Can we prescribe chlorhexidine (antiseptic mouthwash) for a 16-year-old with a tooth infection?

From the Guidelines

Chlorhexidine mouthwash can be prescribed for a 16-year-old with a tooth infection as an adjunctive treatment, but it should not replace definitive dental treatment and antibiotics if necessary. The typical recommendation is 0.12% or 0.2% chlorhexidine gluconate solution used twice daily for rinsing [no specific study cited, as the provided evidence does not directly address chlorhexidine usage]. The patient should rinse with 10-15 ml (about 2-3 teaspoons) for 30 seconds after brushing, then spit it out without swallowing or rinsing afterward. This regimen is usually continued for 7-10 days. According to the guidelines, the primary treatment for tooth infections, such as acute dental abscesses, involves surgical intervention (root canal therapy or extraction of the tooth) [ 1 ]. For infections extending into cervicofacial tissues, treatment may involve incision and drainage, followed by antibiotics like amoxicillin for 5 days [ 1 ]. It's essential to note that chlorhexidine alone is not sufficient to treat a tooth infection; it should be used as part of a comprehensive treatment plan that likely includes antibiotics prescribed by a dentist and definitive dental treatment to address the source of infection [ 1 ]. Common side effects of chlorhexidine include temporary taste alteration, tooth staining, and increased tartar formation. The patient should be advised not to eat, drink, or rinse for at least 30 minutes after using the mouthwash to maximize its effectiveness. Key considerations for prescribing chlorhexidine include:

• The patient's overall health status and potential allergies to chlorhexidine
• The severity and type of tooth infection
• The need for concurrent antibiotic therapy and surgical intervention
• Patient education on proper use and potential side effects of chlorhexidine mouthwash.

From the FDA Drug Label

Warnings For external use only Allergy alert This product may cause a severe allergic reaction. Symptoms may include: wheezing/difficulty breathing shock facial swelling hives rash If an allergic reaction occurs, stop use and seek medical help right away Do not use if you are allergic to chlorhexidine gluconate or any other ingredient in this preparation as a patient preoperative skin preparation (especially on the head or face) in contact with meninges in the genital area When using this product keep out of eyes, ears, and mouth May cause serious and permanent eye injury if placed or kept in the eye during surgical procedures or may cause deafness when instilled in the middle ear through perforated eardrums if contact occurs, rinse with cold water right away wounds which involve more than the superficial layers of the skin should not be routinely treated repeated general skin cleansing of large body areas should not be done except when underlying condition makes it necessary to reduce the bacterial population of the skin Stop use and ask a doctor if irritation, sensitization, or allergic reaction occurs and lasts for 72 hours. These may be signs of a serious condition. Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

The FDA drug label does not answer the question.

From the Research

Prescribing Chlorhexidine for a 16-year-old with a Tooth Infection

• Chlorhexidine is an antiseptic mouthwash commonly used to reduce oral bacteria and prevent infections.
• However, the provided studies do not specifically address the use of chlorhexidine for a 16-year-old with a tooth infection.
• According to 2, antibiotics are used to reduce disease-associated periodontopathogens, but international guidelines are not unanimous in recommending the use of local and/or systemic antimicrobials.
• The study 3 discusses the treatment of dental infections, including the use of antibiotics, but does not mention chlorhexidine.
• The systematic review 4 analyzes the therapeutic effects of antibiotics against oral and periodontal diseases, but does not provide information on the use of chlorhexidine for tooth infections.
• The study 5 investigates the optimum length of treatment with systemic antibiotics in adults with dental infections, but does not address the use of chlorhexidine.
• The study 6 discusses the microbiology and management of endodontic infections in children, including the use of antimicrobial therapy, but does not specifically mention chlorhexidine.

Considerations for Treatment

• The treatment of tooth infections typically involves the removal of the source of infection, such as drainage or extraction, and may include the use of antibiotics.
• According to 4, antibiotics are prescribed only in situations of regional and/or systemic body manifestations, and the choice of antibiotics is not as successful as the local intervention treatment procedure.
• The study 6 suggests that antimicrobial therapy, such as penicillin or amoxicillin, may be considered to supplement dental care, especially when local or systemic spread of the infection is suspected.
• There are no research papers provided that directly address the use of chlorhexidine for a 16-year-old with a tooth infection, so it is unclear if chlorhexidine would be an appropriate treatment option 2, 3, 4, 5, 6.