title: Assessment of the effectiveness of mouthwashes in reducing cariogenic biofilm in orthodontic patients: a systematic review.
abstract: OBJECTIVE
  The use of fixed orthodontic appliances makes it difficult to clean the teeth and accessories associated with it. For this reason, orthodontic patients have used oral antiseptics as coadjuvent means to reduce cariogenic plaque. The aim of this systematic review was to evaluate the effectiveness of oral antiseptics on the reduction of cariogenic plaque on orthodontic patients.
  
  
  METHODS
  This review has been registered at PROSPERO--international prospective register of systematic reviews under the number CRD42013006857.
  
  
  METHODS
  A systematic review of the literature was conducted in the following electronic databases: Scopus, PubMed, Web of Science, Medline, Embase and Cochrane, Grey literature and Clinical Trials, without limitations on the year of publication or language. Clinical studies in patients with fixed orthodontic appliances, who were making use of oral mouthwashes in order to reduce cariogenic plaque, were included. Articles with patients using systemic drugs, syndromic patients, those using mouthwashes for other purposes and/or using different cleaning techniques, and clinical cases were excluded. After selection by title and abstract, potentially eligible articles were read in full. The methodological quality and risk of biases of articles included were evaluated according to the characteristics of the study, measurements and statistical analyses of the study. The methodological quality was classified as high, moderate or low.
  
  
  METHODS
  The search identified 2716 articles, of which 15 met the inclusion criteria. Of these, 8 analyzed chlorhexidine-based mouthwashes, while in 1 article Cetylpyridinium was used; 1 analyzed the mouthwash containing sanguinaria; 1 the use of NaF; 2 articles the use of AmF/SnF2; 2 the use of Listerine(®), 1 also analyzed the association between mouthwashes with octenidine and with PVP-I. Of the articles analyzed, 11 were classified as having high and 4 as having moderate methodological quality.
  
  
  CONCLUSIONS
  There is evidence of effectiveness of the use of oral mouthwashes in the control of cariogenic plaque in patients with fixed orthodontic appliances. The orthodontists may suggest the use of oral antiseptics in the oral hygiene of their patients as coadjuvent means to reduce cariogenic plaque.
  
  
  CONCLUSIONS
  Given current evidence, orthodontists may prescribe mouthwash as an auxiliary method in the control of cariogenic biofilm in orthodontic patients.
authors.affiliation: Department of Healthy, Southwest Bahia State University UESB, Jequié, Bahia, Brazil. Electronic address: matheuspithon@gmail.com.
authors.forename: Matheus Melo
authors.initials: MM
authors.lastname: Pithon
authors.affiliation: Department of Healthy, Southwest Bahia State University UESB, Jequié, Bahia, Brazil.
authors.forename: Letícia Iandeyara Dantas Andrade
authors.initials: LI
authors.lastname: Sant'Anna
authors.affiliation: Department of Healthy, Southwest Bahia State University UESB, Jequié, Bahia, Brazil.
authors.forename: Felipe Carvalho Souza
authors.initials: FC
authors.lastname: Baião
authors.affiliation: Department of Health and Technology Rural, Federal University of Campina Grande, Patos, Paraíba, Brazil.
authors.forename: Rogério Lacerda
authors.initials: RL
authors.lastname: dos Santos
authors.affiliation: Department of Healthy, Southwest Bahia State University UESB, Jequié, Bahia, Brazil.
authors.forename: Raildo da Silva
authors.initials: Rda S
authors.lastname: Coqueiro
authors.affiliation: Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Lucianne Cople
authors.initials: LC
authors.lastname: Maia
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects*; D003773:Dental Plaque / Q000188:drug therapy; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use*; D009910:Oral Hygiene; D009967:Orthodontic Appliances
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes
keywords: Cariogenic plaque; Fixed appliance; Mouth rinses; Mouthwash