Rinsing with chlorhexidine may reduce incidence of dry socket after third molar surgery

Medline and the Science Citation Index were used and searches were made by hand for studies published in any language.

Studies included were human clinical trials evaluating the effect of a chlorhexidine (CHX) rinse on the incidence of alveolar osteitis (AO), following extraction of mandibular third molars, if they randomly assigned individuals to control and CHX rinse groups that used similar criteria to diagnose AO.

Studies were screened by three examiners independently. Due to protocol differences, studies were separated into two groups. Group 1 included studies that evaluated subjects who rinsed with CHX only on the day of surgery and Group 2 studies that evaluated patients who used multiple rinses with CHX.

The relative risk for the single-rinse group was 1.36 (95% confidence interval (CI), 0.80-2.33; P>0.05), whereas for the multiple-rinse group, relative risk was 1.90 (95% CI, 1.46-2.47, P<0.05).

It was not possible to determine if a single rinse with CHX on the day of surgery significantly reduced the incidence of AO. The results of this study do, however, support the conclusion that rinsing at least on the day of surgery and for several days following the removal of the teeth reduces the incidence of AO associated with the extraction of mandibular third molars. The minimum number of days of rinsing needed to produce this effect could not be determined by this analysis. Further studies using a standard definition for AO, and stratification of patients by gender, difficulty of extraction, smoking etc., are needed to determine the best use for CHX rinses in subjects having the mandibular third molar removed.