Chlorhexidine Gluconate Mouthwash Dosing for Oral Use
The standard recommended dose of chlorhexidine gluconate mouthwash is 15 mL of 0.12% solution, used undiluted, swished in the mouth for 30 seconds, twice daily (morning and evening after toothbrushing), then expectorated. 1
Standard Adult Dosing Protocol
- Volume: 15 mL of undiluted 0.12% chlorhexidine gluconate solution 1
- Frequency: Twice daily—morning and evening after toothbrushing 1
- Duration of rinse: 30 seconds 1
- Administration: Swish thoroughly in mouth, then spit out; do not swallow 1
Critical Post-Application Instructions
- Do not rinse with water or other mouthwashes immediately after use 1
- Do not brush teeth immediately after use 1
- Do not eat or drink immediately after use 1
- Wait at least 30 minutes before eating or drinking for maximum effectiveness 2
Alternative Concentration (0.2%)
While the FDA-approved concentration in the United States is 0.12%, international guidelines and research support 0.2% concentration as equally effective:
- 0.2% chlorhexidine: 10 mL twice daily for 1-2 minutes 3
- This concentration is the standard formulation in many countries, with 96% of Norwegian dentists recommending it over diluted versions 4
- Concentrations above 0.2% unnecessarily increase side effects without additional benefit 5
Pediatric Considerations
No specific pediatric dosing for chlorhexidine mouthwash is established in the provided guidelines. The FDA label does not provide pediatric dosing, and chlorhexidine mouthwash is generally not recommended for young children who cannot reliably expectorate the solution 1. For children requiring oral antisepsis, alternative formulations or supervised use with reduced volumes may be considered on a case-by-case basis.
Clinical Context and Indications
Chlorhexidine should be initiated directly following dental prophylaxis and patients should be reevaluated with thorough prophylaxis at intervals no longer than six months 1. Primary indications include:
- Gingivitis treatment and prevention when mechanical plaque control is compromised 5, 6
- Post-periodontal surgery (85% of dentists use it frequently in this setting) 4
- Acute gingivitis episodes (74% frequent use) 4
- Post-oral surgery (57% frequent use) 4
- Stomatitis and herpes simplex infections (73% and 54% use respectively) 4
Important Caveats and Limitations
Avoid concurrent use with anionic toothpaste ingredients: The cationic nature of chlorhexidine is rapidly inactivated by anionic agents found in many toothpastes 7. Patients should brush teeth first, then wait before using chlorhexidine, or use a compatible toothpaste.
Common side effects to counsel patients about:
- Extrinsic tooth staining (77% of dentists report this as a major patient concern) 4
- Increased tartar formation 8
- Bitter taste (12% report inconvenience) 4
- Oral dryness and rare ulcerations (6%) 4
- Rare but potentially fatal allergic reactions 6
Short-term use is preferred: Chlorhexidine is most effective as a short-term adjunct when mechanical debridement is not possible, rather than for long-term continuous use 5, 6. The antimicrobial resistance risk and side effect profile increase with prolonged use 6.
Formulation Selection
Mouthwash is superior to gel formulations for most indications, with 94% of dentists recommending the rinse form over gel 4. The liquid formulation provides better distribution and contact with oral surfaces 5.