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Effectiveness of Chlorhexidine Mouthwash

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Chlorhexidine is a prescribed mouthwash that eliminates bacteria and cures gingivitis. Read the article to learn its indications and efficacy in dentistry.

Medically reviewed by

Dr. Lekshmipriya. B

Published At June 29, 2022
Reviewed AtMay 15, 2024

Why Is Chemical Plaque Control Needed?

Mouthwashes have always been considered an effective chemical plaque control route. Therefore, dentists recommend them to patients as they can reach inaccessible oral areas and are easy to use. Though there are many potent types of mouthwash, namely hydrogen peroxide or peroxyl, essential oils, cetyl pyridinium, povidone-iodine one to two percent gargles, etc., Chlorhexidine gluconate (CHX) is considered an ideal mouthwash for both wound healing and post-surgery in dentistry.

The etiologic factor now widely recognized by dentists over the globe for the development of gingivitis and periodontal disease characterized by either horizontal or vertical bone loss around the tooth and gingival recession is the "mature plaque" or "oral biofilm." Research on gingival disease prevention indicates that for gingivitis to be clinically significant with the onset of symptoms, it may take around ten to 21 days after withdrawal of any chemical or mechanical methods for plaque control.

The development of gingivitis can vary in individuals. Ranging from stress to lack of proper sleep, vitamin deficiencies, addictions, and detrimental habits like smoking and chronic alcoholism, gingivitis has a widespread etiology. Hence, the time needed to develop gingivitis varies from person to person based on the etiologic factors.

Professional scaling done by dentists is advisable every six months to one year, but combining it with effective plaque control measures can help fight gingival disease permanently. Based on this ideology of plaque control, the treatment of gingivitis is always focused on disrupting the regular biofilm that forms over the tooth's enamel surface. Professional scaling by the dentist, mechanical debridement, or chemical plaque control measures are all used in current treatment strategies for gingivitis.

Why Is Chlorhexidine Gluconate Considered a Gold Standard?

In recent decades, 0.2 percent of dental surgeons have recommended Chlorhexidine mouthwashes as a gold-standard antiplaque agent for regular use. As CHX is a biguanide agent, it has antibacterial activity in a broad spectrum range and is known for its very low toxicity. Due to its high binding capacity to the receptors on the oral mucous membrane, compared to other antiseptic mouthwashes, the prolonged antibacterial action of Chlorhexidine molecules remains high in the oral cavity.

Research shows that it takes approximately eight to 12 hours for CHX molecules to be effectively released and have a prolonged action on the oral mucous membranes to inhibit gingival or tooth plaque. The activity of CHX mouthwash has also been proven evidentially in recent decades against anaerobic infections, aerobes, yeasts, and gram-positive and gram-negative bacteria.

What Should One Notify the Doctor Before Taking This Medication?

Individuals with the following conditions must inform their dentists about it.

  • Dentures, front tooth fillings, or other oral appliances.

  • Additional dental or gum-related problems.

  • An uncommon or adverse reaction to food, medicines, dyes, preservatives, foods, or other substances.

  • Either pregnant or planning to conceive.

  • Breastfeeding.

How to Take This Medication?

Use this medication right away after flossing and brushing. Make sure to rinse the mouth of any toothpaste thoroughly. To measure the dosage, use the original container's cap. Take 30 seconds to swish the medicine around in the mouth. Refrain from swallowing it. Avoid combining with water before use. Eat or drink nothing for a few hours following the rinse application. This could lessen the medication's effectiveness.

What Are the Disadvantages of Chlorhexidine Mouthwash?

CHX is the recommended gold standard mouthwash, but it also has certain disadvantages:

  • Some patients report an altered taste sensation based on individual perceptions according to traditional research after using the mouthwash.

  • Up to 0.1 percent of CHX mouthwashes may stain after long-term use, especially on restored teeth, natural tooth surfaces, or enamel stains.

  • Very rare and less reported side effects include desquamation of the oral mucous membrane that may give the user a swollen sensation or parotid gland swelling. However, such side effects are extremely rare, according to evidence and documentation.

  • Prolonged use of CHX in mentally or physically challenged individuals may cause tooth discoloration, which is another challenge as it is an acceptable mouthwash for such individuals to establish proper chemical plaque control and oral hygiene.

When Using This Drug, What Should One Be Aware Of?

See the dentist for a check-up every six months. There could be an unpleasant aftertaste from this drug. Rinsing the mouth after taking this medication will only worsen the bitter taste.

This drug may worsen tartar accumulation and discolor fillings, dentures, and teeth. To help reduce tartar build-up and discoloration, floss once a day and brush using a tartar-controlling toothpaste. If a youngster inadvertently consumes this drug, seek immediate medical attention. Young children may exhibit symptoms of intoxication, including nausea and vomiting.

How Does the Effectiveness of Chlorhexidine Mouthwash Change With a Difference in Concentration?

Recent evidence suggests that one factor behind CHX mouthwashes' effectiveness is the concentrations achieved. According to the current gold standard criterion, a Chlorhexidine mouthwash concentration of 0.12 percent to 0.2 percent is recommended twice a day for combating gingivitis. Clinical trials and studies have shown that a lower concentration of less than 0.1 percent may not be as effective in inhibiting plaque formation.

However, a low concentration of CHX mouthwash can eradicate the disadvantage of tooth staining even after prolonged usage. Also, in many commercial types of mouthwash, alcohol is used as a solvent for solubilizing antimicrobial compounds and flavor masking agents.

Recently, alcohol-free mouthwashes (especially to prevent tooth staining or for people with increased gum sensitivity or allergies) have also been introduced with good antiplaque and anti-inflammatory activity in 0.12 percent to 0.2 percent Chlorhexidine mouthwashes.

To prevent the problem of discoloration in patients suffering from prolonged gingival disease, anti-discoloration systems have now been introduced, such as the combination of 0.2 percent CHX mouthwash containing elements like sodium metabisulphite or ascorbic acid, sodium perborate monohydrate, etc., which are also potent oxygenating agents that are effective in combination with CHX to inhibit dental plaque. These kinds of CHX mouthwashes with an anti-discoloration system are also feasible for long-term use in patients where oral hygiene is compromised, especially after dental or implant surgery in the post-surgical phase of healing, where it is essential to maintain a low level of bacterial biofilm for proper wound healing.


The newer formulations of Chlorhexidine mouthwash can be very effective in long-term or short-term indications relevant to the clinical situation. These commercial mouthwashes use an alcohol-free and anti-discoloration system, making Chlorhexidine ideal for practical use regularly to accelerate wound healing, prevent gingival inflammation, and prevent plaque formation for at least short-term durations. For long-term usage of CHX mouthwashes, a concentration of less than 0.2 percent would be ideal but less effective in preventing plaque

Frequently Asked Questions


How Quickly Does the Mouthwash Chlorhexidine Work?

Chlorhexidine has been demonstrated to be an effective, broad-spectrum antimicrobial specialist with a very low potential for inspiring dermal responses. The bacteria quickly take the chlorhexidine, usually working in 20 seconds.


What Is Chlorhexidine Effective Against?

The chemical chlorhexidine is widely used to reduce dental plaque. It is an antiseptic and disinfectant that is compelling against a large number of microorganisms as well as certain growths and infections. Chlorhexidine is a biocide that works on a wide range of bacteria, including Gram-positive, Gram-negative, and fungi.


What Does Chlorhexidine Mouthwash Do?

Chlorhexidine is a disinfectant and antiseptic. It diminishes the number of microorganisms (microbes) in the mouth or on the skin. It can help with gum disease, mouth ulcers, and infections. It is concluded that chlorhexidine inhibits plaque by adhering to the pellicle-coated enamel surface and having an extended bacteriostatic effect due to its immediate bactericidal action when applied.


Can Chlorhexidine Mouthwash Be Used Every Day?

Chlorhexidine mouthwash can be used twice daily as a mouthwash. However, if used for more than four weeks, chlorhexidine mouthwash can stain teeth and cause tartar, a chalky buildup on the teeth, to form. Its efficacy in patients with moderate to severe gum disease cannot be evaluated based on the available evidence.


Is It Required to Rinse the Mouth With Water After Chlorhexidine?

After brushing and flossing, the mouth should be rinsed with chlorhexidine. Before applying the oral rinse, it is necessary to rinse the mouth with water to remove the toothpaste thoroughly. Additionally, one must avoid eating and drinking for several hours after using the oral rinse.


Which Bacteria Is Resistant to Chlorhexidine?

Although the concept of cross-resistance to antibiotics is still up for debate, some studies have shown that exposure to chlorhexidine increases the likelihood of developing resistance to antibiotics. Over time, it was discovered that Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii all exhibited increased resistance to chlorhexidine, with A. baumannii showing the greatest change.


Why Is Chlorhexidine Better Than Listerine?

The bacteria are destroyed by chlorhexidine, preventing gingivitis. Most studies have demonstrated that chlorhexidine is significantly more effective than Listerine at reducing plaque and gingivitis indices despite its long history of use. Patients frequently experience burning sensations and a bitter taste when using Listerine.


Is Chlorhexidine Better Than Betadine?

Because of its substantial effect, chlorhexidine is a superior antiseptic to povidone-iodine and sodium hypochlorite. Against both superficial and deep incisional infections, chlorhexidine–alcohol was significantly more effective than povidone-iodine (betadine). To prevent surgical site infection following clean-contaminated surgery, preoperative cleansing of the patient's skin with chlorhexidine-alcohol is superior to cleansing with povidone-iodine.


What Happens in the Case of Drinking Water After Chlorhexidine?

It is advised not to drink water immediately after rinsing the mouth with chlorhexidine. This is because it increases the bitterness. The medication's effectiveness may also be reduced by rinsing. In addition, the flavor of foods may also be altered by chlorhexidine.


Does Chlorhexidine Treat Gingivitis?

Gingivitis can be treated with chlorhexidine. It aids in reducing gum bleeding, inflammation (redness), and swelling. The bacteria in the coating (plaque) on the teeth between brushings causes gingivitis.


Can Salt Water Be Used as an Alternative to Chlorhexidine?

After minimally invasive periodontal surgery, saltwater rinses reduce inflammation more effectively than 0.12 percent chlorhexidine. It may be considered the preferred mouth rinse during the initial stages of wound healing due to its low cost and accessibility.


Can Saliva Be Swallowed After Chlorhexidine?

Chlorhexidine should be used as a mouth rinse and not to be swallowed with saliva. It must be spit out. When swallowed, chlorhexidine is poorly absorbed, and mild gastrointestinal irritability or nausea can typically occur as a side effect.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop



dental plaquechlorhexidine
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