Product Guide

A comprehensive guide to chlorhexidine products: Are you familiar with the uses of different concentrations of CHX?

Find out how to avoid suggesting unnecessarily high concentrations, and to manage a patient’s refusal of the treatment. 

In dentistry, chlorhexidine (CHX) is well-known and widely used as an effective and broad-spectrum biocide, antiseptic and disinfectant agent. It acts effectively against a wide range of gram-negative and gram-positive bacteria, yeasts, fungi and many other kinds of microorganisms. The beneficial effects of CHX are confirmed as having a significant effect on dental-plaque formation and accumulation. 

Other than its common use in prophylaxis and treatment of gingivitis, periodontitis and dental caries, it also serves as a supporting agent in keeping the teeth and oral mucosa clean – mainly after various surgical treatments in the mouth.

However, besides the positive impact of the CHX treatment, there are also a number of side effects – which can influence patients’ compliance. The most common are:

  • change in taste
  • staining of teeth, mouth, tooth fillings, and dentures or other mouth appliances
  • mouth irritation, tongue tip irritation

There are, however, solutions that can make CHX treatments more pleasant for patients and reduce any likelihood of non-compliance. These solutions involve knowing the right concentrations to use according to various indications, and choosing the right mouthwash or other product, with the right supportive ingredients.

The optimal period to use different concentrations of chlorhexidine depends on the conditions of a patient’s mouth

According to periodontist Dr. Tihana Divnic-Resnik, for minor cases and gingivitis, two weeks of CHX usage is enough. “In more complicated cases, including for patients that have just had a periodontal or mucogingival surgery and who need to avoid using any tools that may cause irritation while the area is sensitive and swollen, you can recommend CHX for four weeks, and extend it up to six weeks if needed,” she explains. “Besides this, alcohol-free lower concentrations of CHX used for a short time (up to a week) may be beneficial in patients with oral ulcers, erythema multiforme (Steven-Johnson syndrome), ulcerative lichen planus and similar oral conditions.”

It’s not only about CHX

There are many different CHX-based solutions in the market that contain various additives to suppress the side effects, to improve the taste and/or to further support the healing effects. One of the ingredients that has proven to improve the taste of CHX, is Citrox, which is a formulation of soluble bioflavonoids obtained from bitter oranges. 

Besides the taste-enhancing properties, Citrox also has a documented broad-spectrum of antimicrobial, antiviral and antifungal activities against microorganisms present in the mouth. Furthermore, Citrox is praised for its non-toxicity and non-allergenicity. 

What is even more important, is the fact that CHX has shown to be more effective against microorganisms when combined with Citrox. A study by the University of Bern shows that Citrox combined with poly-L-lysine and CHX – as is found in the formulation of ‘Perio plus’ – not only supports the anti-biofilm activity, but that this mixture can be even more effective than pure CHX of the same concentration.

Citrox and cyclodextrine reduce viral load in saliva

A recent study conducted by Carrouel et al. supports the relevance of using cyclodextrine and citrox-containing mouthwashes in reducing the SARS-CoV-2 viral load in saliva. The strongest effect was observed on the first day of use, and for long-term effects (following 7 days of use), these mouthwashes appear to provide a modest benefit compared with placebos in reducing viral load in saliva.

What, when and why

Curaprox’s ‘Perio plus’ product range includes various concentrations of this formula in a range of specialised oral care products, suitable for both short- and long-term use. 

Let’s have a look at different patient conditions, and which concentration of ‘Perio plus’ can be recommended for each.

Perio plus 0.2% forte mouthwash 

It offers the strongest effect on plaque regrowth and works as effective intensive care mainly before and after invasive dental treatment. Suitable for short-term use.

When to use? 

It is advised for care before and after wisdom teeth extractions, implants procedures, and treatments causing trauma in mouth tissues. 

Period of use

3 to 7 days

Contains active ingredients:

Chlorhexidine 0.2 %, Citrox®, Xylitol, VP/VA, Polylysine

Perio plus 0.12% protect mouthwash

‘Perio plus protect’ provides effective antiseptic support for oral hygiene, especially when the mechanic plaque control is not accessible or very painful.

When to use?

This mouthwash is helpful mainly during the treatment of gingivitis, periodontitis and peri-implantitis.

Period of use

Up to 3 weeks

Contains active ingredients:

Chlorhexidine 0.12 %, Citrox®, Xylitol, VP/VA,Polylysine

Perio plus 0.09% regenerate mouthwash 

‘Perio plus regenerate’ accelerates tissue renewal by serving as a short-term mouthwash solution.

When to use? 

Its time-limited usage can greatly benefit your patients, mainly after dental surgeries or other invasive procedures for treatment-related xerostomia, and as an infection protection during epidemics.

Period of use

Up to 1 month

Contains active ingredients:

Chlorhexidine 0.09 %, Citrox®, Hyaluronic acid, Xylitol, VP/VA, Cyclodextrin, Polylysine 

Perio plus 0.05% balance mouthwash 

‘Perio plus balance’ is designed primarily to reduce the risk of gingivitis and caries for people wearing orthodontic appliances.

When to use?

It supports the saliva function in cases of treatment-related xerostomia. It is also helpful for plaque control in patients suffering from motor impairment, and to prevent the risk of gingivitis and caries in orthodontic patients.

Period of use

Up to 6 months

Contains active ingredients:

Chlorhexidine 0.05 %, Citrox®, Sodium fluoride, Xylitol, VP/VA, Polylysine

Lower doses of CHX make the treatment more convenient

In the long term, Curaden’s intention is to support a move towards dental professionals switching to a lower dosage of chlorhexidine more quickly, and complementing it with Citrox®.

“I welcome an approach that allows patients to switch to using lower doses of chlorhexidine more quickly. It is higher doses of chlorhexidine that frequently lead to the negative side effects such as discolouration and taste changes, or even cause the therapy to be abandoned by patients. The addition of natural antiseptics is advantageous, and in my opinion, it definitely promotes wound healing. Also, the ability to perform mechanical cleaning after a treatment, when a wound is first healing, is more limited, so adding Citrox® can definitely reduce the pathogenic microbial film on the wound,” says Dr. Milan Stojanovic, dentist and researcher based at the University of Bern who has tried the ‘Perio plus’ product range with his patients.

Perio plus 0.5%
focus gel

‘Perio plus’ focus gel is designed to provide intensive care to targeted areas of the oral cavity.

When to use? 

It can be easily applied to targeted areas, thus preventing the build-up of bacterial plaque and thereby reducing the risk of inflammation and infection. As it contains Hyaluronic Acid, ‘Perio plus’ focus gel also supports tissue regeneration post-oral surgery.

Period of use

3 to 7 days

Contains active ingredients:

Chlorhexidine 0.5%, Citrox®, Polylysine, Hyaluronic Acid, Xylitol, VP-VA 

Perio plus 0.09% support toothpaste

An SLS (sodium lauryl sulphate)-free toothpaste for patients with various conditions.

When to use?

‘Perio plus’ support toothpaste is ideal for use in conjunction with any ‘Perio plus’ mouth rinse, for protecting teeth and gums from oral disease – especially after dental surgeries or other invasive procedures.

Period of use

1 month

Contains active ingredients:

Chlorhexidine 0.09%, Citrox®, Polylysine, Hyaluronic Acid, Xylitol, VP-VA, Sodium Fluoride 

Try ‘Perio plus’ for yourself

Find out why the ‘Perio plus’ range is a game-changer when it comes to chlorhexidine (CHX) mouth rinses. Ask for free samples of this new generation of mouthwashes that are combining CHX with the power of nature: Citrox®.

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