Chlorhexidine Gluconate

Chlorhexidine gluconate is an ingredient used in disinfectants, cosmetics, and pharmaceutical products. It may be used to disinfect surgical sites and surgical instruments, to clean wounds, or to treat or prevent infections in the mouth or prevent dental plaque. It has also been effective in irrigating and treating root canals during and after root canal therapy, though in more recent years, sodium hypochlorite bleach has become the preferred solution for these endodontic treatments. Chlorhexidine is on the World Health Organization’s List of Essential Medicines and has been used in medical and clinical settings since the 1950s.

While chlorhexidine has been supplanted by newer compounds in some contexts, it remains a highly effective antiseptic that has been shown to destroy 99.9% of microbes in as little as 30 seconds. It is more effective against some types of organisms than others; specifically, in smaller concentrations it is highly effective against Gram-positive bacteria. Clinical studies have demonstrated that using a chlorhexidine gluconate mouthwash, in addition to regular brushing and flossing, can help reverse mild cases of gingivitis and reduce the accumulation of plaque, though there is insufficient evidence of its efficacy against more severe cases of gingivitis. While its clinical benefits against mild gingivitis have been consistently demonstrated, it can also lead to damage of the mucous membranes in the oral cavity, discoloration of the enamel on the teeth, and impaired taste. Because of its specific chemical makeup, it interacts with certain common components of toothpaste and diminishes in efficacy; for this reason, it is recommended that patients wait at least 30 minutes, and preferably as long as two hours, between using toothpaste and rinsing with chlorhexidine gluconate solutions. These same chemical characteristics, however, enhance the efficacy of chlorhexidine solutions to neutralize or outright destroy bacteria when allowed to remain on the skin for a sufficient duration. For this reason, topical products that might deactivate chlorhexidine should be avoided following its use.

More recently, chlorhexidine gluconate has proven to be instrumental in reducing infant mortality rates in developing countries, where inflammation of the umbilical cord has traditionally been a significant risk for neonates; in 2014, the government of Nepal received recognition from the United States Agency for International Development for effectively reducing the neonatal death rate. While it is widely available, affordable, and has many benefits, there are some possible side effects that can arise from certain uses of chlorhexidine gluconate. It is toxic when placed in the ear canal and can lead to deafness in some cases, and it can also lead to gastrointestinal distress when swallowed, or to respiratory distress when inhaled at higher concentrations. There is also insufficient data to determine its carcinogenic potential, which has led the United States Food and Drug Administration to recommend limiting the use of chlorhexidine mouthwashes to no more than six months. Common brand names for topical chlorhexidine gluconate solutions include Hibiclens, Calgon Vesta, ChloraPrep One-Step, Dyna-Hex, and Hibistat Towelette. Chlorhexidine gluconate mouthwash brand names include Paroex, Peridex, PerioChip, Periogard, and Dentohesinim. Chlorhexidine gluconate is also prepared as an oral antiseptic lozenge that includes the topical pain reliever benzocaine, and menthol.