Following oral surgical procedures mechanical plaque control is often uncomfortable and not advisable. However, as plaque build-up can have a negative impact on wound healing antiseptic mouthwashes are often recommended although some studies find no benefit. Chlorhexidine (CHX) essential oils, cetylpyridinium chloride and herbal products have all been studied.
The aim of this review was to assess the effect of different mouthwashes on gingival healing used after oral surgery in adults.
Methods
A protocol was registered in the PROSPERO database and searches undertaken in the Medline/PubMed, Cochrane Library, Clinical Trials Registry, Embase, Latin American and Caribbean Health Sciences Literature (LILACS/BIREME), Web of Science, and Google Scholar databases. Randomised controlled trials (RCTs) in patients aged 16 and older comparing mouthwash against no mouthwash or placebo following any oral surgery procedure were considered. Two reviewers independently screened and selected studies extracted data and assessed risk of bias using the Cochrane RoB-2 tool. The primary outcome was wound healing. Because of a high degree of heterogeneity across the studies only a narrative summary was presented.
Results
- 13 studies involving a total of 539 patients were included.
- 12 different products and concentrations were tested (cetylpyridinium chloride , H2Ocean Sea Salt Oral Care , 0.5% Commiphora molmol (C. molmol) , alkyl dimethyl glycine/alkyl dimethyl amine oxide (C31G) with 6.4% alcohol, essential oils , 0.2% chlorhexidine with or without an anti-discoloration system (ADS), 0.2% hyaluronic acid + 0.2% chlorhexidine + ADS, 5% propolis in aqueous alcohol, 0.12% chlorhexidine with or without alcohol , 0.5% α-bisabolol, and 0.12% chlorhexidine + 0.5% α-bisabolol).
- Chlorhexidine used in different concentrations and combinations was the most frequent mouthwash studied (8 studies).
- 6 studies were considered to be at high risk of bias, 6 studies had some concerns and one study was at low risk of bias.
- 5 studies involving cetylpyridinium chloride, H2Ocean Sea Salt, 0.5% molmol, 5% propolis in aqueous alcohol, and essential oils reported statistically significant benefits for some wound healing criteria.
- 4 out of 5 studies evaluating gingival inflammation reported statistically significantly lower inflammation scores with chlorhexidine and essential oil rinses.
- The overall certainty of the evidence was rated as very low.
Conclusions
The authors concluded: –
The present systematic review demonstrated that some mouthwashes, such as chlorhexidine, cetylpyridinium chloride, H2Ocean Sea Salt, C. molmol 0.5%, and essential oils, led to improvements in the wound healing process after oral surgery. However, as most of the RCTs included in this review were associated with some concerns or high risk of bias, definitive conclusions are precluded. The development of Core Outcome Sets to define and classify gingiva tissue healing are needed, as well as studies that assess patient-centered outcomes.
Comments
The authors pre-registered their protocol and searched a good range of databases only including RCTs. While 13 trials were identified 12 of these used different products and or concentrations of agents and a variety of different surgical procedures were performed. A range of different outcomes and assessment systems were also employed. Consequently, no pooling of data was possible, and a narrative summary presented. Only one of the 13 included studies was considered to be at low risk of bias and the available evidence was considered to be of very low certainty. As the authors note agreement on core outcome sets (COMET) for gingival healing and patients related outcome measures would be helpful for future studies in this area which should be well conducted and reported, of appropriate size and reported in line with SPIRIT and CONSORT guidelines
Links
Primary Paper
Casarin M, de Matos RS, da Silva Nolasco W, Pirih FQ, Muniz FWMG. Effect of mouthwashes on gingival healing after surgical procedures: A systematic review. Eur J Oral Sci. 2023 Apr 17:e12931. doi: 10.1111/eos.12931. Epub ahead of print. PMID: 37069833.
Other references
Dental Elf – 15th Sep 2021
Alveolar osteitis: Are warm saline mouthwashes effective for prevention?
Dental Elf – 21st Nov 2022
