After years of neglecting my poor teeth and gums, a dental hygienist recently treated me and she prescribed chlorhexidine mouthwash. What? A mouthwash you need a prescription for? I immediately went and googled. While it acts lightning-fast to kill bacteria, chlorhexidine (or CHX for short) can have alarming side effects. My hygienist was confident in her recommendation, but I realized from my research there are plenty of safer, cheaper oral health alternatives that may surprise you.
Kristin Goodfellow, RDH, summarized the knowledge and studies done on CHX. Chlorhexidine is a boss at zapping germs, but requires high doses to do so—like 1,200 milligrams per liter. This is why it’s often advised you use it for just 2 weeks. During that time, patients are prone to recoil from the metallic aftertaste. In rare cases, permanent change in taste has been reported. Yes, foodies, I was scared by that too!
Chlorhexidine can cause stains and calculus. Consider that a trade-off for its bacteria-busting abilities. Of greater concern though, according to Goodfellow, is its impact on connective tissue cells called fibroblasts. CHX was found to damage fibroblasts and delay healing after deep-cleaning procedures. Since my dentist would soon do scaling and root planing for my gum disease, I questioned whether now was a good time to try CHX. It’s not for those who have implants, open wounds, or are getting surgery, but accidents have happened. Between 1998 and 2010, the FDA reported 52 anaphylaxis cases, two of which led to death. Even when used properly for 18 days, participants of one study showed DNA damage in their cheek and blood cells.
The RDH who wrote that tell-all chlorhexidine article actually works for OraCare, which uses chlorine dioxide (ClO2) as an alternative. At only 44 milligrams per liter, OraCare’s chlorine dioxide wash requires a much lower concentration of its active ingredient. Plus, there is no bad taste. ClO2 doesn’t stain or cause calculus, nor does it negatively affect fibroblasts.
Okay, so maybe competing brands have an interest in critiquing CHX, but they make a strong case. It turned out the mouthwash I’d already started using before I went to the dentist is another chlorine dioxide rinse, named CloSYS. Someone at the University of Iowa tested CloSYS against Peridex®, the generic CHX brand, and they got identical results. But CloSYS has not given me any dry mouth, tongue swelling, mouth sores, or worsened my gingivitis—which are other common side effects of Peridex.
Could there be effective subs to chlorhexidine that are even simpler or more natural than chlorine dioxide? Yes! One study weighed CHX against two other options: a herb called neem, and tea. Tea and neem equally outperformed CHX for gum health. All were effective at reducing plaque, but tea was actually the best. Dr. Michael Greger of NutritionFacts keeps a green tea jar in his fridge along with powdered Indian gooseberry, shown to stop the plaque-forming ability of mouth bacteria. Even cinnamon extract and turmeric work nearly as well as CHX.
How about bad breath? Multiple studies on oil pulling with sesame oil proved it just as good against mouth odor as CHX. What really shocked me though was this research from 2014: A placebo group—who “pulled” with plain water—had almost equal reduction in plaque and gingivitis as the CHX and sesame oil groups. Crazy! This suggests that much of the benefit from oil pulling could be due to the extended swishing, not just properties of the oil itself. However, the study did not specify how long participants rinsed for. In another study where people rinsed with water for 1 minute, they did not benefit. So before we throw away our pricey prescription mouthwashes and start “water pulling,” let’s at the very least use cheap options like green tea that have well-established effectiveness for our gums and teeth.
Learning all of the above left me astonished. We treat chlorhexidine as the crème de la crème of anti-plaque, yet safer substances from our spice and tea cabinets are equally awesome. What do you do when your health professional writes you a prescription whose side effects just seem unnecessary? I was encouraged by this comment left for Dr. Ellie Phillips, author of Kiss Your Dentist Goodbye who advocates xylitol as a dental secret weapon. The commenter on her website was in the same position as me, told to use chlorhexidine. So she emailed her hygienist to ask about using CloSYS as an alternative and got the approval.
When we face tricky issues like cavities in our teeth and ever-inflamed gums, the cacophony of dental info out there can be overwhelming. While I don’t know how my mouth care routine will evolve over time, one thing that’s clear is I don’t need chlorhexidine to see improvement. I feel safer leaving it on the shelf and continuing to experiment with other teeth treatments— even ones you can find in your kitchen.
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Photo: Alexander Krivitskiy via Unsplash