Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials.

Chia-Hui Wang,Shu-Hui Yang,Hsi-Kuei Lin,Hsiu-Ju Jen,Jui-Chen Tsai,El-Wui Loh

doi:10.1097/jnr.0000000000000401

Abstract

ABSTRACTBackgroundAlveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature.PurposeA systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO.MethodsPubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model.ResultsThe RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]).Conclusions/Implications for PracticeThe results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.

Highlights

Alveolar osteitis (AO), the inflammation of the alveolar bone when an intra-alveolar blood clot disintegrates or fails to form, is one of the most common complications occurring after third molar extraction (Cardoso et al, 2010)
The risk ratio (RR) of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% confidence interval (CI) [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control
A significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control

Summary

Introduction

Alveolar osteitis (AO), the inflammation of the alveolar bone when an intra-alveolar blood clot disintegrates or fails to form, is one of the most common complications occurring after third molar (wisdom-tooth) extraction (Cardoso et al, 2010). The risk of AO has been reported to be associated with the degree of difficulty involved in molar tooth extraction Previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature. Purpose: A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO

Methods

Results

Conclusion