Chlorhexidine gluconate (oral rinse)

Oral health effects

• Extrinsic tooth/tongue staining, taste alteration, calculus

  Effective antiplaque rinse, but prolonged use causes brown extrinsic staining of teeth and tongue, transient taste alteration, and increased supragingival calculus.

  Mechanism: Cationic binding to oral surfaces and dietary chromogens.

  Clinical management: Limit to short courses; professional stain removal; counsel on rinsing away from meals/toothpaste.

• Allergic reactions, including anaphylaxis

  The label warns that anaphylaxis and serious allergic reactions have been reported in postmarketing use; glossal edema is also listed among oral adverse effects.

  Clinical management: Ask about previous reactions to chlorhexidine (including skin antiseptics and coated catheters) before prescribing or using it; do not use in patients with known sensitivity, and treat sudden swelling, urticaria or breathing difficulty as an emergency.

• Mucosal irritation, peeling and salivary gland swelling

  Minor irritation and superficial desquamation of the oral mucosa, stomatitis, glossitis, and cases of parotid swelling/sialadenitis are reported with chlorhexidine rinse (label).

  Clinical management: If mucosal sloughing, soreness or parotid swelling develops, stop the rinse and review; consider an alcohol-free formulation or alternative antiplaque agent.