Chlorhexidine gel: applying it where needed avoids the effects of rinsing

Chlorhexidine gel solves the principal problem of the mouthwash: it distributes the active agent throughout the mouth when the problem is confined to two or three sites.

Targeted application changes the balance between benefit and side effects. Staining and taste alteration arise from diffuse contact; limiting the contact limits both.

The available concentrations cover different uses. Zero point two per cent is the therapeutic concentration for acute phases; zero point one two is more used for longer periods; one per cent exists for brief professional applications.

The clearest indication is the post-surgical phase. Applying gel to the operated site with a cotton bud protects it without exposing the rest of the mouth to the product.

The second indication is localised lesions: pericoronitis, an ulcer, an abscess awaiting treatment. In all these the problem is at one point and mouthwash disperses needlessly.

Around implants with mucositis the gel allows the peri-implant sulcus to be treated selectively, applied with an interdental or single-tufted brush.

Use in a tray is the most effective mode where prolonged contact across a whole arch is required. The gel stays in place for the prescribed time instead of being diluted by saliva.

It is the mode indicated in periodontitis patients whose maintenance is difficult, and in those who, through motor limitation, cannot perform adequate mechanical hygiene.

Contact time is what determines efficacy, and it is why gel outperforms mouthwash at equal concentration. A rinse lasts thirty seconds, a gel in a tray five minutes.

The substantivity of chlorhexidine, its capacity to bind to tissues and release slowly, works better with prolonged contact.

The side effects remain the same, merely reduced in proportion to exposure. The rule of courses with an end date applies to gel too, and should not be relaxed because the product seems more targeted.

Interference with toothpaste surfactants applies here as well: application should be separated from brushing, which is easier to observe with an evening gel.

In summary: gel concentrates the active agent where it is needed and reduces side effects proportionally, tray use maximises contact time, and the rules on limited courses remain identical to those for mouthwash.