Potential Efficacy of Chlorhexidine against Mutans Streptococci and Human Dental Caries

Author(s): C.G. Emilson
Journal: Journal of Dental Research
Volume (number): 73 (3)
Month, Year: March 1994
Major topic: Effectiveness of anti-cariogenic chemotherapeutic other than fluoride
Type of Article: Literature review
Main Purpose: To discuss the effectiveness of chemotherapeutic agents

Overview of method of research: Review of articles

Findings: Chlorhexidine has been studied for many years and has proven itself as an effective anti-cariogenic aide. Antibiotics, both topical and systemic, are the other main chemotherapeutic which has shown effectiveness in the elimination and control of dental plaque but antibiotic use for this purpose has been deemed frivolous. Chlorhexidine differs from fluoride in its main anti-cariogenic activity, namely, it is a more potent antimicrobial, while fluoride, with limited antimicrobial properties, strengthens the teeth themselves. This is the basis for this articles two main conclusions: that besides fluoride, chlorhexidine is the most effective anticariogenic chemotherapeutic and that the concomitant use of fluoride and chlorhexidine is synergistic. While fluoride does less to reduce the mutans streptococci counts in the mouth, it is more able to penetrate decalcified lesions and affect the bacteria retained there, while the chlorhexidine exerts its powerful antimicrobial effects in the macrobiotic areas of the mouth. Chlorhexidine is more effective when applied for longer, such as the use of varnish directly on teeth or placed on removable appliances and even incorporated into dental cements. Long term chlorhexidine use was equally effective when applied at home or by a dental professional. Forty % solution of chlorhexidine varnish proved to be more effective that the 10 or 20% solution. Repeated application of chlorhexidine is necessary due to its inability to eliminate mutans streptococci completely from the oral cavity. Post treatment, recolonization occurs in the pits and fissures of the molar teeth and proceeds in a posterior to anterior direction. The bacterial spread originates in the deep pits and impenetrable interproximal areas f the dentition.

Key points/Summary : Fluoride remains the chemotherapeutic agent of choice, but chlorhexidine may hold a place in the future of caries prevention, particularly as a antimicrobial adjunct to regular fluoride application.

Assessment of article: Raises a lot of good questions about chlorhexidine and was unbiased, including articles which did not support the use of chlorhexidine.