Chlorhexidine mouthwash can be used 24 hours after a tooth extraction and you can rinse with it for as long as 2 weeks.
These recommendations for when you should use it and for how long to use it for are not arbitrary because there are adverse effects if you don't adhere to them.
Chlorhexidine rinsing guidelines:
When can I use chlorhexidine after tooth extraction?
When you can start using chlorhexidine (CHX) gluconate oral rinse is 24 hours after having your tooth removed. Yes, you need to wait a full 24 hours before you can begin rinsing with it. That means you should not use CHX during the first 24 hours after the extraction.
Consequence of rinsing before 24 hours
If you do not wait 24 hours before using chlorhexidine, there can be adverse effects such as non-stop bleeding from the extraction socket.
Rinsing too soon can potentially dislodge the unstable blood clot that is trying to form. The consequence of that is continued bleeding which is not what you want. You want the socket to achieve hemostasis and stop bleeding.
How it happens:
Rinsing with chlorhexidine can generate intraoral pressure in the mouth that can dislodge the forming blood clot.
Once the clot is gone, you will continue to bleed until another blood clot reforms.
In summary, if you use the chlorhexidine rinse within the first 24 hours after your extraction, you may risk continued bleeding if you dislodge the clot. However, this situation isn't unique to using CHX because the same thing can happen even if you rinse with salt water.
Ultimately, you're forbidden to rinse during the first 24 hours after tooth removal. That is a part of the standard extraction aftercare protocol.
How to use it
The directions for use do not include any instructions about when you should rinse after removing a tooth. It only tells you how much and how often to rinse with it if you were prescribed it.
How to rinse with chlorhexidine:
After breakfast, brush your teeth.
Rinse with chlorhexidine for 30 seconds.
Spit out and do not rinse with water.
After dinner, brush your teeth and floss.
Rinse with CHX for 30 seconds.
Spit out and do not rinse with water.
The reason that there are no directions for after oral surgery procedures is that the rinse isn't specifically for extractions. It is a general antibacterial rinse that is used for oral purposes.
How long to use it for
After your tooth extraction, you should only use chlorhexidine mouthwash for as long as two weeks only. You should not use it for longer than 14 days because this mouth rinse can be very staining and a normal prescription for it is only enough for 2 weeks anyway.
The standard sized bottle for this prescription rinse comes in a 473 mL bottle. You're supposed to rinse with 15 mL of the solution twice a day. That means you will be using roughly 30 mL of CHX each day.
If you do the math, that equates to a little over 15 days of bidaily use. Due to the limiting size of the prescription regime, that dentists typically tell patients that you should only use it for as long as 2 weeks.
Of course the exception would be if you had a refill. However, if there is no refill marked on the bottle then it means that your dentist only wants you to use it for 14 days.
Consequences of use for longer than 2 weeks
Chlorhexidine stains are a well known side effect when it is used long term. It can potentially stain your teeth, tongue, and even your dental restorations if you don't maintain a strict oral hygiene regime.
In case you don't believe us, CHX's staining ability is listed on the precautions label.
It can stain your enamel, tongue, and dental restorations.
It can also cause taste alterations.
Stains can be minimized with good brushing and flossing.
Your dentist can remove the stains with a cleaning but visit will take longer.
Chlorhexidine after wisdom tooth extraction
After wisdom teeth removal, you should wait 24 hours before you rinse with chlorhexidine and you should only use it for as long as 2 weeks.
Essentially, there is no difference in how you use this prescription antibacterial rinse whether you've had your wisdom tooth taken out or if you had a regular tooth extracted. The post-operative instructions remain the same and the type of tooth does not make a difference.
Benefits of using chlorhexidine after wisdom teeth removal
The primary benefit of rinsing with chlorhexidine mouthwash after extracting wisdom teeth is that it can potentially reduce the chances of dry socket. It most likely won't help with the surgical pain but it will help prevent infections.
Research have shown that CHX can in fact reduce the incidence of alveolar osteitis (dry socket). As a matter of fact, rinsing with chlorhexidine for 2 weeks after the extraction can reduce the risk by as much as 56%.
This is especially helpful if the patient is at high risk for developing a dry socket.
Dry socket risk factors:
Smokers. Studies have shown that smokers (12%) are 3 times more likely to get dry socket vs non-smokers (4%).
Previous incidence. If you've had this condition before you will be more likely to get it.
Impacted lower wisdom teeth. Impacted lower wisdom teeth have the highest chance of developing a dry socket.
If you have any of the above, you may benefit from rinsing with it for at least 2 weeks after having the third molars removed.
Dos & Don'ts
Wait 24 hours after your extraction to begin using chlorhexidine.
Use the mouth rinse for 2 weeks at most.
Use twice daily, once after breakfast and again after dinner time.
Do not rinse during the first 24 hours after your tooth removal.
Do not use for longer than 2 weeks.
Don't rinse with water immediately afterwards to minimize medicinal taste.
After your tooth extraction or wisdom tooth removal, if you were prescribed chlorhexidine you can begin rinsing with it after the first 24 hours. You may continue to use it for up to 2 weeks and it'll help you prevent infections and dry socket.