Chlorhexidine and ultrasonic cleaning of teeth

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How do the benefits of the using chlorhexidine (in terms of reduced bacterial load) before ultrasonic cleaning of teeth compare against the slight risk of allergic reaction, or in very rare cases, anaphylaxis?

Top papers identified

A study to evaluate and compare the efficacy of preprocedural mouthrinsing and high volume evacuator attachment alone and in combination in reducing the amount of viable aerosols produced during ultrasonic scaling procedure.
Source: The journal of contemporary dental practice; 2012; vol. 13 (no. 5); p. 681-689
Publication Date: 2012
Publication Type(s): Comparative Study Controlled Clinical Trial Journal Article
Authors: Devker, Nihal R; Mohitey, Jyoti; Vibhute, Akshay; Chouhan, Vivek Singh; Chavan, Prithviraj; Malagi, Sachin; Joseph, Rosemary
Abstract: In recent years, ultrasonics has gained prime importance and is considered a valuable tool in the dentist’s armamentarium. Studies have confirmed that an aerosolized bacterial contamination is produced during the use of ultrasonic scalers. To evaluate and compare the efficacy of preprocedural mouthrinsing using a bisbiguanide (chlorhexidine gluconate 0.2%) and high volume evacuator attachment alone and in combination in reducing the amount of viable aerosols produced during ultrasonic scaling procedure. A total 90 subjects were assigned to group I (who rinsed with 0.2% chlorhexidine gluconate prior to scaling), group II (high volume evacuator attachment was used during ultrasonic scaling) and group III (who rinsed with 0.2% chlorhexidine gluconate prior to scaling and in whom high volume evacuator attachment was used during ultrasonic scaling). Control group consisted of subject’s whose mouth was scaled using a piezoelectric ultrasonic scaler without preprocedural rinsing or high volume suction. Aerosol samples were collected using blood agar plates. The blood agar plates containing the aerosol sample were taken to the microbiology department as soon as the sampling was over and were subjected to aerobic culturing. The values obtained showed that all the three groups were effective in reducing the mean colony forming units (CFUs). The results of this study showed that preprocedural rinse and high volume suction were effective when used alone as well as together in reducing the microbial load of the aerosols produced during ultrasonic scaling. There was a significant reduction in the number of CFUs in aerosol samples obtained.

Effect of ultrasonic debridement using a chlorhexidine irrigant on circulating levels of lipopolysaccharides and interleukin-6.
Source: Journal of clinical periodontology; May 2008; vol. 35 (no. 5); p. 415-419
Publication Date: May 2008
Publication Type(s): Research Support, Non-u.s. Gov’t Randomized Controlled Trial Journal Article
Authors: Lee, Monica K; Ide, Mark; Coward, Paula Y; Wilson, Ron F
Abstract: Transient bacteraemia and endotoxaemia, and elevated levels of systemic cytokines have been reported following subgingival debridement. This study aimed to investigate the effect of chlorhexidine (CHX) solution on circulating levels of lipopolysaccharide (LPS) and interleukin-6 (IL-6) when used as an irrigant during ultrasonic debridement in patients with periodontitis. Eighteen patients with moderate to advanced chronic periodontitis were treated in a split-mouth, crossover, single-masked study. Irrigation with 0.02% CHX solution or water was used during treatment of two ipsilateral quadrants on two separate occasions 7 days apart, randomized as to order. Peripheral blood samples were collected for circulating levels of LPS and IL-6 at baseline, 5 and 120 min. after instrumentation commenced. Median concentrations of LPS were elevated from baseline to 5 min. into treatment with both CHX and control irrigant (p<0.05). Median levels of IL-6 increased with both treatments from baseline to 120 min. (p<0.001): CHX, 0.81-1.85 pg/ml; control, 0.78-1.78 EU/ml. Ultrasonic instrumentation in patients with moderate to advanced periodontitis increases circulating levels of
LPS after 5 min. and IL-6 120 min. after commencement of treatment, and is not affected by using 0.02% CHX as an irrigant instead of water.

 Prosol-chlorhexidine irrigation reduces the incidence of bacteremia during ultrasonic scaling with the Cavi-Med: a pilot investigation.
Source: Journal (Canadian Dental Association); Aug 1993; vol. 59 (no. 8); p. 673
Publication Date: Aug 1993
Publication Type(s): Research Support, Non-u.s. Gov’t Randomized Controlled Trial Clinical Trial Journal Article
Authors: Allison, C; Simor, A E; Mock, D; Tenenbaum, H C
Abstract: The purpose of this pilot investigation was to determine whether the incidence of bacteremia following subgingival ultrasonic scaling and root planing could be reduced by the use, pre- and intraoperatively, of an irrigant containing 0.12 per cent chlorhexidine (CHX); Prosol. Individuals having evidence of significant periodontal disease (minimum of seven sites per quadrant 4.0 mm and bleeding on probing) were entered into this study. By use of a random number table, patients were assigned to either the experimental or control groups. The procedures, as described below, were carried out in a double blind fashion so that neither the investigator nor the patient was aware of whether Prosol or placebo was being used. The placebo solution was flavored to make it indistinguishable from Prosol. Patients were first anesthetized. Their gingival crevices were then irrigated using the Cavi-Med ultrasonic scaler. At this point, the ultrasonic action was not activated. Ten minutes later, ultrasonic scaling and root planing with the Cavi-Med unit were begun with a continuous flow of either the placebo or control solutions. Blood samples were taken preoperatively, while postoperative samples were taken one minute after completing the scaling of each quadrant and then 10 minutes after scaling the second quadrant. Routine aerobic and anaerobic bacterial culture methods were used to identify viable bloodborne bacteria. The results show that there was no difference in the distribution or presentation of periodontal disease between the experimental and control quadrants.

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