We included 51 studies that analysed a total of 5345 participants. In addition, other adverse effects such as calculus build up, transient taste disturbance and effects on the oral mucosa were reported in the included studies. Rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining. There is insufficient evidence to determine the reduction in gingivitis associated with chlorhexidine mouthrinse use in individuals with mean GI scores of 1.1 to 3 indicating moderate or severe levels of gingival inflammation. There is no evidence that one concentration of chlorhexidine rinse is more effective than another. There is high-quality evidence of a large reduction in dental plaque with chlorhexidine mouthrinse used as an adjunct to mechanical oral hygiene procedures for 4 to 6 weeks and 6 months. There is high-quality evidence from studies that reported the Löe and Silness Gingival Index of a reduction in gingivitis in individuals with mild gingival inflammation on average (mean score of 1 on the 0 to 3 GI scale) that was not considered to be clinically relevant. One study was assessed as being at unclear risk of bias, with the remaining 50 being at high risk of bias, however this did not affect the quality assessments for gingivitis and plaque as we believe that further research is very unlikely to change our confidence in the estimate of effect. Other side effects have been reported, including build-up of calculus (tartar), temporary taste disturbance and temporary shedding of/damage to the lining of the mouth. Rinsing for 4 weeks or longer causes tooth staining, which requires scaling and polishing carried out by a dental professional. There was no evidence that one concentration or strength of chlorhexidine rinse was more effective than another. The nature of the available evidence does not allow us to determine the level of reduction of gingivitis in people with moderate to severe levels of it. There is also high-quality evidence of a moderate reduction in gingivitis in people with a mild level of it, although because the level of disease was already low this is not considered clinically important. There is high-quality evidence that the use of mouthrinses containing chlorhexidine in addition to usual toothbrushing and cleaning for 4 to 6 weeks or 6 months leads to a large reduction in the build-up of plaque.
The included studies assessed the effects of chlorhexidine mouthrinse used for at least 4 weeks in addition to conventional tooth cleaning on gingivitis in children and adults. We did not exclude studies where some or all participants had medical conditions or special care needs as we considered the use of mouthrinses with chlorhexidine to be particularly relevant to them. Generally study participants were children and adults who had gingivitis or periodontitis, were able to use usual tooth cleaning methods and were healthy. The evidence in this review is up to date as of 28 September 2016. These mouthrinses are readily available over the counter prescriptions generally not being required outside the USA. Therefore people sometimes use mouthrinses containing chlorhexidine in addition to conventional tooth cleaning. Some people have difficulty controlling plaque build-up and preventing gingivitis using only conventional tooth cleaning. Other cleaning methods commonly used include dental floss, interdental brushes and scaling and polishing carried out by a dental professional. Toothbrushing is the main method for maintaining good oral hygiene. It is recognised that maintaining a high standard of oral hygiene is important for the prevention and treatment of gingivitis. Severe periodontitis is the sixth most widespread disease globally. If untreated it may eventually lead to tooth loss. In periodontitis inflammation is accompanied by loss of ligaments and bone supporting the teeth.
In susceptible people gingivitis may lead to periodontitis, which is not reversible. Gingivitis is also very common - studies suggest that as many as 50% to 90% of adults in the UK and USA suffer from it. Gingivitis is a reversible condition when gums become red, swollen and can bleed easily. Does the use of chlorhexidine mouthrinse (a broad spectrum antiseptic) in addition to other conventional tooth cleaning help to control and improve gingivitis (inflammation of the gums)? Does the frequency of rinsing or the concentration of the solution affect the result and are there any undesirable side effects?
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