This question was submitted by a general dentist: Is there any evidence of benefit for the routine use of an antibacterial mouth rinse (ie. chlorhexidine gluconate 0.12%) prior to dental appointments? Would there be any contraindications to this practice?
Drs. Gordon Schwartz from Gumdocs and Suham Alexander provided this quick initial response.
The intended aim of having patients use a pre-procedural antibacterial mouth rinse is to reduce or limit the exposure of patients and dental staff to microorganisms that are found in aerosols in the dental office as well as to decrease contamination of equipment and operatory surfaces whilst performing routine dental procedures. Air-water syringe and handpiece sprays are most concentrated within 2 feet of the patient in the same vicinity as the operator/assistant.
Presently, there is no scientific evidence to suggest that a pre-procedural rinse prevents any clinical infections in dental patients or personnel. The study cited below by Feres et al compared the effectiveness of 0.05% cetylpyridinium chloride (CPC) and 0.12% chlorhexidine gluconate (CHX). Both are equally effective in reducing the number of viable bacteria in aerosols in comparison to the negative control groups (water and no rinse at all). It should be noted, however, that the presence of bacteria alone is not indicative of an infection or that one will be caused by contact with the aerosol.
There are fewer side-effects (mild taste changes and burning feeling) associated with CPC compared to CHX (strong taste, mucosal irritation, staining of the teeth/tongue, metallic taste). Additionally, the lower cost of CPC can be beneficial for practices that employ pre-procedural rinses.
Overall, the use of a pre-procedural rinse may be costly and unnecessary for each and every patient. Rinses may be more beneficial to use in patients at higher risk for infection or before certain procedures such as ultrasonic scaling, dental prophylaxis or where rubber dams cannot be utilized as well as for surgical procedures.
Feres M, Figueiredo LC, Faveri M, Stewart B and de Vizio W. The Effectiveness of a Preprocedural Mouthrinse Containing Cetylpyridinium Chloride in Reducing Bacteria in the Dental Office. JADA 2010; 141(4): 415-22.
USAF Dental Evaluation & Consultation Service – Reducing Bacteria Using Preprocedural Mouth Rinses (6/10)