EFFICACY OF CHLORHEXIDINE MOUTHRINSE IN THE CONTROL OF DENTAL PLAQUE AND GINGIVITIS: A PRISMA-GUIDED SYSTEMATIC REVIEW OF SYSTEMATIC REVIEWS

Background: Chlorhexidine (CHX) has been used as an adjunct to mechanical plaque control since the early 1970s, yet the size and clinical relevance of its effect, and its trade-offs against alternative antiseptics, remain debated. Objective: To synthesise evidence from published systematic reviews on the efficacy and adverse effects of CHX mouthrinses for dental plaque and gingivitis. Methods: A systematic review of systematic reviews was conducted following PRISMA 2020 principles. Targeted searches (October 2026) identified systematic reviews of randomised controlled trials (RCTs) evaluating CHX mouthrinses. Eight reviews published between 2006 and 2025 were included. Effect estimates and risk-of-bias judgements were extracted as reported, and a narrative synthesis was performed; no pooling was undertaken because of overlap among primary trials. Results: CHX mouthrinse consistently reduced plaque: the Cochrane review reported a standardised mean difference (SMD) of −1.45 (95% CI −1.90 to −1.00) at 4–6 weeks and −1.59 (−1.89 to −1.29) at 6 months. Gingival inflammation fell by 0.21 points (95% CI 0.11–0.31) on the 0–3 Gingival Index in mild gingivitis, a change the authors judged of limited clinical importance, with moderate reductions in bleeding. Extrinsic tooth staining increased (SMD 1.07; 0.80–1.34). No consistent advantage of 0.2% over 0.12% was shown. Compared with essential-oil rinses, CHX produced greater plaque reduction but no difference in gingival inflammation; compared with cetylpyridinium chloride, a small plaque advantage appeared only in non-brushing models. Most primary trials were at high risk of bias. Conclusions: CHX is a highly effective short-term anti-plaque adjunct, with a modest effect on gingival indices at low baseline inflammation and predictable local adverse effects. Long-term, low-risk-of-bias trials with standardised outcomes are needed.