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CHLORHEXIDINE

Tonelli, Hume and Kenney: Chlorhexidine: A Review of the Literature. J of Western Society of Perio. Vol 31:No 1:1983.

Purpose:

This review article is a complete discussion of the antimicrobial agent chlorhexidine.

Medical use:

CHX was introduced in the medical profession in the early 1950¹s as a general disinfectant. The major use of the agent has been as a topical antiseptic for presurgical skin preparation. Also it has been used prior to obstetrical and gynecological procedures. CHX can also be used internally in the peritoneal cavity.

General dental use:

It was initially introduced to dentistry to wash operation sites, and for the use in endodontics. The initial report of CHX¹s antiplaque property was made by Schroeder in 1962. Schiot reported a total inhibition of new plaque formation and prevention of the development of gingivitis by an aqueous solution of 0.2% CHX digluconate applied twice a day in the form of a mouthrinse. Some other uses include in the treatment of fractured jaws as an antiplaque mouthrinse, in orthodontics, handicapped patients with poor oral hygiene, patients with dentinogenesis imperfecta, recurrent aphthous ulcerations, in the treatment of candidiasis, and for the treatment of denture stomatitis just to mention some.

Adherence:

CHX displays an affinity for oral surfaces, proteins, bacteria, and extracellular polysaccarides which are of bacterial origin. It is gradually released from retention sites and thus exerts a bacteriostatic effect over a prolonged period of time. It reacts specifically with both organic and inorganic surfaces.

Effects on microgial ecology:

S. mutans and E. coli are highly susceptible. S. sanguis is less susceptible, and there is evidence that the proportion of S. sanguis in plaque increases with long-term CHX use.

Toxicity:

CHX does not penetrate intact gingiva, but it is toxic at clinically applied concentrations if it reaches submucosal tissue surgically.

Side effects:

A diffuse brown discoloration of the teeth has been noted with chronic use of CHX as a mouthrinse. A strong bitter taste, and dryness, soreness and burning sensations are sometimes reported. Desquamation of epithelial cell may occur with high concentration CHX use, and allergic responses, although rare, may occur.

Conclusion:

Discussed are its medical uses as well as general dental uses. The adherence of chlorhexidine through its affinity to oral surfaces is also reviewed as well as its ability to inhibit plaque accumulation and maintain a significant reduction in gingivitis. Finally the paucity of toxic side effects is reviewed. 
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