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4 CEUs
This course was written for dentists, dental hygienists, and assistants.
Educational Objectives
This course has been designed to describe the clinical applications of chlorhexidine gluconate, a broad-spectrum antimicrobial drug. At the end of this course the clinician will be able to:
1. Explain the mechanism of action of chlorhexidine gluconate.
2. Identify the unique property that allows for a prolonged effect.
3. Describe the clinical indications for the use of chlorhexidine gluconate.
4. Understand the mechanism by which chlorhexidine may cause extrinsic stain in some patients and the recommended patient home care strategies to reduce its occurrence.
5. Apply the dosage and guidelines for the clinical use of chlorhexidine gluconate in periodontics, endodontics, oral surgery, operative dentistry and preventive dentistry.
Introduction
Chlorhexidine gluconate (chlorhexidine) is a broadspectrum antimicrobial drug. Acting as an antiseptic, it is an effective bactericidal agent against all categories of microbes, including bacteria, yeast, and viruses.
Chlorhexidine molecules are positively charged (cations) and most bacteria and surface structures in the oral cavity, including the surfaces of teeth and mucous membranes, are negatively charged (anions). In accordance with the principle that opposite charges attract, chlorhexidine binds strongly to all these surface structures.
When chlorhexidine binds to microbial cell walls it induces changes, damaging the surface structure, leading to an osmotic imbalance with consequent precipitation of cytoplasm causing cell death. The substantivity of chlorhexidine enhances this bactericidal effect, which allows for the retention of chlorhexidine in the oral cavity and a prolonged residual antimicrobial effect for up to 12 hours or longer depending on the dosage and form.
Chlorhexidine is safe and has an inherent advantage over antibiotics by not producing resistant microorganisms. As a result chlorhexidine can be used repeatedly and over long periods of time. Furthermore, it destroys all categories of microbes, not just bacteria, and there is little risk for the development of opportunistic infections.
As with many FDA approved drugs, the use of chlorhexidine does have known disadvantages; however, these disadvantages are a small trade off compared to the many advantages and are reversible once the use of chlorhexidine is discontinued.
Chlorhexidine was first used as a mouthrinse as an adjunct to conventional non-surgical periodontal therapy in Europe in the early 1970s. It received FDA approval...