Author: Mario CAPUTO
Date: 21/05/2008



Chlorhexidine is a chemical antiseptic. It is bactericidal to both gram-positive and gram-negative microbes, although it is less effective with some gram-negative microbes. It also has a bacteriostatic action. (Cytotoxic effects)

Rinsing with delmopinol 0.2% and chlorhexidine 0.2%: short-term effect on salivary microbiology, plaque, and gingivitis.


It is often used as an active ingredient in mouthwash designed to kill dental plaque and other oral bacteria. Chlorhexidine can thus be used to improve bad breath.
Chlorhexidine based products are usually utilized to combat or prevent gum diseases such as gingivitis.
Chlorhexidine is indicated for use between dental visits as part of a professional program for the treatment of gingivitis as characterized by redness and swelling of the gingivae, including gingival bleeding upon probing
Continuated use of products containing chlorhexidine for long periods can cause stains on teeth.

Chlorhexidine is also used in non-dental applications. It is used for general skin cleansing, a surgical scrub and a pre-operative skin preparation. Due to other chemicals listed as inactive ingredients, the cleanser solution is not suitable for use as mouthwash. It is often used as a rubbing agent prior to the use of hypodermic or intravenous needles in place of iodine. Chlorhexidine is contraindicated for use near the meninges, in the genital area, and near the eyes and ears. At the 2% concentration, it can cause serious and permanent injury on contact with the eye or if instilled through a perforated eardrum. As a scrub it is not recommended on persons under two months of age.

It is often used in combination with fluoride and xylitol. (Association of chlorhexidine and fluoride for plaque control and white spot lesion remineralization in primary dentition.)

Efficacy of oral chlorhexidine in critical care.
Efficacy of chlorhexidine swabbing in oral health care for people with severe disabilities.
Supragingival irrigation with 0.06% chlorhexidine in naturally occurring gingivitis. I. 6 month clinical observations.
Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration.

Mechanism of action

Chlorhexidine reacts with the microbial cell surface, destroys the integrity of the cell membrane, penetrates the cell and precipitates the cytoplasm leading to cell death.

Chlorhexidine is deactivated by anionic compounds, including the anionic surfactants commonly used as detergents in toothpastes and mouthwashes. For this reason, chlorhexidine mouth rinses should be used at least 30 minutes after other dental products. For best effectiveness, food, drink, smoking, and mouth rinses should be avoided for at least one hour after use. It is also deactivated in the presence of blood and crevicular fluid.
Saliva also has an inactivating action on chlorhexidine.

(Saliva ; Salivary Mucins)

Use of chlorhexidine oral rinse does not result in any significant changes in bacterial resistance, overgrowth of potentially opportunistic organisms or other adverse changes in the oral microbial ecosystem. Few months after chlorhexidine use is discontinued, the number of bacteria in plaque returns to baseline levels and resistance of plaque bacteria to chlorhexidine is equal to that at baseline.

The effect of 0.12% chlorhexidine gluconate rinsing on previously plaque-free and plaque-covered surfaces: a randomized, controlled clinical trial.

Side Effects and Adverse events

The most common side effects associated with Chlorhexidine gluconate oral rinses are

Among postmarketing reports, the most frequently reported oral mucosal symptoms associated with chlorhexidine are

  • stomatitis,
  • gingivitis,
  • glossitis,
  • ulcer,
  • dry mouth,
  • hypesthesia,
  • glossal edema,
  • paresthesia.

Minor irritation and superficial desquamation of the oral mucosa have been noted in patients using chlorhexidine.

There have been cases of parotid gland swelling and inflammation of the salivary glands (sialadenitis) reported in patients using chlorhexidine.

Plaque formation and gingivitis after supervised mouthrinsing with 0.2% delmopinol hydrochloride, 0.2% chlorhexidine digluconate and placebo for 6 months.

Adequate and well-controlled studies in pregnant women have not been done, so this drug should be used during pregnancy only if clearly needed.
Caution should be exercised when chlorhexidine is administered to a nursing woman.

Ingestion of 3-6ml of chlorhexidine by a small child (~10 kg body weight) might result in gastric distress, including nausea, or signs of alcohol intoxication. Medical attention should be sought if more than 12ml of chlorhexidine is ingested by a small child or if signs of alcohol intoxication develop.

(Potential Hypersensitivity Reactions To Chlorhexidine-Impregnated Medical Devices)

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