[Dysphagia] Chlorhexidine and oral care

[eripley at yahoo.com (Irene Campbell-Taylor)]

The following is the information from Glaxo-Smith-Kline, manufacturers of Corsodyl, OTC chlorhexidine product that is, unfortunately, available only in Europe.  Like so many other useful OTC products such as topical ibuprofen etc., it is not available in either the US or Canada although I believe it can be ordered online.
  I used to have the hospital pharmacists make such a mouthwash that I used as a spray but that was in the good old days of full patient care without damaging penny pinching.
   
  ?Chlorhexidine gluconate is an antiseptic and disinfectant agent, which is active against various bacteria, viruses, bacterial spores and fungi. It kills the micro-organisms associated with various mouth and throat infections, and other common conditions in the mouth. These include the Candida albicans fungi that causes thrush infection in the mouth, and bacteria that may infect mouth ulcers or other sore areas in the mouth, eg after dental surgery. Infection of these areas increases discomfort and delays healing. Chlorhexidine has also been shown to prevent the formation and build up of plaque on teeth, which helps prevent inflammation of the gums (gingivitis). It can therefore be used as an aid to oral hygiene, particularly in instances where toothbrushing is a problem, eg following dental surgery or in physically or mentally handicapped people. Chlorhexidine is available as a mouthwash, a spray or a dental gel for the treatment of common dental conditions. The gel is
 used to brush the teeth, or for direct application to sore areas in the mouth. The action of rinsing the mouth with the mouthwash provides a mechanical cleaning action in the mouth. The spray is applied to tooth and gum surfaces, ulcers and other sore areas. All kill micro-organisms in the areas they are in contact with and help maintain oral hygiene. The spray is applied to tooth and gum surfaces, ulcers and other sore areas. All kill micro-organisms in the areas they are in contact with and help maintain oral hygiene. (Note, as it mixes with saliva, it also bathes the cheeks. Some may be aspirated but I know of no resultant problems since the amount is so small).
  ?  The mouthwash should be used as directed to rinse the mouth. It should be spat out, not swallowed. 
  ?  Chlorhexidine is incompatible with certain ingredients of conventional toothpastes. Toothpastes should be used first and the mouth (and if necessary toothbrush) rinsed before using chlorhexidine, or they should be used at a different time of day. 
  ?  Avoid contact of this medicine with the eyes and ears. If it comes into contact with the eyes, rinse immediately with plenty of water. 
  ?  When treating mouth ulcers or oral thrush infections, treatment should be continued for two days after the symptoms have cleared up. 
  ?  When treating inflammation caused by denture rubbing, the dentures should be cleaned and soaked for 15 minutes twice a day in chlorhexidine mouthwash.
  It is important to be aware of and/or test for sensitivity/allergic reaction to chlorhexidine as a few people are significantly susceptible.
   
  Comparison of a phenolic and a 0.2% chlorhexidine mouthwash on the development of plaque and gingivitis.
Clin Prev Dent. 1991 Jul-Aug;13(4):31-5.
Moran J, Pal D, Newcombe R, Addy M.

Chlorhexidine and phenolic mouthrinses have attracted considerable interest as adjuncts to oral hygiene. The aim of this study was to compare two well known proprietary mouthrinse products for their effects on plaque regrowth, the development of gingivitis and the formation of toothstaining. The study was a single-blind, randomized, placebo-controlled, triple cross-over experimental, gingivitis design. A group of 15 volunteers with a very high standard of oral hygiene and gingival health used each rinse for 19 days in the absence of normal toothcleaning. Each period was separated by a 21 day washout. Plaque scores were significantly different between the rinses, being lowest with chlorhexidine and highest with saline. The plaque area increased 3-fold with the phenolic rinse and 6-fold with the saline rinse compared to the chlorhexidine rinse. Similarly, gingivitis increments were lowest with chlorhexidine and highest with saline but differences between rinses did not reach
 significance. Staining was significantly different between rinses, primarily due to minimal staining associated with the saline rinse. Staining occurred with both the chlorhexidine and phenolic mouthrinses. It is concluded that the 0.2% chlorhexidine rinse offers greater oral hygiene benefits than the phenolic rinse. The question of indications and durations of use of mouthwash products should be addressed. It also should not be used in patients with cancer-treatment stomatitis.
   
  Chlorhexidine does stain the teeth and oral tissue but this is much less when the spray is used. Peridex is available on prescription  in Canada and the US but is not available as a spray. It can be decanted into a small, plastic spray bottle and used for patients who can?t swish and spit.


Dr I Campbell-Taylor
Clinical Neuroscientist
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