Dr. Shahzadi Tayyaba Hashmi CHLORHEXIDINE

CHLORHEXIDINE GLUCONATE Chlorhexidine gluconate is an effective bactericidal agent and broad-spectrum antimicrobial drug It has been extensively researched and is the “gold standard” antimicrobial in oral hygiene Chlorhexidine is useful in many clinical disciplines including periodontics, endodontics, oral surgery and operative dentistry

INTRODUCTION Chlorhexidine is a broad-spectrum antimicrobial drug Acting as an antiseptic, it is an effective bactericidal agent against all categories of microbes, including bacteria, yeast and viruses Chlorhexidine was first used as a mouth rinse as an adjunct to conventional non-surgical periodontal therapy Chlorhexidine has proven efficacy as a broad-spectrum antimicrobial for reducing supragingival plaque

CHEMICAL STRUCTURE Chlorhexidine is a symmetrical molecule consisting of four chlorophenyl rings and bisguanide groups connected by a central hexamethylene bridge The compound is strongly base & dicationic at pH levels above 3.5 with positive charges on either side of hexamethylene bridge It is the dicationic nature of chlorhexidine making it extremely interactive with anions, which is relevant to its efficacy

MECHANISM OF ACTION CHX shows different effects at different concentrations The agent is bacteriostatic, whereas at higher concentration it is bactericidal Cationic CHX molecule + negatively charged bacterial cell wall Instant adsorption of CHX to Phosphate containing compounds CHX binds with the phospholipids in the inner cell membrane causing cell wall integrity Leakage of the lesser molecular weight components viz. potassium ions [This is the sub lethal stage of CHX. The action can be reversed. This marks the bacteriostatic property of CHX. If the conc. Is increased and the action continues, the CHX becomes bactericidal in nature]

MECHANISM OF ACTION

PREVENTION OF DENTAL CARIES There are a number of theories concerning the development and progression of dental caries According to the specific Plaque hypothesis, only a limited number of bacteria found in dental plaque can produce dental caries The most prominent among these bacteria are streptococcus mutans and Lactobacilli Streptococcus mutans represent a group of closely related bacterial species that are the primary species that initiate enamel caries Therefore patients with low mutans streptococci population levels in their oral cavity generally have low caries activity and patients with high mutans streptococci population levels generally high caries activity Lactobacilli are the primary causative species of dentinal caries

PREVENTION OF DENTAL CARIES Chlorhexidine is a very potent bactericidal agent for streptococcus mutans, the most significant group of bacterium associated with dental caries Chlorhexidine molecules adhere to the surfaces of streptococcus mutans and produce cell death For patients with a high risk of caries, chlorhexidine rinses can be successfully used to reduce the number of odontopathogenic bacteria

WHAT MAKES CHX UNIQUE Its long lasting bacteriostatic action, also termed as ‘substantivity’ Its action lasts for about 12 hours in the oral cavity after a single rinse The di-cationic CHX molecule, attaches to the pellicle by one cation, to the bacteria attempting to colonize the tooth surface with the other. This is called the ‘Pin-Cushion Effect’ This prolongs the CHX action

USES 1. As an adjunct to oral hygiene 2. Post oral surgery including periodontal surgery or root planing 3. In patients with inter maxillary fixation. 4. For oral hygiene & gingival health in physically & mentally handicapped 5. Medically compromised individuals predisposed to oral infections 6. High caries risk patient 7. Recurrent oral ulceration 8. Removable & fixed orthodontic wearers 9. Treatment of denture stomatitis and dry socket 10. As an immediate prophylactic rinse in the prevention of post- extraction bacteremia

ADVERSE EFFECTS a) Extrinsic staining b) Alteration in taste perception c) Oral mucosal erosion d) Enhanced supragingival calculus formation e) Parotid gland swelling f) Over dosage ingestion of 1 or 2 ounces of CHX oral rinse by a small child might result in gastric distress, including nausea or signs of alcohol intoxication

DOSES AND ADMINISTRATION Recommended use is twice daily oral rinsing for 30 seconds after tooth brushing Usual dosage is 15ml (1 tablespoon) of undiluted chlorhexidine oral rinse Patient should be instructed not to rinse with water or brush teeth or eat immediately after CHX oral rinse CHX should not be ingested and should be expectorated after rinsing

AVAILABLE FORMULATIONS Mouth rinse- aqueous/ alcohol solutions of 0.2% [Zordyl ] Gel [ corsodyl dental gel] Sprays [ Hibispray] Tooth pastes Varnishes Chewing gums Periodontal dressings Sub gingival plaque control [Periochip]