Chlorhexidine mouthwash for the prevention of alveolar osteitis after oral surgery

ISRCTN ISRCTN14646628
DOI https://doi.org/10.1186/ISRCTN14646628
Secondary identifying numbers N/A
Submission date
13/08/2016
Registration date
16/08/2016
Last edited
22/01/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Oral Health
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Alveolar osteitis (AO) is the most common complication of tooth removal. It occurs when a blood clot fails to develop in the tooth socket, or if the blood clot becomes dislodged or disappears. The empty socket causes severe pain, headaches, fever, and paresthesia (pins and needles). Today, treatments are focused on managing the symptoms and these are not very effective, highlighting the importance of preventing the development of AO. The aim of this study is to assess the effectiveness of chlorhexidine mouthwash after tooth extraction in patients who are at risk of developing AO (previous surgical site infection, traumatic extraction, and tobacco smoking).

Who can participate?
Adults who have undergone tooth extractions and are at risk of developing AO

What does the study involve?
After the tooth extraction, participants are randomly allocated to use either chlorhexidine mouthwash or sterile water for 30 seconds, twice daily for 7 days, starting 24 hours after extraction. After 7 days participants are followed-up to check whether they have developed AO.

What are the possible benefits and risks of participating?
Chlorhexidine mouthwash may reduce the chance of developing AO. The only risk is hypersensitivity (allergic reaction) to chlorhexidine.

Where is the study run from?
Valdivia and Panguipulli, Región de Los Ríos, Chile

When is the study starting and how long is it expected to run for?
June 2012 to December 2015

Who is the main contact?
Dr Diego Halabi
diego.halabi@uach.cl

Contact information

Dr Diego Halabi
Scientific

Edificio de Ciencias Biomedicas
Facultad de Medicina
Isla Teja
Valdivia
5090000
Chile

ORCiD logoORCID ID 0000-0002-1474-8066
Phone +56 (0)63 2293928
Email diego.halabi@uach.cl

Study information

Study designProspective stratified parallel randomized double-blind placebo-controlled clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typePrevention
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleChlorhexidine 0.12% mouthwash for the prevention of alveolar osteitis after oral surgery: a double-blind randomized clinical trial
Study acronymChAOP (Chlorhexidine for Alveolar Osteitis Prevention)
Study objectivesChlorhexidine 0.12% mouthwash is better than placebo at preventing alveolar osteitis after oral surgery.
Ethics approval(s)Research Ethic Committee of Health Community Service of Valdivia, Chile, 22/03/2013, ORD.: Nº 073
Health condition(s) or problem(s) studiedAlveolar osteitis (dry socket)
InterventionTreatment: consisted of a mouthwash with 15 mL chlorhexidine 0.12% (Oralgene® Mouthwash 0.12%, Maver, Chile) for 30 seconds, twice daily for 7 days, starting 24 hours after extraction.
Placebo: Sterile water, with the same indications for use as chlorhexidine.
Chlorhexidine and placebo were stored in similar brown plastic bottles, and instructions were given orally and in writing to each participant.

Patients were randomly allocated to the Chlorhexidine or Placebo group, matched by risk factors, and seven groups were formed with the following possible combinations: smoker, previous infection, traumatic extraction, smoker + previous infection, smoker + traumatic extraction, previous infection + traumatic extraction, previous infection, traumatic extraction. To avoid the risk of having more patients in a group, we stored black envelopes in a box containing a paper with the letter C for chlorhexidine or P for placebo (half of each). For each patient who was assigned to a group, the subsequent patient who arrived with the same risk factors was matched to the opposite group, and the respective envelope was discarded (to ensure homogeneity of groups).
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase IV
Drug / device / biological / vaccine name(s)Chlorhexidine 0.12% mouthwash
Primary outcome measurePositive diagnosis of alveolar osteitis was identified in patients with the following two characteristics (both variables must be present):
1. Increasing postoperative pain intensity for 4 days within and around the socket: We asked as a dichotomous variable: yes or no. (AO presents with severe pain, therefore, this variable is easily detectable)
2. Total or partial breakdown of the blood clot in the socket with or without bone exposure: like pain, this variable is easy detectable by clinical examination, the clot should completely cover the socket for proper healing
The primary outcome was measured seven days after dental surgery
Secondary outcome measuresN/A
Overall study start date01/06/2012
Completion date27/12/2015

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants744
Key inclusion criteriaPatients with clinical indications for tooth extraction, and who presented at least one of the following risk factors for developing alveolar osteitis:
1. Tobacco smoker (consumption of ≥ 5 cigarettes 24 hrs before extraction)
2. Previous surgical site infection (clinical diagnosis of chronic periodontitis, acute periodontal conditions, apical periodontitis, pericoronitis, fungal infections, or dental pulp gangrene)
3. Traumatic extraction (lifting a flap, use of elevators for > 4 min, and/or rotary instruments)
Key exclusion criteria1. Patients requiring extraction in the operating theater
2. Patients living in rural areas who manifested difficulty in returning for follow-up
3. Patients allergic to chlorhexidine
4. Patients under antimicrobial therapy, antibiotic prophylaxis, or antibiotics therapy after extraction
Date of first enrolment01/04/2013
Date of final enrolment27/12/2015

Locations

Countries of recruitment

  • Chile

Study participating centres

Dental Emergency Service “ Dr Jorge Sabat Gozalo”
2500, Picarte Street
Valdivia
5090000
Chile
Coñaripe Health Comunity Center
Las Tepas S/N
Panguipulli, Valdivia
5210000
Chile

Sponsor information

Universidad Austral de Chile
University/education

Campus Isla Teja S/N
Valdivia
5090000
Chile

Website http://www.uach.cl
ROR logo "ROR" https://ror.org/029ycp228

Funders

Funder type

Other

Investigator initiated and funded

No information available

Results and Publications

Intention to publish date27/12/2016
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planWe are preparing the manuscript for publication before this year ends (2016)
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/09/2018 22/01/2019 Yes No

Editorial Notes

22/01/2019: Publication reference added