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PubMed1996

A meta-analysis of clinical studies on the caries-inhibiting effect of chlorhexidine treatment.

A meta-analysis was performed on published data on the caries-inhibiting effect of chlorhexidine treatment. The results of the various studies are difficult to evaluate because of various treatment procedures, dissimilar features of participants, and different presentations of study results. A meta-analysis provides a more structured approach than the traditional review, due to systematic analysis and numerical processing of the available information. The objectives of this meta-analysis were: (1) to assess a more accurate estimate of the caries-inhibiting effect of chlorhexidine treatment than provided by individual studies, and (2) to explore factors potentially modifying the effect of chlorhexidine treatment in caries prevention, i.e., the application method, application frequency, target population, the fluoride regime, and caries criteria. Caries reduction was expressed by the prevented fraction, indicating the percentage reduction of caries incidence in the chlorhexidine group. For all prevented fractions, 95% confidence intervals were calculated. The overall caries-inhibiting effect of the chlorhexidine treatment studies was 46% (95% CI = 35% - 57%). Multiple-regression analysis showed no significant influence on the prevented fractions for the variables "application method", "application frequency", "caries risk", "fluoride regime", "caries diagnosis", and "tooth surface".

Adolescent↗

PubMed2006

Controlled release of chlorhexidine from UDMA-TEGDMA resin.

Chlorhexidine salts are available in various formulations for dental applications. This study tested the hypothesis that the release of chlorhexidine from a urethane dimethacrylate and triethylene glycol dimethacrylate resin system can be effectively controlled by the chlorhexidine diacetate content and pH. The filler concentrations were 9.1, 23.1, or 33.3 wt%, and the filled resins were exposed to pH 4 and pH 6 acetate buffers. The results showed that Fickian diffusion was the dominant release mechanism. The rates of release were significantly higher in pH 4 buffer, which was attributed to the increase of chlorhexidine diacetate solubility at lower pH. The higher level of filler loading reduced the degree of polymerization, leading to a greater loss of organic components and higher chlorhexidine release rates.

Chlorhexidine↗

PubMed2000

Adequacy of a new chlorhexidine-bearing polyurethane central venous catheter for administration of 82 selected parenteral drugs.

OBJECTIVE: To screen 82 commonly used parenteral medications for compatibility with a new chlorhexidine-bearing central venous catheter, the ARROWg+ard Blue Plus. Evaluations were performed for completeness of drug delivery and impact, if any, of the drugs on the amount of chlorhexidine removed from the internal lumens. DESIGN: Drug solutions were prepared in dextrose 5% injection or NaCl 0.9% at common concentrations. Three 10-mL aliquots of each drug solution were delivered over 10 minutes, one aliquot through each lumen of the triple-lumen catheter. The initial drug concentrations of the admixtures and the effluent samples were analyzed by HPLC for chlorhexidine content and for the amount of drug delivered relative to its initial concentration. RESULTS: The delivery of the infusion solutions alone through sample catheters resulted in no more than trace amounts of chlorhexidine in the solution. Background amounts ranged from < 2.5 to 6.1 micrograms/mL in the first 10 mL of solution. Administration of none of the drugs tested resulted in a substantial increase in chlorhexidine delivery. Furthermore, delivery of most of the drugs was at least 95% and usually was in excess of 97% of the initial concentration. Concentrations of five drugs, amikacin sulfate, cefoperazone sodium, cefotaxime sodium, cefepime HCl, and netilmicin sulfate were somewhat lower than the initial concentration (range 91-95%), but were still considered acceptable. CONCLUSIONS: The ARROWg+ard Blue Plus central venous catheter can be recommended for use with all of the 82 parenteral drugs tested.

Catheterization↗

PubMed1999

Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis.

BACKGROUND: Several multicenter random clinical trials have studied a second-generation easy-to-use chlorhexidine local delivery system to assess its effectiveness as an adjunct to scaling and root planing, or SRP. METHODS: The author reviews the pharmacokinetics of the local delivery system and two of the multicenter randomized clinical trials. One study evaluated 118 patients using split-arch design and the other study 447 patients using parallel design. All patients underwent SRP. Test sites, which had pocket depths of 5 millimeters or larger, received a chlorhexidine chip (in both studies) or a placebo chip (the parallel study only). Test sites that remained 5 mm or larger were re-treated with a chip at three months and at six months (parallel study only). RESULTS: Both studies found greater mean reductions in probing depth when the chlorhexidine chip was used in conjunction with SRP than when SRP was used alone (1.16 mm vs. 0.7 mm, P < or = .0001, in the split-arch-design study and 0.95 mm vs. 0.65 mm, P = .00001, in the parallel-design study). The combined therapy resulted in significantly more sites with probing depth reductions of 2 mm or more compared with SRP alone (49.5 percent vs. 32.1 percent; P < .0001, in the split-arch-design study and 19.1 percent vs. 8 percent, P < .0001, in the parallel-design study). CONCLUSIONS: Use of the chlorhexidine chip has significantly improved the clinical parameters of periodontitis when used as an adjunct to SRP. CLINICAL IMPLICATIONS: When used with SRP, the chlorhexidine chip offers the clinician a new method of achieving and maintaining periodontal stability.

Anti-Infective Agents, Local↗

PubMed1985

Reduced colonization of newborns with group B streptococci following washing of the birth canal with chlorhexidine.

Possible measures for prevention of neonatal group B streptococcal (GBS) septicemia include active or passiv immunoprophylaxis and administration of penicillin to mothers and infants. In a previous study we have found GBS to be extremely sensitive to chlorhexidine. Furthermore vaginal washing with chlorhexidine diminished the recovery of GBS from parturients. In order to study the effect of chlorhexidine washing upon the colonization of newborns, a study group of chronic GBS carriers, i.e. women who were GBS positive in the 32-36 gestational week as well as during labor was selected. In 18 of these females chlorhexidine washing was performed prior to delivery while 33 chronic carriers served as controls. Screening during labor was performed in 945 consecutive patients. Cultures were collected from the external ear, throat and umbilicus of all infants within 5 minutes of birth and at day 4 of life. At birth 22% of the infants of the chlorhexidine washed mothers were colonized with GBS, in contrast to 52% of the infants from the chronic GBS carriers (p less than 0.05). The proportion of infants harboring GBS at day 4 were similar in the two groups (Tab. I). Among the 945 consecutively screened women, 164 harbored GBS and 54 (33%) of their 164 infants were colonized at birth. The colonization rate of the infants from chronic GBS carriers was significantly higher, 17 of 33 infants (p less than 0.05). This may reflect that the risk of contracting GBS by infants increases with the quantity of GBS in the birth channel.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervix Uteri↗

PubMed2001

A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates.

UNLABELLED: Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). PURPOSE: A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. METHODS: Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. RESULTS: Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing </=1000 g. No neonates in the PI group developed contact dermatitis. CONCLUSION: The novel chlorhexidine-impregnated dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and redressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.

Administration, Cutaneous↗

PubMed1980

Light microscopic and color television image analysis of the development of staining on chlorhexidine-treated surfaces.

Tooth staining with the use of chlorhexidine preparations is the major problem of long term application. Evidence suggests that the staining arises from a cationic/anionic interacation of chlorhexidine with components of certain dietary materials. The purpose of this in vitro study was to compare visually the development of tea and coffee staining on acrylic and tooth specimens treated with chlorhexidine and to follow the development of tea staining on perspex by light microscopy and color television image analysis. All specimens were maintained in their respective beverage for 5 days with test specimens removed three times a day and placed for 2 minutes in an 0.2% chlorhexidine solution. Both test tooth and acrylic specimens showed comparably and markedly increased staining by the beverages compared with control specimens. Color television image analysis of test specimens demonstrated more marked and rapid development of tea staining when studied on a daily basis. Microscopic examination revealed the staining to be made up of small particles of material which increased in size and coalesced with time. Again, marked differences were apparent in the stain on test and control specimens. The results of this in vitro method provided further evidence for a dietary aetiology to chlorhexidine staining and were consistent with clinical findings. Such a method may be useful to assess staining arising from the use of other anti-plaque agents.

Acrylic Resins↗

PubMed1982

Comparison of hypertonic saline and chlorhexidine mouthrinses after the inverse bevel flap procedure.

THE VALUE OF periodontal dressings after periodontal surgery has been questioned. This study further evaluated chlorhexidine as a possible alternative. A group of nine patients requiring comparable bilateral inverse bevel flap procedures underwent preoperative oral hygiene instruction and scaling. Immediately before surgery and up to 3 months postoperatively, clinical records of plaque index, pocket depths and sulcus bleeding index were made. Records were taken of patients' postoperative discomfort and preferences. During the 1st postoperative week either a 0.2% chlorhexidine gluconate or a 1% saline mouthrinse was prescribed. Plaque accumulation and sulcus bleeding were significantly reduced on the sides treated with chlorhexidine. Significant reductions in pocket depths were recorded for both groups but there were not differences between treatments. Less postoperative discomfort was experienced with chlorhexidine, although the difference was not significant. Five patients preferred chlorhexidine, one saline, and three had no preferences. These and previous results suggest that a periodontal dressing is unnecessary or even undesirable after the inverse bevel flap procedure, and may be usefully replaced by a suitable antiplaque agent.

Adult↗

PubMed1989

The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery.

The purpose of this study was to determine the effect of a 0.125% chlorhexidine gluconate rinse on inflammation and bacterial plaque formation after periodontal surgery. Nine patients who required two periodontal surgeries in two posterior areas were selected. The first surgical site was randomly assigned into either 1) active or 2) placebo groups. The patient's second site was assigned to the alternate group. In Group 1 the patients rinsed with chlorhexidine (CH) and in Group 2 with placebo solution, both for 14 days. No periodontal dressing was used and at least 1 month elapsed before the second surgery was performed. Plaque index, gingival index, and crevicular fluid flow measurements were obtained at baseline, and at 1 and 2 weeks after surgery. The chlorhexidine rinse significantly reduced the amount of plaque at both 1 and 2 weeks, and gingival inflammation remained similar to base line measurements at 2 weeks. Neither solution had any effect on the amount of crevicular fluid flow. There was an increase in amount of perceived postoperative pain and gingival swelling with the use of the chlorhexidine rinse, but no difference in the number of pain pills taken during this study. The chlorhexidine rinse was an effective plaque preventive agent after surgical procedures.

Adult↗

PubMed1997

The influence of chlorhexidine on the severity of cyclosporin A-induced gingival overgrowth.

The influence of chemical plaque control, using topically applied 0.12% chlorhexidine, on the severity of cyclosporin A (CsA)-induced gingival overgrowth (GO) was evaluated. Forty Holtzman rats were divided into four groups: 1) control; 2) cyclosporin A: a 10 mg/kg/day subcutaneous dose of CsA; 3) chlorhexidine: 0.12% chlorhexidine (CHX) was applied to the buccal surface of the right mandibular molars; and 4) cyclosporin A/chlorhexidine: a combination of the treatment described for cyclosporin A and chlorhexidine groups. The animals were fed a high sucrose diet during the experiment and were sacrificed after 14 and 21 days. The histometric analysis revealed a significant increase in buccal gingival area in the cyclosporin A group compared to other groups (P < 0.01) after 21 days. The epithelium thickness of the buccal gingiva was significantly increased in the cyclosporin A group, compared to the control group (P < 0.05). The cyclosporin A/chlorhexidine group exhibited statistically significantly lower gingival overgrowth than the cyclosporin A group. These findings, if replicated in human studies, suggest that topically applied 0.12% chlorhexidine may be a valuable measure in the management of cyclosporin-induced gingival overgrowth.

Administration, Topical↗

PubMed1994

Amphiphilic property of chlorhexidine and its toxicity against Streptococcus mutans GS-5.

The toxicity of chlorhexidine digluconate against Streptococcus mutans GS-5 was comparatively determined by measuring its bactericidal activity, and its inhibitory effect on microbial dehydrogenases was studied by the resazurin reduction method. Both methods indicated that chlorhexidine within the range 0.75-5.00 mg/l was highly toxic to Streptococcus mutans, probably due to inhibition of dehydrogenase activity, and the extent of toxicity was closely associated with concentration. In an attempt to better understand the relationship between the amphiphilic nature of chlorhexidine and its toxicity against Streptococcus mutans, the effect of solvent polarity on dehydrogenase inhibition was investigated. A decrease in solvent polarity, induced by inclusion of 5% acetone in the reaction mixture, did not enhance the toxicity of chlorhexidine. This implies that the antimicrobial action of chlorhexidine is mainly attributable to its hydrophilicity, and that the nature of the lipophilic groups is only of secondary importance.

Acetone↗

PubMed1975

Denture stomatitis. Relapse tendency and removal of acquired discolourations in long-term denture disinfection with chlorhexidine.

Five patients with denture stomatitis were initially treated for 14 days with a combination of amphotericin B lozenges and denture soaking in 0.2% chlorhexidine. To prevent recurrence the dentures were then kept overnight in 0.2% chlorhexidine during five months. No relapse occurred, but the dentures (all-acrylic) became heavily discoloured by chlorhexidine. During this period fungi could not be grown either on palatal or on maxillar denture agar models, and clinical signs and symptoms were reduced further. At the end of treatment hypochlorite was used to remove chlorhexidine-induced denture stain. Brushing and soaking (0.16%) proved more efficient than brushing alone, and when a 0.60% solution was used, the stains were generally eliminated in two hours. Hypochlorites in the prevention and removal of chlorhexidine discolourations deserve further attention.

Aged↗

PubMedDate not supplied

Vestibular damage from chlorhexidine in guinea pigs.

In the early 1970s the suspicion arose that chlorhexidine, a disinfectant extensively used for preoperative skin disinfection, was ototoxic if introduced into the middle ear cavity. It has previously been shown by the author that chlorhexidine causes damage to the organ of Corti of guinea pigs when introduced into the tympanic cavity. In the present study the toxic effect of chlorhexidine on the vestibular part of the inner ear is investigated. Middle ears of guinea pigs were exposed to chlorhexidine in two different concentrations in two different solvents. The duration of exposure was varied and the animals were sacrificed and examined at various periods. Damaged neuroepithelia were seen in most of the animals. The extent of damage was related to the concentration of chlorhexidine, to the duration of exposure and to the time lapse after exposure.

Acoustic Maculae↗

PubMedDate not supplied

Effect of chlorhexidine varnish mouthguards on the levels of selected oral microorganisms in pediatric patients.

PURPOSE: The effect of a chlorhexidine varnish delivery system on the levels of selected oral microorganisms was evaluated in caries active pediatric patients, ages 4 to 12 years old. METHODS: Forty-six patients were enrolled into the study when they had multiple carious surfaces and salivary mutans streptococci (MS) levels higher than 10(4) colony forming units (CFUs) per milliliter. This study incorporated a double-blind design and patients were randomly assigned to either the chlorhexidine treatment group or the placebo group. Complete-arch, vacuum-adapted mouthguards (0.02 in. polypropylene coping material) were custom fabricated and coated internally with either a 3.0% chlorhexidine varnish or a placebo varnish. Two pretreatment paraffin-stimulated saliva samples were obtained for culturing prior to varnish treatment. Saliva samples were also obtained immediately after treatment and once a month for up to three months after wearing the mouthguard appliances. Dental restorations were placed at most of these saliva collection visits. Mouthguards were reportedly worn for an average of 9.7 hours per night for approximately seven nights by 40 subjects (87%). RESULTS: After two months, and after three months, there was a significant reduction in MS levels immediately after the chlorhexidine varnish treatment. Total anaerobic and total facultative bacteria levels were not significantly affected. CONCLUSION: One week of nightly use of the chlorhexidine varnish mouthguard system is effective at reducing the number of MS in caries-active pediatric patients in the mixed and primary dentition for at least three months.

Anti-Infective Agents, Local↗

PubMed2001

The impact of chlorhexidine gluconate on the relative cell surface hydrophobicity of oral Candida albicans.

OBJECTIVES: Adherence of Candida albicans has been implicated as the first step in the pathogenesis of oral candidosis, and its relative cell surface hydrophobicity (CSH) a contributory physical force. Chlorhexidine gluconate is by far the commonest antiseptic mouthwash prescribed in dentistry. The intra-oral concentrations of the retained chlorhexidine mouthwash fluctuate considerably due to the dilution effect of saliva and the cleansing action of the oral musculature. Hence the objective of the present study was to investigate the effect of brief exposure to sub-therapeutic concentrations of chlorhexidine gluconate on the relative CSH of C. albicans. DESIGN: The CSH of the isolates was assessed by a biphasic aqueous-hydrocarbon assay. RESULTS: A statistically significant reduction in CSH was observed following the exposure of Candida isolates to 0.005 and 0.0025% chlorhexidine gluconate. CONCLUSIONS: These results elucidate additional mechanisms by which chlorhexidine gluconate suppress candidal pathogenicity despite a brief period of transient exposure within the oral environment.

Adhesiveness↗

PubMed2002

Chlorhexidine.

Chlorhexidine remains the gold standard to which other antiplaque and gingivitis agents are compared. Its effectiveness can be attributed to it bactericidal and bacteriostatic effects and its substantivity within the oral cavity. While other agents may possess one or more of these properties, few possess all three and perform so well. The antimicrobial properties of chlorhexidine are attributed to it di-cationic structure, and it is this same property that is the basis of its most common side effect, extrinsic tooth staining. By understanding the biochemical properties of chlorhexidine, an appreciation for the efficacy and use of chlorhexidine can be developed. It is only in such a way that the efficacy can be maximized and the side effects minimized, allowing chlorhexidine to remain the gold standard.

Anti-Infective Agents, Local↗

PubMedDate not supplied

Bond strength to primary tooth dentin following disinfection with a chlorhexidine solution: an in vitro study.

PURPOSE: The aim of this study was to determine the effect on shear bond strength of chlorhexidine used as a cavity disinfectant on primary tooth dentin. METHODS: Thirty specimens were randomly divided into 3 groups (N = 10) and treated as follows: (1) in Group I, the dentin was acid etched with a 37% phosphoric acid for 15 seconds, washed and dried; (2) in Group II, a 2% commercial chlorhexidine solution (Cav Clean) was applied for 40 seconds, washed and dried following acid etching for 15 seconds; and (3) in Group III, dentin was treated with a 37% phosphoric acid gel containing 2% digluconate of chlorhexidine (Cond AC) for 15 seconds. In all specimens, the adhesive Single Bond (3M) was applied, and composite cylinders (Filtek Z 250) were built. The specimens were sheared with a universal testing machine (Instron) running at a crosshead speed of 0.5 mm/min, and the results calculated in MPa. The specimens were also observed to record the failure mode. RESULTS: ANOVA analysis revealed that the shear bond strength of Group II (17.99+1.15 MPa) was significantly lower than Group I (19.88+1.02 MPa) and Group III (19.57+1.02 MPa). After debonding, 63% of the specimens presented cohesive failure of the material, 24% adhesive failure and 10% cohesive failure of dentin. CONCLUSIONS: The commercial cavity disinfectant containing 2% chlorhexidine had an adverse effect on Single Bond and produced significantly lower shear bond strength than the etch gel with chlorhexidine and the acid etch alone.

Acid Etching, Dental↗

PubMedDate not supplied

The effects of chlorhexidine gel on Streptococcus mutans infection in 10-month-old infants: a longitudinal, placebo-controlled, double-blind trial.

PURPOSE: This study investigated the long-term effects of 0.2% chlorhexidine gel, used as a weekly brush-on gel, on Streptoccocus mutans infection in 10-month-old infants. METHODS: The investigation followed the criteria of a placebo-controlled, double-blind, longitudinal clinical trial. Infants were recruited at birth and oral microbiological swabs were taken at 3 monthly intervals, together with medical, dental, dietary and brushing histories. Children who were found to be colonized with S. mutans were randomly assigned to either the chlorhexidine-gel group (N = 50) or placebo gel group (N = 46), and parents were instructed to brush the gel on the teeth once per week for 12 weeks. In another control group (N = 210), infants did not use either chlorhexidine or placebo gels. Saliva samples were cultured using S. mutans-selective tryptone-yeast extract-cysteine-sucrose-bacitracin (TYCSB) agar. The mean age of the children was 10.2 +/- 2.6 months at the start of the trial and subjects were followed until the ages of 18 months. RESULTS: In the children with initial low S. mutans counts of < 300 CFU/mL, there was a significant percentage reduction in S. mutans counts in the chlorhexidine-gel group compared to the placebo gel and no-gel control groups after 3 months of weekly gel brushing. However, no significant differences with the placebo group were observed after 15 months of follow-up. There were 39 children (41%) who achieved reduction of their S. mutans to 0 CFU/mL. Compared to those who remained infected with S. mutans, these children had higher toothbrushing frequencies (P < .001) and toothpaste use (P < .001), as well as lower frequencies of daily feeds (P < .01), and lesser weekly frequencies of sweet solids and liquids (P < .001). CONCLUSIONS: Children with relatively low initial S. mutans counts (< 300 CFU/mL) showed a reduction in S. mutans counts in the first 3 months when 0.2% chlorhexidine gel was brushed on the teeth weekly. No differences were observed when compared with the placebo and no-treatment groups at later follow-up periods.

Anti-Infective Agents, Local↗