Chlorhexidine

Chlorhexidine

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Answer. It has most positive antibacterial result.

Two daily rinses with 10 mL of 0.2% aqueous solution of chlorhexidine digluconate almost completely inhibit the development of dental plaque, calculus and gingivitis.

Mechanism of Action

Antiplaque Action

• Superior anti-plaque activity of chlorhexidine is because of its property of sustained availability.
• It involves reservoir of chlorhexidine, slowly dissolving from all the oral surfaces which result in bacteriostatic milieu in oral cavity.
• Following are the three mechanisms of plaque inhibition by chlorhexidine:
  • It prevents pellicle formation by blocking the acidic groups on salivary glycoprotein thereby decreasing glycoprotein adsorption on to tooth surface.
  • It prevents adsorption of bacterial cell wall onto tooth surface by binding the bacteria.
  • It prevents the binding of mature plaque precipitating agglutination factors in saliva and displacing calcium from plaque matrix.

Chlorhexidine is effective in inhibiting plaque formation on a clean surface but has little effect over the pre-existing plaque.

Antibacterial Action

• It has a broad-spectrum of antibacterial activity.
• Gram-positive bacteria are more susceptible than gramnegative
• In relatively high concentration, it is bactericidal but in low concentration, it may be bacteriostatic.
• Cationic molecules of chlorhexidine bind readily to the oppositely charged cell wall and interfere with the membrane transport, initiating a leakage of low molecular weight substances
• In high concentration, chlorhexidine penetrates the cell and causes precipitation of cytoplasm (Bactericidal action).

Indications

• In initial periodontal therapy, it is used as adjunct to mechanical oral hygiene.
• After surgeries, immediately after the removal of pack complete plaque control is achieved without use of proximal cleaning aids.
• In handicapped patients whose oral hygiene status is not compatible.
• In medically compromised patient who suffer from recurrent infections.
• Control plaque in patients with gingival enlargement.
• In patients having high risk of caries, chlorhexidine produces synergistic effects with fluoride to prevent caries.
• It is useful in patients undergoing orthodontic treatment, patients admitted in hospital for long time, elderly patients and terminally ill patients.

Disadvantages

• Locally reversible side effects to chlorhexidine use may occur, primarily brown staining of the teeth, tongue and silicate as well as resin restorations
• Transient impairment of taste perception
• Painful, desquamative lesions on the oral mucosa may be associated with burning sensation.