Antimicrobial Activity and Dose/Concentration Concerns with Chlorhexidine Mouthrinses - A Literature Review

Chlorhexidine 漱口水之抗菌活性與使用劑量／濃度之考量－文獻回顧

侯連團(Lien-Tuan Hou) ； 裴紹企(Shao-Chi Pei) ； 林保瑩(Paul Lin) ； 蔡逸民(Alex Yi-Min Tsai)

《中華牙醫學雜誌》 23卷2期 (2004/04) Pp. 77-88

https://doi.org/10.7105/CDJ.200404.0077

摘要

長菌斑是慢性牙周炎之主要原因之一，去除牙齦上菌斑在預防及控制牙周疾病是最重要的策略。雖然機械式去除牙菌斑是最有效的方法，然而許多研究顯示此種方法的操作技巧和民眾採用之動機常超越民眾的能力，特別是殘障等特殊族群，因此許多研究者便朝向發展化學性牙菌斑控制方法。Chlorhexidine漱口水已經有很廣泛及完整的研究，並在臨床上應用已超過四十年，不但成效良好而且無系統性毒性和局部細菌抗藥性，由於其絕佳之抗菌斑效果和口腔內持續性存留期間（長達５－８小時）等特性，一直被認定為化學性牙菌斑控制之金字招牌，Chlorhexidine之超佳抗菌斑能力與其在口腔內維持長效持續性作用有關。其分本身是帶二價陽離子，在其氮原子上之正電荷使得它很容易吸附到帶有負電荷之表面，像細菌之細胞壁，也可吸附到口腔黏膜、牙齒、表膜和垂液中，再慢慢釋放出活性分子發揮殺菌和抑菌之效果。本論文宗旨在回顧及摘要敘述Chlorhexidine漱口水之抗菌斑及抗菌之現況，其作機制、使用濃度與抗菌斑效果之關係、適應症、系統安全性和毒性及與其他口腔衛生產回（像牙膏、牙凝膠、抗齲齒內漱口水等）成分並用時之抗菌斑減效影響。

關鍵字

口樂舒汀(Chlorhexidine) ； 牙齦上菌斑 ； 牙齦炎 ； 牙周致病菌 ； 持續性

並列摘要

Bacterial plaque is the main etiological factor in chronic inflammatory periodontal disease. Removal of supragingival plaque is a critical strategy in the prevention or control of periodontal disease. Mechanical cleaning is the most widely and effectively used method of suprgingival plaque control. Evidence exists that the degree of motivation and skill required with this oral hygiene technique are often far beyond the ability of the majority of patients, especially in groups of handicapped, juvenile, and elderly individuals. Thuse much attention has been focused on the chemical inhibition of plaque formation. Chlorhexidine has been extensively studied and used clinically as an antiseptic for over 40 years with no reports of adverse systemic effects or local bacterial resistance following ingestion of the compound. Due to its supreme antiplaque activity, favorable chemical characteristics of substantivity(5hours), and persistence of action, it is now generally recognized as the primary agent for chemical plaque control; its clinicall efficacy and some minor side effects are also well known to the dental profession. Chlorhexidine is a large dicationic molecule, [16-di(4-chlorphenyl-diguanido)] hexane, with a positive charge distributed over the nitrogen atoms on either side of the hexamethylene bridge. The chlorthexidine molecule has the ability to adsorb onto negatively charged surfaces, such as bacterial cell walls, where it exerts its bacteriostatic and bactericidal effects. The present article reviews and summarizes antiplaque and/or antibacterial activities of chlorhexidine mouthrinses, their relationship to the administered dose or concentration, mechanisms of action, indications of usage, systemic safety and toxicity, and de-optimizing effect of other oral hygiene products.

並列關鍵字

chlorhexidine mouthrinse ； supragingival plaque ； gingivitis ； periodontopathogens ； substantivity