Chlorhexidine with or without alcohol against biofilm formation: efficacy, adverse events and taste preference

Abstract

In recent years, different chlorhexidine formulations have been tested, including an alcohol-free alternative, but the effect of this solution on early biofilm formation is not clear. A crossover, randomized, double-blind clinical trial was conducted to evaluate the effect of two chlorhexidine solutions against supra-and subgingival biofilm formation (NCT#02656251). Thirty-five participants were randomized and asked to rinse twice daily with 15 ml of an alcohol-containing 0.12% chlorhexidine solution, an alcohol-free 0.12% chlorhexidine solution, or placebo. The study was conducted in three experimental periods of 4 days each, with a 10-day washout between the periods. All the experimental periods followed the same protocol, except that the solutions were switched. Biofilm distribution was evaluated every 24 hours by the Plaque-Free Zone Index, during 96 hours. Adverse events were self-reported and sensory evaluation was performed using a hedonic scale. Compared to the placebo, the chlorhexidine solutions resulted in a significantly higher number of surfaces free of plaque over 96 hours (p < 0.01), and were able to prevent subgingival biofilm formation (p < 0.01). The alcohol-free chlorhexidine solution was associated with a lower incidence of adverse events, compared with alcohol-containing chlorhexidine (p < 0.05); it also received better sensory evaluation and acceptance by trial participants, compared with the alcohol-containing chlorhexidine (p = 0.007), and had a similar inhibitory effect on the formation of supra-and subgingival biofilms.

Dental plaque control strategies for the elderly population: A scoping review

“…55,56 Despite the benefits described above, prolonged use of CHX may cause several adverse effects such as: extrinsic staining of teeth, restorations, prostheses or tongue, 57 as well as taste alterations, reversible angioedema or swelling of the parotid glands, and desquamation of the oral mucosa. 58 There is evidence that the 0.2% CHX mouthwash provides a significantly greater reduction of plaque than 0.12% and 0.06% concentrations. 59 The studies reviewed compared the effects of mouthwashes with the same concentration with different frequency of use.…”

Vinegar inhibits the formation of oral biofilm in situ

“…Actually, there are many studies of rinsing solutions used for oral biofilm management and removal, such as chlorhexidine, cetylpyridinium chloride and plant solutions [31][32][33][34]. Among them, chlorhexidine is recognized as the gold standard [35].…”

How can biophotonics help dentistry to avoid or minimize cross infection by SARS-CoV-2?

“…Due to the various factors that contribute to the formation of biofilm and the colonization of microorganisms in the oral cavity, the control of the biofilms in the oral cavity is considered a great challenge. As an alternative, chlorhexidine-based mouthwashes represent the most used chemical strategy for biofilm control [ 114 , [129] , [130] , [131] ]. Chlorhexidine has a large absorption spectrum, which acts on bacteria (Gram-positive and Gram-negative), yeasts, and virus.…”