Effectiveness of Chlorhexidine Mouthwash

Why Is Chemical Plaque Control Needed?

Mouthwashes have always been considered an effective chemical plaque control route. Therefore, dentists recommend them to patients as they can reach inaccessible oral areas and are easy to use. Though there are many potent types of mouthwash, namely hydrogen peroxide or peroxyl, essential oils, cetyl pyridinium, povidone-iodine one to two percent gargles, etc., Chlorhexidine gluconate (CHX) is considered an ideal mouthwash for both wound healing and post-surgery in dentistry.

The etiologic factor now widely recognized by dentists over the globe for the development of gingivitis and periodontal disease characterized by either horizontal or vertical bone loss around the tooth and gingival recession is the "mature plaque" or "oral biofilm." Research on gingival disease prevention indicates that for gingivitis to be clinically significant with the onset of symptoms, it may take around ten to 21 days after withdrawal of any chemical or mechanical methods for plaque control.

The development of gingivitis can vary in individuals. Ranging from stress to lack of proper sleep, vitamin deficiencies, addictions, and detrimental habits like smoking and chronic alcoholism, gingivitis has a widespread etiology. Hence, the time needed to develop gingivitis varies from person to person based on the etiologic factors.

Professional scaling done by dentists is advisable every six months to one year, but combining it with effective plaque control measures can help fight gingival disease permanently. Based on this ideology of plaque control, the treatment of gingivitis is always focused on disrupting the regular biofilm that forms over the tooth's enamel surface. Professional scaling by the dentist, mechanical debridement, or chemical plaque control measures are all used in current treatment strategies for gingivitis.

Why Is Chlorhexidine Gluconate Considered a Gold Standard?

In recent decades, 0.2 percent of dental surgeons have recommended Chlorhexidine mouthwashes as a gold-standard antiplaque agent for regular use. As CHX is a biguanide agent, it has antibacterial activity in a broad spectrum range and is known for its very low toxicity. Due to its high binding capacity to the receptors on the oral mucous membrane, compared to other antiseptic mouthwashes, the prolonged antibacterial action of Chlorhexidine molecules remains high in the oral cavity.

Research shows that it takes approximately eight to 12 hours for CHX molecules to be effectively released and have a prolonged action on the oral mucous membranes to inhibit gingival or tooth plaque. The activity of CHX mouthwash has also been proven evidentially in recent decades against anaerobic infections, aerobes, yeasts, and gram-positive and gram-negative bacteria.

What Should One Notify the Doctor Before Taking This Medication?

Individuals with the following conditions must inform their dentists about it.

• Dentures, front tooth fillings, or other oral appliances.

• Additional dental or gum-related problems.

• An uncommon or adverse reaction to food, medicines, dyes, preservatives, foods, or other substances.

• Either pregnant or planning to conceive.

• Breastfeeding.

How to Take This Medication?

Use this medication right away after flossing and brushing. Make sure to rinse the mouth of any toothpaste thoroughly. To measure the dosage, use the original container's cap. Take 30 seconds to swish the medicine around in the mouth. Refrain from swallowing it. Avoid combining with water before use. Eat or drink nothing for a few hours following the rinse application. This could lessen the medication's effectiveness.

What Are the Disadvantages of Chlorhexidine Mouthwash?

CHX is the recommended gold standard mouthwash, but it also has certain disadvantages:

• Some patients report an altered taste sensation based on individual perceptions according to traditional research after using the mouthwash.

• Up to 0.1 percent of CHX mouthwashes may stain after long-term use, especially on restored teeth, natural tooth surfaces, or enamel stains.

• Very rare and less reported side effects include desquamation of the oral mucous membrane that may give the user a swollen sensation or parotid gland swelling. However, such side effects are extremely rare, according to evidence and documentation.

• Prolonged use of CHX in mentally or physically challenged individuals may cause tooth discoloration, which is another challenge as it is an acceptable mouthwash for such individuals to establish proper chemical plaque control and oral hygiene.

When Using This Drug, What Should One Be Aware Of?

See the dentist for a check-up every six months. There could be an unpleasant aftertaste from this drug. Rinsing the mouth after taking this medication will only worsen the bitter taste.

This drug may worsen tartar accumulation and discolor fillings, dentures, and teeth. To help reduce tartar build-up and discoloration, floss once a day and brush using a tartar-controlling toothpaste. If a youngster inadvertently consumes this drug, seek immediate medical attention. Young children may exhibit symptoms of intoxication, including nausea and vomiting.

How Does the Effectiveness of Chlorhexidine Mouthwash Change With a Difference in Concentration?

Recent evidence suggests that one factor behind CHX mouthwashes' effectiveness is the concentrations achieved. According to the current gold standard criterion, a Chlorhexidine mouthwash concentration of 0.12 percent to 0.2 percent is recommended twice a day for combating gingivitis. Clinical trials and studies have shown that a lower concentration of less than 0.1 percent may not be as effective in inhibiting plaque formation.

However, a low concentration of CHX mouthwash can eradicate the disadvantage of tooth staining even after prolonged usage. Also, in many commercial types of mouthwash, alcohol is used as a solvent for solubilizing antimicrobial compounds and flavor masking agents.

Recently, alcohol-free mouthwashes (especially to prevent tooth staining or for people with increased gum sensitivity or allergies) have also been introduced with good antiplaque and anti-inflammatory activity in 0.12 percent to 0.2 percent Chlorhexidine mouthwashes.

To prevent the problem of discoloration in patients suffering from prolonged gingival disease, anti-discoloration systems have now been introduced, such as the combination of 0.2 percent CHX mouthwash containing elements like sodium metabisulphite or ascorbic acid, sodium perborate monohydrate, etc., which are also potent oxygenating agents that are effective in combination with CHX to inhibit dental plaque. These kinds of CHX mouthwashes with an anti-discoloration system are also feasible for long-term use in patients where oral hygiene is compromised, especially after dental or implant surgery in the post-surgical phase of healing, where it is essential to maintain a low level of bacterial biofilm for proper wound healing.

Conclusion

The newer formulations of Chlorhexidine mouthwash can be very effective in long-term or short-term indications relevant to the clinical situation. These commercial mouthwashes use an alcohol-free and anti-discoloration system, making Chlorhexidine ideal for practical use regularly to accelerate wound healing, prevent gingival inflammation, and prevent plaque formation for at least short-term durations. For long-term usage of CHX mouthwashes, a concentration of less than 0.2 percent would be ideal but less effective in preventing plaque