Adverse events associated with home use of mouthrinses: a systematic review

Abstract

Background: Poor oral hygiene is strongly associated with oral and systemic diseases. Alongside mechanical tooth cleaning, the adjunctive use of mouthrinses has been widely advocated. Although research on the efficacy of various mouthrinse formulations is very active, there are a lack of conclusive data regarding their adverse effects. Methods: We undertook a systematic review in accordance wih PRISMA guidelines of electronic databases of clinical trials of any duration with daily home use of mouthwashes, presenting clinical and subjective side effects (PROSPERO registration: CRD42016054037). Results: After evaluating 614 titles and abstracts, 154 studies were selected for full-text analysis; 85 final papers were included. Based on the active ingredient in the test product, nine categories were created: cetyl pyridinium chloride, essential oils, chlorhexidine, triclosan, natural products, diclofenac, fluorides, delmopinol, and miscellaneous active substances. Most of the studies were of short duration (less than 6 months) with a defective ‘methods’ description; the reporting of adverse events often being overlooked. Both local morphological (oral mucosa and dental-crown staining, mucosal lesions) and functional (taste modifications, abnormal oral sensation) alterations were reported. Tooth staining was the most commonly listed adverse event, but it was quantitatively assessed only in a very small number of papers; most studies relied on patient reports. Staining was time associated; the longer the study, the higher its reported incidence and severity. Conclusions: The reduced report of side effects may partly be due to a lack of an objective measure and lack of general guidelines that demand studies report their adverse events. The most frequently reported adverse effect was teeth staining. As in most studies, the effect was associated with trial duration; clinical trials should be of sufficient duration. New investigations meeting the suggested criteria of a minimal duration of 6 months should be planned.

Current uses of chlorhexidine for management of oral disease: a narrative review

“…Despite anti-plaque properties, increased calculus formation has also been reported with 0.12% CHX mouthwash [ 22 ]. Other less common side effects include burning sensations (glossodynia), desquamation of the oral mucosa, swelling of the parotid gland and oral paraesthesia [ 23 ]. However the most unwanted outcome, that deters patients using of CHX mouthwash, is probably tooth staining [ 24 ].…”

Toxicological and genotoxic evaluation of anacardic acid loaded-zein nanoparticles in mice

“…Caries and periodontal disease can be prevented and controlled by mechanically removing the biofilm and using additional mouthwashes [ 1 ]. Chlorhexidine is currently considered the gold standard chemical antiplaque agent, although its prolonged use is associated to staining teeth and restorations, desquamation and pain in the mucosa, discoloration of the taste buds and taste changes [ 2 ] and the emergence of resistant species [ 3 ]. Therefore, medicinal plants and their phytochemicals are a potential source of therapeutic options for the treatment and prevention of biofilm- dependent oral diseases, considering several advantages, such as their biological properties, low cost and availability [ 4 ].…”

Effect of chlorhexidine on covid 19 virus

“…29 The other less common side effects include burning sensation, desquamation of the oral mucosa, swelling of the parotid gland and oral paraesthesia. 30 The reason for tooth staining after beyond the specified time period is due to nonenzymatic browning (Maillard reaction) and production of the pigmented metal sulphide formation in the pellicle. 31…”