Clinical applications of chlorhexidine in oral wound healing: scoping review of current evidence and research gaps

This scoping review aimed to comprehensively synthesize the current evidence and gaps regarding the use of chlorhexidine (CHX) in oral wound healing after surgical procedures.PRISMA-ScR reporting guidelines were followed. A systematic search of MEDLINE, Embase, Web of Science, and Scopus was conducted to identify primary-level studies published before July-2024.Sixty-six studies, encompassing 6,763 patients met eligibility criteria. Third molar extractions were the most studied procedures (n=44), where CHX use consistently improved wound healing, significantly reduced the risk of alveolar osteitis and alleviated postoperative pain, with over 70% of studies reporting favorable outcomes. CHX application, across different concentrations and pharmaceutical forms, was consistently associated with better wound healing, with gels (n=29) and rinses (n=36) showing favorable results in 75% and 80% of studies, respectively; both 0.12% (n=21, 72.7%) and 0.20% (n=41, 81.3%) concentrations proved effective, with short-term postoperative regimens (7 days, n=27) or intraoperative application (n=22) emerging as the most reliable protocols. Moreover, combinations of CHX with adjuvant agents, particularly chitosan (n=4) and hyaluronic acid (n=5), demonstrated synergistic benefits, although the number of available trials remains limited.In conclusion, current evidence supports the application of CHX as an effective and low-cost adjuvant in optimizing oral wound healing and preventing postoperative complications, singularly alveolar osteítis and postoperative pain after third molar extractions. Both gel and rinse formulations, as well as concentrations of 0.12% and 0.20%, have been shown to be effective, with indications related to clinical context and duration of use. Finally, CHX associatiations with chitosan and hialuronic are promising, although still based on a low evidence level. Future well-designed clinical trials are needed to address current evidence gaps, standardize administration protocols and further explore synergistic combinations.