What should be done for an adult patient with a history of dental issues, who developed white discoloration to the gum line after starting water flossing and rinsing with chlorine dioxide?

White Gum Discoloration from Chlorine Dioxide Rinse

Immediately discontinue the chlorine dioxide mouthwash, as this white discoloration represents chemical irritation or tissue damage to the gingival mucosa. 1

Immediate Management

• Stop all chlorine dioxide rinse use immediately - chlorine dioxide is known to cause tissue damage and discoloration, particularly with prolonged contact times or improper concentrations 1

• Inspect the oral mucosa daily for progression or resolution of the white discoloration 1

• Switch to gentle oral hygiene only - use a soft toothbrush with mild fluoride-containing, non-foaming toothpaste twice daily using the Bass or modified Bass technique 1, 2

• Rinse with plain water or alcohol-free mouthwash (not chlorine dioxide) at least four times daily 2

Understanding the Problem

The white discoloration is likely a chemical burn or tissue irritation from chlorine dioxide exposure. While chlorine dioxide has antimicrobial properties comparable to chlorhexidine for plaque and gingivitis control 3, it has significant tissue compatibility concerns:

• Chlorine dioxide is more damaging to tissues than other oral rinses - it has been documented to cause discoloration and tissue damage even to medical equipment materials 1

• Strong fumes and irritant properties are inherent to chlorine dioxide solutions, requiring ventilation in medical settings 1

• Not recommended for routine oral use - the evidence supporting chlorine dioxide for oral hygiene is very limited, and intermittent use has not proven suitable for long-term oral applications 3, 4

Recommended Alternative Approach

If antimicrobial mouthwash is needed for gingivitis or plaque control, switch to 0.12-0.2% chlorhexidine gluconate used twice daily for 60 seconds 2, 5

Alternative natural product-based options with comparable efficacy and better safety profiles include 1, 2:

• 100% aloe vera mouthwash (10mL twice daily for 1 minute)
• 0.1% turmeric mouthwash (10mL twice daily for 21 days)
• Triphala mouthwash (10mL twice daily) - cost-effective with no reported side effects
• 0.25% lemongrass oil or green tea mouthwash

Follow-Up Care

• Reassess gingival health in 2-4 weeks after discontinuing chlorine dioxide to ensure resolution of the white discoloration 2

• If discoloration persists beyond 1-2 weeks or worsens, refer to a dentist for evaluation of potential tissue necrosis or secondary infection 1

• Avoid painful stimuli during healing - no alcohol-containing products, hot drinks, or spicy foods 1

• Maintain adequate hydration to keep the mouth moist and promote healing 1

Critical Pitfall to Avoid

Do not resume chlorine dioxide use - this agent is not appropriate for routine oral hygiene despite its antimicrobial properties, given the tissue damage risk and limited supporting evidence for oral applications 1, 3, 4