Evaluation of the effectiveness of a pre-brushing rinse in plaque removal: a meta-analysis

A meta-analysis technique was used to pool data from studies to assess the effectiveness of the pre-brushing rinse PLAX on existing plaque and gingivitis.

Studies were identified using MEDLINE and other sources, and grouped according to whether PLAX was used in short- or long-term treatment. The quality of trials was assessed by 2 independent readers. The DerSimonian and Laird random effects model was used. Meta-analyses were performed according to duration and type of PLAX treatment. In "1-day" studies, the effect of PLAX after rinsing and after rinsing and brushing was evaluated, whereas in longitudinal studies, this was done at several follow-up times.

A total of 19 studies were included and mean quality scores ranged from 0.13 to 0.60, for the study protocol from 0.18 to 0.70 and for data analysis and presentation from 0.05 to 0.53. In "1-day" studies, PLAX significantly reduced plaque after rinsing (difference=0.143; 95% CI=0.02-0.27;p=0.022), whereas no significant reduction was observed in post-brushing measures. In "longitudinal" studies, plaque was significantly reduced at 1-2 (difference=0.168; 95% CI=0.09-0.24; p<0.0001), 3-4 (difference=0.179; 95% CI=0.01-0.35; p=0.043), 12 (difference=0.288; 95% CI=0.21-0.37; p<0.0001) and 24 (difference=0.377; 95% CI=0.19-0.57; p=0.0001) weeks. The meta-analysis that evaluated gingivitis showed a significant reduction in inflammation with PLAX treatment at 12 (difference=0.209; 95% CI=0.17-0.25; p<0.0001) and 24 (difference=0.257; 95% CI=0.22-0.29; p<0.0001) weeks follow-up.

Although PLAX use appears to offer some benefit in plaque and gingivitis reduction, the clinical magnitude of the difference and the benefit on oral health are likely to be small.