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No benefits important to patients from the use of chlorhexidine rinse as an adjunct to scaling and root planing in patients with chronic periodontitis
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
NO BENEFITS IMPORTANT TO PATIENTS FROM THE USE OF CHLORHEXIDINE RINSE AS AN ADJUNCT TO SCALING AND ROOT PLANING IN PATIENTS WITH CHRONIC PERIODONTITIS
da Costa LFNP, Amaral CDSF, Barbirato DDS, Leão ATT, Fogacci MF. Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: a meta-analysis. JADA. 2017;148(5):308-318. http:// dx.doi.org/10.1016/j.adaj.2017.01.021. Key words. Periodontology; adjunct treatment; chlorhexidine; chronic periodontitis; scaling and root planing; systematic review. Clinical relevance. Chlorhexidine (CHX) rinse is often used by patients with periodontal disease. Its use as an adjunct therapy to scaling and root planing (SRP) in patients with chronic periodontitis (CP), however, should be supported by evidence showing that it improves clinical outcomes. Study summary. The authors conducted a systematic review (SR) to assess the effects of CHX as an adjunct to SRP in patients with CP. They searched 4 electronic databases through September 2016 for randomized clinical trials that assessed the effects of CHX rinse as an adjunct to SRP on probing depth (PD) and clinical attachment level (CAL) in participants with CP. The authors included 8 randomized clinical trials* that enrolled a total of 331 participants who had used CHX from 14 to 180 days and been followed for up to 8 months. Meta-analyses showed that participants who used CHX had a PD reduction that was 0.33 millimeters highery and 0.24 mm higherz than that of participants who did not use CHX at 40 to 60 days and at 180 days,
respectively. There were no differences in PD at 90 days or in CAL at any of the follow-up points. Strengths and limitations. The authors of this SR seem to have used appropriate methods to search, select, appraise, and synthesize the evidence. According to the authors’ assessments, 3 of the 8 included studies had a high risk of bias. These studies, however, did not seem to show different results than those that were judged to have low risk of bias, and thus it is unlikely that the results of this SR were biased. The results were consistent across trials. Also, although some of the estimates from the meta-analyses are statistically significant and others are not, the message is consistent across outcomes and time points; there is either no effect or a very small benefit that is unlikely to be important to patients as a result of using CHX rinse as an adjunct to SPR. The authors of this SR did not describe whether participants had reported any adverse effects from using CHX, which limits the usefulness of the results in making clinical decisions. Also, since the authors restricted the eligibility of the study to participants who did not use any other antimicrobial, chemical methods for plaque control or systemic conditions that could interact with CP,§ these results are applicable only to patients who meet these criteria. Thus, this evidence shows no important benefits from using CHX as an adjunct to SRP in patients with CP. n http://dx.doi.org/10.1016/j.adaj.2017.08.014 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 3 randomized clinical trials used a 24-hour full-mount disinfection scaling and root planing protocol (90 participants), and 5 used a 4- to 6-visit protocol (241 participants). y Mean difference, 0.33 millimeters; 95% confidence interval, 0.08 mm to 0.58 mm (n ¼ 2 studies). z Mean difference, 0.24 mm; 95% confidence interval, 0.02 mm to 0.47 mm (n ¼ 3 studies). § The authors did not specify which ones these were.
JADA
( )
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http://jada.ada.org
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2017 e1
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
NO BENEFITS IMPORTANT TO PATIENTS FROM THE USE OF CHLORHEXIDINE RINSE AS AN ADJUNCT TO SCALING AND ROOT PLANING IN PATIENTS WITH CHRONIC PERIODONTITIS
da Costa LFNP, Amaral CDSF, Barbirato DDS, Leão ATT, Fogacci MF. Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: a meta-analysis. JADA. 2017;148(5):308-318. http:// dx.doi.org/10.1016/j.adaj.2017.01.021. Key words. Periodontology; adjunct treatment; chlorhexidine; chronic periodontitis; scaling and root planing; systematic review. Clinical relevance. Chlorhexidine (CHX) rinse is often used by patients with periodontal disease. Its use as an adjunct therapy to scaling and root planing (SRP) in patients with chronic periodontitis (CP), however, should be supported by evidence showing that it improves clinical outcomes. Study summary. The authors conducted a systematic review (SR) to assess the effects of CHX as an adjunct to SRP in patients with CP. They searched 4 electronic databases through September 2016 for randomized clinical trials that assessed the effects of CHX rinse as an adjunct to SRP on probing depth (PD) and clinical attachment level (CAL) in participants with CP. The authors included 8 randomized clinical trials* that enrolled a total of 331 participants who had used CHX from 14 to 180 days and been followed for up to 8 months. Meta-analyses showed that participants who used CHX had a PD reduction that was 0.33 millimeters highery and 0.24 mm higherz than that of participants who did not use CHX at 40 to 60 days and at 180 days,
respectively. There were no differences in PD at 90 days or in CAL at any of the follow-up points. Strengths and limitations. The authors of this SR seem to have used appropriate methods to search, select, appraise, and synthesize the evidence. According to the authors’ assessments, 3 of the 8 included studies had a high risk of bias. These studies, however, did not seem to show different results than those that were judged to have low risk of bias, and thus it is unlikely that the results of this SR were biased. The results were consistent across trials. Also, although some of the estimates from the meta-analyses are statistically significant and others are not, the message is consistent across outcomes and time points; there is either no effect or a very small benefit that is unlikely to be important to patients as a result of using CHX rinse as an adjunct to SPR. The authors of this SR did not describe whether participants had reported any adverse effects from using CHX, which limits the usefulness of the results in making clinical decisions. Also, since the authors restricted the eligibility of the study to participants who did not use any other antimicrobial, chemical methods for plaque control or systemic conditions that could interact with CP,§ these results are applicable only to patients who meet these criteria. Thus, this evidence shows no important benefits from using CHX as an adjunct to SRP in patients with CP. n http://dx.doi.org/10.1016/j.adaj.2017.08.014 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 3 randomized clinical trials used a 24-hour full-mount disinfection scaling and root planing protocol (90 participants), and 5 used a 4- to 6-visit protocol (241 participants). y Mean difference, 0.33 millimeters; 95% confidence interval, 0.08 mm to 0.58 mm (n ¼ 2 studies). z Mean difference, 0.24 mm; 95% confidence interval, 0.02 mm to 0.47 mm (n ¼ 3 studies). § The authors did not specify which ones these were.
JADA
( )
- -
http://jada.ada.org
-
2017 e1