Dentists may recommend the use of a chlorhexidine gluconate-based mouthwash, in combination with regular brushing and flossing, to help improve gingivitis in its early stages and with the aim of reducing plaque buildup. Because chlorhexidine gluconate interacts with ingredients in toothpaste to reduce the solubility and presence of active antibacterial compounds, it is recommended that chlorhexidine gluconate rinses be administered at least 30 minutes, and ideally two hours, after brushing the teeth. There is insufficient evidence to support the use of chlorhexidine gluconate mouthwash for moderate or severe gingivitis. Some of the more common brands of chlorhexidine gluconate mouthwash include Dentohexin, Paroex, Peridex, PerioChip, Corsodyl, and Periogard. Chlorhexidine is also available as an oral antiseptic lozenge, called Hexoraletten N, that also contains benzocaine and menthol.
Because of toxicity at high concentrations, the US Food and Drug Administration recommends that chlorhexidine gluconate mouthwashes be used for no more than six months. The FDA also recommends not swallowing chlorhexidine gluconate, though it is not considered dangerous in lower concentrations. For mouthwash solutions, it is recommended that a concentration of .1 to .2% be administered twice daily for at least 30 seconds. While clinical studies conclude that these mouthwashes are moderately effective against plaque buildup and mild gingivitis when compared with mechanical measures alone, they have also been found to have some adverse effects. Chlorhexidine gluconate mouthwash can damage the soft tissue that lines the oral cavity. It may also contribute to the buildup of tartar and impair the taste. When used for longer than four weeks, chlorhexidine gluconate mouthwashes may also lead to staining of the teeth, though more recent formulations that also contain chelated zinc have reduced this potential for staining.
Chlorhexidine gluconate is widely used for disinfection before surgery, to sterilize surgical instruments and the hands of surgeons. It may be used to disinfect the patient’s skin before and after surgery. It is also commonly used to clean wounds, prevent the buildup of dental plaque, and to treat yeast infections in the oral cavity. Chlorhexidine gluconate was first used in medical settings in the 1950s and is included on the World Health Organization’s List of Essential Medicines. It is available over the counter in the United States and is often prepared in a water or alcohol solution. Chlorhexidine gluconate is a powerful antiseptic that kills 99.9% of germs in 30 seconds. While active against many organisms and yeasts, it is ineffective against polioviruses, and its effectiveness against herpes viruses is unknown. It is commonly added to cosmetics, used as a disinfectant, and functions as a preservative in eye drops and the active ingredient in topical treatments and mouthwashes. Though it used to be popular in endodontic therapies, primarily root canal treatments, it is no longer widely used in this application in the developing world.
Chlorhexidine is particularly helpful in developing countries. In Nepal, doctors pioneered the use of chlorhexidine to reduce umbilical cord infection in newborns, dramatically reducing the country’s neonatal mortality rates. Chlorhexidine obstetric lavage has also been demonstrated to reduce transmission of HIV from mother to infant, which is instrumental in developing countries with higher HIV rates. Additionally, chlorhexidine eye drops have been shown to be effective against corneal infections caused by ameobae, which are more prevalent in areas with lower socioeconomic status.