Review Article

A Systematic Review of the Effect of Oral Rinsing with H2O2 on Clinical and Microbiological Parameters Related to Plaque, Gingivitis, and Microbes

Table 2

Main characteristics and results for the studies that assess plaque index.

Study, year, country (reference)
Study design
Systemic conditions
Diagnosis of the oral condition
Plaque index assessed
H2O2 group (concentration)
Rinsing protocol
N (smokers)
Age
Baseline
N(M)/N(F)
End
N(M)/N(F)
CHX group (concentration) Rinsing protocol
N (smokers)
Age
Baseline
N(M)/N(F)
End
N(M)/N(F)
Control group
Rinsing protocol
N (smokers)
Age
Baseline
N(M)/N(F)
End
N(M)/N(F)
Main results (follow-up)
Baseline scores
Mean ± SD
End scores (follow-up)
Mean ± SD
∆ (%)Author conclusions

Studies without experimental gingivitis

Boyd, 1989, USA [15];
Non-RCT
Systemically healthy;
Adolescents with initial oral health scheduled to have fixed orthodontic treatment;
PI (S & L)
H2O2 1.5% + 0.05% NaF + toothbrush;
Once-a-day (1/2 ounce per one minute) during 18 months;
Smokers NR;
Mean age:13.2 yrs;
Baseline: 9/17;
End: 24 individuals in total (proportion of M/F NR).
NA0.05% NaF + toothbrush;
Once-a-day (1/2 ounce per one minute) during 18 months;
Smokers NR;
Mean: 13.5 yrs;
Baseline: 11/23;
End: 32 individuals in total; (proportion of M/F NR).
Percent of sites with PI (S & L) >1:
A:13.15 ± 17.40
B: NA
C: 19.05 ± 26.00
(18 months)
Percent of sites with PI (S & L) >1:
A: 18.50 ± 13.18
B: NA
C: 36.79 ± 35.60
PI (S & L)
A: 5.35 (40.68%)
B: NA
C: 17.74 (93.12%#)
When the percentage of sites with plaque index greater than 1 was considered, the group that used H2O2 showed significantly lower percentage when compared to the control group

Clark, 1989, USA [19]
RCT (parallel)
Systemically healthy;
Gingivitis (at least 8 sites with marginal gingival bleeding)
PIS (Q & H)
H2O2 1.5% (use of toothbrush and dentifrice NR);
Once-a-day (20 ml for 30 s) during 21 weeks;
2 smokers
Mean age: 28.9 yrs
Baseline: 9/16
End: 22 individuals in total (proportion of M/F NR)
NAWater (use of toothbrush and dentifrice NR);
Once-a-day (20 ml for 30 s) during 21 weeks;
No smokers
Mean age 27.8 yrs
Baseline: 8/17
End: 22 individuals in total (proportion of M/F NR)
A: 2.87 ± 0.38
B: NA
C: 2.90 ± 0.25
(6 months)
A: 1.72 ± 0.58
B: NA
C: 1.74 ± 0.46
A: −1.15 (−40.07%)
B: NA
C: −1.16 (−40.00%)
No statistically significant difference between groups

Gomes, 1984, USA [20]
RCT (parallel)
Nonhandicapped staff and handicapped patients—both of them were free of systemic diseases
Individuals without periodontitis (probing depth <5 mm)
PI (L)
H2O2 1.5% (use of toothbrush and dentifrice NR)
Three times per day (10 ml per 60 s) during 7 days
Staff: smokers NR Mean age: 30.34 yrs
Baseline: 5/34
End: NR/NR
Patients: smokers NR
Mean age: 28.65 yrs
Baseline: 30/24
End: NR/NR
NAPlacebo mouth rinse (use of toothbrush and dentifrice NR)
Three times per day (10 ml per 60 s) during 7 days
Staff: smokers NR
Mean age: 29.94 yrs
Baseline: 5/30
End: NR/NR
Patients: smokers NR
Mean age: 28.62 yrs
Baseline: 25/25
End: NR/NR
Staff—male
A: 0.68 ± 0.54
B: NA
C: 0.66 ± 0.38
Staff—female
A: 0.61 ± 0.50
B: NA
C: 0.43 ± 0.24
Patients—male
A: 1.29 ± 0.55
B: NA
C: 1.53 ± 0.69
Patients—female
A: 1.30 ± 0.55
B: NA
C: 1.23 ± 0.59
(7 days)
Staff—male
A: 0.54 ± 0.49
B: NA
C: 0.72 ± 0.52
Staff—female
A: 0.45 ± 0.50
B: NA
C: 0.41 ± 0.26
Patients—male
A: 1.05 ± 0.55
B: NA
C: 1.51 ± 0.55
Patients—female
A: 1.07 ± 0.41
B: NA
C: 1.19 ± 0.57
Staff—male
A: −0.14 (−20.59%#)
B: NA
C: 0.06 (9.09%)
Staff—female
A: −0.16 (−26.22%#)
B: NA
C: −0.02 (−4.65%)
Patients—male
A: −0.24 (−18.60%#)
B: NA
C: −0.02 (−1.31%)
Patients—female
A: −0.23 (−17.69%#)
B: NA
C: −0.04 (−3.25%)
In the within group comparison, a significantly lower plaque score was detected, for both staff and patient groups, only for H2O2
Hasturk, 2004; USA [11]
RCT (parallel)
Systemically healthy
Gingivitis (gingival index >2.0 and >10% sites with bleeding). In the first 28 days, only the mouth rinses were used.
PIS (Q & H)
H2O2 1.5% + 0.05 sodium fluoride toothpaste + toothbrush
Twice daily (quantity not reported for 30 s) during 6 months;
3.9% smokers (N not provided)
Mean age: 31.4 yrs;
Baseline: 19%/51% (N not provided)
End: NR/NR
NAPlacebo mouth rinse 0.05 sodium fluoride toothpaste + toothbrush
Twice daily (quantity not reported for 30 s) during 6 months
18.8% smokers (N not provided)
Mean age: 31.0 yrs
Baseline: 45.8%/54.2% (N not provided)
End: NR/NR
A: 1.03 ± 0.81
B: NA
C: 0.87 ± 0.58
(6 months)
A: 0.99 ± NR
B: NA
C: 0.99 ± NR
A: −0.04 (−3.88%)
B: NA
C: 0.12 (13.79%)
No statistically significant difference between groups

Porwal, 2018, India [10]
RCT (parallel)
Systemically healthy
Gingivitis (modified gingival index of 3 and plaque index of 4)
PIS (Q & H)
H2O2 3% with distilled water (ratio 1 : 1)
Twice daily (10 ml and time not reported) during 15 days
Smokers NR
Mean age: NR
Baseline: 10 individuals in total (proportion of M/F NR)
End: 10 individuals in total (proportion of M/F NR)
CHX 0.2% with distilled water (ratio 1 : 1)
Twice daily (10 ml and time not reported) during 15 days
Smokers NR
Mean age: NR
Baseline: 10 individuals in total (proportion of M/F NR)
End: 10 individuals in total (proportion of M/F NR)
NAA: 3.12 ± 0.44
B: 3.26 ± 0.53
C: NA
(28 days)
A: 1.28 ± 0.86
B: 0.82 ± 0.54
C: NA
A: −1.84 (−58.97%#)
B: −2.44 (−74.85%#)
C: NA
No statistically significant difference between groups

Rashed, 2016, Saudi Arabia [12]
RCT (parallel)
Systemically healthy
Periodontitis (clinical attachment loss >4 mm in >30% of the sites)
PI (O’L)
H2O2 1.5% + scaling and root planning + mechanical oral hygiene
Twice daily (quantity and time not reported) during 10 days
No smokers
Age range: 30–50 yrs
Baseline: 15/0
End: 15/0
CHX 0.2% + scaling and root planing + mechanical oral hygiene
Twice daily (quantity and time not reported) during 10 days
No smokers
Age range: 30−50 yrs
Baseline: 15/0
End: 15/0
Scaling and root planing only + mechanical oral hygiene
Not applicable
No smokers
Age range: 30−50
Baseline: 15/0
End: 15/0
A: NR ± NR
B: NR ± NR
C: NR ± NR
(3 months)
A: NR ± NR
B: NR ± NR
C: NR ± NR
A: NR (NR#)
B: NR (NR#)
C: NR (NR#)
No statistically significant difference among groups

Sharma, 2019; India [21]
RCT (parallel)
Systemically healthy;
Halitosis (patients with organoleptic score >1, in a scale of 0 to 5);
PI (S & L)
H2O2 1.5% (use of toothbrush and dentifrice NR)
Twice daily (10 ml and time not reported) during 15 days
No smokers
Mean age: 24.78 yrs (whole-sample)
Baseline: NR/NR
End: NR/NR
CHX 2% (use of toothbrush and dentifrice NR)
Twice daily (10 ml and time not reported) during 15 days
No smokers
Mean age: 24.78 yrs (whole-sample)
Baseline: NR/NR
End: NR/NR
NAA: 1.82 ± 0.13
B: 1.78 ± 0.22
C: NA
(15 days)
A: 1.68 ± 0.12
B: 1.50 ± 0.26
C: NA
A: −0.14 (−7.69%#)
B: −0.28 (−15.73%#)
C: NA
CHX group showed significantly lower plaque in comparison to H2O2

Studies with experimental gingivitis
Gusberti, 1988, Switzerland [16]
Non-RCT (parallel)
Not reported
Not reported
PI (S & L)
H2O2 1%
Twice daily (15 ml for 30 s) during 21 days
Smokers NR
Mean age NR
Baseline: NR/NR
End: NR/NR
CHX 0.12%
Twice daily (15 ml for 30 s) during 21 days
Smokers NR
Mean age NR
Baseline: NR/NR
End: NR/NR
Flavored alcoholic placebo solution
Twice daily (15 ml for 30 s)
Smokers NR
Mean age NR
Baseline: NR/NR
End: NR/NR
A: 0.00 ± 0.00
B: 0.00 ± 0.00
C: 0.00 ± 0.00
(21 days)
A: 1.40 ± NR
B: 0.35 ± NR
C: 1.56 ± NR
A: 1.40
B: 0.35
C: 1.56
Significantly lower plaque index detected in the CHX group when compared to both groups
No statistically significant difference was detected between H2O2 and control groups

Hoenderdos, 2009 [22] Netherlands
RCT (parallel)
Systemically healthy
Periodontally healthy (no sites with probing depth >5mm)
PIS (Q & H)
H2O2 0.013% + 0.004% glycerol dissolved in demineralized water
Twice daily (15–20 ml for 20 s) during 3 days
Smokers NR
Mean: 24.5 yrs (whole-sample)
Baseline: NR/NR
End: NR/NR
NA0.004% glycerol dissolved in demineralized water
Twice daily (15–20 ml for 20 s) during 3 days
Smokers NR
Mean: 24.5 yrs (whole-sample)
Baseline: NR/NR
End: NR/NR
A: 0.00 ± 0.00
B: NA
C: 0.00 ± 0.00
(3 days)
A: 2.66 ± 0.29
B: NA
C: 2.70 ± 0.32
A: 2.66
B: NA
C: 2.70
No statistically significant difference was detected between groups

Wennström, 1979; Sweden [18]
Non-RCT (cross-over)
Systemically healthy
Oral health
PI (S & L)
H2O2 (1.7 g dissolved in 30 ml of tap water)
Three times a day (30 ml per 2 minutes) during 14 days
Smokers NR
Mean age NR
Baseline: NR/NR (total n = 14)
End: NR/NR (total n = 14).
NAPlacebo mouthwash
Three times a day (30 ml per 2 minutes) during 14 days
Smokers NR
Mean age NR
Baseline: NR/NR (total n = 14)
End: NR/NR (total n = 14).
Percent of sites with score 0
A: 98.90 ± 0.50
B: NA
C: 98.70 ± 0.50
Percent of sites with score 1
A: 1.00 ± 0.40
B: NA
C: 1.30 ± 0.50
Percent of sites with score 2
A: 0.10 ± 0.10
B: NA
C: 0.00 ± 0.00
Percent of sites with score 3
A: 0.00 ± 0.00
B: NA
C: 0.00 ± 0.00
(14 days)
Percent of sites with score 0
A: 46.40 ± 4.30
B: NA
C: 17.20 ± 2.90
Percent of sites with score 1
A: 45.20 ± 3.60
B: NA
C: 37.00 ± 4.80
Percent of sites with score 2
A: 8.70 ± 3.60
B: NA
C: 44.40 ± 6.20
Percent of sites with score 3
A: 0.00 ± 0.00
B: NA
C: 1.40 ± 0.90
Sites with score 0
A: −52.50 (−53.08%)
B: NA
C: −81.50 (−82.57%)
Sites with score 1
A: 44.20 (4420%)
B: NA
C: 35.70 (2,746%)
Sites with score 2
A: 8.6 (8,600%)
B: NA
C: 44.4
Sites with score 3
A: 0 (0%)
B: NA
C: 1.40
Significantly higher percentage of score 0 was detected in the H2O2 group in comparison to the control group
No statistically significant difference was detected between groups of score 1
Significantly lower percentage of score 2 was detected in the H2O2 group in comparison to the control group
Significantly lower percentage of score 2 was detected in the H2O2 group in comparison to the control group

NA: not applicable; NR: not reported; RCT: randomized clinical trial; non-RCT: nonrandomized clinical trial; CHX: chlorhexidine. M: male; F: female. A: H2O2 rinse; B: chlorhexidine rinse; C: control rinse. ∆: delta of mean (final−initial mean); %: percentage of reduction. PI (S & L): plaque index (Silness & Löe, 1964); PIS (Q & H): Quigley–Hein plaque modified by Turesky plaque index; PI (L): plaque index (Löe, 1967); PI (O’L): O’Leary plaque index. Statistically significant differences between groups (H2O2 vs chlorhexidine); statistically significant differences between groups (H2O2 vs control); #statistically significant differences within group (end vs baseline score).