title: Does Chlorhexidine Prevent Alveolar Osteitis After Third Molar Extractions? Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  The prevention of alveolar osteitis (AO) in dental extractions remains a controversial issue. Chlorhexidine is one of the most widely studied antiseptics for the prevention of AO. The purpose of this systematic review and meta-analysis was to assess the efficacy and effectiveness of chlorhexidine in the prevention of AO after third molar extractions.
  
  
  METHODS
  The authors searched databases and the references of each article retrieved up to December 2015. Clinical randomized controlled trials (RCTs) using only chlorhexidine were included. The predictor variable was whether chlorhexidine was used in any formulation, concentration, or regimen. The outcome measurement was the incidence of postoperative AO. The authors also recorded variables describing the characteristics of the included studies. Statistical analysis was performed using STATA 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CIs) were estimated. Forest, l'Abbé, and funnel plots were constructed.
  
  
  RESULTS
  Twenty-three studies published from 1979 to 2015, corresponding to 18 trials (16 parallel-group and 2 split-mouth RCTs), that reported on 2,824 third molar extractions (1,458 in experimental group and 1,366 in control group) were included. The overall relative risk (RR) was 0.53 (95% CI, 0.45-0.62; P < .0001). There was no evidence of heterogeneity (I2= 9.3%; P = .336 by χ2test). The number needed to treat was 8 (95% CI, 7-11). There were no relevant differences between chlorhexidine rinse (RR = 0.58; 95% CI, 0.47-0.71) and gel (RR = 0.47; 95% CI, 0.37-0.60). Chlorhexidine did not cause a larger proportion of adverse reactions than placebo.
  
  
  CONCLUSIONS
  The use of chlorhexidine, in any formulation, concentration, or regimen, is efficacious and effective in preventing AO in patients who have undergone third molar extraction. Chlorhexidine gel was found to be moderately more efficacious than the rinse formulation.
authors.affiliation: Master of Dentistry, Private Practitioner, Steenwijk, Netherlands. Electronic address: rs.fabio8@gmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rodríguez Sánchez
authors.affiliation: Department Head and Professor, Department of Epidemiology and Public Health, University of the Basque Country (UPV/EHU).
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez Andrés
authors.affiliation: Associate Professor of Maxillofacial Surgery, University of the Basque Country (UPV/EHU); Member, Department of Maxillofacial Surgery, BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU).
authors.forename: Iciar
authors.initials: I
authors.lastname: Arteagoitia Calvo
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004368:Dry Socket / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008964:Molar, Third / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control*; D014081:Tooth Extraction / Q000009:adverse effects*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine