What are the alternatives to Chlorhexidine Gluconate (Peridex) 0.12% oral liquid?

From the Guidelines

Chlorhexidine Gluc A/F (Oral) Liqo (Peridex (A/F)) 0.12% Liqo can be alternatively replaced with Terminalia chebula or Arimedadi oil, which have shown comparable effects in reducing gingival inflammation and plaque levels. When considering alternatives to chlorhexidine, it is essential to evaluate the efficacy and safety of various options.

• Terminalia chebula, a natural product, has been studied for its antimicrobial and anti-inflammatory properties, and its effects on oral health have been compared to chlorhexidine in several studies 1.
• A study by Gupta and co-workers (2014) found that a 10% Terminalia chebula mouth rinse reduced gingival inflammation without affecting plaque levels, with effects similar to a 0.12% chlorhexidine mouth rinse 1.
• Another study by Gupta and co-workers (2015) compared a 10% Terminalia chebula mouthwash to a 0.2% chlorhexidine mouthwash and a placebo, finding significant decreases in plaque and gingivitis scores in both the Terminalia chebula and chlorhexidine groups, with no difference between the two 1.
• Arimedadi oil, a polyherbal product, has also been shown to have comparable effects to chlorhexidine in reducing plaque levels and gingival inflammation in patients with mild to moderate gingivitis 1.
• A recent 3-arm randomized controlled clinical trial found that Arimedadi oil and chlorhexidine had similar effects on plaque levels and gingival inflammation after 21 days of use 1.
• Other polyherbal products have also been studied, with six recent controlled clinical trials comparing their effects to chlorhexidine and/or a negative control, finding that these products have comparable effects to chlorhexidine on gingivitis, plaque, and bleeding on probing indices 1. It is crucial to consider the specific oral condition being treated, duration of use needed, and tolerance to side effects when selecting an alternative to chlorhexidine.
• Natural alternatives like Terminalia chebula and Arimedadi oil may provide a suitable option for patients seeking a more natural approach, while still maintaining efficacy comparable to chlorhexidine 1.

From the Research

Alternatives to Chlorhexidine Gluc A/F (Oral) Liqo (Peridex (A/F)) 0.12% Liqo

• Essential oil mouthrinse: Studies have shown that essential oil mouthrinse can be an alternative to chlorhexidine mouthrinse, with similar effects on gingival inflammation 2. However, chlorhexidine mouthrinse may be more effective in controlling plaque 2, 3.
• Fluoride mouthrinse: Fluoride mouthrinse has been shown to be effective in reducing plaque and gingivitis, and may be a suitable alternative to chlorhexidine mouthrinse 3.
• Hydrogen peroxide mouthrinse: Hydrogen peroxide mouthrinse has been shown to be effective in reducing gingival index and plaque index, and may be a suitable alternative to chlorhexidine mouthrinse 4.
• Prebiotic mouthrinse: Prebiotic mouthrinse has been shown to be effective in reducing gingival index, bleeding index, and oral hygiene index, and may be a suitable alternative to chlorhexidine mouthrinse 4.

Comparison of Alternatives

• A systematic review found that chlorhexidine mouthrinse was more effective than essential oil mouthrinse in controlling plaque, but there was no significant difference in reducing gingival inflammation 2.
• A randomized controlled trial found that fluoride mouthrinse and chlorhexidine mouthrinse were more effective than essential oil mouthrinse in reducing plaque and gingivitis 3.
• A randomized controlled trial found that hydrogen peroxide mouthrinse was more effective than other mouthrinses in reducing gingival index and plaque index 4.

Considerations

• The choice of alternative mouthrinse may depend on individual patient needs and preferences.
• Patients with dental caries may require a different mouthrinse than those without dental caries 3.
• The use of mouthrinse should be adjunctive to mechanical plaque control and good oral hygiene practices 4.