What is the recommended usage of medicated dental mouth wash for treating gum disease?

Recommended Usage of Medicated Dental Mouthwash for Treating Gum Disease

Chlorhexidine gluconate (0.12%) mouthwash is the gold standard medicated mouthwash for treating gingivitis, used twice daily for 30 seconds after toothbrushing, with 15 mL of undiluted solution that should be expectorated after rinsing. 1

Standard Protocol for Chlorhexidine Use

• Chlorhexidine therapy should be initiated immediately following a professional dental cleaning (prophylaxis) 1
• Rinse twice daily with 15 mL (½ fl oz) of undiluted solution for 30 seconds, morning and evening after toothbrushing 1
• After rinsing, expectorate the solution and avoid:
  • Rinsing with water
  • Using other mouthwashes
  • Brushing teeth
  • Eating immediately after use 1
• Patients should be reevaluated and given a thorough prophylaxis at intervals no longer than six months 1

Evidence-Based Efficacy

• High-quality evidence shows chlorhexidine mouthrinse reduces plaque significantly when used as an adjunct to mechanical oral hygiene procedures for 4-6 weeks and up to 6 months 2
• Chlorhexidine (0.12-0.2%) provides the most superior antimicrobial effect when used as an adjunct when mechanical debridement is not possible 3
• Chlorhexidine mouthwash reduces gingivitis in individuals with mild gingival inflammation, though the clinical relevance may be limited in mild cases 2

Common Side Effects and Limitations

• Extrinsic tooth staining is the most common and concerning side effect for patients (reported by 77% of dentists) 2, 4
• Other common adverse effects include:
  • Taste disturbance/alteration
  • Oral mucosal effects (soreness, irritation, mild desquamation)
  • Burning sensation in mouth or tongue 2
  • Calculus (tartar) build-up may occur with prolonged use 2
• Due to these side effects, chlorhexidine is typically recommended for short-term use rather than long-term maintenance 3

Alternative Medicated Mouthwashes

• Natural product-based mouthwashes have shown promise as alternatives with fewer side effects, though current evidence is insufficient to recommend them over chlorhexidine 5
• Some alternatives with supporting evidence include:
  • Aloe vera (10 mL, twice daily for 1 minute) has shown anti-inflammatory properties and can be used as an adjunct to mechanical therapy 5
  • Triphala mouthwash (10 mL, twice daily for 2 weeks) has demonstrated effectiveness in reducing plaque and gingival inflammation 5
  • Green tea mouthwash containing 1% tannin (15 mL, twice daily for 1 minute) could be a safe adjunct to mechanical plaque control 5

Best Practices for Optimal Results

• Medicated mouthwash should be used as an adjunct to, not a replacement for, mechanical cleaning (brushing and flossing) 2
• A gap of 30 minutes should be maintained between toothbrushing and rinsing with medicated mouthwash 5
• For patients with periodontitis (more advanced gum disease), chlorhexidine chips may be more effective than mouthwash for localized treatment 3
• The standard concentration of 0.12-0.2% chlorhexidine is recommended; higher concentrations unnecessarily increase side effects without improved efficacy 3

Special Considerations

• For patients with gingivitis during orthodontic treatment, medicated mouthwashes can help control plaque in hard-to-reach areas 5
• For patients with type 2 diabetes and gingivitis, regular use of medicated mouthwash can help manage gingival inflammation 5
• For post-surgical periodontal procedures, chlorhexidine is frequently recommended (used by 85% of dentists) 4
• For acute gingivitis treatment, chlorhexidine is commonly prescribed (used by 74% of dentists) 4

Despite the emergence of natural alternatives, there is currently insufficient evidence to shift from products approved by regulatory dental bodies to natural oral hygiene products for treating gum disease 5. Chlorhexidine remains the most well-established and effective medicated mouthwash for treating gingivitis when used according to the recommended protocol.