What is the recommended dosage and usage of Chlorhexidine (CHX) mouthwash for reducing plaque and gingivitis?

Recommended Dosage and Usage of Chlorhexidine Mouthwash for Reducing Plaque and Gingivitis

For optimal reduction of plaque and gingivitis, chlorhexidine (CHX) mouthwash should be used at a concentration of 0.12% to 0.2%, with 15 mL rinsed for 30 seconds twice daily after toothbrushing, and the patient should expectorate rather than swallow the solution. 1

Dosage Specifications

• Use 15 mL (½ fluid ounce) of undiluted chlorhexidine mouthwash per rinse 1
• Rinse for 30 seconds, twice daily (morning and evening) after toothbrushing 1
• Expectorate the solution after rinsing; do not swallow 1
• Effective concentrations range from 0.12% to 0.2%, with no evidence that one concentration is more effective than another 2, 3

Proper Administration Technique

• Initiate chlorhexidine therapy immediately following a dental prophylaxis (professional cleaning) 1
• After rinsing with chlorhexidine, patients should:
  • Not rinse with water or other mouthwashes immediately after use 1
  • Not brush teeth immediately after use 1
  • Not eat immediately after use 1
• These precautions help maintain the substantivity (prolonged effect) of chlorhexidine in the oral cavity 4

Duration of Treatment

• Patients should be reevaluated and given a thorough prophylaxis at intervals no longer than six months 1
• Chlorhexidine is most effective as a short-term treatment due to side effects with prolonged use 2, 4
• Reassessment of gingival health after 2-4 weeks is crucial for adjusting the treatment plan 5

Efficacy

• High-quality evidence shows chlorhexidine mouthrinse produces a significant reduction in plaque when used as an adjunct to mechanical oral hygiene procedures 2, 3
• For patients with mild gingivitis (mean Gingival Index score of 1 on a 0-3 scale), chlorhexidine reduces gingivitis by 0.21 points after 4-6 weeks of use 2, 3
• There is insufficient evidence to determine the reduction in gingivitis for individuals with moderate to severe gingival inflammation 2, 3

Common Side Effects and Limitations

• Extrinsic tooth staining is a common side effect with chlorhexidine use beyond 4 weeks 2, 4, 3
• Other common adverse effects include:
  • Taste disturbance/alteration 2, 3
  • Effects on oral mucosa (soreness, irritation, mild desquamation, ulceration) 2, 3
  • Burning sensation in the mouth or tongue 2, 3
  • Increased calculus formation 2, 3

Alternative Natural Products

For patients who cannot tolerate chlorhexidine or for long-term maintenance, several natural alternatives show promising results:

• Green tea mouthwash (1-5% concentration) demonstrates similar anti-plaque and anti-gingivitis effects to chlorhexidine 5
• Aloe vera mouthwash (100%) used twice daily for 1 minute reduces plaque and gingival inflammation 5
• Lemongrass oil (0.25%) mouthwash used twice daily for 1 minute for 21 days shows comparable results to chlorhexidine 5

Special Considerations

• Chlorhexidine has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG) 1
• For patients with coexisting gingivitis and periodontitis, special precautions may be needed 1
• Xylitol combined with chlorhexidine may enhance effectiveness against Streptococcus mutans while maintaining anti-plaque and anti-gingivitis effects 6

Remember that mechanical plaque control (proper brushing and flossing) remains the foundation of oral hygiene, with chlorhexidine serving as an effective adjunct, particularly when mechanical cleaning is difficult or compromised 4.