title: Chlorhexidine mouthwash more effective than dentifrice or gel.
abstract: METHODS
  Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL).
  
  
  METHODS
  Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in adults 18 years of age comparing CHX DF/gel with CHX MW written in English or Dutch were considered.
  
  
  METHODS
  Two reviewers independently selected studies, abstracted data and assessed risk of bias. Where possible, a meta-analysis was performed. Difference in means values between test and control at both baseline and end was calculated using a fixed-effects model.
  
  
  RESULTS
  Five RCTs were included, four had a parallel design and one was a cross-over trial. Three studies showed a positive score in favour of the mouthwash. Three studies contributed to a meta-analysis of the effect on 'de novo' plaque formation. There was a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001) in favour of CHX MW. One study assessed tooth staining finding more staining with the use of CHX MW compared to the CHX DF/gel.
  
  
  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.affiliation: Centre for Evidence-based Dentistry, Dental Health Services Research Unit, University of Dundee, Dundee, Scotland, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Richards
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D003773:Dental Plaque / Q000517:prevention & control*; D003802:Dentifrices / Q000627:therapeutic use*; D005884:Gingival Hemorrhage / Q000517:prevention & control*; D005891:Gingivitis / Q000517:prevention & control*; D006801:Humans; D009067:Mouthwashes / Q000627:therapeutic use*; D014075:Tooth Discoloration / Q000139:chemically induced*
chemical_list: D000891:Anti-Infective Agents, Local; D003802:Dentifrices; D009067:Mouthwashes; D002710:Chlorhexidine