Odontogenic infection (adjunctive agent):
Acute simple gingivitis, plaque-associated: Note: Use as monotherapy or, for patients with rapidly advancing disease, severe pain, or an immunocompromising condition, may use in combination with systemic antibiotics (Chow 2022).
Oral rinse: Swish for 30 seconds with 15 mL (one capful) of undiluted oral rinse after toothbrushing, then expectorate; repeat twice daily (morning and evening) until symptoms resolve. Use in addition to regular dental prophylaxis (cleaning).
Periodontitis, nonsevere, plaque-associated: Periodontal chip: Insert 1 chip into a periodontal pocket with a probing pocket depth ≥5 mm. Up to 8 chips may be inserted in a single visit. Repeat every 3 months if pocket depth remains ≥5 mm. If dislodgment occurs within 48 hours, insert a new chip. If dislodgement occurs after this time, reevaluate at 3 months; 7 days of the chip in place is considered a full course (manufacturer’s labeling). Use in addition to periodontal debridement (Jeffcoat 1998; Kasaj 2007; Kumar 2014; Smiley 2015).
Oropharyngeal decontamination (to reduce the risk of hospital-acquired or ventilator-associated pneumonia) (off-label use): Oral rinse:
Cardiac surgical patients: 15 mL swished and gargled or applied to intubated patients by swabbing the oral cavity (buccal, pharyngeal, gingival, tongue, and tooth surfaces) for 30 seconds twice daily. Initiate preoperatively and continue postoperatively for 10 days or until extubation. Avoid food or drink for 30 minutes after rinsing (DeRiso 1996; Houston 2002).
Mechanically-ventilated patients: No specific dosing recommended due to the heterogeneous nature of the studies and paucity of conclusive data.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Chlorhexidine gluconate (oral): Pediatric drug information")
Gingivitis: Limited data available: Children ≥8 years and Adolescents: Oral: Oral rinse (0.12%): Swish 15 mL (one capful) for 30 seconds after toothbrushing, then expectorate; repeat twice daily (morning and evening) (de la Rosa 1998)
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Mouth/Throat:
Paroex: 0.12% (473 mL [DSC]) [alcohol free; contains fd&c red #40 (allura red ac dye), propylene glycol]
Peridex: 0.12% (118 mL, 473 mL, 1893 mL) [contains alcohol, usp, fd&c blue #1 (brilliant blue), saccharin sodium; mint flavor]
Periogard: 0.12% (473 mL [DSC]) [contains alcohol, usp, fd&c blue #1 (brilliant blue), saccharin sodium]
Periogard: 0.12% (473 mL) [alcohol free; contains cremophor el, fd&c blue #1 (brilliant blue), propylene glycol; mint flavor]
Generic: 0.12% (15 mL, 118 mL, 473 mL)
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Mouth/Throat:
DentiCare Rinse: 0.12% (500 mL) [contains alcohol, usp, fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine), methylparaben, propylparaben]
GUM Paroex Oral Rinse: 0.12% (473 mL) [contains fd&c red #40 (allura red ac dye), propylene glycol]
Oro Clear: 0.12% (500 mL, 4000 mL) [contains fd&c blue #1 (brilliant blue), polysorbate 80, quinoline yellow (d&c yellow #10), saccharin sodium]
Perichlor: 0.12% (475 mL) [contains alcohol, usp, fd&c blue #1 (brilliant blue)]
Perichlor Without Alcohol: 0.12% (475 mL)
Peridex: 0.12% (475 mL) [contains alcohol, usp, fd&c blue #1 (brilliant blue), saccharin sodium]
Periogard: 0.12% ([DSC]) [contains alcohol, usp, fd&c blue #1 (brilliant blue), polyethylene glycol (macrogol), saccharin sodium]
Periogard Alcohol Free: 0.12% (470 mL) [contains cremophor el, fd&c blue #1 (brilliant blue), propylene glycol]
Generic: 0.12% (475 mL, 480 mL, 500 mL, 4000 mL)
Oral rinse: Swish rinse and expectorate after rinsing; do not swallow. Use in the morning and evening after brushing teeth. Following administration, do not immediately rinse with water or other mouthwashes, brush teeth, or eat.
Periodontal chip insertion: Pocket should be isolated and surrounding area dried prior to chip insertion. The chip should be grasped using forceps with the rounded edges away from the forceps. The chip should be inserted into the periodontal pocket to its maximum depth. It may be maneuvered into position using the tips of the forceps or a flat instrument. The chip biodegrades completely and does not need to be removed. Patients should avoid dental floss at the site of periodontal chip insertion for 10 days after placement because flossing might dislodge the chip.
Oral rinse: Swish rinse and expectorate after rinsing; do not swallow. Use in the morning and evening after brushing teeth. Following administration, do not rinse with water or other mouthwashes, brush teeth, or eat immediately.
Odontogenic infection:
Gingivitis: Oral rinse: Antimicrobial dental rinse for gingivitis treatment
Periodontitis: Periodontal chip: Adjunctive therapy to scaling and root planing procedures to reduce pocket depth in patients with periodontitis
Medication-related osteonecrosis of the jaw (MRONJ), adjunctive therapy: Oral rinse:; Oropharyngeal decontamination to reduce the risk of ventilator-associated or hospital-acquired pneumonia, Cardiac surgical patients: Oral rinse:; Oropharyngeal decontamination to reduce the risk of ventilator-associated or hospital-acquired pneumonia, Mechanically-ventilated patients: Oral rinse:
Peridex may be confused with Precedex
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Gastrointestinal: Toothache (51%)
Respiratory: Upper respiratory tract infection (28%), sinusitis (14%)
1% to 10%:
Gastrointestinal: Gingival hyperplasia (4%), aphthous stomatitis (2%)
Neuromuscular & skeletal: Arthritis (3%), tendinopathy (2%)
Respiratory: Bronchitis (6%), pharyngitis (4%)
Frequency not defined:
Dermatologic: Cellulitis
Gastrointestinal: Dental discoloration (with oral rinse), dental discomfort, increased tartar formation, mouth discoloration
Infection: Abscess
<1%, postmarketing, and/or case reports: Coated tongue, desquamation, dysgeusia, erythema, geographic tongue, gingivitis, glossitis, hyperkeratosis, hypersensitivity reaction, hypoesthesia, mouth irritation, oral lesion, oral mucosa ulcer, paresthesia, parotid gland enlargement, sialadenitis, stomatitis, tongue changes (short frenum), tongue edema, tongue irritation, trauma, xerostomia
Hypersensitivity to chlorhexidine or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity reactions: Serious allergic reactions, including anaphylaxis, have been reported.
Dosage form specific issues:
• Oral rinse: Staining of oral surfaces (teeth, tooth restorations, dorsum of tongue) may occur; patients exhibited a measurable increase of staining in the facial anterior after 6 months of therapy that is more pronounced when there is a heavy accumulation of unremoved plaque. Stain does not adversely affect health of the gingivae or other oral tissues, and most stain can be removed from most tooth surfaces by dental prophylaxis. Because removal may not be possible, patients with anterior facial restorations with rough surfaces or margins should be advised of the potential permanency of the stain. An increase in supragingival calculus has been observed with use; it is not known if the incidence of subgingival calculus is increased. Dental prophylaxis to remove calculus deposits should be performed at least every 6 months. May alter taste perception during use; has rarely been associated with permanent taste alteration.
• Periodontal chip: Infectious events (eg, abscesses, cellulitis) have been observed rarely with adjunctive chip placement post scaling and root planing; use with caution in patients with periodontal disease and concomitant diseases potentially decreasing immune status (eg, diabetes, cancer). Use in acute periodontal abscess pocket is not recommended.
Other warnings/precautions:
• Appropriate use: Oral rinse: Effect on periodontitis has not been determined; has not been tested in patients with acute necrotizing ulcerative gingivitis.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
None known.
There are no known significant interactions.
Adverse events have not been observed in animal reproduction studies following use of the oral rinse; use of periodontal chip has not been studied. Chlorhexidine oral rinse is poorly absorbed from the GI tract.
It is not known if chlorhexidine is excreted in breast milk. The manufacturer recommends that caution be exercised when administering chlorhexidine oral rinse to nursing women. However, oral rinse is not intended for ingestion; patient should expectorate after rinsing.
Chlorhexidine has activity against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast; it is both bacteriostatic and bactericidal, depending on its concentration. The bactericidal effect of chlorhexidine is a result of the binding of this cationic molecule to negatively charged bacterial cell walls and extramicrobial complexes. At low concentrations, this causes an alteration of bacterial cell osmotic equilibrium and leakage of potassium and phosphorous resulting in a bacteriostatic effect. At high concentrations of chlorhexidine, the cytoplasmic contents of the bacterial cell precipitate and result in cell death.
Absorption:
Oral rinse: ~30% retained in the oral cavity following rinsing and slowly released into oral fluids; poorly absorbed from GI tract. After oral administration application, serum concentrations are not detectable in plasma 12 hours after dose.
Periodontal chip: Chlorhexidine released from chip in a biphasic manner: ~40% within initial 24 hours, then remainder released linearly over 7 to 10 days; no detectable urine or plasma levels measured following insertion of 4 chips under clinical conditions
Duration of action: Serum concentrations: Detectable levels are not present in the plasma 12 hours after administration
Excretion: Oral rinse: Feces (~90%); Urine (<1%)
Solution (Chlorhexidine Gluconate Mouth/Throat)
0.12% (per mL): $0.13 - $0.22
Solution (Peridex Mouth/Throat)
0.12% (per mL): $0.02
Solution (Periogard Mouth/Throat)
0.12% (per mL): $0.02
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