Side effects of chlorhexidine mouth washes

abstract – The side effects of chlorhexidine mouth washes have been evaluated in a group of 50 soldiers during a period of 4 months. Previous publications have shown the effects on plaque formation and gingival conditions. The present paper discusses unfavorable side effects. When rinsing with 0.2 and 0.1 % chlorhexidine gluconate and acetate, some desquamations and soreness in the oral mucosa were observed. Twelve per cent of the tooth surfaces and 62 % of the silicate fillings were discolored, while 36 % of the test persons developed discolored tongues in the experimental period. Because of the side effects, there. are some objections to uncritical use of chlorhexidine in preventive dentistry. A close control is necessary; and until more information is gained, the use of chlorhexidine mouth washes is recommended for short periods only. Other methods of application must be studied.     

The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery

The purpose of this study was to determine the effect of a 0.125% chlorhexidine gluconate rinse on inflammation and bacterial plaque formation after periodontal surgery. Nine patients who required two periodontal surgeries in two posterior areas were selected. The first surgical site was randomly assigned into either 1) active or 2) placebo groups. The patient's second site was assigned to the alternate group. In Group 1 the patients rinsed with chlorhexidine (CH) and in Group 2 with placebo solution, both for 14 days. No periodontal dressing was used and at least 1 month elapsed before the second surgery was performed. Plaque index, gingival index, and crevicular fluid flow measurements were obtained at baseline, and at 1 and 2 weeks after surgery. The chlorhexidine rinse significantly reduced the amount of plaque at both 1 and 2 weeks, and gingival inflammation remained similar to base line measurements at 2 weeks. Neither solution had any effect on the amount of crevicular fluid flow. There was an increase in amount of perceived postoperative pain and gingival swelling with the use of the chlorhexidine rinse, but no difference in the number of pain pills taken during this study. The chlorhexidine rinse was an effective plaque preventive agent after surgical procedures.     

The effects of a 0.12% chlorhexidine-digluconate-containing mouthrinse versus a placebo on plaque and gingival inflammation over a 3-month period

Abstract Several previous studies have evaluated the effects of 0.12% chlorhexidine digluconate (ChD) mouthrinses on plaque and gingival inflammation. However, previously, none have been based in general dental practices. The aim of this study was to evaluate the potential to conduct controlled periodontal clinical trials in co-operation with general dental practitioners (gdps). The project took place in 5 general dental practices in the South of England. 121 healthy subjects (24 at 4 sites and 25 at the 5th). aged 18-65 years, mean 35 ± 12) years participated in a double-blind, randomised study during which they received full mouth assessments for plaque and gingival bleeding at baseline, 6 and 12 weeks. 60 subjects were randomly asigned to use the 0.12% ChD mouth wash and 6i the placebo. The assessments were carried out by 5 gpds, who had previously achieved inter-examiner κ scores of 0.78–0.85 (mean 0.81) for the plaque index (PlI), and of 0.73–0.94 (mean 0.87) for a modified gingival index (mGI), and who maintained κ scores of 0.51–0.90 for PII and of 0.73–1.00 for mGI during the 12 months required to complete the study. 98 subjects (48 ChD and 50 placebo) completed the study. Even though the baseline levels of plaque and gingivitis were low, by week 12, mean whole mouth piaque score of the ChD mouthwash users had fallen from 1.33 at baseline to 0.96 and was significantly lower (p < 0.001) than for the placebo users, 1.31 at baseline to 1.13. Whole-mouth gingival bleeding score fell from 0.56 to 0.42 in the ChD mouthwash group but was unchanged (0.54–0.55) in the placebo group. A subsidiary data analysis which considered the effects at sites indicated that within these overall differences, the ChD users experienced almost 2× the reduction from plaque score 2 at baseline at proximal molar sites over a 12-week period (50.6% ChD versus 27.6% placebo). It was concluded that 0.12% ChD mouthwash reduced plaque accumulation fay 28% and gingival inflammation by 25% over a 12–week period, that it is feasible for a group of gdps to maintain high levels of inter–examiner consistency in the use of PlI and mGI, that it is also feasible to carry out such a multicentre study in general dental practice, and that the use of mean mouth scores per subject to analyse the effects of mouthrinses may well mask variations in response throughout the mouth.     

Use of chlorhexidine as a plaque control measure following surgical treatment of periodontal disease

Abstract Chlorhexidine mouth rinsing was compared with regularly performed professional tooth cleaning as a plaque control measure during healing following periodontal surgery. 14 patients were selected for the study. A Baseline examination included assessment of oral hygiene status, gingival condition, probing depth and attachment level. In each patient, scaling and root planing was earned out in conjunction with the modified Widman flap procedure including reacontouring of alveolar bone irregularities in 2 jaw quadrants. The same procedures without osseous surgery were performed in contralateral jaw quadrants. 7 patients rinsed their mouth with a solution of 0.2% chlorhexidine digluconate twice a day, 2 min each time, for the first 6 months after therapy (healing phase). During the same period the remaining 7 patients were recalled every 2 weeks for professional tooth cleaning ad modum Axelsson & Lindhe (1974). Following reexamination after 6 months, all 14 patients were placed on a maintenance care program which included mechanical prophylaxis once every 3 months for 18 months (maintenance phase). Reexaminations were performed 6, 12 and 24 months after completion of initial therapy. The results revealed that professional tooth cleaning was somewhat more effective as a plaque control measure during healing following surgery than chlorhexidine mouth rinsing. At the end of the healing phase (1) there was a higher frequency of sites with pockets deeper than 4 mm in the patients who rinsed with chlorhexidine, (2) less gain of attachment occurred following chlorhexidine rinsing in pockets with an initial probing depth of >4 mm, and (3) attachment Joss in initially shallow pockets was somewhat more pronounced in the patients who rinsed with chlorhexidine, The differences in the effect of the 2 methods of plaque control, however, were small and in most respects diminished in the course of the maintenance phase. It was concluded that mouth rinsing with chlorhexidine is a proper alternative to plaque control during healing following periodontal surgery.     

The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes

AIM: A randomised, controlled, double-blind, clinical trial was conducted to investigate the effect of a chlorhexidine acetate/xylitol gum (ACHX) on the plaque and gingival indices of 111 elderly occupants in residential homes. A gum containing xylitol alone (X) and a no gum (N) group was included. Participants' opinions about chewing gum were also investigated. METHODS: Subjects chewed 2 pellets, for 15 min, 2x daily for 12 months. RESULTS: In the ACHX group, the plaque and gingival indices significantly decreased (p<0.001) over the 12 months. In the X group, only the plaque score significantly decreased (p<0.05) and in the N control group, both indices remained high and did not change significantly. The acceptance of both chewing gums was high but more participants in the ACHX group felt that the gum kept their mouth healthy (p<0.05). The effect of the ACHX gum on plaque and gingival indices was significantly greater than for the X gum. CONCLUSION: The long-term use of a chlorhexidine acetate/xylitol chewing gum may therefore support oral hygiene routines for an elderly dependent population.     

Influence of topical application of chlorhexidine on chronic gingivitis and gingival wound healing in the dog

Abstract— The present study examines the effect of topically applied chlorhexidine gluconate on chronically inflamed gingiva and standardized gingival wounds. Five beagle dogs were fed a soft "gingivitis inducing" diet for a period of 5 months. Subsequently, a 2 % chlorhexidine solution was applied daily for 42 days to the left molars, premolars, and canines of three dogs, the corresponding teeth in the right quadrants serving as controls. The degree of gingivitis, plaque, gingival exudation, and number of crevicular leukocytes were assessed on days 0, 11, 28, 35, and 42. The healing after gingival biopsy was studied in two dogs using the same parameters on days 0, 4, 7, 14, 28, and 42. In one of the dogs chlorhexidine was applied daily to the teeth and gingiva; the other dog had saline treatment. Biopsies for histologic examination were obtained at the beginning and the end of the experiment. From these criteria, it was shown that one daily topical application of 2 % chlorhexidine gluconate to the teeth and gingiva of the dog removes plaque and resolbes a well-established chronic gingivitis. It is concluded that in the dog it is passible through topical applications of chlorhexidine to establish and maintain a plaque- and gingivitis-free dentition.     

The effect of mouthrinses containing zinc and triclosan on plaque accumulation and development of gingivitis in a 3-week clinical test

Abstract. Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan were compared with a chlorhexidne and a negative control mouthrinse in a 3-week clinical trial. The zinc/triclosan mouthrinses 1 and 2 differed in their ethanol and humectant contents used to deliver the triclosan. The experimental protocol employed the partial mouth gingivitis design, whereby participants wear a toothshield during toothbrushing. Gingival health at baseline was established by professional cleaning, oral hygiene instruction and effective toothbrushing 3 × per day during a pre-experimental period of 2 weeks. The mouthrinses were subsequently used 2 × daily following normal toothbrushing during 3 weeks. The pre-experimental oral hygiene phase very effectively reduced plaque levels and gingival bleeding. During the rinsing period, in the absence of mechanical removal of plaque from the protected teeth, gingival bleeding rose to above the prestudy level in the negative control group. The increments (change from baseline to 21 days) of plaque and bleeding scores for the zinc/triclosan mouthrinse 1 were significantly lower than those in the negative control group. As expected, plaque and gingivitis scores were lowest in the group that rinsed with chlorhexidine. The results extend previous observations on the efficacy of the zinc/triclosan system to maintain gingival health.     

The effect of delmopinol rinsing on dental plaque formation and gingivitis healing

The aim of this study was to investigate a possible dose-response effect of delmopinol hydrochloride, on the development of plaque and on the healing of gingivitis. 64 healthy male volunteers, aged 18-40 years with healthy gingivae and clean teeth, participated. During a 2-week period, the participants refrained from all oral hygiene and rinsed 2x daily with a placebo solution. On day 14 of the study, they received professional toothcleaning, and were randomly assigned to 4 groups. For the following 2 weeks, they rinsed 2x daily for 1 min with 10 ml of 0.05% (15 subjects), 0.1% (17) or 0.2% (16) delmopinol, respectively. 16 subjects rinsed with 0.2% chlorhexidine. No oral hygiene procedures were performed during the test period. On days 0, 14 and 28, gingival bleeding index and the presence of stainable plaque were determined. Periodic identical photographs were used for planimetric determination of buccal plaque extension. No significant difference for the reduction in gingival bleeding index was found between 0.2% delmopinol and chlorhexidine rinsing. The mean plaque index showed its most significant reduction on lingual surfaces of both upper and lower jaws when rinsing with 0.2% delmopinol. Mean plaque extension was reduced by 23% for 0.05%, 39% for 0.1% and 55% for 0.2% delmopinol. A significant dose-response effect for 0.05%, 0.1% and 0.2% delmopinol was found for gingival bleeding index, plaque index and plaque extension. The results show that delmopinol favors the healing of gingivitis and reduces plaque formation.     

Oral use of chlorhexidine gluconate toothpaste in epileptic children.

The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and G I values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.     

Effects on plaque and gingivitis of a chlorhexidine dental gel in the mentally retarded

The effectiveness of a 1% chlorhexidine-containing dental gel on dental plaque and gingival health was evaluated over a period of 6 months using a double-blind procedure. One hundred and seventeen mentally retarded subjects aged between 10-17 years resident in an institution were divided into two groups. One group was assigned daily brushing with the 1% chlorhexidine gel, the other group a placebo quinine sulfate-containing gel. No other form of oral hygiene was used during the experimental period. Assessment of dental plaque accumulation and gingivitis was made at 0, 1, 3, and 6 months. An assessment was also made 2 months after the gel was withdrawn from use and normal toothbrushing procedures resumed. No clinical or statistical advantage was noted in plaque or gingivitis scores in the group receiving chlorhexidine treatment during the 6-month period. This group showed a higher prevalence of tooth staining. It was concluded that periodontal severity and poor oral hygiene exceeded the plaque- and gingivitis-preventing potential of chlorhexidine.     

Oral use of chlorhexidine gluconate toothpaste in epileptic children

abstract — The purpose of this clinical study was to evaluate the effect of a 3-min daily toothbrushing with 1% chlorhexidine gluconate toothpaste on dental plaque, gingivitis and gingival hyperplasia in 30 mentally retarded epileptic children treated with phenytoin. A double-blind cross-over technique was used. Brushing once daily for 2 months with 1% chlorhexidine gluconate toothpaste resulted in significantly lower Pl I and GI values. Gingival hyperplasia was not significantly reduced by the use of the chlorhexidine toothpaste.     

Effect of chlorhexidine gel treatment supplemented with chlorhexidine varnish and resin on mutans streptococci and Actinomyces on root surfaces

The supplementary effect of chlorhexidine varnish and resin on the reappearance of mutans streptococci and Actinomyces spp. on root surfaces after chlorhexidine gel treatment was studied. In 8 subjects with many restored tooth and exposed root surfaces, highly colonized with mutans streptococci, chlorhexidine varnish and resin were applied to the teeth on one side of the mouth and resin alone to the other side. This treatment significantly prolonged the time period of reduced salivary levels of mutans streptococci when added to a preceding period of chlorhexidine gel treatment. In 3 of the 8 subjects, mutans streptococci were undetected for more than 4 weeks after treatment. There was a significant difference between the chlorhexidine varnish/resin side and the resin side for 5 weeks with regard to the mean numbers of mutans streptococci in root surface plaque, whereas for the Actinomyces spp. no significant differences were found. In 2 subjects harboring both Streptococcus mutans and S. sobrinus, the population of S. sobrinus reappeared more readily in saliva and plaque than S. mutans. The chlorhexidine treatment was less effective in suppressing the population of Actinomyces viscosus/naeslundii than the mutans streptococci.     

Effect of chlorhexidine on acidogenicity of dental plaque in vivo.

In order to evaluate the effect of chlorhexidine on the acidogenicity of dental plaque, pH changes in plaque were measured in situ after sucrose applications. The results showed that a 0.2% chlorhexidine mouthrinse inhibited acid production for a period of 24 h, whereas a 0.05% chlorhexidine rinse showed an inhibitory effect for 4 h. It is suggested that the mechanism involved may be related to the retention of chlorhexidine in the mouth and in plaque providing a bacteriostatic milieu which may be of importance in the observed long-term effect.     

The effects of 0.5% chlorhexidine and 0.2% triclosan containing toothpastes on salivary bacterial counts

A number of antimicrobial compounds could be incorporated into toothpastes to enhance plaque inhibitory effects. However, the number of possible formulations is immense and makes clinical testing in plaque and gingivitis studies difficult. In this study, the effects on salivary bacterial counts of a number of chlorhexidine and triclosan toothpastes was evaluated as a predictor of persistence of antimicrobial action in the mouth. The study was a supervised, randomised 15-way crossover study employing 10 healthy human volunteers. All toothpastes were brushed for 1 min and comparison made with a 0.2% chlorhexidine rinse. The latter produced a large drop in salivary bacterial counts to the end of the 7-h study period. The toothpastes decreased salivary bacterial counts and all but two had notably more effect than a water brushing. No toothpaste showed a significant persistence of antimicrobial effect beyond 5 h. In the light of available plaque inhibition data for the toothpastes, persistence of antimicrobial activity beyond 5 h will be necessary for a clinical effect on plaque and gingival health. The method appears to be a simple and rapid screening technique for products formulated to enhance plaque inhibition mediated through an antimicrobial action.     

Effect of chlorhexidine on acidogenicity of dental plaque in vivo

Abstract— In order to evaluate the effect of chlorhexidine on the acidogenicity of dental plaque, pH changes in plaque were measured in situ after sucrose applications. The results showed that a 0.2% chlorhexidine mouthrinse inhibited acid production for a period of 24 h, whereas a 0.05% chlorhexidine rinse showed an inhibitory effect for 4 h. It is suggested that the mechanism involved may be related to the retention of chlorhexidine in the mouth and in plaque providing a bacteriostatic milieu which may be of importance in the observed long-term effect.     

Efficacy of ozonated water over chlorhexidine mouth rinse in chronic gingivitis patients – A comparative clinical study

AimThis study aimed to compare the efficacy of ozonated water mouth rinse over chlorhexidine mouth rinse against the accumulation of plaque in chronic gingivitis patients.Materials and methodsA total of 30 patients with chronic generalized gingivitis were choosen for the study. The duration of this study was 15 days and was divided into three groups. Group 1 patients were advised to rinse with ozonated water¸ group 2 with a chlorhexidine mouth rinse and group 3 with water for 15 days. The clinical parameters like plaque index, gingival index, and bleeding index were recorded at baseline, 7th, and 15th day respectively. Saliva samples were collected for microbial culture at baseline that is before mouth rinse and on the 15th day that is after using mouth rinse from each patient.ResultsThe statistical analysis was performed by using ANOVA and Bonferroni’s Post Hoc test on 30 patients at the end of the 15^thday. There was a significant decrease in mean plaque, gingival, and bleeding scores in group 2 patients that are chlorhexidine mouth rinse. There was also a decrease in the microbial culture at the end of the 15th day in patients with chlorhexidine mouth rinse compared to ozonated water.ConclusionThe results of this study demonstrate that ozonated water was less effective compared to chlorhexidine mouth rinse in reducing plaque in gingivitis patients. But ozonated water can be used as an alternative to CHX.     

Some effects of chlorhexidine on the plaque flora of the Beagle dog

Three series of experiments were performed during which Beagle dogs were given a plaque forming diet, in Series I 10 dogs were sprayed twice daily with 0.2 per cent chlorhexidine and 10 controls with saline for six months. In Series II the same treatment was used for 18 months in 16 dogs (8 treated. 8 controls). In Series III , comprising three dogs, the teeth of the left jaws, were subjected to two different concentrations of chlorhexidine for 5 + 5 weeks (2 resp. 0.1 %) while the teeth of the right jaws received saline treatment. During a subsequent period of 3 months all teeth were created with saline.
Dental plaque was sampled at the end of the three experimental periods, in Series III also one, three, six and thirteen weeks later. The sensitivity to chlorhexidine of the plaque bacteria was tested using a modification of "the paper disc method". In all series the plaque bacteria from chlorhexidine treated teeth displayed reduced sensitivity to the drug. After termination of the chlorhexidine treatment in the Series III-experiments the reduced sensivity to chlorhexidine of plaque bacteria from chlorhexidine treated teeth slowly approached the corresponding values from saline treated teeth.
Plaque samples taken after 18 months (Series II) were studied by means of a dilution-plate method. The- dominating colonies from each plate were identified as gram-negative aerobic rods. Most of the bacteria from chlorhexidine treated dogs grew on trypticase soy agar plates containing 320 μg/ml chlorhexidine. while bacteria from the saline treated animals only grew on plates containing 20 μg/ml.     

Plaque control with chlorhexidine and D-301, a quaternary ammonium compound

Eighteen female dental hygiene students took part in a double-blind, crossover clinical trial of equimolar (2.2 mmol) rinsing solutions of D-301, a quaternary ammonium compound and chlorhexidine digluconate, Rinsings were partly supervised, test periods were 7 days (5 days without oral hygiene) with a 1-week interval. Plaque formation was significantly reduced by both test solutions versus the control; on not precleaned tooth surfaces plaque formation was equally inhibited by the chlorhexidine and D-301 mouthrinses. On precleaned surfaces D-301 significantly inhibited plaque formation compared with the control rinse, but was less effective than chlorhexidine. There was no significant change in the PBI, a measure of gingival inflammation, during any of the test period. Staining of teeth and tongue was judged as equal after chlorhexidine and D-301 use. Reports of taste and gastric disturbances were minimal but more frequent during the D-301 test period.     

Clinical effect of subgingival chlorhexidine irrigation on gingivitis in adolescent orthodontic patients.

Twenty-three adolescent orthodontic patients with gingivitis affecting all banded first molars volunteered for the study. Three measures associated with gingivitis (papilla bleeding index, plaque index, and probing depth) were recorded at four sites for all four molars. A single application of subgingival irrigation with 0.12% chlorhexidine digluconate or isotonic saline was performed for 5 seconds at each site. As determined by coin toss, the first molars on the right or left side of the mouth received either chlorhexidine or saline irrigation. The papilla bleeding index, plaque index, and probing depth were recorded before the treatment and subsequently at 2 weeks and then 4 weeks. The gingival bleeding as determined by papilla bleeding index, was virtually eliminated in 4 weeks by a single application of subgingival irrigation with either chlorhexidine or saline. However, there was no significant reduction in pocket depth or plaque index. In addition, no significant difference between the effect of chlorhexidine or saline was found for any of the outcome measures.     

The effect of different plaque control modalities on the keratinizing potential of the sulcular epithelium in monkeys

The purpose of this study was to determine if various plaque control regimes would be effective in permitting the gingival sulcular epithelium to keratinize. Three adult Rhesus monkeys had their teeth scaled and were placed on specific plaque control regimes including various combinations of prophylaxes, topical chlorhexidine and systemic tetracycline. Over the 2-month experimental period, weekly Plaque and Gingival Indices were determined. Subgingival plaque samples were obtained during the first 2 treatment weeks and at the end of the 1st month. Block sections of individual teeth from the different experimental regimes were serially sectioned to be evaluated histologically for inflammation and keratinization. Plaque and Gingival Indices were significantly reduced by the end of the 8th week compared to the pretreatment levels for all experimental regimes, except that the regime consisting only of three prophylaxes per week failed to reduce the Gingival Index significantly. Rubber cup prophylaxes were less effective in reducing plaque and inflammation than when the prophylaxes were combined with topical chlorhexidine application or systemic tetracycline administration. However, all experimental regimes were capable of reducing the subgingival bacterial flora to a level permitting sufficient reduction in gingival inflammation so that sulcular keratinization would occur. Some degree of sulcular keratinization was observed for every tooth of all experimental regimes. All regimes caused a significant decrease in the Inflammatory Indices relative to the control values. A negative correlation was found between the Crestal Inflammatory Index and the Keratin Width and Keratin Length, while a positive correlation was apparent between the Keratin Width and Keratin Length.