Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

摘要 背景：维持口腔微生物群平衡是通过控制牙菌斑生物膜预防口腔感染性疾病的最简途径。已有研究表明，联合使用漱口水与机械清洁手段对此极为有效。研究目的：明确旨在对比以氯己定（chlorhexidine）为基础的漱口水与含二氧化氯和/或聚六亚甲基胍（polyhexanide）的漱口水在控制口腔微生物群方面的抗菌效果及潜在不良反应/副作用的临床研究。研究设计与实施场景：本系统综述由巴西圣保罗大学鲍鲁牙科学院应用牙科科学研究生阶段的口腔医学团队设计。研究方法：本系统综述检索了截至2020年4月8日的在线数据库，包括PubMed、Embase、Web of Science及Science Direct，检索流程遵循系统综述与荟萃分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南。研究结果：最终纳入8篇2001年至2017年间发表的文献，共评估295名年轻成人、成人及老年受试者（男性占44.75%，女性占55.25%）。其中3篇文献对比了聚六亚甲基胍与氯己定漱口水，5篇对比了二氧化氯与氯己定漱口水，未发现同时对比三种漱口水的研究。研究所用溶液的浓度差异较大，所有受试漱口水均展现出抗菌效果。4篇文献提及未观察到任何副作用或不良反应，3篇未提及相关结果，仅1篇报告了不良反应/副作用情况。结论：含二氧化氯与聚六亚甲基胍的漱口水可作为氯己定的可行替代方案，因其能够减少口腔生物膜，且仅存在极少或未被报道的不良反应或副作用。