From the Guidelines
Chlorhexidine (CHX) mouthwash is recommended at a concentration of 0.12% or 0.2%, used twice daily for oral infection prevention, with a standard regimen involving rinsing with 15-20 ml for 30-60 seconds, after brushing and flossing 1. The most recent and highest quality study, published in the Journal of Clinical Oncology in 2024, provides guidance on the prevention and management of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy, including the use of chlorhexidine mouthwash for oral infection prevention 1. Key points to consider when using chlorhexidine mouthwash include:
- Rinsing with 15-20 ml of 0.12% or 0.2% chlorhexidine solution for 30-60 seconds, twice daily, after brushing and flossing
- Avoiding eating, drinking, or rinsing the mouth for at least 30 minutes after use
- Using chlorhexidine mouthwash for specific treatment periods, such as 1-2 weeks before and after dental surgery, or for general periodontal treatment, rather than for indefinite daily use
- Being aware of potential side effects, including tooth staining, altered taste sensation, and increased calculus formation, especially with prolonged use beyond 2-4 weeks Other studies, such as those published in the International Journal of Oral Science in 2017 and the British Journal of Dermatology in 2016, also support the use of chlorhexidine mouthwash for oral infection prevention, but the 2024 study provides the most recent and highest quality guidance 1. It is essential to follow the specific instructions of a dental professional, as they may customize the regimen based on individual oral health needs.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Paroex ® (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) therapy should be initiated directly following a dental prophylaxis. Patients using Paroex ® should be reevaluated and given a thorough prophylaxis at intervals no longer than six months. Recommended use is twice daily, oral rinsing for 30 seconds, morning and evening after toothbrushing. Usual dosage is 15 mL (½ FL OZ) of undiluted Paroex ®. Patients should be instructed not to rinse with water, or other mouthwashes, brush teeth, or eat immediately after using Paroex ®. Paroex ® is not intended for ingestion and should be expectorated after rinsing. The recommended dosage and usage of chlorhexidine mouthwash for oral infection prevention is:
- Twice daily oral rinsing
- 30 seconds in the morning and evening after toothbrushing
- 15 mL (½ FL OZ) of undiluted solution
- Patients should not rinse with water, or other mouthwashes, brush teeth, or eat immediately after using the mouthwash 2
From the Research
Recommended Dosage and Usage of Chlorhexidine Mouthwash
- The recommended concentration of chlorhexidine mouthwash is between 0.12% to 0.2% 3
- Concentrations above 0.2% may increase unwanted side effects 3
- Chlorhexidine mouthwash is effective in reducing gingivitis and plaque when used as an adjunct to mechanical oral hygiene procedures 4
- The use of chlorhexidine mouthwash for 4 to 6 weeks can reduce gingivitis by 0.21 (95% CI 0.11 to 0.31) compared to placebo or no mouthrinse 4
Usage for Specific Oral Conditions
- For the prevention of postextraction bacteremia, a 0.2% chlorhexidine mouthwash is recommended before dental extractions 5
- Chlorhexidine mouthwash may be used as an adjunctive treatment for gingival health, but its effectiveness in managing periodontitis, dental caries, and other oral diseases is less certain 6
- Chlorhexidine mouthwash can alter the composition of the oral microbiome, but further research is needed to determine its effects on oral and systemic health 7
Adverse Effects
- Extrinsic tooth staining is a common adverse effect of chlorhexidine mouthwash, with a large increase in staining reported in participants using the mouthwash for 4 to 6 weeks 4
- Other adverse effects reported include taste disturbance, effects on the oral mucosa, and a general burning sensation 4
- Tooth staining was the most negative adverse effect reported by patients in one study 3