Hermesch C B, Hilton T J, Biesbrock A R, Baker R A, Cain-Hamlin J, McClanahan S F, Gerlach R W
Department of General Dentistry, The University of Texas Health Science Center, San Antonio, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Apr;85(4):381-7. doi: 10.1016/s1079-2104(98)90061-0.
The purposes of this study were to evaluate the use of 0.12% chlorhexidine gluconate as a prophylactic therapy for the prevention of alveolar osteitis and to further examine subject-based risk factors associated with alveolar osteitis.
The trial was a randomized, double-blind, placebo-controlled, parallel-group study conducted among 279 subjects, each of whom required oral surgery for the removal of a minimum of one impacted mandibular third molar. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine or placebo mouthrinse for 30 seconds for 1 week before and 1 week after the surgical extractions. This regimen included a supervised presurgical rinse. Alveolar osteitis diagnosis was based on the subjective finding of increasing postoperative pain at the surgical site that was not relieved with 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.
In comparison with use of the placebo mouthrinse, prophylactic use of the chlorhexidine mouthrinse resulted in statistically significant (p < 0.05) reductions in the incidence of alveolar osteitis. With chlorhexidine therapy, the subject- and extraction-based incidences of alveolar osteitis in the evaluable subset (271 subjects) were reduced, relative to placebo, by 38% and 44%, respectively. The corresponding odds ratios that describe the increased odds of experiencing alveolar osteitis in the placebo group were 1.87 and 2.05 for subject- and extraction-based analyses, respectively. In comparison with nonuse of oral contraceptives, the use of oral contraceptives in female subjects was related to a statistically significant increase in the incidence of alveolar osteitis (odds ratio = 1.92, p = 0.035). Relative to male subjects, the observed incidence of alveolar osteitis for female subjects not using oral contraceptives was not statistically significant (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).
These data confirm that the prophylactic use of 0.12% chlorhexidine gluconate mouthrinse results in a significant reduction in the incidence of alveolar osteitis after the extraction 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.
本研究旨在评估0.12%葡萄糖酸氯己定作为预防牙槽骨炎的预防性治疗方法，并进一步研究与牙槽骨炎相关的个体风险因素。
该试验是一项随机、双盲、安慰剂对照的平行组研究，共纳入279名受试者，每位受试者均需接受口腔手术以拔除至少一颗下颌阻生第三磨牙。受试者被指示在手术拔牙前1周和拔牙后1周，每天用15毫升氯己定或安慰剂漱口水漱口两次，每次30秒。该方案包括一次有监督的术前漱口。牙槽骨炎的诊断基于手术部位术后疼痛加剧的主观发现，轻度镇痛药无法缓解，并有以下一项或多项临床证据支持：血凝块丢失、血凝块坏死和牙槽骨暴露。
与使用安慰剂漱口水相比，预防性使用氯己定漱口水可使牙槽骨炎的发生率显著降低（p<0.05）。采用氯己定治疗时，可评估亚组（271名受试者）中基于个体和拔牙的牙槽骨炎发生率相对于安慰剂分别降低了38%和44%。在基于个体和拔牙的分析中，描述安慰剂组发生牙槽骨炎几率增加的相应优势比分别为1.87和2.05。与未使用口服避孕药相比，女性受试者使用口服避孕药与牙槽骨炎发生率的显著增加相关（优势比=1.92，p=0.035）。相对于男性受试者，未使用口服避孕药的女性受试者牙槽骨炎的观察发生率无统计学意义（优势比=1.18，p=0.64）。与不吸烟相比，吸烟并未增加牙槽骨炎的发生率（优势比=1.20，p=0.33）。
这些数据证实，预防性使用0.12%葡萄糖酸氯己定漱口水可显著降低下颌阻生第三磨牙拔除后牙槽骨炎的发生率。此外，证实女性使用口服避孕药是发生牙槽骨炎的一个风险因素。
