Chlorhexidine instructions for use for mouth rinse

From this article you will learn:

Chlorhexidine - use as a mouth and throat rinse,
pros and cons of the drug, analogues,
how much does chlorhexidine cost - price in a pharmacy in 2021.

The article was written by a dentist with more than 19 years of experience.

Chlorhexidine or chlorhexidine digluconate (full name) is a broad-spectrum antiseptic that is effective against most pathogenic oral bacteria. Therefore, the drug is widely used both in dentistry and ENT practice - in the form of a solution with concentrations of 0.05%, 0.12% or 0.2%. Chlorhexidine is available ready-made and does not require dilution with water. The drug is available without a prescription, although when used for 7 days or more, it has a number of unexpected side effects, which we will also discuss below.

The drug has no age restrictions - with one “But”. For use in the oral cavity in children under 3 years of age - it can only be used in the form of a spray, or using gauze swabs moistened with an antiseptic solution. At the same time, in children under 3 years of age, it is prohibited to spray the spray on the tonsils and throat (so that the drug does not enter the respiratory tract) - when treating tonsillitis and pharyngitis.

Chlorhexidine: photos of packaging from different manufacturers

How to rinse your mouth with chlorhexidine - Chlorhexidine solution for rinsing the mouth and throat is sold in pharmacies most often in the form of a 0.05% solution. The drug is already ready for use, and there is no need to dilute it with water! The standard regimen for mouth rinsing is 2 times a day (after meals and subsequent brushing), morning and evening, for usually 10 days.

Rinse with 1 portion of 10 ml solution for 1 minute. After rinsing, you should not rinse your mouth with water; it is not advisable to drink water immediately, or eat food for at least 1 hour.

Chlorhexidine bigluconate: comparison of effectiveness

This important section will allow you to understand how effective chlorhexidine digluconate is when compared with other popular oral antiseptics. Published scientific works will help us with this (source), but they also show us that the effectiveness of using chlorhexidine bigluconate will also depend on its concentration.

Efficiency of antiseptics (from greatest to least) –

0.2% chlorhexidine,
0.1% hexitidine (hexoral),
0.05% chlorhexidine,
0.05% cetylpyridine,
0.01% miramistin.

It turns out that a 0.05% chlorhexidine solution is far from the most effective antiseptic for the oral cavity (in the scientific work above, the effectiveness of antiseptics was tested on patients with gum inflammation). The most effective is a 0.2% chlorhexidine solution, followed by 0.1% hexitidine, which is part of the Hexoral rinse solution. Well, Miramistin generally took the last line, and what this is connected with - we will tell you below.

That is why a number of manufacturers produce Chlorhexidine solutions with a concentration of 0.2% and even 0.25%. In addition, there are combination preparations in which chlorhexidine is combined either with a second antiseptic (cetylpyridine, zinc sulfate), or with extracts of medicinal plants, or with components to reduce bleeding gums. Well, there are also forms of release of chlorhexidine - in the form of a gel for gums.

Interesting fact: European dentists consider the 0.12% concentration of chlorhexidine to be low, i.e. in Europe this is only the initial concentration when recommended to patients (prescribed for mild inflammation). Therefore, most pharmacy products with chlorhexidine in Europe have exactly 0.12% concentration. A concentration of 0.2-0.25% is considered already high, which is also effective for relieving severe inflammation (such products are still over-the-counter, but they are usually prescribed by dentists or ENT doctors). The concentration of chlorhexidine 0.05% is considered optimal only for the antiseptic treatment of wounds without purulent discharge.

Indications for use:

The drug is used for the treatment and prevention of various diseases caused by microorganisms sensitive to the action of chlorhexidine:

Prevention of infectious diseases after surgical interventions, including in dental and ENT practice. In dentistry, the drug is also used to treat removable dentures.
Treatment of the skin before and after surgery to prevent infection in urology, surgery, as well as obstetric and gynecological practice.
Disinfection of the skin and mucous membranes before medical and diagnostic procedures in gynecological practice.
The drug is also used to treat various skin diseases of bacterial and fungal etiology, as well as purulent wounds and lesions of the mucous membranes that are caused by microorganisms sensitive to the action of the drug (including stomatitis, periodontitis, gingivitis and aphthae).
In addition, the drug is used after unprotected sexual intercourse to prevent sexually transmitted diseases, including chlamydia, genital herpes, syphilis, trichomoniasis and gonorrhea. And also for treating damaged skin to prevent infection.

Chlorhexidine: application in dentistry and ENT

Chlorhexidine solution has not only a pronounced antimicrobial effect against most pathogenic bacteria, but also a pronounced antifungal effect. But there is something else that makes Chlorhexidine one of the most unique and effective antiseptics for the oral cavity. During the process of rinsing the mouth, a thin film of chlorhexidine bigluconate is formed on the surface of the teeth and mucous membrane, which remains after rinsing (continuing to act for up to 5-7 hours).

Thus, a wide spectrum of action on most pathogenic bacteria, as well as a high residual concentration of this antiseptic (lasting up to 5-7 hours after a single rinse) make it possible to effectively use it for the following dental and ENT diseases:

with gingivitis,
with periodontitis,
for aphthous stomatitis (ineffective for herpetic stomatitis),
in case of inflammation of the socket of an extracted tooth,
with inflammation of the hood above the wisdom tooth,
for disinfection of removable dentures,
in ENT practice for infectious diseases of the throat.

Important: at the end of the article you will find information on the specifics of using Chlorhexidine in each of the listed cases separately. This is important because In different situations there are certain subtleties of application.

When is chlorhexidine needed? Indications

After tooth extraction . The doctor may prescribe oral baths with chlorhexidine if the tooth was removed due to severe inflammation and not planned. During normal extractions, there is no need to make baths or rinse, so as not to damage the blood clot in the socket of the extracted tooth.
For stomatitis . This is an inflammation of the mucous membranes of the cheeks and lips, which manifests itself in small wounds. Inflammation can be caused by various reasons: hormonal, taking medications, allergic reactions and household ones, for example, when eating crackers or seeds.
For inflammation of the gums . In this case, you can use an antiseptic at home for pain and discomfort, but you should definitely see a doctor. Most often, the gums become inflamed due to supra- and subgingival plaque that needs to be removed. The procedure is called periodontal oral hygiene and after it the doctor will no longer prescribe chlorhexidine.

This is due to the peculiarity of the product to create a film on the surface of the teeth, to which new plaque and coloring pigments will “stick”. Therefore, after a course of chlorhexidine, a dark plaque forms on the teeth. Residues of food “stick” to this roughness, which are already difficult to remove on your own, they begin to provoke inflammation and the problem appears all over again. Thus, all the benefits of treatment are negated.

Chlorhexidine: price, composition and release forms

Prices are for 2021. You can buy chlorhexidine for only 20-30 rubles - for a 100 ml bottle with a concentration of 0.05%. 0.05% chlorhexidine spray (it is produced under the Vialine brand) will cost a little more, but in this case the bottle will be equipped with a convenient spray dispenser.

The spray form is more convenient for treating skin wounds, for treating pharyngitis and tonsillitis, as well as when used in young children for irrigation of the oral mucosa. For 0.05% Chlorhexidine spray - the price will be from 90 rubles (for a 45 ml bottle).

Chlorhexidine: the composition of the drug is available in a plastic or glass bottle of 100 ml

Active substance content per 100 ml – → chlorhexidine bigluconate 0.05 g (corresponds to a concentration of 0.05%)

Excipients – purified water 100 ml

→ Chlorhexidine bigluconate instructions for use (download in PDF)

Release forms of Chlorhexidine 0.12% or 0.2% –

Below you can see several products containing a higher concentration of chlorhexidine digluconate. Please note that these are ready-made rinsing solutions that do not require dilution with water.

Rinse aid Parodontax Extra 0.2% –

manufacturer – UK/Germany,
active substances – chlorhexidine 0.2%,
without alcohol,
price for 300 ml – from 210 rubles.

Comments: Parodontax Extra rinse contains a high concentration of chlorhexidine 0.2%, which will be effective when used twice a day - even with severe gum inflammation. It is advisable to use no longer than 10 days. If you use this remedy in complex therapy, then combine this rinse with gels for gums that contain anti-inflammatory rather than antiseptic components (for example, Cholisal or Parodontocide).

PRESIDENT Professional 0.12% or 0.2% –

manufacturer – Italy/Russia,
2 release forms that contain chlorhexidine 0.12% or 0.2%,
without alcohol,
500 ml bottle – from 320 to 400 rubles.

Comments: convenient release forms with good concentrations of chlorhexidine; by the way, the bottles have a volume of 500 ml and are equipped with a dispenser pump. We have already said that chlorhexidine concentrations of 0.12-0.2% are much more effective in the treatment of gingivitis and periodontitis, or tonsillitis (than the usual 0.05% solution). However, it is advisable to use solutions with higher concentrations for no longer than 10 days, maximum 12 days.

It should be noted here that solutions of chlorhexidine 0.12% or 0.2% can still and preferably be used without dilution with water. But if for some reason you need a less concentrated solution, then you can dilute them with water. A solution of chlorhexidine 0.12% can be diluted with water - 1:1, and a solution of chlorhexidine 0.2% - either 1:1 or 1:2.

Chlorhexidine Pharmland, solution for external use 0.5 mg/ml

In patients with open traumatic brain injury, spinal cord injuries, or perforation of the eardrum, contact with the surface of the brain, meninges, and the cavity of the inner ear should be avoided.

In case of contact with the mucous membranes of the eyes, they should be quickly and thoroughly rinsed with water.

Contact of hypochlorite bleaches on fabrics that have previously been in contact with chlorhexidine-containing medications may cause brown stains.

Use Chlorhexidine Pharmland with caution in conditions where the systemic effect may be dangerous, especially in children, if the skin is damaged over large areas.

Special precautions. Given the lack of information on transdermal absorption, systemic effects cannot be ruled out. The likelihood of their occurrence increases with repeated applications, especially when a large area is treated, the surface under an occlusive dressing or mucous membranes, in the presence of damage to the skin (in particular burns), as well as in the case of treating the skin of newborns (taking into account the ratio of the surface area and body weight of the child and occlusive effect of diapers).

The use of chlorhexidine solution in newborns as a skin antiseptic before invasive procedures is associated with a certain risk of developing a chemical burn. Based on spontaneous reporting and literature data, a higher risk of skin reactions has been identified in preterm neonates, particularly those born before 32 weeks of gestation, in whom chlorhexidine was used during the first two weeks of life.

Before performing invasive procedures, it is necessary to remove all materials soaked in chlorhexidine: bandages, sheets, napkins, gowns, etc. Do not use excessive amounts of solution. The solution should not be allowed to accumulate in skin folds, under the patient’s body, or on materials that are in direct contact with the child’s skin.

If an airtight dressing (occlusive dressing) is to be applied to skin that has previously been exposed to chlorhexidine, ensure that there is no excess chlorhexidine solution on the skin before applying the dressing.

After opening the polymer container, there is a risk of microbial contamination of the drug.

Chlorhexidine bigluconate: instructions for use, composition

Clinical and pharmacological group – antiseptic/antimicrobial agent. The drug has a bactericidal effect against most pathogenic bacteria in the oral cavity - gram-positive and gram-negative (both aerobic and anaerobic) microorganisms. At concentrations of about 0.2%, chlorhexidine also has a fairly pronounced antifungal effect. As for the antiviral effect of chlorhexidine, it is minimal and has no clinical significance.

How to rinse your mouth with Chlorhexidine

Instructions for use - recommends using aqueous solutions of chlorhexidine for rinsing the mouth and throat. We pay attention to this because... There are also alcohol solutions of chlorhexidine, which can be used exclusively for antiseptic treatment of rooms and surfaces in medical institutions. In addition, in adults we recommend using not 0.05%, but solutions with higher concentrations from 0.12 to 0.25%, because they are much more effective in treating inflammatory diseases of the mouth and throat.

Application scheme –

You need to rinse your mouth or throat 2 times a day (morning and evening). The scheme is simple: we had breakfast/dinner, immediately after eating, brushed our teeth, then rinsed our mouth with Chlorhexidine solution for 1 minute. We remind you once again that after rinsing with chlorhexidine, you should not rinse your mouth with water or eat food for several hours. The course of rinsing for most dental diseases is 10 days, rarely – up to 12-14 days. For gargling, 7-10 days are usually enough.

The concentration of chlorhexidine should be at least 0.2% –

if you smoke,
if you eat a lot of carbohydrates,
if you have long-term chronic gum inflammation,
if you have concomitant chronic tonsillitis,
have gastrointestinal diseases,
if you have had candidiasis (thrush) in the past.

In patients from the list above, gum inflammation or chronic tonsillitis can occur with the formation of an “association” of pathogenic bacteria (directly causing inflammation) with fungal flora. Clinical studies show that the addition of fungal flora makes pathogenic bacteria less sensitive to antimicrobial agents, i.e. to antiseptics and antibiotics. In addition, chlorhexidine at a concentration of 0.2% is highly effective against fungal flora directly.

Important: chlorhexidine from any manufacturer does not require dilution, i.e. it is completely ready for use. You need to rinse your mouth not for 20-30 seconds, but for a full 1 minute . This is important because It is during this time that an indelible thin film of “chlorhexidine bigluconate” is formed on the mucous membrane of the oral cavity and teeth, which will have an antiseptic effect for up to 7 hours even after rinsing.

Important: clinical studies (source) have revealed that chlorhexidine can be inactivated by a component of oral hygiene products, sodium lauryl sulfate. This is of great clinical importance because rinsing with chlorhexidine in the morning and evening is usually recommended after oral hygiene. Studies have shown that after using hygiene products with sodium lauryl sulfate, ideally 2 hours should pass (at least 30 minutes, but this is not enough) so that this does not affect the effectiveness of chlorhexidine. Therefore, if you are going to use chlorhexidine as a mouth rinse, we recommend buying toothpaste without sodium lauryl sulfate (SLS).

Chlorhexidine bigluconate

Name: Chlorhexidine bigluconate Pharmacological action: An aqueous solution of chlorhexidine bigluconate is a local antiseptic with a predominantly bactericidal effect. Chlorhexidine bigluconate is close in chemical structure to bigumal and is a dichlorine-containing biguanide derivative. The mechanism of action is based on its ability to change the properties of the cell membrane of a microorganism. After the dissociation of chlorhexidine salts, the resulting cations react with the bacterial membranes, which have a negative charge. In this case, the lipophilic groups of the drug contribute to the disaggregation of the lipoprotein membrane of bacteria, as a result of which the osmotic balance is disturbed and the loss of potassium and phosphorus from the bacterial cell occurs. Under the influence of the drug, the cytoplasmic membrane of the bacterium is destroyed and its osmotic balance is disrupted, resulting in the death of the bacterium.

The drug is effective against strains of the following microorganisms: Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamidia spp., Bacteroides fragilis, Treponema pallidum, Gardnerella vaginalis. In addition, chlorhexidine bigluconate is active against Ureaplasma spp. and is moderately active against some strains of Proteus spp. and Pseudomonas spp. Viruses (except the herpes virus), as well as fungal spores, are resistant to the drug. The drug is not absorbed into the systemic circulation when applied topically and does not have a systemic effect.

After treating the skin (including the skin of the hands), a certain amount of the drug remains on the skin, so chlorhexidine digluconate has a long-lasting antibacterial effect and can be used to treat the surgical field and the surgeon’s hands. The antimicrobial activity of the drug remains in the presence of pus, blood and other physiological fluids, however, it is worth noting that in this case its effectiveness is somewhat reduced.

Indications for use: The drug is used for the treatment and prevention of various diseases caused by microorganisms sensitive to the action of chlorhexidine. Indications for use of the drug depend on its initial concentration.

Chlorhexidine bigluconate solution 0.05%, 0.1% and 0.2%: Prevention of infectious diseases after surgical interventions, including in dental and ENT practice. In dentistry, the drug is also used to treat removable dentures. Treatment of the skin before and after surgery to prevent infection in urology, surgery, as well as obstetric and gynecological practice. Disinfection of the skin and mucous membranes before medical and diagnostic procedures in gynecological practice. The drug is also used to treat various skin diseases of bacterial and fungal etiology, as well as purulent wounds and lesions of the mucous membranes that are caused by microorganisms sensitive to the action of the drug (including stomatitis, periodontitis, gingivitis and aphthae). In addition, the drug is used after unprotected sexual intercourse to prevent sexually transmitted diseases, including chlamydia, genital herpes, syphilis, trichomoniasis and gonorrhea. As well as treating damaged skin to prevent infection.

Chlorhexidine bigluconate solution 0.5%: Used for processing medical instruments at a temperature of 70 degrees Celsius. Treatment of infected wounds, burns and other injuries to the skin and mucous membranes.

Chlorhexidine bigluconate solution 1%: Used for treating medical instruments, devices and working surfaces of equipment that are not desirable to be disinfected by heat treatment. Disinfection of the patient's skin and surgeon's hands before surgery. Prevention of infection of burns and postoperative wounds.

Chlorhexidine digluconate solution 5% and 20%: Used to prepare solutions of various concentrations on an aqueous, glycerin or alcohol basis.

Directions for use: Chlorhexidine bigluconate is used for the local treatment of infectious diseases. To prevent sexually transmitted diseases, it is recommended to use a 0.05% solution of chlorhexidine bigluconate no more than 2 hours after unprotected sexual intercourse. Men are advised to administer 2-3 ml of the drug into the urinary canal, women 1-2 ml into the urinary canal and 5-10 ml into the vagina. In addition, it is recommended to treat the skin areas on the pubis, genitals and inner thighs with the solution. Urination is allowed 2 hours after using the drug, otherwise the effectiveness of chlorhexidine bigluconate is reduced. Patients suffering from inflammation of the urinary tract (including urethritis and urethroprostatitis) are advised to administer 2-3 ml of a 0.05% solution of chlorhexidine digluconate into the urinary canal 1-2 times a day. It is recommended to use the drug every other day. The duration of treatment is 10 days.

In dental and ENT practice, for the prevention of postoperative infection, a 0.05% or 0.1% solution of chlorhexidine bigluconate is usually prescribed 2-3 times a day in the form of rinses or irrigations.

For the treatment of wound and burn surfaces, as well as other damage to the skin, a 0.05%, 0.02% or 0.5% solution of chlorhexidine bigluconate is usually used. The drug is used in the form of irrigation or applications 2-3 times a day. Application time is usually from 1 to 3 minutes. To disinfect the surgical field, use a 20% solution of chlorhexidine digluconate, previously diluted with 70% ethyl alcohol (for 1 part of a 20% solution of chlorhexidine digluconate, take 40 parts of 70% ethyl alcohol). The resulting solution is used to disinfect the surgical field twice; the surgical field is treated a second time 2 minutes after the first disinfection.

In urological practice, before performing diagnostic procedures (for example, cystoscopy), lavage of the bladder with a 0.02% solution of chlorhexidine digluconate is indicated.

Preparation of solutions of a given concentration from a 20% solution of chlorhexidine digluconate: To prepare 1 liter of a 0.5% alcohol solution of chlorhexidine digluconate, take 25 ml of a 20% solution of chlorhexidine digluconate and add 70% ethyl alcohol to the mark. To prepare 1 liter of 0.5% solution of chlorhexidine digluconate, take 25 ml of 20% solution of chlorhexidine digluconate and add distilled water or water for injection (sterile water) to the mark. To prepare 1 liter of 0.05% solution of chlorhexidine digluconate, take 2.5 ml of 20% solution of chlorhexidine digluconate and add distilled water or water for injection (sterile water) to the mark. To prepare 1 liter of 0.02% solution of chlorhexidine digluconate, take 1 ml of 20% solution of chlorhexidine digluconate and add distilled water or water for injection (sterile water) to the mark. To prepare 1 liter of 0.1% solution of chlorhexidine digluconate, take 5 ml of 20% solution of chlorhexidine digluconate and add distilled water or water for injection (sterile water) to the mark.

The preparation of solutions must take place under aseptic conditions. Sterilization of prepared aqueous solutions of the drug in an autoclave at a temperature of 116 degrees Celsius for 30 minutes is allowed. Solutions prepared on the basis of hard water have a less pronounced bactericidal effect, which is explained by the formation of slightly soluble chlorhexidine salts. It is prohibited to sterilize the drug using ionizing radiation.

Side effects: When using the drug, some patients experienced the development of such side effects as dry skin, itching, rash, photosensitivity, dermatitis. With long-term use of the drug in the form of rinses and irrigations of the oral cavity, patients noted a change in the color of the teeth, the formation of tartar and a change in taste sensations.

Contraindications: Increased individual sensitivity to the components of the drug. The drug is contraindicated for use in patients suffering from dermatitis. The drug is used with caution in pediatrics. It is not recommended to use the drug to disinfect the surgical field during surgical interventions on the central nervous system and auditory canal. The drug is not used in ophthalmology. The drug is not used simultaneously with other antiseptic solutions.

Pregnancy: When the drug was used topically in women during pregnancy and lactation, there was no effect of chlorhexidine on the health of the child. However, long-term use of the drug during pregnancy and lactation is not recommended.

Interaction with other drugs: When the pH of the medium is more than 8, sedimentation occurs. Using hard water to prepare chlorhexidine solutions reduces its bactericidal properties. The drug is not used in combination with anionic compounds, including soap. The drug is not compatible with carbonates, chlorides, phosphates, borates, sulfates and citrates. Chlorhexidine bigluconate increases the sensitivity of microorganisms to the action of kanamycin, neomycin, cephalosporin and chloramphenicol. Ethyl alcohol enhances the bactericidal effect of chlorhexidine.

Overdose: When using the drug according to the instructions, an overdose is impossible. In case of accidental ingestion of the drug, gastric lavage using milk, mild soap, gelatin or raw egg is indicated. There is no specific antidote; in case of side effects, symptomatic therapy is carried out.

Release form: Solution 0.05% for external use, 100 ml in bottles made of polymer material with a nozzle, 1 bottle in a cardboard package. Solution 0.05% for external use, 100 ml in glass bottles, 1 bottle in a cardboard package. Solution 20%, 100 ml in bottles made of polymer material, 1 bottle in a cardboard package. Solution 20%, 500 ml in bottles made of polymer material with a cap, 1 bottle in a cardboard package. Solution 20%, 500 ml in bottles made of polymer material with a cap, 16 bottles per box.

Storage conditions: It is recommended to store the drug in a dry place protected from direct sunlight at a temperature of 1 to 25 degrees Celsius. The shelf life of the drug in the form of a 0.05% solution is 2 years. The shelf life of the drug in the form of a 20% solution is 3 years. The shelf life of the prepared solutions is 1 week.

Composition: 1 ml of the drug in the form of a 0.05% solution of chlorhexidine digluconate contains: Chlorhexidine digluconate – 0.5 mg; Excipients.

1 ml of the drug in the form of a 20% solution of chlorhexidine bigluconate contains: Chlorhexidine bigluconate – 0.2 g; Excipients.

Attention! The description of the drug “ Chlorhexidine bigluconate ” on this page is a simplified and expanded version of the official instructions for use. Before purchasing or using the drug, you should consult your doctor and read the instructions approved by the manufacturer. Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.

Chlorhexidine: expert reviews

Chlorhexidine mouthwash solution - reviews have both positive and negative. However, if you look more closely, most of the negative reviews are associated solely with the incorrect use of the drug. A few examples…

Example of ineffectiveness No. 1 –

Some people use this antiseptic for inflammation and bleeding gums, but then complain that the effect was short-lived and the inflammation returned. And the reason is simple... Gum inflammation is caused by soft microbial plaque and hard dental deposits. Therefore, if, before using chlorhexidine, the dentist does not carry out ultrasonic cleaning of teeth from microbial plaque and stone, the use of an antiseptic will bring only a small short-term effect.

Comment: the antiseptic chlorhexidine has only surface activity, and it does not penetrate into the thickness of dental plaque. Accordingly, it has an antimicrobial effect only on bacteria located on the surface of dental plaque. And if you decide to carry out a course of antiseptic rinses (without removing supra- and subgingival dental plaque), then pathogenic bacteria from the deep layers of plaque or tartar will continue to have a negative effect on your gums. Although for some time the inflammation will indeed decrease.

Example of ineffectiveness No. 2 –

We have already said above that if you smoke, if you have long-term chronic inflammation of the gums, or if you consume a lot of carbohydrates, in this case (in addition to a large number of pathogenic bacteria), there is also a high contamination of the oral mucosa with fungi of the genus Candida. The latter not only play a role in inflammation, but also reduce the effectiveness of antiseptics against bacteria. In general, in these patients, the use of 0.05% chlorhexidine is ineffective and only a 0.2% concentration is needed.

Example of ineffectiveness No. 3 –

It concerns whether it is possible to rinse your mouth with Chlorhexidine for stomatitis. In case of herpetic stomatitis, which is caused by the herpes virus, rinsing your mouth with chlorhexidine is simply pointless, because the drug does not have any significant antiviral activity. And only with aphthous stomatitis, rinsing with chlorhexidine can really be useful, because in some cases, the causes of ulcerations on the mucous membrane can be not only allergic reactions, but sometimes also pathogenic bacteria (for example, staphylococci).

Advantages of the antiseptic Chlorhexidine -

very high antimicrobial activity,
low price,
long-term effect (after a one-minute rinse, a thin film of “chlorhexidine digluconate” remains on the mucous membrane and teeth, which will have an antiseptic effect for up to 5-7 hours).

Disadvantages of Chlorhexidine –

Unfortunately, the drug has more than just benefits. Chlorhexidine bigluconate - instructions for use contain practically no information about the disadvantages, but experience in use and scientific research allows us to say the following:

has a bitter taste (children do not like it),
has no clinically significant effectiveness against viruses (and don’t be confused by the fact that the official instructions recommend chlorhexidine for herpes - the trick here is that in this case it is recommended by the manufacturer not for the virus itself, but for the prevention of associated bacterial complications),
with prolonged use, it can temporarily stain the surface of the teeth and tongue a darkish color (Fig. 5-6),
not compatible with oral hygiene products containing sodium lauryl sulfate (partial inactivation occurs),
In addition, chlorhexidine also has significant side effects that appear within 7 days from the start of its use (we will also discuss this below).

Blackening of teeth when rinsing with Chlorhexidine: photo

In defense, it is worth noting that darkening occurs only on those tooth surfaces on which there is a layer of microbial plaque or tartar (Fig. 5-6). There are also advantages to this - you will immediately notice that it’s time for you to go to the dentist for a professional teeth cleaning procedure. In addition, the darkening of the teeth will be temporary and will disappear within a few days after the end of the course of rinsing.

Chlorhexidine rinse: side effects

You may be surprised, but the use of Chlorhexidine, regardless of concentration (at least for 7 days), has completely unexpected consequences, which not even every clinician knows about. Reputable scientific research (source) has revealed not only positive effects from suppressing the activity of pathogenic bacteria, but also negative ones. For example, a course of rinsing with chlorhexidine significantly changed the composition of the microflora in the oral cavity, or rather, the ratio of different types of microorganisms in relation to each other.

As a result, the number of bacteria increased, which are distinguished by more active production of lactic acid, which leads to an increase in the content of lactic acid in the oral fluid (saliva), and a shift in pH to the acidic side. This also simultaneously leads to a decrease in the buffer capacity of saliva, which reduces the ability to neutralize acids secreted by cariogenic bacteria. Acidic pH promotes demineralization of tooth enamel (leaching of calcium), which increases the risk of tooth decay.

Important for patients with cardiovascular pathology –

Other scientific studies have shown that chlorhexidine interferes with the ability of oral bacteria to convert nitrates (found in foods) into nitrites. This bacterial activity is called “nitrate-reducing” and is one of the mechanisms that regulates our blood pressure. The fact is that nitrites formed by bacteria then enter the blood, helping to lower blood pressure and, accordingly, a decrease in the production of nitrites by oral bacteria leads to an increase in blood pressure.

This may not be very noticeable in completely healthy people, but may be significant in patients with chronic cardiovascular pathology. All these data are confirmed by scientific research - “The increase in plasma nitrite after a dietary nitrate load is markedly attenuated by an antibacterial mouthwash. Nitric Oxide" (2008), authors – Mirco Govoni, Emmelie Å. Jansson, Eddie Weitzberg, Jon O. Lundberg. If you wish, you can read this study using the link above using a browser translator.

Chlorhexidine mouth rinse - detailed analysis of indications for use

We have already said that chlorhexidine has very high efficiency - due to its high antimicrobial activity, as well as its high residual concentration on the oral mucosa (24stoma.ru). Instructions for the use of chlorhexidine for the oral cavity include the following main indications for the use of the drug...

After tooth extraction - usually after extraction, antiseptic rinses are prescribed 2-3 times a day (rinse for 1 minute).
Moreover, you need to rinse your mouth not with active movements, but simply put an antiseptic in your mouth and “sniffle a little” - this is called antiseptic baths. The fact is that active rinsing movements will almost certainly lead to the loss of a blood clot from the socket of the extracted tooth. And then inflammation (alveolitis) may develop in the hole. After tooth extraction, you should rinse your mouth with chlorhexidine especially in the following cases - 1) if the removal was difficult, 2) if the tooth was removed due to inflammation, 3) if you have carious teeth or dental deposits in your mouth, infection in which can lead to suppuration blood clot in the socket. Moreover, in these cases it is sufficient to use only a 0.05% concentration of chlorhexidine. In the absence of the above, rinsing your mouth with antiseptics is not necessary.

For alveolitis of the socket of an extracted tooth - chlorhexidine for rinsing the mouth with alveolitis (this is the name for inflammation of the socket of an extracted tooth) is an excellent remedy. Normally, the socket after removal is closed by a blood clot (Fig. 7), but if the clot falls out or its necrotic disintegration as a result of inflammation, the socket may look like in Fig. 8. In this situation, the optimal use of chlorhexidine 0.12-0.2% concentration. However, it is important to understand that rinsing the mouth during inflammation of the socket is not the main treatment, and you cannot cure alveolitis with antiseptic rinses or antibiotics alone. In the inflamed hole there is a disintegrated blood clot, which needs to be scraped out of the hole, washed it and put the medicine inside. Only a dental surgeon can do this, and this is the main treatment for alveolitis.

In case of inflammation of the hood over the wisdom tooth – when a wisdom tooth is erupting, a so-called “hood” remains over it for some period of time. It is understood as a section of the mucous membrane that lies completely or partially on the chewing surface of the wisdom tooth (Fig. 9). A space is formed between the hood and the tooth where bacteria multiply well and food is retained.

This leads to inflammation of the hood, which is expressed in swelling of the mucous membrane, discharge of pus and even difficulty opening the mouth. Of course, rinsing the mouth with chlohexidine helps well with this disease, but it will only be sufficient for minor inflammation (concentration 0.12-0.2%). With serious inflammation, rinsing alone is no longer enough, and more professional treatment of the inflamed hood is necessary.

After opening the gumboil - if you have opened a purulent abscess on your gum (in common parlance - gumboil) and put a drainage into the incision, then antiseptic rinses are extremely necessary. This is due to the fact that purulent discharge will be released from the incision, spreading throughout the entire oral cavity. Antiseptics will help protect the oral mucosa and tonsils from purulent infection. Important: you don’t need to rinse too vigorously, because... otherwise the drain may fall out of the incision. The optimal concentration is 0.12-0.2%.

For inflammation/bleeding gums – the main symptoms of gum inflammation are their redness, swelling and bleeding, and subsequently – tooth mobility. Chlorhexidine bigluconate for gum inflammation is optimally used in a concentration of 0.2%, and the result will be better if you combine antiseptic rinses - also with applications of anti-inflammatory gels for the gums.
Inflammation of the gums (gingivitis and periodontitis):

For stomatitis (Fig. 12) - we have already said above that chlorhexidine for stomatitis caused by the herpes virus is completely ineffective (since the antiviral activity of this drug is almost zero). But for aphthous stomatitis, rinsing with chlorhexidine can be used, but again, not as the main means of treatment, but only as part of complex therapy. For the herpetic form of stomatitis, the antiseptic Miramistin, which has antiviral activity, should be used (Fig. 13).

Dangers of using chlorhexidine mouthwash

You should not uncontrollably use chlorhexidine solution to rinse your gums and teeth; this can lead to a number of problems.

Chlorhexidine affects not only pathogens, but also the natural flora of the oral cavity, which can ultimately lead to imbalances in the microflora. Uncontrolled use of an antiseptic has an effect on both good microbes and bad ones, but after stopping use, the bad microbes grow faster than the good ones.
Constant use of an antiseptic can cause microflora resistance. According to recent studies, chlorhexidine causes resistance to antibiotics when they are really needed.
Due to regular use of chlorhexidine for rinsing, intense dark plaque may appear on the teeth and tongue. This problem will have to be solved in the dentist's chair. This solution should be used only after consultation with a doctor and only for a limited period. This also applies to various toothpastes and rinses that contain it.

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Well, it’s very important -

The duration of the course of antiseptic rinses - the standard course of rinsing the mouth with chlorhexidine 0.05% - is usually 10 days, but if necessary - up to 12-14 days.
It is advisable to use solutions of 0.12-0.25% concentration for no longer than 8-10 days (although in the manufacturers’ recommendations you can see up to 14 days). Long-term use will cause oral dysbiosis and also increase the risk of developing oral thrush. In addition, we should not forget about the side effects that we discussed above. If you would like to continue the course of antiseptic rinses, then after the end of the 10-day period of using Chlorhexidine, it is better to switch to mouth rinses containing fluorides and extracts of medicinal plants. Both fluorides and plant extracts have their own antiseptic effect (moderate), but they are harmless even with prolonged use.

Remember that for gum inflammation, Chlorhexidine is effective only as part of complex therapy, and only after removing dental plaque. Don’t make the mistakes of many thousands of people who suppress the symptoms of inflammation with antiseptics and antibiotics, while the inflammation progresses unnoticed. Many such people turn to the dentist too late - when the teeth become mobile, and often the only help is tooth extraction.
An additional anti-inflammatory effect can be provided by the use of special anti-inflammatory toothpastes, which help strengthen the gums. Read more about choosing such hygiene products in our article: → Rating of toothpastes for bleeding

Chlorhexidine during pregnancy, in children -

Chlorhexidine can be used without restrictions during pregnancy and breastfeeding, but preferably in courses of no more than 8-10 days. The drug is not absorbed into the blood and has only surface activity. Studies have not revealed a negative effect of the drug in these groups of patients. Chlorhexidine in children can also be used in short courses of up to 10 days (there is no age limit).

Remember that children under 3 years old do not know how to rinse their mouths and therefore may choke. Therefore, their oral cavity can be treated either with gauze swabs soaked in an antiseptic solution, or using Chlorhexidine spray. But keep in mind that in children under 3 years of age, the spray can be used to irrigate the mucous membrane of the entire oral cavity, with one exception - you cannot spray the spray directly into the throat and tonsils (this can lead to reactive laryngospasm). The latter can only be done in children over 3 years old.

Storage conditions -

store in a place protected from light at a temperature not exceeding 25°C.
shelf life: 2 years,
store in places inaccessible to children,
do not use after expiration date. We hope that our article on the topic: Chlorhexidine bigluconate instructions for use was useful to you!

Sources :
1. Dental education of the author of the article, 2. Based on personal experience as a dental surgeon, periodontist, maxillofacial surgeon, 3. National Library of Medicine (USA), 4. PubMed.gov scientific research database, 5. “Optimization of conservative treatment of patients with periodontitis” (Komleva A.S.), 6. Compositions of products were taken from the official websites of manufacturers.

Chlorhexidine bigluconate 0.05% 100 ml external solution.

APPROVED by the order of the Chairman of the Committee for Control of Medical and Pharmaceutical Activities of the Ministry of Health of the Republic of Kazakhstan dated "___"_______________201_year No._____ Instructions for the medical use of the drug Chlorhexidine bigluconate Trade name Chlorhexidine bigluconate International nonproprietary name Chlorhexidine Dosage form Solution for external use 0.05% Composition 1 liter of the drug contains the active substance - chlorhexidine digluconate 2.5 g 20% concentrate excipient - purified water Description Transparent, colorless or slightly opalescent liquid, odorless. Pharmacotherapeutic group Antiseptics and disinfectants. Biguanides and amidines. ATC code D08АС02 Pharmacological properties Antiseptic. The drug is active against vegetative forms of gram-negative and gram-positive bacteria, as well as yeast, dermatitis and lipophilic viruses; it acts on bacterial spores only at elevated temperatures. Cleanses and disinfects the skin without causing damage. Indications for use For the prevention of sexually transmitted diseases (syphilis, gonorrhea, trichomoniasis, chlamydia, herpes). It is also used in gynecology and obstetrics as an antiseptic. Method of application and dosage Chlorhexidine digluconate as a prophylactic agent should be used after urination and treating the genitals with warm water without soap. Use a syringe without a needle to inject the contents of the bottle into the urethra of men (2-3 ml), women (1-2) and into the vagina for 2-3 minutes. It is also necessary to treat the skin of the inner thighs, pubis, and genitals. After the procedure, do not urinate for 2 hours. The prophylactic agent must be used no later than 2 hours after sexual intercourse. Side effects - allergic reactions - dry skin, itching, dermatitis, soft hand skin, photosensitivity. Contraindications - hypersensitivity to chlorhexidine - dermatitis. Use caution in childhood, pregnancy, lactation. Drug interactions Used in a neutral environment: at pH 5-8 the difference in activity is small, at more than pH 8 a precipitate forms. When used simultaneously with iodine preparations, the development of dermatitis is possible. Pharmaceutically incompatible with soap and alkalis. Ethanol enhances the effectiveness of the drug. Special instructions Do not use chlorhexidine solutions for treating the conjunctiva and for washing body cavities, treating deep wounds and burns. In case of contact with the mucous membranes of the eyes, they should be quickly and thoroughly rinsed with water. The bactericidal effect increases with increasing temperature. At temperatures above 100°C, the drug is partially destroyed. Overdose Not identified Release form and packaging 100 ml in polyethylene dropper bottles with screw-on polyethylene caps. 70 bottles and 70 pieces of instructions for use in the state and Russian languages are placed in a group container. Storage conditions: Protected from light at a temperature not exceeding 25°C. Keep out of the reach of children! Shelf life: 3 years Do not use after expiration date. Dispensing conditions Without a prescription Republic of Kazakhstan, Almaty, st. Mametova 3. Tel.: 8(727)2712712, 71-11-86. email mail Owner of the registration certificate Nurer LLP, Republic of Kazakhstan Address of the organization that accepts claims from consumers on the quality of products of Nurer LLP on the territory of the Republic of Kazakhstan, Almaty, st. Mametova, 3 tel: 8(727)2712712 fax, 271-11-86, email. mail