What are the management options for a sore throat caused by chlorhexidine (CHX) mouthwash?

Management of Sore Throat Caused by Chlorhexidine Mouthwash

For sore throat caused by chlorhexidine mouthwash, discontinuation of the product is recommended as the primary management approach, followed by symptomatic treatment with ibuprofen or paracetamol for pain relief.

Immediate Management

• Discontinue chlorhexidine mouthwash use immediately to prevent further irritation and allow the throat to heal 1
• Rinse the mouth thoroughly with water to remove any remaining chlorhexidine residue 1
• Use ibuprofen or paracetamol for pain relief of acute sore throat symptoms 2

Symptomatic Relief Options

Topical Treatments

• Apply an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating 2
• Consider using a mucoprotectant mouthwash (e.g., Gelclair) three times daily for protective coating of irritated mucosa 3
• Apply white soft paraffin ointment to the lips every 2 hours if there is associated lip irritation 2, 3

Oral Rinses

• Use warm saline mouthwashes to cleanse and soothe the throat 2
• Do not restart chlorhexidine as it is not recommended for treatment of established oral mucositis or sore throat 2

Monitoring and Follow-up

• Monitor for signs of allergic reaction to chlorhexidine, which may include:
  • Wheezing/difficulty breathing
  • Facial swelling
  • Hives or rash 1
• If allergic reaction occurs, seek immediate medical attention 1
• If irritation persists for more than 72 hours despite discontinuation, consult a healthcare provider 1

Alternative Mouthwash Options

• If an antimicrobial mouthwash is still needed, consider alternatives such as:
  • Echinacea/sage spray, which has shown similar efficacy to chlorhexidine/lidocaine spray for sore throat relief 4
  • Povidone-iodine mouthwash, although it has less antimicrobial effect than chlorhexidine 5

Common Side Effects of Chlorhexidine

• Sore throat and mouth irritation are common adverse events reported with chlorhexidine use 6
• Other common side effects include:
  • Taste changes
  • Tooth staining
  • Tongue irritation 6, 7
• Most adverse effects resolve after discontinuation of the mouthwash and receiving dental prophylaxis 6

Prevention of Future Episodes

• Avoid using chlorhexidine mouthwash at concentrations higher than recommended 8
• Consider diluting chlorhexidine mouthwash if you have experienced throat irritation previously 6
• Maintain good oral hygiene with a soft toothbrush or swab after meals 3
• Avoid potential irritants such as smoking, alcohol, spicy foods, and hot beverages 3

Remember that chlorhexidine is not recommended for treatment of established oral mucositis or sore throat according to multiple guidelines 2, so alternative treatments should be considered for ongoing oral care needs.