J Korean Acad Periodontol.  2009 Sep;39(3):303-310. 10.5051/jkape.2009.39.3.303.

The effect of chlorhexidine on reduction of viable organisms in aerosol produced by ultrasonic scaler

  • 1Department of Periodontics, The Institute of Oral Health Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. pkoyang@skku.edu


The aerosol generated by ultrasonic scaler can contain bacteria or virus which can penetrate into body through respiratory systems of dentists, dental hygienist or patients. The aim of this study is to evaluate the effect of chlorhexidine digluconate as preoperative mouthrinse or lavage for ultrasonic scaler on the reduction of viable organisms in aerosol produced during periodontal treatment using ultrasonic scaler.
30 patients with moderate chronic periodontitis were included and divided into 3 groups: Control (no preoperative mouthrinse and tap water as lavage), CHG (preoperative mouthrinse with 0.1% chlorhexidine digluconate and tap water as lavage), CHL (no reoperative mouthrinse and 0.1% chlorhexidine digluconate as lavage). Each patient received scaling or subgingival curettage for 30 min. In CHG group, mouthrinse with chlorhexidine digluconate was performed for 1 min. before treatment. Before, during and after scaling or subgingival curettage, air sampling was performed for 7 min. each (1000 L/7 min.) with trypticase-soy agar plate. Agar plates were incubated in 37degrees C aerobically. The numbers of colony-forming units (CFU) were counted and compared.
The numbers of CFUs of the samples obtained during treatment were 97+/-14.0 in control, 73.1+/-14.9 in CHG group and 44.5+/-9.0 in CHL group. The difference among the 3 groups was determined to be statistically significant (one-way ANOVA with Bonferroni's correction, p-value: 0.0003). In contrast, the numbers of CFU of samples obtained before and after treatment were not significantly different among the groups.
Chlorhexidine digluconate used as preoperative mouthrinse or lavage for ultrasonic scaler can reduce the microorganisms in aerosol produced during periodontal treatment using ultrasonic scaler. Less number of microorganisms were detected when chlorhexidine was used as lavage for ultrasonic scaler.


aerosols; bacteria; chlorhexidine; ultrasonic therapy

MeSH Terms

Chronic Periodontitis
Dental Hygienists
Respiratory System
Stem Cells
Subgingival Curettage
Therapeutic Irrigation
Ultrasonic Therapy


  • Figure 1 Air sampler (M Air T™, Millipore Corp., Massachusetts, USA) for inhaling the aerosols produced by ultrasonic scaler before, during or after the treatment. The trypticase-soy agar plate is installed at the entrance of the air sampler.

  • Figure 2 Bacterias colonizing on trypticase-soy agar plates (sampled during treatment). Less number of microorganisms were detected when chlorhexidine was used as lavage for ultrasonic scaler.

  • Figure 3 Mean (±SD) numbers of the colony-forming units (CFUs) cultured on the agar plates used during treatment. The numbers CFUs are 97±14.0 in control, 73.1±14.9 in CHG group and 44.5±9.0 in CHL group. The difference among the 3 groups was statistically significant (indicated by *, one-way ANOVA with Bonferroni's correction, p-value: 0.0003).


1. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. I.Moderately advanced periodontitis. J Clin Periodontol. 1981. 8:57–72.
2. Boretti G, Zappa U, Graf H, Case D. Short-term effects of phase I therapy on crevicular cell populations. J Periodontol. 1995. 66:235–240.
3. Lee ES, Moon IS, Chai JK, Kim JK. The comparative study of the effectiveness of ultrasonics and curette for the removal of calculus on the root surface. J Korean Acad Periodontol. 1990. 20:153–163.
4. Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. J Am Dent Assoc. 1994. 125:579–584.
5. Miller RL, Micik RE. Air pollution and its control in the dental office. Dent Clin North Am. 1978. 22:453–476.
6. Legnani P, Checchi L, Pelliccioni GA, D'Achille C. Atmospheric contamination during dental procedures. Quintessence Int. 1994. 25:435–439.
7. Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J Dent Res. 1968. 48:49–56.
8. Harrel SK, Barnes JB, Rivera-Hidalgo F. Aerosol and splatter contamination from the operative site during ultrasonic scaling. J Am Dent Assoc. 1998. 129:1241–1249.
9. Miller RL. Characteristics of blood-containing aerosols generated by common powered dental instruments. Am Ind Hyg Assoc J. 1995. 56:670–676.
10. Rosen S, Schmakel D, Schoener M. Incidence of respiratory disease in dental hygienists and dietitians. Clin Prev Dent. 1985. 7:24–25.
11. Allsopp J, Basu MK, Browne RM, Burge PS, Matthews JB. Survey of the use of personal protective equipment and prevalence of work related symptoms among dental staff. Occup Environ Med. 1997. 54:125–134.
12. Harrel SK, Barnes JB, Rivera-Hidalgo F. Reduction of aerosols produced by ultrasonic scalers. J Periodontol. 1996. 67:28–32.
13. Muir KF, Ross PW, MacPhee IT, Holbrook WP, Kowolik MJ. Reduction of microbial contamination from ultrasonic scalers. Br Dent J. 1978. 145:76–78.
14. Hugo WB, Longworth AR. Some aspects of the mode of action of chlorhexidine. J Pharm Pharmcol. 1964. 16:655–662.
15. Schiott CR, Loe H, Jensen SB, et al. The effect of chlorhexidine mouthrinses on the human oral flora. J Periodontal Res. 1970. 5:84–89.
16. Basu MK, Browne RM, Potts AJ, Harrington JM. A survey of aerosol-related symptoms in dental hygienists. J Soc Occup Med. 1988. 38:23–25.
17. Suppipat N. Ultrasonics in periodontics. J Clin Periodontol. 1974. 1:206–213.
18. Leggat PA, Kedjarune U. Bacterial aerosols in the dental clinic: a review. Int Dent J. 2001. 51:39–44.
19. Micik RE, Miller RL, Leong AC. Studies on dental aerobiology: 3. Efficacy of surgical masks in protecting dental personnel from airborne bacterial particles. J Dent Res. 1971. 50:626–630.
20. Willeke K, Qian Y, Donnelly J, Grinshpun S, Ulevicius V. Penetration of airborne microorganisms through a surgical mask and a dust/mist respirator. Am Ind Hyg Assoc J. 1996. 57:348–355.
21. Williams GH 3rd, Pollok NL 3rd, Shay DE, Barr CE. Laminar air purge of microorganisms in dental aerosols: prophylactic procedures with the ultrasonic scaler. J Dent Res. 1970. 49:1498–1504.
22. Trenter SC, Walmsley AD. Ultrasonic dental scaler: associated hazards. J Clin Periodontol. 2003. 30:95–101.
23. Riley RL, Knight M, Middlebrook G. Ultraviolet susceptibility of BCG and virulent tubercle bacilli. Am Rev Resp Dis. 1976. 113:413–418.
24. Lang NP, Brecx MC. Chlorhexidine digluconate-an agent for chemical plaque control and prevention of gingival inflammation. J Periodont Res. 1986. 21:Suppl 16. 74–89.
25. Puig Silla M, Montiel Company JM, Almerich Silla JM. Use of chlorhexidine varnishes in preventing and treating periodontal disease. A review of the literature. Med Oral Patol Oral Cir Bucal. 2008. 13:257–260.
26. Kolahi J, Soolari A. Rinsing with chlorhexidine gluconate solution after brushing and flossing teeth: a systematic review of effectiveness. Quintessence Int. 2006. 37:605–612.
27. Grossman E, Reiter G, Struzenberger OP, et al. Six-month study on the effects of a chlorhexidine mouthrinse on gingivitis in adults. J Periodont Res. 1986. 21:Suppl 16. 33–43.
28. Lee ME, Cho KS, Chai JK, Kim JK. The antimicrobial and clinical effects of a single subgingival irrigation of chlorhexidine and tetracycline solution in periodontal pocket. J Korean Acad Periodontol. 1990. 20:133–152.
29. Um HS, Han SB. Effect of subgingival chlorhexidine irrigation on bacteria invaded the periodontitis- affected roots. J Korean Acad Periodontol. 1989. 19:35–45.
30. Quirynen M, Avontroodt P, Peeters W, et al. Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation. J Clin Periodontol. 2001. 28:1127–1136.
31. Ciancio S. Expanded and future uses of mouthrinses. J Am Dent Assoc. 1994. 125:29–32.
32. Logothetis DD, Martinez-Welles JM. Reducing bacterial aerosol contamination with a chlorhexidine gluconate prerinse. J Am Dent Assoc. 1995. 126:1634–1639.
33. Wirthlin MR, Choi JH, Kye SB. Use of chlorine dioxide mouthrinse as the ultrasonic scaling lavage reduces the viable bacteria in the generated aerosols. J West Soc Periodontol Periodontal Abstr. 2006. 54:35–44.
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