Chlorhexidine mouthrinse as an adjunctive treatment for gingival health

James, P. M. C.; Worthington, Helen V; Parnell, C. J.; Harding, Máiréad; Lamont, Thomas; Cheung, Andrea; Whelton, Helen; Riley, Philip

doi:10.1002/14651858.cd008676.pub2

Cited by 309 publications

(350 citation statements)

References 153 publications

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ To the best of our knowledge, this is the first study showing the impact of 7-day use of CHX on the oral microbiome. A large body of literature suggests that mouthwashes with CHX are effective in reducing dental plaque accumulation, gingival inflammation and bleeding [2][3][4] . However, the view about oral bacteria and oral health has changed substantially over the last few years 12 .…”

Section: Discussionmentioning

confidence: 99%

Effects of Chlorhexidine mouthwash on the oral microbiome

Bescós

Ashworth

Cutler

et al. 2020

Sci Rep

184

165

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Following a single blind, cross-over and non-randomized design we investigated the effect of 7-day use of chlorhexidine (CHX) mouthwash on the salivary microbiome as well as several saliva and plasma biomarkers in 36 healthy individuals. They rinsed their mouth (for 1 min) twice a day for seven days with a placebo mouthwash and then repeated this protocol with CHX mouthwash for a further seven days. Saliva and blood samples were taken at the end of each treatment to analyse the abundance and diversity of oral bacteria, and pH, lactate, glucose, nitrate and nitrite concentrations. CHX significantly increased the abundance of Firmicutes and Proteobacteria, and reduced the content of Bacteroidetes, TM7, SR1 and Fusobacteria. This shift was associated with a significant decrease in saliva pH and buffering capacity, accompanied by an increase in saliva lactate and glucose levels. Lower saliva and plasma nitrite concentrations were found after using CHX, followed by a trend of increased systolic blood pressure. Overall, this study demonstrates that mouthwash containing CHX is associated with a major shift in the salivary microbiome, leading to more acidic conditions and lower nitrite availability in healthy individuals.Chlorhexidine (CHX) has been commonly used in dental practice as antiseptic agent since 1970, due to its long-lasting antibacterial activity with a broad-spectrum of action 1 . Since then, many clinical trials have shown effective results of CHX for the clinical management of dental plaque and gingival inflammation and bleeding 2-4 . This is supported by other studies using in vitro methods and reporting positive results of CHX in reducing the proliferation of bacterial species associated with periodontal disease, such as Enterobacteria, Porphyromonas gingivalis, Fusobacterium nucleatum, as well as different species of Actinomyces and Streptococcus, including Streptococcus mutans, which is considered the main etiological agent of dental caries 4,5 . Other studies have also reported that the use of CHX was effective in the treatment of halitosis, especially in reducing the levels of halitosis-related bacteria colonising the dorsal surface of the tongue 6 .The anti-microbial activity of CHX however, has been extensively studied using in vitro culture methods, which limit the identification and cultivation of all microorganisms in the environment 4 . To the best of our knowledge, only one recent study has investigated the effect of CHX mouthwash on mixed bacterial communities (microbiome) of the tongue using new genome sequencing techniques such as 16 S rRNA 7 . The study found differences in over 10 different species colonizing the tongue, and a lower microbial diversity after using CHX for a week, but did not analyse other parameters related to oral health such as pH, lactate production or buffering capacity 7 . Additionally, we and others have recently shown that the use of CHX in healthy subjects can attenuate the nitrate-reducing activity of oral bacteria by at least 80% 8-11 . This in turn leads to lo...

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Section: Discussionmentioning

confidence: 99%

Effects of Chlorhexidine mouthwash on the oral microbiome

Bescós

Ashworth

Cutler

et al. 2020

Sci Rep

184

165

View full text Add to dashboard Cite

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“…International literature on CHX mouthwashes reports uneven results. 32,33 This may depend on the sample size or on the oral hygiene indications given to the patients. Obviously, studies that left patient to his daily oral hygiene habits will introduce inevitable bias that can thus affect the plaque-dependent gingivitis.…”

Section: F P-valuementioning

confidence: 99%

Therapeutic efficacy of chlorhexidine‐based mouthwashes and its adverse events: Performance‐related evaluation of mouthwashes added with Anti‐Discoloration System and cetylpyridinium chloride

Guerra

Pasqualotto

Rinaldo

et al. 2019

Int J Dental Hygiene

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Objectives To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti‐Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results Sixty‐six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1‐T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0‐T2) was −9.82 (SD = 9.27; 95% CI −5.48 to 14.16; P = 0.000), −19.31 (SD = 11.33; 95% CI −14.15 to −24.47; P = 0.000) and −21.13 (SD = 12.56; 95% CI −15.70 to −26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX.

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“…Both facts suggest resolution of soft tissue swelling, which is-along with bleeding-one of the classical symptoms of an inflammation. This resolution, however, might have been caused by two different ways of action: The first-and well assessed-is a reaction of the pharmacologic, i.e., antibacterial effect of chlorhexidine on bacteria in oral biofilms [28]. By controlling the antimicrobial inflammatory trigger, healthy mucosa may be re-established within an interval of days to weeks [29].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy—A Randomized Clinical Trial

Sahrmann

Bettschart²,

Wiedemeier

et al. 2019

Dentistry Journal

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Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

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Chlorhexidine mouthrinse as an adjunctive treatment for gingival health

Abstract: This is a repository copy of Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.

Cited by 309 publications

References 153 publications

Effects of Chlorhexidine mouthwash on the oral microbiome

Effects of Chlorhexidine mouthwash on the oral microbiome

Therapeutic efficacy of chlorhexidine‐based mouthwashes and its adverse events: Performance‐related evaluation of mouthwashes added with Anti‐Discoloration System and cetylpyridinium chloride

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy—A Randomized Clinical Trial

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