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differences were only observed for the secondary outcome (Figuero, Roldan, et al., 2019). In addition, direct comparisons between similar agents/formulations, delivered either as dentifrice or mouth rinse, are not available. The decision to select a specific toothpaste or a mouth rinse should be also based on a combination of factors: • Patient preferences including cost, taste, etc. • Unwanted effects including staining, burning sensation during use, etc. • Potential negative impacts on beneficial aspects of the oral micro - biome highlighted in recent evidence (e.g. impact on nitric oxide pathway) (Bescos et al., 2020). • Potential negative impacts on blood pressure: one short-term (7- days) study suggested a non-statistically significant “trend” for chlorhexidine mouth rinse to cause a small elevation in systolic blood pressure from 103 mmHg to 106 mHg (Bescos et al., 2020). The clinical significance of this is unknown. • Depending on the specific agent already selected, a decision must be made regarding their frequency and duration of use.
and copolymer ( n = 18, S-WMD = −1.313), and chlorhexidine ( n = 2, S-WMD = −1.278, not statistically significant), although comparing the formulations was not a specific objective of the review. Effects on plaque levels were best with chlorhexidine at high concentra - tions ( n = 3, S-WMD = −1.512) and triclosan and copolymer ( n = 23, S-WMD = −1.164). In a previously published network meta-analy - ses, chlorhexidine and triclosan and copolymer were the most ef - fective agents for plaque reduction, but no clear differences were observed for gingival index control (Escribano et al., 2016; Figuero, Herrera, et al., 2019). Additional factors have been discussed in the overall evaluation of adjunctive agents.
R4.13 | Which antiseptic is the most effective in mouth rinses?
Evidence-based recommendation (4.13) If an antiseptic mouth rinse formulation is going to be adjunctively used, we suggest products containing chlorhexidine, essential oils and cetylpyridinium chloride for the control of gingival inflammation, in periodontitis patients in supportive periodontal care. Supporting literature Escribano et al. (2016); Figuero, Herrera, et al. (2019); Figuero, Roldan, et al. (2019); Serrano et al. (2015) Quality of evidence CoE Class I—24 RCTs with, at least, 6-month follow-up Grade of recommendation Grade B—↑ Strength of consensus Consensus (17.9% of the group abstained due to potential CoI)
R4.12 | Which antiseptic is the most effective in dentifrices?
Evidence-based recommendation (4.12) If an antiseptic dentifrice formulation is going to be adjunctively used, we suggest products containing chlorhexidine, triclosan- copolymer and stannous fluoride-sodium hexametaphosphate for the control of gingival inflammation, in periodontitis patients in supportive periodontal care. Supporting literature Escribano et al. (2016); Figuero, Herrera, et al. (2019); Figuero, Roldan, et al. (2019); Serrano et al. (2015) Quality of evidence Twenty-nine RCTs with, at least, 6-month follow-up Grade of recommendation Grade B—↑ Strength of consensus Consensus (17.4% of the group abstained due to potential CoI)
Background
Intervention In order to control gingival inflammation during supportive peri - odontal care, the adjunctive use of some agents has been proposed. These products can be delivered as mouth rinses. Available evidence In the systematic review (Figuero, Roldan, et al., 2019), the adjunc - tive use of 11 different mouth rinse formulations were evaluated for controlling gingival inflammation, with a clear heterogeneity in the number of available studies for each product. The magnitude of effect in gingival indices changes, in formulations with more than one study available, ranged from S-WMD = −2.248 (essential oils, n = 10), to S-WMD = −1.499 (cetylpyridinium chloride, n = 5), and to S-WMD = −1.144 (chlorhexidine at high concentrations, n = 5), although comparing the formulations was not a specific objective of the review. In a previously published network meta-analyses (a statistical technique which allows the integration of data from di - rect and indirect comparisons, namely treatments compared among trials through a common comparator treatment), chlorhexidine and essential oil mouth rinses were ranked as the most efficacious
Background
Intervention In order to control gingival inflammation during supportive peri - odontal care, the adjunctive use of some agents has been proposed. These products can be delivered as dentifrices. Available evidence In the systematic review (Figuero, Roldan, et al., 2019), the adjunc - tive use of 14 different dentifrice formulations was evaluated for controlling gingival inflammation, with a clear heterogeneity in the number of available studies for each product. The magnitude of effect in gingival indices changes, in formulations with more than one study available, was headed by stannous fluoride with sodium hexametaphosphate ( n = 2, S-WMD = −1.503), followed by triclosan
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