The Efficacy Of Intra-alveolar 0.2% Chlorhexidine Gel On Alveolar Osteitis: A Meta Analysis

Background: Alveolar osteitis is a relatively common complication after dental extractions.Especially the incidence was reported up to 37.5% following mandibular third molar extractions.Researchers are focusing on local as well as systematic administration routes preventing alveolar osteitis to reduce the pain and trouble of patients.Chlorhexidine is a broad spectrum antibiotic which is active against Gram-positive and Gram-negative bacteria,yeasts and viruses.It is also one of the most commonly used antiseptic agents for skin and mucous membranes disinfection.In dentistry,it is used as mouth rinses,oral irrigations and slow release devices.CHX is used as an adjunct to scaling and root planing procedures,which is helpful in gingivitis and periodontitis,also for prevention of dental caries.There are more and more researches on chlorhexidine preventing dry socket in recent years,but the results between studies are contradictory.It is imperative to make a systematic review on these related studies,so as to make better guidance for clinical medication.Objective: The objective of this meta-analysis was to assess the effect of 0.2% chlorhexidine gel in preventing alveolar osteitis following mandibular third molar extraction(s).Methods: We serched database PubMed,Cochrane Library,Embase,Web of Science,Science Direct to find the published randomized clinical trials about preventing alveolar osteitis by chlorhexidine gel.The references of identified articles were also searched for relevant studies that met our eligibility criteria.The last search updated on 23 April,2016.The search strategy combined key words with free-text words,and the main search terms used were ‘dry socket',‘mandibular third molar' and ‘chlorhexidine'.We include researches according to inclusion and exclusion criteria.Then extract the basic information,intervention arrangements and the alveolar osteitis incidence of the research objects,and quality assessment were followed.Treatment effects were combined by meta-analysis using RevMan 5.3 and Stata 12.0 software.Results: We included 11 trials in this meta-analysis.Compared to the control,0.2% chlorhexidine gel reduced the risk of alveolar osteitis by 62%(RR = 0.38,95% CI = 0.28-0.53,P < 0.00001)following mandibular third molar extraction(s).The subgroup analysis results indicated that 0.2% chlorhexidine gel reduced the risk of alveolar osteitis after mandibular third molar extraction(s)by 75%(RR = 0.25,95% CI = 0.11-0.58)and 56%(RR = 0.44,95% CI = 0.30-0.63)compared to no treatment and placebo,respectively.However,the occurrence of alveolar osteitis following mandibular third molar extraction(s)was not significantly different between 0.2% chlorhexidine gel and 0.12% chlorhexidine mouthwash(RR = 0.24,95% CI = 0.06-1.00).Conclusion: The results showed that 0.2% chlorhexidine gel was effective in preventing alveolar osteitis after lower third molar extraction(s).We cannot explicitly state whether 0.2% chlorhexidine is more effective than 0.12% chlorhexidine mouthwash in preventing alveolar osteitis,because of a lack of additional primary studies.Additional original studies about the effect of 0.2% chlorhexidine gel in preventing alveolar osteitis as well as comparing 0.2% chlorhexidine gel with 0.12% chlorhexidine mouthwash and with other interventions are needed to determine the best method to prevent alveolar osteitis following mandibular third molar extraction(s).In addition,studies evaluating the effect of 0.2% chlorhexidine gel on alveolar osteitis in old groups are also needed to make better clinical application guidelines in performing mandibular third molar extraction(s).