Efficacy of chlorhexidine in the prevention of alveolar osteitis after permanent tooth extraction. Systematic review and meta-analysis.
Abstract
Background: Dental extraction is a routine task performed by dental surgeons. This procedure may sometimes cause associated postoperative complications such as: edema, pain, trismus and alveolar osteitis (AO). Objective: To evaluate the efficacy of chlorhexidine (CHX) in the prevention of alveolar osteitis after permanent tooth extraction, through a systematic review and meta-analysis. Materials and Methods: A literature search was carried out until December 2018 in the following biomedical databases: PubMed, Embase, SciELO, Science Direct, SIGLE, LILACS, Google Scholar and The Cochrane Central Register of Controlled Trials (CENTRAL). The selection criteria for the studies were: randomized clinical trials published in the 5 years prior to the realization of this study, which reported the use of CHX in the prevention of AO. The risk of study bias was analyzed through the Cochrane Manual for systematic reviews of interventions. Results: The search strategy resulted in a selection of 22 articles; 17 of these were used to perform the meta-analysis. All of them reported that CHX is effective in preventing AO. Conclusion: The literature reviewed suggests that the use of CHX is effective in AO prevention; however, more studies comparing the efficacy of chlorhexidine gel with chlorhexidine used as an irrigant or as mouthwash are necessary.
References
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11. Halabi D, Escobar J, Alvarado C, Martínez N, Muñoz C. Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial. J Appl Oral Sci. 2018; 26: e20170245.
12. Eshghpour M, Danaeifar N, Kermani H, Nejat AH. Does Intra- Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double- Blinded Randomized Clinical Trial. J Oral Maxillofac Surg. 2018;76(5): 939.e1- 939.e7.
13. Cho H, David MC, Lynham AJ, Hsu E. Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial. Br J Oral Maxillofac Surg. 2018; 56(1): 54-9.
14. Qureshi SW, Siddiqui M, Amin G, Sundas C. Effect of chlorhexidine gel application to prevent dry socket after mandibular 3rd molar extraction. Professional Med J. 2018; 25(9): 1350-5.
15. Osunde OD, Anyanechi CE, Bassey GO. Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses. Niger J Clin Pract. 2017; 20(4): 470-3.
16. Kaur J, Raval R, Bansal A, Kumawat V. Repercussions of intraalveolar placement of combination of 0.2% chlorhexidine & 10 Mg metronidazole gel on the occurrence of dry sockets- A randomized control trial. J Clin Exp Dent. 2017; 9(2): e284-8.
17. Choubarga N, Subha SD, Anup KS. Efficacy of Warm Saline and Chlorhexidine Mouth Rinses in the Prevention of Alveolar Osteitis after Third Molar Surgery: A Comparative Study. IJOCR. 2017; 5(4): 270-3.
18. Gopee P, Rikhotso E. Impacted mandibular third molars: the efficacy of prophylactic antibiotics and chlorhexidine mouthwash in preventing postoperative infections. S Af Dent J. 2017; 72(5): 213-8.
19. Requena-Calla S, Funes-Rumiche I. Effectiveness of intra-alveolar chlorhexidine gel in reducing dry socket following surgical extraction of lower third molars. A pilot study. J Clin Exp Dent. 2016; 8(2): e160-3.
20. Jesudasan JS, Wahab PU, Sekhar MR. Effectiveness of 0.2% chlorhexidine gel and a eugenol-based paste on postoperative alveolar osteitis in patients having thirdmolars extracted: a randomised controlled clinical trial. Br J Oral Maxillofac Surg. 2015; 53(9): 826-30.
21. Freudenthal N, Sternudd M, Jansson L, Wannfors K. A double-blind randomized study evaluating the effect of intra-alveolar chlorhexidine gel on alveolar osteitis after removal of mandibular third molars. J Oral Maxillofac Surg. 2015; 73(4): 600-5.
22. Rubio-Palau J, Garcia-Linares J, Hueto-Madrid JA, González-Lagunas J, Raspall-Martin G, Mareque-Bueno J. Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2015; 20(1): e117-22.
23. Inamdar MNK, Chauhan R, Mapare SA, Goswami RP, Goswami Y, Khadri S. Prevention of Dry Socket using Chlorhexidine Gel and Ornidazole Gel in Impacted Mandibular Third Molar: A Comparative Randomized Prospective Study on 30 Patients. J Int Oral Health. 2015; 7(11): 41-6.
24. Shahakbari R, Erfanian M. Efficacy of 1% versus 0.2% Chlorhexidine Gel in Reducing the Frequency of Alveolar Osteitis following Mandibular Third Molar Surgery: Randomized Clinical Trial. IOSR-JDMS. 2015; 14(5): 69-72.
25. Khan MA, Khan FR, Umer F, Haider SM, Hasan T. Clinical Efficacy of Single Dose Chlorhexidine Gel Application in Molars Extractions-A Randomized Clinical Trial. J Pak Dent Assoc. 2015; 24(4): 175181.
26. Abu-Mostafa NA, Alqahtani A, Abu-Hasna M, Alhokail A, Aladsani A. A randomized clinical trial compared the effect of intra-alveolar 0.2 % Chlorohexidine bio-adhesive gel versus 0.12% Chlorohexidine rinse in reducing alveolar osteitis following molar teeth extractions. Med Oral Patol Oral Cir Bucal. 2015; 20(1): e82–7.
27. Haraji A, Rakhshan V. Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk. J Oral Maxillofac Surg. 2014; 72(2): 259-65.
28. Shaban B, Azimi H, Naderi H, Janani A, Zarrabi M, Nejat A. Effect of 0.2 Chlorhexidine Gel on Frequency of Dry Socket Following Mandibular Third Molar Surgery: A Double-Blind Clinical Trial Clinical Trial. JDMT. 2014; 3(4): 175-9.
29. Ahmedi J, Ahmedi E, Agani Z, Hamiti V, Recica B, Dragusha A. The efficacy of 1% chlorhexidine gel on the reduction of dry socket occurence following surgical third molar extraction—pilot study. OJST. 2014, 4: 152-60.
30. Younus S, Ghumman N, Latif K, Chishty M. Efficacy of chlorhexidine gel vschlorhexidine rinses in reducing incidence of dry socket in mandibular third molar surgery. Pakistan Oral and Dental Journal. 2014; 34(2): 249-52.
31. Sanchez A, Castillo H, Guerrero H, Marín J. Comparing chlorhexidine mouthwashes 0.12% and hydrogen peroxide 1.5% in the prevention of alveolitis post extraction of lower third molar. Pueblo cont. 2014; 25(2): 33-7.
2. Rodríguez-Sánchez F, Rodríguez-Andrés C, Arteagoitia-Calvo I. Does chlorhexidine prevent alveolar osteitis after third molar extractions? Systematic review and meta-analysis. J Oral Maxillofac Surg. 2017; 75(5): 901-14.
3. Zhou J, Hu B, Liu Y, Yang Z, Song J. The efficacy of intra-alveolar 0.2% chlorhexidine gel on alveolar osteitis: a meta-analysis. Oral Dis. 2017; 23(5): 598-608.
4. Reiland MD, Ettinger KS, Lohse CM, Viozzi CF. Does administration of oral versus intravenous antibiotics for third molar removal have an effect on the incidence of alveolar osteitis or postoperative surgical site infections? J Oral Maxillofac Surg. 2017; 75(9): 1801-8.
5. Taberner-Vallverdú M, Sánchez-Garcés MA, Gay-Escoda C. Efficacy of different methods used for dry socket prevention and risk factor analysis: a systematic review. Med Oral Patol Oral Cir Bucal. 2017; 22(6): e750-8.
6. Taberner-Vallverdú M, Nazir M, Sánchez-Garcés MA, Gay-Escoda C. Efficacy of different methods used for dry socket management: a systematic review. Med Oral Patol Oral Cir Bucal. 2015; 20(5): e633-9.
7. Tarakji B, Saleh LA, Umair A, Azzeghaiby SN, Hanouneh S. Systematic review of dry socket: a etiology, treatment and prevention. J Clin Diagn Res. 2015; 9(4): ZE10-3.
8. Hutton B, Catalá-López F, Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin. 2016; 147(6): 262-6.
9. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Colaboration, 2011.
10. Jadhao VA, Rao A, Hande P, Mahajani M, Raktade PP, Gedam R, Acharya V, Tekale PD. The Efficiency of Three Irrigating Solutions after SurgicalRemoval of Impacted Mandibular Third Molars: A Cross-sectional Study. J Contemp Dent Pract. 2018;19(9):1147-51.
11. Halabi D, Escobar J, Alvarado C, Martínez N, Muñoz C. Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial. J Appl Oral Sci. 2018; 26: e20170245.
12. Eshghpour M, Danaeifar N, Kermani H, Nejat AH. Does Intra- Alveolar Application of Chlorhexidine Gel in Combination With Platelet-Rich Fibrin Have an Advantage Over Application of Platelet-Rich Fibrin in Decreasing Alveolar Osteitis After Mandibular Third Molar Surgery? A Double- Blinded Randomized Clinical Trial. J Oral Maxillofac Surg. 2018;76(5): 939.e1- 939.e7.
13. Cho H, David MC, Lynham AJ, Hsu E. Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial. Br J Oral Maxillofac Surg. 2018; 56(1): 54-9.
14. Qureshi SW, Siddiqui M, Amin G, Sundas C. Effect of chlorhexidine gel application to prevent dry socket after mandibular 3rd molar extraction. Professional Med J. 2018; 25(9): 1350-5.
15. Osunde OD, Anyanechi CE, Bassey GO. Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses. Niger J Clin Pract. 2017; 20(4): 470-3.
16. Kaur J, Raval R, Bansal A, Kumawat V. Repercussions of intraalveolar placement of combination of 0.2% chlorhexidine & 10 Mg metronidazole gel on the occurrence of dry sockets- A randomized control trial. J Clin Exp Dent. 2017; 9(2): e284-8.
17. Choubarga N, Subha SD, Anup KS. Efficacy of Warm Saline and Chlorhexidine Mouth Rinses in the Prevention of Alveolar Osteitis after Third Molar Surgery: A Comparative Study. IJOCR. 2017; 5(4): 270-3.
18. Gopee P, Rikhotso E. Impacted mandibular third molars: the efficacy of prophylactic antibiotics and chlorhexidine mouthwash in preventing postoperative infections. S Af Dent J. 2017; 72(5): 213-8.
19. Requena-Calla S, Funes-Rumiche I. Effectiveness of intra-alveolar chlorhexidine gel in reducing dry socket following surgical extraction of lower third molars. A pilot study. J Clin Exp Dent. 2016; 8(2): e160-3.
20. Jesudasan JS, Wahab PU, Sekhar MR. Effectiveness of 0.2% chlorhexidine gel and a eugenol-based paste on postoperative alveolar osteitis in patients having thirdmolars extracted: a randomised controlled clinical trial. Br J Oral Maxillofac Surg. 2015; 53(9): 826-30.
21. Freudenthal N, Sternudd M, Jansson L, Wannfors K. A double-blind randomized study evaluating the effect of intra-alveolar chlorhexidine gel on alveolar osteitis after removal of mandibular third molars. J Oral Maxillofac Surg. 2015; 73(4): 600-5.
22. Rubio-Palau J, Garcia-Linares J, Hueto-Madrid JA, González-Lagunas J, Raspall-Martin G, Mareque-Bueno J. Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial. Med Oral Patol Oral Cir Bucal. 2015; 20(1): e117-22.
23. Inamdar MNK, Chauhan R, Mapare SA, Goswami RP, Goswami Y, Khadri S. Prevention of Dry Socket using Chlorhexidine Gel and Ornidazole Gel in Impacted Mandibular Third Molar: A Comparative Randomized Prospective Study on 30 Patients. J Int Oral Health. 2015; 7(11): 41-6.
24. Shahakbari R, Erfanian M. Efficacy of 1% versus 0.2% Chlorhexidine Gel in Reducing the Frequency of Alveolar Osteitis following Mandibular Third Molar Surgery: Randomized Clinical Trial. IOSR-JDMS. 2015; 14(5): 69-72.
25. Khan MA, Khan FR, Umer F, Haider SM, Hasan T. Clinical Efficacy of Single Dose Chlorhexidine Gel Application in Molars Extractions-A Randomized Clinical Trial. J Pak Dent Assoc. 2015; 24(4): 175181.
26. Abu-Mostafa NA, Alqahtani A, Abu-Hasna M, Alhokail A, Aladsani A. A randomized clinical trial compared the effect of intra-alveolar 0.2 % Chlorohexidine bio-adhesive gel versus 0.12% Chlorohexidine rinse in reducing alveolar osteitis following molar teeth extractions. Med Oral Patol Oral Cir Bucal. 2015; 20(1): e82–7.
27. Haraji A, Rakhshan V. Single-dose intra-alveolar chlorhexidine gel application, easier surgeries, and younger ages are associated with reduced dry socket risk. J Oral Maxillofac Surg. 2014; 72(2): 259-65.
28. Shaban B, Azimi H, Naderi H, Janani A, Zarrabi M, Nejat A. Effect of 0.2 Chlorhexidine Gel on Frequency of Dry Socket Following Mandibular Third Molar Surgery: A Double-Blind Clinical Trial Clinical Trial. JDMT. 2014; 3(4): 175-9.
29. Ahmedi J, Ahmedi E, Agani Z, Hamiti V, Recica B, Dragusha A. The efficacy of 1% chlorhexidine gel on the reduction of dry socket occurence following surgical third molar extraction—pilot study. OJST. 2014, 4: 152-60.
30. Younus S, Ghumman N, Latif K, Chishty M. Efficacy of chlorhexidine gel vschlorhexidine rinses in reducing incidence of dry socket in mandibular third molar surgery. Pakistan Oral and Dental Journal. 2014; 34(2): 249-52.
31. Sanchez A, Castillo H, Guerrero H, Marín J. Comparing chlorhexidine mouthwashes 0.12% and hydrogen peroxide 1.5% in the prevention of alveolitis post extraction of lower third molar. Pueblo cont. 2014; 25(2): 33-7.
Published
2019-10-31
How to Cite
ARBILDO-VEGA, Heber et al.
Efficacy of chlorhexidine in the prevention of alveolar osteitis after permanent tooth extraction. Systematic review and meta-analysis..
Journal of Oral Research, [S.l.], v. 8, n. 5, p. 406-415, oct. 2019.
ISSN 0719-2479.
Available at: <https://www.joralres.com/index.php/JOralRes/article/view/joralres.2019.065>. Date accessed: 24 apr. 2024.
doi: https://doi.org/10.17126/joralres.2019.065.
Issue
Section
Reviews
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