Chlorhexidine mouthwash

What is it for?

A powerful antibacterial disinfectant, chlorhexidine mouthwash is commonly recommended or prescribed by the dentist as a medical aid in the treatment of gum and oral disorders.

More precisely, the chlorhexidine mouthwash is extraordinarily effective in the chemical control of bacterial plaque (a sticky patina made up of millions of bacteria immersed in a matrix that adheres as an adhesive to the surface of the teeth).
According to the magazine European Journal of Oral Sciences, chlorhexidine mouthwashes seem to be the most effective of all for disinfecting the oral cavity and preventing dental infections.
As we will see in the course of the discussion, chlorhexidine mouthwashes should not be used for long periods as they can alter the natural color of the dental enamel, causing unsightly stains on the teeth (removable only by professional dental cleaning).

Deepening

Chlorhexidine is a powerful synthetic antibacterial with dual action: this substance acts as a bactericidal (kills germs) and bacteriostatic (prevents the replication of bacteria) agent. Chlorhexidine also appears to be active against some capsule fungi and viruses.
In mouthwashes, the active ingredient is precisely chlorhexidine gluconate (salified gluconic acid with chlorhexidine in aqueous solution)

Therapeutic uses

At concentrations of 0.2%, chlorhexidine is widely used as an active ingredient in the preparation of medicated mouthwashes intended to rebalance the altered bacterial load of the oral cavity. Often times, these mouthwashes are even prescribed to prevent some typical oral ailments such as gingivitis and bleeding gums.
We are all aware of the fundamental importance of oral hygiene for the prevention of infections and dental diseases. However, due to some morbid conditions, it is not always possible to guarantee an impeccable oral cleaning with the help of toothpaste, brush and dental floss ( or pipe cleaner). To ensure satisfactory oral hygiene and to annihilate bacteria, as long as the disease or ailment is not healed, it is sometimes recommended to rinse the mouth with chlorhexidine mouthwashes.
For this purpose, rinses with this type of mouthwash are indicated in the following circumstances:

Prevention of alveolitis (especially), dental granuloma, cysts or other dental infections after tooth extraction
Prevention of infections after major dental surgery (e.g. apicoectomy). In general, fillings and devitalizations do not require treatments with chlorhexidine mouthwashes
Prevention of dental infections in wearers of fixed or mobile dental prostheses
Treatment of mouth ulcers
Support in the treatment of pathologies of the periodontium (pyorrhea)
Reparative treatment of injured gingival tissues, dependent on oral cysts or dental trauma
Treatment of halitosis (mouthwashes with 0.05% chlorhexidine)
Prevention of plaque and tartar accumulation: the therapeutic effect is enhanced when the chlorhexidine mouthwash is enriched with xylitol

Does it prevent tooth decay?

Although chlorhexidine is considered the anti-plaque agent par excellence, the use of mouthwashes thus formulated does not appear to be completely effective in preventing tooth decay.
According to the magazine Operative Dentistryin fact, it seems that the role of chlorhexidine in the prevention of caries pathologies is rather controversial. First of all, dentists recommend using these mouthwashes for relatively short periods, in order to avoid the typical side effects of chlorhexidine (alteration of the natural color of the teeth, burning of the oral mucous membranes, etc.). Starting from this assumption, it can be deduced that the alleged ineffectiveness of chlorhexidine mouthwashes against tooth decay is not due so much to the low antibacterial power of the substance, but rather to its necessarily infrequent use. In support of this "hypothesis, we must not forget that caries is not simply caused by the presence of bacteria in the oral cavity: caries pathology is in fact a" multifactorial infection, the result of an intertwining of elements that are not always easily identifiable.

Method of use and warnings

To obtain the maximum therapeutic effect, it is important to know the correct way to use the chlorhexidine mouthwash which - let us remember once again - is a drug in all respects.
To avoid that the teeth are tinged with black or yellowish spots (typical side effect of chlorhexidine abuse) it is strongly recommended to respect the doctor's instructions to the letter.
First, it is essential to use medicated mouthwashes with a concentration of chlorhexidine adequate for your ailment. While for the treatment of halitosis chlorhexidine gluconate should not exceed 0.05%, in the treatment of gingivitis or in the prevention of infections after dental surgery, the concentration of the active ingredient in the mouthwash can vary from 0.12% to 0, 2%.
Having established therefore that the rinsing therapy with chlorhexidine mouthwashes can only be performed with medical advice, let's now see how the product is used:

Rinse the mouth for about 50-60 seconds with a measuring cup of chlorhexidine mouthwash: (about 10 ml) after a dental operation, the rinsing must be slow and very gentle to avoid unstitching the sutures.
Respect the instructions provided by the manufacturer: a too short rinsing time causes insufficient absorption of chlorhexidine, while a prolonged rinsing increases the risk of stains on the teeth. In the "image below it can be seen how the ideal concentration of absorbed chlorhexidine (4 mg) requires different rinsing times based on the concentration of the active ingredient (15 seconds for 0.3% chlorhexidine mouthwashes, 30 seconds for 0.2% products and 60 seconds for products at 0.12%)

Do not swallow the product
Do not rinse your mouth with water after gargle with mouthwash
Immediately after rinsing, it is recommended NOT to brush your teeth with toothpaste. It is in fact known that some ingredients commonly used in the formulation of a toothpaste (in particular sodium lauryl sulfate and sodium monofluorophosphate) tend to deactivate or alter the disinfectant-antibacterial effect of chlorhexidine. Therefore, it is advisable to brush your teeth with the toothpaste only after 30 minutes / 2 hours from rinsing Alternatively, when the anti-plaque solution is taken in combination with toothpaste and toothbrush, it is suggested to use a toothpaste whose composition does not alter the functioning of the chlorhexidine mouthwash.

To avoid damaging the color of the dental enamel (typical side effect of these products) it is recommended not to continue the therapy beyond the term established by the doctor. In general, rinses with chlorhexidine mouthwashes should be performed at most twice a day, for a period not exceeding 14-21 consecutive days.