title: The effect of an oxygenating agent on chlorhexidine-induced extrinsic tooth staining: a systematic review.
abstract: BACKGROUND
  Although chlorhexidine digluconate (CHX) is currently the most effective mouthwash for reducing plaque and gingivitis, one of its side effects is extrinsic tooth staining. Interestingly, oxygenating agents may reduce this staining.
  
  
  OBJECTIVE
  The aim of this review was to systematically search the literature for data concerning the inhibiting effect of an oxygenating agent (OA) on CHX-induced tooth staining.
  
  
  METHODS
  MEDLINE-PubMed, Cochrane-CENTRAL, EMBASE and other relevant electronic databases were searched for articles that were published up to November 2011. Articles were included if they were randomized controlled trials or controlled clinical trials conducted with healthy subjects ≥ 16 years of age that compared the effects of CHX mouthrinse combined with an OA with the effects of CHX alone.
  
  
  RESULTS
  An independent screening of 1183 titles and abstracts resulted in 4 publications that met the inclusion criteria. The extracted data allowed meta-analyses of intermediate length studies and showed that combining an OA with CHX mouthrinses led to a significant reduction in tooth staining (mean difference: 0.27; P = 0.02) and plaque scores (mean difference: 0.10; P = 0.003) when compared with CHX alone. One of the included studies reported a side effect for one participant. The present review was limited by the availability of data, and the included studies were methodologically and clinically heterogeneous, which affected the quality and interpretation of the evidence.
  
  
  CONCLUSIONS
  There is moderate evidence that a combination of CHX and an OA reduces tooth staining without interfering with plaque growth inhibition.
authors.affiliation: School of Dental Hygiene, Hogeschool Utrecht, University of Applied Sciences, Utrecht, The Netherlands. nelleke.vanmaanen-schakel@hu.nl
authors.forename: N W D
authors.initials: NW
authors.lastname: van Maanen-Schakel
authors.forename: D E
authors.initials: DE
authors.lastname: Slot
authors.forename: E W P
authors.initials: EW
authors.lastname: Bakker
authors.forename: G A
authors.initials: GA
authors.lastname: Van der Weijden
mesh_terms: D002710:Chlorhexidine / Q000009:adverse effects*; D003773:Dental Plaque / Q000517:prevention & control*; D006801:Humans; D009067:Mouthwashes / Q000009:adverse effects* / Q000737:chemistry; D016877:Oxidants / Q000737:chemistry / Q000627:therapeutic use*; D014075:Tooth Discoloration / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D009067:Mouthwashes; D016877:Oxidants; D002710:Chlorhexidine