Chlorhexidine reduces the incidence of alveolar osteitis in the absence of systemic antibiotics.

The threat of antibiotic resistance has been a global public health issue. This problem is often aggravated by inappropriate antibiotic administration, including those after the third molar surgery. Thus, systemic antibiotic use in third molar surgery should be considered strictly. The use of antiseptics after third molar surgery, such as chlorhexidine, may help prevent postoperative complications; therefore, its use should be encouraged. This study aimed to determine whether chlorhexidine is beneficial in preventing alveolar osteitis without systemic antibiotics. This review was conducted to determine whether chlorhexidine is beneficial in preventing alveolar osteitis (AO) and was designed according to the PICO model. Alternating combinations of keywords were used, including "third molar surgery," "chlorhexidine," "mouthwash," "wound dressing," and "irrigation" to search PubMed, Cochrane Library, and Scopus. Clinical studies of third molar surgery that reported clinical outcomes after postoperative chlorhexidine supplementation without systemic antibiotic prescription were included. Twelve studies were included in the meta-analysis. The incidence of alveolar osteitis (AO) in the chlorhexidine group was significantly lower than that in the control group (9.58% vs. 16.8%, P < 0.0001). Chlorhexidine reduced the risk of AO by 42.9%. The use of chlorhexidine can effectively prevent AO and should be considered good clinical practice to mitigate antimicrobial resistance.