Chlorhexidine inactivation by saliva

doi:10.1016/0030-4220(90)90377-5

Oral Surgery, Oral Medicine, Oral Pathology

Volume 69, Issue 4, April 1990, Pages 444-449

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(90)90377-5 Get rights and content

Abstract

Chlorhexidine mouth rinsing is commonly used for oral flora reduction. Indigenous microorganisms (viridans streptococci) are significantly suppressed, while “hospital-acquired” gram-negative bacilli are not affected in vivo. To explain the discrepancies between good in vitro and poor in vivo activity of chlorhexidine, minimum bactericidal concentration values for 120 isolates were studied by means of a standard dilution method in fresh whole saliva, broth, and glucose 5%. Both saliva and broth significantly reduced the bactericidal activity of chlorhexidine against all microorganisms tested as compared to glucose 5% (p < 0.01). Minimum bactericidal concentrations for indigenous flora were significantly lower than the values obtained for the “hospital-acquired” microorganisms (p < 0.05). These observations of chlorhexidine inactivation by saliva may explain why chlorhexidine mouth rinsing is of limited value in decontaminating the oral cavity.

References (34)

McGawWT et al.
Oral complications of acute leukemia: prophylactic impact of a chlorhexidine mouth rinse regimen
Oral Surg Oral Med Oral Pathol
(1985)
BernhoftCH et al.
Oral findings in irradiated edentulous patients
Int J Oral Surg
(1985)
LawrenceCA
Antimicrobial activity, in vitro, of chlorhexidine
J Amer Pharm Assoc
(1960)
SharonA et al.
The effect of chlorhexidine mouth rinses on oral Candida in a group of leukemic patients
Oral Surg Oral Med Oral Pathol
(1977)
SpijkervetFKL et al.
Effect of chlorhexidine rinsing on the oropharyngeal ecology in patients with head and neck cancer who have irradiation mucositis
Oral Surg Oral Med Oral Pathol
(1989)
PittTL et al.
In vitro susceptibility of hospital isolates of various bacterial genera to chlorhexidine
J Hosp Infect
(1983)
KlebanoffSJ et al.
The peroxidase—thiocyanate—hydrogen peroxide antimicrobial system
Biochim Biophys Acta
(1966)
MassonPL et al.
An iron-binding protein common to many external secretions
Clin Chim Acta
(1966)
HollowayPM et al.
The effects of sub-lethal concentrations of chlorhexidine on the bacterial pathogenicity
J Hosp Infect
(1986)
BonesvollP et al.
Retention of chlorhexidine in the human oral cavity after mouth rinses
Arch Oral Biol
(1974)

SkoglundLA et al.

Desquamative mucosal reactions due to chlorhexidine gluconate

Int J Oral Surg

(1982)

LangNP et al.

Chlorhexidine digluconate—an agent for chemical plaque control and prevention of gingival inflammation

J Periodont Res

(1986)

LangsletA et al.

Chlorhexidine treatment of oral candidiasis in seriously diseased children

Acta Paediatr Scand

(1974)

AddyM

Hibitane in the treatment of aphthous ulceration

J Clin Periodontol

(1977)

AxelssonP et al.

Efficacy of mouth rinses in inhibiting dental plaque and gingivitis in man

J Clin Periodontol

(1987)

HennesseyTD

Some antibacterial properties of chlorhexidine

J Periodont Res

(1973)

WaltersTH et al.

Antifungal action of chlorhexidine

Microbios

(1983)

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: This study was supported by the Netherlands Cancer Foundation (K.W.F.) Grant no. GUKC 86.3.

View full text

Chlorhexidine inactivation by saliva

Abstract

Oral Surg Oral Med Oral Pathol

Int J Oral Surg

J Amer Pharm Assoc

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Hosp Infect

Biochim Biophys Acta

Clin Chim Acta

J Hosp Infect

Arch Oral Biol

Int J Oral Surg

Chlorhexidine digluconate—an agent for chemical plaque control and prevention of gingival inflammation

J Periodont Res

Chlorhexidine treatment of oral candidiasis in seriously diseased children

Acta Paediatr Scand

Hibitane in the treatment of aphthous ulceration

J Clin Periodontol

Efficacy of mouth rinses in inhibiting dental plaque and gingivitis in man

J Clin Periodontol

Some antibacterial properties of chlorhexidine

J Periodont Res

Antifungal action of chlorhexidine

Microbios