Skip to main content

Chlorhexidine (EENT) (Monograph)

Brand names: Paroex, Peridex, PerioChip, PerioGard
Drug class: Astringents

Medically reviewed by Drugs.com on Jun 10, 2024. Written by ASHP.

Introduction

Topical anti-infective; cationic bisbiguanide.1 2 3 33 90 91

Uses for Chlorhexidine (EENT)

Gingivitis

Used as a mouthwash or oral rinse (topical oral solution) for treatment of gingivitis; used between dental visits as part of a professional program.1 2 90 91

Periodontitis

Used subgingivally (extended-release insert) for treatment of adult periodontitis as an adjunct to scaling and root planing to reduce periodontal pocket depth;3 used as part of a periodontal maintenance program that includes good oral hygiene.3

Prevention of Dental Caries

Has been used as a topical oral solution for prevention of dental plaque and dental caries† [off-label] when conventional oral hygiene measures are difficult or impossible, such as in patients with fractured jaws, periodontal surgery, or orthodontic treatments and in patients with seizure disorders, rheumatoid arthritis, mental retardation, and cerebral palsy.8 33 34 44

Mucositis and Other Oral Complications in Individuals with Altered Immunocompetence

Has been used as a topical oral solution to decrease incidence and severity of mucositis† [off-label] and other oral complications† [off-label] in patients with altered immunocompetence, including those undergoing bone marrow transplantation,10 11 14 20 21 radiation therapy,15 21 38 or chemotherapy.12 13 15 19 20 21 38

Has been used as a topical oral solution as adjunct to surgical debridement, plaque removal, and systemic anti-infectives in treatment of linear gingival erythema† [off-label], necrotizing ulcerative gingivitis† [off-label], and necrotizing ulcerative periodontitis† in immunocompromised individuals, including patients with HIV infection.88 89

Such use has been beneficial for prevention or treatment of oral complications in some immunocompromised individuals,10 12 13 14 15 20 21 62 but inconsistent results reported in some studies.11 19 20 21

Oropharyngeal Decontamination in Critically Ill Patients

Has been used as a topical oral solution for oral hygiene and oropharyngeal decontamination in an attempt to decrease the incidence of nosocomial respiratory tract infections in critically ill patients†, including immunocompromised patients and those undergoing mechanical ventilation or heart surgery.19 21 39 85 86

Chlorhexidine (EENT) Dosage and Administration

Administration

Oral, Topical Use Only

Topical oral solution (0.12%): Administer topically as mouthwash or oral rinse.1 2 90 91

Oral solution is for topical use only and should not be ingested.1 2 90 91

Consider that some commercially available topical oral solutions of the drug contain 11.6% alcohol1 2 and some are alcohol free.90 91

Administer undiluted.1 2 90 91

Immediately prior to initiation of treatment, provide professional dental prophylaxis.1 2 90 91 Reevaluate patient with thorough dental prophylaxis throughout treatment at intervals not exceeding 6 months.1 2 90 91

Instruct patients to brush their teeth immediately prior to each use of the topical oral solution.1 2 90 91 Then, place appropriate volume of the oral solution into the mouth, swish for 30 seconds, and expectorate the solution.1 2 90 91

Instruct patients to not rinse with water or other mouthwashes and to not brush their teeth or eat immediately after using the topical oral solution.1 2 90 91

Subgingival Administration

Administered subgingivally as extended-release inserts into periodontal pockets by a dental health-care provider.3

Place a single insert containing 2.5 mg of chlorhexidine gluconate into each periodontal pocket that has a probing depth ≥5 mm.3

Isolate periodontal pocket and dry surrounding area prior to insertion.3 Grasp flat end of insert with forceps and place (curved end first) into periodontal pocket to its maximum depth.3 If necessary, further maneuver insert into position using tips of forceps or a flat instrument.3

Advise patients to avoid dental floss at insertion sites for 10 days after placement.3

If insert dislodges ≤48 hours after placement, place a new insert.3 If insert dislodges >48 hours but <7 days after placement, do not replace insert; reevaluate at 3 months and place new insert if pocket depth has not been reduced to <5 mm.3 If insert dislodges ≥7 days after placement, no action required since this is considered a full course of treatment.3

Inserts will biodegrade within periodontal pockets and do not need to be manually removed.3

Consult manufacturer’s literature for additional information on subgingival administration of chlorhexidine inserts.3

Dosage

Available as chlorhexidine gluconate; dosage expressed in terms of the salt.1 2 3 90 91

Adults

Gingivitis
Oral, Topical Use Only

0.12% topical oral solution: 15 mL as a mouthwash or oral rinse twice daily for 30 seconds (morning and evening after toothbrushing).1 2 90 91

Periodontitis
Subgingival

Dosage varies depending on size, shape, and number of periodontal pockets treated.3

2.5-mg insert: Place one insert into each periodontal pocket that has a probing depth ≥5 mm.3 Manufacturer states up to 8 inserts may be placed during a single visit.3

Place new insert every 3 months into pockets that continue to have a probing depth of ≥5 mm.3

Consider other treatment options (e.g., combination therapy, surgical intervention) if periodontal pockets with a probing depth of ≥5 mm do not respond within 9–12 months.79

Prescribing Limits

Adults

Periodontitis
Subgingival

Maximum of 8 inserts during a single visit.3

Detailed Chlorhexidine topical dosage information

Cautions for Chlorhexidine (EENT)

Contraindications

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Anaphylaxis and other serious allergic reactions reported in patients receiving dental preparations containing chlorhexidine.1 2 3 90 91

Serious allergic reactions, including fatal anaphylaxis, reported rarely with topical chlorhexidine preparations used on the skin (e.g., solutions, washes, sponges, swabs), including OTC topical preparations.4 45 48 63 64 66 92

Hypersensitivity reactions can occur within minutes following topical exposure.92 Symptoms may include wheezing or difficulty breathing, facial swelling, urticaria that can quickly progress to more serious symptoms, severe rash, or life-threatening shock.92

Prior to prescribing or recommending any preparation that contains chlorhexidine, ask patients whether they have ever had an allergic reaction to antiseptics or any preparation containing chlorhexidine.92

If allergic reaction occurs or is suspected, discontinue the drug and carefully monitor the reaction and provide immediate respiratory and/or cardiovascular support as needed.92

Precautions Related to Topical Oral Solution

Possible staining of teeth and other oral surfaces, such as tooth surfaces, restorations, and dorsum of the tongue.1 2 4 5 8 10 18 90 91 Stains usually can be removed by conventional professional prophylactic techniques, although additional time may be required to complete the prophylaxis.1 2 90 91

Possible increased supragingival calculus; professional dental prophylaxis to remove calculus deposits recommended at intervals not exceeding 6 months.1 2 90 91

Alterations in taste perception reported.1 2 4 90 91 May be avoided if used after meals.2 90 91

Effect on periodontitis not determined.1 2 90 91 If used as a mouthwash or oral rinse in patients with coexisting gingivitis and periodontitis, presence or absence of gingival inflammation following treatment should not be used as a major indicator of underlying periodontitis.1 2 90 91

Precautions Related to Subgingival Inserts

Use in acutely abscessed periodontal pockets not studied and not recommended.3 Management of periodontal disease should include consideration of potentially contributing medical disorders, such as cancer, diabetes, and compromised immune function.3

Avoid dental floss at insertion site for 10 days after placement; flossing might dislodge insert.3

Some mild to moderate sensitivity is normal during first week after placement of a subgingival insert; however, dentist should be promptly notified if pain, swelling, or other problems occur.3

Specific Populations

Pregnancy

Topical oral solution: No adequate and controlled studies to date in pregnant women;1 2 90 91 use during pregnancy only when clearly needed.1 2 90 91

Subgingival insert: No adequate and controlled studies to date in pregnant women;3 use during pregnancy only when clearly needed.3

Lactation

Topical oral solution: Not known if chlorhexidine distributes into human milk following use as a mouthwash or oral rinse.1 2 90 91 Use with caution in nursing women.1 2 90 91

Pediatric Use

Topical oral solution: Safety and efficacy not established in pediatric patients <18 years of age.1 2 90 91

Subgingival insert: Safety and efficacy not established in pediatric patients <18 years of age.3 77

Geriatric Use

Subgingival insert: Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.3 No overall differences in safety or efficacy between geriatric and younger adults.3

Common Adverse Effects

Topical oral solution: Increased staining of teeth, esthetic restorations, and other oral surfaces; increased calculus formation; alteration of taste perception.1 2 90 91

Subgingival inserts: Toothache, upper respiratory infection, headache.3 23

Chlorhexidine (EENT) Pharmacokinetics

Absorption

Bioavailability

Topical oral solution: Systemic absorption does not appear to occur following use as a mouthwash or oral rinse.78

Subgingival insert: Systemic absorption does not appear to occur.50 77

Following use of a 0.12% topical oral solution of chlorhexidine gluconate as a mouthwash or oral rinse, approximately 30% of drug is retained in oral cavity.1 2 5 8 34 90 91 The drug is bound to phosphate groups principally on coatings of mucous membrane surfaces8 and gradually released into oral fluids1 2 5 8 34 90 91 for up to 24 hours.8

Following subgingival administration of biodegradable extended-release insert containing 2.5 mg of chlorhexidine gluconate, the drug is slowly released into periodontal pocket.3 50 In vitro study indicates approximately 40% of the drug is released during first 24 hours and remainder is released in almost linear manner over 7–10 days.3

Distribution

Extent

Following oral administration† of a 300-mg dose of chlorhexidine gluconate, peak plasma concentrations of 0.206 mcg/mL were attained 30 minutes after the dose; however, the drug was undetectable in plasma 12 hours after the dose.1 2 77 90

Following subgingival administration of biodegradable chlorhexidine inserts into 4 periodontal pockets in adults, the drug was not detectable in plasma or urine (limits of detection: 30 ng/mL).3 50

Elimination

Elimination Route

Following oral administration† of a single 300-mg dose, the drug is excreted in feces via biliary elimination (90%) and urine (<1%).1 2 90 91

Stability

Storage

Oral, Topical Use Only

Solution

20–25° C (may be exposed to 15–30°).1 2 90 91

Subgingival

Insert, extended-release

20–25° C (may be exposed to 15–30°).3

Actions and Spectrum

Advice to Patients

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Chlorhexidine Gluconate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral (Topical Use Only)

Solution

0.12%*

Chlorhexidine Gluconate Oral Rinse

Paroex

Sunstar

Peridex

3M ESPE

PerioGard

Colgate

PerioGard Alcohol Free

Colgate

Subgingival

Insert, extended-release

2.5 mg

PerioChip

Dexcel Pharma

AHFS DI Essentials™. © Copyright 2025, Selected Revisions June 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. Colgate Oral Pharmaceuticals. PerioGard (chlorhexidine gluconate) oral rinse USP 0.12% prescribing information. New York, NY; 2015 Jul.

2. 3M ESPE Dental Products. Peridex (chlorhexidine gluconate) 0.12% oral rinse prescribing information. St. Paul, MN; 2017 Oct.

3. Dexcel Pharma Technologies. PerioChip (chlorhexidine gluconate) 2.5 mg extended-release insert prescribing information. Yokneam, Israel; 2012 Nov.

4. Martindale: the complete drug reference. 32nd ed. Parfitt K, ed. London: Pharmaceutical Press, 1999:1229-31.

5. Robinson CP. Chlorhexidine gluconate oral rinse (Peridex oral rinse)—a review. Drugs of Today. 1988; 24:221-8.

6. Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R eds. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000:690-702.

7. Tattawasart U, Maillard JY, Furr JR et al. Development of resistance to chlorhexidine diacetate and cetylpyridinium chloride in Pseudomonas stutzeri and changes in antibiotic susceptibility. J Hosp Infect. 1999; 42:219-29. https://pubmed.ncbi.nlm.nih.gov/10439995

8. Farndal O, Turnbull RS. A review of the literature on use of chlorhexidine in dentistry. J Amer Dental Assoc. 1986; 112:863-9.

9. Killoy WJ. Assessing the effectiveness of locally delivered chlorhexidine in the treatment of periodontitis. J Amer Dent Assoc. 1999; 130:567-70.

10. Ferretti GA, Ash RC, Brown AT et al. Chlorhexidine for prophylaxis against oral infections and associated complications in patients receiving bone marrow transplants. J Amer Dent Assoc. 1987; 114:461-7.

11. Epstein JB, Vickars L, Spinelli J et al. Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation. Oral Surg Oral Med Oral Pathol. 1992; 73:682-9. https://pubmed.ncbi.nlm.nih.gov/1437036

12. Rutkauskas JS, Davis JW. Effects of chlorhexidine during immunosuppressive chemotherapy. A preliminary report. Oral Surg Oral Med Oral Pathol. 1993; 76:441-8. https://pubmed.ncbi.nlm.nih.gov/8233423

13. McGaw WT, Belch A. Oral complications of acute leukemia: prophylactic impact of a chlorhexidine mouth rinse regimen. Oral Surg Oral Med Oral Pathol. 1985; 60:275-80. https://pubmed.ncbi.nlm.nih.gov/3862040

14. Ferretti GA, Ash RC, Brown AT et al. Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant. 1988; 3:483-93. https://pubmed.ncbi.nlm.nih.gov/3056555

15. Ferretti GA, Raybould TP, Brown AT et al. Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double- blind trial. Oral Surg Oral Med Oral Pathol. 1990; 69:331-8. https://pubmed.ncbi.nlm.nih.gov/2179802

16. Russell AD, Day MJ. Antibacterial activity of chlorhexidine. J Hosp Infect. 1993; 25:229-38. https://pubmed.ncbi.nlm.nih.gov/7907620

17. Bollen CML, Quirynen M. Microbiological response to mechanical treatment in combination with adjunctive therapy. A review of the literature. J Periodontol. 1996; 67:1143-58. https://pubmed.ncbi.nlm.nih.gov/8959563

18. Greenstein G, Polson A. The role of local drug delivery in the management of periodontal diseases: a comprehensive review. J Periodontol. 1998; 69:507-20. https://pubmed.ncbi.nlm.nih.gov/9623893

19. Bunetel L, Bonnaure-Mallet M. Oral pathoses caused by Candida albicans during chemotherapy. Oral Surg Oral Med Oral Pathol. 1996; 82:161-5.

20. Epstein JB, Schubert MM. Oral mucositis in myelosuppressive cancer therapy. Oral Surg Oral Med Oral Pathol. 1999; 88:273-6.

21. Committee on Research, Science, and Therapy et al. Position Paper. Periodontal considerations in the management of the cancer patient. J Periodontol. 1997; 68:791-801. https://pubmed.ncbi.nlm.nih.gov/9287071

22. Barry AL, Fuchs PC, Brown SD. Lack of effect on antibiotic resistance on susceptibility of microorganisms to chlorhexidine gluconate or povidone iodine. Eur J Clin Microbiol Infect Dis. 1999; 18:920-1. https://pubmed.ncbi.nlm.nih.gov/10691210

23. Jeffcoat MK, Bray KS, Ciancio SG et al. Adjunctive use of a subgingival controlled-release chlorhexidine chip reduces probing depth and improves attachment level compared with scaling and root planing alone. J Periodontol. 1998; 69:989-97. https://pubmed.ncbi.nlm.nih.gov/9776027

24. Aursnes J. Cochlear damage from chlorhexidine in guinea pigs. Acta Otolaryngol. 1981; 92:259-71. https://pubmed.ncbi.nlm.nih.gov/7324895

25. Tabor E, Bostwick DC, Evans CC et al. Corneal damage due to eye contact with chlorhexidine gluconate. JAMA. 1989; 261:557-8. https://pubmed.ncbi.nlm.nih.gov/2909794

26. MacRae SM, Brown B, Edelhauser HF. The corneal toxicity of presurgical skin antiseptics. Am J Ophthalmol. 1984; 97:221-32. https://pubmed.ncbi.nlm.nih.gov/6696033

27. Jeffcoat MK, Palcanis KG, Weatherford TW et al. Use of a biodegradable chlorhexidine chip in the treatment of adult periodontitis: clinical and radiographic findings. J Periodontol. 2000; 71:256-62. https://pubmed.ncbi.nlm.nih.gov/10711616

28. Ellenhorn MJ, Schonwald S, Ordog G et al. eds. Ellenhorn’s medical toxicology. 2nd ed. Baltimore: Williams & Wilkins; 1997:1208-10.

29. Case DE. Safety of Hibtain. I. Laboratory experiments. J Clin Periodontol. 1977; 4:66-72. https://pubmed.ncbi.nlm.nih.gov/275278

30. Massano G, Ciocatto E, Rosabianca C et al. Striking aminotransferase rise after chlorhexidine self-poisoning. Lancet. 1982; 1:289. https://pubmed.ncbi.nlm.nih.gov/6120309

31. Quinn MW, Bini RM. Bradycardia associated with chlorhexidine spray. Arch Dis Child. 1989; 64:892-3. https://pubmed.ncbi.nlm.nih.gov/2774629 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1792556/

32. Anderson MH, Bales DJ, Omnell KA. Modern-management of dental caries: the cutting edge is not the dental bur. J Amer Dent Assoc. 1993; 124:37-44.

33. Denton DW. Chlorhexidine. In: Block SS, ed. Disinfection, sterilization, and preservation. 4th edition. Philadelphia: Lea & Febiger; 1991:274-89.

34. Jones CG. Chlorhexidine: is it still the gold standard? Periodontology 2000. 1997; 15:55-62.

35. Netuschil L, Weiger R, Preisler R et al. Plaque bacteria counts and vitality during chlorhexidine, meridol, and listerine mouthrinses. Eur J Oral Sci. 1995; 103:355-61. https://pubmed.ncbi.nlm.nih.gov/8747670

36. Laufman H. Current use of skin and wound cleansers and antiseptics. Am J Surg. 1989; 157: 3:359-65. https://pubmed.ncbi.nlm.nih.gov/2645807

37. Fourrier F, Cau-Pottier, Boutigay et al. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Inten Care Med. 2000; 26:1239-47.

38. Dodd MJ, Dibble SL, Miaskowski C et al. Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy- induced mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90:39-47. https://pubmed.ncbi.nlm.nih.gov/10884634

39. DeRiso AJ, Ladowski JS, Dillon TA et al. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996; 109:1556-61. https://pubmed.ncbi.nlm.nih.gov/8769511

40. Sokolne WA, Heasman PA, Stabholz A et al. Sustained local delivery of chlorhexidine in the treatment of periodontitis: a multi-center study. J Periodontol. 1997; 68:32-8. https://pubmed.ncbi.nlm.nih.gov/9029449

41. Bollmer BW, Sturzenberger OP, Vick V et al. Reduction of calculus and Peridex stain with Tartar-control Crest. J Clin Dent. 1995; 6:185-7. https://pubmed.ncbi.nlm.nih.gov/8624229

42. Ellepola AN, Samaranayake LP. The effect of brief exposure to sub- therapeutic concentrations of chlorhexidine gluconate on the germ tube formation of oral Candida albicans and its relationship to post- antifungal effect. Oral Dis. 2000; 6:166-71. https://pubmed.ncbi.nlm.nih.gov/10822360

43. Forgie AH, Paterson M, Pine CM. A randomised controlled trial of the caries-preventive efficacy of a chlorhexidine-containing varnish in high- caries-risk adolescents. Caries Res. 2000; 34:432-9. https://pubmed.ncbi.nlm.nih.gov/11014911

44. Francetti L, del Fabbro M, Testori T et al. Chlorhexidine spray versus chlorhexidine mouthwash in the control of dental plaque after periodontal surgery. J Clin Periodontol. 2000; 27:425-30. https://pubmed.ncbi.nlm.nih.gov/10883872

45. Garvey LH, Roed-Petersen J, Husum B. Anaphylactic reactions in anaesthetised patients—four cases of chlorhexidine allergy. Acta Anaesthesiol Scand. 2001; 45:1290-4. https://pubmed.ncbi.nlm.nih.gov/11736685

46. Grossman E, Meckel AH, Isaacs RL et al. A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanquinarine on dental plaque and gingivitis. J Periodontol. 1989; 60:435-40. https://pubmed.ncbi.nlm.nih.gov/2689627

47. Knight BA, Puy R, Douglass J et al. Chlorhexidine anaphylaxis: a case report and review of the literature. Intern Med J. 2001; 31:436-7. https://pubmed.ncbi.nlm.nih.gov/11584911

48. Lauerma AI. Simultaneous immediate and delayed hypersensitivity to chlorhexidine digluconate. Contact Derm. 2001; 44:59. https://pubmed.ncbi.nlm.nih.gov/11156034

49. MacNeill S, Rindler E, Walker A et al. Effects of tetracycline hydrochloride and chlorhexidine gluconate on Candida albicans. An in vitro study. J Clin Periodontol. 1997; 24:753-60. https://pubmed.ncbi.nlm.nih.gov/9350560

50. Soskolne WA, Chajek T, Flashner M et al. An in vivo study of the chlorhexidine release profile of the PerioChip in the gingival crevicular fluid, plasma and urine. J Clin Periodontol. 1998; 25:1017-21 https://pubmed.ncbi.nlm.nih.gov/9869352

51. Beiswanger BB, Mallat ME, Jackson RD et al. Clinical effects of a 0.12% chlorhexidine rinse as an adjunct to scaling and root planing. J Clin Dentistry. 1992; 3:33-8.

52. Jenkins S, Addy M, Wade W et al. The magnitude and duration of the effects of some mouthrinse products on salivary bacterial counts. J Clin Periodontol. 1994; 21:397-401. https://pubmed.ncbi.nlm.nih.gov/8089241

53. Baqui AAMA, Kelley JI, Jabra-Rizk MA et al. In vitro effect of oral antiseptics on human immunodeficiency virus-1 and herpes simplex virus type 1. J Clin Periodontol. 2001; 28:610-16. https://pubmed.ncbi.nlm.nih.gov/11422581

54. Block C, Robenshtok E, Simhon A et al. Evaluation of chlorhexidine and povidone iodine activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis using a surface test. J Hosp Infect. 2000; 46:147-52. https://pubmed.ncbi.nlm.nih.gov/11049709

55. Suller MTE, Russell AD. Antibiotic and biocide resistance in methicillin- resistant Staphylococcus aureus and vancomycin-resistant enterococcus. J Hosp Infect. 1999; 43:281-91. https://pubmed.ncbi.nlm.nih.gov/10658804

56. Kampf G, Hofer M, Wendt C. Efficacy of hand disinfectants against vancomycin-resistant enterococci in vitro. J Hosp Infect. 1999; 42:143-50. https://pubmed.ncbi.nlm.nih.gov/10389064

57. Kampf G, Jarosch R, Ruden H. Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA). J Hosp Infect. 1998; 38:297-303. https://pubmed.ncbi.nlm.nih.gov/9602978

58. Greenstein G, Tonetti M and the Research, Science et al. Position Paper. The role of controlled drug delivery for periodontitis. J Periodontol. 2000; 71:125-40. https://pubmed.ncbi.nlm.nih.gov/10695948

59. Meiller TF, Kelley JI, Jabra-Rizk MA et al. In vitro studies of the efficacy of antimicrobials against fungi. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91:663-70.

60. Rabe LK, Hillier SL. Effect of chlorhexidine on genital microflora, Neisseria gonorrhoeae, and Trichomonas vaginalis in vitro. Sex Transm Dis. 2000; 74-8.

61. Goroncy-Bermes P, Schouten MA, Voss A. In vitro activity of a nonmedicated handwash product, chlorhexidine, and an alcohol-based hand disinfectant against multiply resistant gram-positive microorganisms. Infect Control Hosp Epidemiol. 2001; 22:194-6. https://pubmed.ncbi.nlm.nih.gov/11379706

62. Ellepola ANB, Samaranayake LP. Adjunctive use of chlorhexidine in oral candidosis: a review. Oral Dis. 2001; 7:11-7. https://pubmed.ncbi.nlm.nih.gov/11354914

63. Okano M, Nomura M, Hata S et al. Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989; 125:50-2. https://pubmed.ncbi.nlm.nih.gov/2910207

64. Snellman E, Rantanen T. Severe anaphylaxis after a chlorhexidine bath. J Am Acad Dermatol. 1999; 40:771-2. https://pubmed.ncbi.nlm.nih.gov/10321611

65. Yong D, Parker FC, Foran SM. Severe allergic reactions and intra- urethral chlorhexidine gluconate. Med J Aust. 1995; 162:257-8. https://pubmed.ncbi.nlm.nih.gov/7891607

66. Evans RJ. Acute anaphylaxis due to topical chlorhexidine acetate. BMJ. 1992; 304:686. https://pubmed.ncbi.nlm.nih.gov/1571641 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881536/

67. Chisholm DG, Calder I, Peterson D et al. Intranasal chlorhexidine resulting in anaphylactic circulatory arrest. BMJ. 1997; 315:785. https://pubmed.ncbi.nlm.nih.gov/9345172 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127534/

68. Terazawa E, Shimonaka H, Nagase K. Severe anaphylactic reaction due to a chlorhexidine-impregnated central venous catheter. Anesthesiology. 1998; 89:1296-8. https://pubmed.ncbi.nlm.nih.gov/9822040

69. Oda T, Hamasaki J, Kanda N et al. Anaphylactic shock induced by an antiseptic-coated central venous catheter. Anesthesiology. 1997; 87:1242-3. https://pubmed.ncbi.nlm.nih.gov/9366479

70. Nicoletti G, Boghossian V, Gurevitch F et al. The antimicrobial activity in vitro of chlorhexidine, a mixture of isothiazolinones (‘Kathon’ CG) and cetyl trimethyl ammonium bromide (CTAB). J Hosp Infect. 1993; 23:87-111. https://pubmed.ncbi.nlm.nih.gov/8097222

71. Rikimaru T, Kondo M, Kondo S et al. Efficacy of common antiseptics against mycobacteria. Int J Tuberc Lung Dis. 2000; 4:570-6. https://pubmed.ncbi.nlm.nih.gov/10864189

72. Odore R, Colombatti Valle V, Re G. Efficacy of chlorhexidine against some strains of cultured and clinically isolated microorganisms. Vet Res Commun. 2000; 24:229-38. https://pubmed.ncbi.nlm.nih.gov/10836268

73. Regent Medical. Information sheet for Hibiclens (chlorhexidine gluconate) antiseptic/antimicrobial skin cleanser. From website. http://www.regentmedical.com

74. Lampe MF, Ballweber LM, Stamm WE. Susceptibility of Chlamydia trachomatis to chlorhexidine gluconate gel. Antimicrob Agents Chemother. 1998; 42:1726-30. https://pubmed.ncbi.nlm.nih.gov/9661012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC105674/

75. Regent Medical. Material safety data sheets for Hibiclens chlorhexidine gluconate). From website. http://www.regentmedical.com

76. American Academy of Periodontology, Committee on Research, Science and Therapy. Chemical agents for the control of plaque and gingivitis. American Academy of Periodontology; Chicago IL, 1994 Apr.

77. Dexcel Pharma, Edison, NJ: Personal communication.

78. Colgate Oral Pharmaceuticals, Canton, MA: Personal communication.

79. Stabholz A, Shapira L, Maher D et al. Using the PerioChip in treating adult periodontitis: an interim report. Compend Contin Educ Dent. 2000; 21:325-34. https://pubmed.ncbi.nlm.nih.gov/11199684

80. Reviewers’ comments (personal observations).

81. Karpinia K, Magnusson I, Biesbrock AR et al. The effectiveness of two different battery-powered toothbrushes on whitening through removal of stain. J Clin Dent. 2002; 13:215-8. https://pubmed.ncbi.nlm.nih.gov/12518493

82. Garcia-Godoy F, Ellacuria J. Effectiveness of sonicare power toothbrush to remove chlorhexidine stains. Am J Dent. 2002; 15:290-2. https://pubmed.ncbi.nlm.nih.gov/12572650

83. De Soet JJ, Gruythuysen RJ, Bosch JA et al. The effect of 6-monthly application of 40% chlorhexidine varnish on the microflora and dental caries incidence in a population of children in surinam. Caries Res. 2002; 36:449-55. https://pubmed.ncbi.nlm.nih.gov/12459619

84. Baca P, Munoz MJ, Bravo N et al. Effectiveness of chlorhexidine-thymol varnish for caries reduction in permanent first molars of 6-7-year-old children: 24-month clinical trial. Community Dent Oral Epidemiol. 2002; 30:363-8. https://pubmed.ncbi.nlm.nih.gov/12236827

85. Houston S, Hougland P, Anderson JJ. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care. 2002; 11:567-70. https://pubmed.ncbi.nlm.nih.gov/12425407

86. Genuit T, Bochicchio G, Napolitano LM et al. Prophylactic chlorhexidine oral rinse decreases ventilator-associated pneumonia in surgical ICU patients. Surg Infect. 2001; 2:5-18.

87. Brooks SE, Walczak MA, Hameed R et al. Chlorhexidine resistance in antibiotic-resistant bacteria isolated from the surfaces of dispensers of soap containing chlorhexidine. Infect Control Hosp Epidemiol. 2002; 23:692-5. https://pubmed.ncbi.nlm.nih.gov/12452299

88. Pistorius A, Willershausen B. Cases of HIV-associated characteristic periodontal disease. Eur J Med Res. 1999; 4:121-5. https://pubmed.ncbi.nlm.nih.gov/10085280

89. American Academy of Periodontology, Committee on Research, Science and Therapy. Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. J Periodontol. 2001; 72:1790-800 https://pubmed.ncbi.nlm.nih.gov/11811516

90. Sunstar Americas. Paroex (chlorhexidine gluconate) oral rinse 0.12% prescribing information. Schaumburg, IL; 2015 Sep.

91. Colgate Oral Pharmaceuticals. PerioGard (chlorhexidine gluconate) alcohol free oral rinse USP, 0.12% prescribing information. New York, NY; 2014 Jan.

92. US Food and Drug Administration. FDA drug safety communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2017 Feb 2. From FDA website. http://www.fda.gov/Drugs/DrugSafety/ucm530975.htm

Medical Disclaimer