From the Guidelines
Long-term use of chlorhexidine (CHX) mouth rinse is not recommended for managing chronic halitosis due to its potential side effects and disruption of the oral microbiome. While CHX is effective for short-term halitosis control, typically limited to 2 weeks of use, prolonged usage can cause significant side effects including tooth staining, altered taste sensation, increased calculus formation, and disruption of the oral microbiome 1. For managing chronic halitosis, a comprehensive approach is more effective, including:
- Regular tongue cleaning
- Proper oral hygiene (brushing twice daily and flossing)
- Regular dental cleanings
- Adequate hydration
- Addressing underlying causes such as gum disease or dry mouth If halitosis persists despite these measures, a dental professional should evaluate for potential underlying conditions. Alternative mouthwashes, such as those containing Terminalia chebula or Arimedadi oil, have shown comparable effects to CHX in reducing plaque and gingival inflammation, without the potential side effects of long-term CHX use 1. For short-term use when indicated, CHX is typically prescribed as a 0.12% or 0.2% solution, used as a 15-30 second rinse twice daily. However, the risks associated with long-term CHX use outweigh its benefits, and alternative approaches should be considered.
From the Research
Effectiveness of Chlorhexidine Mouth Rinse for Halitosis
- The effectiveness of chlorhexidine mouth rinse in managing halitosis has been studied in several trials 2, 3, 4, 5.
- A study published in the Journal of Indian Society of Periodontology found that 0.2% chlorhexidine rinse was effective in reducing breath mercaptan levels and volatile sulfur compounds (VSCs) in patients with oral malodor 2.
- Another study published in the International journal of dental hygiene found that a single rinse with 0.05% chlorhexidine mouthwash reduced VSCs levels in morning breath, although the difference was not statistically significant compared to a placebo 3.
- A systematic review published in The Cochrane database of systematic reviews found that chlorhexidine mouthrinse reduced gingivitis and plaque, but also caused extrinsic tooth staining and other adverse effects 4.
Long-term Use of Chlorhexidine Mouth Rinse
- The long-term use of chlorhexidine mouth rinse has been studied in several trials, with mixed results 6, 4, 5.
- A study published in the Journal of periodontology found that rinsing with 0.2% alcohol-free chlorhexidine for 1 week caused more irritation to oral mucosa, greater burning sensation, and increased altered taste perception compared to a placebo rinse 6.
- A study published in Oral surgery, oral medicine, and oral pathology found that daily or weekly rinsing with 0.12% chlorhexidine solution for 6 weeks improved periodontal conditions and reduced salivary Streptococcus mutans, Lactobacillus, and Candida albicans counts in a geriatric population, but the improvements were not maintained 6 weeks after the rinsing regimen was completed 5.
Adverse Effects of Chlorhexidine Mouth Rinse
- The adverse effects of chlorhexidine mouth rinse have been reported in several studies, including taste disturbance, effects on the oral mucosa, and extrinsic tooth staining 6, 4.
- A systematic review published in The Cochrane database of systematic reviews found that rinsing with chlorhexidine mouthrinse for 4 weeks or longer causes extrinsic tooth staining, and other adverse effects such as calculus build up, transient taste disturbance, and effects on the oral mucosa were reported in the included studies 4.