DTUK2910

21Perio TribuneNovember 29-December 5, 2010United Kingdom Edition T he use of antiseptic mouthwashes as a sec- ondary line of defence against the onset of periodontal disease has been in existence for approximately 40 years. In addition to conventional brushing, mouthwashes offer a number of significant advantag- es for patients, helping to con- trol the oral pathogens that lead to problems like halitosis, den- tal caries and of course, dental plaque biofilm formation. However, for patients with manual dexterity issues who may find brushing difficult, as well as those recovering from implant or endodontic surgery, an antiseptic mouthrinse may be vital in maintaining good oral health and/or preventing the onset of infection. Numerous clinical stud- ies have sought to establish the effectiveness of the active in- gredients commonly found in mouthwashes, including chlo- rhexidine (CHX), cetyl pyridin- ium chloride and plant extracts such as essential oils and chlo- rophyll in controlling the spread of supragingival plaque and gingivitis. Overall, it has been shown that mouthwashes con- taining chlorhexidine are by far the most proficient in control- ling sub-gingival plaque, eradi- cating oral fungi and reducing the bleeding and inflammation associated with gingivitis when compared to other antimicro- bial agents, including hydrogen peroxide. 1, 2, 3, 4, 5 Chlorhexidine is a highly ef- fective bactericide, thanks to its capacity to set up chemical links with the anionic groups such as phosphates and sulphates found in the cell wall of bacteria, leading to an increase in cel- lular permeability and thereby destabilising the bacterial cell, ultimately leading to its de- struction or eradication during brushing. 6 Although considered to be the ‘gold standard’ of chemical antiseptic agents,7 there are a few limitations and drawbacks that go along with using this otherwise highly effective in- gredient. One of the main disadvan- tages of using chlorhexidine is its tendency to cause stain- ing on the teeth, especially in the inter-proximal areas and the mucous membranes on the back of the tongue, as well as the lead to discolouration of dental restorations and prosthe- ses. This is caused by the chemi- cal interaction of tooth-bound chlorhexidine and leftover chromogens from food or bev- erages and is known as the Maillard reaction. A look at the effectiveness of chlorhexidine-based mouthwashes Howard Thomas discusses the advantages of mouthwashes in the treatment of peri- odontal disease, with a specific look at chlorhexidine-based products page 22DTà