The Effect of Chlorhexidine Mouthwash, With or Without Alcohol, on Plaque and Gingivitis: A Systematic Review and Meta‐Analysis
Bregje W. M. van Swaaij, Maud Joosstens, G. A. (Fridus) Van der Weijden, Liselet de Vries, Dagmar Else SlotABSTRACT
Aim
This study systematically assessed the available literature on the effect of a chlorhexidine mouthwash without alcohol (CHXalc−) compared to a chlorhexidine mouthwash with alcohol (CHXalc+) on plaque and parameters of gingivitis. Side effects and user appreciation were secondary outcomes.
Materials and Methods
MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched up to January 2025 to identify eligible studies. Studies evaluating the effect of CHXalc− compared to CHXalc+ were included. A descriptive analysis and, when feasible, a meta‐analysis were performed. The risk of bias was assessed, and the body of evidence was evaluated using the GRADE approach.
Results
After screening, 17 papers met the inclusion criteria and were included. A descriptive analysis demonstrated that most studies showed no differences in plaque, bleeding, and gingivitis scores between CHXalc− and CHXalc+. In non‐brushing studies, the overall meta‐analysis of plaque scores showed a significant difference in favour of CHXalc+ on end (SMD = 0.49; 95% CI [0.03; 0.95], p = 0.04) and incremental difference scores (SMD = 0.82; 95% CI [0.40; 1.24], p = 0.0001). For brushing studies, the overall meta‐analysis showed no significant differences in plaque scores. Further meta‐analyses of bleeding and gingival index scores showed, in majority, no significant differences between CHXalc− and CHXalc+. Tooth surface discoloration scores also did not differ. Taste preference was divided, with half of the comparisons with outcomes in favour of CHXalc− and the other half showing no difference.
Conclusion
When a CHX‐mouthwash is used in non‐brushing situations, there is weak evidence that CHXalc− provided a reduced effect regarding plaque control than CHXalc+. In brushing situations, there is weak evidence for no difference between CHXalc− and CHXalc+ in terms of plaque control. Regarding parameters of gingival inflammation and side effects, there is weak to moderate evidence indicating no difference between CHXalc− and CHXalc+. Regarding user perception of taste, no clear preference emerged from the eligible papers.