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PubMed1978

Chlorhexidine gel and Steradent employed in cleaning dentures.

It was the purpose of the study to test the efficacy of brushing with a 1% chlorhexidine gel or a commercial solution cleanser (Steradent) in preventing formation of plaque on the fitting surface of new dentures. The study group consisted of 74 denture wearers with denture stomatitis who were assigned randomly to one of four treatment groups, testing either the chlorhexidine gel, a placebo gel, Steradent, or a placebo solution. The experiment was started immediately after denture treatment was completed. The experimental period was 1 month. The amount of denture plaque, the clinical condition of the palatal mucosa, and the concentration of yeasts in mucosal and denture smears were recorded while the patients used their original dentures and after the experimental period. Plaque had formed on all new dentures but to a smaller extent in the groups testing the chlorhexidine gel or the placebo gel. The study does not provide any obvious evidence of a chemical effect of chlorhexidine gel or Steradent as a means to prevent formation of microbial plaque on the mucosal surface of maxillary complete dentures.

Biguanides↗
PubMed1995

Mouth-rinsing with chlorhexidine causes a delayed, temporary increase in the levels of oral viridans streptococci.

The indigenous oral flora of 27 volunteers was monitored longitudinally over a 4-week period. Bacteria attached on buccal epithelial cells were counted by microscopy. Salivary bacterial colonies and the presence of alpha-hemolysis were examined after aerobic culturing on blood agar plates. The buccal and salivary bacterial counts were stably maintained in most subjects in the two repeated base-line samplings taken at 1-week intervals. Rinsing with a chlorhexidine mouthwash 45 min before sampling dramatically reduced the amount of epithelial cell-adherent bacteria. One day after the chlorhexidine rinse, however, the numbers of the epithelial cell-adherent bacteria exceeded the base-line level, and a similar decrease-increase pattern of changes was detected for the salivary alpha-hemolytic streptococcal counts. The non-hemolytic salivary bacterial counts were not affected by chlorhexidine. Subsequent weekly samplings showed no difference from the base-line samplings. The chlorhexidine-induced, delayed increase of viridans streptococci on oral epithelial surfaces should be considered a possible risk factor in medically compromised patients.

Adult↗
PubMedDate not supplied

Cochlear damage from chlorhexidine in guinea pigs.

The disinfectant chlorhexidine has been extensively used as preoperative skin sterilizing agent. In the early 1970s it was suspected from clinical experience that inner ear damage with deafness might result from chlorhexidine accidentally introduced into the middle ear during preoperative skin disinfection. In order to study if chlorhexidine by local application in the middle ear has any ototoxic effect resulting in morphological changes in the organ of Corti, the tympanic cavity of guinea pigs was exposed to two different concentrations of the substance. Two different solvents were used and the duration of exposure was varied. The animals were sacrificed 2, 3, 4 or 10 weeks after exposure. In surface preparations of the organ of Corti, damage was seen in almost all exposed ears, related in extent to the concentration of chlorhexidine, the duration of exposure, and the time lapse after exposure. Furthermore, it was found that inner ear damage often extended beyond the organ of Corti and pathological changes were also observed in the mucosal lining of the tympanic cavity.

Animals↗
PubMed1993

Efficacy evaluations on five chlorhexidine teat dip formulations.

Three developmental postmilking teat dip formulations containing chlorhexidine digluconate were evaluated against Staphylococcus aureus and Streptococcus agalactiae in sequential experimental exposure trials. Two additional commercial chlorhexidine digluconate teat dip products were evaluated in natural exposure trials. Under conditions of experimental challenge, the developmental formulations were efficacious against Staph. aureus but did not significantly reduce incidence of new IMI by Strep. agalactiae. None of the three formulations of a conventional germicide used as teat sanitizers effectively reduced incidence of new Strep. agalactiae IMI under experimental challenge conditions. In the natural exposure trials with negative controls, a .35% chlorhexidine teat sanitizer had efficacy of 88.7% against Staph. aureus and 51.4% against Strep. agalactiae. The .5% chlorhexidine product reduced Staph. aureus and Strep. agalactiae IMI by 86 and 56%, respectively.

Administration, Cutaneous↗
PubMed1998

A clinical study of bacterial contamination of chlorhexidine-coated filaments of an interdental brush.

The purpose of this study was to assess the effectiveness of a chlorhexidine coating on the nylon filaments of an interdental brush in reducing bacterial contamination from actual clinical usage. In addition, the residual antimicrobial capacity of the coating over time from clinical exposure was studied. The same type of interdental brush, one with chlorhexidine-coated nylon filaments (antibacterial) and one with uncoated (control) nylon filaments was used with 20 subjects who were participating in a periodontal maintenance program. All subjects had more than four interproximal spaces large enough to accommodate the interdental brush at the start of the study. The subjects served as their own controls in this cross-over design. They used their brushes daily for one and two weeks, respectively. After the last use, each brush was kept in a controlled environment (20-22 degrees C, 65% relative humidity) for 24 hours for air drying. It was found that antimicrobial activity was detected on the chlorhexidine-coated filaments, even after one or two weeks of storage. The mean residual antimicrobial activity of the test filaments at one week was significantly higher than that found on the filaments after two weeks. The mean number of bacteria attached to the antimicrobial filaments were significantly fewer than those on uncoated, control filaments at both one week and two weeks of usage. These results suggest that chlorhexidine-coated filaments on an interdental brush can significantly reduce bacterial contamination and retain this antimicrobial activity for up to two weeks of use.

Adult↗
PubMed1999

In vitro susceptibility of gram-negative bacterial isolates to chlorhexidine gluconate.

OBJECTIVE: To investigate the susceptibility of clinical isolates of gram-negative bacteria to chlorhexidine gluconate. DESIGN: Prospective laboratory study. SETTING: Tikur Anbessa Hospital, Addis Ababa, Ethiopia. SUBJECTS: Clinical specimens from 443 hospital patients. MAIN OUTCOME MEASURES: Significant number of gram negative bacteria were not inhibited by chlorhexidine gluconate (0.02-0.05%) used for antisepsis. RESULTS: Four hundred and forty three strains of gram-negative bacteria were isolated from Tikur Anbessa Hospital patients. Escherichia coli (31.6%) and Klebsiella pneumoniae (23%) were the most frequently isolated bacteria followed by Proteus species (13.3%), Pseudomonas species (9.2%), and Citrobacter species (6.1%). Each organism was tested to chlorhexidine gluconate (CHG), minimum inhibitory concentration (MIC) ranging from 0.0001% to 1%w/v. All Salmonella species and E. coli were inhibited by CHG, MIC < or = 0.01%. Twenty nine per cent of Acinetobacter, 28% of K. pneumoniae and Enterobacter species and 19-25% of Pseudomonas, Proteus and Providencia species were only inhibited at high concentrations of CHG (> or = 0.1%). CONCLUSION: Our results showed that a significant number of the gram-negative bacterial isolates were not inhibited by CHG at the concentration used for disinfection of wounds or instruments (MIC 0.02-0.05% w/v). It is therefore important to select appropriate concentration of this disinfectant and rationally use it for disinfection and hospital hygiene. Continuing follow up and surveillance is also needed to detect resistant bacteria to chlorhexidine or other disinfectants in time.

Anti-Bacterial Agents↗
PubMedDate not supplied

Chlorhexidine varnishes prevent gingivitis in adolescents.

BACKGROUND: Chlorhexidine, a cationic anti-microbial agent, prevents gingivitis by inhibiting plaque accumulation. Gingivitis is the most predominant form of periodontal disease in children and adolescents. The purpose of this study was to determine the effects of a chlorhexidine varnish on the gingival status of adolescents. METHODS: The subjects of this study were 10-15 years old adolescents randomly divided into a control (C) and a treatment (T) group, n = 53 and n = 57, respectively. After restoration of all caries lesions, a prophylaxis was given to both C and T groups. A 10 percent chlorhexidine varnish was applied to the entire dentition of T subjects at BL; and one week and three months thereafter. One calibrated examiner determined blindly the Gingival Index (GI) of all subjects. RESULTS: The average percentage of sites per subject with GI scores of 2 or 3 at BL, and after three and six months for the T group were, respectively, 3.68 +/- 7.13, 0.71 +/- 2.43 and 0.16 +/- 0.62. The corresponding values for the C group were 2.11 +/- 3.68, 1.27 +/- 2.94 and 1.59 +/- 5.20. Profile analysis revealed that over a 6-month period subjects of T group had significantly fewer sites with GI scores 2 and 3 than subjects in the C group (p = 0.025). CONCLUSIONS: It is concluded that the professional application of a chlorhexidine varnish significantly improved the gingival health of adolescents over a 6-month period.

Administration, Topical↗
PubMed2001

Subgingival utilization of a 1% chlorhexidine collagen gel for the treatment of periodontal pockets. A clinical and microbiological study.

This study evaluates the effect of subgingival irrigation with a 1% chlorhexidine collagen gel in periodontal pockets as an adjunct procedure to scaling and root planing (SRP). Thirty-seven sites with probing depth (PD) of 5-7 mm and BANA positive in 6 patients with chronic periodontal disease were selected. Sites were assigned to different treatment groups consisting of SRP only (group 1), SRP + irrigation with collagen gel (group 2), or SRP + irrigation with collagen gel containing 1% chlorhexidine (group 3). Subgingival irrigation was performed after initial SRP and at 7, 14 and 21 days. Clinical measurements including PD, plaque index (PI), gingival index (GI), gingival recession (GI), bleeding on probing (BOP) and clinical attachment level (CAL) were performed at the selected sites at baseline, 60 and 90 days and the BANA test was performed on plaque samples from the same sites at baseline and 90 days. There was an improvement in clinical parameters in all groups with a significantly greater decrease in GI and bleeding in the chlorhexidine group. There was a greater reduction of BANA positive sites in groups 2 and 3. The authors concluded that 1% chlorhexidine collagen gel is a promising adjunct to SRP in the treatment of adult periodontitis.

Adult↗
PubMed1999

Use of a whitening dentifrice for control of chlorhexidine stain.

A major drawback to clinicians prescribing and patients using chlorhexidine rinse is the development of extrinsic staining. In order to assess the effectiveness of a whitening dentifrice in controlling chlorhexidine stain, fifty-seven subjects rinsed with chlorhexidine twice daily while brushing twice daily with either fluoridated whitening or a fluoridated regular dentifrice. Stain was assessed at 1, 2, and 3 month intervals using a stain index with two components; one with parameters for color intensity and one for tooth percentage covered with stain. Facial surfaces accumulated less stain than lingual surfaces. For many, although not all surfaces, and at many, although not all time periods, the group utilizing the whitening dentifrice exhibited less staining. It is advantageous to recommend a whitening dentifrice that has demonstrated stain suppression when prescribing a chlorhexidine rinse. Improved patient satisfaction leading to increased compliance with the antimicrobial regimen is a desired outcome.

Adolescent↗
PubMed2003

[Chlorhexidine varnishes in dentistry].

Since the discovery of chlorhexidine as a potential surface antiseptic in the fifties, it has been abundantly used in different kinds of dental pharmaceutics. During the past decade chlorhexidine containing varnishes have been added to this list. These products present several advantages in comparison to the existing chlorhexidine formulations. Varnishes should be considered as further options for prevention of fissure and approximal caries, possibly in combination with already established methods. For patients at high risk for root surface caries, varnish application might be a meaningful preventive and therapeutic approach. In this paper, the existing literature on the use of two different chlorhexidine varnishes (Cervitec and EC40) in different fields in dentistry will be reviewed.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Effect of a twice daily 0.12% chlorhexidine rinse on the oral health of a geriatric population.

The inhibitory effect of a chlorhexidine rinse on gingival inflammation and plaque accumulation has been well documented. The purpose of this study was to determine whether a twice daily oral rinse with 0.12% chlorhexidine will resolve denture-associated inflammation in a geriatric population. Thirty-six subjects, average age 83 years, were randomly divided into two groups, active and control, and further stratified into three subgroups, removable partial dentures, complete overdentures and lacking a removable prosthesis. Gingival (Löe and Silness '63) and plaque (Silness and Löe '64) indexes were performed on teeth Nos 3, 9, 12, 19, 25 and 28 at baseline and at 60 days. The subjects, following baseline measurements, were required to rinse twice daily for 30 seconds with either a 15 ml solution of 0.12% chlorhexidine or a placebo and instructed to continue their normal oral hygiene routine. The data were statistically analyzed. When active and control groups were compared, either in total or within their stratified subdivisions, significant differences were observed (P less than 0.001). The active group had a 10.27% and 16.68% reduction in the gingival and plaque indexes, respectively, compared to insignificant changes in the control groups. It was concluded that although chlorhexidine proved effective in reducing inflammation and plaque scores, this reduction was not influenced by the type of prosthesis worn.

Aged↗
PubMed2004

Effect of calcium hydroxide and chlorhexidine based gutta-percha points on gingival fibroblasts and epithelial tumor cells.

AIMS AND METHODS: The aim of the present study was to demonstrate the possible effect of different endodontic calcium hydroxide and chlorhexidine-based gutta-percha points, on two different human cell culture systems. Two different calcium hydroxide (Roeko, Langenau, Germany) and one chlorhexidine (Activ Point/Roeko, Langenau, Germany) gutta-percha points were tested with gingival fibroblasts and epithelial tumor cells over a period of six days (n = 12). Conventional gutta-percha points (VDW, Munich, Germany) and cells that were not exposed to any substances served as controls (n = 12). Study parameters included cell vitality, cell count, protein synthesis and cell proliferation. RESULTS: All tested materials induced cell growth specific alterations. Chlorhexidine-based gutta-percha points showed a significant lower protein synthesis with both, gingival fibroblasts (0.013 +/- 0.009 mg/ml) and epithelial tumor cells (0.07 +/- 0.039 mg/ml), when compared with the controls (p > 0.05). Protein synthesis increase of the epithelial tumor cells (0.581 +/- 0.013 mg/ml, control) was observed with the conventional gutta-percha points (0.688 +/- 0.078 mg/ml) and with both gutta-percha points containing different calcium hydroxide-based formulations (0.776 +/- 0.115 and 0.7 +/- 0.047 mg/ ml). CONCLUSIONS: Under the conditions of this study, chlorhexidine containing gutta-percha points showed the highest effect on cell growth inhibition. No significant differences were observed between the tested material and the two different cell culture types.

Adult↗
PubMed1992

[Anaphylactic shock with ventricular fibrillation induced by chlorhexidine].

We experienced a case in which a 66 year-old male patient developed anaphylactic shock followed by ventricular fibrillation, possibly due to intravenous aspiration of chlorhexidine used for topical application when right internal jugular vein was punctured. He was successfully resuscitated without any sequelae. Although lymphocyte transformation test failed to identify the specific allergen, IgE antibodies against chlorhexidine in the patient's serum were detected by radioallergosorbent technique. Chlorhexidine is an extensively used antiseptic, but there have been many reports regarding severe adverse reactions associated with its use. Chlorhexidine does not seem to be a safe antiseptic.

Aged↗
PubMed2005

Chlorhexidine-containing glass ionomer cement. A clinical investigation on the fissure caries inhibiting effect in first permanent molars.

UNLABELLED: Glass ionomer cement with addition of chlorhexidine used as a varnish on tooth surfaces has been shown to reduce the number of interproximal mutans streptococci (ms). The effect of a single application of such a varnish containing 2.5% chlorhexidine on occlusal caries development of the first permanent molars on 6-year-old children in a high caries incidence area was investigated. The children were examined according to WHO criteria and 262 children with 2 caries free contra-lateral molars were selected for treatment. Salivary ms samples were collected using the Strip-mutans (SM) method. After brushing the occlusal surfaces with a toothbrush and pumice in water slurry, rinsing and drying with a cotton roll, glass ionomer cement containing chlorhexidine (GI-CHX) and glass ionomer (GI) were applied randomly with a micro brush and the varnish was covered with occlusal wax. At baseline, the mean defs was 18.18 and DMFS was 0.25 and after one year 18.24 and 0.83 respectively. The salivary ms scores were high or very high (SM 2 and 3) in 85.6% at baseline. At the one-year follow up, the GI-CHX and GI materials could not be detected in the fissures. Also, a large number of fissure sealants had been placed in the molars outside the study protocol; thus 4% of the GI-CHX and GI, and 70% of the untreated were sealed at year one. Overall, there was no significant difference between the caries-reducing effect of GI-CHX and GI, but a trend towards a higher effect was seen for GI-CHX. Excluding the sealed molars the reduction was 74% in the GI-CHX-group, and 71% in the GI-group. CONCLUSION: Addition of 2.5% chlorhexidine to glass ionomer did not seem to increase the caries-reducing effect of the varnish in this high caries incidence population.

Anti-Infective Agents, Local↗
PubMed2006

Intra-alveolar chlorhexidine gel for the prevention of dry socket in mandibular third molar surgery. A pilot study.

PURPOSE: Chlorhexidine is a good prophylactic agent for post-extraction dry socket alveolitis. The bio-adhesive 0.2% chlorhexidine gel could improve this action since its intra-alveolar positioning would allow a more direct action on the alveolus and more prolonged action of the medication. MATERIALS AND METHOD: We present a single blind, randomised study on 30 patients to evaluate the efficacy of the bio-adhesive 0.2% chlorhexidine gel, placed only once within the alveolus, on the reduction of the incidence of impacted third molar post-extraction dry socket alveolitis and its post-operative effects on patients. RESULTS: A reduction of 42.65% in the occurrence of alveolitis and a more favourable post-operative period in the experimental group was observed. In the control group, the appearance of alveolitis was 30.76% opposite to 17.64 % in the experimental group. CONCLUSIONS: The bio-adhesive 0.2% chlorhexidine gel, applied only once after the extraction of impacted third molars, seems to be an appropriate option for the reduction of alveolitis. It improves the buccal aperture and oedema in the post-operative period, although further double blind studies with larger samples are necessary.

Adult↗
PubMed2005

Antimicrobial effect in vitro of chlorhexidine and calcium hydroxide impregnated gutta-percha points.

UNLABELLED: The aim of this study was to evaluate the antimicrobial activity of points containing antiseptics used for temporary obturation in endodontics. Points containing calcium hydroxide (Roeko and Hygienic), and chlorhexidine (Roeko) were tested and gutta-percha points served as control (Meta Dental Corp.). The following microorganisms were studied: Streptococcus mutans (Sm), Enterococcus faecalis (Ef), Staphylococcus aureus (Sta), Candida albicans (Ca), Fusobacterium nucleatum (Fn) ATCC 25586, Porphyromonas gingivalis (Pg) ATCC 33277, and Prevotella intermedia (Pi) ATCC 25611. The experiments were organized in three stages: 1st stage: one point of each kind was placed on agar plates previously seeded with microorganisms. 2nd stage: Another group of points was immersed in broth for 24 hours and placed on the seeded agar. Samples were then incubated at 37 degrees in the conditions of oxygen and for the time required by each microorganism. The zones of bacterial inhibition around each point were measured. The pH values of the broths were recorded. 3rd stage: the immersion broths were inoculated with suspensions of microorganisms, incubated, seeded on plates by dissemination and incubated. CFU counts were performed. RESULTS: points containing chlorhexidine showed inhibition zones with every microorganism in the 1st stage and, in the 2nd stage, with most of the microorganisms studied, except for Fn and Pi. Calcium hydroxide containing points did not inhibit any of the microorganisms assessed. Broth pH values did not exhibit any changes. CFU counts of the broths in which chlorhexidine points had been immersed showed total inhibition for all the microorganisms. The differences between materials were statistically significant (p<0.05) (ANOVA). In the conditions of this study, chlorhexidine-containing points proved to be effective against most of the tested strains.

Anti-Infective Agents, Local↗
PubMed2006

Comparison of two chlorhexidine rinse protocols on the incidence of alveolar osteitis following the surgical removal of impacted third molars.

PRINCIPLES: Alveolar osteitis (dry socket) is the most common complication following the extraction of permanent teeth. This study was undertaken to compare the effect of two chlorhexidine rinse protocols on the incidence of alveolar osteitis in patients undergoing surgical removal of impacted mandibular third molar teeth. METHODS: A prospective randomized clinical trial was conducted among 99 subjects. Patients were randomly assigned into two groups. Subjects were instructed to rinse twice daily with 15 ml of chlorhexidine rinse 30 seconds for one week before and one week after surgery (group I) or one week after surgery (group II). Postoperatively, all patients were instructed to return in one week or sooner if bothersome pain increased or persisted. Data were collected regarding abnormal healing, presence of necrotic tissue, exposed bone, and absence of clot. RESULTS: The results indicated group I and group II were not statistically significant different in the reduction of alveolar osteitis. CONCLUSIONS: To reduce alveolar osteitis after impacted third molar surgery, it was observed use of postoperative chlorhexidine rinse was adequate. The postoperative use of chlorhexidine is more feasible than both preoperative and postoperative use.

Adolescent↗
PubMed2006

Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study.

PURPOSE: The purpose of this pilot study was to determine if a difference existed between nosocomial pneumonia rates for intubated critical care unit (CCU) patients who received twice-daily oral hygiene care with 0.12% chlorhexidine gluconate and those who received the standard oral care. METHODS: Over seven months (February to August), CCU patients were identified through screening and informed consent procedures, and randomized into 1 of 2 groups. Over the 7 months, due to the critically ill nature of the patients, only 5 subjects were enrolled. While in the study, twice-daily oral hygiene care consisted of brushing the cheeks, teeth, and endotracheal tube with a suctioning toothbrush using an FDA-approved 0.12% chlorhexidine gluconate antimicrobial agent with the experimental group (2 intubated patients in the CCU). The control group (3 intubated patients in the CCU) received the standard oral care 6 times per day utilizing a soft foam swab and half strength hydrogen peroxide. All oral care was performed by the nursing staff. The number of persons developing nosocomial pneumonia was monitored until hospital discharge. RESULTS: Results revealed that 1 person out of 3 in the control group was discharged from the hospital with a diagnosis of nosocomial (aspiration) pneumonia. Neither of the 2 subjects in the experimental group was diagnosed with nosocomial pneumonia. Preliminary findings suggest that twice-daily oral hygiene care with 0.12% chlorhexidine gluconate may reduce the risk of nosocomial pneumonia in intubated patients more than the 6-times daily standard oral care protocol. The standard oral care protocol does not include the use of an FDA-approved antimicrobial solution. However, the small size of the sample makes this finding inconclusive. CONCLUSION: Twice-daily oral hygiene care with 0.12% chlorhexidine gluconate may hold promise as a nosocomial pneumonia reduction strategy within hospital CCUs; however, its application requires further testing.

Adult↗