Dr. Shahzadi Tayyaba Hashmi

CHLORHEXIDINE

CHLORHEXIDINE GLUCONATEChlorhexidine gluconate is an effective

bactericidal agent and broad-spectrum antimicrobial drug

It has been extensively researched and is the “gold standard” antimicrobial in oral hygiene

Chlorhexidine is useful in many clinical disciplines including periodontics, endodontics, oral surgery and operative dentistry

INTRODUCTIONChlorhexidine is a broad-spectrum antimicrobial

drugActing as an antiseptic, it is an effective

bactericidal agent against all categories of microbes, including bacteria, yeast and viruses

Chlorhexidine was first used as a mouth rinse as an adjunct to conventional non-surgical periodontal therapy

Chlorhexidine has proven efficacy as a broad-spectrum antimicrobial for reducing supragingival plaque

CHEMICAL STRUCTUREChlorhexidine is a symmetrical molecule

consisting of four chlorophenyl rings and bisguanide groups connected by a central hexamethylene bridge

The compound is strongly base & dicationic at pH levels above 3.5 with positive charges on either side of hexamethylene bridge

It is the dicationic nature of chlorhexidine making it extremely interactive with anions, which is relevant to its efficacy

MECHANISM OF ACTION

CHX shows different effects at different concentrationsThe agent is bacteriostatic, whereas at higher concentration it is bactericidalCationic CHX molecule + negatively charged bacterial cell wall

Instant adsorption of CHX to Phosphate containing compounds

CHX binds with the phospholipids in the inner cell membrane causing cell wall integrity

Leakage of the lesser molecular weight components viz. potassium ions

[This is the sub lethal stage of CHX. The action can be reversed. This marks the bacteriostatic property of CHX. If the conc. Is increased and the action continues, the CHX becomes bactericidal in nature]

MECHANISM OF ACTION

PREVENTION OF DENTAL CARIES

There are a number of theories concerning the development and progression of dental caries

According to the specific Plaque hypothesis, only a limited number of bacteria found in dental plaque can produce dental caries

The most prominent among these bacteria are streptococcus mutans and Lactobacilli

Streptococcus mutans represent a group of closely related bacterial species that are the primary species that initiate enamel caries

Therefore patients with low mutans streptococci population levels in their oral cavity generally have low caries activity and patients with high mutans streptococci population levels generally high caries activity

Lactobacilli are the primary causative species of dentinal caries

PREVENTION OF DENTAL CARIES

Chlorhexidine is a very potent bactericidal agent for streptococcus mutans, the most significant group of bacterium associated with dental caries

Chlorhexidine molecules adhere to the surfaces of streptococcus mutans and produce cell death

For patients with a high risk of caries, chlorhexidine rinses can be successfully used to reduce the number of odontopathogenic bacteria

WHAT MAKES CHX UNIQUEIts long lasting bacteriostatic action, also

termed as ‘substantivity’Its action lasts for about 12 hours in the oral

cavity after a single rinseThe di-cationic CHX molecule, attaches to the

pellicle by one cation, to the bacteria attempting to colonize the tooth surface with the other. This is called the ‘Pin-Cushion Effect’

This prolongs the CHX action

USES1. As an adjunct to oral hygiene2. Post oral surgery including periodontal surgery or root

planing3. In patients with inter maxillary fixation.4. For oral hygiene & gingival health in physically &

mentally handicapped5. Medically compromised individuals predisposed to oral

infections6. High caries risk patient7. Recurrent oral ulceration8. Removable & fixed orthodontic wearers9. Treatment of denture stomatitis and dry socket10. As an immediate prophylactic rinse in the prevention of

post-extraction bacteremia

ADVERSE EFFECTSa) Extrinsic staining b) Alteration in taste perceptionc) Oral mucosal erosiond) Enhanced supragingival calculus formatione) Parotid gland swellingf) Over dosage ingestion of 1 or 2 ounces of CHX oral

rinse by a small child might result in gastric distress, including nausea or signs of alcohol intoxication

DOSES AND ADMINISTRATIONRecommended use is twice daily oral rinsing

for 30 seconds after tooth brushingUsual dosage is 15ml (1 tablespoon) of

undiluted chlorhexidine oral rinsePatient should be instructed not to rinse with

water or brush teeth or eat immediately after CHX oral rinse

CHX should not be ingested and should be expectorated after rinsing

AVAILABLE FORMULATIONSMouth rinse- aqueous/ alcohol solutions of

0.2% [Zordyl ]Gel [ corsodyl dental gel]Sprays [ Hibispray]Tooth pastesVarnishes Chewing gumsPeriodontal dressingsSub gingival plaque control [Periochip]

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