CHLORHEXIDINE COMPOUND

Chlorhexidine belongs to bis-biguanides, which also include alexidine

compound as well.
These are cationic agents with fungicidal and bactericidal activity
against gram-positive and gram-negative organisms.
Chlorhexidine is a chlorophenyl biguanide that has been used as
acetate and more commonly as gluconate salt, which makes it more
soluble for use in mouth rinses, gels and dentrifices, for control of
plaque end gingivitis.

MECHANISM OF ACTION:

It binds to anionic groups on the bacterial surface, probably the

phosphate groups of teichoic acid in gram positive bacteria and
phosphate groups of lipopolysaccharide in gram negative bacteria.
When bis-biguanides bind to organismsthe cell membrane becomes
permeable, allowing cytoplasmic contents to leak.
By virtue of their cationic properties they also bind electrostatically to
hydroxyapetite crystals of teeth, to acquired pellicle and to buccal
mucosa.

EFFICACY:

The efficacy of chlorhexidine mouth rinse as antiplaque/antigingivitis

agent is dose dependent in rage of 0.03% to 0.2%.
Chlorhexidine is neutralized by common toothpaste additives such
as sodium lauryl sulfate and sodium mono fluoro phosphate and to
maximize effectiveness it may be best to keep more than a 30-minute
interval between brushing and using the mouthwash.

CLINICAL INDICATIONS FOR CHLORHEXIDINE:

A. SHORT TERM APPLICATION
a. Healing phase in periodontal surgery.
b. Healing phase in oral surgery in mandibular fracture, third molar
extraction.
c. Pre-surgical use to reduce bacteremia.
d. Therapy for apthous ulcerations.
e. Therapy of denture stomatitis.
f. Therapy of acut necrotizing ulcerative gingivitis.
g. In patients of oral candidiasis.

B. INTERMITTENT APPLICATION (3-4 MONTHS CYCLE):

a.
b.
c.
d.

Repeated denture stomatitis.

Adjunct to periodontal membrane care.
High caries activity to decrease load of streptococcus mutans.
Dental implants to reduce plaque and gingivitis.

C. LONG TERM APPLICATION:

a. Medically compromise patients including agranulocytosis,

leukemia, haemophilia, thrombocytopenia, kidney disease,
allergies, bone marrow transplant and AIDS.
b. Iatrogenic risk patients, who are using cytotoxic drugs,
immunospressants, radiation therapy.
c. Physically handicapped patients.
d. Mentally handicapped patients.

CHLORHEXIDINE GLUCONATE
COMPOSITION (AS MOUTH WASH):
1.
2.
3.
4.
5.
6.
7.

0.12% chlorhexidine gluconate.

Water.
11.6% alcohol.
Glycerine.
PEG-40 sorbitan di-iso-stearate.
Flavor agent.
Sodium saccharine.

LOCAL DELIVERY OF ANTISEPTIC AGENT:

A resorbable delivery system has been tested for subginguval

placement of chlorhexidine gluconate in form of a small chip (4.0
*5.0*0.35mm) . it is composed of a biodegradeable hydrolysed gelatin
matrix, cross linked with gluteraldehyde and also containing glrcerine
and water into which 2.5mg of chlorhexidine gluconate has been
incorporated per chip.
This delivery system releases chlorhexidine in gingival crevicular fluid
>100ug/ml for at least 7 days, concentration well above the tolerance
of most oral bacteria.
Chip degrades in 7-10 days so removal is not needed.

SIDE EFFECTS:
1. Stains on teeth anterior restorations and dorsum of tongue. The
brownish discoloration of teeth and tongue is due to the disintegration
of bacterial membranes leading to the denaturation of
bacterial proteins. At the same time, disulfide functions are reduced to
thiol functions that form dark complexes with iron ions found in saliva.
2. Promaote supragingival calculus formation.
3. Mucosal desquamation.
4. Soreness.
5. Bitter taste that requires masking by compatible flavouring agents.
6. Disturbed taste sensation.