This systematic review assessed the efficacy of chlorhexidine for the prevention of alveolar osteitis and occurrence of adverse reactions. Databases were searched until 20 April 2011. Trial inclusion criteria were: titles/abstracts relevant to topic; prospective 2-arm (or more) clinical study design. Trial exclusion criteria were: not all entered subjects accounted for; subjects of both groups not followed up the same way; lack of computable data; chlorhexidine not the primary test agent; duplication of data; outcome of interest other than incidence of alveolar osteitis. Individual datasets were extracted from accepted articles. Bias risk in trials was assessed. 10 of 13 included trials were accepted. From these, 16 dichotomous datasets were extracted. Two of six application protocols favoured chlorhexidine over placebo: Single application of 0.2% chlorhexidine gel placed in the socket immediately after extraction versus placebo gel (RR 0.40; 95% CI: 0.18-0.90; p=0.03) and 0.12% chlorhexidine rinse applied on day of surgery and used twice daily for 7 days postoperatively versus placebo rinse (RR 0.50; 95% CI: 0.27-0.93; p=0.03). These results are negated due to high bias risk. Chlorhexidine did not cause higher adverse reactions than placebo. Further high-quality randomised control trials are needed.
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