Aims: Our purpose was to systematically review the literature on the effectiveness of chlorhexidine varnish for preventing dental caries in children and adolescents and to determine its effectiveness compared to fluoride varnish. Methods: MEDLINE, EMBASE and the Cochrane Library were searched through December 2009 to identify relevant randomised trials with blind outcome assessment and a minimum duration of 1 year. The search was later updated in MEDLINE and the Cochrane Library to March 19th, 2010. Risk of bias of the included trials was assessed. The primary outcome was the caries increment. Results: Twelve trials met the inclusion criteria for the review. There was considerable variation between trials in the concentration and frequency of application of the chlorhexidine varnish, in baseline caries levels and in background exposure to fluoride. Six parallel-group trials reported no statistically significant difference in caries increment in permanent teeth with the application of chlorhexidine varnish compared to placebo or no treatment. The results of 4 split-mouth trials were conflicting: 2 trials found no significant difference in caries increment and 2 reported statistically significant results in favour of chlorhexidine varnish. One trial of the effect of chlorhexidine varnish in primary teeth demonstrated a statistically significant reduction in caries increment. The results of 1 trial comparing chlorhexidine varnish with fluoride varnish for preventing caries in adolescents were equivocal. Conclusion: Evidence regarding the effectiveness of chlorhexidine varnish for preventing caries is inconclusive. Further well-conducted randomised trials are required before chlorhexidine varnish can be recommended for caries prevention.
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- Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington HV: Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2008;4:CD001830.
- Araujo AMPG, Naspitz GMCC, Chelotti A, Cai S: Effect of cervitec on mutans streptococci in plaque and on caries formation on occlusal fissures of erupting permanent molars. Caries Res 2002;36:373–376.
- Attin R, Tuna A, Attin T, Brunner E, Noack MJ: Efficacy of differently concentrated chlorhexidine varnishes in decreasing mutans streptococci and lactobacilli counts. Arch Oral Biol 2003;48:503–509.
- Baca P, Junco P, Bravo M, Baca AP, Muñoz MJ: Caries incidence in permanent first molars after discontinuation of a school-based chlorhexidine-thymol varnish program. Community Dent Oral Epidemiol 2003;31:179–183.
- Baca P, Muñoz MJ, Bravo M, Junco P, Baca AP: Effectiveness of chlorhexidine-thymol varnish for caries reduction in permanent first molars of 6- to 7-year-old children: 24-month clinical trial. Community Dent Oral Epidemiol 2002;30:363–368.
- Baca P, Muñoz MJ, Bravo M, Junco P, Baca AP: Effectiveness of chlorhexidine-thymol varnish in preventing caries lesions in primary molars. ASDC J Dent Child 2004;71:61–65.
- Balanyk TE, Sandham HJ: Development of sustained-release antimicrobial dental varnishes effective against Streptococcus mutans in vitro. J Dent Res 1985;64:1356–1360.
- Bonesvoll P, Lökken P, Rölla G, Paus PN: Retention of chlorhexidine in the human oral cavity after mouthrinses. Arch Oral Biol 1974;19:209–212.
- Bratthall D, Serinirach R, Rapisuwon S, Kuratana M, Luangjarmekorn V, Luksila K, Chaipanich P: A study into the prevention of fissure caries using an antimicrobial varnish. Int Dent J 1995;45:245–254.
- De Amorim RG, Leal SC, Bezerra ACB, De Amorim FPLG, De Toledo OA: Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition. Int J Paediatr Dent 2008;18:446–451.
- De Soet JJ, Gruythuysen RJM, Bosch JA, van Amerongen WE: The effect of 6-monthly application of 40% chlorhexidine varnish on the microflora and dental caries incidence in a population of children in Surinam. Caries Res 2002;36:449–455.
- Du MQ, Tai BJ, Jiang H, Lo ECM, Fan MW, Bian Z: A two-year randomized clinical trial of chlorhexidine varnish on dental caries in Chinese preschool children. J Dent Res 2006;85:557–559.
- Emilson CG: Effect of chlorhexidine gel treatment on Streptococcus mutans population in human saliva and dental plaque. J Dent Res 1981;89:239–246.
- Emilson CG: Potential efficacy of chlorhexidine against mutans streptococci and human dental caries. J Dent Res 1994;73:682–691.
- Ersin NK, Eden E, Eronat N, Totu FI, Ates M: Effectiveness of 2-year application of school-based chlorhexidine varnish, sodium fluoride gel, and dental health education programs in high-risk adolescents. Quintessence Int 2008;39:e45–e51.
- Fennis-le YL, Verdonschot EH, Burgersdijk RC, König KG, van‘t Hof MA: Effect of 6-monthly applications of chlorhexidine varnish on incidence of occlusal caries in permanent molars: a 3-year study. J Dent 1998;26:233–238.
- Forgie AH, Paterson M, Pine CM, Pitts NB, Nugent ZJ: A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high-caries-risk adolescents. Caries Res 2000;34:432–439.
- Haukali G, Poulsen S: Effect of a varnish containing chlorhexidine and thymol (Cervitec) on approximal caries in 13- to 16-year-old schoolchildren in a low-caries area. Caries Res 2003;37:185–189.
- Higgins JPT, Deeks JJ: Selecting trials and collecting data; in Higgins JPT, Altman DG (eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2 (updated 2009). London, Cochrane Collaboration, 2009, chapt 7.
- Jenatschke F, Elsenberger E, Welte HD, Schlagenhauf U: Influence of repeated chlorhexidine varnish applications on mutans streptococci counts and caries increment in patients treated with fixed orthodontic appliances. J Orofac Orthop 2001;62:36–45.
- Kay EJ, Locker D: Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol 1996;24:231–235.
- Le YL, Schaeken MJM: Effect of single and repeated application of chlorhexidine varnish on mutans streptococci in plaque from fissures of premolar and molar teeth. Caries Res 1993;27:303–306.
- Loesche WJ: Role of Streptococcus mutans in human dental decay. Microbiol Rev 1986;50:353–380.
- Madlena M, Vitalyos G, Marton S, Nagy G: Effect of chlorhexidine varnish on bacterial levels in plaque and saliva during orthodontic treatment. J Clin Dent 2000;11:42–46.
- Marinho V, Higgins J, Logan S, Sheiham A: Fluoride varnishes for preventing dental caries in children and adolescents: Cochrane Database Syst Rev 2002a;1:CD002279.
- Marinho V, Higgins J, Logan S, Sheiham A: Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002b;1:CD002280.
- Marinho V, Higgins J, Logan S, Sheiham A: Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003a;1:CD002278.
- Marinho V, Higgins J, Logan S, Sheiham A: Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003b;3:CD002284.
- Mejàre I, Lingström P, Petersson LG, Holm AK, Twetman S, Källestål C, Nordenram G, Lagerlöf F, Söder B, Norlund A, Axelsson S, Dahlgren H: Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand 2003;61:321–330.
- Ogaard B, Larsson E, Glans R, Henriksson T, Birkhed D: Antimicrobial effect of a chlorhexidine-thymol varnish (Cervitec) in orthodontic patients: a prospective, randomized clinical trial. J Orofac Orthop 1997;58:206–213.
- Petersen PE: The World Oral Health Report 2003:Continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31:3–23.
- Petersson LG, Magnusson K, Andersson H, Almquist B, Twetman S: Effect of quarterly treatments with a chlorhexidine and a fluoride varnish on approximal caries in caries-susceptible teenagers: a 3-year clinical study. Caries Res 2000;34:140–143.
- Plotzitza B, Kneist S, Berger J, Hetzer G: Efficacy of chlorhexidine varnish applications in the prevention of early childhood caries. Eur J Paediatr Dent 2005;6:149–154.
- Ribeiro LG, Hashizume LN, Maltz M: The effect of different formulations of chlorhexidine in reducing levels of mutans streptococci in the oral cavity: a systematic review of the literature. J Dent 2007;35:359–370.
- Rodrigues CRMD, Marquezan M, Barroso LP, Grande RHM, Myaki SI, Kabakura V, Miyamura A: Effect of chlorhexidine-thymol varnish on caries lesion development in first permanent molars. J Clin Dent 2008;19:18–21.
- Rölla G, Löe H, Rindom Schiött C: Retention of chlorhexidine in the human oral cavity. Arch Oral Biol 1971;16:1109–1116.
- Schaeken MJ, Schouten MJ, Van Den Kieboom CW, Van Der Hoeven JS: Influence of contact time and concentration of chlorhexidine varnish on mutans streptococci in interproximal dental plaque. Caries Res 1991;25:292–295.
- Schaeken MJ, van der Hoeven JS, Hendriks JC: Effects of varnishes containing chlorhexidine on the human dental plaque flora. J Dent Res 1989;68:1786–1789.
- Skold-Larsson K, Fornell AC, Lussi A, Twetman S: Effect of topical applications of a chlorhexidine/thymol-containing varnish on fissure caries assessed by laser fluorescence. Acta Odontol Scand 2004;62:339–342.
- Splieth C, Steffen H, Rosin M, Welk A: Caries prevention with chlorhexidine-thymol varnish in high-risk schoolchildren. Community Dent Oral Epidemiol 2000;28:419–423.
- Twetman S: Antimicrobials in future caries control? A review with special reference to chlorhexidine treatment. Caries Res 2004;38:223–229.
- Twetman S, Petersson LG: Interdental caries incidence and progression in relation to mutans streptococci suppression after chlorhexidine-thymol varnish treatments in schoolchildren. Acta Odontol Scand 1999;57:144–148.
- Van Houte J: Bacterial specificity in the etiology of dental caries. Int Dent J 1980;30:305–320.
- Vanobbergen J, Declerck D, Mwalili S, Martens L: The effectiveness of a 6-year oral health education programme for primary schoolchildren. Community Dent Oral Epidemiol 2004;32:173–182.
- Van Rijkom HM, Truin GJ, van’t Hof MA: A meta-analysis of clinical studies on the caries-inhibiting effect of chlorhexidine treatment. J Dent Res 1996;75:790–795.
- Zhang Q, van Palenstein Helderman WH, van’t Hof MA, Truin GJ: Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review. Eur J Oral Sci 2006a;114:449–455.
- Zhang Q, van’t Hof MA, Truin GJ, Bronkhorst EM, van Palenstein Helderman WH: Caries-inhibiting effect of chlorhexidine varnish in pits and fissures. J Dent Res 2006b;85:469–474.
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Received: March 22, 2010
Accepted after revision: May 20, 2010
Published online: July 7, 2010
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 2, Number of References : 47
Vol. 44, No. 4, Year 2010 (Cover Date: September 2010)
Journal Editor: Beighton D. (London)
ISSN: 0008-6568 (Print), eISSN: 1421-976X (Online)
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