Antiseptic treatment (chlorhexidine) to prevent tooth decay in children and young people

Cochrane: This review examined the effectiveness of varnishes and gels containing chlorhexidine in preventing tooth decay in children and young people. Tooth decay is a very common disease that over time destroys the tooth surface. It has been estimated to affect up to 80% of people in high-income countries and, despite being preventable through oral hygiene and dietary measures and the use of agents such as fluoride that reduce risk of decay, it is likely to remain a problem, especially in low-income countries. Tooth decay can result in pain and infection, and in young children may require treatment in hospital under a general anaesthetic. As well as causing anxiety and pain, this may mean the child or young person missing time at school and their parents or carers having to take time off work, possibly losing income and incurring extra costs. Prevention of tooth decay is simpler and possibly cheaper than waiting until it occurs and then requires extensive treatment.
Tooth decay is largely preventable, and a range of things may assist this: twice-daily toothbrushing with a fluoride toothpaste, reducing both the amount of and number of times per day sugar is eaten, and drinking water that contains fluoride (bottled or tap, depending on where you live).

Tooth decay occurs when certain types of bacteria (germs) in the mouth, such as Streptococcus mutans, produce acids from the sugar we eat, which dissolve the hard enamel coating on our teeth. The chemical antiseptic treatment chlorhexidine is highly successful at destroying these bacteria and can be used safely at home in the form of a gel, spray, chewing gum, toothpaste or mouthrinse. Alternatively, chlorhexidine can be applied as a varnish to the surface of teeth by a dentist.


The evidence in this review, carried out through the Cochrane Oral Health Group, is up-to-date at 25 February 2015. We found eight studies that were suitable to include in this review. The studies involved a total of 2876 children from birth to 15 years of age who were at moderate to high risk of tooth decay. Six of the studies looked at the effects of dental professionals applying different strengths of chlorhexidine varnishes to the baby teeth, permanent teeth or both types of teeth in children and adolescents. The other two studies looked at the effects of parents placing chlorhexidine gel on their children's baby teeth. There were no studies that examined other products containing chlorhexidine, such as sprays, toothpastes, chewing gums or mouthrinses.


The results did not provide evidence that chlorhexidine varnish or gel reduces tooth decay or reduces the bacteria that encourage tooth decay. The studies did not evaluate other outcomes such as pain, quality of life, patient satisfaction or direct and indirect costs of interventions. Four studies measured side effects and found none were observed.


Due to the lack of suitable studies and concerns about possible bias in the included studies, the evidence is very low quality. As a result, we are not able to conclude whether or not chlorhexidine is effective in preventing tooth decay in children or adolescents, when compared to placebo (an inactive substitute for chlorhexidine) or no treatment. Future research on the use of chlorhexidine to prevent tooth decay is needed and should consider both primary and permanent teeth and should assess other chlorhexidine-containing products that can be used at home, such as toothpastes or mouthrinses.

We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine-containing oral products.