Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Beáta Kerémi; Katalin Márta; Kornélia Farkas; László M Czumbel; Barbara Tóth; Zsolt Szakács; Dezső Csupor; József Czimmer; Zoltán Rumbus; Péter Révész; Adrienn Németh; Gábor Gerber; Péter Hegyi; Gábor Varga

doi:10.2174/1381612826666200515134450

Effects of Chlorine Dioxide on Oral Hygiene - A Systematic Review and Meta-analysis

Curr Pharm Des. 2020;26(25):3015-3025. doi: 10.2174/1381612826666200515134450.

Authors

Beáta Kerémi¹, Katalin Márta², Kornélia Farkas^{2

3}, László M Czumbel¹, Barbara Tóth⁴, Zsolt Szakács², Dezső Csupor⁴, József Czimmer⁵, Zoltán Rumbus², Péter Révész⁶, Adrienn Németh⁶, Gábor Gerber⁷, Péter Hegyi^{2

8}, Gábor Varga¹

Affiliations

¹ Department of Oral Biology, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
² Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
³ Institute of Bioanalysis, Medical School, University of Pecs, Pecs, Hungary
⁴ Department of Pharmacognosy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
⁵ Division of Gastroenterology, First Department of Medicine, Medical School, University of Pecs, Pecs, Hungary
⁶ Department of Otorhinolaryngology (ENT), Medical School, University of Pecs, Pecs, Hungary
⁷ Department of Anatomy, Histology and Embryology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
⁸ Szentágothai Research Centre, University of Pecs, Pecs, Hungary

Abstract

Background: Effective and selective oral rinses are required in the daily medical and dental practice. Currently mouthwashes used have substantial side effects.

Objectives: Our aim was to evaluate the efficacy of chlorine dioxide-containing mouthwashes in comparison with other previously established mouth rinses in healthy adults using oral hygiene indices.

Methods: This work was registered in PROSPERO (CRD42018099059) and carried out using multiple databases and reported according to the PRISMA statement. The search terms used were "chlorine dioxide" AND "oral", and only randomised controlled trials (RCTs) were included. The primary outcome was the alteration of the plaque index (PI), while the secondary outcomes were the gingival index (GI) and bacterial counts. For the risk of bias assessment, the Cochrane Risk of Bias Tool was used. Statistical analysis for data heterogeneity was performed by Q-value and I2-tests.

Results: 364 articles were found in the databases. After the selection process, only five RCTs were eligible for meta-analysis. Data heterogeneity was low. There were no statistical differences in effectiveness between chlorine dioxide and other effective mouth rinses in PI (0.720±0.119 vs 0.745±0.131; 95%; confidence intervals (CIs): 0.487-0.952 vs 0.489-1.001, respectively) and GI (0.712±0.130 vs 0.745±0.131; 95% CIs: 0.457-0.967 vs 0.489- 1.001, respectively) and also in bacterial counts.

Conclusion: Chlorine dioxide reduces both plaque and gingival indices and bacterial counts in the oral cavity similar to other routinely used oral rinses, however, the evidence supporting this outcome is very limited. Therefore, further large scale RCTs are needed to decrease the risk of bias.

Keywords: Chlorine dioxide; gingival index; meta-analysis; mouthwash; oral hygiene; plaque index; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Chlorine Compounds* / pharmacology
Humans
Mouthwashes / pharmacology
Oral Hygiene*
Oxides / pharmacology

Substances

Chlorine Compounds
Mouthwashes
Oxides
chlorine dioxide

Grants and funding

The study was funded by the Hungarian Human Resources Development Operational Program (EFOP-3.6.2-16-2017-00006 and EFOP-3.6.3-VEKOP-16-2017-00009), an Economic Development and Innovation Operative Program Grant (GINOP 2.3.2-15- 2016-00048) and an Institutional Developments for Enhancing Intelligent Specialization Grant (EFOP-3.6.1-16-2016-00022) of the National Research, Development and Innovation Office. Additional support was received by the Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapy thematic program of the Semmelweis University, Hungary.