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-S.SARASWATHI
BDS Final Year

INTRODUCTION:
 CHLORHEXIDINE a GOLD STANDARD IN
CHEMICAL PLAQUE CONTROL with outstanding
bacteriostatic and bactericidal properties
 Effective on both gram positive and gram negative
bacteria, although it is less effective with some
gram negative bacteria

Chemical structure:
 Chlorhexidine 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 intractive with anions,
which is relevant to its efficacy

Available in three forms:
 Digluconate- most commonly used & water
soluble
 Acetate- water soluble
 Hydrochloride salts- sparingly water soluble

Mechanism of action:
 Antimicrobial activity:
CHX shows different effects at different concentrations
The agent is bacteriostatic, whereas at higher concentration it is
bactericidal
cationic 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]

Intracellular coagulation

Slows down leakage of intracellular
components

Cytoplasmic coagulation

Irreversible cell damage [bactericidal]

• Antiplaque activity:
Three mechanism for inhibition of plaque by CHX:
1. The effective blocking of the acidic group of
salivary glycoproteins will reduce their
adsorption to hydroxyapatite and formation of
acquired pellicle
2. The ability of bacteria to bind to tooth surface
may be reduced by adsorption of CHX to the
extracellular polysaccharides of their capsule
3. The CHX may compete with calcium ions for
acidic agglutination factors in plaques

What makes it so unique?
 Its long lasting bacteriostatic action, also
termed as ‘substantivity’
 Its action lasts for about 12 hours in the oral
cavity after a single rinse
 The dicationic 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

Uses:
1. As an adjunct to oral hygiene
2. Post oral surgery including periodontal surgery or root
planing
3. In patients with inter maxillary fixation.
4. For oral hygiene & gingival health in physically & mentally
handicapped
5. Medically compromised individuals predisposed to oral
infections
6. High caries risk patient
7. Recurrent oral ulceration
8. Removable & fixed orthodontic wearers
9. Treatment of denture stomatitis and dry socket
10. As an immediate prophylactic rinse in the prevention of
post-extraction bacteremia

Adverse effects:
a) Extrinsic staining
b) Alteration in taste perception
c) Oral mucosal erosion
d) Enhanced supragingival calculus formation
e) Parotid gland swelling
f) Overdosage: 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

Dosage & administration:
 Recommended use is twice daily oral rinsing
for 30 seconds after tooth brushing
 Usual dosage is 15ml (1 tablespoon) of
undiluted chlorhexidine oral rinse
 Patient 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

Chlorhexidine products:
 Mouth rinse- aqueous/ alcohol solutions of
0.2% [Peridex, Periogard, Periosol]
 Gel [corsodyl dental gel]
 Sprays [Hibispray]
 Tooth pastes
 Varnishes
 Chewing gums
 Periodontal dressings
 Subgingival plaque control [Periochip]

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Chlorhexidine

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