Module 4: Prevention of Oral Disease
Special Care- Prevention of Oral Disease

4.2 Antimicrobials

Some children with chronic diseases or disorders such as leukemia, kidney failure, immune deficiencies, or Down syndrome 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. Children may also experience discomfort or pain from lesions or infections, which may interfere with chewing and nutritional intake. In these instances, use of antimicrobials may be considered.

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 (CHX) has been used widely in countries other than the United States to prevent dental caries and periodontal diseases in people with special health care needs. Its antimicrobial effects are particularly useful against mutans streptococci (S. mutans) in children at high risk for dental caries. In the United States, CHX is used primarily in rinses, although research with varnish and gels appears promising. 4 For children that cannot rinse, CHX can be applied with a cotton swab twice a day. Children may object to the taste, and CHX often produces black stains on teeth.


Xylitol, a low-calorie sugar substitute used in certain chewing gums and other food products, may reduce the incidence of dental caries in women and children. Short-term exposure to xylitol has been shown to decrease S. mutans levels in saliva and plaque. 6 In addition to decreasing the incidence of dental caries, xylitol may also decrease the transmission of S. mutans from parents to infants and children. Xylitol is most often sold as an ingredient in chewing gum, mints, or candies. Evidence for the effectiveness of xylitol has been demonstrated only when it is used three to five times a day and when more than 4 grams per day is ingested. Products containing xylitol are not appropriate for children under age 3 and may not be appropriate for children with feeding or eating difficulties or poor oral-motor control because of the risk of choking. 7

Systemic Antibiotics

Children with aggressive periodontal diseases may require adjunctive antimicrobial therapy in conjunction with localized mechanical debridement. In pediatric periodontal diseases associated with systemic disease (e.g., severe congenital neutropenia, Papillon-Lefèvre syndrome, leukocyte adhesion deficiency), adjunctive use of systemic antibiotics has been recommended. 8