Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

Santos, Dayanne Simões Ferreira; Peralta-Mamani, Mariela; Brandão, Felipe Suaki; Andrade, Flaviana Bombarda de; Cruvinel, Thiago; Santos, Paulo Sérgio da Silva

doi:10.1590/1516-3180.2020.0776.r1.18052021

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…Moreover, patients did not experience side effects in the short term (2 weeks) and when using lower concentrations (0.1% chlorine dioxide). Similar results were found about the adverse effect of chlorine dioxide in another systematic review [ 59 ]. However, the experimental mouthwash’s overuse (with 24–48 h incubation time) can be cytotoxic or apoptotic on human cells [ 60 ].…”

Section: Discussionsupporting

confidence: 87%

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

et al. 2023

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Objectives We aimed to conduct a systematic review on published data in order to investigate the efficacy of mouthwash products containing chlorine dioxide in halitosis. Study design Systematic review and meta-analysis Methods Our search was conducted on 14th October 2021. We searched the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. We analysed data on adults with halitosis, included only randomised controlled trials and excluded in vitro and animal studies. The interventional groups used chlorine dioxide, and the comparator groups used a placebo or other mouthwash. Our primary outcomes were changes in organoleptic test scores (OLS) and Volatile Sulfur Compound (VSC) levels from baseline to the last available follow-up. Results We found 325 articles in databases. After the selection process, ten articles were eligible for qualitative synthesis, and 7 RCTs with 234 patients were involved in the meta-analysis. Our findings showed a significant improvement in the parameters of the chlorine dioxide group compared to the placebo group in OLS one-day data (mean difference (MD): -0.82; 95% confidence intervals (95% CIs): [-1.04 –-0.6]; heterogeneity: I2 = 0%, p = 0.67); and one-week OLS data (MD: -0.24; 95% CIs: [-0.41 –-0.07]; I2 = 0%, p = 0.52); and also changes in H2S one-day data (standardised mean difference (SMD): -1.81; 95% CIs: [-2.52 –-1.10]); I2 = 73.4%, p = 0.02). Conclusion Our data indicate that chlorine dioxide mouthwash may be a good supportive therapy in oral halitosis without known side effects.

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Section: Discussionsupporting

confidence: 87%

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

et al. 2023

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“…Some meta-analyses demonstrated the effects of mouthwashes including delmopinol [ 16 , 47 , 48 , 50 ], amine fluoride (AmF)/stannous fluoride (SnF) [ 16 , 31 , 50 ], alexidine [ 47 , 50 ], and triclosan [ 47 , 50 ]. The results were inconsistent, and their effects were not significantly different from those of placebo rinse, except for triclosan ( Table 2 and Table 3 ).…”

Section: Intended Effects Of Mouthwash On Biofilm Controlmentioning

confidence: 99%

“…However, the authors stated that the evidence supporting the outcome was very limited because of the varied study durations and designs. Santos et al used a systematic review to determine the antimicrobial effects of ClO 2 mouthwashes [ 31 ]. Five articles compared the efficacies of ClO 2 and CHG.…”

Section: Intended Effects Of Mouthwash On Biofilm Controlmentioning

confidence: 99%

“…The most widely investigated antimicrobial mouthwashes are those containing chlorhexidine gluconate (CHG) [ 23 , 24 , 25 ], essential oils (EOs) [ 23 , 24 , 25 , 26 ], and cetylpyridinium chloride (CPC) [ 27 ]. The efficacies of mouthwashes containing povidone-iodine [ 28 ], delmopinol [ 29 ], hexetidine [ 30 ], polyhexanide [ 31 ], chlorine dioxide [ 31 ], sodium hypochlorite [ 32 ], chlorine dioxide [ 33 ], natural compounds [ 34 ], and hydrogen peroxide [ 35 ] have also been reported. Most mouthwashes reduce biofilm accumulation and gingival inflammation; however, the strength of the evidence supporting their effects varies.…”

Section: Introductionmentioning

confidence: 99%

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Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects

et al. 2022

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Antimicrobial mouthwash improves supragingival biofilm control when used in conjunction with mechanical removal as part of an oral hygiene routine. Mouthwash is intended to suppress bacterial adhesion during biofilm formation processes and is not aimed at mature biofilms. The most common evidence-based effects of mouthwash on the subgingival biofilm include the inhibition of biofilm accumulation and its anti-gingivitis property, followed by its cariostatic activities. There has been no significant change in the strength of the evidence over the last decade. A strategy for biofilm control that relies on the elimination of bacteria may cause a variety of side effects. The exposure of mature oral biofilms to mouthwash is associated with several possible adverse reactions, such as the emergence of resistant strains, the effects of the residual structure, enhanced pathogenicity following retarded penetration, and ecological changes to the microbiota. These concerns require further elucidation. This review aims to reconfirm the intended effects of mouthwash on oral biofilm control by summarizing systematic reviews from the last decade and to discuss the limitations of mouthwash and potential adverse reactions to its use. In the future, the strategy for oral biofilm control may shift to reducing the biofilm by detaching it or modulating its quality, rather than eliminating it, to preserve the benefits of the normal resident oral microflora.

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“…89 Additional evidence that the use of chlorine dioxide oral rinses, available OTC in most drug stores or supermarkets with other oral care products reduces oral biofilm intraorally and rinsing removable prosthetics (dentures) in this eliminates biofilm-decreasing aspiration potential. [90][91][92] Placing all elderly patients on chlorhexidine or chlorine dioxide daily rinses as a preventive measure should be recommended to aid in preventing aspiration pneumonia. This should be a more predictable approach in elderly patients who lack manual dexterity to perform oral homecare with a toothbrush.…”

Section: Pulmonary Diseasementioning

confidence: 99%

Oral Biofilms and their Connection to Systemic Health

Kurtzman¹,

Horowitz

Johnson³

et al. 2022

MRAJ

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Systemic and oral health are interconnected via bacteria and their byproducts which can circulate throughout the body which are found in the oral biofilm. Oral biofilm and its associated periodontal health have not been frequently addressed in patients with systemic health issues. This is especially true for those patients who do not respond to medical treatment via their physician for systemic issues. The periodontal sulcus in the absence of clinical presence of periodontal disease (bleeding on probing, gingival inflammation) may have oral biofilm present. Periodontal reaction is dependent on the patient’s immune response to the associated bacteria and their byproducts present in the oral biofilm. Increasing evidence has emerged in recent years that are connecting oral biofilms with systemic conditions, either by initiating them or by complicating those medical conditions. Patient health needs to be considered as a whole-body system with connections that may originate in the oral cavity and have distant effects throughout the body. In order to maximize the patient’s total health, healthcare needs to be a coordination between the physician and dentist to eliminate the oral biofilm and aid in the prevention of systemic disease or minimize these effects to improve the overall patient health and their quality of life. Various systemic health areas have been associated with the bacteria in oral biofilms and their byproducts. Those include cardiovascular disease, chronic kidney disease, diabetes, pulmonary disease, prostate cancer, colon cancer, pancreatic cancer, pre-term pregnancy, erectile dysfunction, Alzheimer’s disease, and rheumatoid arthritis. This article will discuss oral biofilm, its systemic effects, and review the medical conditions associated with the oral systemic connection with an extensive review of the literature to aid in demonstrating the total body connection.

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Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

Cited by 5 publications

References 32 publications

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects

Oral Biofilms and their Connection to Systemic Health

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