This is a guide for the prescription only chlorhexidine mouthwash (CHX) with all of it's technical specifications and things to know about it.
Below is a summary overview of this drug but click each one for more information.
Summary Overview:
Description: Antiseptic oral rinse available by prescription only.
Ingredients: 1,1'-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate, Water, Alcohol (11.6%), Glycerin, PEG-40, Sorbitan diisostearate, Flavor, Sodium saccharin, FD&C Blue No. 1
How to use: After breakfast and before bed, rinse with 15 ml undiluted for 30 seconds and then spit out.
Indications: Broadly used for various oral conditions (gum disease, etc).
Contraindications: Sensitivity, allergy, and those under 18 years old.
Pharmacology: Disrupts cell membranes and coagulates cytoplasmic proteins.
Warnings: Subgingival calculus increase and allergic reactions.
Precautions: Stains and taste alteration.
Adverse effects: Stains (teeth, tongue, restorations), taste alteration, allergies, ulcers, mucocele, stomatitis, glossitis, dry mouth, salivary gland swelling, etc.
Cost: Inexpensive (covered by insurance).
Description
Chlorhexidine mouthwash (chlorhexidine gluconate 0.12% oral rinse) is an antiseptic rinse that is commonly prescribed by dentists. It is a simple and effective medication that can be used for a variety of oral conditions.
Drug facts:
Brand names - Peridex, Periogard, PerioRx, Perisol, Paroex, Oro Clense
Drug class - antiseptic & antibacterial
Availability - prescription only (not a controlled substance)
Dosage form - liquid solution
Cost - low cost
It works by reducing the number of bacteria in your mouth by killing them, preventing their grow, and reducing gum inflammation.
Ingredients
Chlorhexidine gluconate is a salt of chlorhexidine and gluconic acid. It is also a near neutral solution with a pH range of 5-7.
Full list of ingredients:
1,1'-hexamethylene bis [5-(p-chlorophenyl) biguanide]di-D-gluconate
Water
Alcohol (11.6%)
Glycerin
PEG-40
Sorbitan diisostearate
Flavor
Sodium saccharin
FD&C Blue No. 1
This medicated oral rinse is technically colorless but it is often dyed with FD&C blue #1 which gives it its distinct blue color.
How to use
Ideally before you use the chlorhexidine oral rinse you should brush and floss your teeth. That way you have a clean mouth, tooth surfaces, and gums for the for the medicated rinse to work on.
Directions for use:
Fill the cap to the "fill line" which is 15 mL or 1/2 oz.
Swish around in mouth for 30 seconds undiluted.
Spit out and do NOT rinse with water immediately afterwards to minimize medicinal taste.
Do not eat or drink until lunch time if using in the morning.
Use twice a day (after breakfast and before bed).
Who can use it
Chlorhexidine in mouthwash form is only recommended for adults age 18 and over. Children under the age of 18 should NOT use it because clinical effectiveness and safety has not yet been established.
How long to use it
You should use it for as long as you were directed by your dentist. Everyone's condition is different and thus every treatment plan will differ. However, as a rule of thumb most dentists do not recommend using chlorhexidine rinse for longer than 2 weeks at a time.
If you miss a dose, please use it as soon as possible but if it is close to your next dose, just use it once. Do not double the amount or use it twice.
Storage
Do not refrigerate or freeze.
Throw away any unused CHX mouthwash after expiry date.
Keep out of reach from children.
Indications
Chlorhexidine mouthwash is broadly used in dentistry to treat a variety of dental conditions. Although most commonly you'll be using it if you have a gum issue or after a deep cleaning.
Soft tissue uses:
Gum disease (gingivitis & periodontitis).
Periodontal abscess.
Peri-implantitis.
Endodontic-periodontal lesions.
Hard tissue uses:
Dry socket - may help reduce symptoms and help prevent it after extractions. This is especially important if you've had this condition before.
Root canal disinfectant.
Bacterial aerosolisation - reduces aerosolisation by 70-90%.
This medicated rinse is usually not the primary treatment for most conditions but is rather used as an adjunct. In other words, if you're having a toothache it may help but probably won't get rid of it completely.
Contraindications
Chlorhexidine rinse should not be used by any persons who is hypersensitive to CHX or allergic to it. If you've had a bad reaction to it in the past, please do not use. Those under the age of 18 also should not use this rinse unless explicitly directed by their doctor/dentist.
Drug interactions
There are no known drug to drug interactions with chlorhexidine rinse.
It is generally known as relatively safe to use due to its poor absorption across membranes.
Even if a large volume is accidentally ingested, it is poorly absorbed from the gastrointestinal tract.
Plasma levels of it are undetectable with normal use.
Toothpaste interactions
Toothpastes with polyacrylic acid (carbomer) may adversely react with CHX by reducing its efficacy. Studies have shown that using the two concurrently will reduce the amount of residual CHX in the mouth after rinsing.
Pharmacology
Chlorhexidine gluconate oral rinse is a cationic surfactant made of a synthetic biguanide. It has broad spectrum antibacterial, antifungal, and is even effective for COVID-19.
Mechanism of action:
It reduces bacterial load by disrupting cell membranes and coagulating cytoplasmic proteins. This kills them and prevents further growth.
Approximately 30% of CHX is retained in the mouth after rinsing.
It remains active in the mouth for up to 12 hours after use.
CHX mouthwash has very poor absorption across membranes so levels of it are typically undetectable in the plasma. Most of it is eliminated through feces (~90%) and less than 1% is excreted through urine.
Warnings
The effect of chlorhexidine mouthwash on periodontitis has not yet been determined.
Increase of subgingival calculus was noted during clinical trials. This should be removed by a dentist or hygienist every 6 months.
Allergic reactions have been reported with overall chlorhexidine usage that is not exclusive to the oral rinse formulation.
The increase in tartar formation can be reduced and minimized with diligent oral hygiene. That means brushing twice a day with tartar control toothpaste and flossing your teeth before bed.
Precautions
The three main precautions with using chlorhexidine rinse is the potential alteration of taste, potential oral staining and tartar build up.
Taste alteration. While using CHX, it may alter your taste perception for up to four hours after use. This side effect is temporary and it should go away if you discontinue use.
Staining. CHX is not a whitening mouthwash because it can cause brown discoloration on teeth, dental restorations (fillings), and even tongue staining.
Tartar formation. Studies have shown that when plaque is exposed to CHX, there is an increase in tartar formation due to increased uptake of calcium and phosphate.
Chlorhexidine rinse stains can be removed with professional dental cleanings but the appointment may require more time. Yes, the stains on teeth and on your tongue can be removed.
Pregnancy precautions
Pregnancy teratogenic effects - Pregnancy category B reproduction studies with rats demonstrated that doses up to 300 mg/kg/day and 40 mg/kg/day in rabbits showed no evidence of harm to the fetus. No human studies have been conducted.
Breastfeeding - it is unknown if CHX is excreted in milk but it is known that it is poorly absorbed through membranes.
Fertility - there is no evidence of impaired fertility in rats even with doses up to 100 mg/kg/day.
Adverse effects
Despite its wondrous benefits, use of chlorhexidine gluconate oral rinse does come with some adverse effects that may affect your mouth or well-being.
Side effects:
Teeth staining
Tartar formation
Tongue staining and geographic tongue
Dental restoration staining
Alteration of taste
Allergic reactions (itching, redness, anaphylaxis)
Aphthous ulcers
Mucocele
Stomatitis and glossitis
Dry mouth
Salivary gland swelling
Please consult your dentist or physician about potential side effects. If you notice any, you may report side effects to the FDA at 1-800-FDA-1088.
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Overdose
Due to the poor gastrointestinal absorption of chlorhexidine, it is unlikely for harmful effects to occur even when swallowed accidentally.
However, the formulation does contain 11.6% alcohol so excessive swallowing may produce nausea, vomiting, and signs of drunkenness. These symptoms are no different than swallowing listerine mouthwash.
Inebriation is not pleasant but if a child ingests this accidentally, please seek medical help immediately. Children do not process nor tolerate ingesting alcohol the same way that adults do.
Cost
The cost for chlorhexidine mouthwash will vary depending on what insurance you have and the pharmacy that you go to. It is prescription only but it is relatively inexpensive and typically fully covered by most insurance plans.
However, if you shop for it online you can find pricings from $8-20 but you won't be able to purchase it without a license or prescription.
