Comparing the Effect of 0.06%, 0.12% and 0.2% Chlorhexidine on Plaque, Bleeding and Side Effects in an Experimental Gingivitis Model

A Parallel Group, Double Masked Randomized Clinical Trial

Maliha Haydari; Ayse Gul Bardakci; Odd Carsten Koldsland; Anne Merete Aass; Leiv Sandvik; Hans R. Preus


BMC Oral Health. 2017;17(118) 

In This Article


Chlorhexidine (CHX) is a bis-biguanide with documented bacteriostatic and bactericidal effects, on both Gram positive and - negative bacteria,[1] fungi and some lipophilic viruses.[2] In the 1970's CHX was studied and recommended by researchers as part of the prevention and therapy of periodontal diseases[3] because of its plaque inhibitory effect.[4–7] Besides its proven immediate bactericidal effect, chlorhexidine binds to the oral mucosa from which it is slowly released, prolonging its antibacterial effect.[4,8]

In Norway, CHX has mainly been marketed as a 0.2% non-alcohol solution, but recently a 0.12% mouthwash has also been approved. These two CHX mouthrinse formulations are only recommended for short term use, i.e. for patients that – for one reason or the other - cannot keep their mechanical tooth cleaning up to standard. A 0.06% solution, for daily use, has also recently been approved for the Norwegian market, claiming in ads (no references displayed) prevention of gingival problems and that it reduces the amount of plaque 3.5 times compared with mechanical tooth cleaning.

Only few studies have compared the effects of 0.2% and 0.12% CHX on periodontal indices. A systematic review[9] included 10 publications, and concluded that 0.2% CHX had a slightly better effect than 0.12%, but the practical, clinical implication of this finding was regarded as uncertain. Nearly all of the included articles in this systematic review[9] had applied the plaque index of Quigley and Hine[10] – or the Turesky modification[11] of this index. Since these indices include disclosing solutions and also variably register the protein coating of teeth, one should also test the efficacy of the CHX concentrations using other scoring indices, like the Løe & Silness'[12] which only scores dental plaque. Moreover, to help the clinicians in their selection of the most effective plaque-preventing mouthwash when new products are presented, the actual commercial products should be tested, because added ingredients for commercially motivated enhanced taste, flavor and color may reduce the effect of the highly reactive CHX molecule. Based on a working hypothesis of 0.12% and 0.2% CHX having equal plaque-preventing effects and 0.06% CHX having a comparatively less efficacy, the aim of the present study was to compare the efficacy of the 2, in Norway, newly marketed (0.12% and 0.06% CHX), and the already well known mouthwash (0.2% CHX) – on plaque and gingivitis using both the Turesky modification of the Quigley and Hine plaque index[11] and the plaque and gingival index of Løe and Silness,[12] as well as reporting on the short-term side effects.