Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials.
Chia-Hui Wang, Shu-Hui Yang, Hsiu-Ju Jen and 3 others
PMID 32956135WHAT IT FOUND
Chlorhexidine rinse or gel after molar extraction lowered dry socket risk.
The trials did not clearly rank rinse versus gel, but three direct comparisons favoured rinse; controls varied, so that result is uncertain.
Key findings
01In pooled trials, 0.12% chlorhexidine rinse lowered alveolar osteitis risk versus control (RR = 0.54, 95% CI [0.41, 0.72]).
02In pooled trials, 0.2% chlorhexidine gel lowered alveolar osteitis risk versus control (RR = 0.47, 95% CI [0.34, 0.64]).
03In three trials comparing rinse with gel directly, rinse had a lower alveolar osteitis incidence than gel (RR = 0.61, 95% CI [0.39, 0.95]).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
None of the included trials reported protocol registration, so selective reporting could not be ruled out. Some trials had high risk of bias in outcome measurement or randomization, and the rinse-versus-gel trials had allocation concerns. Control groups differed across trials, including saline, placebo, dry dressing, and no treatment, which can change the relative risk. The direct rinse-versus-gel finding rested on only three trials, and the authors called the mismatch with the subgroup analysis a methodology problem. The paper reported 0.2% rinse as significantly lower than control, but the 95% CI was 0.52 to 1.35. The trials varied in molar type, extraction method, alveolar osteitis diagnosis, and reported patient factors, so the results may not apply to every dental patient. The evidence is from dental trials, not studies of care delivered by nurses.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude chlorhexidine rinse is definitively better than gel. The direct rinse-versus-gel result came from only three trials, and the authors said the difference from the no-subgroup finding suggests a methodology problem.