Anti-Plaque and Anti-Inflammatory Effects of Mouthwashes in Orthodontic Patients

Objectives: Orthodontic patients experience considerable difficulty in achieving appropriate oral hygiene due to severe plaque retention and gingival inflammation around appliances and lack of manual dexterity. Mouthwashes are usually considered as convenient adjuncts to daily oral hygiene procedures. Thus, this review was to evaluate the anti-plaque and anti-inflammatory effects of mouthwashes in orthodontic patients.
Methods: A protocol was pre-registered on PROSPERO (CRD42019127080). By August 2020, PubMed, EMBASE, CENTRAL and grey literature databases were systematically searched based on the PICOS strategy. After screening, randomized controlled trials among orthodontic patients evaluating the effects of mouthwashes with at least one plaque- or gingival inflammation-related index were included. Relevant data were extracted and risk of bias was evaluated using the Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwash and blank control/placebo groups were pooled to estimate weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Publication bias and sensitivity analyses were performed.
Results: Of 1144 articles, 27 studies satisfied the eligibility criteria for systematic review and 16 studies were included for meta-analyses. None of the studies had low risk of bias, where the attrition bias was the main source of bias followed by selection and detection bias (Figure 1). After meta-analyses, significant lower scores of both the plaque- and gingival inflammation-related indices were observed in mouthwash group (Plaque Index: WMD-0.49, 95%CI-0.96 to -0.03 (blank control); -0.27, -0.34 to -0.20 (placebos as control); Gingival Index: -0.47, -0.81 to -0.12 (blank control); -0.46, -0.65 to -0.28 (placebos as control); Figure 2), with no significant evidence of publication bias. Sensitivity analysis showed similar results.
Conclusions: Mouthwashes have better effects compared to blank control or placebos on reducing dental plaque or gingival inflammation. It seems daily rinsing with mouthwashes is an effective oral hygiene procedure for orthodontic patients to obtain better oral health status.