Why Is Chemical Plaque Control Needed?
Mouthwashes have always been considered an effective chemical plaque control route. Therefore, they are recommended by the dentist to the patient as they can reach out to the 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 1 to 2 % gargles, etc., Chlorhexidine gluconate or 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, treatment of gingivitis is always focused on disrupting the regular biofilm that forms over the enamel surface of the tooth. Professional scaling by the dentist, mechanical debridement, or chemical plaque control measures all find their use in current treatment strategies for gingivitis.
Why Is Chlorhexidine Gluconate Considered a Gold Standard?
0.2 % Chlorhexidine mouthwashes have always been recommended in recent decades by dental surgeons as a gold standard antiplaque agent for regular use. As CHX is a biguanide agent, it has an antibacterial activity of a broad spectrum range and is also 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 for effectively inhibiting 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 Are the Disadvantages of Chlorhexidine Mouthwash?
CHX is the recommended gold standard mouthwash, but it also has certain disadvantages:
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Some patients report an altered taste sensation based on individual perceptions according to traditional research after using the mouthwash.
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Staining may occur on long-term use of CHX mouthwashes up to 0.1 %, especially on teeth that are restored or on natural tooth surfaces or enamel stains.
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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. But such side effects are extremely rare, according to evidence and documentation.
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Prolonged use of CHX in mentally or physically challenged individuals may cause tooth discoloration is another challenge as it is an acceptable mouthwash for such individuals to establish proper chemical plaque control and oral hygiene.
How Does the Effectiveness of Chlorhexidine Mouthwash Change With a Difference in Concentration?
According to recent evidence, one factor behind CHX mouthwashes' effectiveness is the concentrations achieved. According to the current gold standard criterion, a Chlorhexidine mouthwash concentration of 0.12 % to 0.2 % is recommended twice a day for combating gingivitis. According to the clinical trials and conducted studies, a lower concentration of less than 0.1 % may not be as effective in the inhibition of plaque formation.
But 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 the antimicrobial compounds in the mouthwash and the 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 % to 0.2 % 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 % 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.
Conclusion
The newer formulations of Chlorhexidine mouthwash can be very effective in the long or short-term indications relevant to the clinical situation. Using an alcohol-free and anti-discoloration system in these commercial mouthwashes makes 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 % would be ideal but less effective in preventing plaque.
