PERIOPERATIVE USE OF 0.12-PERCENT CHLORHEXIDINE GLUCONATE FOR THE PREVENTION OF ALVEOLAR OSTEITIS - EFFICACY AND RISK FACTOR-ANALYSIS

Objectives. The purposes of this study were to evaluate the use of 0.1 2% chlorhexidine gluconate as a prophylactic therapy for the preventio n of alveolar osteitis and to further examine subject-based risk facto rs associated with alveolar osteitis. Design. The trial was a randomiz ed, double-blind, placebo-controlled, parallel-group study conducted a mong 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were ins tructed to rinse twice daily with 15 ml of chlorhexidine or placebo mo uthrinse for 30 seconds for 1 week before and 1 week after the surgica l extractions. This regimen included a supervised presurgical rinse. A lveolar osteitis diagnosis was based on the subjective finding-of incr easing postoperative pain at the surgical site that was not relieved w ith mild analgesics, supported by clinical evidence of one or more of the following: loss of blood clot, necrosis of blood clot, and exposed alveolar bone. Results. In comparison with use of the placebo mouthri nse, prophylactic use of the chlorhexidine mouthrinse resulted in stat istically significant (p < 0.05) reductions in the incidence of alveol ar osteitis. With chlorhexidine therapy, the subject-and extraction-ba sed incidences of alveolar osteitis in the evaluable subset(271 subjec ts) were reduced, relative to placebo, by 38% and 44%, respectively. T he corresponding odds ratios that describe the increased odds of exper iencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject-and extraction-based analyses, respectively. In comparison wit h nonuse of oral contraceptives, the use of oral contraceptives in fem ale subjects was related to a statistically significant increase in th e incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relat ive to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically si gnificant (odds ratio = 1.18, p = 0.64). Smoking did not increase the incidence of alveolar osteitis relative to not smoking (odds ratio = 1 .20, p = 0.33). Conclusions. These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significa nt reduction in the incidence of alveolar osteitis after the extractio n of impacted mandibular third molars. In addition, oral contraceptive use in females was confirmed to be a risk factor for the development of alveolar osteitis.