By Sarah Guy
Using chlorhexidine (CHX) gel on infants' teeth achieves no more than using fluoride toothpaste alone to prevent early childhood caries (ECC), show the results of a randomized, controlled clinical trial.
The research team reports a mere 2% difference in ECC rates in a cohort of 24-month olds assigned to twice-daily toothbrushing with a low-fluoride paste plus once-daily CHX application (CHX group), or use of the fluoride toothpaste alone (controls).
Given the findings and known costs generated by CHX use, Kim Seow, from The University of Queensland in Brisbane, Australia, and colleagues suggest that CHX should not be recommended in this population.
"It is possible that toothbrushing alone had resulted in such high levels of caries prevention that any additional effects of CHX were not apparent," they write in the International Journal of Paediatric Dentistry.
The team randomly assigned 110 children to the CHX group and 89 to the control group. The children's mothers completed a validated questionnaire by telephone when their child was aged 6, 12, and 18 months, including questions on their child's medical and dental health, and to report their compliance with toothpaste and CHX use.
A respective 61 and 58 children from the CHX and control groups, were examined at 24 months of age and Seow and co-investigators observed respective ECC rates of 5% and 7%; a nonsignificant difference.
There were also no significant differences between the groups in the numbers of caries per child with carious teeth, says the team, adding that the low numbers of ECC are likely to result from the telephone contact with oral health professionals, increasing the mothers' motivation to follow toothbrushing instructions and dietary advice.
Compliance with the study protocol appeared to be a concern, however, with the percentage of children brushing their teeth twice daily significantly higher in the CHX group than in controls, at 80% versus 67%.
However, within the CHX group, 80% of children were reported to be noncompliant (did not apply the CHX gel once per day).
However, Seow and co-authors explain that the intent-to-treat approach used in the trial renders the estimate of treatment effect true to real life.
"Therefore, although the compliance is low, it does not invalidate our study. Rather the low compliance is part of the reason why chlorhexidine was not effective," they say.
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