Chlorhexidine is the Evil Villain in your Dental Practice

Chlorhexidine is the Evil Villain in your Dental Practice. Photo courtesy of Krakenimages.com/stock.adobe.com.

In most fairy tales, there’s a villain that gives the heroine what they desperately want, but it comes at a price. Ursula will give you legs, but at the cost of your voice. If you’re giving your patients chlorhexidine to fulfill the wish to kill bacteria, you've just been tricked by an evil villain. You’ve probably always detested the dark shadow (stain and calculus) that chlorhexidine casts upon your patients’ teeth, but these side effects are foreboding to more complicated rules and contraindications to poor unfortunate souls who use it. What is chlorhexidine’s evil plan? Sure, she kills bacteria, but at what price?

Limited to 2 Weeks of Use

Ever notice in our favorite Disney movies that the villain’s spell is short? Like, unrealistically short, only lasting until midnight or the 3rd day at sunset. With chlorhexidine’s narrow 14-day window, she offers little time to work her “magic.” Even for mild gingivitis, tissue usually takes upwards of 30 days to start healing. Do we still need to worry about bacteria after 2 weeks? Of course. So, what do we give the patients instead of chlorhexidine?

Only Indicated for Gingivitis

Chlorhexidine tells us that only she can help patients with gingivitis. Has your practice ever used chlorhexidine off label? If so, you’re not alone. After all, it’s what we learned in school to kill bacteria. Since bacteria is a common enemy of periodontal disease, implants, and extractions, it seems it would be suitable anywhere bacteria is at play. Chlorhexidine is contraindicated for all of those uses. It gets worse. Let us journey further into the dark forest of risks and limitations.

Inhibits Fibroblasts

Using chlorhexidine after scaling and root planing? Stop. According to a 1991 study conducted by Charles D. Alleyn, DDS: “Exposure of root surfaces to Chlorhexidine significantly inhibits subsequent fibroblast attachment which may interfere with regeneration of the periodontium.”1Chlorhexidine all but halts the healing process. What’s most alarming is this study is over 20 years old, and practices still send SRP patients home with chlorhexidine, unaware of her consequences.

Inactivated in Presence of Blood/Saliva

Yep, you heard that right. Like a true villain, chlorhexidine sets forth the ultimate double standard: she’ll kill bacteria in your patient's mouth- but not with blood or saliva present. As found in a 1990 study, this explains why chlorhexidine is of limited value in decontaminating the oral cavity.2-4 How do we avoid saliva in the mouth? We can’t. This contributes to why chlorhexidine is contraindicated for implants, extractions, and periodontal disease.

Cytotoxic Effects

Since 2006, we’ve been warned of the cytotoxic effects of chlorhexidine on cells and cautioned against her use. Does your practice rely on chlorhexidine as a pre-rinse? You just counteracted the positives of any antibacterial precautions with a high dose of cytotoxic effects. Furthermore, at 1,200 ppm this makes chlorhexidine obsolete as a post-op rinse choice.

Severe Allergic Reactions

Hypersensitivity is always a risk with chlorhexidine. Immediate allergic reactions are the most serious, but patients can also experience delayed reactions days or weeks later.5 To send a patient home with a rinse that has been documented to sometimes cause severe anaphylactic shock can be nerve wracking to say the least. The most unsettling, documented cases both occurred with patients in the United Kingdom. In the first, a woman was killed in the dental chair after a fatal allergic reaction from pre-rinsing with chlorhexidine. In the second, an autopsy of a 63-year-old male showed the cause of death to be an allergic reaction to chlorhexidine.

So, what is chlorhexidine’s evil plan? She wants to deceive you into thinking she’s a friend to your practice and patients. Fortunately, there is an alternative whose mission is to make sure you never use chlorhexidine again. OraCare is the only other professional rinse choice. It kills the same bacteria as chlorhexidine at just 44 ppm, and without the side effects: no staining, calculus buildup, or altered taste. What really makes this a knight in shining armor, are the additional benefits it provides: OraCare kills viruses & fungi, eliminates volatile sulfur compounds, and breaks up biofilm. OraCare is also safe for long term use, giving your patients a true “happily ever after."

Reference

1. Alleyn, C. D., DDS, O’Neal, R. B., Strong, S. L., Scheidt, M. J., Van Dyke, T. E., & McPherson, J. C. (1991). The Effect of Chlorhexidine Treatment of Root Surfaces on the Attachment of Human Gingival Fibroblasts In Vitro. Retrieved fromhttps://onlinelibrary.wiley.com/doi/10.1902/jop.1991.62.7.434. Journal of Periodontology, 62(7), 434438.

2. Clinical implications of the growth-suppressive effects of chlorhexidine at low and high concentrations on human gingival fibroblasts and changes in morphology. Marzena Wyganowska-Swiatkowska, Malgorzata Kotwicka, Paulina Urbaniak, Agnieszka Nowak, Ewa Skrzypczak-Jankun, Jerzy Jankun Int J Mol Med. 2016 Jun; 37(6): 1594–1600. doi: 10.3892/ijmm.2016.2550

3. Ioannis Tsourounakis, Angela A. Palaiologou‐Gallis, Diana Stoute, Pooja Maney and Thomas E Lallier, Effect of Essential Oil and Chlorhexidine Mouthwashes on Gingival Fibroblast Survival and Migration, Journal of Periodontology, 84, 8, (1211-1220), (2013).

4. Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006;37(8):605–612.

5. ASCIA in conjunction with ANZAAG, the Australian & New Zealand Anaesthetic Allergy Group. Updated April 2019. Chlorhexidine Allergy