From the Guidelines
The proper protocol for mouthcare using chlorhexidine (CHX) gluconate mouthwash involves rinsing with 0.12% or 0.2% chlorhexidine solution for at least twice daily. According to the most recent and highest quality study available, specifically the 2024 guideline on prevention and management of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy 1, patients at risk for osteoradionecrosis who have delayed healing after dental extraction may be prescribed antiseptic mouth rinses, including chlorhexidine gluconate solution.
Key Considerations for Chlorhexidine Mouthwash Use
- The solution should be swished throughout the entire mouth, including between teeth and at the gumline, then spit out completely.
- Patients should avoid eating, drinking, or rinsing their mouth for at least 30 minutes after use to maximize effectiveness.
- The typical treatment duration is variable and should be determined based on the specific condition being treated and the healthcare provider's recommendations.
- Chlorhexidine works by binding to oral surfaces and releasing slowly over time, providing antibacterial action by disrupting bacterial cell membranes.
- Common side effects include temporary taste alteration, tooth staining, and increased tartar formation, which can be minimized by proper technique and duration adherence.
Important Precautions
- Patients should discontinue use and consult their healthcare provider if they experience severe irritation or allergic reactions.
- The use of chlorhexidine mouthwash should be part of a comprehensive oral care plan that includes regular brushing, flossing, and dental check-ups.
- For patients with specific conditions, such as those undergoing radiation therapy, the use of chlorhexidine mouthwash should be guided by the recommendations of a healthcare provider or dentist, taking into account the individual's risk factors and treatment plan.
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 proper protocol for mouthcare using chlorhexidine gluconate mouthwash is:
- Initiate therapy after a dental prophylaxis
- Use twice daily, in the morning and evening, after toothbrushing
- Rinse with 15 mL (½ FL OZ) of undiluted solution for 30 seconds
- Expectorate after rinsing, do not swallow
- Avoid rinsing with water, other mouthwashes, brushing teeth, or eating immediately after use
- Reevaluate and undergo a thorough prophylaxis at intervals no longer than six months 2
From the Research
Proper Protocol for Mouthcare using Chlorhexidine (CHX) Gluconate Mouthwash
The proper protocol for mouthcare using chlorhexidine (CHX) gluconate mouthwash involves several key considerations:
- Concentration and Regimen: The concentration of chlorhexidine gluconate can vary, and the regimen of use may differ depending on the product and the individual's oral health needs 3.
- Frequency and Duration: The frequency and duration of use can impact the effectiveness of chlorhexidine gluconate mouthwash in reducing plaque and gingivitis 4.
- Mechanical Oral Hygiene: Chlorhexidine gluconate mouthwash should be used as an adjunct to mechanical oral hygiene procedures, such as toothbrushing and flossing 4.
Adverse Effects and Considerations
Some adverse effects and considerations to keep in mind when using chlorhexidine gluconate mouthwash include:
- Taste Changes and Tooth Staining: Chlorhexidine gluconate mouthwash can cause taste changes and tooth staining, particularly with long-term use 3, 5, 4.
- Oral Mucosa Effects: Chlorhexidine gluconate mouthwash can cause effects on the oral mucosa, including soreness, irritation, and mucosal ulceration/erosions 4.
- Calculus Formation: The effect of chlorhexidine gluconate mouthwash on calculus formation is inconclusive 4.
Effectiveness against Viruses
Chlorhexidine gluconate mouthwash has been shown to be effective in reducing the salivary viral load of SARS-CoV-2 6, and may have effectiveness against other viruses 7.
- Reduction in Viral Load: Chlorhexidine gluconate mouthwash can reduce the viral load of SARS-CoV-2 in saliva for at least 60 minutes 6.
- Comparison to Other Mouthwashes: Chlorhexidine gluconate mouthwash may be more effective than other mouthwashes in reducing viral load, but more research is needed to confirm this 7.