WHY CHLORHEXIDINE CONSIDERED THE BEST ANTIBACTERIAL AGENT IN DENTISTRY?
In dentistry, although many antimicrobial agents would appear to be suitable for plaque control in the oral cavity only few have been found to possess consistent clinical efficacy. This is because many of the antimicrobial agents lacks the property of substantivity and efficacy against oral microorganisms. Currently in the market, a lot are formulated antimicrobial agents which includes essential oils, metals (Zinc, Stannous, Copper), phenols (Triclosan), plant extracts (Terminalia Chebula Extract, Garlic Extract, Occimum Sanctum, Aloe Vera Enzymes etc). Still, none of these agents possess both bacteriostatic and bacteriocidal effect antimicrobial property and substantivity property( the ability to retain in the oral cavity) as good as chlorhexidine. Chlorhexidine is considered a gold standard compared to other antimicrobial agents because it possess superior antiplaque property because of its encouraging results for dental health.
Chlorhexidine was developed in late 1940s as a result of search for antiviral agents. It was found that chlorhexidine does not possess antiviral activity but instead it possesses both bacteriostatic and bacteriocidal activity. The use of chlorhexidine was begun as a general disinfectant with a broad antimicrobial spectrum. Its antimicrobial spectrum include most of the microbials such as gram positive and gram negative organism including bacterial spores, lipophilic viruses, yeasts and dermatophytes, etc.
That is why chlorhexidine was extensively used in various medical fields such as gynecology, urology, ophthalmology and treatment of burns etc. The first use of chlorhexidine in dental practice was in washing operation site and disinfecting root canals, subsequently reports appeared in the literature on the plaque control, prevention of caries, as a denture disinfectant, in the treatment of dry socket, apthous ulcers.
CHLORHEXIDINE's BENEFITS IN OUR PRACTICE
Dentistry soon realized that chlorhexidine possesses other properties beneficial for use in there practice. These effects are outlined, and specific recommendations are given regarding chlorhexidine’s use by general practitioners.
I. Chlorhexidine and Its Use in HIV Infection
Common oral disease such as gingivitis and periodontitis are usual in HIV patients due to compromised immune system, chlorhexidine is offered as a palliative therapy for these conditions which can prevent the more serious complications. This drug can play an important role in the treatment of HIV associated gingivitis and periodontitis. apthous stomatatis, candidiasis, herpes virus and HIV associated neoplastic lesions. Chlorhexidine found to be effective in reducing candida species in HIV affected individuals adults and children.
II. Chlorhexidine as a Root Canal Irrigant
Intracanal tissues treated with chlorhexidine completely inhibited the growth of E. feacalis. A study was made in the bovine dentine and pulp specimen took up and subsequently released chlorhexidine. Martin and Nind investigated the efficacy of chlorhexidine as a pre-surgical disinfectant of apicectomy sites and observed beneficial effects. A number of studies have proved that 2% chlorhexidine is found as effective than sodium hypochlorite in reducing the growth of E.feacalis
With the higher concentration the substantivity of chlorhexidine was found to be for 12 weeks. It has been studied for its various properties such as antimicrobial activity, residual antimicrobial activity and biocompatibility.
Despite its usefulness as an inhibitor, chlorhexidine cannot be solely as main irrigant in standard endodontic cases because chlorhexidine do not dissolve necrotic tissue remnants, which other irrigants can do such as EDTA. The use of chlorhexidine in combination with other irrigation solution can give you a much successful treatment.
III. Chlorhexidine Relation To Bond Strength
Chlorhexidine preserves dentin bond Chlorhexidine can be useful for preservation of dentinal bond strength. Chlorhexidine contains protease inhibitors which counteracts Matrix metalloproteinases ( partially responsible for hybrid layer degradation)
IV. Chlorhexidine in Prosthodontic Treatments
With the use of chlorhexidine mouthwash, studies shows that gingival health was found to be improved in patients with fixed prosthodontic therapy. Significantly, applying chlorhexidine gels for 2 weeks to fitting surface of maxillary dentures can reduce inflammation and fungal activity in of complete denture.
The side effect of long term soaking of dentures is it causes acrylic staining. By rinsing with 0.12% chlorhexidine for 14 days together with soaking denture overnight the same solution eliminate candida albicans on the denture surface. This indicates that has a considerable antifungal effect in the oral cavity and further, that fungi are the responsible micro-organism in rather than bacteria.
In patients with overdenture, application of chlorhexidine gel has shown significant reduction in bleeding score and pocket depths. A combination of chlorhexidine and fluoride therapy has significantly reduced the caries incidence on abutment tooth.
V. Chlorhexidine And Implantology
Chlorhexidine act as an adjunct therapy for implants. In surgical procedure of dental implants placement, chlorhexidine rinse is generally applied until suture removal in order to reduce the risk of infection and to aid healing.
VI. Chlorhexidine And Oral Health and Conditions
A. Peri-implantitis is rapidly becoming a major oral disease. In peri-implant biofilm,bacterial communities were identified belonging to the genera Butyviribrio, Campylobacter, Eubacterium,Prevotella, Selenomonas, Streptococcus Actinomyces, Leptotrichia, Propionibacterium, Peptococcus, Campylobacter and Treponema.
B. Chlorhexidine is found to be effective in the maintenance of gingival health in patients with implants and significant reduction in bacterial level with use of chlorhexidine as an irrigating solution.
C. Use of Chlorhexidine in Recurrent Apthous
Stomatitis Chlorhexidine can be used in patients suffering from recurrent apthous ulceration on the basis that natural course of recurrency oral ulcers can be extended due to bacterial contamination.
Several studies support the benefits of this therapy that chlorhexidine mouth rinse can reduce the incidence, severity and duration of apthous ulceration whereas chlorhexidine gel significantly reduced severity and duration.
D. Chlorhexidine and its Role in Dental Caries Prevention
Chlorhexidine found to be effective in reducing S. mutans. In saliva and dental plaque. Many studies have proved that there is direct relation between the S. mutans level in plaque and saliva and incidence of caries. The mechanism of chlorhexidine as a caries inhibitor is by interfering with the metabolic activity of S. mutans by abolishing activity of phosphonyl pyruvate compound.
Chlorhexidine in the form of mouthwash and gel has found to be effective in reducing the level of microorganisms but faster recovery of microorganisms to original level was a frequent observed. Moreover, the use of these two preparations is associated with side effects such as staining and altered taste sensation.
Chlorhexidine is not only an excellent antiplaque agent but it also possesses very good antimicrobial properties. Its broad antimicrobial spectrum can be considered as boon for maintaining overall oral health. A lot of research supports the use of various forms and in wide variety of oral disorders. Though its use is restricted because of its known side effects, a new formulation with anti-discolouration system has shown promising results. More importantly chlorhexidine has shown promising results in controlling caries.
Chlorhexidine is a very useful substance in our dental practice. It has indeed a lot of uses that can make our treatment's prognosis in higher range of success. However, it is important that we take note that Chlorhexidine comes in different delivery form such as liquid and gel forms; different concentrations and different intended functions. Why do we need to take note of this? A very basic example is we can NOT use Chlorhexidine Mouthwash as an irrigating solution in our RCT, we need to use Chlorhexidine form and concentration for dental purpose that doesn't contain surfactants and emulsifiers. Using a mouthwash in the canal will leave a thin film along the dentinal tubules. In other words, in order for Chlorhexidine to become truly effective, we have to use its right form and concentration including other components combined to it on what we intend to achieve in the treatment.
Dr. Bryan Anduiza - Writer
Dr. Jean Galindez - Editor
Researchgate Website by Simone Deliperi
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