Chlorhexidine gluconate is an antiseptic and disinfectant agent commonly used in various healthcare settings. It's effective against a wide range of microorganisms, including bacteria, fungi, and viruses.

It's often found in mouthwashes, skin cleansers, surgical scrubs, and other medical and personal care products. In oral care, it's used to treat gingivitis and to maintain oral hygiene. In surgical settings, it's used to disinfect skin before surgery and to sterilize instruments.

Chlorhexidine gluconate is an antiseptic drug that is effective against Bacteria and Fungi. It is used to treat the following conditions:

• As oral antimicrobial rinse for the treatment of Gingivitis.
• Scaling and root planing operations are used as adjunctive therapy (dental chip) to minimise the depth of the pocket in individuals with periodontitis.
• Adults' Off-Label Use of Chlorhexidine Gluconate:
  • As a supplement to therapy for the management of medication-induced jaw osteonecrosis
  • For Oropharyngeal decontamination to lower the risk of hospital-acquired or ventilator-associated pneumonia in patients undergoing cardiac surgery and those who are mechanically ventilated

Chlorhexidine Dose in Adult

Chlorhexidine use in Gingivitis:  

• After brushing your teeth, take 15 mL of the mouthwash (which is about one capful).
• Swish it around in your mouth for 30 seconds.
• Then spit it out.
• Do this twice a day, once in the morning and once in the evening.

It's important to start this routine right after you've had a dental cleaning.

Chlorhexidine Use in Periodontitis:  

• Your dentist will place a small chip into any deep pockets in your gums. These pockets are usually 5 millimeters deep or more.
• They can put up to 8 chips in during one visit if needed.
• You might need this treatment every 3 months for pockets that are still deep.
• If the chip falls out within 48 hours, they'll put in a new one. But if it stays in for a week or more, you've had the full treatment.

Chlorhexidine off-label use in the treatment of Oropharyngeal decontamination to reduce the risk of hospital-acquired or ventilator-associated pneumonia:

For heart surgery patients:

• They'll have the patient rinse with 15 mL of the mouthwash or apply it with a swab inside the mouth twice a day.
• They start this before surgery and continue for 10 days after surgery, or until the patient no longer needs a breathing tube.
• After rinsing, the patient shouldn't eat or drink for 30 minutes.

For patients on ventilators:

• There's no specific dose recommended because the studies are mixed.

Chlorhexidine Dose in Children

Chlorhexidine use in Gingivitis:

For kids aged 8 and up and teenagers with gingivitis:

• After they brush their teeth, they should swish 15 mL (that's about one capful) of the mouthwash in their mouth for 30 seconds.
• Then they spit it out.
• They should do this twice a day, once in the morning and once in the evening.

Pregnancy Risk Factor B

• Using chlorhexidine oral rinse during pregnancy is considered low risk, as studies on animals haven't shown any harmful effects.
• However, the safety of the periodontal chip during pregnancy hasn't been studied.
• Chlorhexidine from the mouthwash isn't absorbed much by the body when swallowed.

Chlorhexidine Dose in Kidney Disease:

• The manufacturer's instructions don't mention any need to change the dosage for people with kidney problems.

Chlorhexidine Dose in Liver Disease:

• The manufacturer's instructions don't mention any need to change the dosage for people with liver problems.

Common Side Effects of Chlorhexidine gluconate include:

• Respiratory:
  • Upper respiratory tract infection
  • Sinusitis
• Gastrointestinal:
  • Toothache

Less Common Side Effects of Chlorhexidine gluconate inlcude:

• Neuromuscular & skeletal:
  • Arthritis
  • Tendonitis
• Gastrointestinal:
  • Gingival hyperplasia
  • Aphthous stomatitis
• Respiratory:
  • Bronchitis
  • Pharyngitis

Frequency not defined:

• Dermatologic:
  • Cellulitis
• Infection:
  • Abscess
• Gastrointestinal:
  • Increased tartar formation
  • Mouth discolouration
  • Dental discolouration with an oral rinse
  • Dental discomfort

Contraindication to Chlorhexidine gluconate include:

• If someone is allergic to chlorhexidine or any ingredient in the product, they shouldn't use it.

Warnings and Precautions

Hypersensitivity reactions

• Some people can have serious allergic reactions, including anaphylaxis, to chlorhexidine.
• If you experience symptoms like difficulty breathing, swelling of the face, lips, tongue, or throat, or severe itching after using chlorhexidine, seek medical help immediately.

Oral Rinse

• Using chlorhexidine oral rinse might cause staining on teeth, dental restorations, and the tongue, especially if there's a lot of plaque buildup.
• This staining isn't harmful to your gums or other mouth tissues, and most of it can be removed during a dental cleaning.
• However, if you have dental work on the front teeth with rough surfaces or edges, the staining might be harder to remove.
• Also, using chlorhexidine might lead to more buildup of tartar on the teeth, but it's not clear if it affects tartar below the gumline.
• It might change how things taste while you're using it, and in rare cases, it could cause a permanent change in taste.

Periodontal chip

• Using periodontal chips can sometimes lead to rare infections like abscesses or cellulitis, especially when they're used along with scaling and root planing.
• So, it's important to be cautious if you have gum disease and other conditions that might weaken your immune system, like diabetes or cancer.
• It's not recommended to use these chips in pockets with acute periodontal abscesses.

Monitor:

None required

How to administer Chlorhexidine gluconate:

Using Chlorhexidine Oral Rinse:

• Swish the rinse around in your mouth and then spit it out; don't swallow it.
• Use it in the morning and evening right after you brush your teeth.
• After using the rinse, don't rinse your mouth with water or other mouthwashes, brush your teeth, or eat anything immediately.

Inserting Periodontal Chips:

• Before inserting the chip, dry the area around the pocket where it'll go.
• Hold the chip with forceps, making sure the rounded edges are away from the forceps.
• Put the chip into the gum pocket as far as it can go.
• You can move it into place using the tips of the forceps or a flat tool.
• The chip will break down on its own, so you don't need to take it out.
• Avoid using dental floss in the area where the chip was inserted for 10 days afterward, as flossing could move the chip.

Mechanism of action of Chlorhexidine gluconate:

• Chlorhexidine can kill many types of bacteria, both those that stain purple (gram-positive) and those that stain pink (gram-negative), as well as some yeasts.
• It can either stop bacteria from growing or kill them, depending on how much is used.
• When there's a little bit of chlorhexidine, it messes up the balance inside bacterial cells, making them stop growing.
• But with a lot of chlorhexidine, it causes the insides of the bacteria to clump up and die.
• This happens because chlorhexidine sticks to the surface of bacteria and makes them fall apart.

Absorption and Excretion:

Oral Rinse:

• Retention in Oral Cavity: About 30% of chlorhexidine from the oral rinse stays in the mouth after rinsing and is slowly released into oral fluids.
• Limited Absorption: It's not absorbed well from the gastrointestinal (GI) tract after swallowing.
• Serum Concentrations: After using the rinse, chlorhexidine isn't detectable in the blood plasma 12 hours later.
• Excretion: Most of the chlorhexidine from the oral rinse is excreted in the feces (about 90%), with only a small amount excreted in urine (<1%).

Periodontal Chip:

• Release Pattern: Chlorhexidine is released from the chip in two phases: about 40% is released in the first 24 hours, and the rest is released steadily over 7 to 10 days.
• No Detectable Levels: Under clinical conditions, no measurable levels of chlorhexidine are found in urine or plasma after inserting four chips.
• Duration of Action: Detectable levels of chlorhexidine are not present in the plasma 12 hours after administration.

Chlorhexidine international brands:

• DentiCare Rinse
• GUM Paroex Oral Rinse
• APO-Chlorhexidine
• Chlorhexidine Alcohol Free
• Oro Clear
• Oro-Clense
• Perichlor
• Peridex
• Elgydium
• Eludrilperio
• A'Fresh
• Afresho
• Alpha-Hexidine Sungkwang Gargle
• Amident
• Antiseptol
• Periogard
• X-Pur Chlorhexidine
• Atoseptal
• B-Mouthwash
• Bacto Scrub
• Baxil
• Benodent CLX
• Bucoglobin Gel Dental
• Chlorhexil
• Cidegol C
• Clear Mouthwash
• Clohex
• Coglu
• Bucoseptil
• Chlohexin Gargle
• Chlorasept
• Collunovar
• Corsodyl
• Corsodyl
• Mint
• Deratin
• Dynexan Proaktiv
• Eburos
• Elugel
• Everguard
• Fresh Breath
• Health Mouthwash
• Hexabir
• Hexamedal
• Hexidine
• Hexidine Mouth Wash
• Hexidine Mouthwash
• Hexisept
• Hexitol
• Medilixin
• Odontol Plac
• Oracare
• Oradex
• Orahex
• Oraklean
• Oral-C
• Oralgene
• Oralon
• Oralon Dental Gel
• Oralxidine
• Oraxine
• Paroex
• Perio-Aid
• Periochip
• Periokin Gel
• Prexidine
• Prodent Plac
• Qualikin
• Savacol Mouth and Throat Rinse
• Scrub Stat 4
• Septofort
• Sorexidine
• Tarodent
• Ya Nuo
• Zordyl

Chlorhexidine brands in Pakistan: