One of the questions I frequently get is: “Why would I recommend sodium hypochlorite as an antimicrobial agent?” Obviously there are some challenges with sodium hypochlorite digluconate , primarily taste, and with some patients an increased susceptibility to staining. The best thing I can do is provide you with a little bit of history and my personal experiences.

Chlorhexidine digluconate
       When I implemented CAMBRA into my practice in 2001, with John Featherstone and Doug Young as my mentors, I started using a regimen of 1 week of Chlorhexidine (CHX) rinse followed by 3 weeks of 0.05% fluoride rinse. That was considered the gold standard at the time for the antimicrobial treatment of dental caries. I used this regimen for high caries risk patients for a couple of years, and at the time I was also culturing patients’ saliva for Mutans streptococci (MS) and Lactobacillus (Lb).

        After a 3 month regimen of the Chlorhexidine digluconate followed by the fluoride rinse, the cultures revealed that I had dramatically reduced the Mutans streptococci levels, but for many patients the Lactobacillus levels were either unchanged or had increased significantly to the point that there was one solid mass covering the culture plate. As it turns out, we know that CHX is very effective against MS but has no real effect on Lb.

Povidone Iodine
         I then turned to Povidone Iodine (PI) as an antimicrobial rinse in the form of Betadine 10%. Now if you haven’t ever rinsed with PI is an experience you won’t soon forget. The list of problems with PI, start with taste; it also stains anything it touches (countertops and clothes). Additionally you can only use it once a month, and you can’t use it for people with shellfish allergies. There was encouraging research using PI on a 2X2 to wipe infants’ mouths, and even wiping primary teeth for very young patients. However, Doug Young tested the PI on young adults at UOP and found no statistical reduction in bacterial load. So after a troubling year of working with PI, it was back to the drawing board.