Introduction

Historically, chlorhexidine has been considered a safe and effective antimicrobial agent to control plaque and gingivitis.^{1,2,3,4,5,6,7}  These properties have stood the test of time with chlorhexidine still regarded as the most effective chemical anti-plaque agent.  According to Addy, "Chlorhexidine has not been superceded as a chemical anti-plaque agent, although other compounds have been shown to be useful."⁸  Similarly, Jones has stated that, "After 20 years of use by the dental profession, chlorhexidine is recognized as the gold standard against which other anti-plaque and gingivitis agents are measured."⁹

However, the side effect of extrinsic staining which results from chlorhexidine use remains the single most confounding limitation to its long-term use and has been the topic of considerable discourse and study.^{8,9,10,11,12,13,14,15,16,17,18,19,20,21}

Explanations of the staining mechanism have been postulated.^{9,22,23,24,25,26,27,28,29}    It has been suggested that the staining results from compounds which are products of a series of rearrangement reactions between sugars and amino acids.  This reaction is termed the maillard or non-enzymatic browning reaction, also seen in the browning of foods high in carbohydrates and sugars, such as apples and potatoes.²⁹  The stain mechanism has also been described as a result of a local precipitation reaction between tooth-bound chlorhexidine and chromogens found within foodstuffs and beverages.⁹

To counteract the staining drawback of chlorhexidine rinses, several studies have examined different delivery systems and stain control approaches for their effects on chlorhexidine stain.  These have included chewing gums,^10,15 sprays and gels,¹¹ a less concentrated formulation,^12,13,16 a morning vs. evening rinse time,¹⁷ incorporation of chlorhexidine into a dentifrice,^18,19 use of a sonic toothbrush,³⁰ oxidizing mouthwash,^14,31 toothpicks,³⁴ tartar control dentifrice,²⁰ and a whitening toothpaste.^21,35,36,37

To date, most studies utilizing whitening dentifrices have examined subsequent stain removal after the occurrence of chlorhexidine induced stain.  This study examines the control of initial stain deposition rather than removal of pre-existing chlorhexidine stain.

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