tooth health

Chlorhexidine mouthwash

What is it for?

Powerful antibacterial disinfectant, chlorhexidine mouthwash is commonly recommended or prescribed by the dentist as a medical aid in the treatment of gum disease and oral cavity.

More precisely, chlorhexidine mouthwash is extraordinarily effective in the chemical control of bacterial plaque (sticky patina consisting of millions of bacteria immersed in a matrix that adheres as a glue to the surface of the teeth).

As reported in the European Journal of Oral Sciences, chlorhexidine mouthwashes seem to be the most effective ever to disinfect the oral cavity and prevent dental infections.

As we will see in the course of the discussion, chlorhexidine mouthwashes should not be used for long periods because they can alter the natural color of the tooth enamel, causing unsightly stains on the teeth (removable only by professional dental cleaning).

deepening

Chlorhexidine is a powerful synthetic antibacterial with a dual action: this substance acts as a bactericidal agent (kills germs) and bacteriostatic (prevents the replication of bacteria). Chlorhexidine also appears to be active against some capsule fungi and viruses.

In mouthwashes, the active ingredient is chlorhexidine gluconate (gluconic acid salified with chlorhexidine in aqueous solution)

Therapeutic uses

At concentrations of 0.2%, chlorhexidine is widely used as an active ingredient in the preparation of medicated mouthwashes destined to rebalance the altered bacterial load of the oral cavity. Often these mouth rinses are even prescribed to prevent some typical oral cavity disorders such as gingivitis and bleeding gums.

We are all aware of the fundamental importance of oral hygiene for the prevention of infections and dental diseases. However, due to some morbid conditions, it is not always possible to guarantee an impeccable oral cleaning with the help of toothpaste, brush and dental floss (or brush). To ensure satisfactory oral hygiene and to kill bacteria, as long as the disease or disorder is not restored, it is sometimes recommended to rinse the mouth with chlorhexidine mouthwashes.

For this purpose, rinses with this type of mouthwash are indicated in the following circumstances:

  • Prevention of alveolitis (especially), dental granuloma, cysts or other dental infections after tooth extraction
  • Prevention of infections after an important dental intervention (eg apicectomy). In general, fillings and devitalizations do not require treatment with chlorhexidine mouthwashes
  • Prevention of dental infections in patients with fixed or mobile dental prostheses
  • Treatment of oral ulcers
  • Support in the treatment of diseases of the periodontium (pyorrhea)
  • Reparative treatment of injured gingival tissues, dependent on oral cysts or dental trauma
  • Treatment of halitosis (mouthwashes with 0.05% chlorhexidine )
  • Prevention of plaque and tartar accumulation: the therapeutic effect is enhanced when chlorhexidine mouthwash is enriched with xylitol

Prevents tooth decay?

Although chlorhexidine is considered the anti-plaque agent par excellence, the use of such mouthwashes does not seem to be completely effective in preventing tooth decay.

According to what has been reported in the journal Operative Dentistry, it seems that the role of chlorhexidine in the prevention of carious diseases is rather controversial. Let's start by saying that dentists recommend using these mouthwashes for relatively short periods, in order to avoid the typical side effects of chlorhexidine (alteration of the natural color of the teeth, burning of the oral mucosa, etc.). Starting from this assumption, we deduce that the presumed inefficacy of chlorhexidine mouthwashes against caries is not due to the poor antibacterial power of the substance, but rather to a use of the same necessarily infrequently. In support of this hypothesis, we must not forget that caries is not caused simply by the presence of bacteria in the oral cavity: carious pathology is in fact a multifactorial infection, the result of an interweaving of elements that are not always easily identifiable.

Use and warnings

To get the maximum therapeutic effect, it is important to know the correct use of chlorhexidine mouthwash which - let us remember again - is a drug in all respects.

To prevent the teeth from tinting with black or yellowish stains (a typical side effect of chlorhexidine abuse) it is strongly recommended to follow the doctor's instructions to the letter.

First, it is essential to use medicated mouthwashes with a concentration of chlorhexidine that is adequate for your condition. While for the treatment of halitosis chlorhexidine gluconate should not exceed 0.05%, in the treatment of gingivitis or in the prevention of infections after a dental operation, the concentration of the active ingredient in the mouthwash can vary from 0.12% to 0, 2%.

Thus established that rinsing therapy with chlorhexidine mouthwashes can only be performed after medical advice, let's see how to use the product:

  1. Rinse your mouth for about 50-60 seconds with a scoop of chlorhexidine mouthwash: (about 10 ml) after a dental operation, the rinsing must be slow and very gentle to avoid ripping the stitches.
  2. Respect the indications provided by the manufacturer: a rinsing time too short causes insufficient absorption of chlorhexidine, while a prolonged rinsing increases the risk of stains forming on the teeth. The image below shows how the ideal concentration of chlorhexidine absorbed (4 mg) requires different rinsing times based on the concentration of the active ingredient (15 seconds for mouthwashes at 0.3% chlorhexidine, 30 seconds for products at 0.2% and 60 seconds for 0.12% products)

  1. Do not swallow the product
  2. Do not rinse your mouth with water after gargle with mouthwash
  3. Immediately after rinsing, it is recommended NOT to brush the teeth with toothpaste. It is in fact known that some ingredients commonly used in the formulation of a toothpaste (in particular sodium lauryl sulfate and sodium monofluorophosphate) tend to deactivate or alter the disinfectant-antibacterial effect of chlorhexidine. Therefore, it is advisable to brush the teeth with toothpaste only after 30 minutes / 2 hours after rinsing. Alternatively, when the anti-plaque solution is taken in combination with toothpaste and toothbrush, it is suggested to use a toothpaste whose composition does not alter the functioning of the chlorhexidine mouthwash.

To avoid damaging the color of the dental enamel (a typical side effect of these products) it is recommended not to continue therapy beyond the time limit set by the doctor. Generally, rinses with chlorhexidine mouthwashes should be performed at most twice a day, for a period not exceeding 14-21 consecutive days.