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PubMed2006

Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis.

INTRODUCTION: Nosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation. METHODS: This study is a meta-analysis of randomized controlled trials assessing the effect of chlorhexidine on the incidence of nosocomial pneumonia. Data sources were Medline, EMBASE, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Out of 1,251 articles screened, 4 randomized, controlled trials were identified that included a total of 1,202 patients. Descriptive and outcome data were extracted by two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, and mortality. A random effects model was used. RESULTS: The incidence of nosocomial pneumonia in the control group was 7% (41 out of 615) compared to 4% (24 out of 587) in the treatment group. Gram-negative bacteria accounted for 78% of the total isolates, with Pseudomonas aeruginosa being the most frequently isolated pathogen irrespective of the intervention provided. Duration of mechanical ventilation and intensive care unit length of stay were comparable between the two groups. Overall, the use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia (odds ratio of 0.42; 95% confidence interval 0.16-1.06) or the mortality rate (odds ratio 0.77, 95% confidence interval 0.28-2.11). CONCLUSION: The use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate. The lack of benefit may reflect the few studies conducted in this area. Future trials should focus on a combination strategy of mechanical and pharmacological interventions.

Administration, Oral↗
PubMed1982

The use of fluoride and chlorhexidine for the prevention of radiation caries.

A regime of four topical applications of 1.0% sodium fluoride-1.0% chlorhexidine digluconate plus daily rinses with an 0.05% sodium fluoride-0.2% chlorhexidine solution prevented radiation caries completely. It also resulted in remineralization of incipient existing lesions. Use of the chlorhexidine-fluoride rinses alone also stopped radiation caries but did not permit remineralization to occur. Use of four topical applications with a fluoride gel and daily rinses with an 0.05% sodium fluoride solution was not sufficient to prevent radiation caries. No chlorhexidine staining was observed. The patients' acceptance of and compliance with the program and the rinses was excellent.

Chlorhexidine↗
PubMed2004

Cytotoxicity of chlorhexidine digluconate to murine macrophages and its effect on hydrogen peroxide and nitric oxide induction.

Chlorhexidine, even at low concentrations, is toxic for a variety of eukaryotic cells; however, its effects on host immune cells are not well known. We evaluated in vitro chlorhexidine-induced cytotoxicity and its effects on reactive oxygen/nitrogen intermediate induction by murine peritoneal macrophages. Thioglycollate-induced cells were obtained from Swiss mice by peritoneal lavage with 5 ml of 10 mM phosphate-buffered saline, washed twice and resuspended (10(6) cells/ml) in appropriate medium for each test. Cell preparations contained more than 95% macrophages. The cytotoxicity was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay and the presence of hydrogen peroxide (H2O2) and nitric oxide (NO) by the horseradish peroxidase-dependent oxidation of phenol red and Griess reaction, respectively. The midpoint cytotoxicity values for 1- and 24-h exposures were 61.12 +/- 2.46 and 21.22 +/- 2.44 microg/ml, respectively. Chlorhexidine did not induce synthesis or liberation of reactive oxygen/nitrogen intermediates. When macrophages were treated with various sub-toxic doses for 1 h (1, 5, 10, and 20 microg/ml) and 24 h (0.5, 1, and 5 microg/ml) and stimulated with 200 nM phorbol myristate acetate (PMA) solution, the H2O2 production was not altered; however, the NO production induced by 10 microg/ml lipopolysaccharide (LPS) solution varied from 14.47 +/- 1.46 to 22.35 +/- 1.94 micromol/l and 13.50 +/- 1.42 to 20.44 +/- 1.40 micromol/l (N = 5). The results showed that chlorhexidine has no immunostimulating activity and sub-toxic concentrations did not affect the response of macrophages to the soluble stimulus PMA but can interfere with the receptor-dependent stimulus LPS.

Animals↗
PubMed2003

Antimicrobial activity of different concentrations of NaOCl and chlorhexidine using a contact test.

The purpose of this study was to analyze the in vitro antimicrobial activity of sodium hypochlorite (1% and 5%) and chlorhexidine (0.12%, 0.5% and 1%). Bacterial samples (ATCC) of Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Porphyromonas gingivalis and Fusobacterium nucleatum were submitted to a contact test. Solutions were evaluated at different time intervals: immediately, 5 min, 15 min, and 30 min after contact and repeated 10 times. The results of the contact test showed that 0.12% chlorhexidine did not eliminate E. faecalis at any time interval, while 0.5% and 1% chlorhexidine and 1% and 5% sodium hypochlorite did. These results permit us to conclude that to obtain better antimicrobial activity, chlorhexidine in a concentration greater than 0.12% should be used.

Anti-Bacterial Agents↗
PubMed1981

The inhibitory effect of chlorhexidine digluconate on dental plaque formation. A scanning and transmission electron microscope study.

The purpose of this study was to determine the effect of chlorhexidine digluconate mouthrinses on the development of dental plaque in man. The dental plaques were formed on strips of triacetylcellulose film (TAC), which were attached to the lingual surfaces of the mandibular incisors by silk suture thread on 20 human volunteers. Differences in the degree of plaque formation on TAC films after 2, 4 and 24 hours were observed in placebo vs. chlorhexidine treated samples using both scanning and transmission electron microscopy. It was found that (1) solutions containing chlorhexidine digluconate and lactic aluminum have an inhibitory effect of the development of dental plaque on the TAC film as evaluated by electron microscopy, (2) the TAC film was a convenient model for the study of early dental plaque formation by electron microscopy, (3) the three types of pellicle reported by Tryggve Lie (1977) were also observed, (4) the method enabled evaluation of the bacterial accumulation of TAC films. After 2 hours, there was no visible difference in the bacterial accumulations on placebo or chlorhexidine treated films. After 4 and 24 hours considerable differences were observed.

Adult↗
PubMed1988

The use of chlorhexidine in the management of gingivitis in children.

Two double-blind studies were conducted in 191 children in Mexico. Following a dental prophylaxis, either a 0.12% chlorhexidine gluconate mouthrinse or a placebo was used under supervised conditions in comparable groups twice per day. The chlorhexidine treatments resulted in a significant decrease of gingivitis when compared to the placebo rinse. Although superficial mucosal desquamations were seen in some chlorhexidine users, they were transient and without discomfort. The increase of cosmetic side effects, e.g., dental stain and supragingival calculus, was without consequence to the gingival health of the subjects. The use of a chlorhexidine rinse twice per day and as adjunct to regular oral hygiene procedures achieved a considerable benefit against gingivitis in children in two studies extending over ten and 12 weeks.

Adolescent↗
PubMed1989

The effect of 2% chlorhexidine digluconate irrigation on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets.

Eight patients with moderate periodontitis volunteered to participate in a study to assess the effect of subgingival 2% chlorhexidine irrigation, with and without scaling and root planing, on clinical parameters and the level of Bacteroides gingivalis in periodontal pockets. Each quadrant was required to have at least one site with a probing depth of 6 mm or greater and bleeding on probing. The patients were treated following a randomized four quadrant design: one quadrant received no treatment; a second quadrant received scaling and root planing only; a third quadrant received chlorhexidine irrigation only; the fourth quadrant received scaling and root planing, plus chlorhexidine irrigation. Sites to receive chlorhexidine were irrigated at 0, 1, 2, and 3 weeks. Clinical and microbiological indices were measured and recorded at 0, 5, 7, 11, and 15 weeks. The clinical parameters measured included; Plaque Index (PI), Gingival Index (GI), probing depth (PD), Bleeding Tendency (BT), and attachment level (AL). The attachment level was measured using an occlusal stint as a fixed reference point. The level of Bacteroides gingivalis was measured by labeling the plaque sample with a polyclonal fluorescent antibody. The plaque smear was then read using a fluorescent microscope at 1000 magnification. The Spearman Rank-Order Correlation was used to determine the relationship between parameters at baseline. The effects of the treatment groups were compared using the Neuman-Keuls Multiple Comparison Technique. The results showed that a positive correlation existed between B. gingivalis (rs = 0.68) and Bleeding Tendency and between P1I (rs = 0.77) and GI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanguinarine on dental plaque and gingivitis.

This study compared the clinical efficacy of three mouthrinses containing either 0.12% chlorhexidine, phenolic compounds, or sanguinarine, which were used unsupervised, in a placebo-controlled, double-blind study of 6 months' duration. The study was conducted according to ADA clinical guidelines for evaluation of antigingivitis agents and was completed by 481 adults. Following baseline exams and a prophylaxis, subjects were randomly divided into treatment groups matched for age, gender, and gingivitis severity, and were instructed to use the rinses in accordance with manufacturer's directions. Followup examinations evaluated supragingival plaque, gingivitis, and gingival bleeding. Compared to placebo at 6 months, the group rinsing with 0.12% chlorhexidine had significantly less gingivitis (31% reduction), gingival bleeding (39% reduction), and plaque (49% reduction) and was significantly better than any of the other treatment groups (P less than 0.05). Both the phenolic and sanguinarine groups showed moderate, yet significant, reductions in plaque compared to placebo (24% and 12% respectively) yet were significantly less effective than the 0.12% chlorhexidine rinse (P less than 0.05). However, neither the phenolic nor sanguinarine rinses were significantly different than placebo in their effects on gingivitis or gingival bleeding. These results support previous published results on the superiority of 0.12% chlorhexidine when used in conjunction with professional care and as an adjunct to routine oral hygiene practices.

Adult↗
PubMed1990

Supragingival irrigation with 0.06% chlorhexidine in naturally occurring gingivitis. I. 6 month clinical observations.

The purpose of this study was to assess the efficacy of supragingival irrigation with 0.06% chlorhexidine gluconate (CHX) on naturally occurring gingivitis. The relative benefit of CHX irrigation in comparison with CHX rinsing, water irrigation, and normal oral hygiene was evaluated. In a blind, placebo-controlled 6-month study 222 patients were assigned to one of four groups: Group 1: Once daily irrigation with 300 ml water followed by irrigation with 200 ml 0.06% chlorhexidine gluconate (experimental); Group 2: Twice daily rinsing with 15 ml 0.12% chlorhexidine (positive control); Group 3: Once daily irrigation with 500 ml water (irrigation control) and Group 4: Sodium fluoride dentifrice for normal oral hygiene only (negative control). All groups used the same sodium fluoride dentifrice for tooth brushing. At baseline, 3 months, and 6 months patients were examined for Gingival Index (GI), Bleeding on Probing (BOP), Plaque Index (PLI), Pocket probing depth (PD), Calculus Index (CI), and stain. After the baseline visit all patients received a supra- and subgingival oral prophylaxis. At 6 months GI and BOP were significantly (P less than or equal to 0.05) reduced by adjunctive CHX irrigation (42.5% and 35.4%, respectively), CHX rinse (24.1% and 15.0%), and water irrigation (23.1% and 24.0%) compared to tooth brushing alone. Plaque was significantly (P less than or equal to 0.05) reduced only by CHX irrigation (53.2%) and CHX rinse (43.3%) while calculus and staining were significantly (P less than or equal to 0.05) increased in the two chlorhexidine groups (276.4% (irrigation) and 273.2% (rinse)). Although significant (P less than or equal to 0.05), pocket probing depth reduction was minimal after CHX irrigation (4.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Day-long reduction of oral malodor by a two-phase oil:water mouthrinse as compared to chlorhexidine and placebo rinses.

Few scientific investigations have addressed the ability of mouthrinses to reduce oral malodor for periods longer than 3 hours. In the present report, we have employed simple, recently described techniques to assess the day-long reduction in oral malodor of a novel 2-phase oil:water mouthrinse (TPM), as compared to a corresponding placebo rinse, and to a commercial 0.2% chlorhexidine mouthrinse. Sixty dental students were divided randomly into 3 groups, and instructed to use one of the rinses prior to bedtime and the following morning. Measurements carried out in the late afternoon, about 8 to 10 hours following rinsing, were compared with baseline measurements carried out in the late afternoon of the previous day. Volatile sulphide levels were measured using a portable industrial sulphide monitor. Microbial levels were estimated using a simple rinsing technique employing sterilized milk. These quantitative techniques were corroborated by organoleptic (hedonic) ratings of a single odor judge. Both TPM and chlorhexidine brought about significant decreases in volatile sulphides (P less than 0.05) as compared to the placebo group. These results were corroborated by the organoleptic data. Similarly, both chlorhexidine and TPM were highly effective in reducing microbial levels as measured by the rinsing technique, in comparison to the placebo group. Chlorhexidine appeared to be more effective than TPM in all measurement categories, although only in the case of microbial activity was there a significant (P less than 0.05) difference between the two groups.

Bacteria↗
PubMed1992

Rinsing with delmopinol 0.2% and chlorhexidine 0.2%: short-term effect on salivary microbiology, plaque, and gingivitis.

The aim of this short-term study was to compare the effect of delmopinol HCl 0.2% and chlorhexidine digluconate 0.2% rinses on the development of dental plaque, the healing of experimental gingivitis, and the salivary microbiology. As part of a larger study protocol, 45 healthy males enrolled in an oral hygiene program to upgrade their oral health. For this portion of the study, participants had their teeth professionally cleaned on day 0. The participants then abstained from standard mechanical oral hygiene procedures, but applied a placebo solution twice daily for 2 weeks. At the end of this period the subjects received a second professional cleaning and were then assigned to 2 treatment groups: Group 1 rinsed with 10 ml of delmopinol HCl 0.2% and Group 2 rinsed with 10 ml of chlorhexidine digluconate 0.2% for 1 minute twice daily for the next 2 weeks and continued to refrain from mechanical oral hygiene procedures. At the end of the placebo and active treatment periods 1) saliva samples were taken and cultivated on a series of media; 2) the degree of gingivitis was assessed with gingival crevicular fluid (GCF) and gingivitis index (GI); and 3) the plaque index was assessed and the stainable buccal plaque extension was analyzed planimetrically. No changes in the salivary microbiological counts were detected for the subjects rinsing with delmopinol. Subjects rinsing with chlorhexidine showed significant reductions of anaerobes, aerobes, and S. mutans in saliva. The amounts of GCF and GI were reduced largely to the same extent in both treatment groups. Mean plaque extension was reduced by 52% after delmopinol and 88% after chlorhexidine rinsing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2002

Efficacy of chlorhexidine mouthrinses with and without alcohol: a clinical study.

BACKGROUND: Plaque control is the main method for preventing periodontal diseases. Chlorhexidine digluconate mouthrinse is widely recognized as helping to maintain plaque control. Most of these mouthrinses contain alcohol, making them impractical for many patients, including those with oral mucosal hypersensitivity. Mouthrinses without alcohol might cause fewer side effects, but also be less efficient. In this study, we evaluated the efficacy of a 0.12% chlorhexidine mouthrinse without alcohol against one with 11% ethanol and a placebo. METHODS: This a double-blind, parallel group study with 96 patients who tested 3 mouthrinses containing 1) chlorhexidine digluconate 0.12% sodium fluoride 0.05%, and ethanol 11% (group 1; CHX-A); 2) the same solution without alcohol (group 2; CHX-NA); and a placebo (group 3; P). Plaque and bleeding indexes were recorded in all patients prior to treatment and at 14 and 28 days. RESULTS: There were significant differences in plaque, gingivitis, and papilla bleeding indexes in both chlorhexidine rinses compared to placebo, but no differences between the 2 CHX products. CONCLUSIONS: In this study, the alcohol-free rinse was as effective as one containing alcohol in controlling plaque and reducing gingival inflammation. Therefore, it would seem that its use can be recommended in all patients, but especially in patients for whom the use of alcohol is contraindicated.

Adult↗
PubMed2003

Effects of chlorhexidine, minocycline, and metronidazole on Porphyromonas gingivalis strain 381 in biofilms.

BACKGROUND: Porphyromonas gingivalis is found in subgingival biofilm and is associated with periodontal disease. Bacteria in biofilms are able to resist higher antimicrobial concentrations than in suspension. Little is known about the susceptibility of P. gingivalis in biofilms to antimicrobial agents. The effects of chlorhexidine gluconate, minocycline hydrochloride, and metronidazole on P. gingivalis biofilms were examined in vitro. METHODS: P. gingivalis strain 381 biofilms were prepared on 32 hydroxyapatite disks. At 0, 24, 72, and 144 hours after perfusion of the three antimicrobial agents, two disks from each device were used to assess the antimicrobial effects by adenosine triphosphate (ATP) bioluminescence, and for morphological investigation by scanning electron microscopy (SEM). RESULTS: Close relationships were found between the results of the ATP analyses and the SEM observations in all groups examined. A significant decrease (P < 0.001) in ATP content was found between the chlorhexidine-treated and control groups. The extracellular matrix structure and P. gingivalis cells were altered in the presence of chlorhexidine. Minocycline hydrochloride also caused a decrease (P < 0.05) in the ATP content and morphological change on P. gingivalis biofilms. Metronidazole showed no significant efficacy against P. gingivalis biofilms. CONCLUSION: Chlorhexidine gluconate was effective at reducing the viability of P. gingivalis 381 cells in biofilms, while minocycline hydrochloride and metronidazole exhibited weaker effects.

Adenosine Triphosphate↗
PubMed2005

A systematic review on the effects of subgingival chlorhexidine gel administration in the treatment of chronic periodontitis.

BACKGROUND: Since scaling and root planing are not always successful, predominantly when access to periodontal defects is compromised, various antimicrobial agents as adjuncts have been suggested to enhance their efficacy. Gel vehicles delivering chlorhexidine (CHX) have become available and tested for these indications. METHODS: An electronic (MEDLINE and Cochrane Oral Health Group Specialized Trials Register) and manual search were made to detect studies concerning the use of chlorhexidine gels as a single measure of treatment and as an adjunct to scaling and root planing. Only full-text randomized controlled trials published in English up to January 2005 were included. RESULTS: Eight studies were finally selected. Due to considerable heterogeneity in study design and outcome variables measured a qualitative data analysis was performed. There is evidence that subgingival chlorhexidine gel administration as a monotherapy temporarily reduces bleeding tendency on probing; a clinical effect coinciding with relevant microbiological changes described in all but one study. To what extent chemical effects contribute to these changes appears to be related to the frequency of gel administration. There seem to be little to no data indicating that the treatment outcome of scaling and root planing will benefit from the adjunctive subgingival administration of a CHX gel. CONCLUSION: The limited data currently available on the effects of subgingival chlorhexidine gel application do not justify its use in the treatment of chronic periodontitis.

Anti-Infective Agents, Local↗
PubMed2006

Effect of a controlled-release chlorhexidine chip on clinical and microbiological parameters and prostaglandin E2 levels in gingival crevicular fluid.

BACKGROUND: The aim of the present study was to determine the effect of a chlorhexidine chip on crevicular prostaglandin E2 (PGE2) levels and on the clinical and microbiological parameters of periodontitis when used as adjunctive therapy to scaling and root planing (SRP) in patients with chronic periodontitis. METHODS: This randomized single-blind study was carried out in parallel design. The test group received SRP plus chlorhexidine chip, whereas the control group received SRP alone. Thirty-four subjects, aged 20 to 55 years, with chronic periodontitis were recruited. Clinical indices, microbiological samples, and gingival crevicular fluid (GCF) samples were evaluated at baseline and after 1, 3, and 6 months. Microbiological samples were evaluated under a light microscope. GCF PGE2 levels were determined using radioimmunoassay. RESULTS: Significant improvements could be found for all clinical variables in both groups over the study period. The mean changes in probing depth obtained by SRP plus chlorhexidine chip were greater than those obtained by the SRP alone group at 3 and 6 months. In the test group, there was also significant gain in clinical attachment level at 6 months. When data were combined from all groups, significant reductions in GCF PGE2 levels and number of microorganisms were noted at all time points. However, in the test group, reduction was greater at 6 months for crevicular PGE2 level and at 3 and 6 months for proportions of spirochetes. CONCLUSION: Based on the findings of this study, the chlorhexidine chip reduced GCF PGE2 levels and had positive effects on clinical parameters and subgingival flora when used as adjunctive therapy to SRP in patients with chronic periodontitis.

Adult↗
PubMed2006

Clinical benefits of subgingival chlorhexidine varnish application as an adjunct to same-day full-mouth root planing: a pilot study.

BACKGROUND: Although scaling and root planing are considered the therapeutic standard for periodontitis, weakly responding sites often occur. To improve treatment outcome, several chemomechanical treatment concepts have been developed. Recently, the clinical surplus value of a highly concentrated chlorhexidine varnish has been shown when used as an adjunct to sequential scaling and root planing. The aim of this study was to explore the clinical effects of a treatment strategy for chronic periodontitis based on a combination of same-day full-mouth root planing and subgingival chlorhexidine varnish administration. METHODS: A randomized, controlled, single-blind, parallel trial was conducted on 12 chronic periodontitis patients. The control group received oral hygiene instructions and same-day full-mouth root planing. The test group received the same instructions and treatment; however, all pockets were additionally disinfected using a chlorhexidine varnish. Clinical response parameters were recorded at baseline and subsequently after 1 and 3 months. RESULTS: Both treatment strategies showed significant reductions in probing depth at both follow-up visits in comparison with baseline levels (P or=7 mm) was found favoring the test group. CONCLUSION: These preliminary findings suggest that the outcome of same-day full-mouth root planing may benefit from the subgingival administration of a highly concentrated chlorhexidine varnish.

Adult↗
PubMed1989

[Studies on bacterial contamination of chlorhexidine coated filaments of the toothbrush].

The purpose of the present investigation was to determine bacterial contamination of chlorhexidine coated and uncoated (normal) nylon filaments of toothbrushes. Ten healthy subjects were employed in this study and the test toothbrush of four lines and thirty-eight tufts were used twice a day. Test periods were 1, 8, and 20 days for each filaments of toothbrush and after they brushed the used toothbrush was kept at the constant condition (20 degrees C, 65% RH). After each test period, those toothbrushes were immediately collected and kept at the same condition for drying. After 0, 3, 6, 9, and 24 hours of drying, two tufts of filaments were pulled out from the toothbrush and cutted into two parts (end- and root-side of tufts) by sterile scissors. Each cutted part of filaments was washed with PBS and the aliquots was incubated on Brucella blood agar plate at 37 degrees C for 48 hours. The number of bacteria attached to filaments was enumerated. The results were as follows: 1. The number of bacteria attached to both end- and root-sides of chlorhexidine coated filaments decreased with the time of drying. 2. At the root-side of the normal filaments, the number of contaminated bacteria increased with the test periods. 3. The isolated bacteria from tested toothbrushes were mainly gram positive at shorter period, however, gram negative rods were also found at longer period. 4. The anti-bacterial activity of the end-side of chlorhexidine coated filaments diminished at eight days of the use, however, their activity at the root-side still remained even at twenty days. From these results, it was clear that the bacterial contamination of toothbrush was affected by several factors such as the condition of drying, the site of tufts, the using period of toothbrush and so on. To prevent this problem, it is important to keep it at good storage condition and to change it periodically. The developed chlorhexidine coated filaments of the toothbrush also indicates to be one of the useful way for prevention of bacterial contamination of toothbrush.

Chlorhexidine↗
PubMed1977

The effect of chlorhexidine and some other detergents on the activity of dextransucrase from Streptococcus mutans.

The inhibitory effect of chlorhexidine and other bis-biguanides on the formation of dental plaque is not fully understood. The present paper describes the effect of chlorhexidine and some selected detergents on the activity of dextransucrase (EC 2.4.1.5.), an enzyme involved in the formation of important components of dental plaque. All detergents examined exerted an inhibitory effect on dextransucrase activity, to some degree dependent on the presence of charged groups and their characters. The high concentrations of chlorhexidine necessary to inhibit dextransucrase activity seem to exclude the possibility that chlorhexidine exerts its plaque inhibiting effect by means of an effect on dextransucrase.

Biguanides↗