Clorhexidina

Chlorhexidine is available in various pharmaceutical forms, suitable for different clinical needs:

• Chlorhexidine mouthwash (0.10%–0.20%)
• Chlorhexidine dental floss or toothpaste 
• Chlorhexidine oral or dental gel
• Chlorhexidine antiseptic sprays
• Chlorhexidine shampoo
• Chlorhexidine solution for skin or medical use.

Chlorhexidine is particularly indicated for:

• preventing and treating gingivitis and periodontitis;
• reducing bacterial plaque and gum inflammation;
• oral hygiene following dental procedures (extractions, implants, periodontal surgery);
• maintaining the health of the oral mucosa in patients with poor hygiene or at high risk of infection;
• the control of gingival bleeding and halitosis of bacterial origin.

The clinical interest in chlorhexidine stems not only from its antimicrobial efficacy but also from its safety profile, when used correctly and for limited periods. Commercial products in the form of chlorhexidine mouthwash are formulated to maximise antiseptic efficacy and minimise adverse reactions, often being enriched with soothing, astringent or remineralising agents.

The administration regimen varies depending on the concentration and the product. 

For example, chlorhexidine mouthwash: rinse for 1 minute with 10–15 ml of undiluted solution, twice daily, after meals, for 7–14 days. After use, the solution should be spat out without rinsing with water and without swallowing it.

The use of chlorhexidine is contraindicated in cases of:

• known hypersensitivity to chlorhexidine or any of the excipients;
• children under 6 years of age (for most mouthwashes);
• prolonged use without medical advice.

It is recommended to brush your teeth before rinsing, leaving an interval of at least 30 minutes, as some toothpastes may reduce the effectiveness of chlorhexidine. 

The presence of ingredients such as zinc citrate, xylitol, clay or plant extracts contributes to tolerability and a soothing effect on the gums.

Adverse reactions are generally localised and reversible:

• temporary changes in taste;
• a burning sensation or oral discomfort;
• temporary discolouration of the teeth, tongue or fillings;
• mild dry mouth.

These effects tend to diminish or disappear after stopping use.

Chlorhexidine may interact with anionic agents present in toothpastes or other oral hygiene products, reducing their effectiveness. No significant interactions with food have been reported, but it is recommended to avoid consuming liquids or food immediately after rinsing.

Systemic overdose is unlikely due to topical use. Accidental ingestion of large quantities may cause gastrointestinal irritation, nausea or vomiting, requiring medical assessment.

Products containing chlorhexidine should be stored at room temperature, protected from light and moisture, in the original, tightly closed packaging. Keep out of reach of children.

• PubMed, Chlorhexidine in dentistry: pharmacology, uses and side effects
• ScienceDirect, Effects of a chlorhexidine mouthwash on clinical parameters of gingivitis, dental plaque and oral polymorphonuclear leukocytes
• PubMed, Current uses of chlorhexidine in the treatment of oral conditions: a narrative review
• MDPI, Efficacy of chlorhexidine following oral surgery in wound healing: systematic review and meta-analysis