The Effect of Cetylpyridinium Chloride Compared to Chlorhexidine Mouthwash on Scores of Plaque and Gingivitis: A Systematic Review and Meta-Analyses.

Abstract

Aim: To evaluate the effectiveness of cetylpyridinium chloride (CPC) and chlorhexidine (CHX) mouthwashes (MW) on plaque and gingivitis scores for patients with gingivitis, in brushing as well as non-brushing situations.

Methods: A comprehensive search of MEDLINE-PubMed and Cochrane-CENTRAL was conducted to identify clinical and randomised controlled trials comparing CPC and CHX mouthwashes on plaque and gingivitis scores. The staining index was evaluated as a secondary outcome. In addition, the risk of bias was assessed. The data was summarised using a descriptive approach, and whenever possible, a meta-analysis was conducted. The results for brushing and non-brushing studies were presented separately. Grading was applied using the GRADE approach to rate the certainty of evidence.

Results: The search resulted in 424 unique papers, from which 14 full-text papers providing 18 comparisons were selected. Different concentrations of CPC-MW (0.1%, 0.075%, 0.05%) and CHX-MW (0.2%, 0.12%) were used. The risk of bias was estimated to be low, moderate or high for each study. A meta-analysis for non-brushing models showed a significant favour for CHX-MW in plaque index scores (0.55 [95% CI: 0.19; 0.91], p = 0.003). For brushing, no significant differences were found between CPC-MW and CHX-MW. The descriptive analysis supports these findings. CHX-MW tends to stain more than CPC-MW.

Conclusion: There is moderate certainty for a small statistically significant favourable effect of CHX-MW over CPC-MW for plaque control in non-brushing situations, but no difference between them for plaque and gingivitis prevention in brushing situations.