Expert consensus on the use of oral antiseptics in oral surgery: Evidence-based clinical practice guidelines

Antiseptic management in oral surgery remains heterogeneous, with no standardised, procedure-specific protocols guiding the perioperative use of agents such as chlorhexidine (CHX) or cetylpyridinium chloride (CPC). This consensus document aims to integrate the best available evidence with structured expert judgement to generate evidence-based clinical practice guidelines for the use of oral antiseptics across dentoalveolar and implant surgical scenarios.

A structured two-round expert consensus process was employed, combining a systematic literature search of PubMed/MEDLINE with a structured expert panel discussion conducted in December 2025. Seven oral surgeons and implantologists from four leading Spanish universities participated. Consensus was organised around five thematic blocks regarding the use of oral antiseptics: indications and safety, preoperative preparation, postoperative care, management of complications, and future research priorities.

Following independent duplicate screening, 69 studies were included in the qualitative synthesis. CHX 0.12-0.2% (in monotherapy or in combination with CPC) was established as the reference perioperative antiseptic, with evidence supporting its efficacy in reducing postoperative complications (RR=0.66; 95% CI 0.55 to 0.80). A risk-stratified postoperative protocol was formulated, incorporating gel, rinse, and spray formulations adapted to individual patient profiles. Povidone-iodine and CPC were identified as evidence-supported alternatives. Complication-specific recommendations were generated for wound dehiscence, alveolar osteitis, and localised postoperative infection, ranging from conservative antiseptic irrigation and intra-alveolar gel application to escalating surgical and systemic antibiotic management based on severity. All recommendations were explicitly classified as evidence-based, expert consensus-derived, or a combination, reflecting the variable quality of supporting data across clinical scenarios.

CHX constitutes the gold standard oral antiseptic for perioperative use in oral surgery. The expert panel recommends CHX+CPC combination formulations (e.g., 0.12% CHX+0.05% CPC) as an alternative perioperative antiseptic option, offering comparable antimicrobial efficacy with an improved tolerability profile relative to CHX monotherapy. Individualised, risk-stratified protocols, which account for procedural complexity, patient comorbidities, and antiseptic tolerability, are recommended to optimise clinical outcomes while minimising adverse effects.