My relationship with chlorhexidine has been on the rocks for years. I should have known—the red flags were there all along. You told me that you could help me, but all you did was cause more problems. Chlorhexidine, I’ve always hated that you stain the teeth that I love so dearly, and I was annoyed at the way you would add calculus after I had taken so much time to get rid of it all. But I was willing to let all that slide because you killed bacteria better than the others. But when I found out that you inhibit fibroblasts and have actually killed people—I am done. This relationship needs to end for so many reasons because this dysfunction can’t be the norm.
You only wanted a short-term thing
When we first met, I was so excited to introduce you to my patients. I thought that you could really make a difference, and I couldn’t wait for them to try you out. I was told that you could be used for bleeding, so I let you help me with those who required the most assistance. Some had periodontal disease, others had failing implants, and some patients had just been through rough dental surgery. It was only later that I found out that you were really only supposed to be used for gingivitis. You lied to me. I thought you were the best, and I kept trying to make it work. But the fact that you require such a high concentration (1,200 ppm) to be effective actually makes you dangerous to be used for any longer than two weeks.1 I'm looking for something more long-term.
Also by Kristin Goodfellow:
Do you even have a job?
Shortly after we started seeing each other, I began to hear rumors about you. Eventually I found out that you don’t even work. You completely gaslighted me into believing that you were great at all of these things, and I was silly enough to believe you. Now other hygienists are telling me that you’re unable to work in saliva and blood.2 Did you think that I eventually wouldn’t catch on to your lack of effectiveness? I can’t believe that you have tricked me for so long. If you are inhibited by blood and saliva, how could we ever be able to make this work in the mouth?
You’re literally toxic
Honestly, using you makes me feel terrible, and the fact that you are so unpleasant toward my patients is something I can no longer overlook. They need so much help to heal properly after dental treatment, and you are cytotoxic to the cells that help to rebuild tissue. You can’t support me in my goals for patient treatment and inhibit the cells that are essential for proper healing.3 I realize that I am a part of this problem, and I have to stop. If I continue to offer you as an option for use, then I will continue to make my job harder and cause problems for my beloved patients.
You’re bad for me—and everyone
You’ve done a great job at keeping this little fact hidden, but we hygienists have been talking, and your secret is out. We know about her. The young woman who died after using you after she had a tooth extracted.4 I’ve also seen the report from the FDA about all the other significant allergic reactions that you have caused.5 How you’re not banned from use altogether, I will never know, but I can’t continue to allow you to hurt people.
I am moving on. I have taken a lot of time to work on myself and have earned enough continuing education credits to know that there are better options out there. I have already found a new love in activated chlorine dioxide. Not only does it kill bacteria faster, but it has a lot more to offer because it also kills viruses and fungi. It also enjoys helping me to control biofilm and reduces volatile sulfur compounds, without having any of your toxic traits. Plus, my patients love it.
I hope no hygienist uses you ever again. Goodbye.
Editor's note: This article appeared in the June 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
1. Downs RD, Banas JA, Zhu M. An in vitro study comparing a two-part activated chlorine dioxide oral rinse to chlorhexidine. Perio-Implant Advisory. Jan. 21, 2015. www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16411500/an-in-vitro-study-comparing-a-twopart-activated-chlorine-dioxide-oral-rinse-to-chlorhexidine
2. Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006;37(8):605-612.
3. Alleyn CD, O’Neal RB, Strong SL, et al. The effect of chlorhexidine treatment of root surfaces on the attachment of human gingival fibroblasts in vitro. J Periodontol. 1991:62(7):434-438. https://onlinelibrary.wiley.com/doi/10.1902/jop.1918.104.22.1684
4. Edwards A. Dental patient, 30, 'turned blue and died after mouthwash led to fatal allergic reaction'. DailyMail. September 15, 2011. https://www.dailymail.co.uk/news/article-2037634/Sacha-Rumaner-turned-blue-died-swilling-mouthwash-led-fatal-allergic-reaction.html
5. FDA drug safety communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. US Food & Drug Administration. Feb. 9, 2017. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-rare-serious-allergic-reactions-skin-antiseptic