title: The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review.
abstract: OBJECTIVE
  Based on the existing scientific literature, the effect of chlorhexidine (CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect.
  
  
  METHODS
  MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks.
  
  
  RESULTS
  Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores.
  
  
  CONCLUSIONS
  Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance.
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Slot
authors.forename: C E
authors.initials: CE
authors.lastname: Berchier
authors.forename: M
authors.initials: M
authors.lastname: Addy
authors.forename: U
authors.initials: U
authors.lastname: Van der Velden
authors.forename: G A
authors.initials: GA
authors.lastname: Van der Weijden
mesh_terms: D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000009:adverse effects / Q000627:therapeutic use*; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D003802:Dentifrices / Q000008:administration & dosage / Q000627:therapeutic use*; D005782:Gels; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D010512:Periodontal Index; D016032:Randomized Controlled Trials as Topic; D014075:Tooth Discoloration / Q000139:chemically induced* / Q000145:classification
chemical_list: D000891:Anti-Infective Agents, Local; D003802:Dentifrices; D005782:Gels; D002710:Chlorhexidine
keywords: CHX dentifrice; CHX gel; CHX toothpaste; chlorhexidine; plaque; systematic review; tooth staining