4.2 Antimicrobials
Some children with chronic diseases or disorders such as leukemia, kidney failure, immune deficiencies, or Down syndrome may experience moderate to severe gingivitis or periodontitis at an early age. They may also experience more fungal infections or other opportunistic infections than other children. Discomfort and pain from lesions or infections may interfere with chewing and nutritional intake.
Oral antimicrobial rinses are generally recommended only for children who can swish and spit. The alcohol content of the rinses may also be a contraindication for children. In these situations, concentrations that can be swabbed, brushed, or sprayed onto the gingiva are more effective than rinses.
Chlorhexidine
Chlorhexidine (CHX) has been used widely in other countries to prevent
dental caries and periodontal diseases in persons with special
health care needs. Its antimicrobial effects are particularly useful against
Streptococcus mutans (S mutans) in children at high risk for
dental caries. Currently, use of CHX in dental caries prevention is considered
off label by FDA. CHX comes in products such as gels, gum, varnishes,
and rinses and is available in various concentrations. In the United States,
CHX is used primarily in rinses, although research with varnish and gels
appears promising. Varnishes and gels would be more appropriate than rinses
for many children with special health care needs. Rinses
can be applied with a cotton swab twice a day. Oral health professionals
should keep abreast of product and protocol updates for using
CHX with children.
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