Chlorhexidine: is it still the gold standard?

Area of Science:

• Oral hygiene and Periodontology
• Dental pharmacology
• Antimicrobial agents

Background:

• Chlorhexidine has been the gold standard antiplaque and gingivitis agent for two decades.
• Its efficacy stems from the dicationic nature of the molecule, providing persistent antimicrobial effects.
• Understanding chlorhexidine's chemical properties is key to optimizing its clinical use.

Purpose of the Study:

• To explain the clinical efficacy and safety data of chlorhexidine based on its chemical properties.
• To identify patient groups who would benefit most from chlorhexidine.
• To guide optimal use of chlorhexidine formulations for maximizing therapeutic effects and minimizing side effects.

Main Methods:

• Review of existing literature on chlorhexidine's chemical properties and clinical data.
• Analysis of the relationship between the molecule's dicationic nature and its antimicrobial persistence.
• Examination of the chemical basis for side effects such as tooth staining and interactions with other agents.

Main Results:

• Chlorhexidine's dicationic structure provides persistent bactericidal and bacteriostatic effects on tooth surfaces, underpinning its clinical efficacy.
• Extrinsic tooth staining is linked to a precipitation reaction between tooth-bound chlorhexidine and dietary chromogens.
• Anionic agents, common in toothpastes, can reduce chlorhexidine's activity, necessitating careful co-administration.

Conclusions:

• Understanding chlorhexidine's chemical properties allows for targeted application in patients with compromised oral hygiene.
• Optimizing chlorhexidine delivery through various formulations can enhance its therapeutic benefits.
• Maximizing chlorhexidine's efficacy and minimizing side effects ensures its continued status as the gold standard antiplaque agent.