Prevention Of Alveolar Osteitis Research Articles

Effect of chlorhexidine gel on the prevention of alveolar osteitis and post‐operative pain following transalveolar extraction of impacted mandibular third molars: A randomized study

AbstractObjectiveThis study aimed to compare the efficacy of 0.2% chlorhexidine gel with warm saline mouth rinse (WSMR) in the prevention of alveolar osteitis (AO) following transalveolar impacted mandibular third molar (IMTM) extraction after accounting for surgical operative confounding factors.Materials and MethodsWe conducted a parallel design randomized study. Participants were consenting adults randomly assigned to 0.9% WSMR and 0.2% chlorhexidine gel (administered twice daily post‐operatively) groups. All participants were followed up daily post‐operatively for one week. The primary outcome was an incidence of AO, assessed using Blum's criteria. Fischer's exact tests and regression models were used to investigate the effect of interventions on AO.ResultsOne hundred participants were enrolled in the study, with 50 participants in each group. A higher incidence of AO was observed in the WSMR group than the chlorhexidine group (16% vs. 2%, p = 0.01). However, after adjusting for duration of extraction (aOR: 0.18; 95% CI: 0.02, 1.71) and bone operating time (aOR: 0.16; 95% CI: 0.02, 1.47), the difference was not statistically significant.ConclusionsIn conclusion, the study demonstrates that the application of the 0.2% chlorhexidine gel was not significantly more effective in preventing AO compared with the use of WSMR following transalveolar IMTM extraction after controlling for operative factors.

Efficacy of Chlorhexidine after Oral Surgery Procedures on Wound Healing: Systematic Review and Meta-Analysis.

Our objective was to evaluate qualitatively and quantitatively, through a systematic review and meta-analysis, available evidence on the efficacy of chlorhexidine (CHX) when applied after oral surgery on wound healing and related clinical parameters. MEDLINE/PubMed, Embase, CENTRAL, Web of Science, and Scopus were searched for studies published before January 2023. The quality of the methodology used in primary-level studies was assessed using the RoB2 tool; meta-analyses were performed jointly with heterogeneity and small-study effect analyses. Thirty-three studies and 4766 cases were included. The results point out that the application of CHX was significantly more effective, compared to controls where CHX was not employed, providing better wound healing after oral surgery (RR = 0.66, 95% CI = 0.55-0.80, p < 0.001). Stratified meta-analyses confirmed the higher efficacy of 0.20% CHX gel vs. other vehicles and concentrations (p < 0.001, respectively). Likewise, the addition of chitosan to CHX significantly increased the efficacy of surgical wound healing (p < 0.001). The use of CHX has also been significantly beneficial in the prevention of alveolar osteitis after any type of dental extraction (RR = 0.46, 95% CI = 0.39-0.53, p < 0.001) and has also been effective when applied as a gel for a reduction in pain after the surgical extraction of third molars (MD = -0.97, 95% CI = -1.26 to -0.68, p < 0.001). In conclusion, this systematic review and meta-analysis demonstrate on the basis of evidence that the application of CHX exerts a beneficial effect on wound healing after oral surgical procedures, significantly decreasing the patient's risk of developing surgical complications and/or poor wound healing. This benefit was greater when CHX was used at 0.20% in gel form with the addition of chitosan.

Efficacy of tranexamic acid in prevention of alveolar osteitis following surgical removal of impacted mandibular third molar.

Many preventive measures are described to avoid alveolar osteitis (AO) during third molar surgery (TMS), but very few are found to be effective. Tranexamic acid (TA), an antifibrinolytic agent, impedes the proteolytic degradation of fibrin and prevents blood clot disintegration. The study was conducted to determine the efficacy of intra-alveolar application of TA soaked in Gelfoam in prevention of AO. This was a randomized control trial. A total of 200 patients (100 in control group and 100 in study group) reporting for TMS were allocated randomly. Following surgery, TA soaked in gel foam was placed in socket and sutured in the study group, while in the control group, closure was done by suturing. Patients followed subsequently to observe the incidence of AO, pain severity, and duration of healing after AO. Z-test, Mann-Whitney test, and t-test were applied, respectively, to compare the incidence of AO, severity of pain, and duration of healing between the two groups. The incidence of AO in the control group was 18% and 6% in the study group. Patients in the control group experienced severe pain as compared to patients in the study group. The duration of healing varied from 12 to 16 days in the control group, but in the study group, it was <10 days. TA significantly reduces the incidence of AO in addition to the reduced severity of pain and enhanced healing. We recommend the routine use of TA, owing to its astonishing rewards.

Effectiveness of Honey in the Treatment and Prevention of Alveolar Osteitis: Systematic Review and Meta-analysis.

Honey has been used for millennia as a treatment for covering wounds that are difficult to repair. Hippocrates already reported the benefits of honey with this type of treatment. The objective of this work is to evaluate the literature on the use of honey in cases as preventive as treatment complications after extractions, more specifically alveolar osteitis or alveolitis. A systematic literature review was carried out on PubMed, LILACS and Dimensions platforms, following PRISMA guidelines, to gain more knowledge on the topic. Due to the scarcity of articles on the topic, there are no restrictions regarding languages, publication dates or impact factor journal. Animal studies and reviews were excluded. Risk of bias was assessed through Review Manager Software 5.4. With simple, low-cost, and affordable medications, many of the complications after tooth extractions can be resolved more quickly and less painfully for patients with more significant difficulties, whether financial or access, to other treatments. Honey is an effective prevention and treatment for alveolar osteitis.

Use of chlorhexidine 0.2% gel to prevent alveolar osteitis in mandibular third molar surgical extraction.

Objectives: To evaluate the efficacy of 0.2% chlorhexidine gel placed intra alveolar in the prevention of alveolar osteitis after the surgical extraction of mandibular third molar. Study Design: Randomized Control trial. Setting: Department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro/Hyderabad. Period: January 2016 to July 2016. Material &amp; Methods: This study consisted of 40 patients in control group A and 40 patients of Chlorohexidine gel group B used after surgical extraction. A single dose of 0.2% bio-adhesive gel was introduced in group B while the control group A was left alone. Postoperative complications like pain, swelling, limited mouth opening, and dry socket were seen. Frequency and percentages were calculated. Mean +/- SD were calculated for quantitative variables. Results: On 3rd day patients reported with pain in group A were 24 and in group B were 15. Pain was seen in 4 patients (10%) on 15th day in group A while in group B no patient came with pain. 19 patients reported with dry socket on day 3 in group A and 4 patients in group B, While none of the patient encountered with Dry socket on 15th day in group in both groups. Conclusion: The data presented indicates that the bio-adhesive gel containing 0.2% chlorohexidine, applied post-extraction produced a better patient recovery.

Efficacy of chlorhexidine in the prevention of alveolar osteitis after permanent tooth extraction. Systematic review and meta-analysis.

Background: Dental extraction is a routine task performed by dental surgeons. This procedure may sometimes cause associated postoperative complications such as: edema, pain, trismus and alveolar osteitis (AO). Objective: To evaluate the efficacy of chlorhexidine (CHX) in the prevention of alveolar osteitis after permanent tooth extraction, through a systematic review and meta-analysis. Materials and Methods: A literature search was carried out until December 2018 in the following biomedical databases: PubMed, Embase, SciELO, Science Direct, SIGLE, LILACS, Google Scholar and The Cochrane Central Register of Controlled Trials (CENTRAL). The selection criteria for the studies were: randomized clinical trials published in the 5 years prior to the realization of this study, which reported the use of CHX in the prevention of AO. The risk of study bias was analyzed through the Cochrane Manual for systematic reviews of interventions. Results: The search strategy resulted in a selection of 22 articles; 17 of these were used to perform the meta-analysis. All of them reported that CHX is effective in preventing AO. Conclusion: The literature reviewed suggests that the use of CHX is effective in AO prevention; however, more studies comparing the efficacy of chlorhexidine gel with chlorhexidine used as an irrigant or as mouthwash are necessary.

A comparative Prospective Clinical Study of Efficacy of Platelet-Rich Fibrin (PRF) and Chlorhexidine Gel for Wound Healing Enhancement and Prevention of Alveolar Osteitis

Objective: The purpose of this research was to compare the effectiveness of intra-alveolar platelet rich fibrin (PRF) and chlorhexidine gel for pain relief and quality of socket healing (Epithelialization) with prevention of dry socket after the surgical removal of impacted third molars.Patients and methods: A total of 30 patients (17 males and 13 females; with a mean age of 30 years). who required extraction of impacted third molars were randomly divided into three groups: PRF group ; PRF were placed in the extraction sockets ,chlorhexidine CHX gel 0.2% group ; 1 ml CHX were placed in the extraction sockets and control group, while the sockets remained empty. All the patients were evaluated for Pain (VAS), degree of inflammation, healthy granulation tissue formation and number of exposed socket walls (socket epithelialization) , dry socket incidence and maximum interincisal mouth opening MIO at 1st , 3rdand 7th, post-operative day. Results: In the PRF group, a significantly less pain was recorded in the third and seventh postoperative days (P = 0.003, 0.04) respectively. Group (PRF) showed better soft tissue and socket healing than chlorhexidine gel and control groups but non-significant difference was observed. PRF reduced the incidence of alveolar osteitis. .Conclusion: PRF in this study illustrates the promising results to be used effectively in the prevention of alveolar osteitis. PRF treated cases showed better response to postoperative pain, better clinical socket healing with reduction of inflammation and more improvement of maximum interincisal mouth opening MIO than chlorhexidine gel 0.2% after the removal of third molars.

The influence of intra-alveolar application of honey versus Chlorhexidine rinse on the incidence of Alveolar Osteitis following molar teeth extraction. A randomized clinical parallel trial.

BackgroundAlveolar Osteitis (AO) is a complication occurs on the post-extraction days that includes pain and disintegrated blood clot. Chlorhexidine (CHX) rinse after extraction is an effective method for decreasing the incidence of AO. Honey has natural antibacterial properties and effectiveness when it is used as a dressing on burns and wounds. However, the effect of intraoral honey dressings on healing is still not adequately studied. This study aimed to compare pain and AO after extraction of a molar tooth in a group of patients who received the intra-alveolar application of Manuka Honey post-operatively with another group who used 0.2% CHX rinse.Material and MethodsA randomized clinical trial of parallel groups was carried out on 100 patients who had a single molar tooth extraction. They were randomly divided into two groups. Group1 (G1) used 0.2 % CHX twice daily for 7 days. In Group2 (G2), Manuka Honey applied topically by a cotton swab into the socket directly after extraction and on Day3. Re-evaluation, including pain assessment, empty socket, and halitosis was done on day 3 and day 7.ResultsG1 included 43 patients and G2 included 57 patients. Higher grades of pain, more empty sockets, and halitosis were found in G2 than in G1 on day3 and day7 without significant differences. Four cases of AO were found in G1 (9.3%) and 7 cases in G2 (12.3%), without significant difference between the two groups according to Chi-squared tests (p=0.753).ConclusionsThe application of Manuka honey in the extraction socket directly after extraction and on day 3 has been found to be insignificantly less efficient in the prevention of AO than CHX rinse twice daily for seven days. However, honey is promising as natural dressing material and further studies are recommended. Key words:Manuka honey, Chlorhexidine, Alveolar Osteitis, extraction, dry socket.

Prevention of Alveolar Osteitis following Third Molar Surgery

Prevention of Alveolar Osteitis following Third Molar Surgery

The use of chlorhexidine in the prevention of alveolar osteitis after third molar extractions.

Data sourcesCochrane Central Register of Controlled Trials (CENTRAL), Medline through PubMed, Scopus, Science Direct, ISI Web of Science, Evidence-Based Dentistry, ClinicalTrials.gov, the European Union Clinical Trials Register, the Spanish General University Board database of doctoral theses in Spain (TESEO), the Spanish National Research Council (CSIC) bibliographic databases, and the Spanish Medical Index (IME).Study selectionRandomised controlled trials (RCTs) (with or without placebo) of patients of any age or gender who underwent maxillary or mandibular third molar extractions. Studies were required to have analysed the efficacy of only chlorhexidine in any concentration, formulation or treatment regimen for preventing alveolar osteitis (AO). There was no language restriction.Data extraction and synthesisData extraction was carried out independently by two researchers, and a third researcher was consulted in case of disagreements. When explicit data were not stated in the text, they were calculated using data from the tables where possible. In addition, authors were contacted to obtain any necessary missing information. Datasets were assessed for heterogeneity, and meta-analysis was conducted on homogenous datasets. Publication bias was assessed through funnel plots. The research was conducted and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsTwenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and two split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P<.0001). There was evidence of low heterogeneity (I2 = 9.3%; P = 0.336 by X2 test). The number needed to treat was eight (95% CI, 7-11). There were no differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60) for the prevention of AO after third molar extractions. Chlorhexidine did not cause more adverse reactions than placebo.ConclusionsThe use of chlorhexidine, in any formulation (rinse or gel), concentration (0.12% or 0.20%), or regimen (before, during and/or after surgery), is efficacious and effective in preventing AO in patients who have undergone third molar extraction. The findings showed that in order to prevent one case of AO, eight patients would have to be treated with chlorhexidine. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.

Local use of antifibrinolytic agent in prevention of alveolar osteitis (A clinical study)

The study was done to evaluate the effect of local use of antifibrinolytic agent in the prevention of alveolar osteitis after extraction of impacted mandibular 3rd molar. The study took place on 90 consecutive patients (45 patients in each group). After surgical extraction the sockets were irrigated immediately with 10ml of solution (tranexamic acid or placebo) for 2 min. 4 times / day (every 6 hours) for 2 days. Patients returned in five to seven days for suture removal complaining of postoperative pain were examined to verify the severity of the localized osteitis which graded as mild, moderate, or severe according to the patient’s stated degree of pain which scored according to visual analogue scale .The incidence of dry sockets in the group treated with 10% tranexamic acid was 6.6% compared with 28.8% in the sockets treated with placebo. In addition, the untreated group presented with dry sockets judged to be more severe.

Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses.

Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years. Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson's Chi-square, Fisher's exact, or Mann-Whitney U-tests as appropriate. P <0.05 was considered statistically significant. The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648). Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.

Efficacy of Warm Saline and Chlorhexidine Mouth Rinses in the Prevention of Alveolar Osteitis after Third Molar Surgery: A Comparative Study

Efficacy of Warm Saline and Chlorhexidine Mouth Rinses in the Prevention of Alveolar Osteitis after Third Molar Surgery: A Comparative Study

Salt water mouthwash post extraction reduced post operative complications.

Randomised controlled trial. Patients aged ≥16 years requiring non-surgical extraction were randomised into three groups. Group A (n = 40) were instructed to gargle six times daily with warm saline and group B (n = 40) twice daily; group C (n = 40) were not instructed to gargle with warm saline and served as controls. All patients received the same oral antibiotics and analgesics, and similar postoperative instructions, except regarding saline rinses. Mouth rinsing was to start 24 hours after the procedure and patients were reviewed at 72 hours. The patients were evaluated 72 h post-operatively for the presence of alveolar osteitis, acute inflamed socket and acute infected socket by an independent observer who was blinded to the treatment group. One hundred and twenty patients were randomised (40 per group). The overall prevalence of alveolar osteitis was 10.0% and that of acute inflamed socket was 25.0%. No cases of acute infected socket were observed.There was a statistically significant difference between the study groups with respect to the development of alveolar osteitis (x(2) = 15.43, df = 2, P = 0.001), but not for acute inflamed socket, with only 2.5% of the saline groups (2 out of 80) developing alveolar osteitis compared with 25% (10 of 40) in the control group. The instruction to use warm saline mouth rinse is beneficial in the prevention of alveolar osteitis after dental extractions. There is no significant difference in the efficacy of the twice-daily warm saline mouth rinse regimen compared to the six times daily regimen. The twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with the six times daily rinse routine.

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. Objectives: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. Study Design: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d’Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). Results: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. Conclusions: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance. Key words:Alveolar osteitis, dry socket, chlorhexidine bioadhesive gel, mandibular third molar surgery.

Comparative study of the effect of warm saline mouth rinse on complications after dental extractions

The aim of the present study was to determine the effect of saline mouth rinse on postoperative complications following routine dental extractions. Patients aged ≥16 years, who were referred to the oral surgery clinic with an indication for non-surgical extraction of pathologic teeth, were prospectively and uniformly randomized into three groups. Group A (n=40) were instructed to gargle six times daily with warm saline and group B (n=40) twice daily; group C (n=40) were not instructed to gargle with warm saline and served as controls. Information on demographic characteristics, indications for extraction, and the development of complications, such as alveolar osteitis, acute inflamed socket, and acute infected socket, was obtained and analyzed. There were no significant differences between patients who gargled six times daily with warm saline and those who gargled twice daily with reference to either alveolar osteitis or acute inflamed socket (P>0.05). However saline mouth rinses at either frequency were beneficial in the prevention of alveolar osteitis in comparison with those who did not rinse. A twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with a six times daily rinse regimen.

The efficacy of tincture of benzoin compound in the management of extraction sockets of mesio-angularly impacted mandibular third molars

Aim To clinically determine the efficacy of tincture of benzoin compound in the treatment and prevention of alveolar osteitis (dry socket) following surgical disimpaction of mesio-angularly impacted mandibular third molars. Patients and methods This is a 6-year prospective study of 232 patients with mesio-angularly impacted mandibular third molars requiring dental extractions at the University of Calabar Teaching Hospital, Nigeria. The subjects were recruited into two different groups, A (control) and B (tincture of benzoin compound), by simple random sampling. Results In Groups A and B, 16 (13.8%) and 3 (2.6%) of the subjects, respectively, developed alveolar osteitis. There were more males (n = 123, 53.0%) than females (n = 109, 47.0%) in the two groups, with male-to-female ratio of 3:1. There were more subjects (n = 11, 68.7%) between 25–44 years in Group A, with a mean age of 31.5 years, than in Group B, with a mean age of 28.3 years. The most common reason for extraction was dental caries and its sequelae (n = 121, 52.1%). Conclusion This study suggests that the tincture of benzoin compound is beneficial and safe in the treatment and prevention of alveolar osteitis.

Randomized, Double-Blind Study of Effectiveness of Intra-Alveolar Application of Chlorhexidine Gel in Reducing Incidence of Alveolar Osteitis and Bleeding Complications in Mandibular Third Molar Surgery in Patients With Bleeding Disorders

Chlorhexidine (CHX) is an antimicrobial agent used in the prevention of tooth decay, periodontal disease, and postextraction alveolar osteitis (AO). Recently, a bioadhesive gel to deliver the active substance, CHX, was introduced. The intra-alveolar placement of the bioadhesive gel allows a more direct and prolonged therapeutic effect of CHX, which is useful in the prevention of AO after extraction of impacted third molars. The intra-alveolar application of the bioadhesive CHX gel in patients with bleeding disorders may increase the risk of postoperative bleeding complications. Inversely, bleeding disorders might influence the efficacy of CHX for AO prevention. The purpose of the present study was to evaluate the effectiveness of the bioadhesive 0.2% CHX gel in reducing the incidence of impacted third molar postextraction AO in patients with bleeding disorders. We performed a double-blind, randomized, parallel-group study of 38 patients with bleeding disorders. The experimental group (n = 14) was treated with bioadhesive 0.2% CHX gel applied intraoperatively once after surgical removal of the third molar. The control group (n = 24) was treated in an identical fashion with placebo gel. We observed a 57.15% reduction in the incidence of AO in the experimental group. The control group had a 17% incidence of AO and the experimental group had a 7% incidence of AO (P = .402). Bleeding complications occurred in 21% of the experimental group compared with 29% of the control group (P = .601). As described in previous studies, the single intra-alveolar application of the bioadhesive 0.2% CHX gel in an intraoperative fashion seems to reduce the incidence of AO after removal of impacted third molars in patients with bleeding disorders. On the basis of the reported percentage of bleeding complications, the routine use of postoperative local hemostatic measures is recommended.

Pre-operative Chlorhexidine mouth rinses reduce the incidence of dry socket

Medline and the Cochrane library databases were searched and additional studies located by scrutinising publications obtained. Studies included in analysis were randomised controlled trails (RCT) about prevention of alveolar osteitis (AO) that were written in English, French, German or any of the Nordic languages (Danish, Finnish, Icelandic, Norwegian, Swedish). Duplicate publications, those with flawed data and RCT that generally addressed postoperative complications were excluded. The RCT were quality assessed using the Jadad scale and then categorised and tabulated, according to the main test interventions, to the following domains: antibiotics trials; chlorhexidine trials; trials of PEPH (an antifibrinolytic-active propylic ester of p-hydrobenzoic acid); and other trials including factorial trials (combined interventions) and factorial test groups of RCT belonging to any of the aforementioned domains. A total of 90 publications were identified, from which 32 RCT were included, from 12 different countries, covering the time period 1971-2005. An adequate method of random allocation was reported in 47% of the RCT. Eight different RCT assessed different antibiotic regimens. Tetracycline trials revealed the greatest preventive effects on AO, with absolute risk reductions (ARR) ranging from 12-31% and numbers needed to treat (NNT) ranging from three to eight treated individuals. The effect of chlorhexidine rinses for prevention of AO was studied in five RCT with ARR ranging from 3-25% (NNT, four to 36 treatments). Overall, evidence about chlorhexidine rinses on the prevention of AO was inconclusive, but the available data indicate that 0.12% chlorhexidine rinsing pre-operatively and 7 days postoperatively reduces the frequency of AO following surgical removal of lower third molars. Similarly, evidence for the effectiveness of the antifibrinolytic agent PEPH (considered in three trials) was inconclusive, as was that for the other 18 trials agents. Local treatment with tetracycline, and also 0.12% chlorhexidine rinsing pre-operatively and 7 days postoperatively, seem to have significant and clinically relevant preventive effect on AO following surgical removal of lower third molars.

In vitro comparison of chlorhexidine and povidone–iodine on the long-term proliferation and functional activity of human alveolar bone cells

This work reports the behaviour of osteoblastic human alveolar bone cells (first subculture) in the presence of chlorhexidine (CHX) and povidone-iodine (PI). Short contact (2 min) of 24-h cultures with CHX, at 0.12 and 0.2%, and PI, at 5 and 10%, caused cell death within minutes; contact with 1% PI resulted in loss of the elongated characteristic cell shape. Cell adhesion was adversely affected at concentrations higher than 5 x 10(-5)% CHX or 0.05% PI. Long-term exposure to CHX at 10(-5) and 10(-4)% or PI at 10(-4)% had little effect on cell growth and caused an induction in the synthesis of alkaline phosphatase (ALP). Concentrations of CHX and PI similar and higher than, respectively, 5 x 10(-4)% or 0.05% caused dose-dependent deleterious effects. CHX affected mainly the cell growth, whereas the effects of PI were observed mostly in ALP production and matrix mineralization. Considering the levels of CHX and PI used routinely in the oral cavity, results suggest that CHX has a higher cytotoxicity profile than PI. This observation might have some clinical relevance regarding the potential utility of PI in the prevention of alveolar osteitis.