Comparative efficacy of preprocedural mouthwashes in reducing microbial aerosols during dental procedures: A network meta-analysis.

BACKGROUND This study aimed to evaluate and rank the efficacy of common preprocedural mouthwashes in reducing microbial aerosols during dental procedures via network meta-analysis (NMA) and provide evidence-based guidance for clinical infection control.

METHODS We systematically searched eight electronic databases from inception to February 2025. Randomized controlled trials (RCTs) assessing mouthwashes for reducing microbial aerosols during dental procedures were included. A Bayesian NMA with a random-effects model was performed. Risk of bias was assessed using the Cochrane tool, and the certainty of evidence was evaluated using the CINeMA framework. Surface under the cumulative ranking curve (SUCRA) and standardized mean difference (SMD) with 95% confidence interval (CI) were calculated to quantify intervention effects.

RESULTS Twenty-five RCTs involving 1111 participants and eight interventions were included. Compared with the control group, chlorhexidine (CHX) showed the largest effect (SMD = -7.10, 95% CI [-9.44, -4.73]), followed by herbal mouthwash (SMD = -5.16, 95% CI [-8.04, -2.17]) and povidone-iodine (PVP-I) (SMD = -4.57, 95% CI [-8.79, -0.21]). Efficacy ranking based on SUCRA values was as follows: CHX (0.90), cetylpyridinium chloride (CPC) (0.68), herbal mouthwash (0.61), PVP-I (0.53), essential oil mouthwash (0.44), normal saline (0.42), hydrogen peroxide (0.39), and control (0.03).

CONCLUSIONS CHX appears to be the most effective mouthwash for reducing microbial aerosols, with CPC and herbal mouthwashes as viable alternatives, particularly for patients with CHX intolerance or mucosal sensitivity. However, evidence for CPC is limited, and the overall certainty is low. Further well-designed RCTs are needed, especially to evaluate efficacy against viral aerosols.