title: The effect of chlorhexidine dentifrice or gel versus chlorhexidine mouthwash on plaque, gingivitis, bleeding and tooth discoloration: a systematic review.
abstract: OBJECTIVE
  To systematically review and evaluate the available scientific evidence on the effectiveness of chlorhexidine dentifrice or gel (CHX DF/gel) compared to chlorhexidine mouthwash (CHX MW) on plaque, bleeding, gingival inflammation and tooth discoloration scores.
  
  
  METHODS
  PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched to identify appropriate studies.
  
  
  RESULTS
  Independent screening of the 2256 unique titles and abstracts resulted in five publications that met the eligibility criteria. Considerable heterogeneity was found between the studies. Three of the five studies showed a positive effect on plaque scores in favour of the CHX MW. With respect to gingival index and bleeding scores, no significant differences were found. Chlorhexidine mouthwash, however, showed a significantly more tooth discoloration than the CHX DF/gel. A meta-analysis of the effect on 'de novo' plaque formation of CHX DF/gel versus CHX MW resulted in a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001).
  
  
  CONCLUSIONS
  Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.
authors: Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.
authors: S C
authors: SC
authors: Supranoto
authors: D E
authors: DE
authors: Slot
authors: M
authors: M
authors: Addy
authors: G A
authors: GA
authors: Van der Weijden
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D003773:Dental Plaque / Q000517:prevention & control*; D003774:Dental Plaque Index; D003802:Dentifrices / Q000627:therapeutic use*; D005782:Gels; D005884:Gingival Hemorrhage / Q000517:prevention & control*; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use*; D010512:Periodontal Index; D014075:Tooth Discoloration / Q000139:chemically induced*
chemical_list: D000891:Anti-Infective Agents, Local; D003802:Dentifrices; D005782:Gels; D009067:Mouthwashes; D002710:Chlorhexidine
keywords: bleeding; chlorhexidine; dentifrice; gel; gingivitis; mouthwash; oral hygiene; plaque; systematic review; tooth discoloration