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    Chlorhexidine & Its Uses

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    Sriya Saatwika Reddy
    Chlorhexidine (CHX) is a broad-spectrum antimicrobial widely used in dentistry. It was first developed in the 1940s-50s and has since been used for skin antisepsis, wound cleaning, and as a mouthwash. CHX has bactericidal effects against both gram-positive and gram-negative bacteria through a combination of electrostatic binding to bacterial cell walls and cytoplasmic coagulation. In endodontics, CHX is commonly used as a root canal irrigant and intracanal medicament due to its substantivity, antimicrobial activity, and low toxicity. Recent advances include the use of CHX in combination with other irrigants like EDTA in mixtures like QMix

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    Chlorhexidine & Its Uses

    Uploaded by

    Sriya Saatwika Reddy
    109 views40 pages
    Chlorhexidine (CHX) is a broad-spectrum antimicrobial widely used in dentistry. It was first developed in the 1940s-50s and has since been used for skin antisepsis, wound cleaning, and as a mouthwash. CHX has bactericidal effects against both gram-positive and gram-negative bacteria through a combination of electrostatic binding to bacterial cell walls and cytoplasmic coagulation. In endodontics, CHX is commonly used as a root canal irrigant and intracanal medicament due to its substantivity, antimicrobial activity, and low toxicity. Recent advances include the use of CHX in combination with other irrigants like EDTA in mixtures like QMix

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    CHX PPT

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    Chlorhexidine (CHX) is a broad-spectrum antimicrobial widely used in dentistry. It was first developed in the 1940s-50s and has since been used for skin antisepsis, wound cleaning, and as a mouthwash. CHX has bactericidal effects against both gram-positive and gram-negative bacteria through a combination of electrostatic binding to bacterial cell walls and cytoplasmic coagulation. In endodontics, CHX is commonly used as a root canal irrigant and intracanal medicament due to its substantivity, antimicrobial activity, and low toxicity. Recent advances include the use of CHX in combination with other irrigants like EDTA in mixtures like QMix

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    109 views40 pages

    Chlorhexidine & Its Uses

    Uploaded by

    Sriya Saatwika Reddy
    Chlorhexidine (CHX) is a broad-spectrum antimicrobial widely used in dentistry. It was first developed in the 1940s-50s and has since been used for skin antisepsis, wound cleaning, and as a mouthwash. CHX has bactericidal effects against both gram-positive and gram-negative bacteria through a combination of electrostatic binding to bacterial cell walls and cytoplasmic coagulation. In endodontics, CHX is commonly used as a root canal irrigant and intracanal medicament due to its substantivity, antimicrobial activity, and low toxicity. Recent advances include the use of CHX in combination with other irrigants like EDTA in mixtures like QMix

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    Chlorhexidine

    &
    Its Uses
    CONTENTS
    1. INTRODUCTION
    2. HISTORY
    3. CHEMICAL STRUCTURE
    4. PROPERTIES
    5. MECHANISM OF ACTION
    6. GENERAL USES
    7. AVAILABLE FORMS
    8. STORAGE
    9. USES IN CONS & ENDO
    CHLORHEXIDINE
    Digluconat
    e

    CH
    X

    Acetate Hydrochloride
    HISTORY
    Ophthalmology,
    Urology, Gynecology Use widespread
    1ST Developed & in dentistry
    Otorhinolaryngology

    1947 1954 1957 1959 1970s

    Antiseptic

    Cleaning skin,
    wounds & mucous Plaque Inhibition
    membranes

    Hibitane
    Chemical Structure
    4-chlorophenyl ring
    Biguanide groups
    Hexamethylene chain
    PROPERTIES
    • Antimicrobial activity
    • Substantivity
    • Surface tension
    • Dissolution of organic tissues, biofilm and
    smear layer
    • Cytotoxic effect
    • Genotoxicity
    • Lubricating properties
    • Rheological action (present in the gel
    presentation, keeping the debris in suspension)
    • Inhibits metalloproteinase
    • Chemically stable
    • Water soluble
    • Colorless - pale straw-colored / slightly
    opalescent
    • Odorless / almost odorless substance.
    • Extremely bitter taste that must be masked in
    formulations intended for oral use
    Antimicrobial activity
    CHX is bactericidal and effective against Gram-positive and Gram-negative
    bacteria, facultative and strict anaerobes yeasts and fungi, particularly Candida
    albicans.
    It also retains its activity in the presence of blood and organic matters
    Liquid form CHX kills microorganisms in 30 s or less, while in the gel
    formulation it takes from 22 s (2% CHX gel) to 2 h (0.2% CHX gel)

    Gomes BP, Vianna ME, Zaia AA, Almeida JF, Souza-Filho FJ, Ferraz CC. Chlorhexidine in
    endodontics. Brazilian dental journal. 2013 Mar;24:89-102.
    SUBSTANTIVITY (Long term
    continued effect)
    Absorption to dental hard tissues with gradual and prolonged
    release at therapeutic levels
    It is concentration and time dependent

    CHX – highest substantivity (12hrs plaque inhibition)


    As Root canal irrigating substance prevented microbial activity
    from 48 h, 7 days (in the liquid and gel formulation), 21 days, 4
    weeks, up to 12 weeks
    SUBSTANTIVITY (Long term continued
    effect)
    Absorption to dental hard tissues with gradual and prolonged
    release at therapeutic levels

    It is concentration and time dependent

    Ruksakiet K, Hanák L, Farkas N, Hegyi P, Sadaeng W, Czumbel LM, Sang-Ngoen T, Garami A, Mikó A, Varga G, Lohinai Z.
    Antimicrobial efficacy of chlorhexidine and sodium hypochlorite in root canal disinfection: a systematic review and meta-analysis
    of randomized controlled trials. Journal of endodontics. 2020 Aug 1;46(8):1032-41.
    Lowconcentratio
    n (0.005% to
    0.01%)
    High concentrations

    Constant
    monolayer of
    CHX
    Efficacy : NaOCl VS CHX
    MECHANISM OF
    ACTION
    At high doses (2%)

    Electrostatic binding between cationic molecules and


    negatively charged bacterial cell wall

    Bactericidal action

    Precipitation & coagulation of cytoplasmic proteins

    Cell death
    At low doses(0.2%)

    Cell membrane integrity


    altered

    Bacteriostatic effect

    Leakage of low molecular weight bacterial


    components
    Available Forms
    Gel base
    0.1%, 0.2%, 0.12%
    pH 6-9
    Toothbrush or trays

    Mouth rinse
    Aqueous or alcohol – 0.2% / 0.12%
    optimal pH range of 5.5 to 7.0

    Sprays
    0.1%, 0.2%
    1-2mg – delivered to all tooth surfaces
    2% CHX > 2% CHX solution

    Lubricates the root canal walls


    Decreasing the risks of instrument breakage
    Elimination of organic tissues
    Reduction of smear layer formation
    Maintains almost all the dentinal tubules open because its viscosity
    keeps the debris in suspension (rheological action)
    keep the “active principle” of CHX in contact with the microorganisms for
    a longer time, inhibiting their growth
    STORAGE
    Shelf life - 1 year
    Gel formulation - 10 months
    CONSERVATIVE
    MMP inhibition (etch and rinse)
    1. Use of chlorhexidine following the etching procedure with 37% phosphoric acid and prior to the application of the bonding
    agent
    2. CHX acts as unspecific inhibitor of MMPs by altering their three-dimensional structure and depleting metal ions (Ca2+,
    Zn2+), which are necessary for their function
    3. CHX is able to inactivate all MMPs existing in dentin at a concentration of only 0.02%
    4. 2% CHX for 60 s to 0.002% CHX for 15 s

    5. Using chlorhexidine (CHX) as therapeutic primer in etch-and rinse systems, these enzymes are inhibited and the adhesive
    bond to dentin is maintained for a longer time period.
    6. MMP inactivation by CHX, it remains stable for longer periods
    Dentine bonding
    1. CHX application prior to acid etching has no adverse effects
    on immediate composite adhesive bonds in coronal dentin,
    pulp chamber dentin, enamel, or with resin-reinforced glass-
    ionomer cements.
    2. Endodontic irrigation with CHX solution significantly
    increased bond strength to root dentin
    foam pellet after the etching procedure
    thorough removal of the phosphoric acid
    appropriate exposure time
    cavity is air-dried
    re-moistened with the selected adhesive system

    The utilization of CHX is not able to completely prevent nanoleakage and subsequent gradual loss of the adhesive bond, but it is
    certainly an important step towards a durable and stable adhesion between dentin and composite resin. In summary, when using
    etch-and-rinse systems, applying a pure aqueous solution of CHX (0.2%; 30 s) as therapeutic primer after etching and before
    administration of the bonding agent can contribute to a delay of degradation processes and hence improves the long-term stability
    of the adhesive bond to dentin.

    Rinsing with water after CHX application should be avoided (water can remove CHX from dentin)
    immediate strength of the adhesive bond is not altered by CHX application, however, after longer periods of time, the stability of
    adhesive bonds created using CHX is even considerably improve
    Self conditioning systems
    1. CHX integration in self-conditioning systems can impair the mechanical properties of the bonding agents and the adhesive
    bond to dentin
    AIM:-POTENTIALLY USED IN ADHESIVE AND RESTORATIVE
    DENTISTRY.
    A pH-sensitive CHX release response was noted when loaded in MSN
    grafted PGA nanoparticles.
    The formulated drug-loaded nanocarrier demonstrated excellent
    physicochemical, spectral, and biological characteristics SUCH AS
    considerable
    • capacity to penetrate effectively inside dentinal tubules
    • high antibacterial efficacy
    ENDODONTICS
    Root Canal Irrigants
    1. Broad spectrum antimicrobial action, substantivity and low
    toxicity
    2. Incapacity of tissue dissolution and does not promote a superficial
    necrosis

    3. 2% CHX gel produced the cleanest dentin wall surfaces when


    compared with other irrigants, including NaOCl
    (Viscosity, rheological action, better mechanical cleansing)
    Interaction with Endodontic Irrigants
    NaOCl + CHX
    Orange-brown precipitate
    Chemical smear layer
    Covers dentinal tubules
    Interfere with the seal of the root filling

    Precipitate changes the color of the tooth and is cytotoxic


    Irrigation regimen : NaOCl would be used throughout
    instrumentation, followed by EDTA, and CHX would be
    used as a final irrigant
    Intracanal medicament
    1. Bactericidal and neutralizes the remaining tissue debris
    2. CHX is more effective than CH against E. faecalis
    infection in dentinal tubules
    3. Antimicrobial activity of CHX is reduced when
    combined
    4. CHX alone does not act as a physical barrier and does not
    present radiopacity
    5. Recommended for a short period of time (3-5 days)
    6. Delivered with a syringe
    CH + CHX
    1. Antimicrobial activity of CH increases with the
    combination with CHX (pH =13)
    2. Studies have also shown that CH pastes added with CHX
    gel, alone or with ZnO, have greater antimicrobial activity
    than those prepared with distilled water or saline
    3. Inflammatory internal and external root resorption
    4. Best antimicrobial activity = 15-30days
    DIFFUSION INTO THE DENTINAL TUBULES

    Anti microbial effect


    2% CHX
    CH + 2%CHX
    CH + 2%CHX +ZnO
    CH + sterile saline
    Disinfection of Obturation Cones
    1. Kill vegetative forms within short periods of time
    2. 2% CHX did not change gutta-percha cone properties
    after exposure for up to 30 min (less harmful)
    3. Some residual antibacterial action.
    4. CHX was a better disinfectant compared with NaOCl,
    High values of surface free energy.
    CHX smaller contact angles than NaOCl
    CORONAL
    MICROLEAKAGE
    Coronal microleakage during the intracoronal bleaching

    CHX used as a vehicle for sodium perborate

    Enhanced antimicrobial activity & did not affect adversely


    dentin microhardness
    CHX has been recommended as an alternative to NaOCl,
    especially in cases of
    Open apex
    Root resorption
    Foramen enlargement
    Root perforation
    RECENT ADVANCES
    Qmix (17% EDTA 2% CHX)
    Mixture of a bisbiguanide antimicrobial agent (2% CHX), a
    polyaminocarboxylic acid calcium-chelating agent (17% EDTA), saline, and
    a surfactant [16].
    QMix has shown to have superior antimicrobial property compared to CHX
    in reducing E. faecalis and the ability to remove the smear layer that is
    similar to EDTA

    Lim BS, Parolia A, Chia MS, Jayaraman J, Nagendrababu V. Antimicrobial efficacy of QMix on
    Enterococcus faecalis infected root canals: a systematic review of in vitro studies. Restorative dentistry &
    endodontics. 2020 Mar 4;45(2).

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