Effectiveness of Chlorhexidine Mouthrinse for Gingival Health

Gingivitis is an inflammatory condition that is caused by the accumulation and persistence of dental plaque. The early stages of gingivitis present itself in the way of redness, swelling,and bleeding of the gingivae. To measure the effectiveness of chlorhexidine in reducing the plaque build-up, and thereby gingivitis, an intervention review was conducted.

Below is an easy-to-understand summary of the review that was originally published in the Cochrane Database of Systemic Reviews, 2017, Issue 3.To read the fullreview, click here.

Citation: James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinseas an adjunctive treatment for gingival health.


  • To evaluate the effectiveness of chlorhexidine mouthrinsefor controlling gingivitis and plaque in adjunct to mechanical oral hygiene procedures (MOHP). It also evaluates the effectiveness in comparison to MOHPalone/MOHP plusplacebo mouthrinse.
    (MOHP include: toothbrushing with/without the use of dental floss or interdental cleaning aids and professional tooth cleaning periodontal treatment).
  • To determine if the effectiveness of chlorhexidine depends on the concentration or the frequency of rinsing (once versus twice a day).
  • To report any adverse effects associated with chlorhexidine mouthrinse observed in included trials.

Selection Criteria:

Trials included in this review were randomized controlled trials that measured the effects of chlorhexidine mouthrinsealong with MOHP for a minimum of 4 weeks ongingivitis in adults and children.
In the selected trials:

  • Participants had gingivitis or periodontitis
  • All participants were healthy
  • Some or all participants had medical conditions or special care needs

Data Collection and Analysis:

Two review authors screened the search results extracted data and assessed the risk of bias of the included studies independently.In studies thathad missing data or where clarification was required, the review team contactedthe authors for details where feasible.
For continuous outcomes, means and standard deviations were used to obtain the mean difference and 95% confidence interval (CI).For studies that used the same scale and standardized mean differences, the mean differences were combined.For dichotomous outcomes, the team reported risk rations and 95% confidence intervals. The heterogeneityrandom‐effects models for all meta‐analyses were used.

Study Characteristics:

51 studies were part of this review that analyzeda total of 5345 participants. Most participants in these studies were otherwise healthy children or adults suffering from gingivitis or periodontitis. Most participants were also able to use the usual tooth cleaning methods. The study also included participants who had medical conditions or special care needs as the use of chlorhexidine mouthrinse is even more important for them.
The studies included evaluated the effects of chlorhexidine mouthrinse on gingivitis when used for at least 4 weeks in adjunct with conventional tooth cleaning procedures.

Main Results:

After 4 to 6 weeks of use, chlorhexidine mouthwash showed a reduction in gingivitis and plaque when compared to groups that were using a placebo, control or no mouthrinse. There was, however, insufficient data to determine the effectiveness of chlorhexidine in the reduction of calculus and the effect of different concentrations or frequencies of mouthrinse use. Moreover, participants in the chlorhexidine group showed a large increase in extrinsic tooth stainingat 7-12 weeks and 6 months.

Key Results:

Using high-quality evidence, this survey concludes that the use of chlorhexidine mouthwash along with toothbrushing for 4-6 weeks or 6 months leads to a significant reduction in plaque buildup. It also prevents stains for 4 weeks. Furthermore, evidence indicates that the use of chlorhexidine also leads to a moderate reduction of mild level gingivitis. Since the severity of gingivitis is low, this is not considered clinically important.
The level of gingivitis reduction in people with moderate to severe levels can not be determined with the data available. Some side effects, besides tooth staining, associated with the use of chlorhexidine for 4 weeks or longer include temporary taste disturbance and temporary damage to inner mouth lining.


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