CRD summary: This review assessed whether rinsing with chlorhexidine reduced the occurrence of alveolar osteitis (AO) following mandibular third molar removal. The authors concluded that multiple rinsing may reduce the incidence of AO. It was difficult to establish the robustness of the findings due to poor reporting of the review methods and a lack of information on the individual studies.

CRD commentary: The review used defined inclusion criteria for the intervention, participants and study design, though the inclusion criteria for the outcomes were somewhat unclear. No language restrictions were applied to the searches, but the limited set of sources searched means that relevant studies might have been missed. The review methodology was reasonably well described, although appropriate measures did not seem to have been taken to reduce error and bias during the data extraction process. Only a subset of studies was quality assessed and important aspects of quality, such as method of randomisation and concealment of allocation, were not considered. A more detailed description of the primary study populations would have been useful and enabled an assessment of the extent of clinical heterogeneity. Statistical heterogeneity was not investigated and details of the statistical pooling were not provided; it was therefore unclear whether the studies were appropriately pooled. Owing to the lack of details on several aspects of the review methodology and on individual studies, it was difficult to establish the robustness of the conclusions. From the data available it was inappropriate to conclude that rinsing at least on the day of surgery and several days after leads to a benefit, given that some of the studies also administered CHX prior to surgery and all these studies were pooled together.