What is Chlorhexidine Gluconate Oral Rinse. How does it work in treating gingivitis. What are the potential side effects of using this mouthwash. Is Chlorhexidine Gluconate safe for long-term use. When should you avoid using this oral rinse.

Understanding Chlorhexidine Gluconate Oral Rinse: Composition and Mechanism

Chlorhexidine Gluconate Oral Rinse, commonly known as PerioGard, is a powerful antimicrobial mouthwash containing 0.12% chlorhexidine gluconate. This active ingredient is a salt of chlorhexidine and gluconic acid, with a complex molecular formula of C22H40Cl2N10·2C6H3O7 and a molecular weight of 897.77. The rinse is formulated in a base containing water, 11.6% alcohol, glycerin, and other ingredients to create a near-neutral solution with a pH range of 5-7.

How does Chlorhexidine Gluconate work against oral bacteria? The antimicrobial properties of this compound provide significant activity during oral rinsing. Clinical studies have shown a general reduction in both aerobic and anaerobic bacteria counts, ranging from 54-97% through six months of use. This broad-spectrum action makes it an effective tool in combating various oral pathogens.

Key Components of PerioGard Oral Rinse

• 0.12% chlorhexidine gluconate (active ingredient)
• Water
• 11.6% alcohol
• Glycerin
• PEG-40 sorbitan diisostearate
• Flavor
• Sodium saccharin
• FD&C Blue No. 1

Clinical Applications and Efficacy of Chlorhexidine Gluconate Mouthwash

PerioGard is primarily indicated for use between dental visits as part of a professional program for the treatment of gingivitis. But what exactly characterizes gingivitis, and how does this oral rinse help? Gingivitis is typically identified by redness, swelling of the gums, and gingival bleeding upon probing. The antimicrobial action of chlorhexidine gluconate targets the bacteria responsible for these symptoms, helping to reduce inflammation and promote gum health.

Is Chlorhexidine Gluconate effective against all forms of gum disease? While PerioGard has shown significant efficacy in treating gingivitis, it’s important to note that it has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG). Additionally, for patients with coexisting gingivitis and periodontitis, special precautions may be necessary, and the use of this rinse should be under professional guidance.

Benefits of Using Chlorhexidine Gluconate Oral Rinse

1. Reduction in plaque-forming bacteria
2. Decrease in gingival inflammation
3. Improvement in overall oral hygiene
4. Professional-grade treatment between dental visits
5. Long-lasting antimicrobial effect

Potential Side Effects and Precautions of PerioGard Use

While Chlorhexidine Gluconate Oral Rinse is highly effective, it’s not without potential side effects. What should users be aware of when using this product? One of the most common side effects is an increase in tooth staining. In clinical testing, 56% of chlorhexidine gluconate oral rinse users exhibited a measurable increase in facial anterior stain after six months, compared to 35% of control users. Additionally, 15% of users developed what was judged to be heavy stain.

Can the staining caused by PerioGard be removed? In most cases, the staining can be removed through conventional professional prophylactic techniques. However, it may require additional time during dental cleanings. Patients with anterior facial restorations featuring rough surfaces or margins should use this product with discretion, as staining in these areas may be more challenging to remove.

Other Potential Side Effects and Considerations

• Increase in supragingival calculus formation
• Alteration in taste perception
• Potential hypersensitivity reactions
• Not recommended for use during pregnancy unless clearly needed
• Should be used under the care and supervision of a dental professional

Contraindications and Warnings for Chlorhexidine Gluconate Use

Are there individuals who should avoid using PerioGard? Chlorhexidine Gluconate Oral Rinse should not be used by persons known to be hypersensitive to chlorhexidine gluconate or other ingredients in the formula. Hypersensitivity and generalized allergic reactions have been reported in some cases.

What precautions should be taken regarding periodontitis? The effect of PerioGard on periodontitis has not been definitively determined. For patients with coexisting gingivitis and periodontitis, the presence or absence of gingival inflammation following treatment should not be used as a major indicator of underlying periodontitis. Regular dental check-ups are crucial for monitoring overall oral health.

Important Warnings for PerioGard Users

• Increased risk of supragingival calculus formation
• Potential for tooth staining and taste alterations
• Not recommended for patients with known hypersensitivity to ingredients
• Regular dental prophylaxis recommended at intervals not greater than six months
• Caution advised for patients with anterior facial restorations

Long-Term Effects and Microbial Resistance Considerations

Does long-term use of Chlorhexidine Gluconate lead to bacterial resistance? A six-month clinical study using chlorhexidine gluconate oral rinse did not result in any significant changes in bacterial resistance, overgrowth of potentially opportunistic organisms, or other adverse changes in the oral microbial ecosystem. This suggests that the product remains effective over extended periods without promoting the development of resistant bacterial strains.

What happens when chlorhexidine gluconate use is discontinued? Three months after discontinuation, the number of bacteria in plaque typically returns to baseline levels. Additionally, the resistance of plaque bacteria to chlorhexidine gluconate was found to be equal to that at baseline, indicating no lasting changes in bacterial susceptibility.

Key Findings on Long-Term Use

1. No significant bacterial resistance development
2. No overgrowth of opportunistic organisms
3. Reversible effects on oral microbial ecosystem
4. Consistent antimicrobial efficacy over six months
5. Return to baseline bacterial levels after discontinuation

Proper Usage and Administration of PerioGard Oral Rinse

How should PerioGard be used for optimal results? As with all prescription drugs, Chlorhexidine Gluconate Oral Rinse should be used under the care and supervision of a dentist or physician. The typical regimen involves rinsing twice daily with 15 mL (about 1 tablespoon) for 30 seconds, then expectorating. It’s important not to swallow the rinse and to use it consistently as directed for the prescribed duration.

When is the best time to use PerioGard in relation to other oral care products? For maximum effectiveness, it’s recommended to use PerioGard after brushing and flossing. Users should avoid eating, drinking, or rinsing for at least 30 minutes after use to allow the active ingredient to work effectively.

Tips for Effective Use of Chlorhexidine Gluconate Oral Rinse

• Rinse twice daily with 15 mL for 30 seconds
• Use after brushing and flossing
• Avoid eating, drinking, or rinsing for 30 minutes after use
• Do not swallow the rinse
• Follow the prescribed duration of use

Comparing Chlorhexidine Gluconate to Other Oral Rinses

How does PerioGard compare to over-the-counter mouthwashes? Chlorhexidine Gluconate Oral Rinse is a prescription-strength product with a higher concentration of active antimicrobial ingredients compared to most over-the-counter options. Its efficacy in treating gingivitis and reducing plaque is generally superior to non-prescription alternatives, particularly for patients with more severe gum issues.

Are there alternatives to Chlorhexidine Gluconate for patients concerned about staining? For patients who are particularly concerned about tooth staining or have a history of sensitivity to chlorhexidine, dentists may recommend alternative antimicrobial rinses. These could include products containing cetylpyridinium chloride or essential oils, which may have a lower risk of staining but may also be less potent in their antimicrobial action.

Advantages of Chlorhexidine Gluconate Over Other Oral Rinses

1. Higher antimicrobial potency
2. Longer-lasting effects between uses
3. Prescription-strength formulation
4. Clinically proven efficacy in treating gingivitis
5. Professional oversight in treatment plan

In conclusion, Chlorhexidine Gluconate Oral Rinse (PerioGard) is a powerful tool in the treatment of gingivitis and maintenance of oral health. Its unique formulation and mechanism of action provide significant benefits in reducing plaque and gingival inflammation. However, users should be aware of potential side effects, particularly tooth staining, and use the product under professional guidance. Regular dental check-ups and proper oral hygiene practices remain essential components of overall oral health management, even when using this effective antimicrobial rinse.

Periogard Chlorhexidine Gluconate Oral Rinse

• Description

  PerioGard (Chlorhexidine Gluconate Oral Rinse, 0.12%) is an oral rinse containing 0.12% chlorhexidine gluconate N, N”-bis(4-chlorophenyl)-3, 12-diimino-2, 4, 11, 13-tetraazatetradecane-diimidamide di-D-gluconate in a base containing water, 11.6% alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor, sodium saccharin, and FD&C Blue No. 1. PerioGard^® oral rinse is a near-neutral solution (pH range 5-7). Chlorhexidine gluconate is a salt of chlorhexidine and gluconic acid, with a molecular formula of C22h40Cl2N10·2C6h3O7 and a molecular weight calculated to be 897.77.

• Ingredients

• Clinical Pharmacology

  Chlorhexidine gluconate provides antimicrobial activity during oral rinsing. The clinical significance of 0.12% chlorhexidine gluconate oral rinse’s antimicrobial activities is not clear. Microbiological sampling of plaque has shown a general reduction of counts of certain assayed bacteria, both aerobic and anaerobic, ranging from 54-97% through six months’ use. Use of a chlorhexidine gluconate oral rinse in a six-month clinical study did not result in any significant changes in bacterial resistance, overgrowth of potentially opportunistic organisms, or other adverse changes in the oral microbial ecosystem. Three months after chlorhexidine gluconate use was discontinued, the number of bacteria in plaque had returned to baseline levels and the resistance of plaque bacteria to chlorhexidine gluconate was equal to that at baseline.

• Indications and Usage

  PerioGard^® (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) is indicated for use between dental visits as part of a professional program for the treatment of gingivitis as characterized by redness and swelling of the gingivae, including gingival bleeding upon probing. PerioGard^® oral rinse has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG). For patients having coexisting gingivitis and periodontitis, see PRECAUTIONS.

• Contraindications

  PerioGard^® should not be used by persons who are known to be hypersensitive to chlorhexidine gluconate or other formula ingredients.

• Warnings

  The effect of PerioGard^® on periodontitis has not been determined. An increase in supragingival calculus was noted in clinical testing with users of chlorhexidine gluconate oral rinse compared with control users. It is not known if chlorhexidine gluconate use results in an increase in subgingival calculus. Calculus deposits should be removed by a dental prophylaxis at intervals not greater than six months. Hypersensitivity and generalized allergic reactions have occurred. See CONTRAINDICATIONS.

• Precautions

  Not for use by persons who are known to be hypersensitive to chlorhexidine gluconate or other formula ingredients. Can cause an increase in staining of teeth, calculus formation and alteration in taste perception. Should not be used during pregnancy unless clearly needed. Like all prescription drugs, use Colgate PerioGard under the care and supervision of a dentist or physician. General: For patients having coexisting gingivitis and periodontitis, the presence or absence of gingival inflammation following treatment with PerioGard^® should not be used as a major indicator of underlying periodontitis. PerioGard^® can cause staining of oral surfaces, such as tooth surfaces, restorations, and the dorsum of the tongue. Not all patients will experience a visually significant increase in tooth staining. In clinical testing, 56% of the chlorhexidine gluconate oral rinse users exhibited a measurable increase in facial anterior stain, compared to 35% of control users after six months; 15% of the chlorhexidine gluconate users developed what was judged to be heavy stain, compared to 1% of control users after six months. Stain will be more pronounced in patients who have heavier accumulations of unremoved plaque. Stain resulting from the use of PerioGard^®does not adversely affect health of the gingivae or other oral tissues. Stain can be removed from most tooth surfaces by conventional professional prophylactic techniques. Additional time may be required to complete the prophylaxis. Discretion should be used when prescribing to patients with anterior facial restorations with rough surfaces or margins. If natural stain cannot be removed from these surfaces by a dental prophylaxis, patients should be excluded from PerioGard^® treatment if permanent discoloration is unacceptable. Stain in these areas may be difficult to remove by dental prophylaxis and, on rare occasions, may necessitate replacement of these restorations. Some patients may experience an alteration in taste perception while undergoing treatment with a chlorhexidine gluconate oral rinse. Rare instances of permanent taste alteration following chlorhexidine gluconate oral rinse use have been reported via postmarketing surveillance. Carcinogenesis, Mutagenesis, Impairment of Fertility: In a drinking water study in rats, carcinogenic effects were not observed at doses up to 38 mg/kg/day. Mutagenic effects were not observed in two mammalian in vivo mutagensis studies with chlorhexidine gluconate. The highest doses of chlorhexidine used in a mouse dominant-lethal assay and a hamster cytogenetics test were 1000 mg/kg/day and 250 mg/kg/day, respectively. No evidence of impaired fertility was observed in rats at doses up to 100 mg/kg/day. Pregnancy: Teratogenic Effects: Reproduction studies have been performed in rats and rabbits at chlorhexidine gluconate doses up to 300 mg/kg/day and 40 mg/kg/day, respectively, and have not revealed evidence of harm to the fetus. However, adequate and well-controlled studies in pregnant women have not been done. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when PerioGard^® is administered to a nursing woman. In parturition and lactation studies with rats, no evidence of impaired parturition or of toxic effects to suckling pups was observed when chlorhexidine gluconate was administered to dams at doses up to 100 mg/kg/day. Pediatric Use: Clinical effectiveness and safety of PerioGard^® have not been established in children under the age of 18.

• Adverse Reactions

  The most common side effects associated with chlorhexidine gluconate oral rinses are: (1) an increase in staining of teeth and other oral surfaces, (2) an increase in calculus formation, and (3) an alteration in taste perception; see WARNINGS and PRECAUTIONS. Oral irritation and local allergy-type symptoms have been spontaneously reported as side effects associated with use of chlorhexidine gluconate rinse. The following oral mucosal side effects were reported during placebo-controlled adult clinical trials: aphthous ulcer, grossly obvious gingivitis, trauma, ulceration, erythema, desquamation, coated tongue, keratinization, geographic tongue, mucocele, and short frenum. Each occurred at a frequency of less than 1.0%. Among postmarketing reports, the most frequently reported oral mucosal symptoms associated with chlorhexidine gluconate oral rinse are stomatitis, gingivitis, glossitis, ulcer, dry mouth, hypesthesia, glossal edema, and paresthesia. Minor irritation and superficial desquamation of the oral mucosa have been noted in patients using chlorhexidine gluconate oral rinses. There have been cases of parotid gland swelling and inflammation of the salivary glands (sialadentitis) reported in patients using chlorhexidine gluconate oral rinse.

• Overdosage

  Ingestion of 1 or 2 ounces of PerioGard^® (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) by a small child (~10 kg body weight) might result in gastric distress, including nausea, or signs of alcohol intoxication. Medical attention should be sought if more than 4 ounces of PerioGard^® oral rinse is ingested by a small child or if signs of alcohol intoxication develop.

• Dosage and Administration

  PerioGard^® therapy should be initiated directly following a dental prophylaxis. Patients using PerioGard^® should be reevaluated and given a thorough prophylaxis at intervals no longer than six months. Recommended use is twice daily oral rinsing for 30 seconds, morning and evening after toothbrushing. Usual dosage is ½ fl. oz. (marked on dosage cup) of undiluted PerioGard^®. Patients should be instructed not to rinse with water or other mouthwashes, brush teeth, or eat immediately after using PerioGard^®. PerioGard^® is not intended for ingestion and should be expectorated after rinsing.

• How Supplied

  PerioGard^® is supplied as a blue liquid in 16 fluid ounce amber plastic bottles with child-resistant closures and dosage cups. Store above freezing (32°F).

• Storage

• Directions for Use

• Interactions

• Manufacture and Distribution

  Colgate Oral Pharmaceuticals Subsidiary of Colgate-Palmolive Company 300 Park Avenue New York, NY 10022

• Pharmacokinetics

  Pharmacokinetic studies with a 0. 12% chlorhexidine gluconate oral rinse indicate approximately 30% of the active ingredient is retained in the oral cavity following rinsing. This retained drug is slowly released into the oral fluids. Studies conducted on human subjects and animals demonstrate chlorhexidine gluconate is poorly absorbed from the gastrointestinal tract. The mean plasma level of chlorhexidine gluconate reached a peak of 0.206 µg/g in humans 30 minutes after they ingested a 300 mg dose of the drug. Detectable levels of chlorhexidine gluconate were not present in the plasma of these subjects 12 hours after the compound was administered. Excretion of chlorhexidine gluconate occurred primarily through the feces (~90%). Less than 1% of the chlorhexidine gluconate ingested by these subjects was excreted in the urine.

Chlorhexidine Mouthwash: Uses and Side Effects

Unfortunately, gingivitis is a real disease— not just something your dentist talks about to scare you. Without the proper dental care, gingivitis can develop, causing symptoms like:

• Irritation
• Redness
• Swelling

But thankfully, there are ways to treat gingivitis and reverse it. One way to do so is with prescription chlorhexidine mouthwash. Let’s take a closer look at what chlorhexidine (CHX) mouthwash is used for and the possible side effects that come with it.

What Is Chlorhexidine Mouthwash?

Chlorhexidine (klor-HEX-i-deen) mouthwash is a prescription rinse with antibacterial properties. This germicidal mouthwash helps decrease bacteria in your mouth.

Based on a 2017 study, CHX mouthwash is the most effective antiseptic mouthwash in controlling dental plaque and gingivitis. The same study concluded that CHX mouthwash can be offered to patients who have dental plaque-induced gingivitis.

You cannot find chlorhexidine mouthwash over the counter— it must get prescribed to you by your dentist.

What Is It Used For?

CHX mouthwash is primarily used to treat gingivitis. Gingivitis is a mild and early form of gum disease (periodontitis) that manifests when your mouth gets infected due to a buildup of bacteria and plaque (a sticky, nearly invisible film on the teeth). The infection occurs where the teeth meet the gums.

Gingivitis itself doesn’t always cause symptoms but often makes the gums swollen, red, and tender. Since gingivitis doesn’t seem to always cause terribly uncomfortable symptoms, many people are tempted to just ignore it. However, if gingivitis is left untreated, it can quickly lead to periodontitis, which is a much more severe stage of gum disease.

Periodontitis is serious, so you really don’t want to develop this disease. Without treatment, periodontitis can destroy the bone that supports your teeth, potentially causing tooth loss. It also creates an increased risk of heart disease, diabetes, and respiratory disease.

There are certain factors that increase the chance of developing gingivitis, including:

• Smoking or chewing tobacco
• Pregnancy or other hormonal changes
• Family history of gum disease
• Diabetes

The best way to prevent gingivitis is to practice proper dental care, which includes:

• Brushing your teeth twice a day
• Flossing at least once a day
• Getting dental cleanings every six months
• Rinsing with an over-the-counter mouthwash
• Limit sugary foods and drinks

Signs and symptoms of gingivitis include:

• Bad breath that doesn’t go away (even after brushing)
• Swollen, red, and tender gums
• Gums that bleed easily
• Sensitivity to hot and cold foods
• Pain when you chew food
• Loose teeth
• Gums are pulling away from the teeth

Your dentist will confirm the diagnosis of gingivitis with X-rays. If you have gingivitis, your dentist may refer you to a gum disease specialist called a periodontist, or they may handle your treatment plan themself.

Since gingivitis is reversible, your dentist will come up with a treatment plan that helps control the bacterial infection and restores healthy teeth and gums. A gingivitis treatment plan can include:

• A thorough professional teeth cleaning to remove plaque and tartar
• “Scaling” to remove bacteria from the teeth and under the gums
• “Planing” to smooth the surface of the tooth roots
• Dental restorations to smooth jagged surfaces (smooth surfaces are easier to clean)
• An at-home dental cleaning plan
• A prescription antibiotic mouthwash like chlorhexidine

Note: Chlorhexidine mouthwash is used to treat gingivitis, not periodontitis. CHX can actually make periodontitis worse.

How to Use Chlorhexidine Mouthwash

The dosage and length of use for CHX mouthwash differ for each patient, so be sure to use it exactly how your dentist ordered it. Typical dosages for adults are 15 milliliters of the rinse twice a day, but again, your dentist will prescribe the specific dosage you need for your particular case.

⚠️ Do not change your dosage unless your dentist tells you to. ⚠️

To use CHX mouthwash, follow your doctor’s orders on the prescription label. Use the rinse after you’ve brushed and flossed your teeth. Be sure to rinse the toothpaste completely from your mouth before using the mouthwash. Avoid eating or drinking for several hours after using the oral rinse (including rinsing your mouth with water).

Swish the chlorhexidine wash in your mouth for 30 seconds, then spit it out. Do not swallow the rinse, and do not mix it with water.

Possible Side Effects

Just like most prescription medications, there is a risk of side effects with chlorhexidine mouthwash. More common side effects of CHX rinses include:

• Taste alteration: Your sense of taste may be altered during treatment. In rare cases, chlorhexidine may cause permanent taste alteration.
• Staining: CHX mouthwash can cause staining on tooth surfaces, restorations, and your tongue. Usually, a thorough cleaning from a dental professional can remove stains.
• Tartar formation: This prescription medication may cause an increase in tartar formation.
• Bitter aftertaste: You may experience a bitter aftertaste after using CHX. Do not rinse your mouth with water after using the mouthwash because this will increase the bitter taste.

Tell your doctor right away if you experience more rare side effects, such as:

• A serious allergic reaction (Signs of allergic reactions can include shortness of breath, nasal congestion, skin rash/hives, itching, or swelling of the face.)
• Mouth irritation
• Swollen glands on neck or side of face
• Irritation on the tip of your tongue

Keep Gingivitis at Bay With Good Dental Hygiene

Chlorhexidine is a great, effective antibacterial mouthwash that helps reverse gingivitis.