In 1954, chlorhexidine was first used in clinical settings. Since then, patients have received it to treat a range of dental problems, including but not limited to gum irritation, swelling, and bleeding. Great, right? Wrong. While there are benefits to this rinsing, the disadvantages outweigh them by a wide margin. Which raises the question of whether we should continue using chlorhexidine. Let's explore this further to find the answer.
Dental offices now use chlorhexidine as a "safety shield." Even though it's solely meant to treat gingivitis, many dental practitioners advise using it for a number of off-label purposes. This rinse is recommended as a last resort. How effective is it, though? Even though chlorhexidine has excellent antibacterial properties and can treat gingivitis, it also contains a substantial amount of 1200 parts per million. This then raises the possibility of adverse side effects.
Many people are not aware of the more serious repercussions, one of which is the inhibition of fibroblasts, even though the majority of chlorhexidine users report "manageable" side effects (i.e. staining). In a 1991 study, it was discovered that using 0.12% chlorhexidine on human gingival fibroblasts greatly hampered the periodontium's ability to heal and regenerate. The additional dangers associated with patients utilizing the rinse over an extended period of time are a serious issue as well. As briefly indicated above, this product has exceptionally high parts per million, which limits consumption to no more than two weeks. Unaware of the additional harm they are doing to both their patients and themselves, sadly, many dental professionals are sending their periodontal patients home with the product to use after this time period. Even though it may be unfortunate, these are not the only issues. Staining, burning, cytotoxicity, calculus formation, inactivation in blood/saliva, etc. are a few of the other contraindications. Why is it still suggested, then? Comfortability, to put it simply.
68 years ago, dental practitioners learned about chlorhexidine in academic settings, and it’s been carried over since. Consequently, it became their only alternative. But chlorhexidine is no longer considered the gold standard of care, just like other dental treatments, procedures, and products that were formerly advised. Let's examine amalgams as an example. 150 years later, we are learning that amalgams are poisonous, impair tooth structure, and can cause significant illness or additional decay. Don't forget about airflow versus scale and polish. This approach is not only quicker but also more effective because it can clean those difficult-to-reach areas. As is evident, dentistry has advanced. Because of the convenience of use, the technique, and the risks, we have subsequently progressed past the previously described. With chlorhexidine, it's time to take similar action.
Despite the fact that chlorhexidine's dangers clearly exceed its benefits, many dental offices continue to use this rinse. This often comes down to familiarity and a lack of understanding about a better option. The good news is that activated chlorine dioxide is an additional choice. Although activated chlorine dioxide (CLO2) has been around since the 1800s, the dental industry only became aware of it in the early 2000s. While not to be mistaken with stabilized chlorine dioxide (NaCLO2), this potent ingredient treats a variety of dental problems, including halitosis and periodontitis. To enhance the oral health of all dental patients, it can be applied universally in dentistry.
Additionally, it can address similar problems at considerably lower parts per million (44ppm).
The best part of activated chlorine dioxide is that it has neither adverse effects nor limitations. As a result, this serves as both a chlorhexidine substitute and a general oral health option.
In light of the findings, we no longer have to rely solely on believing in and trusting chlorhexidine. To answer the original query posed at the start of this article, "Should we still be using chlorhexidine?" The response is simple to understand. No.
Kristin Goodfellow RDH
Kristin is Chief Clinical Officer of OraCare, a practicing Registered Dental Hygienist