Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial

Abstract

ObjectiveTo determine the effectiveness of chlorhexidine 0.12% mouthwash (CHX) after tooth extraction for the prevention of alveolar osteitis (AO).Material and methodsWe conducted a double-blind randomised clinical trial stratified by risk factors. We enrolled a cohort of 822 patients who underwent dental extractions, and were considered to be at risk of developing AO (previous surgical site infection, traumatic extraction, and tobacco smoking). After extraction, patients were randomly allocated for CHX group or placebo group, matched by risk factors. The primary outcome was clinical diagnosis of AO: increasing postoperative pain for 4 d within and around the socket, and total or partial breakdown of the blood clot in the socket with or without bone exposure.ResultsFollow-up was completed by 744 participants (372 chlorhexidine and 372 placebo). We detected no significant differences between the two groups at baseline. After completed follow-up, risk factors were equally distributed between the two groups. Overall incidence of OA was 4.97%, in which 27 participants treated with placebo (7.26%) and 10 participants treated with CHX (2.69%) developed AO. CHX reduced the incidence of AO by 63% [Absolute Risk Reduction: 4.57 (95% CI 1.5-7.7), Number Needed to Treat: 21.88 (95% CI 13.0-69.3), Fisher's exact test: p=0.006]. No adverse effects were reported.ConclusionThe use of chlorhexidine 0.12% mouthwash after tooth extraction is safe and effective in reducing the incidence of AO in high-risk patients.

Modifications of emergency dental clinic protocols to combat COVID‐19 transmission

“…All patients receiving treatment rinsed for 30 seconds with 0.12% chlorhexidine (CHX) and 30 seconds with 1.5% hydrogen peroxide solution. Preoperative rinses with CHX demonstrate a significant reduction in colony forming units and postoperative infections 35‐37 . Other literature indicates that SARS‐CoV‐2 may be more vulnerable to oxidative destruction 22,38 .…”

Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: a randomized controlled clinical study

“…Clinical data was collected with regard to AO formation on the 3rd and 7th days after surgery. Symptoms of this postoperative complication were evaluated with the following characteristics: (1) postoperative pain with increasing severity 2 to 3 days in, and around the extraction site; (2) partial or total loss of blood clot and exposure of the alveolar bone with or without halitosis [30,31]. Other defining symptoms such as radiating pain towards the temporal region and ear, inflamed gingival margin, ipsilateral regional lymphadenopathy and, less commonly, low-grade fever, were also noted [13,31,32].…”

“…Sample size was calculated with PASS 2000 software [33]. An incidence of 10% in the CGF group and 30% in the control group was estimated to detect a difference (P0 -P1) with the binomial hypothesis test [31,34]. This showed that 57 subjects would be sufficient to obtain 96% power in detecting a statistical difference between the test and control groups, with a target significance level of 0.05.…”

Alveolar Osteitis Following Tooth Extraction: Systematic Review and Google Trends Analysis Instigated by the First Upper Premolar Case Reported from Iraq

“…Several measures are used to reduce the incidence of AO including warm saline mouth rinse, the use of prophylactic antibiotics, chlorhexidine mouthwash, and platelet-rich fibrin (Eshghpour, Dastmalchi, Nekooei, & Nejat, 2014;Osunde, 2015;Xue et al, 2015;Halabi, Escobar, Alvarado, Martinez, & Muñoz, 2018;Unsal & Erbasar, 2018). However, Xue and co-authors confirmed that Prophylactic amoxicillin (or clindamycin) is not effective for the prevention or reduction of postoperative inflammatory complications after the removal of impacted mandibular third molars in the Chinese population (Xue et al, 2015).…”

“…On the other hand, Tek and co-workers found that Ankaferd Blood Stopper (ABS) can be used safely for haemostasis following an impacted mandibular third molar surgery without potentially increasing the risk of AO formation (Tek et al, 2014). Very recently, Halabi and others, verified that 0.12% chlorhexidine mouthwash is safe and effective in reducing the incidence of AO in high-risk patients (Halabi et al, 2018). Unsal and colleagues as well as Eshghpour and co-workers verified in their experimental clinical trials that platelet-rich fibrin (PRF) significantly reduced the AO incidence, especially following mandibular third molar surgery, among smokers, and it also had a positive effect on postoperative pain levels although it did not affect periodontal healing (Eshghpour & Dastmalchi, 2014;Unsal & Erbasar, 2018).…”