Does chlorhexidine improve periodontal health and bacterial profiles in patients with special health care needs? A systematic review and meta-analysis

Abstract

Chlorhexidine (CHX) containing products are commonly used as adjuncts to mechanical oral hygiene in patients with special health care needs (SHCN), who often face challenges with plaque control. This study evaluated the effectiveness of CHX in improving periodontal outcomes in this population. Electronic searches of PubMed, Embase, and Web of Science were conducted for studies published from January 1945 through December 31, 2024. Randomized controlled trials assessing CHX use in patients with SHCN were included. Primary outcomes were changes in plaque index (PI) and gingival index (GI), with secondary outcomes including adverse effects. Random-effects meta-analyses were performed using Hedges’ g for PI and mean differences for GI. Twelve randomized controlled trials involving 1,135 participants were included. CHX significantly reduced plaque (Hedges’ g = −1.49; 95% CI, −2.07 to −0.91; P < .001) and gingival inflammation (mean difference = −0.21; 95% CI, −0.31 to −0.12; P < .001). Greater benefits were observed with 0.2% formulations, topical delivery, and longer duration. Adverse effects, including tooth staining and taste alteration, were mild and reversible. Overall, short-term CHX use (2–6 weeks) significantly improves periodontal outcomes in patients with SHCN and is clinically effective and well tolerated.