Does Chlorhexidine Prevent Alveolar Osteitis after Third Molar Extractions? Systematic Review and Meta-Analysis

Publication date: Available online 13 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Fabio Rodríguez Sánchez, Carlos Rodríguez Andrés, Iciar Arteagoitia Calvo
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 following third molar extractions. We searched databases and the references of each article retrieved up to December 2015. Randomized controlled clinical trials (RCTs) using only chlorhexidine were included. The predictor variable was whether or not chlorhexidine was used in any formulation, concentration, or regimen. The outcome measure was the incidence of postoperative AO. We also recorded variables describing the characteristics of the included studies. The statistical analysis was performed using Stata version 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CI) were estimated. Forest, l'Abbe, and funnel plots were constructed. Overall, 23 studies published from 1979 to 2015 corresponding to 18 trials, 16 parallel-group and 2 split-mouth RCTs, were included, with 2824 extractions (1458 in the experimental group and 1366 in the control group), involving third molars. The overall relative risk (RR) is 0.53 (95% CI 0.45 to 0.62) (P<0.0001). There was no evidence of heterogeneity (I² 9.3%; chi-squared test, P=0.336). The number needed to treat was 8 (95% CI 7 to 11). There were no significant differences between chlorhexidine formulations: rinse (RR 0.58; 95% CI 0.47 to 0.71) and gel (RR 0.47; 95% CI 0.37 to 0.60). Chlorhexidine did not cause a higher proportion of adverse reactions than placebo. To conclude, 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 more efficacious than the rinse formulation, but not significantly.



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