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PubMed1999

Preventive action of short-term and long-term chlorhexidine rinses.

The purpose of this study was to evaluate the effects of 0.12% chlorhexidine mouthrinses on the presence of plaque and gingivitis, either used as the only oral hygiene practice during a short period of time (21 days) or associated with routine daily brushing for 180 days. The experimental subjects were 40 dental students of an average age of 20.9 years. Following a thorough examination and mechanical prophylaxis. The subjects were divided into two treatment groups. Twenty subjects stopped all oral hygiene procedures for 21 days except for twice-daily rinses with 0.12% chlorhexidine or a placebo. Plaque, gingivitis scores and oral soft tissue health were recorded on days 0, 7, 14 and 21 for the short term group and on days 0, 90 and 180 of experimentation for the long term group. After 21 days of rinsing, plaque accumulation, gingivitis and bleeding on probing were significantly lower in the chlorhexidine group than in the placebo group. After three and six months of mouthrinses, the chlorhexidine group had less plaque and significantly less gingivitis than the placebo group. No significant differences in adverse oral soft tissue effects were observed between the different groups. It was concluded that a 0.12% chlorhexidine digluconate mouthrinse can provide an important adjunct to the prevention and control of gingivitis when used as the only oral hygiene practice or with regular personal hygiene procedures. The results obtained in this clinical study, using stringent parameters of evaluation with statistic analysis, corroborated the results obtained by other studies.

Adult↗

PubMed1992

The effect of 1% chlorhexidine gel delivered with toothpicks on proximal dental plaque. A pilot study.

The aim of this study was to determine the effect of 1% chlorhexidine gel delivered with toothpicks on interproximal dental plaque. Seven follow-up patients participated in two treatment periods of 1 week each, separated by a normal oral hygiene period of one week. The study had double-blind design. The plaque index by Silness and Löe (Acta Odontol Scand 22: 121-135, 1964) was scored on mesial, distal, buccal and lingual surfaces of each tooth after plaque disclosure, with an aqueous solution of erythrosine and the measurements were performed by the same examiner, at the initial visit and at the end of every experimental week. The ability to use toothpicks was checked and upgraded to the individual need. The participants were instructed to carry out their normal oral hygiene procedures, with placebo gel or 1% chlorhexidine gel delivered interproximally with toothpicks once daily. No significant differences in the measurement of plaque were noted between placebo gel and 1% chlorhexidine gel at interproximal areas. After treatment with 1% chlorhexidine gel, the mean distribution of plaque score 0 was increased significantly (P < 0.05), from 30.7 sites (52%) to 42 sites (71.1%) when all sites are taken into account and compared to the placebo period. 1% Chlorhexidine gel delivered by toothpick on interproximal areas had a limited effect on reduction of dental plaque.

Aged↗

PubMed2004

Treatment of incipient peri-implant infections using topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement.

This report presents the clinical results three months after application of minocycline microspheres as an adjunct to mechanical treatment of incipient peri-implant infections compared to adjunctive treatment employing 1% chlorhexidine gel application. Sixteen patients in the minocycline group and 14 in the chlorhexidine group completed the study. Each patient had one or more implants with probing depth > or = 4 mm combined with bleeding and/or exudate on probing and presence of putative pathogenic bacteria. At baseline, patients were randomly assigned to minocycline or chlorhexidine treatment. Follow-up examinations were carried out after 10, 30, 60 and 90 days. The combined mechanical/antimicrobial treatment for the chlorhexidine group did not result in any reduction in probing depth and only limited reduction of bleeding scores. The adjunctive use of minocycline microspheres, on the other hand, resulted in improvements in both probing depths and bleeding scores. For the deepest sites of the treated implants, mean probing depth was reduced from 5.0 mm to 4.1 mm. The reductions in bleeding scores, although greater than for the chlorhexidine group, were modest. Thus, the question as to what extent the combined mechanical/minocycline treatment could be considered adequate for the treated lesions remains to be answered. The present short-term findings, however, encourage further studies with longer observation intervals on adjunctive use of minocycline microspheres in the treatment of periimplant lesions.

Adult↗

PubMedDate not supplied

Local application of sustained-release delivery system of chlorhexidine in Down's syndrome population.

The effect of local applications of sustained-release delivery polymer containing chlorhexidine as an adjunct to mechanical plaque removal was studied in institutionalized children with Down's syndrome. Thirty children, ages 8-13, participated in the study. Clinical parameters (P1I, GI, papillary bleeding) were recorded and bacterial samples from selected permanent teeth were collected and processed before and following treatment. Following the registration of clinical findings and collection of plaque, all children had their teeth scaled and polished and were randomized into three treatment groups of ten subjects each: Subjects in group I had their teeth coated with ethyl cellulose containing chlorhexidine; those in group II had their teeth coated with placebo polymer and those in group III received no further treatment. Individual oral hygiene habits were not interfered with. The application of the solutions to the respective groups was done every 3 days for 21 days. Chlorhexidine treatment significantly reduced the PLI, GI total aerobic counts and S. viridans counts compared to no treatment. The placebo group showed similar effects to that of the chlorhexidine-treated group except for the total aerobic counts which were not affected. The results suggest that the use of chlorhexidine in a sustained-release dosage form applied to the tooth surfaces may prove useful in the control of plaque and its sequela in children with Down's syndrome.

Adolescent↗

PubMed1990

Oral antimicrobial agents--chlorhexidine.

Chlorhexidine's structural characteristics give it potent antimicrobial activity, effectiveness at low concentrations, substantivity that prolongs its therapeutic effect in the oral environment, minimal resorption from the gastrointestinal tract, and the ability to reduce plaque. The use of this agent for oral stomatitis in neoplasia patients has recently been studied. Treatment-associated oral soft tissue inflammation and ulceration were significantly reduced by chlorhexidine in patients undergoing intensive chemotherapy. Reductions in total streptococci and yeast counts were also observed. When used in conjunction with systemic antifungal agents, such as nystatin or clotrimazole, a significantly decreased incidence of clinical oral candidiasis and Candida septicemia was observed. In contrast, in two studies in which high-dose head and neck radiation therapy was applied, there was no reduction in stomatitis. Oral gram-negative bacilli have been shown to increase in high-dose chemotherapy patients who are taking chlorhexidine during the treatment period (3 wk to 2 mo). However, no increase in systemic gram-negative infections or other adverse negative medical consequences were observed. This agent appears to be of therapeutic benefit in reduction of dental plaque, gingivitis, and stomatitis in the high-risk chemotherapy population when used in conjunction with other topical and systemic antimicrobial agents as prophylaxis. Although no toxic or serious adverse effects of chlorhexidine rinse have been observed in the short-term studies to date, the effects of longer-term chlorhexidine administration should be evaluated.

Bone Marrow Transplantation↗

PubMedDate not supplied

Comparison of two commercially available chlorhexidine mouthrinses: I. Staining and antimicrobial effects in vitro.

Several commercially produced chlorhexidine rinses are now available. These formulations vary in concentration and recommended regimens of use. One formulation, a 0.1% chlorhexidine rinse, anecdotally has been reported to not produce the characteristic dental staining. The aim of this study was to compare the 0.1% formulation with a 0.2% commercially produced chlorhexidine rinse for staining and antimicrobial effects in vitro. Tea staining of tooth and acrylic specimens exposed to the two rinses at various dilutions was measured over a 5-day period. Minimum inhibitory dilutions of each product against standard test bacteria were determined by agar dilution. The 0.1% product produced no staining of specimens greater than that noted with controls. At equivalent concentrations, the 0.2% product produced heavy staining of specimens. The antimicrobial effect of the two products was similar but the overall profile for the 0.1% preparation suggested activity derived from ingredients other than chlorhexidine. The results suggest that the chlorhexidine in the 0.1% rinse was partly or completely inactivated and, although staining may not occur in vivo, the formulation would have a much reduced antiplaque action.

Chlorhexidine↗

PubMedDate not supplied

Effect of chlorhexidine on Madin Darby canine kidney cells.

Sheets of MDCK cells were severely damaged by the commonly used antiseptic, chlorhexidine. Damage was indicated by changes in the characteristic blister formation normally observed in sheets of these cells growing on the base of culture flasks. Results are given for reduction in blister number with increasing chlorhexidine concentration. Damage was indicated also by increasing transport of radiolabeled inulin across the sheets after treatment with increasing concentrations of chlorhexidine. The mechanism of chlorhexidine damage is discussed. The conclusion is that chlorhexidine could be an important contributory factor in the failure of ultrafiltration in peritoneal mesothelial cells, and its use should be avoided with magnesium-containing dialysis fluids in kidney-failure patients.

Animals↗

PubMed1995

Contamination of mercurochrome and chlorhexidine-cetrimide in a teaching hospital.

A study on the contamination of antiseptics was done in a teaching hospital, during March and April 1989. Ninety-five samples of 9 antiseptics from 23 wards were cultured. Results showed that 2 of 12 and 3 of 5 samples of mercurochrome and chlorhexidine-cetrimide compound were contaminated. This led to a wider scale study on the two products. It was found that over one-half of the samples of mercurochrome and 6 of 54 samples of chlorhexidine-etrimide compound were contaminated. Mercurochrome was contaminated by gram-positive and chlorhexidine-cetrimide compound by gram-negative bacteria. Contamination of mercurochrome was found in samples taken from the pharmacy and wards, and of chlorhexidine-cetrimide compound from wards only. Mercurochrome was removed from the hospital formulary and the use of chlorhexidine-cetrimide compound was more restricted.

Anti-Infective Agents, Local↗

PubMed1993

The effect of baking soda/hydrogen peroxide dentifrice (Mentadent) and a 0.12 percent chlorhexidine gluconate mouthrinse (Peridex) in reducing gingival bleeding.

The purpose of this study was to determine the effectiveness of a baking soda/hydrogen peroxide dentifrice, Mentadent, and a 0.12 percent chlorhexidine gluconate mouthrinse, Peridex, in reducing gingival bleeding. Forty subjects were divided into three groups; the baking soda group, the chlorhexidine group and the control group. All groups received oral hygiene instruction and brushed and flossed three times per day. Bleeding point scores were evaluated at baseline and at five weeks. The baking soda/hydrogen peroxide group used the supplied dentifrice as their sole toothpaste. The 0.12 percent chlorhexidine group used the mouthrinse twice per day. The control group performed oral hygiene as instructed. At five weeks, the 0.12 percent chlorhexidine mouthrinse significantly reduced gingival bleeding. The dentifrice and control groups revealed no statistically significant reductions. The results indicate that the 0.12 percent chlorhexidine mouthrinse is useful in improving oral health, whereas the baking soda/hydrogen peroxide dentifrice offered no advantages to conventional oral hygiene.

Adult↗

PubMed1993

Clinical and microbiological effects of subgingival application of a chlorhexidine gel in chronic periodontitis. A pilot study.

Clinical and microbiological effects of subgingival application of a 1% chlorhexidine gel were studied. Eleven patients with chronic periodontitis participated in the study. In each patient two pairs of single rooted teeth with at least 20% attachment loss and probing depth > 4 mm were selected. Contralateral sites were randomly allocated to test and control groups receiving chlorhexidine or placebo gel respectively. The gels were applied once daily for two consecutive days. The clinical parameters comprised plaque index, gingival index, probing pocket depth and bleeding on probing. The composition of the subgingival microbiota was estimated with use of dark field microscopy. Baseline measurements were taken two weeks prior to chlorhexidine application. Microbiological and clinical parameters were further monitored 2, 7, 14 and 28 days after the last gel application. Chlorhexidine gel application did not significantly change the composition of the microflora compared to placebo application. There were no major differences in plaque and gingival indices. Effects on probing pocket depth of the chlorhexidine gel application may have been disguised by an influence from the diameter of the needle with which the application was performed. Needles with a diameter of 25G resulted in increases in probing pocket depth which indicates a possible mechanical trauma. This effect was not observed when needles with a diameter of 23G were used.

Adult↗

PubMed1993

Effects of intra-articular chlorhexidine diacetate lavage on the stifle in healthy dogs.

Eight dogs were determined to be orthopedically normal on the basis of prelavage physical examination, stifle radiography, synovial fluid analysis, and force plate analysis (peak vertical force normalized for body weight, and time on the force plate). Each dog had 1 stifle randomly assigned to be lavaged with 100 ml of a commercially available 0.05% (w/v) chlorhexidine diacetate solution, and the contralateral stifle was lavaged with lactated Ringer's solution. Difference was not detected between the chlorhexidine diacetate and lactated Ringer's solution-treated joints, with regard to results of synovial fluid analysis and clinical lameness evaluations on days 4 and 8 after lavage. Chlorhexidine diacetate caused a more intense synovitis than did lactated Ringer's solution, as determined by histologic evaluation of synovial membrane specimens after necropsy on day 8; however, a difference in the intensity of toluidine blue staining of articular cartilage was not found between treatments. Chlorhexidine diacetate, as a 0.05% (w/v) solution, cannot be recommended as a joint lavage fluid until the duration of inflammatory changes in the synovial membrane are determined or until the chemical constituents of chlorhexidine diacetate causing the synovitis can be identified and removed.

Animals↗

PubMed1996

Mutans streptococci caries and chlorhexidine.

Mutans streptococci, particularly Streptococcus mutans and Streptococcus sobrinus, can be shown to be highly associated with caries in humans. Together with Lactobacillus spp., they are regarded as significant odontopathogens. Because of their association with dental disease, an evaluation of the numbers of Mutans streptococci organisms in plaque and saliva may aid in the diagnosis of caries activity. In conjunction with this concept, control and prevention of caries has been sought by reducing the numbers of bacteria colonizing an individual. Despite the associations between dental disease and Mutans streptococci, which can be demonstrated in groups of people, these methods have not been entirely successful. Because of the wide range of factors involved, counts are not very effective in diagnosing caries activity or risk in an individual. Nevertheless, counts may be used to establish a normal pattern of colonization for a patient, and deviation from this pattern will indicate a change in their oral status, which can be included as a parameter in diagnosis. Accurate and relatively simple commercial tests for counting mutans streptococci and lactobacilli are available. In patients with high caries activity and high counts of mutans streptococci, chlorhexidine may be employed as an adjunct to other preventive measures. Chlorhexidine delivered in a gel form has been shown to be effective in the control and prevention of caries. Combinations of chlorhexidine with fluoride may be even more effective. Sustained release devices, like varnishes, reduce the numbers of mutans streptococci in a patient's mouth to levels below detection for long periods, but their effectiveness in preventing and controlling caries has not yet been assessed. The decision to use microbiological methods to aid diagnosis, and chlorhexidine to reduce or eliminate mutans streptococci, rests with the practitioner. Although the microbiological tests for caries activity or prediction are not 100 per cent accurate, they can be useful in certain situations. In addition, chlorhexidine as an adjunct in control and prevention of caries has been shown to have value. This short review introduces readers to the literature, so that they will not dismiss microbiology, but make decisions on the use of microbiological methods based on their own experience and the experience of others.

Chlorhexidine↗

PubMed1997

[Two cases of anaphylactic shock induced by chlorhexidine].

We reported two patients who developed skin eruptions and severe hypotension immediately after scrubbing their wound in the leg using 4% chlorhexidine solution. Both patients were successfully treated by epinephrine administration. Patient-1 (a 42-year-old man) had his wound scrubbed using this antiseptic several times before the operation. He showed a positive skin scratch test for chlorhexidine. Patient-2 (a 74-year-old man) had no prior treatment with chlorhexidine. Positive lymphocyte transformation test was not demonstrated in these patients. It has been reported that more than 10% of patients with anaphylactic shock induced by chlorhexidine use had previous exposure to it and 80% of them had it used for mucosa or wound washing. From these results, we should keep it in mind that chlorhexidine is not likely to be a safe antiseptic and can possibly induce anaphylactic shock.

Adult↗

PubMed1998

[Anaphylactic shock associated with a central venous catheter impregnated with chlorhexidine and silver sulfadiazine].

A 28 year-old male patient developed anaphylactic shock on separate occasions, possibly due to the contact with a central venous catheter impregnated with chlorhexidine and silver sulfadiazine. He was successfully resuscitated. On the second operation, blood basophils disappeared and plasma histamine level increased extremely up to 80 ng.ml-1 soon after anaphylactic shock. One year after the first shock, he did not develop anaphylactic shock following the insertion of a central venous catheter without the impregnation. Pin prick test and scratch test showed positive reactions only to chlorhexidine. Latex-specific anti-IgE antibody was not detected. Therefore, chlorhexidine was confirmed as the causative agent of anaphylactic shock. Because chlorhexidine is extensively used as an antiseptic drug in emergency rooms and intensive care units, we should be aware of the possibility of chlorhexidine induced anaphylactic reactions.

Adult↗

PubMed2006

Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci.

BACKGROUND: Historically, methods of interrupting pathogen transmission have focused on improving health care workers' adherence to recommended infection control practices. An adjunctive approach may be to use source control (eg, to decontaminate patients' skin). METHODS: We performed a prospective sequential-group single-arm clinical trial in a teaching hospital's medical intensive care unit from October 2002 to December 2003. We bathed or cleansed 1787 patients and assessed them for acquisition of vancomycin-resistant enterococci (VRE). We performed a nested study of 86 patients with VRE colonization and obtained culture specimens from 758 environmental surfaces and 529 health care workers' hands. All patients were cleansed daily with the procedure specific to the study period as follows: period 1, soap and water baths; period 2, cleansing with cloths saturated with 2% chlorhexidine gluconate; and period 3, cloth cleansing without chlorhexidine. We measured colonization of patient skin by VRE, health care worker hand or environmental surface contamination by VRE, and patient acquisition of VRE rectal colonization. RESULTS: Compared with soap and water baths, cleansing patients with chlorhexidine-saturated cloths resulted in 2.5 log(10) less colonies of VRE on patients' skin and less VRE contamination of health care workers' hands (risk ratio [RR], 0.6; 95% confidence interval [CI], 0.4-0.8) and environmental surfaces (RR, 0.3; 95% CI, 0.2-0.5). The incidence of VRE acquisition decreased from 26 colonizations per 1000 patient-days to 9 per 1000 patient-days (RR, 0.4; 95% CI, 0.1-0.9). For all measures, effectiveness of cleansing with nonmedicated cloths was similar to that of soap and water baths. CONCLUSION: Cleansing patients with chlorhexidine-saturated cloths is a simple, effective strategy to reduce VRE contamination of patients' skin, the environment, and health care workers' hands and to decrease patient acquisition of VRE.

Adult↗

PubMed1984

Topical chlorhexidine diphosphanilate (WP-973) in burn wound sepsis.

We studied the diphosphanilate salt of chlorhexidine (WP-973), as a 2% cream, for therapeutic activity in two rat models of fatal burn wound infection. Control treatments were infection and placebo cream; infection only; infection and 1% sulfadiazine silver; and burning only. Activity against Pseudomonas aeruginosa or Proteus mirabilis was tested in surface-inoculated rats with 20% scalds. Treatments were initiated 24 hours or four hours, respectively, after inoculation. Pseudomonas-infected rats were treated once a day for ten days. Proteus-infected rats were treated once a day for five days. In these experimental models, chlorhexidine diphosphanilate was equal to silver sulfadiazine, an established topical chemotherapeutic agent. In vitro activity was examined using bacteremia isolates from 65 burned patients. Using agar diffusion trench plates, chlorhexidine diphosphanilate was active against all strains. No evidence of cross-resistance between sulfonamide and chlorhexidine diphosphanilate or its components was observed.

Administration, Topical↗

PubMed2002

Clinical and microbiological effects of local chlorhexidine applications.

AIM: To study the effects of an application of chlorhexidine varnish (40%) on dental plaque. DESIGN: Randomised controlled clinical trial. SUBJECTS: 40 patients (50% females), aged 25-34 years after undergoing any necessary restorative treatment. Exactly one half of these individuals practiced good oral hygiene, the efforts of the others were poor. METHOD: Test groups received a chlorhexidine varnish application, the control group received a placebo varnish. Initially and after 2 and 6 weeks, a modified Dentocult SM-test, bleeding on probing, and a plaque index (Quigley-Hein) were recorded. RESULTS: In contrast to the control group, improvements in plaque index and bleeding on probing scores were found in patients with poor oral hygiene. The results of the Dentocult SM-tests showed a considerable reduction of streptococcus colonisation. The test group with good oral hygiene showed only slight improvement of the examined indices after chlorhexidine application. The index parameters of all patients of the placebo groups remained unchanged over the examination time period. CONCLUSION: The application of a chlorhexidine varnish reduced the quantity of the Streptococcus mutans colonies significantly and improved clinical parameters in patients with elevated plaque accumulation.

Adult↗

PubMed1985

Effect of chlorhexidine and acetic acid on phagocytosis by polymorphonuclear leucocytes.

The effect of two disinfectants, chlorhexidine and acetic acid, on host leucocytes and bacteria was studied. At a concentration of 50 mg/l, chlorhexidine was found to be bactericidal without interfering with leucocyte function. A concentration of 500 mg/l of acetic acid was neither leucotoxic nor bactericidal. Effects equivalent to the aforementioned were achieved in serum by increasing the chlorhexidine concentration by a factor of 20 and the acetic acid concentration by a factor of 5. Acetic acid reduced leucocyte function more rapidly than it killed bacteria. On the basis of these findings, chlorhexidine is to be preferred for local application in burn wounds to prevent colonisation and infection.

Acetates↗