Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial

Diego Halabi,Carlos Muñoz,Nicolette Martinez,Jose Escobar,Cyntia Alvarado

doi:10.1590/1678-7757-2017-0245

Abstract

ObjectiveTo determine the effectiveness of chlorhexidine 0.12% mouthwash (CHX) after tooth extraction for the prevention of alveolar osteitis (AO).Material and methodsWe conducted a double-blind randomised clinical trial stratified by risk factors. We enrolled a cohort of 822 patients who underwent dental extractions, and were considered to be at risk of developing AO (previous surgical site infection, traumatic extraction, and tobacco smoking). After extraction, patients were randomly allocated for CHX group or placebo group, matched by risk factors. The primary outcome was clinical diagnosis of AO: increasing postoperative pain for 4 d within and around the socket, and total or partial breakdown of the blood clot in the socket with or without bone exposure.ResultsFollow-up was completed by 744 participants (372 chlorhexidine and 372 placebo). We detected no significant differences between the two groups at baseline. After completed follow-up, risk factors were equally distributed between the two groups. Overall incidence of OA was 4.97%, in which 27 participants treated with placebo (7.26%) and 10 participants treated with CHX (2.69%) developed AO. CHX reduced the incidence of AO by 63% [Absolute Risk Reduction: 4.57 (95% CI 1.5-7.7), Number Needed to Treat: 21.88 (95% CI 13.0-69.3), Fisher's exact test: p=0.006]. No adverse effects were reported.ConclusionThe use of chlorhexidine 0.12% mouthwash after tooth extraction is safe and effective in reducing the incidence of AO in high-risk patients.

Highlights

Patients who undergo dental extractions are at risk of developing post-operative complications, and the most common is the alveolar osteitis (AO)12
Our group8 recently reported an incidence of 6.4% of AO, and we determined by a logistic regression model that previous surgical site infection, tobacco smoking and traumatic extraction are risk factors for developing AO
chlorhexidine 0.12% mouthwash (CHX) reduced the incidence of AO by 63% [Absolute Risk Reduction: 4.57 (CI95% 1.5-7.7), Number Needed to Treat: 21.88 (CI95% 13.0-69.3)]

Summary

Introduction

Patients who undergo dental extractions are at risk of developing post-operative complications, and the most common is the alveolar osteitis (AO). Our group recently reported an incidence of 6.4% of AO, and we determined by a logistic regression model that previous surgical site infection, tobacco smoking and traumatic extraction are risk factors for developing AO. These risk factors explain why there were changes in prevalence ranging from 3.9% up to 29.6% for the third molar. With a risk model that predicts the development of AO, it is possible to implement preventive health care to those individuals at high risk. Clinicians can reduce health care costs and provide comfort for patients

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Results

Conclusion