The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta-analysis

Abstract

Background Mouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis in orthodontic patients. Methods By April 16, 2022, multiple databases and grey literature were searched based on the PICOS strategy. Randomized controlled trials in orthodontic patients evaluating the efficacy of mouthwashes with at least one microbial parameter and/or plaque- and/or gingival inflammation-related index were included. Relevant data were extracted, and the risk of bias was evaluated using Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwashes and placebos/blank controls were pooled to estimate the weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Sensitivity analysis, and certainty of evidence were evaluated. Results Of 1684 articles, 32 studies satisfied the eligibility criteria, and nine were included for meta-analysis. Missing outcome data was the primary source of bias. Compared to blank controls, the short-term application of fluoride mouthwashes significantly reduced the colony counts of Mutans streptococci (MS), while the long-term application may not be effective. Compared to placebos or blank controls, Chlorhexidine mouthwashes significantly reduced the colony counts of multiple microorganisms in the short-term. Compared to placebos or blank controls, herbal mouthwashes showed the inhibitory effect of MS in the short-term, with some results lacking statistical significance. After meta-analysis, significant lower plaque- and gingival inflammation-related indexes were observed in the Chlorhexidine mouthwashes groups [Gingival Index: WMD = -0.45, 95%CI = -0.70 to -0.20 (placebos as control); WMD = -0.54, 95%CI = -0.96 to -0.13 (blank controls); Plaque Index: WMD = -0.70, 95%CI = -1.12 to -0.27 (blank controls)]. Significant lower gingival inflammation-related indexes were observed in the herbal mouthwashes groups [Gingival Index: WMD = -0.20, 95%CI = -0.32 to -0.09 (blank controls)]. Conclusions The short-term application of fluoride mouthwashes may reduce the colony counts of cariogenic bacteria, but the long-term effect is not evident. Chlorhexidine may reduce the colony counts of multiple microorganisms in the short-term. Short-term application Chlorhexidine and herbal mouthwashes may effectively reduce plaque- and gingival inflammation-related indexes. However, the risk of bias, inconsistency, and imprecision in the included studies may reduce the certainty of the evidence.

Administration of Clinical COVID-19 Mouthwashing Protocol and Potential Modulation of Pediatric Oral Bacterial Prevalence of Selenomonas noxia: A Pilot Study

“…These concepts introduce variables that may be considered intrinsic limiting factors to the inferences that can be drawn from these observations. For example, this study was an observational retrospective analysis of saliva samples collected using the strict COVID-19 mouth washing protocol and did not use an experimental model to evaluate the potential effects of different active agents within the mouth washing agents such as chlorhexidine, povidone-iodine, and fluoride [ 43 , 44 ]. The incorporation of a prospective, experimental model in future studies evaluating these potential effects would help to determine what variables (including extended time of gargling or rinsing, frequency of protocol administration including daily or multiple times per day, or constituent active ingredients—or some combination thereof) may be the most effective at reducing or eliminating this organism from pediatric patients.…”

Higher Prevalence of the Periodontal Pathogen Selenomonas noxia among Pediatric and Adult Patients May Be Associated with Overweight and Obesity

“…Moreover, existing studies have outlined the well-documented associations between advancing age and the development of periodontal disease, which do not appear to be similar to the observations from this study and the distribution of Selenomonas within the study sample [ 29 , 30 ]. Although strong evidence demonstrates that the development of gingivitis and periodontal disease may be more common among adolescents and young adults undergoing orthodontic treatment, none of the subjects included in this study had fixed appliances or braces [ 31 , 32 , 33 ]. In addition, S. noxia was found in similar percentages in both pediatric and adult samples, which may suggest that the prevalence of this organism is related to factors other than those of the more traditional periodontal pathogens discussed above [ 34 , 35 ].…”

Clinical effect of chlorhexidine and sodium fluoride on corrosion behavior and surface topography of nitinol orthodontic archwires

“…In addition, antiseptics in the form of mouthwashes produced an antimicrobial effect by controlling plaque deposits, microbial reduction, gingival inflammation and healing stimulation, whereas those containing fluorides were highly effective as cariostatic agents [ 3 ]. Fluoride and antiseptic use resulted in some corrosion of dental alloys, as was mostly proved under in vitro conditions [ 4 ].…”