Wednesday, August 16, 2017

The role of chlorhexidine in caries prevention

Resident’s Name: Brian Darling                                                                                 Date: 8/16/2017

Article Title: The role of chlorhexidine in caries prevention
Author(s): Jaana Autio-Gold
Journal: Operative Dentistry
Date: 2008; 33: 710-716
Major Topic: Chlorhexidine and its effect on caries
Type of Article: Literature Review
Main Purpose: This article aimed to describe the current evidence on chlorhexidine and its effect on caries prevention.
Key Points: Although there are mixed and some promising results from studies about chlorhexidine gels and varnishes, there is currently insufficient evidence for it to be recommended for use in caries prevention.
·      The most persistent mutans streptococci (MS) reductions by chlorhexidine delivery systems are achieved by varnishes followed by gels and then mouth rinses.
·      Only 0.12% chlorhexidine mouthrinses are marketed in the US
·      People with higher levels of MS develop more caries
·      Studies on the effect of chlorhexidine mouthrinses have failed to show a significant effect on caries reduction
·      There is a small body of evidence that chlorhexidine gels may be able to reduce caries in children. More studies are needed to validate the effectiveness of chlorhexidine gels. 
·      Reducing the levels of plaque and/or MS may not always correlate with a reduction in caries 
·      Chlorhexidine varnishes were developed to increase the substantitivity, length of time of suppression, and effectiveness of the delivery of chlorhexidine to sites colonized by MS
·      There is a small body of mixed evidence regarding the effectiveness of chlorhexidine varnish to reduce caries
·      Some studies in vivo and in vitro have shown combinations of fluoride and chlorhexidine to be synergistic against MS. However, clinical trials of fluoride and chlorhexidine combinations have not demonstrated this combination to provide an additional preventive effect
·      The main clinical problem of chlorhexidine is the difficulty in suppressing or eliminating MS for an extended period of time
·      Pre-treatment MS levels are generally reached within 2-6 months after chlorhexidine treatment.
o   There must be reservoirs or retentive sites in the dentition that are not or hardly affected by the chlorhexidine treatment.
o   Patients with more retentive sites such as faulty restorations, occlusal fissures, enamel cracks, incipient lesions, and patients with orthodontic appliances were more rapidly colonized by MS
·      Chlorhexidine staining as a side effect:
o   Yellow-brown staining
o   Usually occurs in cervical third of crown and in interproximal areas
o   Most pronounced staining occurs along CEJ or root surface, in pits and fissures, and existing composite restorations and occasionally the tongue
o   Staining occurs in one-third to ½ of patients
o   Usually evident within several days after initiation of daily rinses
o   Removable with the exception of porous restorations or open margins
·      Altered taste sensation is a side effect of chlorhexidine that usually lasts several hours but is uncommon and self-limiting
·      Chlorhexidine rinses should not be recommended for caries prevention
·      Use of different chlorhexidine modes or a combination of chlorhexidine-fluoride therapy for caries prevention has been “suggestive but incomplete”

Assessment of Article:  Level of Evidence/Comments: III

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