© Molekuul | Dreamstime.com
Chlorine dioxide has antimicrobial properties that work against many bacteria, spores, and viruses.

Why your team should be implementing an antimicrobial preprocedural rinse

Aug. 1, 2020
Breaking the chain of infection both inside and outside the dental environment is a crucial step for communities as dental practices reopen.

Sponsored article

Now more than ever, the dental community has a heightened awareness of aerosols associated with dental procedures. The aerosolization of infectious agents can result in cross-contamination in the operatory and the potential transmission of disease to clinicians, staff, and patients. The use of preprocedural rinses may be advised to reduce harmful agents, such as viruses, bacteria, and fungi, that can be aerosolized during dental procedures.

Prerinse significance

Research demonstrates that dental aerosols can travel up to 30 feet and be found in areas that are not used for clinical procedures.1 If left untreated, contaminated air can circulate from room to room with the capability of transmitting diseases.

Implementing a prerinse before every dental appointment reduces the risk of infectious agent transmission via aerosols. Numerous studies have demonstrated the benefits of using an antimicrobial prerinse to reduce oral bacteria, with as high as a 94.1% reduction in colony-forming units.1 Gupta et al. demonstrated that a routine preprocedural mouth rinse could eliminate most bacteria-containing aerosols generated by the use ultrasonic units.2


Mouth rinses are classified as antiseptic, antibacterial, or antimicrobial. Antiseptic mouth rinses inhibit the growth and/or multiplying of infectious agents, including viruses, bacteria, fungi, and protozoa.3 Antibacterial rinses kill bacteria or hinder their reproduction.1 Antimicrobials destroy or inhibit the growth of microorganisms, especially pathogenic microorganisms.3

When using rinses, patients’ medical histories should be taken into consideration for contraindications such as allergies. Rinses with dyes, gluten, sulfates, or triclosan can produce negative reactions. Therefore, ingredients should be carefully examined.

Home care

Clinical studies demonstrate that agents in both healthy and disease states have been linked to respiratory infections, which range from the common cold to SARS.4,5 Eliminating infectious agents through meticulous home care can reduce the risk of transmission.

Periodontal effects of chlorine dioxide

One option to consider for a prerinsing agent is stabilized chlorine dioxide. In evaluating its usefulness, is important to recognize both what it does to benefit the mouth and also what it does not do.

Clinical studies conducted by Wirthlin et al. analyzed in vitro the effects of chlorine dioxide and chlorhexidine mouth rinses on cells involved in periodontal healing.6 The results revealed that chlorine dioxide had a minimal effect on gingival fibers, periodontal ligaments, and osteoblasts. There was also no significant effect on lactate dehydrogenase (LDH), which is released by cells upon damage of cell membranes.6 The research concluded that its formulation, antibacterial activity, and low toxicity indicated that it was an effective postsurgical lavage.6

The same clinical study tested chlorhexidine and its effects on overall periodontal healing. Chlorhexidine concentrations over 0.003% showed total cell death and negative effects on gingival fibers, periodontal ligaments, and osteoblasts.6 Chlorhexidine showed significantly more LDH released by osteoblasts than by chlorine dioxide and experimental controls.6 Chlorhexidine decreased the number of gingival fibers when applied to root surfaces and led to epithelial hyperkeratosis and increased thickness of the oral epithelium. The authors noted that “[chlorhexidine] used post-surgically on open wounds of the palate inhibited the wound closure, resulting in more granulation of the tissue, a lack of epithelial closure, and a detrimental effect on the bone.”6

Chlorhexidine can cause staining on teeth, soft tissues, and restorations due to the color of the product, as well as oral mucosal lesions due to the drying effects of alcohol in the product. Increased calculus formation has been reported with the use of chlorhexidine.6

Chlorine dioxide has antimicrobial properties that work against many bacteria, spores, and viruses. Clinical studies demonstrate chlorine dioxide is effective in the control of waterline contamination in ultrasonic scaling units. Products that contain a ready-to-use formula with chlorine dioxide can be a valuable chairside tool for use as a prerinse. Patients can also use these products and at home to eliminate destructive oral bacteria.


Breaking the chain of infection both inside and outside the dental environment is a crucial step for communities. As dental practices reopen, dental professionals now carry the important responsibility of explaining the capabilities of over-the-counter antimicrobial oral care products to lessen the potential for destructive bacteria. One such product line is available from CloSYS. Its products contain a patented antimicrobial chlorine dioxide formula that is pH balanced, naturally activated by amino acids in saliva, does not require premixing, and does not harm healthy bacteria. 

Editor’s note: This article is sponsored by CloSYS. Content has been reviewed for editorial integrity per RDH guidelines. For more information on RDH standards of editorial excellence, see rdhmag.com/page/submission-guidelines.


  1. Narayana TV, Mohanty L, Sreenath G, Vidhyadhari P. Role of preprocedural rinse and high volume evacuator in reducing bacterial contamination in bioaerosols. J Oral Maxillofac Pathol. 2016;20(1):59‐65. doi:10.4103/0973-029X.180931
  2. Gupta G, Mitra D, Ashok KP, et al. Efficacy of preprocedural mouth rinsing in reducing aerosol contamination produced by ultrasonic scaler: a pilot study. J Periodontol. 2014;85(4):562‐568. doi:10.1902/jop.2013.120616
  3. American Dental Association. Oral health topics. Mouthwash (mouth rinse). Last updated August 29, 2019. Accessed April 15, 2020. https://www.ada.org/en/member-center/oral-health-topics/mouthrinse#
  4. Aas JA, Paster BJ, Stokes LN, et al. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol. 2005;43(11):5721-5732.
  5. Gomes-Filho IS, Passos JS, Seixas da Cruz S. Respiratory disease and the role of oral bacteria. J Oral Microbiol. 2010;2:10.3402/jom.v2i0.5811.
  6. Wirthlin MR, Ahn BJ, Enriquez B, Hussain MZ. Effects of stabilized chlorine dioxide and chlorhexidine mouthrinses in vitro on cells involved in periodontal healing. J West Soc Periodontol Periodontal Abstr. 2006;54(3):67-71.

AMBER AUGER, MPH, RDH, is a practicing dental hygienist and clinical innovations implementation specialist. With 14 years of experience in the dental industry, Auger works with practices to provide customized protocols to refocus on the patient experience and to utilize systemic approaches to periodontal therapy. She is a regular contributor to RDH magazine, a featured author for DentistryIQ, and host of #AskAmberRDH. Auger also provides preventive services abroad yearly and is always willing to have dental professionals join her team. She can be reached at [email protected].