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     One of the earliest signs of periodontal disease is red or bleeding gum tissue.  

     If this condition is allowed to continue it will develop into  periodontitis which will cause loss of bone and supportive structures around your teeth.  Most adult teeth are lost because of periodontal disease.  

     To help prevent this breakdown of the gum tissue you need to brush and floss 2 times day.  If any bleeding is noticed it means you need to brush and floss more often or more thoroughly and that you need your teeth professionally cleaned.

     Carefully cleaning every day and professional cleaning every six months is needed to remove the hard deposit called calculus that builds up on your teeth.  

     Calculus acts like a piece of sandpaper that is wrapped around your teeth causing irritation because of its roughness. This roughness and irregularity leads to bacteria growth and infection in the gum tissue. 

     There is no place for alcohol based mouthrinse.  Since gum disease is a protein based disease (as opposed to decay which is carbohydrate) the more drying that occurs in the mouth the more tissue sloughs and the more protein is available for metabolism which supports the progression of gum disease. IDF Dr Light 5/15/05

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     The goal is to have smooth teeth so plaque and tartar can not cling to your teeth thus limiting bacteria growth.  It is, however, impossible for you to remove this calculus, it must be removed by your dentist or a hygienist. 

     For this persistent cause of bleeding a mouth rinse called Periogard can be professional prescribed for you . It is the most effective mouthrinse for removing plaque and fighting gingivitis. It has a solution of Chlorhexidine that controls the growth and kills the bacteria that is causing your gum disease.  

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     It has a few side effects:  


If you are allergic to Chlorhexidine you will not be able to use this product.  


It may cause staining of teeth, restorations and your tongue.  Not everyone will experience this.  This stain can be removed by having your teeth professional cleaned.


Increase in calculus formation above the gumline may develop.  We will monitor your condition for these deposits.


Lingering after taste that may change taste perception. You will adjust to time to this effect with no permanent change to your taste perception.


This drug should not be used if you are pregnant or nursing.

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Chlorhexidine rinses must be used daily for two weeks straight to be effective. Occasional or "scattershot" use will not work. After a two-week regimen of rinse use, harmful bacteria will not regrow into colonies for four to six weeks.

    How to use:


Use 1/2 fl. oz. of undiluted 


Swish in mouth for 30 seconds


After rinsing for 30 seconds be sure to spit  out all the rinse, do NOT swallow any of the rinse.


To minimize medicinal taste, DO NOT rinse with water immediately after use.


In the morning brush and floss for 2 minutes and than rinse with  chlorhexidine for 30 seconds


In the evening brush and floss and rinse again for 30 seconds.

  1. Take any missed dose as soon as possible but not if it is almost time for the next dose. If it is time for the next dose, skip the missed dose and resume your regular schedule. Do not "double-up" the dose. Store at room temperature below 77 degrees. Do not freeze.

  2. To minimize the staining apply Chlorhexidine with the hollow cup brush tip of the Rota-dent perio tool to only the gum tissue, especially focus on the areas with pockets depths over 4mm.  You may also alternate CHX with custom bleaching trays at home.

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0.12% Chlorhexidine Oral Rinse





bulletExceptional flavor 
bulletChlorhexidine Gluconate 0.12% is the leading prescription oral rinse to fight gingivitis.
bulletSignificantly reduces gingival inflammation and bleeding due to gingivitis.
bulletSafe, clinically proven formula.
bulletConvenient 16-oz. bottle comes with unit dose cup.


To insure successful results following periodontal treatments, your cooperation in maintaining  excellent oral hygiene is essential.

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News Updates on Chlorhexidine

Chx without alcohol

This is why we use Chlorhexidine AND fluoride rinse with our patients:

The effect of a mouthrinse containing chlorhexidine and fluoride on plaque and gingival bleeding.

The aim of this study was to test the effect of a rinse with 0.05% sodium fluoride and 0.05% chlorhexidine on plaque and gingival inflammation
compared with a placebo without these agents. I Subjects were asked to rinse for 30 s with 10 ml of the respective test or placebo rinse after
normal oral hygiene for 8 weeks. 39 subjects completed the study. There was no significant difference in the 2 groups at baseline with respect to
either plaque or bleeding scores. After scaling and 8 weeks use of the test rinse, there were significant reductions (p < 0.001) in both plaque
and bleeding. The control group showed no significant reduction in plaque scores after 8 weeks, but a significant (p < 0.05) reduction in bleeding.
However, this reduction was significantly greater (p < 0.001) in the test group than in the control. The test group had a significantly greater (p
< 0.05) stain score than the control at baseline. After scaling and rinsing for 8 weeks, stain scores were lower for both groups compared to
baseline but reached significance (p < 0.05) only for the control group. It is concluded that, as an adjunct to normal oral hygiene, the
chlorhexidine/fluoride rinse had a significant inhibitory effect on plaque and bleeding but its effect on staining is uncertain.
Joyston-Bechal S, Hernaman N. Department of Oral Medicine and Periodontology, London Hospital Medical College, UK. PMID: 8421116 [PubMed - indexed for MEDLINE
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Alcohol-Free Chlorhexidine Rinse as Effective as One with Alcohol

Researchers in Spain compared the effectiveness of an 11% alcohol- chlorhexidine rinse to an alcohol-free formulation.  Both rinses contained 0.12% chlorhexidine and 0.05% sodium fluoride.  A placebo rinse was used for the control group.
The 97 study subjects were between 25 and 50 years of age, with a minimum of 22 teeth.  Participants were asked to use their assigned rinse once daily for 30 seconds for the 28-day study.  They were also instructed to brush 3-times/daily at least 30 minutes before rinsing. Plaque and bleeding scores were recorded at baseline, 2-weeks and 4- weeks. No significant changes were observed in the placebo group.  Both chlorhexidine rinse groups showed reductions in bleeding and plaque levels.  No differences were seen between the alcohol rinse and the alcohol-free rinse.

Leyes Borrajo, J., Garcia Varela, L., Lopez Castro, G., Rodriguez-Nunez, M., Barcia Figueroa, M ., Gallas Torreira, M.:  Efficacy of Chlorhexidine
Mouthrinses with and without Alcohol:  A Clinical Study.  J of Perio 73: 317-321, 2002.

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Chlorhexidine & S. mutans

Chlorhexidine has been proposed as a potent chemotherapeutic agent against oral bacteria. The purpose of this study was to investigate the effectiveness of combining oral rinses to reduce S. mutans levels in human saliva.

Sixteen healthy adult subjects were randomly assigned to one of fourrinse groups using a 4-cell crossover design. The groups rinsed twicea day for 7 days with one of the following: 0.12% chlorhexidine (PerioGard®), 1.5% hydrogen peroxide (Peroxyl®), a combined chlorhexidine + hydrogen peroxide, or water (control).

No significant differences were seen in S. mutans levels among the groups; however, the levels of total streptococci on day 7 samples were significantly lower in the chlorhexidine and chlorhexidine + hydrogen peroxide groups than in the hydrogen peroxide and control groups. There was no additional decrease seen in S. mutans or total streptococci levels in the group receiving chlorhexidine + hydrogen peroxide compared to chlorhexidine alone. Adding hydrogen peroxide to the chlorhexidine mouthrinse did not result in a further
decrease in S. mutans levels.

[Menendez A  Comparative analysis of the antibacterial effects of combined mouthrinses on Streptococcus mutans   Oral Microbiology and
Immunology 2005;20(1):31.]


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Mouthwashes As Adjuncts To Oral Hygiene 

 There is a range of mouthwashes available to the consumer. Some of these are purely cosmetic, while others have been clinically proven to improve oral hygiene and reduce plaque, a major cause of periodontal diseases. The efficacy of  cetylpyridinium chloride as a mouthwash prior to toothbrushing does little to reduce plaque levels or improve oral health. Solely using mouthrinses as the only method of oral hygiene will be detrimental to their periodontal health.1:  Chlorhexidine preparations have the slight advantage over essential oils with respect to plaque reduction. Unlike essential oil mouthwashes chlorhexidine preparations can stain teeth, are generally indicated for shorter-term use and can alter taste perceptions for up to several hours post rinsing. The percentage reduction from control of EO mouthwash and chlorhexidine groups after twice daily rinsing for six weeks 2: Overall plaque index at six weeks  Chlorhexidine 0.1 percent was 54 percent and Chlorhexidine 0.2% was 77 percent. Both agents have a range of uses in the management of oral conditions where plaque levels could be problematic.  Mouthwash can be used after mechanical methods  to further reduce plaque levels because mechanical plaque removal alone may not achieve these low scores on a regular basis.  

Another significant use of mouthwashes is to reduce malodour. Oral malodour is multifactorial in its origins but a main cause is metabolic products from bacteria residing in bacterial plaque, on the tongue or present in saliva. Mouthwash containing chlorhexidine is beneficial in the management of oral malodour and reduce levels of odourgenic bacteria. Chlorhexidine  has been used successfully to ensure maintenance of gingival health around dental implants and reduce bacteria. 

 References 1 Seymour RA, Heasman PA. Pharmacological control of periodontal disease. II. Antimicrobial agents. J Dent. 1995 Feb;23(1):5-14. 2 Axelsson P & Lindhe J. Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man. J. Clin Periodontol 1987; 14: 205-212. 3 Ramfjord SP: Maintenance care for treated periodontitis patients. J. Clin Periodontol 1987; 14: 433-437.6/04

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Evidence-based control of plaque and gingivitis Most adults brush and floss inadequately, and constant education and /or reinforcement is often required. Bacteria are usually left behind with mechanical oral health routines, and chemotherapeutic agents may have a key role as adjuncts to daily home-care. To date, two antiseptic mouthwashes have received the ADA seal of acceptance: Peridex, Zila Pharmaceuticals chlorexidine (CHX),  essential oil (EO) mouthwash. CHX has a strong affinity for tooth and tissue surfaces, but can cause brown staining on the teeth and tongue. Patients must also wait until all traces of toothpaste are removed before rising with CHX. Long-term use of an EO mouthwash is microbiologically safe, with no changes observed n the bacterial composition of supragingival plaque, and no evidence of antimicrobial resistance. A number of trails have demonstrated the long-term plaque and gingivitis-reducing properties of both CHX and EO mouthwashes. These studies clearly demonstrate that these agents have lasting efficacy and can access hard-to-reach areas. [A Santos Evidence-based control of plaque and gingivitis J Esthet Restor Dent 2003;15(1):25-30.]

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February 06, 2008    

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