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• W2334146946 abstract "Systematic review conclusion. Chlorhexidine varnish (CHX-V) may be effective in preventing root caries in the absence of regular professional tooth cleaning and oral hygiene instructions for patients who need special care.Critical summary assessment. A review of six randomized controlled trials demonstrates that CHX-V may benefit patients who require special care.Evidence quality rating. Limited.Clinical questionDoes the application of CHX-V reduce the incidence or activity of root caries in adult patients with gingival recession compared with that in adult patients who do not receive CHX-V application?Review methodsReviewers searched three databases through Dec. 23, 2010. Two of the reviewers hand searched the reference lists of the selected articles. They limited inclusion to published articles written in English and to randomized controlled trials (RCTs) conducted in adults in which investigators compared the use of CHX-V with placebo, control treatment or fluoride varnish (FV). They assessed heterogeneity among the studies, as well as risk of bias, according to the 2009 RCT checklist of the Dutch Cochrane Center1Dutch Cochrane Centre Formulier II voor het Beoordelen van een Randomised Controlled Trial (RCT).http://dcc.cochrane.org/sites/dcc.cochrane.org/files/uploads/RCT.pdfGoogle Scholar and the 2001 Consolidated Standards of Reporting Trials (CONSORT) statement.2Consolidated Standards of Reporting Trials (CONSORT) Group The CONSORT Statement: The Checklist.www.consort-statement.org/consort-statementGoogle ScholarMain resultsThe systematic review included six studies. The number of participants ranged from 11 to 234. The authors of the systematic review were unable to determine the number of participants in one study. The inclusion criteria were different for each study; the participants ranged from those who were physically dependent to those who recently had undergone periodontal surgery. Concentrations of CHX-V used in the various studies were 1 percent, 10 percent and 40 percent. All of the studies involved application of CHX-V at three-month intervals, except one that included four weekly applications and another application at six months. Three studies included oral hygiene instruction, another study did not and the investigators in two studies did not specify whether hygiene instruction was offered. Investigators in none of the studies reported the frequency or effectiveness of home care practices. Outcome measures included root caries incidence and root caries activity (which they assessed according to color and texture). The studies had, on average, a moderate estimated risk of bias. Meta-analysis of two studies that involved applications of CHX-V 1 percent and one study that involved CHX-V 10 percent indicated that the interventions resulted in a weighted mean difference of 0.65 in favor of the intervention (P = .0003; 95 percent confidence interval, −1.01 to −0.30). The results of two studies not included in the meta-analysis indicated that the applications effectively reduced root caries activity, incidence or both. The results of one study demonstrated that applications of CHX-V 1 percent were ineffective in reducing root caries incidence and activity. The findings in another study involving both CHX-V 40 percent and CHX-V 1 percent did not demonstrate an effect on caries incidence or activity. It is unclear whether the concentration of CHX-V was a factor with regard to effectiveness.ConclusionsCHX-V may provide a beneficial effect for patients who require special care. The strength of the recommendation is graded as weak.COMMENTARYImportance and contextRoot caries is prevalent in patients with exposed root surfaces, especially patients affected by xerostomia. Effective chemotherapeutic agents are desirable for the treatment and prevention of root caries. When thorough mechanical plaque control is not possible, the application of chemotherapeutic agents may be advantageous for patients who require special care and for their caregivers. As the population continues to age and elderly people are able to retain more natural dentition, root caries may become increasingly prevalent.Strengths and weaknesses of the systematic reviewExperienced authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.3Moher D Liberati A Tetzlaff J Altman DG PRISMA GroupPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6 (2009): e1000097Crossref PubMed Scopus (40610) Google Scholar The authors of the systematic review were thorough in their analysis and reporting of this collection of studies. The systematic review was published in a respected, peer-reviewed journal. However, some weaknesses in it are evident.The review included only articles published in English, which have been posited as being more likely to contain positive results.4Egger M Zellweger-Zahner T Schneider M Junker C Lengeler C Antes G Language bias in randomised controlled trials published in English and German.Lancet. 1997; 350: 326-329Abstract Full Text Full Text PDF PubMed Scopus (809) Google Scholar By using Grading of Recommendations Assessment, Development and Evaluation criteria,5Grading of Recommendations Assessment, Development and Evaluation Working Group Welcome (home page).www.gradeworkinggroup.org/index.htmGoogle Scholar the authors determined that the evidence had a moderate risk of bias. The authors did not indicate that participants' sex was not reported in some of the studies. Presenting a forest plot of the results of the individual studies and of the meta-analysis would have improved the review's clarity.The three studies included in the meta-analysis had sufficiently different inclusion and exclusion criteria and methods to suggest that a combined analysis of them might not be appropriate. Tan and colleagues6Tan HP Lo EC Dyson JE Luo Y Corbet EF A randomized trial on root caries prevention in elders.J Dent Res. 2010; 89: 1086-1090Crossref PubMed Scopus (125) Google Scholar studied elderly patients living in residential and nursing homes who had basic self-care ability, including the ability to perform oral hygiene. Researchers applied CHX-V 1 percent or FV and provided oral hygiene instruction. The study by Baca and colleagues7Baca P Clavero J Baca AP González-Rodríguez MP Bravo M Valderrama MJ Effect of chlorhexidine-thymol varnish on root caries in a geriatric population: a randomized double-blind clinical trial.J Dent. 2009; 37: 679-685Crossref PubMed Scopus (36) Google Scholar included institutionalized elderly people without consideration of their ability to perform activities of daily living. Investigators in this study applied only CHX-V 1 percent; they did not provide oral hygiene instruction. The third study included in the meta-analysis, by Banting and colleagues,8Banting DW Papas A Clark DC Proskin HM Schultz M Perry R The effectiveness of 10% chlorhexidine varnish treatment on dental caries incidence in adults with dry mouth.Gerodontology. 2000; 17: 67-76Crossref PubMed Scopus (58) Google Scholar included patients with xerostomia who were 45 to 75 years of age and in good oral health but who had a high caries rate. This cohort was treated with CHX-V 10 percent. Each group followed a different application schedule. The authors of the meta-analysis provided no explanation of how they accounted for the differing time intervals over which the caries increments were calculated, differences in the application regimens and differences in the use of fluoride.Strengths and weaknesses of the evidenceThis systematic review included six studies. These studies involved different inclusion criteria, study populations, CHX-V concentrations, application regimens and study duration. The study populations were at high risk of experiencing root caries owing to prior periodontal treatment, physical limitations or low salivary flow. Furthermore, the investigators in each study used a different method of determining root caries activity. Caries outcomes were reported incompletely. The heterogeneity of the studies makes the synthesis of their results problematic and generalization of their findings difficult.Implications for dental practiceAlthough the authors of the systematic review concluded that application of CHX-V in the absence of professional cleaning is effective for patients who need special care, the conclusion is based on a single study of 11 participants.9Johnson G Almqvist H Non-invasive management of superficial root caries lesions in disabled and infirm patients.Gerodontology. 2003; 20: 9-14Crossref PubMed Scopus (17) Google Scholar Thus, the evidence for this specific application is weak. Systematic review conclusion. Chlorhexidine varnish (CHX-V) may be effective in preventing root caries in the absence of regular professional tooth cleaning and oral hygiene instructions for patients who need special care.Critical summary assessment. A review of six randomized controlled trials demonstrates that CHX-V may benefit patients who require special care.Evidence quality rating. Limited. Systematic review conclusion. Chlorhexidine varnish (CHX-V) may be effective in preventing root caries in the absence of regular professional tooth cleaning and oral hygiene instructions for patients who need special care.Critical summary assessment. A review of six randomized controlled trials demonstrates that CHX-V may benefit patients who require special care.Evidence quality rating. Limited. Systematic review conclusion. Chlorhexidine varnish (CHX-V) may be effective in preventing root caries in the absence of regular professional tooth cleaning and oral hygiene instructions for patients who need special care. Critical summary assessment. A review of six randomized controlled trials demonstrates that CHX-V may benefit patients who require special care. Evidence quality rating. Limited. Clinical questionDoes the application of CHX-V reduce the incidence or activity of root caries in adult patients with gingival recession compared with that in adult patients who do not receive CHX-V application? Does the application of CHX-V reduce the incidence or activity of root caries in adult patients with gingival recession compared with that in adult patients who do not receive CHX-V application? Review methodsReviewers searched three databases through Dec. 23, 2010. Two of the reviewers hand searched the reference lists of the selected articles. They limited inclusion to published articles written in English and to randomized controlled trials (RCTs) conducted in adults in which investigators compared the use of CHX-V with placebo, control treatment or fluoride varnish (FV). They assessed heterogeneity among the studies, as well as risk of bias, according to the 2009 RCT checklist of the Dutch Cochrane Center1Dutch Cochrane Centre Formulier II voor het Beoordelen van een Randomised Controlled Trial (RCT).http://dcc.cochrane.org/sites/dcc.cochrane.org/files/uploads/RCT.pdfGoogle Scholar and the 2001 Consolidated Standards of Reporting Trials (CONSORT) statement.2Consolidated Standards of Reporting Trials (CONSORT) Group The CONSORT Statement: The Checklist.www.consort-statement.org/consort-statementGoogle Scholar Reviewers searched three databases through Dec. 23, 2010. Two of the reviewers hand searched the reference lists of the selected articles. They limited inclusion to published articles written in English and to randomized controlled trials (RCTs) conducted in adults in which investigators compared the use of CHX-V with placebo, control treatment or fluoride varnish (FV). They assessed heterogeneity among the studies, as well as risk of bias, according to the 2009 RCT checklist of the Dutch Cochrane Center1Dutch Cochrane Centre Formulier II voor het Beoordelen van een Randomised Controlled Trial (RCT).http://dcc.cochrane.org/sites/dcc.cochrane.org/files/uploads/RCT.pdfGoogle Scholar and the 2001 Consolidated Standards of Reporting Trials (CONSORT) statement.2Consolidated Standards of Reporting Trials (CONSORT) Group The CONSORT Statement: The Checklist.www.consort-statement.org/consort-statementGoogle Scholar Main resultsThe systematic review included six studies. The number of participants ranged from 11 to 234. The authors of the systematic review were unable to determine the number of participants in one study. The inclusion criteria were different for each study; the participants ranged from those who were physically dependent to those who recently had undergone periodontal surgery. Concentrations of CHX-V used in the various studies were 1 percent, 10 percent and 40 percent. All of the studies involved application of CHX-V at three-month intervals, except one that included four weekly applications and another application at six months. Three studies included oral hygiene instruction, another study did not and the investigators in two studies did not specify whether hygiene instruction was offered. Investigators in none of the studies reported the frequency or effectiveness of home care practices. Outcome measures included root caries incidence and root caries activity (which they assessed according to color and texture). The studies had, on average, a moderate estimated risk of bias. Meta-analysis of two studies that involved applications of CHX-V 1 percent and one study that involved CHX-V 10 percent indicated that the interventions resulted in a weighted mean difference of 0.65 in favor of the intervention (P = .0003; 95 percent confidence interval, −1.01 to −0.30). The results of two studies not included in the meta-analysis indicated that the applications effectively reduced root caries activity, incidence or both. The results of one study demonstrated that applications of CHX-V 1 percent were ineffective in reducing root caries incidence and activity. The findings in another study involving both CHX-V 40 percent and CHX-V 1 percent did not demonstrate an effect on caries incidence or activity. It is unclear whether the concentration of CHX-V was a factor with regard to effectiveness. The systematic review included six studies. The number of participants ranged from 11 to 234. The authors of the systematic review were unable to determine the number of participants in one study. The inclusion criteria were different for each study; the participants ranged from those who were physically dependent to those who recently had undergone periodontal surgery. Concentrations of CHX-V used in the various studies were 1 percent, 10 percent and 40 percent. All of the studies involved application of CHX-V at three-month intervals, except one that included four weekly applications and another application at six months. Three studies included oral hygiene instruction, another study did not and the investigators in two studies did not specify whether hygiene instruction was offered. Investigators in none of the studies reported the frequency or effectiveness of home care practices. Outcome measures included root caries incidence and root caries activity (which they assessed according to color and texture). The studies had, on average, a moderate estimated risk of bias. Meta-analysis of two studies that involved applications of CHX-V 1 percent and one study that involved CHX-V 10 percent indicated that the interventions resulted in a weighted mean difference of 0.65 in favor of the intervention (P = .0003; 95 percent confidence interval, −1.01 to −0.30). The results of two studies not included in the meta-analysis indicated that the applications effectively reduced root caries activity, incidence or both. The results of one study demonstrated that applications of CHX-V 1 percent were ineffective in reducing root caries incidence and activity. The findings in another study involving both CHX-V 40 percent and CHX-V 1 percent did not demonstrate an effect on caries incidence or activity. It is unclear whether the concentration of CHX-V was a factor with regard to effectiveness. ConclusionsCHX-V may provide a beneficial effect for patients who require special care. The strength of the recommendation is graded as weak. CHX-V may provide a beneficial effect for patients who require special care. The strength of the recommendation is graded as weak." @default.
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• W2334146946 title "Use of chlorhexidine varnish to prevent root caries may benefit some patients" @default.
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