐1.46, ‐0.25] |
| 1.10 Plaque 6 months TQH (0‐5) Show forest plot | 6 | 967 | Mean Difference (IV, Random, 95% CI) | ‐0.73 [‐0.88, ‐0.57] |
| 1.10.1 CHX versus placebo/control rinse | 6 | 967 | Mean Difference (IV, Random, 95% CI) | ‐0.73 [‐0.88, ‐0.57] |
| 1.11 Calculus 4‐6 weeks Show forest plot | 2 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.11.1 CHX versus placebo/control rinse | 2 | 102 | Mean Difference (IV, Random, 95% CI) | 0.02 [‐0.09, 0.14] |
| 1.12 Calculus 7‐12 weeks Show forest plot | 6 | 425 | Std. Mean Difference (IV, Random, 95% CI) | 0.32 [‐0.04, 0.69] |
| 1.12.1 CHX versus no rinse | 1 | 95 | Std. Mean Difference (IV, Random, 95% CI) | 1.02 [0.59, 1.45] |
| 1.12.2 CHX versus placebo/control rinse | 5 | 330 | Std. Mean Difference (IV, Random, 95% CI) | 0.14 [‐0.08, 0.36] |
| 1.13 Calculus 6 months Show forest plot | 4 | 323 | Std. Mean Difference (IV, Random, 95% CI) | 0.80 [0.33, 1.26] |
| 1.13.1 CHX versus no rinse | 1 | 91 | Std. Mean Difference (IV, Random, 95% CI) | 1.39 [0.93, 1.85] |
| 1.13.2 CHX versus placebo/control rinse | 3 | 232 | Std. Mean Difference (IV, Random, 95% CI) | 0.60 [0.24, 0.96] |
| 1.14 Tooth staining 4‐6 weeks dichotomous Show forest plot | 2 | 156 | Risk Ratio (M‐H, Random, 95% CI) | 5.41 [2.03, 14.47] |
| 1.14.1 CHX versus no rinse | 1 | 118 | Risk Ratio (M‐H, Random, 95% CI) | 4.44 [1.43, 13.80] |
| 1.14.2 CHX versus placebo/control rinse | 1 | 38 | Risk Ratio (M‐H, Random, 95% CI) | 9.88 [1.37, 71.44] |
| 1.15 Tooth staining 7‐12 weeks dichotomous Show forest plot | 1 | Risk Ratio (M‐H, Random, 95% CI) | Subtotals only | |
| 1.15.1 CHX versus no rinse | 1 | 118 | Risk Ratio (M‐H, Random, 95% CI) | 2.50 [1.29, 4.83] |
| 1.16 Tooth staining 4‐6 weeks Show forest plot | 8 | 415 | Std. Mean Difference (IV, Random, 95% CI) | 1.07 [0.80, 1.34] |
| 1.16.1 CHX versus no rinse | 1 | 94 | Std. Mean Difference (IV, Random, 95% CI) | 1.54 [1.08, 2.00] |
| 1.16.2 CHX versus placebo/control rinse | 7 | 321 | Std. Mean Difference (IV, Random, 95% CI) | 0.97 [0.73, 1.22] |
| 1.17 Tooth staining 7‐12 weeks Show forest plot | 11 | 581 | Std. Mean Difference (IV, Random, 95% CI) | 1.19 [0.98, 1.40] |
| 1.17.1 CHX versus no rinse | 1 | 95 | Std. Mean Difference (IV, Random, 95% CI) | 1.32 [0.88, 1.77] |
| 1.17.2 CHX versus placebo/control rinse | 10 | 486 | Std. Mean Difference (IV, Random, 95% CI) | 1.17 [0.93, 1.41] |
| 1.18 Tooth staining 6 months Show forest plot | 4 | 323 | Std. Mean Difference (IV, Random, 95% CI) | 1.54 [1.22, 1.86] |
| 1.18.1 CHX versus no rinse | 1 | 91 | Std. Mean Difference (IV, Random, 95% CI) | 1.18 [0.73, 1.62] |
| 1.18.2 CHX versus placebo/control rinse | 3 | 232 | Std. Mean Difference (IV, Random, 95% CI) | 1.69 [1.38, 1.99] |
