Limited evidence for the effectiveness of antiseptic sprays for control of plaque and gingival inflammation.

Data sourcesPubMed, the Cochrane Library and Web of Science databases.Study selectionRandomised controlled trials (RCTs) providing information on the effectiveness of oral sprays on plaque or gingival inflammation and published in English were considered.Data extraction and synthesisTwo reviewers independently screened the studies, abstracted data and assessed risk of bias using the Cochrane tool. Disagreements were resolved by discussion and consensus. Estimates from suitable studies were pooled using a random effects meta-analysis.ResultsTwenty trials involving a total of 720 patients were included. The majority of the studies (14) used chlorhexidine (0.12 or 0.2%). The other six studies used Hyaluronic acid (HA); 0.2% hexetidine; 0.2% stannous fluoride; triclosan (TRN); cetylpyridinium chloride (CPC); and benzydamine hydrochloride (B-HCl). Ten studies involved physically or mentally challenged patients, six trials involved healthy adults. Significant reductions in dental plaque ranging from 22% to 78% were reported in 14 studies with 11 studies reporting significant improvement in gingival health with 13% to 75% reductions in Gingival Index (GI) scores. Meta-analysis (three studies) of 0.2% chlorhexidine (CHX) spray intervention, without prophylaxis at baseline, showed reductions in Plaque Index (PI) = 0.74 (95%CI: -1.03 to -0.45) and Gingival Index (GI) = 0.22 (95% CI: -0.38 to -0.06). Five studies provided a prophylaxis before study initiation, three used 0.2% CHX spray. Meta-analysis demonstrated an increase of 0.18 (95% CI: -0.01 to 0.37) in PI scores. Two RCTs compared 0.12% and 0.2% CHX spray, and a meta-analysis showed increases of 1.71 (95% CI: 1.27 to 2.14) and 1.58 (95% CI: 1.23 to 1.93), respectively, in PI scores.ConclusionsThe authors concluded that the available evidence suggests that oral sprays are an acceptable delivery method for antiseptic agents. CHX is the most widely investigated antiseptic agent used in oral sprays, and meta-analyses suggested it to be effective in reducing plaque scores and gingival inflammation. However, considering that bias to some extent existed in the included studies, the findings in this review should be interpreted with caution.