What are the different roles for Chlorhexidine Mouth Rinse in dentistry?

Chlorhexidine gluconate (CHX) mouth rinse is a well-known and effective antimicrobial rinse option, used most often in dentistry for control of plaque associated with periodontal disease (including gingivitis) and adjunctive use between dental visits for the treatment of gingivitis. There are also less common indications, for example in the management of dental caries (an off-label use).

Before reviewing these, depending on the country you practice in, it is important to be aware that some or all of the following uses may be off-label/unlicensed uses for you and that while there is evidence for some uses there is less certain evidence for others.

The Pharmaceutical Journal states that CHX can be prescribed and recommended for the following:

• Oral hygiene and plaque inhibition - particularly useful for patients who are at higher risk for dental caries and those who have difficulty performing proper oral hygiene measures, such as immediately after surgery. It should be noted that the interval between tooth brushing and CHX mouthwash, should also be greater than 30 minutes if a toothpaste containing fluoride was used. Otherwise, rinsing could remove fluoride introduced intraorally during brushing with fluoride toothpaste, and in addition CHX is cationic and can interact with the anionic components of many toothpastes, reducing the benefits.
• Gingivitis
• Management of oral ulceration and erosive mucosal conditions to help prevent secondary infection
• Management of halitosis
• Prevention of ventilator-associated pneumonia for ventilated patients

Other uses of CHX include:

• Management of necrotizing periodontal disease
• Pre-surgical mouth rinse to reduce oral microbial load prior to surgery such as implant or periodontal surgery
• Post-operative rinses after surgery to aid healing
• In the management of peri-implant disease
• Denture stomatitis and oral candidiasis

A recent systematic review found moderate evidence that pre-procedural mouth rinsing with antiseptics, such as CHX, can reduce intraoral bacterial loads and therefore the level of bacteria aerosolized during dental procedures. This is an unlicensed/off-label use. The same review noted evidence for plaque reductions and for use in patients with gingivitis or dry sockets. However, it found 'less certain evidence' for other uses.

CHX mouth rinse is available in two concentrations, either as a 0.20% formulation or as a 0.12% formulation such as Colgate PerioGard (available in the United States). While one is a higher concentration than the other, the amount used is inversely related to the concentration. The formulations are equally effective in controlling plaque and for use in patients with gingivitis.

CHX is a versatile rinse, effective for several uses as part of professional and home care. It is important to understand which uses are off-label or unlicensed uses and which are indications where you practice.