Rinsing with chlorhexidine gluconate (CHX) may help a toothache if the source of the pain stems from the surrounding soft tissue like the gums. Although if the source comes from hard tissue that is not easily accessible by this prescription rinse, it will be ineffective.
Ultimately, whether this prescription rinse can help your tooth pain would depend on what oral condition you're afflicted by.
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When chlorhexidine can relieve a toothache
Using the chlorhexidine oral rinse can help alleviate a toothache but only for some dental conditions, not all of them. For the most part, it will help relieve some of the pain only if the conditions involve the gums (gingiva).
Conditions it helps with:
Pericoronitis (gum inflammation around wisdom tooth).
Gum infection or gum pain.
Gum injury (eating, toothbrushing, flossing, etc).
The reason chlorhexidine can help with these types of tooth pain is that the source is more external than internal. Since the gums are facing the oral environment directly, it permits this prescription rinse to directly exert its topical effects on it.
Rinsing with chlorhexidine is one of the best ways to alleviate tooth pain from pericoronitis, which is gum inflammation around a wisdom tooth. The gingiva will often look red, poofy, swollen, and bleeds very easily.
Partially impacted wisdom teeth are the most prone to pericoronitis because food can become lodged underneath of the gum flap.
Stuck food will cause gum swelling and inflammation, which can be quite painful.
This is one of the most common causes of wisdom teeth emergency visits.
Why it works: Chlorhexidine is superb at reducing bacteria, gum swelling, gum bleeding, and gum inflammation. Since the swollen gums are easily accessible to the topical effects of this medicated rinse, it will help relieve your toothache.
Typically the pain should gradually subside after rinsing twice daily with CHX for about 2 weeks. That is how long it takes for the condition to completely resolve but you will notice a gradual improvement with each passing day.
Pain from a gum infection can be partially alleviated by rinsing with chlorhexidine. Depending on why it got infected and what caused it, it can potentially get rid of the toothache completely or only partially.
Types of gum infections:
Gum abscess. If there is an abscess, the antibacterial rinse will only be able to prevent the condition from getting worse. It will not cure it completely but you should still feel better rinsing with it than if you weren't rinsing with it.
Stuck food. Food that is lodged into the gums such as a fish bone, tortilla chip, popcorn kernel, etc will cause it to swell up. The medicated rinse will help control the swelling.
Gum disease. Gingivitis or periodontitis will induce gum swelling, bleeding, and pain. The very mild forms can be alleviated with CHX but the more severe ones will require professional dental treatment such as a deep teeth cleaning.
Why it works: Fortunately, most of these gum infections are located in an area where the prescription rinse can reach topically. This means its full effects can be exerted on it and help manage your symptoms.
However, depending on the severity of the infection the most that this oral rinse can do is prevent it from getting worse or slow down its progression.
If you injury the gums, using the chlorhexidine oral rinse can help speed up the healing and recovery process. This in turn will lessen the amount of pain.
Sources of gum injury:
Food. Most commonly pizza burns, soup burns, or scratching the gums with hard sharp food like tortilla chips.
Aggressive brushing. Brushing your teeth too hard especially with a hard bristled brush can injure the gums. In severe situations, you can even cause the gums to recede permanently. No, it will not grow back naturally on its own afterwards.
Aggressive flossing. If you floss too deep or too hard, you can also injure the delicate gingiva. Please be mindful not to be so aggressive. If you feel that the floss is having a tough time going through, you can try a thinner floss made of "silk".
When chlorhexidine can't help tooth pain
When rinsing with chlorhexidine won't help with your toothache is if the source of the pain is located internally within the tooth. The antibiotic rinse will not be able to reach the source of what is hurting you, thus rendering it completely ineffective for pain relief.
Toothaches chlorhexidine can't relieve:
Abscesses around the apex of the tooth root.
Fractured teeth are beyond what an antibiotic mouth rinse can treat.
Pain from the tooth nerve can only be relieved via mechanical means.
Cavities cannot be treated with a mouthwash.
Chlorhexidine mouthwash is completely ineffective for relieving toothaches caused by periapical abscesses. This is an infection that is located at the tip of the tooth root that is deeply embedded into your jaw bone.
The mouth rinse won't work because the liquid solution is unable to reach the periapical abscess. The infection is essentially protected by the bone in your jaw and also your gums. These two layers form a protective barrier insulating it from topical medications.
If you fractured your tooth, rinsing with chlorhexidine will do nothing to relieve the pain. The only way to get relieve is by repairing the fracture if it is mild or extracting the tooth if it is severe.
You know that mouthwashes can't repair broken teeth right?
Tooth nerve pain
You can try rinsing with chlorhexidine as much as you want but if your toothache is coming from the tooth nerve, you are wasting your time. The reason the medicated mouthwash has no effect is because the source of the pain is coming from within the tooth.
The nerve is located in the center of the tooth and is insulated and protected by layers of dentin and enamel. These two layers are impervious to topical medications so it will be ineffective.
We can all wish that a prescription mouthwash can eliminate tooth decay and relieve the pain but unfortunately that is impossible. Cavities can only be mechanically removed by drilling it out and only your dentist can do that.
Since you are unable to get rid of the cavity, the pain will persist despite continuously rinsing with CHX. Therefore, you most likely won't get any pain relief from using it.
While chlorhexidine gluconate oral rinse is a fantastic antiseptic mouthwash, it can't relieve all toothaches. If the source of your pain involves the gums then it may be able to alleviate some of the discomfort. However, if it is coming from within the tooth or some other deeply embedded oral structure, it will be ineffective at reducing tooth pain.
Nonetheless, we recommend seeing a dentist for a dental check up if you are having a toothache. You never know what exactly is the cause and what kind of treatment you need. The only way to be sure is by getting a proper diagnosis and proper dental treatment.