CHEMICAL PLAQUE CONTROL
(CHLORHEXIDINE)
PRESENTED BY- LOVELEEN KAUR
ROLL NO. 21201024
BDS THIRD YEAR
INTRODUCTION
• Microbial plaque is the major etiology of periodontal
diseases.
• Plaque control is the regular removal of microbial
plaque and the prevention of its accumulation on the
teeth and adjacent gingival surfaces.
CHLORHEXIDINE
Is a GOLD STANDARD IN CHEMICAL PLAQUE CONTROL
with outstanding bacteriostatic and bactericidal
properties.
Effective on both gram positive and gram negative
bacteria, although it is less effective with some gram
negative bacteria.
CHEMICAL STRUCTURE:
Chlorhexidine is a symmetrical molecule consisting of FOUR
CHLOROPHENYL RINGS and BISGUANIDE GROUPS connected by a
CENTRAL HEXAMETHYLENE BRIDGE. The compound is strongly base
& dicationic at ph levels above 3.5 with positive charges on either side
of hexamethylene bridge.It is the "dicationic nature" of chlorhexidine
making it extremely intractive with anions, which is relevant to its
efficacy.
Mechanism of action:
(Antimicrobial Activity)
CHX shows different effects at different concentrations. The agent is
bacteriostatic, whereas at higher concentration it is bactericidal.
Cationic CHX molecule+ negatively charged bacterial
cell wall
Instant adsorption of CHX to Phosphate containing
compounds
CHX binds with the phospholipids in the inner cell
membrane causing cell wall integrity
Leakage of the lesser molecular weight components
viz. potassium ions
[This is the sub lethal stage of CHX. The action can be
reversed. This marks the bacteriostatic property of CHX. If
the conc. Is increased and the action continues, the CHX
becomes bactericidal in nature]
Intracellular coagulation
Slows down leakage of intracellular
components
Cytoplasmic coagulation
Irreversible cell damage [bactericidal]
Antiplaque activity:
Three mechanism for inhibition of plaque by
CHX:
1. The effective blocking of the acidic group of
salivary glycoproteins will reduce their
adsorption to hydroxyapatite and formation of
acquired pellicle
2. The ability of bacteria to bind to tooth surface
may be reduced by adsorption of CHX to the
extracellular polysaccharides of their capsule
3. 3. The CHX may compete with calcium ions for
acidic agglutination factors in plaques
What makes it so unique?
Its long lasting bacteriostatic action, also termed as
'substantivity.
Its action lasts for about 12 hours in the oral cavity after a single r
The dicationic CHX molecule, attaches to the tooth surface
(pellicle) by one cation, to the bacteria attempting to colonize
the tooth surface with the other. This is called the 'Pin-
Cushion Effect'
Uses :
I. As an adjunct to oral hygiene
II. Post oral surgery including periodontal surgery or root planing
III. In patients with inter maxillary fixation.
IV. For oral hygiene & gingival health in physically & mentally
handicapped
V. Medically compromised individuals
VI. predisposed to oral infections
VII. High caries risk patient
VIII. Recurrent oral ulceration
IX. Removable & fixed orthodontic wearers
X. Treatment of denture stomatitis and dry socket
XI. As an immediate prophylactic rinse in the prevention of post-
Adverse effects:
a)Extrinsic staining
b) Alteration in taste perception
c)Oral mucosal erosion
d)Enhanced supragingival calculus formation
e)Parotid gland swelling (stenosis of the
parotid)
Overdosage : ingestion of 1 or 2 ounces of
CHX oral rinse by a small child might result in
gastric distress, including nausea or signs of
Dosage & administration:
Recommended use is twice daily oral rinsing for
30 seconds.
Usual dosage is of 0.12-0.2 percent of 15ml (1
tablespoon) of undiluted chlorhexidine oral rinse.
Patient should be instructed not to rinse with
water or brush teeth or eat immediately after
CHX oral rinse.
CHX should not be ingested and should be
expectorated after rinsing.
The chlorhexidine preparations compared were a
0.12% concentration used at a 15 ml dose for a
rinsing time of 30 seconds and a 0.2%
concentration used at a dose of 10 ml for 60
seconds. After 72 hours, the plaque index (PI)
from all volunteers was recorded at 6 sites per
tooth. All participants received a questionnaire to
evaluate their perception of the mouthrinses.
Results: After 72 hours, the 15 ml/30 second/0.12% CHX
group had a mean whole mouth Pl of 1.65 (SD 0.31)
compared with a (SD mean PI of 1.60 (SD 0.40) for the 10
ml/60 second/0.2% CHX group. The difference in plaque
scores between the groups was not statistically significant.
Results
Should not be used immediately after the
toothbrushing.
WHY....?
Sodium lauryl sulphate appears to adversely
affect the retention of chlorhexidine and its
plaque inhibiting action. Rinsing with
chlorhexidine should therefore not be performed
in combination with tooth brushing.
The chlorhexidine should be used 0.5 to 2 hrs
after the toothbrushing.
Chlorhexidine products:
Mouth rinse- aqueous/ alcohol solutions of 0.2%
[Peridex, Periogard, Periosol]
Gel [corsodyl dental gel]
Sprays [Hibispray]
Tooth pastes
Varnishes
Chewing gums
Periodontal dressings
Subgingival plaque control
