 Hello everybody, Andrea Mayesca here with Dental Elm. So let's talk about chlorhexidine today. So whether you are a dental hygienist using it in your practice or not, you've probably heard about chlorhexidine. You have heard that you probably should be using it, that those periopatients where it's just taking a while for things to get better. Well, they need something else, right? Like brushing, doing everything at home, coming in for their cleaning every three months. They need something else. Like they need a mouth wash, a mouth rinse, such as chlorhexidine to kind of get in there properly to help to heal up those areas. Now, I've been in offices where I know we've had it. We talk about recommending it, but we don't always, we don't think about it, usually because insurance doesn't always cover it. If we do sub-tingible irrigation, you would be using chlorhexidine or something with that effect in the office. If you're putting that code through, at least here in Canada, it's about $56, $57 depending on what you're coding and how much you're putting through, right? But a lot of insurance companies don't cover it. But to really be part of a perioprogram, simply cleaning the teeth isn't enough. If you need something else, at least that's what we've always been taught, right? So, pay attention because I'm going to change your entire thinking soon. But that's what I always thought. Even just a couple weeks ago, we've been seeing a lot of periopatients lately in the practice where I work at and we do have a full perioprogram. Meaning, you know, we would do quad scaling, depending on how much quad per charter they have. We talk to them at every single appointment about what they should be doing at home. But a lot of the times, when we get to talking about, okay, the gums are bleeding a lot. I want to do a sub-tingible irrigation for you. It's like a medicine that we clean underneath the gums using a syringe and that will help to heal things up. But just so you know, it might not be covered by insurance. It's $57, but you do need this. You know, that's just something that we would have said. But a lot of patients pretty much say, okay, well, I can't afford another $57. I know you're saying I need it, but let's just see what happens. You know, we can give them a prescription where they can get it at home. And it is suggested to use it every night and no eating or drinking for at least a half an hour afterwards. So it's best to do it at the end of the night and it can stain the teeth. Okay, so that's just kind of a quick recap on chlorhexene. But I was talking with a dental company the other day and, you know, I had a series of questions to ask. Like I was just asking things about, okay, well, I see a lot of children with cavities, you know, I need something different. What do you have for me? Because I talk to this company often because they are constantly looking into things. They're constantly doing their research to see what people need and what is the research showing that proves to work. And I just happened to mention chlorhexene. I said, you know, I need something for my periopatience. What do you suggest? And I was just about to order a bunch of those. It is called Paradex. In fact, I can show you guys quickly if you want. I'm just going to share my screen here. I just want to show you guys what I'm thinking. So in case you have no idea what I'm talking about. So Paradex. So this is Paradex here. Okay, so you've probably seen this before. Sorry guys, I'm trying to zoom in. There we go. So this is Paradex. So it looks like a medicine, doesn't it? Like it looks like a medicine, but this is something that we are supposed to be using. You know, so we all thought underneath the gums as subgenital irrigation. But on top of that, it's a good idea or it was a good idea to have the patients use this at home too. Okay, so this is what I'm talking about. So I did ask this company. I said, well, I was just going to order some because in my personal practice, I am a mobile dental hygienist. So in my personal practice, I'm getting a lot of patients with perio. You know, I need to give them something else. I've been recommending saltwater because that's, you know, cheap, not expensive, but that will at least help to heal things up. Well, she showed me this article, which I'm going to actually show you guys too. And I will have to zoom in. So to make a long story short, I am showing you guys this article here. Where is it? Okay. Sharing my screen. Chlorhexidine has been found to be toxic. Now, but don't go crazy with this. You know, anything can be found to be toxic. It doesn't mean it actually is. It doesn't mean, you know, we're going to die from it. It doesn't mean we're doing like major harm to our patients, right? And keep in mind though, too, that this article is from 1999. So this is a while ago. This is nothing new. I need to find something more recent. And I know that she said that she wanted to look into that for me. Because I wanted something a little more recent. But even then, so what this is pretty much saying. So I'm going to zoom in a little bit more. And I'll save the link for you guys also on the bottom of the video in case you want to look into it. PubMed is excellent because even if you read this, they will show you similar articles over here that are probably more current. So have a look. They will show you more here. Like even here, you guys. So here's actually a recent article from 2018, which I will pop up later on, but it's pretty much saying the same thing. That, okay, we always thought that chlorhexidine helps to speed up the healing of the attachments. So I did zoom in quite a bit. I hope that that's enough there for you. But what they're finding is it doesn't actually do that. What they're finding is, so I did read the whole article. So I'm going to share it with you, but I did just highlight kind of the end part here. So it could speed up some healing. Okay. Some healing. Yes. Which is why we have been using it because why not. But it's such a little amount. And what it's actually doing is it's more toxic to our tissues. And it is preventing actually the most healing from happening. So yes, in some people it could be doing a little bit, but it's toxic to our tissues. Okay. You guys. So I can't say that enough, but even even thinking about the other things too is it causes stain. It has a horrible taste and patients do have to pay for it. Right. But again, it's toxic to the tissues and it contains alcohol. I'm pretty sure. Anyway, just double check. I'm pretty sure I've never actually looked at the label that closely, but I'm pretty sure it does contain alcohol. There are a lot of patients out there. You guys that shouldn't be having alcohol in their mouth rinses because if they have dry mouth to begin with, which could happen with anybody, this is going to make it worse. So why would you give them something like this? Right. But let me just click on this article from 2018 actually. I didn't notice this before and I can show you guys the link to this one too. So I'm just going to look at this really quickly. Let's see. So, yeah, see, so this is basically saying the same thing that let's see. Sorry guys. I'm just reading that quickly. Let's do two. Okay. So basically what this is saying is for those root areas. Okay. Where is typically where perio happens. So perio happens in between the teeth, you know, obviously. And if somebody is suffering from gum recession, you know, that can lead of course to bone loss. So that is when if the gums are bleeding a lot, things are leading to bone loss or they have bone loss, you would want, you would think to recommend something like chlorhexidine to help to kill those cells that are causing perio because you want to promote attachment. But even this article is saying the same thing that it does have an effect. It does halt things, but it's not such a big deal where it, it overrides the fact that chlorhexidine is toxic to the tissues and it has a bad taste. So I will copy this for you for you guys to look into it, but that's just basically what this is saying. So chlorhexidine works, but it's toxic to the tissue, but it doesn't work for everybody. Okay. So now you might be wondering, okay, so we've been using chlorhexidine forever. Is there something else out there that we should be using? Yes, there is. So let me just stop sharing my screen for a moment. I am going to look that up for you. So this is what I've been looking into. I've been doing a lot of research and I'm going to, I'm going to show you guys and tell you guys what I had just ordered for my patients. And the nice thing is what I had ordered. Sorry guys, just taking a second to find it. What I had ordered is good for other things too. So I talked about it a little bit actually in a video that I just did. Just talking about a dental company that I have been looking into that you all should look into too because they are amazing. Things have come such a long way. We can offer patients the most amazing things. So I did find that. I'm just letting it load here. Okay guys, so I'm going to share my screen and I'll show you guys what I've been looking at. So it is called an Opti Rinse. There, can you guys see my screen? Okay, let me just zoom in. It's an Opti Rinse. It comes in mint and like a fruit, like berry flavor. But I'm actually going to click this so that hopefully it kind of shows me more information. But what this is, is it contains xylitol as well. So if you guys have heard me talk about xylitol before, it just helps to change the pH in our mouth. And changing that pH in the mouth means that cavities and perio have less of a chance to survive and get larger. So it's the same thing for cavities and the same thing for perio. We want to stop that bacteria from happening and this is what it does. So it doesn't just cover it up or help to treat it, but it actually stops. It carries process and the perio process. So once though, once somebody does have cavities, once they do have perio, this is still a good rinse to use because it helps to prevent further cavities and further perio because cavities and perio can get worse quickly, right? So you need something to counteract that. So, and I'll show you guys what I was looking at. So I'm going to zoom in again. Sorry for all my zooming and zooming out. So read this right here. So it's alcohol-free, which is perfect. You do not want to give a patient a rinse with alcohol in it. Listerine or types of them do have alcohol in them. It just is too harmful to our tissues. So if you're going to recommend something like Listerine, make sure that they get the one with zero alcohol in it. It doesn't work as well or as quickly. Alcohol will still kill things quickly, okay? But it kills everything else too. So why don't you give them another alternative? But this is just my opinion, plus all of the research I have been doing. So have a look at pubmed.com and just sort of like type in things like xylitol, chlorhexene. You will find so much more on this. But look at this, you guys. So this rinse helps to reduce all of these different types. That cause caries, gingivitis, perio, and zirostomia. How many people do we know might get cavities, might get perio, and have zero, zero stomia? Almost everybody has one of those things. So this rinse helps everybody. And it has xylitol, as I said, to help to bring that pH down to neutral. And it's not toxic, you guys. It's not toxic. So chlorhexene, they're starting to find, yes, it works a little bit for some people, but it's also toxic. So why would you want to recommend that for somebody? You know, I mean, again, I guess I shouldn't talk like that because we all have our own opinions. But this is mine. I would rather try something else first, see if that works, and go from there. And this is also good for children and adults. Six years and older because there is a fluoride content in it. So they have the two different types. So they have the 0.05 or the 0.2, in my opinion, and makes more sense to get the one with more of that in there, and they should be using it every day, okay? On the bottle, it says, I think once a week, maybe for the 0.2 or a couple times a week, but they say that because you can get this over the counter. So they have to be careful, right? The 0.05, they say that you can use it every day. So in my opinion, what I would do is if I have a child that really could benefit from xylitol and the fluoride, I would tell the parents to get the 0.05 if they're concerned that they might swallow it. They might say something like, well, they can spit. Sometimes they don't. So they get the one 0.05 if they really need that extra help. But there's a lot of things to look into. So don't take my word for it. I will leave the link for you guys on the bottom. Oh, and I just, I'm happy to see this. So look at how they compare the rinse compared to chlorhexene, you guys. It has the same antimicrobial effect and is not toxic. So which one are you going to recommend to your patients? Have them spend the money on chlorhexene or use this rinse. I plan to use it like in my practice too. So I can actually help to clean underneath the gumline with this also. Why not? You could technically dip your scaler in there and then use it that way. So that's what I plan to do. And it can't hurt, right? It can't hurt. So you see how it's so important to keep on doing your research. Because there's so much out there. There's so many things. But also look for articles that aren't from 1999. So the one that I showed you at first is from 1999. But look into them further to see articles that are more current. Okay. So I hope this helps to open your eyes a little bit. I plan to be using this for my portfolio because I was audited. So I will be submitting my portfolio January 2020. But this is definitely something that I have spent a lot of time looking into and talking to different people, talking to different dental professionals. So I'm definitely going to use this. So but let me know you guys if you have any questions because I probably forgot to mention something. But thank you guys for listening and good luck with everything. And I'll see you guys in the next one.