Peridex | Healthgrades | (chlorhexidine gluconate rinse)

Brand Name: Peridex

Generic Name: CHLORHEXIDINE GLUCONATE

Drug Type: HUMAN PRESCRIPTION DRUG

Route: ORAL

Dosage Form: RINSE

Data Current As Of: 2018-10-05

Peridex 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. Peridex has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG). For patients having coexisting gingivitis and periodontitis, see PRECAUTIONS.

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

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 post marketing reports, the most frequently reported oral mucosal symptoms associated with Peridex 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 Peridex. There have been cases of parotid gland swelling and inflammation of the salivary glands (sialadenitis) reported in patients using Peridex.

Ingestion of 1 or 2 ounces of Peridex 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 Peridex is ingested by a small child or if signs of alcohol intoxication develop.

Peridex therapy should be initiated directly following a dental prophylaxis. Patients using Peridex 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 15ml (marked in cap) of undiluted Peridex. Patients should be instructed to not rinse with water or other mouthwashes, brush teeth or eat immediately after using Peridex. Peridex is not intended for ingestion and should be expectorated after rinsing.

Peridex is supplied as a blue liquid in 0.5-ounce (15ml), 4-ounce (118ml), 1-pint (473ml) and 64-ounce (1893ml) white or amber plastic bottles with child-resistant dispensing closures.

STORE at 20°C to 25°C (68°F to 77°F ), excursions permitted to 15°C to 30°C (59°F to 86°F) [See USP controlled Room Temperature].

Rx only

Keep out of reach of children

WHAT TO EXPECT WHEN USING PERIDEX (CHLORHEXIDINE GLUCONATE 0.12%) ORAL RINSE

Your dentist has prescribed Peridex™ (Chlorhexidine Gluconate 0.12%) Oral Rinse to treat your gingivitis, to help reduce the redness and swelling of your gums, and also to help you control any gum bleeding. Use Peridex regularly, as directed by your dentist, in addition to daily brushing. Spit out after use. Peridex should not be swallowed.

If you develop allergic symptoms such as skin rash, itch, generalized swelling, breathing difficulties, light headedness, rapid heart rate, upset stomach or diarrhea, seek medical attention immediately. Peridex should not be used by persons who have a sensitivity to it or its components.

Peridex may cause some tooth discoloration or increase in tartar (calculus) formation, particularly in areas where stain and tartar usually form. It is important to see your dentist for removal of any stain or tartar at least every six months or more frequently if your dentist advises.

• Both stain and tartar can be removed by your dentist or hygienist. Peridex may cause permanent discoloration of some front-tooth fillings.
• To minimize discoloration, you should brush and floss daily, emphasizing areas which begin to discolor.
• Peridex may taste bitter to some patients and can affect how foods and beverages taste. This will become less noticeable in most cases with continued use of Peridex.
• To avoid taste interference, rinse with Peridex after meals. Do not rinse with water or other mouthwashes immediately after rinsing with Peridex.

If you have any questions or comments about Peridex, contact your dentist, pharmacist or 3M ESPE Dental Products toll free at 1-800-634-2249.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

STORE at 20°C to 25°C (68°F to 77°F ), excursions permitted to 15°C to 30°C (59°F to 86°F) [See USP controlled room temperature].

Revised: October/2017

Made in U.S.A. for:
3M ESPE Dental Products
2510 Conway Avenue
St. Paul, MN 55144-1000 U.S.A.

© 3M 2017

Principal Display Panel – Peridex Bottle Label

NDC 48878-0620-1

Peridex™

(CHLORHEXIDINE GLUCONATE 0.12%)

ORAL RINSE

DIRECTIONS FOR USE: Fill cap to the “fill line” (15 ml). Swish in
mouth undiluted for 30 seconds, then spit out. Use after breakfast
and before bedtime. Or, use as prescribed.

NOTE: To minimize medicinal taste, do not rinse with water
immediately after use.

Rx only

KEEP OUT OF REACH OF CHILDREN

Dispense in bottle as provided or in amber glass

REF 12132

3M ESPE I.D. No.

70-2010-5520-2

PERIDEX16LBLDL

1 Pint (473ml)

3M ESPE

Chlorhexidine Gluconate (Oral): Pediatric Medication

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Paroex [DSC]; Peridex; Periogard

Brand Names: Canada

APO-Chlorhexidine; Chlorhexidine Alcohol Free [DSC]; DentiCare Rinse; GUM Paroex Oral Rinse; Oro Clear; Oro-Clense; Perichlor; Peridex; Periogard; X-Pur Chlorhexidine

What is this drug used for?

• It is used to treat or prevent mouth infections.
• It may be given to your child for other reasons. Talk with the doctor.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.

This drug may interact with other drugs or health problems.

Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe to give this drug with all of your child’s other drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.

What are some things I need to know or do while my child takes this drug?

• Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
• Take care of your child’s teeth. See a dentist often.

If your child is pregnant or breast-feeding a baby:

• Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.

What are some side effects that I need to call my child’s doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Very bad gum pain or swelling.
• Numbness or tingling in the mouth.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:

• Mouth irritation.
• Staining of the mouth, teeth, or fillings.
• Tartar buildup on teeth.
• Change in taste. Rarely, this may not go away.

These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best given?

Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.

• Have your child brush and floss teeth before rinsing. Have your child rinse with 1 tablespoon (15 mL) of this drug for 30 seconds.
• Do not let your child swallow this drug.
• Have your child rinse 2 times a day, in the morning and in the evening.
• To avoid problems with the taste of food, have your child use this drug after meals. Do not let your child eat, brush teeth, or rinse with water or other mouthwash right after using this drug.

What do I do if my child misses a dose?

• Give a missed dose as soon as you think about it.
• If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
• Do not give 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

• Store at room temperature.
• Protect from heat.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

• If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
• Do not share your child’s drug with others and do not give anyone else’s drug to your child.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. The use of this information is governed by the Lexicomp End User License Agreement, available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Last Reviewed Date

2020-09-08

Copyright

© 2021 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

Chlorhexidine: Uses, Interactions, Mechanism of Action

Anti Mucedine Feminine Wash	Chlorhexidine acetate (0.1 g/100mL)	Liquid	Topical	Jiangxi Renhetang pharmaceutical chain Co., Ltd.	2021-03-16	Not applicable	US
Anti-bac Hand	Chlorhexidine acetate (0.45 g/100mL)	Soap	Topical	Fujian Jinghua Biotechnology Co.,Ltd.	2020-04-25	Not applicable	US
Antibacterial Protective Hand	Chlorhexidine gluconate (.0045 g/.9g)	Lotion	Topical	HANOVER PEN CORP dba HPC Global	2013-02-01	Not applicable	US
Antibacterial Protective Hand	Chlorhexidine gluconate (.07075 g/14.15g)	Lotion	Topical	HANOVER PEN CORP dba HPC Global	2013-02-01	Not applicable	US
Antiseptic Cleansing Wipes	Chlorhexidine gluconate (0. 0002 mg/1mg)	Swab	Topical	Guangdong Comfort Medical Products Co., Ltd.	2017-07-17	Not applicable	US
Antiseptic Cleansing Wipes	Chlorhexidine gluconate (0.0002 mg/1mg)	Swab	Topical	Foshan Flying Medical Products Co., Ltd.	2012-12-27	Not applicable	US
Bei Ling Tong Bao Er Zheng Yuan Antibacterial Creams	Chlorhexidine acetate (0.03 g/15g)	Cream	Topical	Jilin Mancaotang Health Management Group Co Ltd	2018-11-20	2019-10-21	US
Chinese Herb Essence Bacteriostatic Feminine Wash	Chlorhexidine acetate (0.1 g/100mL)	Liquid	Topical	Jiangxi Renhetang pharmaceutical chain Co., Ltd.	2021-03-16	Not applicable	US
DermacinRx Clorhexacin	Chlorhexidine gluconate (4 g/100mL) + Dimethicone (50 mg/1mL) + Mupirocin (20 mg/1g)	Kit	Topical	PureTek Corporation	2016-06-02	Not applicable	US
DermacinRx Surgical ComboPak	Chlorhexidine gluconate (4 g/100mL) + Dimethicone (50 mg/1mL)	Kit	Topical	PureTek Corporation	2015-04-28	Not applicable	US

Peridex™ vs LISTERINE® | LISTERINE® Professional

Peridex™ vs LISTERINE® | LISTERINE® Professional
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– Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis. J Clin Periodontol. 1990;17:575-579.

Peridex

^TM vs LISTERINE^® for Gingivitis and Dental Plaque

Objective

Determine the efficacy of 2 mouthrinses—LISTERINE® Antiseptic and Peridex™—used as supplements to regular oral hygiene measures in reducing supragingival dental plaque and gingivitis (N=124). 

Methodology

Double-blind, controlled, parallel design clinical study of healthy male and female subjects (aged ≥21 years) with preexisting plaque and gingivitis but without evidence of periodontitis. 

Results

At 6 months, gingivitis development was inhibited by 35.9% in the LISTERINE® Antiseptic group and by 30.5% in the Peridex™ group, when compared to the hydroalcohol control (P<0.001).

At 6 months, gingivitis development—in posterior regions—was inhibited by 33. 2% and 34.4% in the LISTERINE® Antiseptic group and by 26.6% and 33.8% in the Peridex™ group, when compared to the hydroalcohol control (P<0.001).²

Conclusion

LISTERINE® Antiseptic produces gingivitis reductions comparable to Peridex™ at 6 months (including gingivitis in posterior regions).

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Is peridex and chlorhexidine the same thing?

Is peridex and chlorhexidine the same thing? Chlorhexidine (Peridex) is an antibacterial mouth rinse that is used to treat gingivitis (redness and swelling of the gum), but you’ll need a prescription to use it.

What is the generic name for peridex? chlorhexidine gluconate rinse (Peridex, Periogard) Dosage.

What can I use instead of peridex? Peridex is prescription-only and comes in a mint flavor. One alternative that is very similar is Gum Paroex (0.12% chlorhexidine gluconate) mouth rinse from Sunstar. Paroex differs from Peridex by being alcohol-free.

Do I need a prescription for Peridex? Peridex is an over the counter and prescription medicine used as an oral rinse to treat the symptoms of Gingivitis and as an adjunct to scaling and root planing. Peridex may be used alone or with other medications.

Is peridex and chlorhexidine the same thing? – Related Questions

What is the generic name for chlorhexidine?

Peridex (chlorhexidine gluconate 0.12%) Oral Rinse is an antimicrobial rinse used along with tooth brushing and flossing as part of a program to treat gingivitis. Peridex is available in generic form.

When should you not use chlorhexidine?

Do not use it on skin areas that have cuts or scrapes. Apply the medicine in a well-ventilated place and do not use it while you are smoking. Adults, teenagers, and children 2 months of age and older: Open the pouch and use the handle to remove the swabstick applicator.

Can you drink water after using Peridex?

Swish the medicine in your mouth for at least 30 seconds, then spit it out. Do not swallow the mouthwash. Do not add water to the oral rinse. Do not rinse your mouth with water or other mouthwashes right after using Peridex.

What can be used in place of chlorhexidine?

The results of this study suggest that SmartMouth Clinical DDS Advanced Oral Rinse is an effective over-the-counter alternative to 0.12% chlorhexidine prescription mouthrinse in reducing gingival inflammation, bleeding and plaque, particularly when concerns over tooth staining, taste alteration, and patient compliance

Is Peridex better than Listerine?

After 14 days, the average PBS for Peridex and Perimed was significantly lower than for Listerine Antiseptic and water. We concluded that both Peridex and Perimed were effective in reducing plaque and gingivitis when used as a 2 x daily mouthrinse by subjects refraining from other oral hygiene procedures.

Can I use Listerine instead of Peridex?

Conclusion. LISTERINE® Antiseptic produces gingivitis reductions comparable to Peridex™ at 6 months (including gingivitis in posterior regions).

Can I buy chlorhexidine over the counter?

Chlorhexidine gluconate is mainly available over the counter in products used to clean and prepare the skin before surgery and injections to reduce bacteria that can trigger skin infections. Products are typically available as solutions, washes, sponges and swabs.

Can you use Peridex long term?

NOTE: Peridex may cause alteration of taste perception during use and may increase staining of teeth and other oral surfaces. To avoid this, use Peridex only during the first 2 weeks of the healing process. There is no need for prolonged use.

How long after chlorhexidine can I eat?

After using chlorhexidine, wait at least 30 minutes before rinsing your mouth with water or mouthwash, brushing your teeth, eating, or drinking.

Is chlorhexidine better than Listerine?

This study has demonstrated that chlorhexidine was superior to Listerine and Meridol in its ability to maintain low plaque scores and gingival health during this 3-week period of no mechanical oral hygiene.

Can I use chlorhexidine mouthwash every day?

Chlorhexidine is an antiseptic which kills most bacteria. In the UK chlorhexidine mouthwashes are licensed for 30 days’ use and are not recommended for routine use. This systematic review suggests that chlorhexidine mouthwash may be considered as an addition to usual care for people with mild gum disease.

Is salt water as good as chlorhexidine?

Saltwater was as effective as chlorhexidine in reducing dental plaque (p = 0.19) and A. actinomycetemcomitans (p = 0. 35) count and while chlorhexidine was superior against S.

Is chlorhexidine better than alcohol?

Both are available in aqueous and alcoholic preparations,1,3,4 and both are effective against a wide range of bacteria, viruses and fungi, although chlorhexidine has more residual antiseptic activity on the skin after application. The evidence base guiding appropriate selection of antiseptic agents is poor.

How long should you use chlorhexidine?

Chlorhexidine is an antiseptic against a broad spectrum of bacteria. The authors found high-quality evidence that short-term (4-6 weeks) and longer-term (6 months) use of chlorhexidine mouthwash in addition to usual toothbrushing and cleaning leads to a large reduction in the build-up of plaque.

Why is chlorhexidine prescription only?

Chlorhexidine destroys the bacteria, thereby preventing the gingivitis from occurring. However, chlorhexidine does not prevent plaque and tartar from forming; proper tooth brushing and flossing are still necessary and important. Chlorhexidine is available only with your dentist’s or medical doctor’s prescription.

How long should I use peridex?

Chlorhexidine (Peridex) should not be used for longer than 6 months. Long-term use of chlorhexidine (Peridex) can increase the staining of your teeth, dental fillings, and tongue. Additionally, using chlorhexidine (Peridex) for more than 6 months have not shown to be more effective.

Can you use peridex after brushing teeth?

How to use Peridex Mouthwash. Rinse your mouth with the solution after brushing your teeth, usually twice daily (after breakfast and at bedtime) or as directed by your doctor. Measure 1/2 ounce (15 milliliters) of the solution using the supplied measuring cup.

Can you eat after using chlorhexidine mouthwash?

Chlorhexidine oral rinse should be used after you have brushed and flossed your teeth. Rinse the toothpaste completely from your mouth with water before using the oral rinse. Do not eat or drink for several hours after using the oral rinse.

Is chlorhexidine toxic?

Chlorhexidine diacetate generally is of low to moderate acute toxicity, but is highly acutely toxic when applied to the eye.

What is the #1 dentist recommended brand of mouthwash?

Listerine antiseptic mouth rinse- is the #1 dentist recommended brand and most widely used in the country.

Does Listerine have chlorhexidine?

The effects of two daily 10-mL rinses with 0.12% chlorhexidine digluconate, the quaternary ammonium compound cetylpyridinium chloride, the phenolic compound Listerine, or the plant alkaloid sanguinarine were compared with those of rinses with a placebo.

Peridex Alternatives | Healthfully

Peridex Mouthwash (chlorhexidine gluconate) is the first broad-spectrum antiseptic mouthwash to receive the ADA Seal of Acceptance for treatment of gingivitis 1. Its time-release formula reduces redness and gum swelling and helps control bleeding of gums. Children under 12 years of age should not have access to this product. If you are pregnant, nursing or sensitive to Peridex, some alternatives are available.

Stannous Fluoride

Prescription-grade stannous fluoride, dispensed by dentists, reportedly tastes better than fluoride from the pharmacy. Two of the better brands are Stanimax and PerioMed, and are sold only to dentists, not to pharmacies. Products like stannous fluoride may help children and adults who suffer from mouth ulcers induced by chemotherapy. It is a preventative as well as a therapeutic agent.

• Prescription-grade stannous fluoride, dispensed by dentists, reportedly tastes better than fluoride from the pharmacy.
• Two of the better brands are Stanimax and PerioMed, and are sold only to dentists, not to pharmacies.

Nilstat Rinse

Difference Between 20% & 35% Opalescence

People undergoing intense chemotherapy are at risk for fungal and oral yeast infections evidenced by white patches in the mouth. Nilstat rinses, Mycostatin or Mycelex lozenges help treat the mouth and throat. Avoid using toothbrushes during times when gums are swollen or bleeding. Use a sponge-tip brush, a facecloth or gauze to gently clean teeth and gums prior to using any antibacterial mouth rinse product.

• People undergoing intense chemotherapy are at risk for fungal and oral yeast infections evidenced by white patches in the mouth.

Magic Mouthwash

Magic Mouthwash is a prescription mixture of Benadryl, Maalox, Nystatin and lidocaine. This product numbs the mouth for about 30 minutes and helps prevent mouth sores following intense oral treatments. Used for current oral conditions, this product provides some temporary pain relief due to numbing.

Mouthwash Kits

Over the Counter Medication for Oral Thrush

In January 2011, CutisPharma, Inc. introduced a new line of mouthwash compounding kits for dispense by dentists and pharmacies. Ingredients are comparable to those found in Magic Mouthwash, also produced by the same company. Twelve kits on the market allows for customized prescriptions, based on individual symptoms and conditions.

Oradex

Oradex has a low concentration of cholorhexidine gluconate for long-term usage. Low concentrations of the same ingredients that are in Peridex may help some people tolerate it with fewer side effects and less staining of teeth. This product does not contain alcohol, reducing the number of side effects and making it safe for children.

Hydrogen Peroxide

Hydrogen peroxide is a natural sanitizer, killing microorganisms by oxidizing them. Use 3 percent peroxide as a germicidal mouthwash or gargle. Another option is to mix baking soda with enough peroxide to make a paste for brushing your teeth with, and follow brushing with the hydrogen peroxide rinse. The taste of peroxide is unappealing and you should avoid swallowing it in large amounts or on a regular basis.

• Hydrogen peroxide is a natural sanitizer, killing microorganisms by oxidizing them.
• The taste of peroxide is unappealing and you should avoid swallowing it in large amounts or on a regular basis.

PERIODONTICS: A Rationale for Combining Chlorhexidine and Fluoride

ABSTRACT: There are questions as to whether chlorhexidine and fluoride can be used together. The purpose of this paper is to determine if chlorhexidine (CHX) and fluoride (Fl) when combined could be used as a powerful tool for the prevention of caries and gingivitis. A search over a 25-year period was conducted to locate studies about the mechanisms of action for CHX and Fl, the rationale for combining chlorhexidine and fluoride, and the interactions between CHX and Fl. In addition, studies describing the effects of combinations of CHX and sodium fluoride (NaF) at different concentrations, the effects on acid production associated with dental plaque, and the effects on CHX and Fl together in reducing gingivitis were also located. The search resulted in approximately 50 articles. Additional articles were obtained through article references. The objective of this study was to prepare a literature review on the rationale for combining chlorhexidine and fluoride. There is clinical evidence that a combination of CHX and Fl exhibits a decrease in caries production and gingival inflammation. When used together topically in the same vehicle CHX and NaF do not decrease the presence of free ionized Fl nor reduce the availability of CHX below therapeutic levels. When CHX and NaF have been combined at different concentrations, all plaque samples showed greater inhibitory effects of plaque regrowth and lower colony-forming units than when the agents were used separately. Clinically significant and useful reductions in gingival inflammation have been shown when CHX and NaF are combined and used with regular oral hygiene practices. From this review of the literature, it is apparent that CHX and Fl (specifically NaF) can be combined without losing their individual properties. For certain high-risk groups these formulations may be essential to oral health. Suitable products and the importance of sequence and timing in their application must be recognized by dentists and dental hygienists.

Extensive research has been conducted to determine methods for reducing or eliminating caries and gingivitis. These two common diseases are associated with dental plaque. Chemical adjuncts to mechanical plaque debridement have been investigated to aid in the control of dental plaque formation. One of the most studied and effective agents for the prevention of caries is fluoride (Fl). Chlorhexidine (CHX) has proven to be the most powerful chemical adjunct to reduce gingivitis. Chlorhexidine has also been used to reduce the number of Streptococcus mutans for caries prevention. It would seem of value to combine these two agents in controlling tooth decay and gingivitis. Fluoride and chlorhexidine combinations have been tested in toothpastes, gels, rinses, sprays and varnishes. 3,5,6,8,9,12-14,16-18,22,26-28 At present, commercial combination products are not available in North America. There are questions as to whether CHX and Fl can be used together because of their ionic properties. The purpose of this literature review is to determine if CHX and Fl when combined could be used as a powerful tool for the prevention of caries and gingivitis for those individuals for whom conventional therapy is not effective.

BACKGROUND OF CHLORHEXIDINE AND FLUORIDE

Chlorhexidine is an antimicrobial and a cationic bisbiguanide that in its active form has the unique ability to be adsorbed to oral tissues such as hydroxyapatite, tooth surfaces, oral mucosa and salivary mucins for extended periods of time, and then be released later when its concentration in the oral cavity is reduced.24,25 This extended binding and slow release allows the antimicrobial to reduce bacterial recolonization for about 24 hours.24,25 While retained in the oral cavity, CHX also appears to be adsorbed onto the bacterial cell surface due to the cell surface negative charge at physiologic pH. 4 Upon binding to the bacterial cell, CHX can disrupt the cytoplasmic membrane, damaging the permeability barrier, thus allowing the drug entrance to the cytoplasm where it causes a precipitation of its cellular contents (Table 1).11 CHX has been studied and found to be effective against Gram positive and negative bacteria, fungi, yeast and both facultative aerobic and anaerobic flora.7 Due to its bactericidal effects on these microorganisms it has been studied extensively for its use in the medical and dental fields.

Fluoride anion is used most commonly in the prevention of dental caries to strengthen tooth structure.10 During tooth development and to some degree also in the oral cavity, fluoroapatite is formed when fluoride is present. Fluoroapatite resists acid demineralization significantly better than hydroxyapatite. However, fluoride has other effects against cariogenic microorganisms (Table 1). In its ionic form it has the ability to be toxic to Streptococcus mutans (S. mutans) at high concentrations, and at low concentrations it can exert an antienzymatic effect on the organism. 10 Inhibition of these enzymes decreases the ability of S. mutans to produce acid and to transport and store glucose and its analogues.10

RATIONALE TO COMBINE CHLORHEXIDINE AND FLUORIDE

Many preparations of CHX or fluoride are available for the prevention of gingivitis and caries (Table 2). Luoma et al.16 states that “clinical observations indicate single chemical agents used in prevention of dental diseases exert their action merely or predominately against either caries or gingivitis.” McDermid et al.18 has proposed that a combination of an anticaries and antiplaque agent may be useful and provide an additive protective effect if each agent acts at a different site. A potentially useful combination of CHX in any oral hygiene product with the addition of fluoride could be beneficial in reducing caries increments.29 Since there can be an inhibitory effect on acid production and plaque formation by CHX, it may reduce the cariogenic challenge enough for fluoride to act more effectively. 27 There is evidence that, when used together for caries prevention, CHX and Fl provide additive benefits and together may prove valuable in the prevention of oral diseases.12 A number of studies have been conducted on the effects of combining CHX and fluoride in the same vehicle and their interactions with one another (Table 2).5,6,12-17,21,22 In spite of their opposite charges they have been shown to be successfully incorporated into the same vehicle without affecting their individual activity.5,6,12-17,21,27,28 It appears that there is more damage to the outer structures of S. mutans by the combination of CHX and fluoride than by each agent alone.20 It has been speculated that a combination of CHX and fluoride could exhibit a decrease in caries production and gingival inflammation.6 There is clinical evidence that this is possible.16 It has been shown that, when used together topically, sodium fluoride (NaF) and CHX in the same vehicle do not decrease the presence of free ionized fluoride or its protective action on enamel,6,16 nor reduce the availability of CHX below therapeutic levels. 6,19

INTERACTIONS

Chlorhexidine, a strong cationic compound, has the ability to form low-solubility salts with anions such as sulphate, phosphate and chloride24,25 which can make it a difficult agent to incorporate into dental products without losing its antiseptic properties through interactions with other ingredients.2 A fluoride used commonly in toothpaste, monofluorophosphate (MFP), was studied for its possible compatibility in formulations with CHX.2 Results from this study showed that when clinically relevant concentrations of 0.2% CHX and 8.0% MFP were used, a visible precipitate formed in all samples.2 This eliminated a large portion of the free CHX, leading the authors to conclude that MFP and CHX are not compatible.2 In a study by Dolles et al.,5 it was found that when 2.0% CHX and 0.1% NaF were used together in a toothpaste, the NaF could be fully recovered, leading to the conclusion that ingredients other than the NaF were interacting and binding with the CHX. Sodium lauryl sulphate, a detergent commo
nly used in dentifrices, was studied for its compatibility with CHX and also found to react with and render CHX ineffective.1 The time intervals of 3 to 120 minutes between use of CHX and sodium lauryl sulphate also showed that use of the two agents at a 3 minute interval did not decrease the plaque index and in fact the two agents need to be used at least 30 minutes apart or preferably greater that 120 minutes apart.1 It is apparent that ingredients in toothpaste which are anionic such as sodium lauryl sulphate and MFP can have adverse affects on CHX both before and after its use. This may be due to ionic interactions21 but to date no such interactions have been found with NaF and CHX.12

CARIES PREVENTION

Due to the apparent compatibility of CHX and NaF, a combination of the two may be effective in caries prevention (Table 2).28 Over a two year period, Luoma et al.16 tested a 0.05% CHX and 0.044% NaF mouthrinse and toothpaste on schoolchildren and found there to be a 53% reduction in caries increment. In this study, interproximal caries were decreased by 73.2%, vestibular/lingual by 66.3% and occlusal caries by 15.3%, showing that significant caries reduction could be obtained with the exception of fissure caries.16 Ullsfoss et al.27 found that when a 0.2% CHX mouthrinse was used twice daily along with a 0.05% NaF mouthrinse once daily on children where the premolars were fitted with orthodontic bands scheduled for extraction, the fluoride rinse alone did not totally prevent caries but the CHX and NaF rinses used together were more effective. The reduction of lesion depth and mineral loss of the teeth examined by microradiographic data showed the lesions to be in the same range as sound enamel. Another study using dentifrices has shown a trend toward decreased caries incidence with subjects using 2.0% CHX and 0.1% NaF together compared with subjects using the agents separately. The highest number of subjects who did not have caries during the study period were from the CHX and NaF group. 5 It is important to note that these dentifrices did not contain sodium lauryl sulphate.5 Contrary to these findings, use of a CHX and fluoride varnish for the prevention of proximal caries in children found the combination offered no added benefit when applied every six months when compared with a fluoride varnish alone.22

PLAQUE REDUCTION

It is known that CHX and fluoride at high concentrations can produce a bactericidal effect against S. mutans, the major bacteria responsible for caries.7 Studies have shown that when CHX and NaF have been combined at different concentrations all plaque samples showed greater inhibitory effects of plaque regrowth and lower colony-forming units than when the agents were used separately (Table 2).9,18 CHX and NaF in a combination rinse form were used on subjects highly colonized by S. mutans (those with 100% detectable S. mutans at the beginning of the test period).27 After CHX and NaF rinsing only 20% of the surfaces showed colonization by S. mutans, whereas the fluoride rinse group showed 64% colonization.27 Plaque samples from this same study showed that after the CHX and NaF rinse only 53% of the samples were positive for S. mutans; whereas the fluoride group was 100% positive, demonstrating that fluoride alone did not eliminate S. mutans as effectively.27 When disinfection by a 1.0% CHX gel followed by the daily use of a 1.0% NaF gel was used to analyze the reappearance of S. mutans, it was found that S. mutans suppression was considerably longer than a placebo without fluoride.29 Even though S. mutans was not completely eradicated in this study, there was a significant decrease in the amount of recolonization by the bacterium.29 In contrast to these findings, a study by Mendieta et al.19 did show that when a 0.12% CHX and a 0.12% CHX and 0.022% NaF rinse were tested for plaque regrowth, the 0.12% CHX rinse performed better by one index than the combination rinse.

ACID PRODUCTION

Acid production plays an important role in the process of dental caries and it has been postulated that, since CHX and fluoride can alter this process at different stages, when used together there may be a synergistic effect. 18 A limitation of fluoride when used alone is that it has difficulty preventing caries formation if the plaque pH is too low.27 A way to increase the pH so that fluoride can act more effectively would be to use an agent that could reduce the acid formation of dental plaque.27 Since CHX has been shown to decrease plaque and subsequently reduce the amount of acid production, it would seem to be a worthwhile agent to use to accomplish the above proposition. Fluoride has also been shown to inhibit glycolysis and acid production, but when used together with CHX the terminal pH after glycolysis was shown to be much lower than if each agent were used alone.8,9,18,27 Mineral loss from enamel due to acid attack has also been shown to decrease when a combination of CHX and NaF have been used instead of NaF alone.27 This observation was believed to be due to decreased acid production and a pH drop for a short time of time, thus allowing available fluoride to form fluorapatite.27

GINGIVITIS

As it has been shown that CHX and Fl together can have an effect on caries production, the formulations would be of even greater value if they could also reduce gingivitis (Table 2). When a 0.12% CHX and 100 ppm NaF mouthrinse was evaluated over a six week period where the subjects rinsed with the test solution or a placebo that contained neither CHX nor NaF, the results of the study showed that after six weeks the greatest decrease in gingival bleeding was found with the CHX and NaF group, but significant only for the mandibular posterior buccal and the lingual of mandibular anterior and posterior areas that can receive less attention from toothbrushing.12 Another study13 showed similar results when 0.05% CHX and 0.05% NaF at a pH of 6.0 was tested on adult subjects for a reduction in gingival inflammation along with regular oral hygiene practices. The test solution showed both significant and clinically useful reductions in gingival inflammation and added a useful component to regular oral hygiene practices and periodontal debridement for the reduction of gingival bleeding.13 With respect to area-specific reductions in gingival bleeding, it has been reported that vestibular bleeding was reduced from 63% to 14% and mesial bleeding from 59% to 39% using a toothpaste and mouthrinse with 0. 05% CHX and 0.044% NaF for two years.17 The combination of CHX and Fl in toothpaste form has also been evaluated for its effect on gingivitis.28 One study showed that, six weeks into the 6 month trial the test group using a 1.0% CHX and 1000 ppm NaF toothpaste two times per day had lower gingivitis and bleeding scores than the control groups, but little additional reductions were achieved after six weeks.28

SIDE EFFECTS

A common side effect of CHX is tooth staining and this may be the reason CHX has not been incorporated into commercially-available products designed for long-term use.23 Studies of the combination of CHX and Fl have looked at the amount of tooth staining of the subjects.5,12-14,28 When used in combination, it appears the fluoride may produce a reduced effect on CHX’s propensity to cause tooth staining.5 To further support this, it has been shown that, when children rinsed or brushed with a CHX and NaF preparation, there was little or no staining of the teeth. 16 The finding from this study is difficult to apply to adults since their intake of beverages such as red wine, tea and coffee, and smoking habits, all of which can propensiate the staining from CHX, were not a factor in this study involving children.13 A reason proposed for this decreased staining aside from diet and smoking is that fluoride can reduce the adsorption of CHX to oral surfaces.5 Interestingly, when a CHX and NaF gel and mouthrinse were used on patients who had received orofacial radiation and had little or no saliva, there was no staining present on the subjects’ teeth.14 The author of this study postulated that saliva
may have a contributory effect on CHX’s propensity to cause staining.14

DELIVERY DEVICES

The most common form of plaque control is toothbrushing with toothpaste.21 Numerous studies have shown that CHX and NaF can be used together in toothpaste form and result in decreased plaque, gingivitis and caries.5,6,16,17,21,28 It is important to note that, when using a mouthrinse containing CHX and a toothpaste containing NaF, it has been found in one study that the combination therapy shows greater efficacy when the CHX is used prior to toothpaste, which is the opposite order that most toothpastes and mouthrinses are commonly used. 21 Of greatest importance when combining a CHX rinse with a fluoride toothpaste that contains sodium lauryl sulphate is that the two be used at least thirty minutes apart.1

Mouthrinses are another common vehicle for delivering chemical agents and many studies have shown that CHX and NaF can be formulated together to also decrease plaque, gingivitis and caries to a greater extent than the use of just one of the agents.12-14,27 Varnishes containing both CHX and NaF have also been tested but the results showed that there was no added benefit to combining the two agents into one vehicle.22 CHX and NaF gels have also been successfully formulated and have proven to be of great benefit to the prevention of dental caries and gingivitis when followed by a CHX and NaF rinse in patients who have received head and neck radiation.14 The gel prevented caries formation and also caused remineralization of incipient carious lesions, a result that was not found in the group that used just the CHX and NaF mouthrinse. 14 Gingivitis was also markedly reduced in this study and no complications of oral infection were noted during the study period.14

INDICATIONS FOR USE

It appears possible and beneficial to use CHX and NaF simultaneously in the prevention of caries and gingivitis. At present, there are no commercially-available products that contain both CHX and NaF. Therefore, when combining two separate preparations of the antimicrobials, oral health professionals need to be careful to prevent antagonistic interactions with the CHX and other ingredients such sodium lauryl sulphate.1 Individuals who have shown the most benefit from the use of this combination have been those identified as having a high caries risk such as children, orofacial radiation patients and the medically-compromised.13,14,16 Daily use of the combination has been shown to be most successful, whereas when a once-weekly rinse was tested to try to increase compliance, the results did not reach clinical significance. 26 For patients currently receiving little prevention of caries and/or gingivitis from their current regime, this combination may be of value, but for chronic long-term use by the average person, this recommendation is not warranted at this time.28

CONCLUSIONS

From the review of this literature it is apparent that, although CHX and Fl (specifically NaF) have opposite charges, they can be combined without losing their individual properties. Many authors realize that the combination of these two chemotherapeutic agents is not required for everyone, but for certain high-risk groups these formulations may be essential to the maintenance of their oral health. It is clear that commercial products that would combine CHX and NaF would be of value for the prevention of caries and gingivitis. Dentists and dental hygienists can already use the combinations, however they must apply the suitable products and recognize the importance of sequence and timing in their application (Table 3).

eeann Donnelly, Dip. D.H., 4th Year B.D.Sc. Student; Hannu S. Larjava, D.D.S., Ph.D., Dipl. Perio, Chair, Division of Periodontics & Dental Hygiene; Bonnie J. Craig, Dip. D.H., M.Ed., Director, Dental Hygiene Degree Completion (B.D.Sc.) Program, Faculty of Dentistry, University of British Columbia.

Oral Health welcomes this original article. Complete references available upon request.

REFERENCES

1.Barkvoll P, Rolla G, Svendsen AK: Interaction between chlorhexidine gluconate and sodium lauryl sulfate in vivo. J Clin Periodontol 1989; 16: 593-595.

2.Barkvoll P, Rolla G, Bellagamba S: Interaction between chlorhexidine gluconate and sodium monofluorophosphate in vitro. Scand J Dent Res 1988; 96: 30-33.

3.Chikte UM, Pochee E, Rudolph MJ, Reinach SG: Evaluation of stannous fluoride and chlorhexidine sprays on plaque and gingivitis in handicapped children. J Clin Periodontol 1991;18: 281-286.

4.Davies A: The mode of action of chlorhexidine. J Periodont Res 1973; 8(Suppl 12): 68-75.

5.Dolles OK, Bonesvoll P, Gamst ON, Gjermo P: Determination of fluoride and chlorhexidine from chlorhexidine/fluoride-containing dentifrices. Scand J Dent Res 1979; 87: 115-122.

6.Dolles OK, Gjermo P: Caries increment and gingival status during 2 years’ use of chlorhexidine-and-fluoride-containing dentifrices. Scand J Dent Res 1980; 88: 22-27.

7.Emilson C: Susceptibility of various microorganisms to chlorhexidine. Scan J Dent Res 1977; 85: 255-265.

8.Giertsen E, Scheie AA: Effects of mouthrinses with chlorhexidine and zinc ions combined with fluoride on the viability and glycolytic activity of dental plaque. Eur J Oral Sci 1995; 103: 306-312.

9.Giertsen E, Scheie AA: Effects of chlorhexidine-fluoride mouthrinses on viability, acidogenic potential, and glycolytic profile of established dental plaque. Caries Res 1995; 29: 181-187.

10.Hamilton, IR: Effects of fluoride on enzymatic regulation of bacterial carbohydrate metabolism. Caries Res 1977; (suppl 1): 262-291.

11.Hennessey T. Some antimicrobial properties of chlorhexidine. J Periodont Res 1973; 12(suppl 12):61-67.

12.Jeffcoat MK, Bray KS, Ciancio S, Dentino AR, et al.: Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improbes attachment level compared with scaling and root planing alone. J Periodontol 1998; 69: 989-997.

13.Jenkins S, Addy M, Newcombe R: Evaluation of a mouthrinse containing chlorhexidine and fluoride as an adjunct to oral hygiene. J Clin Periodontol 1993; 20: 20-25.

14.Joyston-Bechal S, Hernaman N: The effect of a mouthrinse containing chlorhexidine and fluoride on plaque and gingival bleeding. J Clin Periodontol 1993; 20: 49-53.

15.Katz S: The use of fluoride and chlorhexidine for the prevention of radiation caries. JADA 1982; 104.

16.Luoma H, Ainamo J, Soderholm S, Meurman J, Helminen S: Reduction of enamel solubility and plaque development with chlorhexidine-fluoride solutions. Scand J Dent Res 1973; 81: 523-527.

17.Luoma H, Murtomaa H, Nuuja T, Nyman A, Nummikoski P, Ainamo J, Luoma AR: A simultaneous reduction of caries and gingivitis in a group of schoolchildren receiving chlorhexidine-fluoride applications. Caries Res 1978; 12: 290-298.

18.Maynard JH, Jenkins SM, Moran J, Addy M, Newcombe RG Wade WG: A 6-month home usage trial of a 1% chlorhexidine toothpaste (II). Effects on the oral microflora. J Clin Periodontol 1993; 20: 207-211.

19.McDermid AS, Marsh PD, Keevil CW, Ellwood DC: Additive inhibitory effects of combinations of fluoride and chlorhexidine on acid production by Streptococcus mutans and Streptococcus sanguis. Caries Res 1985; 19: 64-71.

20.Mendieta C, Vallcorba N, Binney A, Addy M: Comparison of 2 chlorhexidine mouthwashes on plaque regrowth in vivo and dietary staining in vitro. J Clin Periodontol 1994; 21: 296-300.

21.Meurman JH: Ultrastructure, growth, and adherence of Streptococcus mutans after treatment with chlorhexidine and fluoride. Caries Res 1988; 22: 283-287.

22.Ostela I, Karhuvaara L, Tenovuo J: Comparative antibacterial effects of chlorhexidine and stannous fluoride-amine fluoride containing dental gels against salivary Streptococci mutans. Scand J Dent Res 1991; 99: 378-383.

23.Owens J, Addy M, Faulkner J, Lockwood C, Adair R: A short-term clinical study designed to investigate the chemical plaque inhibitory properties of mouthrinses when used as adjuncts to toothpastes: applied to chlorhexidine. J Clin Periodontol 1997; 24: 732-737.

24.Petersson LG, Magnusson K, Andersson H, Deierbor
g G, Twetman S: Effect of semi-annual applications of a chlorhexidine/fluoride varnish mixture on approximal caries incidence in schoolchildren. A three-year radiographic study. Eur J Oral Sci 1998; 106: 623-627.

25.Prayitno S, Addy M: An in vitro study of factors affecting the development of staining associated with the use of chlorhexidine. J Periodontal Res 1979; 14: 397-402.

26.Rolla G, Loe H, Schiott R: The affinity of chlorhexidine for hydroxyapatite and salivary mucins. J Periodontal Res 1970; 5: 90-95.

27.Rolla G, Melsen B: On the mechanism of the plaque inhibition by chlorhexidine. J Dent Res 1975; 54: 1357-1362.

28.Spets-Happonen S, Luoma H, Forss H, Dentala J, Alaluusua S, Juoma A-R, Gronroos L, Syvaoja S, Tapaninen H, Happonen P: Effects of a chlorhexidine-fluoride-strontium rinsing program on caries, gingivitis and some salivary bacteria among Finnish schoolchildren.. Scand J Dent Res 1991; 99: 130-138.

29.Ullsfoss BN, Ogaard B, Arends J, Ruben J, Rolla G, Afseth J: Effect of a combined chlorhexidine and NaF mouthrinse: an in vivo human caries model study. Scand J Dent Res 1994; 102: 109-112.

30.Yates R, Jenkins S, Newcombe R, Wade W, Moran J, Addy M: A 6-month home usage trial of a 1% chlorhexidine toothpaste (I). Effects on plaque, gingivitis, calculus and toothstaining. J Clin Periodontol 1993; 20: 30-138.

31.Zickert I, Emilson CG, Ekblom K, Krasse B: Prolonged oral reduction of Streptococcus mutans in humans after chlorhexidine disinfection followed by fluoride treatment. Scand J Dent Res 1987; 95: 315-320.

Table 1: Effect of Fluoride and Chlorhexidine on Bacteria

Table 2 : Effects of Various Combinations of Fluoride and Chlorhexidine on Caries, Plaque Formation and Gingivitis in Clinical Trials

		Effect compared to Study	Formulation	single agents or placebo
Luoma et al. 1973	Mouthrinse 0.05% NaF/	Decrease in plaque mass	0.022% CHX
Luoma et al. 1980	Dentifrice and mouthrinse 0.044%	Decrease in DMFS	NaF/0.05% CHX	Decrease in bleeding
Dolles/Gjermo 1980	Dentifrice 0.1% NaF/2.0% CHX	Decrease in caries incidence
Katz 1982	Gel 1.0% NaF/1.0% CHX and	Complete prevention of	mouthrinse 0.05% NaF/0.2% CHX	radiation caries
	Mouthrinse 0.05% NaF/0.2% CHX	Remineralization of incipient lesions
		Complete prevention of radiation caries
Spets-Happonen	Mouthrinse 0.04% NaF/0.5% CHX	Decrease in DMFS et al. 1991	every 3rd week	Negligible effect on bleeding and bacterial counts
Jenkins et al. 1993	Mouthrinse 100 ppm NaF/	Decrease in plaque score	0. 12% CHX	Decrease in gingivitis
Joyston-Bechal/	Mouthrinse 0.05% NaF/0.05% CHX	Decrease in plaque score Hernaman 1993		Decrease in bleeding
Yates et al. 1993	Dentifrice 1000 ppm NaF/1.0% CHX	Decrease in plaque and bleeding similar to CHX alone
Mendieta et al. 1994	Mouthrinse 0.022% NaF/0.12% CHX	Decrease in plaque but less than that of CHX alone
Giersten/Scheie	Mouthrinse 0.05% NaF/0.05% CHX	Marked inhibition of pH fall 1995	Mouthrinse 0.05% NaF/0.2% CHX	Reduced glucose consumption

Table 3: Practical Recommendations for Combined Use of Fluoride and Chlorhexidine

1. When toothpaste containing sodium lauryl sulphate is used, CHX rinse should be used a minimum of 30 minutes before or after brushing with the toothpaste.

2. When toothpaste containing sodium fluoride and no sodium lauryl sulphate is used, brushing can immediately follow the CHX rinse.

3. When two mouthrinses are used together, use the CHX first followed by the NaF rinse. The NaF rinse can be used immediately after the CHX rinse. Brushing with regular toothpaste containing sodium lauryl sulphate is again recommended only after a minimum of 30 minutes.

90,000 Peridex (chlorhexidine gluconate 0.12% mouthwash) Side effects, images, usage, dosage, overdose in RxList

• Generic name: Chlorhexidine gluconate 0.12% mouthwash
• Brand name: Peridex

Information for Peridex patients, including side effects

Trademarks: Paroex, Peridex, PerioChip, Periogard, Perisol.

Generic Name: Chlorhexidine Gluconate (Mouthwash)

What is Chlorhexidine Gluconate?

Chlorhexidine gluconate is a germicidal mouthwash that reduces bacteria in the mouth.

Chlorhexidine gluconate oral rinse is used to treat gingivitis (swelling, redness, bleeding of the gums). Chlorhexidine gluconate is usually prescribed by your dentist.

Chlorhexidine gluconate mouthwash is not suitable for all types of gingivitis. Use this medication only for the condition that your dentist prescribed it for. Do not pass this medication to another person, even if they have the same gum symptoms as you.

Chlorhexidine gluconate may also be used for purposes not listed in this medication guide.

aspirin anti-inflammatory

What are the possible side effects of chlorhexidine gluconate?

Chlorhexidine gluconate may cause a rare but serious allergic reaction that can be life-threatening. Get emergency medical help if you have any of these signs of an allergic reaction: urticaria, severe skin rash; wheezing, shortness of breath; cold sweat, feeling dizzy; swelling of the face, lips, tongue, or throat.

Call your doctor right away if you have:

• white spots or sores in the mouth or lips;
• mouth ulcers; or
• swelling of the salivary glands (under the jaws).

Common side effects may include:

• mouth irritation;
• staining of teeth;
• dry mouth;
• unusual or unpleasant taste in the mouth; or
• a decrease in taste.

This is not a complete list of side effects and they may arise.Ask your doctor about side effects. You can report side effects to the FDA by calling 1-800-FDA-1088.

What is the most important information I should know about chlorhexidine gluconate?

Chlorhexidine gluconate may cause a rare but serious allergic reaction that can be life-threatening. Get emergency medical help if you have: hives, severe skin rash; wheezing, shortness of breath; cold sweat, feeling dizzy; swelling of the face, lips, tongue, or throat.

Do not give this medicine to a child or teenager without the advice of a doctor. This medicine can cause severe irritation or chemical burns in young children.

Information for Peridex patients, including how to take

What should I discuss with my doctor before using chlorhexidine gluconate?

You should not use this medication if you are allergic to chlorhexidine gluconate.

If you have periodontal disease, you may need special treatment when using chlorhexidine gluconate.

Do not give this medicine to a child or teenager without the advice of a doctor. This medicine can cause severe irritation or chemical burns in young children. Chlorhexidine gluconate is not approved for use by anyone younger than 18 years old.

It is not known if this medicine will harm an unborn baby. Tell your doctor if you are pregnant or planning to become pregnant.

It is not known whether chlorhexidine gluconate passes into breast milk or if it could affect a nursing baby.Tell your doctor if you are breastfeeding.

How do I use chlorhexidine gluconate?

Follow all directions on the prescription label. Do not use this medicine in larger or smaller amounts, or for longer than recommended.

Rinse mouth with chlorhexidine gluconate twice daily. after brush your teeth.

Measure dose using the medicine cup. Rinse the medicine in your mouth for at least 30 seconds, then spit it out. Do not swallow mouthwash.

Do not add water to the mouthwash. Do not rinse your mouth with water or other mouthwash immediately after using chlorhexidine gluconate.

Chlorhexidine gluconate may leave an unpleasant taste in the mouth. Do not rinse your mouth to get rid of the aftertaste after taking the medicine. You can wash off the medicine and reduce its effectiveness.

Stratter side effects in children

Use this medication for the full prescribed length of time.Your symptoms may improve before the gingivitis is completely gone. Chlorhexidine gluconate does not treat viral or fungal infections such as herpes, canker sores, or oral thrush (yeast infection).

Visit your dentist at least once every 6 months for preventive dental and gum care.

Store chlorhexidine gluconate at room temperature away from moisture and heat.

Information for Peridex Patients Including Missed Dose

What happens if I miss a dose?

Use the missed dose as soon as you remember, but brush your teeth first.Skip the missed dose if it’s time for your next scheduled dose. Do not Use additional medicine to make up for a missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Helpline at 1-800-222-1222, especially if a child has swallowed 4 or more ounces of this medication.

Chlorhexidine overdose can only occur if the medication is swallowed.Overdose symptoms may include nausea, abdominal pain, or alcohol intoxication.

What should I avoid while taking chlorhexidine gluconate?

Chlorhexidine gluconate can stain teeth, dentures, dental restorations, the tongue or the inside of the mouth. Talk to your dentist about ways to remove stains from these surfaces. False teeth that have scratched surfaces can be more difficult to remove stains.

Prescription drugs for high blood pressure

Avoid eating, drinking, or brushing your teeth right after taking this medication.

Do not use any other mouthwash unless your doctor has told you to.

What other drugs will affect chlorhexidine gluconate?

Other drugs you take by mouth or inject are unlikely to affect your mouthwash with chlorhexidine gluconate. But many medicines can interact with each other. Tell each of your healthcare providers about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal products.

Where can I get more information?

Your pharmacist or dentist can provide more information about chlorhexidine gluconate mouthwash.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medicine only as directed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. is accurate, up-to-date and complete.(“Multum”), but no guarantees are given. The information contained herein about the drug may vary over time. Multum’s information has been collected for use by medical practitioners and consumers in the United States, and therefore Multum does not warrant that use outside the United States is appropriate unless specifically noted otherwise. Multum’s Medication Information does not recommend medication, patient diagnosis, or recommend therapy.Multum’s Drug Information is an information resource designed to help licensed healthcare practitioners care for their patients and / or serve consumers who see this service as an addition to the experience, skills, knowledge and judgment of healthcare practitioners, not a replacement. The absence of a warning for a given drug or drug combination should in no way be construed as an indication that the drug or drug combination is safe, effective, or appropriate for any given patient.Multum assumes no responsibility for any aspect of health care that is governed by the information Multum provides. The information contained in this document is not intended to cover all possible uses, indications, precautions, warnings, drug interactions, allergic reactions or side effects. If you have questions about any medications you are taking, please ask your doctor, nurse, or pharmacist.

Copyright 1996-2019 Cerner Multum, Inc.

Peridex (chlorhexidine gluconate 0.12% mouthwash): use, dosage, side effects, interactions, warning

• Generic name: chlorhexidine gluconate 0.12% mouthwash
• Brand name: Peridex

Product description

What is Peridex and how is it used?

Peridex is an over-the-counter and prescription medication used as an oral rinse to treat gingivitis symptoms, and as an adjunct to flaking and straightening the roots.Peridex can be used alone or with other medicines.

Peridex belongs to a class of drugs called antibiotics, mouthwash.

It is not known whether peridex is safe or effective in children.

What are the possible side effects of Peridex?

Peridex may cause serious side effects, including:

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• urticaria
• severe skin rash,
• wheezing,
• difficulty breathing,
• cold sweat,
• feeling dizzy,
• swelling of the face, lips, tongue or throat,
• white patches or sores in the mouth or on lips,
• mouth ulcers and
• swelling of the salivary glands (under the jaws)

Get immediate medical attention if you have any of the above symptoms.

The most common side effects of Peridex include:

• mouth irritation,
• tooth staining,
• dry mouth,
• unusual or unpleasant taste in the mouth, and
• taste loss

Tell your doctor if you have you have any side effects that bother you or that do not go away.

These are not all of the possible side effects of Peridex. Ask your doctor or pharmacist for more information.

Ask your doctor about side effects. You can report side effects to the FDA by calling 1-800-FDA-1088.

DESCRIPTION

Peridex (0.12% chlorhexidine gluconate) Oral Rinse is an oral rinse containing 0.12% chlorhexidine gluconate (1, 1 ^one -hexamethylene bis [5- (p-chlorophenyl) biguanide ] 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. Peridex is a nearly neutral solution (pH range 5-7). Chlorhexidine gluconate is a salt of chlorhexidine and gluconic acid. Its chemical structure is

Indications and Dosage

INDICATIONS

Peridex is indicated for use between dental visits as part of a professional treatment program for gingivitis, which is characterized by redness and swelling of the gums, including bleeding of the gums on probing.Peridex has not been tested in patients with acute necrotizing ulcerative gingivitis (ANUG). For patients with concurrent gingivitis and periodontitis, see PRECAUTIONS .

DOSAGE AND ADMINISTRATION

Peridex therapy should be started immediately after dental prophylaxis. Patients using Peridex should be reevaluated and thoroughly prevented at intervals of no more than six months. Recommended use is to rinse your mouth twice a day for 30 seconds, morning and evening after brushing your teeth.The usual dosage is 15 ml (indicated on the cap) of undiluted Peridex. Patients should be instructed not to rinse their mouth with water or other mouthwash, brush their teeth, and eat immediately after using Peridex. Peridex is not intended to be taken by mouth and should be coughed up after rinsing.

HOW SUPPLIED

Peridex Supplied as a blue liquid in white or amber plastic bottles of 0.5 oz (15 ml), 4 oz (118 ml), 1 pint (473 ml) and 64 oz (1893 ml) ) with lockable lids out of the reach of children.

STORE 20 ° C to 25 ° C (68 ° F to 77 ° F), excursions allowed 15 ° C to 30 ° C (59 ° F to 86 ° F) [Ref. USP controlled room temperature].

Keep out of reach of children

Made in USA for: 3M ESPE Dental Products, 2510 Conway Avenue, St. Paul, MN 55144-1000 USA. Revision: October 2015

Side effects and drug interactions

SIDE EFFECTS

The most common side effects associated with rinsing the mouth with chlorhexidine gluconate are: 1) increased staining of teeth and other oral surfaces; 2) increased formation of dental calculus; and 3) change in taste perception, see. WARNINGS and PRECAUTIONS . Oral irritation and local allergy symptoms have been spontaneously reported as side effects associated with the use of a chlorhexidine gluconate rinse. The following oral mucosal side effects have been reported in placebo-controlled clinical trials in adults: aphthous ulcer, pronounced gingivitis, trauma, ulceration, erythema, desquamation, plaque on the tongue, keratinization, geographic location of the tongue, mucocele and short frenum …Each of them occurred with a frequency of less than 1.0%. Among post-marketing reports, the most common oral mucosal symptoms associated with Peridex are stomatitis, gingivitis, glossitis, ulcers, dry mouth, hypesthesia, glossal edema, and paresthesia. Patients taking Peridex experienced minor irritation and superficial scaling of the oral mucosa. Cases of parotid swelling and inflammation of the salivary glands (sialadenitis) have been reported in patients taking Peridex.

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DRUG INTERACTIONS

No information provided.

Warnings

WARNINGS

The effect of Peridex in periodontitis has not been determined. An increase in supragingival calculus has been observed in clinical trials in Peridex users compared to control users. It is not known whether the use of Peridex results in an increase in subgingival calculus. Tartar deposits should be removed with dental prophylaxis at intervals of no more than six months.Anaphylaxis as well as serious allergic reactions have been reported during post-marketing use of dental products containing chlorhexidine. See CONTRAINDICATIONS .

PRECAUTIONS

PRECAUTIONS

General

1. In patients with concomitant gingivitis and periodontitis, the presence or absence of gingival inflammation after treatment with peridex should not be used as a primary indicator of underlying periodontitis.
2. Peridex can stain oral surfaces such as tooth surfaces, restorations and the dorsum of the tongue. Not all patients have a visually significant increase in tooth staining. In clinical trials, 56% of Peridex users showed a noticeable increase in fore-face spots compared to 35% of control users at six months; 15% of Peridex users developed what was considered a strong stain, compared to 1% of control users after six months.The stain will be more pronounced in patients who have stronger plaque accumulations that have not been removed. Stains resulting from the use of Peridex do not adversely affect the health of the gums or other tissues in the mouth. The stain can be removed from most dental surfaces using the usual professional prophylactic methods. Additional time may be required to complete prophylaxis. Caution should be exercised when prescribing restorations for anterior teeth with rough surfaces or margins to patients.If natural stains cannot be removed from these surfaces with dental prophylaxis, patients should be excluded from Peridex treatment if permanent discoloration is unacceptable. Stains in these areas are difficult to remove with dental prophylaxis and, in rare cases, these restorations may need to be replaced.
3. Some patients may experience taste changes during treatment with Peridex. In the course of post-marketing surveillance of the product, rare cases of irreversible change in taste have been reported after using Peridex.

Pregnancy

Teratogenic effects

Pregnancy category B

Reproduction studies were performed in rats and rabbits at chlorhexidine gluconate doses up to 300 mg / kg / day and 40 mg / kg / day, respectively, and showed no evidence of harm for the fetus. However, there have been no adequate and well-controlled studies in pregnant women. Since animal reproduction studies do not always predict human response, this drug should only be used during pregnancy if absolutely necessary.

Nursing mothers

It is not known whether this drug is excreted in breast milk. Since many drugs are excreted in breast milk, care should be taken when prescribing Peridex to lactating women. In rat labor and lactation studies, no evidence of impaired labor or toxic effects in nursing pups was observed when chlorhexidine gluconate was administered to females at doses that were more than 100 times the human dose of 30 ml (2 caps) …) Peridex per day.

Pediatric use

Clinical efficacy and safety of Peridex in children under 18 years of age have not been established.

Carcinogenesis, mutagenesis, impaired fertility

In a study of drinking water in rats, carcinogenic effects were not observed at doses up to 38 mg / kg / day. No mutagenic effects were observed in two mammals. In vivo Chlorhexidine gluconate mutagenesis studies. The highest chlorhexidine doses used in the mouse dominant lethality test and the hamster cytogenetic 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.

Overdose and Contraindications

OVERDOSE

Ingestion of 1 or 2 ounces of peridex by a young child (~ 10 kg body weight) may cause stomach upset, including nausea or signs of alcohol intoxication. Seek medical attention if a young child has swallowed more than 4 ounces of peridex or if signs of alcohol intoxication appear.

CONTRAINDICATIONS

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

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Clinical Pharmacology

CLINICAL PHARMACOLOGY

Peridex provides antimicrobial action during mouthwash. The clinical significance of the antimicrobial activity of Peridex is unclear. Microbiological plaque sampling showed an overall reduction in certain test bacteria, both aerobic and anaerobic, ranging from 54 to 97% over six months of use.

Use of Peridex 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 stopping the use of Peridex, the number of bacteria in the plaque returned to the baseline level, and the resistance of the plaque bacteria to chlorhexidine gluconate was equal to the baseline level.

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Pharmacokinetics.

Pharmacokinetic studies of peridex indicate that approximately 30% of the active ingredient, chlorhexidine gluconate, remains in the mouth after rinsing. This delayed drug is slowly released into the oral fluids. Studies in humans and animals demonstrate that chlorhexidine gluconate is poorly absorbed from the gastrointestinal tract. The mean plasma chlorhexidine gluconate levels peaked at 0.206 μg / g in humans 30 minutes after a 300 mg dose.No detectable levels of chlorhexidine gluconate were present in the plasma of these subjects 12 hours after compound administration. Chlorhexidine gluconate is excreted mainly with feces (~ 90%). Less than 1% of the chlorhexidine gluconate ingested by these subjects was excreted in the urine.

Medication Guide

PATIENT INFORMATION

WHAT TO EXPECT WHEN USING PERIDEX (CHLORHEXIDINGLUCONATE 0.12%) ORAL RINSING

Your dentist has prescribed Peridex (Chlorhexidine% Gluconate) to reduce porexidine, 12% gluconate, to reduce rinsing. redness and swelling of the gums, and to control bleeding from the gums.Use Peridex regularly as directed by your dentist in addition to brushing your teeth daily. Spit it out after use. Peridex should not be swallowed.

If you develop allergic symptoms such as skin rash, itching, general swelling, difficulty breathing, dizziness, heart palpitations, upset stomach or diarrhea, seek immediate medical attention. Peridex should not be used by persons who have sensitivity to it or its components.

Peridex may cause some discoloration of teeth or increased tartar (tartar) formation, especially in areas where stains and tartar are common.It is important to visit your dentist to remove stains or tartar at least once every six months, or more often if your dentist advises.

• Both stain and tartar can be removed by a dentist or hygienist. Peridex can cause permanent discoloration of some anterior fillings.
• To minimize discoloration, you should brush and floss your teeth daily, highlighting areas that are starting to discolor.
• In some patients, Peridex may taste bitter and affect the taste of foods and beverages.This will become less noticeable in most cases as you continue to use Peridex.
• To avoid taste disturbances, rinse the peridex after eating. Do not rinse with water or other mouthwash immediately after rinsing Peridex.

If you have any questions or comments about Peridex, please contact your dentist, pharmacist or 3M ESPE Dental Products toll-free at 1-800-634-2249.

Call your doctor to inquire about side effects.You can report side effects to the FDA by calling 1-800-FDA-1088.

STORE 20 ° C to 25 ° C (68 ° F to 77 ° F), excursions permitted up to 15-30 ° C (59 ° F to 86 ° F) [Ref. USP controlled room temperature].

Clinical Study Gum Disease: Frio Mouthwash – Clinical Research Register

Rinsing the mouth with chlorhexidine solution to reduce the severity of gingivitis and the formation of dental plaque

Review Question

Does rinsing your mouth with chlorhexidine (broad spectrum antiseptic), in addition to other commonly used methods of brushing your teeth, help control and reduce symptoms of gingivitis (inflammation of the gums)? Is the result influenced by the frequency of rinsing or the concentration of the solution, and are there any unwanted side effects?

Relevance

Gingivitis is a reversible condition in which the gums become red, swollen, and bleed easily.Gingivitis is widespread – according to studies conducted, this disease affects about 50-90% of the adult population in the UK and the United States. In predisposed individuals, gingivitis can lead to periodontitis, which is not reversible. In periodontitis, inflammation is accompanied by loss of ligaments and bone support of the teeth. If left untreated, this can lead to tooth loss. Severe periodontitis is the sixth most common disease worldwide.

Maintaining a high level of oral hygiene is believed to be important for the prevention and treatment of gingivitis.Brushing your teeth is the main method of maintaining good oral hygiene. Other commonly used cleaning methods include flossing, interdental brushes, plaque removal, and polishing performed by a dentist. Some people find it difficult to control plaque build-up and prevent gingivitis by just brushing their teeth. Therefore, they sometimes use chlorhexidine-containing mouthwashes in addition to regular brushing. These mouthwashes are widely available over the counter; prescriptions are generally not required outside of the United States.

Characteristics of research

We included 51 studies that analyzed a total of 5345 participants. The evidence in this review is current to 28 September 2016. Most of the study participants were children and adults with gingivitis or periodontitis who used conventional methods of brushing their teeth and were generally healthy. We did not exclude studies in which some or all of the participants had certain medical conditions or special care needs, as we felt that using chlorhexidine mouthwashes was especially important for them.The included studies evaluated the effects of chlorhexidine mouthwashes used for at least 4 weeks, in addition to routine brushing, in children and adults with gingivitis.

Key Outcomes

There is high quality evidence that the use of chlorhexidine mouthwashes in addition to regular brushing for 4-6 weeks or 6 months results in significant plaque reduction.There is also high quality evidence for a moderate reduction in the severity of gingivitis in people with mild gingivitis, but since the disease was mild, this is not considered clinically important. The nature of the available evidence does not allow us to determine the degree of improvement in the severity of symptoms of gingivitis in people with moderate to severe disease.

There was no evidence that a certain concentration of chlorhexidine solution was more effective than another.

Rinsing for 4 weeks or more causes staining of the teeth, requiring removal and polishing by a dentist Other side effects have also been reported, including tartar formation (dental plaque), temporary taste disturbance, and temporary damage to the oral mucosa.

Quality of evidence

The risk of bias in one study was unclear and high in the other 50, but this did not affect the quality of the assessment of gingivitis and plaque, and we believe that further studies are unlikely to change our confidence in the estimate of the effect.90,015 90,000 to be or not to be? To be!

Prevention of dental caries is a fairly simple set of measures that will help you maintain a beautiful smile for a long time. Many people think that for this it is enough just to brush your teeth in the morning and in the evening, to come to the dentist on time for preventive examinations. This is actually very important. But there are other equally important types of prevention that you need to know about. Only with time comes an understanding of the lost as a result of a frivolous attitude towards oneself, one’s health.But you need very little – to know and understand, to do daily what will become a good good habit and necessity.

Why do you need to maintain oral hygiene?

People living in Russia are surprisingly indifferent to themselves. They come to the dentist only when it is necessary to get help for acute pain. Out of 100 people, 92 have problems with tooth decay. In 99 people out of a hundred older age, periodontal disease is common. Only in children, the percentage of damage is 5% lower than in adults.The main thing is that no one even thinks about why this is happening. But it is enough to follow simple measures to be healthy.

Brush and paste

Should I be reminded that the toothbrush is the primary tool for removing deposits from the surface of teeth and gums? But not every brush is the right tool for this. A toothbrush must have artificial bristles with rounded tips, a comfortable handle, and most importantly, the stiffness of the bristles must correspond to the state of the enamel and gums.Stiff bristles should only be used as directed by your healthcare practitioner.

And if there is an increased sensitivity of the teeth or bleeding gums, then it is better to use a brush with soft bristles. It is better to purchase brushes with different heights of bristles. The toothpaste is also selected depending on the condition of the teeth and gums. If there is an increased sensitivity of the teeth, do not use highly abrasive toothpastes. Special pastes are suitable for sensitive teeth.

Anti-inflammatory pastes are used for bleeding and sore gums. However, such pastes containing chlorhexidine are not recommended to be used for more than 10-14 days. Chlorhexidine can cause the development of resistant (chlorhexidine-resistant) microbial strains, is a fluoride antagonist (i.e. it cannot penetrate into the tooth enamel) and stains teeth yellow. Therefore, chlorhexidine-containing pastes are prescribed only during an exacerbation of inflammatory diseases.

How to properly brush your teeth?

Apart from the cost of the brush and paste, cleaning is a free but very effective preventive measure. To use the tool correctly, it is necessary to teach the kids from the cradle, but for this you need to be able to properly use this adult himself.

1. If you brush your teeth only twice a day, and you spend less than 5 minutes, then consider that you are achieving almost nothing. This process should be carried out slowly, with careful movements it is necessary not only to clean the surface, but gradually clean all the interdental spaces.Moving the brush in a vertical plane from the base to the cutting part, it is necessary to remove all food debris and plaque.
2. You can try to use an irrigator to clean the interdental space and gums. It creates a powerful pulsating jet of water that washes away all difficult to reach areas. This development is especially good for people who have had fixed prosthetics and have placed crowns.
3. The correct procedure ends, oddly enough, with the treatment of the back of the tongue.Here, food debris accumulates in the recesses between the papillae. Microflora develops on the remains, which is the cause of many problems. This procedure helps to get rid of unpleasant odor from the mouth.
4. After completion, it is recommended to massage the gum surface gently with your fingers. In a circular motion, you need to go through the entire surface. Such an effect will greatly improve the supply of blood to the gums, remove stagnant places.

Fine hygiene thread

Floss – toothpicks are designed to thoroughly remove plaque and food debris from hard-to-brush contact surfaces of the teeth.The threads have different shapes in cross-section – round or flat. Some dental floss is impregnated with fluoride, which additionally strengthens the enamel in hard-to-clean areas and helps prevent tooth decay. You need to use floss before brushing your teeth, as well as after each meal.

Food is our friend and enemy!

It turns out that freshly squeezed juice, which is extremely beneficial for the body, is an enemy for our teeth. It contains fruit acids that destroy enamel.The man invented candy and soda as if on purpose to destroy the enamel.

Bacteria just sit and wait for sugar and acids. After sweets, it is imperative to rinse the mouth with boiled water until the sensation of sweetness completely disappears.

But there are also friends: seafood, poultry, veal, cottage cheese and butter. Hard cheeses are very useful as they neutralize the action of acids and supply the body with calcium.Even bitter chocolate is on our side. The cocoa beans included in it inhibit the growth and reproduction of bacteria. Black tea strengthens the enamel of the teeth and regulates the acid-base balance in the mouth, while natural coffee has an antibacterial effect. Teeth cooperate with products that are sources of fluoride on a parity basis, since excess fluoride intake (fluoridated water, milk, salt) can cause fluorosis (a chronic disease of the skeletal system and teeth, which manifests itself as stains, erosion on the enamel of the teeth, etc.). Especially carefully the amount of fluoride should be monitored in children. Therefore, you should find out the concentration of fluoride in drinking water in the place of residence. The optimal concentration of fluoride in drinking water is 1 mg / l, if it is higher, then it is better to replace the water source, use fluoride-free children’s toothpastes.

Denture for teeth

Poor and irregular brushing of teeth results in persistent plaque. This “cultural” layer contains microbes and a breeding ground for uninvited guests.Hence, gum disease and destructive tooth decay.

So how do you get rid of this unpleasant picture in your mouth? The answer is simple – you need to sign up for … denticure! This is the name of a set of measures for professional oral hygiene. How is denture done? First, the doctor determines the patient’s dental status by examination, with the obligatory calculation of caries indicators, the quality of hygiene, and an assessment of the condition of the gums. After a complete diagnosis, the doctor proceeds to actually professional teeth cleaning, removing plaque, tartar using special ultrasound devices, instruments and pastes.After antiseptic treatment, dental surfaces are polished with very low dispersion aerosols.

Finally, the teeth are coated with a special compound that permanently protects the teeth from microbes that cause caries. The whole procedure takes no more than an hour, but it gives an amazing effect.

It is recommended to do denture systematically, at least 2 times a year, as well as during the period preceding dental treatment. In addition to removing plaque, the doctor can carry out deep fluoridation of the teeth, which is especially indicated for pregnant women, people with weak enamel, as well as for children with newly erupted permanent teeth.During denture, an experienced doctor gives recommendations on oral hygiene, individually selects toothpastes, brushes, threads (floss).

What means of prevention does the clinic offer you?

In our clinic, professional oral hygiene is performed in the following way:

• Air flow – modern technology for removing supragingival and subgingival dental calculus and stains. It is a powder that is supplied to the tooth under pressure with a stream of air.
• Removal of dental plaque, which is often the cause of caries, using special ultrasound devices.
• Local enrichment of teeth with fluoride – thus effective protection and strengthening of tooth enamel is achieved.

Do you want to keep a beautiful snow-white smile for a long time and protect your teeth from caries? We invite you to denture!

After the first visit to professional hygiene, each patient receives a certificate with a cumulative 5% discount for each subsequent visit.

90,000 Peridex (% chlorhexidine gluconate for rinsing empty waste)

home preparations a-z list of side effects preparation center peridex (chlorhexidine gluconate 0.12% mouthwash) preparation

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How does Peridex and how does it win?

Peridex – for the purpose of being sold without a prescription, which is used as a preparation for rinsing the empty mouth for the treatment of symptoms of gingivitis and how to improve the scale and structure of roots.Peridex can be used with different labels.

Peridex should be kept up to the class of drugs, which are called Antibiotics, rinsing for emptying the company.

Invisible, safe and efficient Peridex for children.

What are the possible side effects of peridex?

Peridex can cause serious side effects, including:

• wuliki,
• strong shkirny visip,
• wheeze,
• difficult to understand,
• cold pit,
• Pochutya Zamorochennya,
• nabryk of the face, lips, tongue and throat,
• bili plami abo rani vseredini company abo on the lips,
• climbs in roti, i
• napryak of slinky trees (with slits)

It is inaccurate to pursue medical assistance, if you have symptoms, you are overwhelmed.

Peridex High Frequency Side Effects Include:

• teasing company,
• farbuvannya teeth,
• dryness at roti,
• uninvited or unacceptable relish in roti, i
• Decrease in tastes

Look at your friend, if you have some fatal problems, if you are turbulent or not to know.

Not all possible side effects of peridex. For otrimannya additional information, turn to your doctor or pharmacist.

Call your doctor for the medical pleasure of some other faults. You can see the FDA issue number 1-800-FDA-1088 for adverse effects.

DESCRIPTION

Peridex ™ (chlorhexidine gluconate 0.12%) empty rinse rota – no empty rinse rinse with 0.12% chlorhexidine gluconate (1,1-hexamethylene bis [5- (p-chlorophenyl) di-guanid -gluconate) at the base, which reveals water, 11.6% alcohol, glucerin, PEG-40 sorbitan diisostearate, flavoring agent, sodium saccharin and FD&C Blue No. 1.Peridex – mayzhe neutral razchin (pH range 5-7). Chlorhexidine gluconate is a combination of chlorhexidine and gluconic acid. Yogo chemical structure:

VIEWS

Peridex indications for treatment with visits to the dentist as a part of professional programs for treatment of gingivitis, which are characterized by harshness and are quite clear, including ash bleeding when probed. Peridex was not tested in the middle of patients with necrotizing virazkovy gingivitis (ANUG). Schodo paciєntіv, scho mayut sutnі gіngіvіti and periodontitis, div ZAPOBIZHNI WALK .

DOSING THAT ADMINISTRATSIYA

Therapy with peridex should be done without the need for a median period of dental prophylaxis. Patients, such as peridex vicorists, have to re-evaluate and carry out retail prophylaxis with an interval of no more than six months. It is recommended to rinse your mouth twice a day for a stretch of 30 seconds, in the evenings when cleaning your teeth. Zvichana dose – 15 ml (designated in krishtsі) of unbroken peridex. Patients should be instructed not to rinse with water and other means for rinsing the company, brush their teeth and not immediately write the Peridex victorian.Peridex is not a sign for the reception in the middle, and the second step is for the rinse.

YAK TO SUPPLY

Peridex Available at 0.5-ounce (15 ml), 4-ounce (118 ml), 1-ounce (473 ml) and 64-ounce (1893 ml) bili or burstin plastic dancers from children with shouts for vidachi.

ZERIGAYTE at 20 ° C to 25 ° C, allowable excursions up to 15 ° C to 30 ° C (div. USP controlled room temperature).

Zberigati out of reach of children

Founded in the USA for: 3M ESPE Dental Products, 2510 Conway Avenue, St.Paul, MN 55144-1000 U.S.A. Looked at: January 2015 p.

SLIDESHOW

POBICHNI EFFEKTI

The most widespread side effects, tied from the mouthwash with chlorhexidine: 2) improvement of the number; 3) zm_na sprynattya relish, div ADVANCE і ZAPOBIZHNI COME . The growth of empty mouth and symptoms of allergy spontaneously appear as fatal effects, due to the intake of rinsing with chlorhexidine gluconate.For an hour, placebo-controlled clinical vip tests for older adults have experienced such a mucous membrane of the mouth light: aphthae, absolutely obvious gingivitis, trauma, mucus, erythema, short Kozhen trawling at a frequency of less than 1.0%. Symptoms of the mucus membrane of an empty mouth, associated with Peridex, are often seen among post-marketing events, such as stomatitis, gingivitis, glositis, feverishness, dryness in the mouth, hypoesthesia, swelling of the mouth and paresthesia.Slightly teasing and surface desquamation of the mucous membrane of the empty company was indicated among the patients who were stuck with Peridex. I have seen about the fall of the naprya of the priushnoy zalozi and the inflamed sludge (sialadenitis) of the patients, who were stuck with Peridex.

DRUG ADDICTIONS

Information not provided.

ADVANCED

Infusion of Peridex for periodontal disease is not of significance. After an hour of clinical viprobuvan in Peridex corystuvachi, it was determined that the supragingival calculus was increased in proportion to the control ones.It is unrealistic to produce a vicious preparation Peridex to the extent of subgingival calculus. The stone is added after seeing for additional dental prophylaxis at intervals of no more than six months. I have seen about anaphylaxis, as well as about serious allergic reactions during the post-marketing campaign with dental products, which revenge chlorhexidine. Marvel CONTRAINDICATIONS .

ZAPOBIZHNI COME IN

Rooms

1. For patients who may suffer from hyperthyroidism and periodontal disease, the manifestation of or the appearance of inflammation is clear when Peridex is not vicious as the main indicator of the main periodontitis.
2. Peridex can be used to re-fill the oral surfaces, such as tooth surfaces, and to restore the stylish part of the tongue. Not all patients are able to visually improve their teeth. During an hour, 56% of Peridex corystics vyyavili more than the increase of facial beaches on the front panel, approximately from 35% of control corystuvachіv through a drink; 15% of Peridex koristuvachіv were broken, as vvazhayut, with strong plums, in some cases from 1% of control koristuvachіv through pіvroku.The flame will be more bending among the children, as it may be more important to buy the invisible nalot. The flame, rejected as a result of the Peridex victorian, does not infuse negatively on the health, and the other tissues of the mouth empty are clear. Vive to the beach with large dental surfaces using highly professional and preventive methods. For the completion of prophylaxis, it may take an additional hour. It is necessary to fix the judgment when assigned to the patients with the restoration of the facial part of the front part with short surfaces or edges.It’s hard to see natural beaches for additional dental prophylaxis, patients after being treated with Peridex, as it’s always unacceptable to color. The flame in the chihmuses can be important to provide for additional dental prophylaxis, and in rare cases it is possible to replace these restorations.
3. Deyakі patsієnti can conceive of a change in spryyatty savor before the hour of being treated with Peridex. I have seen about the ridkisnі vipadas of the last changes savoring the use of the drug Peridex for an hour to be careful for the products for sale.

Communication

Teratogenic Effects

Category B

Pre-breeding was carried out on pike-perch and rabbits at doses of chlorhexidine gluconate up to 300 mg / kg / day and 40 mg / kg / day, and there was no sign of shkodi for the fetus. However, adequate and well-controlled dosages of vaginal women were not carried out. Oscillations of reproduction on animals do not depend on the reaction of people, the whole drug should be used for an hour of vaginosity if there is an obvious need.

Yearly materials

The drug cannot be administered in breast milk. Oskіlki a lot of drugs are given with breast milk, after being careful with Peridex, women who are pregnant. In pre-adult breeds and lactation on pike, there were no signs of breaking down of the canopy, which is toxic in flux on ferruginous pigs, if chlorhexidine gluconate was administered to dams at doses, as bullets were 100 times larger, people were no longer peridex for a day.

Pediatric Victory Day

Clinical efficiency and safety Peridex is not installed in children up to 18 years old.

Carcinogenesis, mutagenesis, destruction of roduction

The carcinogenic effect in pike-perch did not occur in pre-drinking water at doses up to 38 mg / kg / dob. Mutagenic effects were not detected in two researchers in natural minds before mutagenesis with chlorhexidine gluconate. The new doses of chlorhexidine, which were tested in the analysis of the dominant-lethal reaction on the misha and the cytogenetic tests of the homosexuals, became 1000 mg / kg / day and 250 mg / kg / day as an ad hoc basis.Zhodnyh signs of impaired fertility did not deteriorate in schuras at doses up to 100 mg / kg / dob.

OVERDOSE

Provostuvannya 1 or 2 oz peridex by a little child (

10 kg of oil) can cause shlunkovy distress, including nudota or signs of alcoholic sp’aninnya. Slid zvurnut for medical aid, as if the little child poked more than 4 ounces of peridex, as if there were signs of alcoholic sp’yaninnya.

CONTRAINDICATIONS

Peridex doesn’t need to be used by people, who, as they seem, may need to adjust their sensitivity to chlorhexidine gluconate or other formulas.

KLINICHNA PHARMACOLOGIYA

Peridex will prevent anti-microbial activity for an hour when the empty company is rinsed. The clinical significance of the antimicrobial activity of Peridex is not clear. The microbiological view of the culture has shown in the background a change in the number of young pre-juvenile bacteria, both aerobics and anaerobics, in between 54 to 97% of six months.

Peridex stagnation in a six-month-old clinical preschool did not cause significant changes in bacteriosis, an overworldly growth of potentially intellectually pathogenic organisms, or even unpleasant diseases of microorganisms.Three months later, after the intake of the drug “Peridex”, the number of bacteria in the nallote turned to a normal level, and the rate of bacteria to dental nalot to chlorhexidine gluconate was added to the same on the cob.

Pharmacokinetics

Pharmacokinetic dosages with Peridex show that approximately 30% of the total amount of chlorhexidine gluconate is discharged into empty mouths for rinsing. The dose of the drug is poured into the mouth every day. Before it was carried out on people and creatures, it was shown that chlorhexidine gluconate could get so badly wet from the intestinal tract.The average level of chlorhexidine gluconate in plasma up to 0.206 mcg / g in humans after 30 minutes, when the stench was poured into a dose of the drug in a dose of 300 mg. After 12 years, after the introduction of the half-dose in the plasma, the cells did not appear in the presence of chlorhexidine gluconate. Injection of chlorhexidine gluconate in the presence of feces (

90%). Less than 1% chlorhexidine gluconate, which is consumed by the cim to the patients, in vivodivya from the cross.

INFORMATION ABOUT HVORIKH

SCHO CHOKATI AT VICORISTANE PERIDEX (CHLORHEXIDINE GLUCONATE 0.12%) STRIP STRIPS

The dentist has designated an oral preparation for emptying Peridex ™ (chlorhexidine gluconate 0.12%) for the treatment of gingivitis, the change in the condition of the skin is clear, and also for the control of bleeding is clear.Zastosovay Peridex regularly, at the request of the dentist, to complete the cleaning of teeth. Viplyunite pislya vicoristannya. Do not slid kovtati peridex.

If you have allergic symptoms, such as shkirny visip, sverbіzh, generalization of the embryo, difficulty in dysfunction, zamorochennya, accelerated heart rate, dislodgement of the slurry, or dіarrhea, inaccurately get burnt. Peridex is not for people who are sensitive to any and all components.

Peridex can give a change to the color of teeth, or to improve the setting of dental calculus, especially in places, so you can make yourself play that dental stone.It is important to advise your dentist to see the beaches, or take the dental stone once at a time, or more often, as your dentist will please.

• І plamu, і dental stone can be seen by a dentist or a hygienist. Peridex can be permanently corrected to the color of any anterior tooth fillings.
• Schob minimizuvati zmіnu koloru, yodnya next to cleaning with a brush and thread, shy accent on dilyankas, which are repaired zebarvlyuvatisya.
• Peridex can be a great gusto for kids and can be infused with gusto.In most cases, we will be less likely to wash it with more Peridex consumption.
• Schob uniknuty pereshkod relish, rinse with Peridex write. Do not use water to rinse with water or rinse directly with the Peridex rinse.

If you have any power supply or comments from Peridex, contact your dentist, pharmacist, or 3M ESPE dental products by phone without a shipment at 1-800-634-2249.

Call your doctor for the medical pleasure of some other faults.You can see the FDA issue number 1-800-FDA-1088 for adverse effects.

Save at temperatures from 20 ° C to 25 ° C, allow excursions up to 15 ° C to 30 ° C (div. USP controlled ambient temperature).

• Stagnation of sulbutyaminu, secondary effects, interaction, supplementing and increasing
• Stagnation of rosemary, inferior effects, interaction, supplementation and growth
• Rosa of olii geranium Vikoristannya, pobichnii efekti, vzaimodiya, supplementing and upgrading
• Stagnation of routine, side effects, interaction, replenishment and maintenance
• Stagnation of shavlії, defective effects, interaction, increasing and increasing

Antiseptics and their role in oral hygiene

PERIO-AID – maximum efficiency, minimum side effects!

Preparations with chlorhexidine differ in the concentration of the active substance ( chlorhexidine) , the presence of aromatic oils and alcohol, taste and manifestation of side effects.

The concentration of chlorhexidine in oral care products can be as high as 0.2%. It has been proven that a 0.2% chlorhexidine solution most effectively fights against pathogenic bacteria, viruses, fungi. But at the same time, the side effects (staining of dental plaque in a dark brown color, a change in the perception of taste, damage to the mucous membrane) with its use are most pronounced.

DENTAID , as a result of many studies, has found that the concentration of chlorhexidine can be reduced without loss of therapeutic effectiveness if cetylpyridine chloride is added to the solution! In 1992, the PERIO-AID series was developed with 0 chlorhexidine content.12% vs. 0.05%.

The active substances PERIO-AID 0.12% are: 0.12% chlorhexidine and 0.05% cetylpyridine chloride. Thanks to the combined effect of these two components, the same maximum result is achieved as from products with a concentration of 0.2% chlorhexidine. But when using PERIO-AID 0.12% , side effects are much less pronounced than with 0.2% of drugs!

PERIO-AID 0.12% is available in rinse, gel and spray form.The mouthwash is mainly prescribed as part of a comprehensive treatment for periodontitis. The gel and spray allow you to apply the drug specifically to the desired area (for example, , after tooth extraction or operations on the soft tissues of the oral cavity) and prevent bacteria and other pathogenic microorganisms from causing inflammation, which will certainly lead to complications. Also, dentists often recommend using PERIO-AID gel to brush your teeth like a toothpaste – to achieve a better and faster result of periodontitis treatment. PERIO-AID 0.12% belongs to the treatment series and must be used as directed by a physician.

PERIO-AID with a concentration of 0.05% belongs to the therapeutic and prophylactic series and is called MAINTENANCE ( in translation: protection, maintenance) . PERIO-AID MAINTENANCE is prescribed for people who have undergone periodontitis treatment and need constant control over the number of pathogenic bacteria, viruses, fungi – this drug helps to maintain oral hygiene at the proper level and thereby prevent recurrence of the complication of the disease.Also P ERIO-AID MAINTENANCE is useful for people with an increased degree of plaque formation.

Products PERIO-AID have a light mint taste that everyone will like and will not interfere with the correct use of the drug.

PERIO-AID does not contain alcohol – no characteristic odor (this is especially important for those who drive a car, for teachers, lecturers and other public people ).By the way, the combination of chlorhexidine with alcohol more often causes a change in taste perception and leads to a greater expression of this side effect.

It should be remembered that drugs with chlorhexidine are curative and curative-prophylactic. It is not recommended to use them for a long time, as this can provoke dysbiosis of the oral cavity, which in turn will contribute to a rapid increase in the number of pathogenic bacteria, viruses and fungi.Usually doctors prescribe drugs with chlorhexidine in the stage of exacerbation of gum disease (profuse serous-purulent discharge from periodontal “pockets”, etc.). The recommended period of use is 2-4 weeks for preparations with a high chlorhexidine content, and up to a year – with a low content. The duration of use should be determined by your dentist, who will take into account all your individual characteristics.

After eliminating acute symptoms, it is recommended to switch to drugs intended for the prevention of gum disease, for example VITIS GINGIVAL .

It may be interesting that chlorhexidine has a detrimental effect on the bacterium Streptococcus mutans, which causes tooth decay.