Chlorhexidine mouthwash more effective than dentifrice or gel

Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL).

Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in adults 18 years of age comparing CHX DF/gel with CHX MW written in English or Dutch were considered.

Two reviewers independently selected studies, abstracted data and assessed risk of bias. Where possible, a meta-analysis was performed. Difference in means values between test and control at both baseline and end was calculated using a fixed-effects model.

Five RCTs were included, four had a parallel design and one was a cross-over trial. Three studies showed a positive score in favour of the mouthwash. Three studies contributed to a meta-analysis of the effect on 'de novo' plaque formation. There was a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001) in favour of CHX MW. One study assessed tooth staining finding more staining with the use of CHX MW compared to the CHX DF/gel.

Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.