{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:54:58Z","timestamp":1783583698209,"version":"3.55.0"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,1]],"date-time":"2019-08-01T00:00:00Z","timestamp":1564617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dental Hygiene"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate whether chlorhexidine mouthwash (CHX\u2010MW), with an anti\u2010discoloration system(ADS), is effective in preventing extrinsic tooth surface discoloration. Additionally, this paper seeks to evaluate whether CHX combined with an ADS maintains its efficacy with respect to reducing plaque and gingivitis scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>MEDLINE\u2010PubMed and Cochrane\u2010Central were searched up to October 2018 to identify eligible studies. Papers evaluating the effect of CHX\u2010MW+ADS compared to CHX without an ADS were included. A descriptive analysis and when feasible a meta\u2010analysis was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Screening resulted in 13 eligible publications, presenting 16 comparisons. Six of these evaluated the MW in a non\u2010brushing model and ten as an adjunct to toothbrushing. A descriptive analysis demonstrated that the majority showed no differences in bleeding, gingivitis and plaque scores. This was confirmed by the meta\u2010analysis. In non\u2010brushing experiments, the difference\u2010of\u2010means (DiffM) for plaque scores was 0.10 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.45, 95%CI: [\u22120.15; 0.34]) and for the gingival index 0.04 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.15,95%CI: [\u22120.02; 0.11]). The DiffM in brushing studies for plaque scores was 0.01 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.29, 95%CI: [\u22120.01; 0.02]) and for the gingival index 0.00 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.87,95%CI: [\u22120.05; 0.06]). With respect to staining scores, the meta\u2010analysis revealed that in non\u2010brushing studies, the standardized mean difference was 3.19 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0005,95%CI: [\u22123.98; \u22121.41]) while in brushing studies, the DiffM was 0.12 (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.95,95%CI: [\u22123.32; 3.55]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is moderate quality evidence from non\u2010brushing studies that the addition of an ADS to CHX\u2010MW reduces tooth surface discoloration and does not appear to affect its properties with respect to gingival inflammation and plaque scores. In brushing studies, there is also moderate quality evidence that ADS does not affect the anti\u2010plaque and anti\u2010gingivitis efficacy of CHX. The majority of comparisons and the meta\u2010analysis including these indicate no significant effect of ADS on tooth staining in situations where the mouthwash is used in addition to toothbrushing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/idh.12402","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T14:13:00Z","timestamp":1557151980000},"page":"27-43","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Does chlorhexidine mouthwash, with an anti\u2010discoloration system, reduce tooth surface discoloration without losing its efficacy? A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7364-8612","authenticated-orcid":false,"given":"Bregje W. M.","family":"Van Swaaij","sequence":"first","affiliation":[{"name":"Department of Dental Hygiene, Hogeschool Arnhem Nijmegen University of Applied Sciences Nijmegen The Netherlands"},{"name":"Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam, Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-8384","authenticated-orcid":false,"given":"G. A. (Fridus)","family":"van der Weijden","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam, Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W. P.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Division Clinical Methods and Public Health, Academic Medical Centre (AMC) University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8780-7306","authenticated-orcid":false,"given":"Filippo","family":"Graziani","sequence":"additional","affiliation":[{"name":"Department of Surgical, Medical Medical and Molecular Pathology and Critical Care Medicine University of Pisa Pisa Italy"},{"name":"Department of Periodontology UCL Eastman Dental Institute London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7234-0037","authenticated-orcid":false,"given":"Dagmar E.","family":"Slot","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA) University of Amsterdam, Vrije Universiteit Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Gum disease","author":"Guinness World Records","year":"2001"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12366"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2009.01415.x"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2014.140336"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/eos.12302"},{"key":"e_1_2_11_7_1","first-page":"38","article-title":"Adherence to oral hygiene and dental self\u2010care","volume":"27","author":"Poplinger A","year":"1993","journal-title":"Refuat Hapeh Vehashinayim"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12331"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345950740080501"},{"key":"e_1_2_11_10_1","first-page":"399","article-title":"Chlorhexidine (CHX) in dentistry: state of the art","volume":"61","author":"Varoni E","year":"2012","journal-title":"Minerva Stomatol"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2008.01238.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ID.0000000000000854"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2012.01883.x"},{"key":"e_1_2_11_14_1","first-page":"1","article-title":"Chlorhexidine mouthrinse as an adjunctive treatment for gingival health","volume":"3","author":"James P","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_15_1","first-page":"221","article-title":"Chlorhexidine and taste. 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