• Dayanne Simões Ferreira Santos, Mariela Peralta-Mamani, Felipe Suaki Brandão, Flaviana Bombarda Andrade, Thiago Cruvinel, and SantosPaulo Sérgio da SilvaPSDS0000-0002-0674-3759DDS, PhD. Dentist and Associate Professor, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), São Paulo (SP), Brazil..
• DDS. Dentist and Master's Student, Department of Surgery, Stomatology, Pathology and Radiology, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), São Paulo (SP), Brazil.
• Sao Paulo Med J. 2022 Jan 1; 140 (1): 42-55.

BackgroundMaintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this.ObjectivesTo identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota.Design And SettingSystematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil.MethodsA systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThe studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects.ConclusionMouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

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