The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: A systematic review

Journal of Clinical Periodontology

Volumn 37, Issue 9, 2010, Pages 829-839

  Berchier, C E ^a,b   Slot, D E ^b   Van Der Weijden, G A ^a,b  

^a Clinic for Periodontology   (Netherlands)

^b UNIVERSITY OF AMSTERDAM   (Netherlands)

Author keywords

chlorhexidine; concentration; gingivitis; mouthrinse; mouthwash; plaque; systematic review

Indexed keywords

CHLORHEXIDINE; MOUTHWASH; TOPICAL ANTIINFECTIVE AGENT;

ARTICLE; COHORT ANALYSIS; COMPARATIVE STUDY; GINGIVITIS; HUMAN; PERIODONTAL DISEASE; PERIODONTICS; RANDOMIZED CONTROLLED TRIAL (TOPIC); TOOTH PLAQUE;

ANTI-INFECTIVE AGENTS, LOCAL; CHLORHEXIDINE; COHORT STUDIES; DENTAL PLAQUE; DENTAL PLAQUE INDEX; GINGIVITIS; HUMANS; MOUTHWASHES; PERIODONTAL DISEASES; PERIODONTAL INDEX; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 77955764069     PISSN: 03036979     EISSN: 1600051X     Source Type: Journal    
DOI: 10.1111/j.1600-051X.2010.01575.x     Document Type: Article

References (69)

1. Addy, M. (1986) Chlorhexidine compared with other locally delivered anti-microbials. A short review. Journal of Clinical Periodontology 13, 957 964.
2. Addy, M., Jenkins, S. Newcombe, R. (1991) The effect of some chlorhexidine-containing mouthrinses on salivary bacterial counts. Journal of Clinical Periodontology 18, 90 93.
3. Addy, M., Moran, J., Wade, W. Jenkins, S. (1992) The evaluation of toothpaste production in promoting gingival health. In : Embery, G. Rolla, G. (eds). Clinical and Biological Aspects of Dentifrices, pp. 249 262.
4. Agerbaek, N., Melsen, B. Rölla, G. (1975) Application of chlorhexidine by oral irrigation systems. Scandinavian Journal of Dental Research. 83, 284 287.
5. Altman, D. G. (1999) Clinical trials. Practical Statistics for Medical Research, 1st edition, pp. 448.
6. Bolanowski, S. J., Gescheider, G. A. Sutton, S. V. (1995) Relationship between oral pain and ethanol concentration in mouthrinses. Journal of Periodontal Research 30, 192 197.
7. Bonesvoll, P. Gjermo, P. (1978) A comparison between chlorhexidine and some quaternary ammonium compounds with regard to retention, salivary concentration and plaque inhibiting effect in the human mouth after mouthrinses. Archives of Oral Biology 23, 289 294.
8. Bonesvoll, P., Lokken, P. Rölla, G. (1974a) Influence of concentration, time, temperature and pH on the retention of chlorhexidine in the human oral cavity after mouth rinses. Archives of Oral Biology 19, 1025 1029.
9. Centre for Evidence-Based Medicine, University of Oxford (England)- Levels of Evidence (March 2009) [WWW document]. Available at : (accessed 09 July 2009)
10. Consort statement. Available at : (accessed October 12, 2008).
11. Cumming, B. R. Löe, H. (1973) Optimal dosage and method of delivering chlorhexidine solutions for the inhibition of dental plaque. Journal of Periodontal Research. 8, 57 62.
12. Dallal, G. E. (2007) Intention-To-Treat Analysis. In: The Little Handbook of Statistical Practice [WWW document]. Available at : (accessed on 9 May 2010).
13. Denton, G. W. (1991) Chlorhexidine. In : Block, S. S. (ed). Disinfection, Sterilization and Preservation, 4th ed, pp. 274 289.
14. Dutch Cochrane Center. RCT-checklist of the Dutch Cochrane Center. Available at : (accessed 12 October 2008).
15. Esposito, M., Coulthard, P., Worthington, H. V. Jokstad, A. (2001) Quality assessment of randomized controlled trials of oral implants. The International Journal of Oral & Maxillofacial Implants 16, 783 792.
16. FDA (U.S. Food and Drugs Administation) 2008) Department of Health & Human Services Available at : (accessed 9 may 2010).
17. Feres, M., Gursky, L. C., Faveri, M., Tsuzuki, C. O. Figueiredo, L. C. (2009) Clinical and microbiological benefits of strict supragingival plaque control as part of the active phase of periodontal therapy. Journal of Clinical Periodontology 36, 857 867.
18. Flötra, L., Gjermo, P., Rölla, G. Waerhaug, J. (1971) Side effects of chlorhexidine mouthwashes. Scandinavian Journal of Dental Research 79, 119 125.
19. Francetti, L., Del Frabbo, M., Basso, M., Testori, T., Taschieri, S. Weinstein, R. (2004) Chlorhexidine spray versus mouthwash in the control of dental plaque after implant surgery. Journal of Clinical Periodontology 31, 857 862.
20. Francis, J. R., Hunter, B. Addy, M. (1987) A comparison of three delivery methods of chlorhexidine in handicapped children (I). Effects on plaque, gingivitis and tooth staining. Journal of Periodontology 58, 451 454.
21. Gjermo, P. (1977) Hibitane in periodontal disease. Journal of Clinical Periodontology 4, 94 101.
22. Gjermo, P. (1989) Chlorhexidine and related substances. Journal of Dental Research 68, 1602 1608.
23. Haps, S., Slot, D. E., Berchier, C. E. Van der Weijden, G. A. (2008) The effect of cetylpyridinium chloride-containing mouth rinses as adjuncts to toothbrushing on plaque and parameters of gingival inflammation: a systematic review. International Journal of Dental Hygiene 6, 290 303.
24. Harper, P. R., Milson, S., Wade, W., Addy, M., Moran, J. Newcombe, R. G. (1995) An approach to efficacy screening of mouthrinses: studies on a group of French products (II). Inhibition of salivary bacteria and plaque in vivo. Journal of Clinical Periodontology 22, 723 727.
25. Hase, J. C., Attstrom, R., Edwardsson, S., Kelty, E. Kisch, J. (1998) 6- month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo. (I). Effect on plaque formation and gingivitis. Journal of Clinical Periodontology 25, 746 753. (Pubitemid 128705904)
26. Higgins, J. P. T., Green, S. (eds) (2009) Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration. Available at : (accessed 9 may 2010).
27. Hull, P. S. (1980) Chemical inhibition of plaque. Journal of Clinical Periodontology 7, 431 442.
28. Jenkins, S., Addy, M. Newcombe, R. G. (1994) Dose response of chlorhexidine against plaque and comparison with triclosan. Journal of Clinical Periodontology 21, 250 255.
29. Jenkins, W. M. M. (1996) The prevention and control of chronic periodontal disease. In : Murray, J. J. (ed). Prevention of Oral Disease, 3rd ed, pp. 129 133.
30. Kalaga, A., Addy, M. Hunter, B. (1989) The use of 0.2% chlorhexidine as an adjunct to oral health in physically and mentally handicapped adults. Journal of Periodontology 60, 381 385.
31. Keijser, J. A., Verkade, H., Timmerman, M. F. Van der Weijden, G. A. (2003) Comparison of 2 commercially available chlorhexidine mouthrinses. Journal of Periodontology 74, 214 218.
32. Kornman, K. S. (1986a) The role of supragingival plaque in the prevention and treatment of periodontal diseases. A review of current concepts. Journal of Periodontal Research 21, 5 22.
33. Kornman, K. S. (1986b) Antimicrobial agents. Dental Plaque Control Measures and oral Hygiene Practices, pp. 121 142.
34. Laher, A. Cleaton-Jones, P. E. (1996) Chlorhexidine rinsing in physically handicapped pupils in Kathehong. The Journal of the Dental Association of South Africa 51, 343 346.
35. Lang, N. P. Brecx, M. C. (1986) Chlorhexidine digluconate. An agent for chemical plaque control and prevention of gingival inflammation. Journal of Periodontal Research 21 (Suppl. 16), 74 89.
36. Lang, N. P., Wilson, T. G. Corbet, E. F. (2000) Biological complications with dental implants: their prevention, diagnosis and treatment. Clinical Oral Implants Research 11, 146 155.
37. Lie, M. A., van der Weijden, G. A., Timmerman, M. F., Loos, B. G., van Steenbergen, T. J. van der Velden, U. (1998) Oral microbiota in smokers and non-smokers in natural and experimentally-induced gingivitis. Journal of Clinical Periodontology 25, 677 686.
38. Lobene, R. R., Soparkar, P. M. Newman, M. B. (1982) Use of dental floss. Effect on plaque and gingivitis. Clinical Preventive Dentistry 4, 5 8.
39. Löe, H. (1967) The gingival index, the plaque index and the retention index systems. Journal of Periodontology 38, 38 44.
40. Löe, H. Schiott, C. R. (1970) The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. Journal of Periodontal Research 5, 79 83.
41. Mandel, I. D. (1988) Chemotherapeutic agents for controlling plaque and gingivitis. Journal of Clinical Periodontology 15, 488 498.
42. Mendieta, C., Vallcorba, N., Binney, A. Addy, M. (1994) Comparison of 2 chlorhexidine mouthwashes on plaque regrowth in vivo and dietary staining in vitro. Journal of Clinical Periodontology 21, 296 300.
43. Moher, D., Schulz, K. F. Altman, D. (2001a) CONSORT GROUP (Consolidated Standards ofReporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Journal American Medical Association 285, 1987 1991.
44. Moher, D., Schulz, K. F. Altman, D. G. (2001b) CONSORT GROUP (ConsolidatedStandards of Reporting Trials). The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Annals Internal Medicine 134, 657 662.
45. Moher, D., Schulz, K. F. Altman, D. G. (2001c) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357, 1191 1194. (Pubitemid 32378696)
46. Moher, D., Schulz, K. F. Altman, D. G. (2001d) CONSORT. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Medical Research Methodology 1, Epub.
47. Mühlemann, H. R. Son, S. (1971) Gingival sulcus bleeding - a leading symptom in initial gingivitis. Helvetica Odontolologica Acta 15, 107 113.
48. Needleman, I., Moles, D. R., Worthington, H. (2005) Evidence-based periodontology, systematic reviews and research quality. Periodontology 2000 37, 12 28.
49. Neto, C. A. F., Parolo, C. C. F., Rösing, C. K. Maltz, M. (2008) Comparative analysis of the effect of two chlorhexidine mouthrinses on plaque accumulation and gingival bleeding. Brazilian Oral Research 22, 139 144.
50. Persson, R. E., Truelove, E. L., LeResche, L. Robinovitch, M. R. (1991) Therapeutic effects of daily or weekly chlorhexidine rinsing on oral health of a geriatric population. Oral Surgery Oral Medicine Oral Pathology 72, 184 191.
51. Pizzo, G., Guiglia, R., Imburgia, M., Pizzo, I., D'Angelo, M. Giuliana, G. (2006) The effects of antimicrobial sprays and mouthrinses on supragingival plaque regrowth: a comparative study. Journal of Periodontology 77, 248 256.
52. Quigley, G. A. Hein, J. W. (1962) Comparative cleansing efficiency of manual and powerbrushing. Journal American Dental Association 65, 26 29.
53. Quirynen, M., Avontroodt, P., Peeters, W., Pauwels, M., Coucke, W. van Steenberghe, D. (2001) Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation. Journal of Clinical Periodontology 28, 1127 1136.
54. Quirynen, M., De Soete, M. van Steenberghe, D. (2002) Infectious risk for oral implants: a review of the literature. Clinical Oral Implants Research 13, 1 19. (Pubitemid 41719934)
55. RCT-checklist of the Dutch Cochrane Center [WWW document]. Available at : (assessed 9 July 2009)
56. De la Rosa, M. Sturzenberger, O. P. (1976) Clinical reduction of gingivitis through the use of a mouthwash containing two quarternary ammonium compounds. Journal of Periodontology 47, 535 537.
57. Sanz, M. Herrera, D. (1998) Role of oral hygiene during the healing phase of periodontal therapy. In : Lang, N. P., Attström, R. Löe, H. (eds). Proceedings of the European Workshop on Mechanical Plaque Control, pp. 248 267.
58. Saxer, U. P. Mühlemann, H. R. (1975) Motivation und Auklarung. Schweizerische Monatsschrift fur Zahnheilkunde 85, 905 919.
59. Segreto, V. A., Collins, E. M., Beiswanger, B. B., De La Rosa, M., Isaacs, R. L., Lang, N. P., Mallat, M. E. Meckel, A. H. (1986) A comparison of mouthrinses containing two concentrations of chlorhexidine. Journal of Periodontal Research 21 (Suppl. 16), 23 32.
60. Sheen, S. Addy, M. (2003) An in vitro evaluation of the availability of cetylpyridinium chloride and chlorhexidine in some commercially available mouthrinse products. British Dental Journal 194, 207 210.
61. Silness, J. Löe, H. (1964) Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontologica Scandinavica 22, 121 135.
62. Smith, R. G., Moran, J., Addy, M., Doherty, F. Newcombe, R. G. (1995) Comparative staining in vitro and plaque inhibitory properties in vivo of 0.12% and 0.20% chlorhexidine mouthrinses. Journal of Clinical Periodontology 22, 613 617.
63. Swallow, J. N., Davies, D. E. Hawkins, S. D. (1969) Gingival disease prevalence in mentally handicapped adults. The effects of an oral hygiene programme. British Dental Journal 127, 376 379.
64. Turesky, S., Gilmore, N. D. Glickman, I. (1970) Reduced plaque formation by the chloromethyl analogue of victamine C. Journal of Periodontology 41, 41 43.
65. Van der Weijden, G. A., Timmerman, M. F., Nijboer, A., Reijerse, E. Van der Velden, U. (1994) Comparison of different approaches to assess bleeding on probing as indicators of gingivitis. Journal of Clinical Periodontology 21, 589 594.
66. Van der Weijden, G. A., Timmerman, M. F., Novotny, A. G. A., Rosema, N. A. M. Verkerk, A. A. J. (2005) Three different rinsing times and inhibition of plaque accumulation with chlorhexidine. Journal of Clinical Periodontology 32, 89 92.
67. Van Steenberghe, D., Avontroodt, P., Peeters, W., Pauwels, M., Coucke, W., Lijnen, A. Quirynen, M. (2001) Effect of different mouthrinses on morning breath. Journal of Periodontology 72, 1183 1191.
68. Van Strydonck, D. A., Timmerman, M. F., Van der Velden, U. Van der Weijden, G. A. (2005) Plaque inhibition of two commercially available chlorhexidine mouthrinses. Journal of Clinical Periodontology 32, 305 309.
69. Verhagen, A. P., de Vet, H. C., de Bie, R. A., Kessels, A. G., Boers, M., Bouter, L. M. Knipschild, P. G. (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Journal of Clinical Epidemiology 51, 1235 1241.