Introduction
Self-medication is being increasingly promoted by the provisions of the Health Structure Act. This naturally means that the number of drugs freely available in pharmacies has increased considerably. The illnesses listed in the law as so-called trivial diseases are thus excluded from medical prescriptions. These include inflammation of the mouth and throat. Chlorhexidine also belongs to the therapy of such diseases.
Synonyms in a broader sense
Chlorhexidine digluconate, ParoexChlorhexidine is an antiseptic which was already developed in the 1940s. It belongs to the group of polyguanides. However, it is not highly soluble in water and therefore not suitable as a rinsing solution.
Therefore, it was replaced by chlorhexidine digluconate, which is very well soluble in water and is identical with regard to its effectiveness. Today only chlorhexidine digluconate is used. This includes, for example, the agent Chlorhexamed® forte.
It was initially used in veterinary and human medicine to treat skin infections and wounds. Chlorhexidine digluconate is available as ready-to-use solutions in concentrations of 0.1%, 0.15% and 0.2%. It is also available as a 1% gel. Its effectiveness has been proven in over 3,000 scientific publications. This makes chlorhexidine digluconate one of the most frequently investigated drugs.
Indications
Chlorhexidine digluconate has the ability to adhere to teeth and oral mucosa for a long time. This not only has an immediate effect, but also a depot effect. That is why it was soon used to treat infections in the oral cavity and to inhibit dental plaque.
This is an indication for chlorhexidine digluconate, inflammation of the oral mucosa (stomatitis) and gums (gingivitis) caused by bacteria. Chlorhexidine digluconate is used as a rinsing solution before and after oral surgery to prevent bacterial complications. Another application is the rinsing of root canals during root canal treatment by the dentist.
The gel is used to treat gum pockets. However, long-term application to reduce the bacteria in the dental plaque is not advisable, since naturally, in addition to the pathogens, the beneficial bacteria are also affected, and this leads to a disturbance of the oral flora. There is a risk that germs that are not covered by the antiseptic will take over.
In special cases, such as patients who are severely restricted in their oral hygiene due to a broken jaw, it is however advisable to use chlorhexidine digluconate for a short period of time. It is applied by rinsing with the undiluted solution. A prophylactic rinsing with chlorhexidine digluconate has proven to be effective in protecting the dentist against bacteria in the aerosol, for example during the removal of tartar.
Accidental swallowing of the solution is not harmful as chlorhexidine digluconate is not absorbed and is excreted 100% unchanged. When using oral irrigators, the addition of chlorhexidine digluconate enhances the cleansing effect. For prosthesis wearers, overnight storage of the prosthesis in a chlorhexidine digluconate solution from time to time has proven to be effective.
This inactivates the germs that cause mucosal inflammation (denture stomatitis) caused by prostheses. Since caries is caused by bacteria and chlorhexidine has a bacteria-killing effect, it can be clearly stated that chlorhexidine greatly reduces the risk of caries formation. More problematic, however, are the side effects of long-term use.
CHX does not distinguish between good and bad bacteria. The good bacteria, which are necessary for the proper functioning of the body, are also destroyed. One application brings the entire oral flora into imbalance.
It should therefore only be used in exceptional cases. A general caries prophylaxis by CHX is to be rejected! For wound disinfection chlorhexidine is used in prescribed wound sprays.
These preparations can be sprayed directly onto the affected area after wound cleansing without contact. An application without burning is often advertised. In case of complaints, the application can be repeated several times a day, especially in the context of periodontitis therapy with gum pockets.
Bepanthen plus wound spray contains chlorhexidine in addition to the healing-promoting active ingredient dexpanthenol. In the initial treatment of fresh wounds, chlorhexidine reduces the number of germs by fighting bacteria and fungi, thus preventing infections. The effect of chorhexidine digluconate is based on its ability to attach itself to the cell wall of the bacteria, destroying them and thus preventing the spread of the bacteria.
In higher doses of the antiseptic it penetrates into the cell and destroys it. Besides its effect on bacteria, it has also been shown to be effective against certain viruses. These are mainly the so-called herpes viruses.
A great advantage of chlorhexidine digluconate is that up to now no resistance to the effect of chlorhexidine has been proven among the pathogens. A successful therapy can be proven after only a few days. As with other effective drugs, there are side effects even with longer duration of therapy with chlorhexidine digluconate.
This can lead to taste irritations. There is also brown discoloration of teeth, plastic fillings and the tongue. The occurrence of discoloration can be very different from individual to individual.
The reason for this is still unknown. A possible explanation would be a different composition of the saliva. In rare cases there may be a delay in wound healing.
However, all side effects are reversible, i.e. they disappear again when the drug is discontinued or can be eliminated by the dentist. Chlorhexidine (also known as chlorhexidine digluconate, CHX or Chlorhexamed) is an antiseptic that has a wide range of applications in dentistry. There are several dosage forms: gel, spray, ointment, varnish and chips.
What they all have in common is that the active ingredient adheres to the teeth and mucous membrane for a long time and destroys the bacterial cell membrane. 1. chlorhexidine gel is used according to the dentist’s instructions in antibacterial therapy of gingivitis and periodontitis (inflammation of the periodontium; often incorrectly called periodontosis in the vernacular). The dentist can apply it into the interdental spaces with a brush or with a disposable syringe and a blunt cannula.
It is also used for final polishing before fluoridation. The 1% gel is recommended to the patient for home use as a support of periodontal therapy. The gel can also be used during orthodontic treatment when oral hygiene is limited.
Before using the gel, brush the teeth as usual with toothpaste, making sure that the oral cavity is thoroughly rinsed with water. Then apply the gel with a cotton swab to the areas in need of treatment and let it work for at least 1 minute. The gel can also be used like a toothpaste.
The treatment should not take longer than one month. 2. chlorhexidine spray 1,5 % As a spray, chlorhexidine is often recommended as a disinfectant for denture wearers. It prevents bacterial plaque (the so-called tooth film) from adhering to the denture and adjacent mucous membrane.
Sprays can also be used to disinfect toothbrushes, tongue brushes or splints. Chlrohexidine is also contained in throat sprays such as Collu-Blache. Chlorhexidine digluconate is also very helpful for sore throats.
3. chlorhexidine ointment, cream chlorhexidine digluconate is used for the care of infected wounds, friction-induced inflammation and umbilical care. The widely used ointment Bepanthen® Antiseptic Wound Cream contains chlorhexidine as well as dexpanthenol. 4. mouthwash: 0.1% or 0.2% The most widely known form of chlorhexidine is the fluid form.
There are studies which prove that the use of a mouth rinse containing chlorhexidine in cases of difficult oral hygiene (e.g. post-operative, disability) significantly reduces the formation of the bacterial tooth film. The liquid form is used preoperatively to prevent bacteremia (presence of bacteria in blood). It is also used for dry mouth (xerostomia) and unpleasant bad breath.
Furthermore, liquid form of chlorhexidine digluconate is used in endodontics – root canals are often rinsed with this solution to fight bacteria. Often the cavities (colloquially called “hole in the tooth”) created after caries removal are cleaned with this solution before the filling is placed. Some patients are recommended to use a mouthwash for daily care (e.g. in case of gum problems), but it should be noted that after about two weeks the risk of discoloration of the tooth, tongue and mucous membrane is quite high.
Chlorhexidine is used in many common mouth rinses (0.1% or 0.2%). Daily after brushing your teeth, a mouth rinse solution should be added. Such mouth rinses are particularly popular post-operatively, e.g. after the extraction of a tooth, to prevent a possible infection of the wound.
The use of chlorhexidine is also advisable for periodontitis treatment. Even if oral hygiene should be made more difficult for various reasons, rinsing with chlorhexidine is recommended. This may be the case for people with physical or mental handicaps or for a stay in hospital where adequate hygiene is not possible.
Due to its positive charge it adheres well to the oral mucosa, the tooth and the bacteria, where it is then slowly released. It thus offers long-lasting protection and fights the bacteria, which cannot cause inflammation. Mouthwashes containing chlorhexidine are medicines and must therefore be purchased from a pharmacy.
Mouthwashes should also only be used for a limited period of time, as they can cause discoloration of the teeth, tongue and oral mucosa if used over a longer period of time. This brownish discoloration can be removed by a prophylaxis assistant after discontinuing the product. A toothpaste with abrasive ingredients can also provide the first remedy. In addition, the sense of taste may be impaired, which will disappear again after the product has been discontinued. In any case, the duration of use of the preparation should be discussed with a dentist.
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