Menu
Preprocedural mouthwashes are used to reduce microbial load in aerosols generated during dental procedures. A recent network meta-analysis Int Dent Hyg, 2026) compared the efficacy of commonly used mouthwashes and ranked them based on available evidence.
The analysis included 25 randomized controlled trials with 1111 participants and evaluated eight interventions. A Bayesian network meta-analysis with a random-effects model was used. Outcomes were expressed as standardized mean difference SMD) with 95% confidence intervals, and ranking was performed using SUCRA values. Risk of bias and certainty of evidence were also assessed.
Chlorhexidine CHX) showed the largest reduction in microbial aerosols compared to control SMD 7.10, 95% CI 9.44 to 4.73. It also ranked highest in SUCRA 0.90, indicating the greatest probability of being the most effective intervention.
Other agents showed moderate effects. Cetylpyridinium chloride CPC) ranked second SUCRA 0.68, although the direct evidence supporting it was limited. Herbal mouthwashes demonstrated a notable reduction SMD 5.16, 95% CI 8.04 to 2.17) and ranked third SUCRA 0.61 . Povidone-iodine PVPI) also reduced microbial load SMD 4.57, 95% CI 8.79 to 0.21 , with a SUCRA of 0.53.
Essential oil mouthwashes, normal saline, and hydrogen peroxide showed lower efficacy, with SUCRA values below 0.45. The control group had minimal effect SUCRA 0.03.
From a clinical perspective, CHX remains the most effective option for reducing bacterial aerosols during procedures. CPC and herbal formulations may be considered in patients with CHX intolerance or mucosal sensitivity. PVPI is another alternative, though with variable effect estimates.
The overall certainty of evidence across comparisons was low, and heterogeneity between studies was present. Most studies focused on bacterial aerosols, with limited data on viral reduction.
Current evidence supports the use of CHX as a preprocedural rinse, while highlighting the need for further well-designed trials, particularly for viral outcomes and standardized protocols.
Zhou Q, Hong F, Xiao Y, Lin Y, Li E, Yu X. Comparative efficacy of preprocedural mouthwashes in reducing microbial aerosols during dental procedures: A network meta-analysis. Infect Dis Health. 2026 Apr 19;313 100426. doi: 10.1016/j.idh.2026.100426. Epub ahead of print. PMID 42008926.
