Hydrogen peroxide solution after implant or perio surgery?

Cases and Questions
#1

Do you recommend a mouthwash containing hydrogen peroxide (3%) after implant or perio surgery?

#2

Guest comments:

No. Always CHX.
#3

Aquiles Mas comments:

No. The fizz will bubble out and break down clots. And cause havoc with your surgical site. CHX is the way to go.
#4

Sharon Mateja comments:

Have you considered OraCare? It is a 2 part system mixed equally and forms active Chlorine Dioxide. It kills virus, bacteria, fungus, does not fizz, is FDA approved and it kills SELECTIVELY unlike hydrogen peroxide that kills everything and desiccates tissue.
#5

Tim comments:

I have always used CHX, as I was trained that way in my perio residency 15 years ago, but I can't imagine that it would be a problem. While I still use CHX I am not aware that it has any magical benefits in fact it has been shown to inhibit fibroblast attachment and we have all seen how it stains teeth. I have switched to using ioRinse presurgical rather than CHX and if it were more readily available I would probably prescribe it instead. I assume the other people that posted have some first hand knowledge of the detrimental effects of peroxide but with good surgical technique I can't imagine it being much of a problem. For now though it aint broke so I aint gonna fix it.... I will continue with my CHX BID for 7 days.
#6

Daniel Camm comments:

There are some studies that indicate that chlorhexidine inhibits healing of surgical sites. I would never use peroxide. It will destroy clot formation. I am using a regimen developed by StellaLife. Many clinicians are beginning to use it. I heard about it from Mike Pikos. Check out the StellaLife website. My contact person is Mark Sirota. (305) 900-8552
#7

Tim comments:

Stella Life is a great product and I routinely recommend it for patients that insist on using an everyday product. My only issue with it is that it it OTC and fairly expensive and I refuse to be a dispensing pharmacy. Check out the Stella Life Gel too as I think it is the best product in their line. Another good option would be Thera Stom from Forward Science
#8

OMS, PhD comments:

There are studies looking at a possible relation to chlorhexidine (CHX) and a decrease in cellular proliferation with specific inhibition of early fibroblastic formation and collagen synthesis. Studies have found that the drug DOES do this but it is DOSE dependent. Chlorohexidine in oral solution is 0.12%. Chlorhexidine used for skin preps and operative scrubs on average are 2% commonly but also 3%. Some pulpal treatments are 2%. Studies indicated that around 0.2% or higher began to show some cellular inhibition but did have a marked slowing of cellular proliferation. Somehow, this was confounded to the oral dosing and concentration. Studies at this dose did show some cellular slowing but no direct inhibition (1). However, Marrotti (2) found the same dose dependent observation but at far lower concentrations. As such, it is difficult to know exactly how it affects the healing process of a wound.

There are four stages of wound healing. The 4 phases of hemostasis, inflammation, proliferation and remodeling. Fibroblasts are critical in the hemostasis phase and the proliferation stage. The hemostasis phase should be completed within a few hours to a day or so following injury. Followed by the inflammation phase which is (1-3 days) but up to a week and then the proliferation stage (4 days to 21 days) and then the remodeling stage (3 weeks and beyond depending on the tissue involved, degree of injury and the host factors). Thus, looking at that model, it may be prudent not to use the CHX for 24 hours and stop at day 5-7. However, the other issue is bacteria on the wound surface versus cellular proliferation reduction. Which has a more deleterious action on wound healing?

Stellalife is another product with great claims but is not regulated by the FDA similar to other supplements like Ginko, etc and other homeopathic remedies. The ingredients are Arnica, Calendula, Chamomilla, Echinacea A & P, Hepar Hypericum, Ignatia, Ledum palustre, Ruta, Silicea, Staphysagria. Inactive ingredients: Allantoin, Hydroxyethylcellulose, Peppermint oil, Sodium benzoate, Xylitol, Purified Water. Those ingredients should not make the medicament so pricey. You can read their research here Research - StellaLife . Some studies, not the best designed, and many of the studies listed are “case reviews.” However, the biochemistry study, “Cytocompatibility Properties of an Herbal Compound Solution Support In vitro Wound Healing” did have some interesting observations regarding cellular activity and wound width to healing time comparing CHX and Stellalife.

  1. Clive and Layman, The effects of chlorhexidine on the attachment and growth of cultured human periodontal cells. J Periodontol
    . 1992 Jul;63(7):598-602. doi: 10.1902/jop.1992.63.7.598

  2. Marrotti and Rumph, Chlorhexidine-induced changes to human gingival fibroblast collagen and non-collagen protein production. J Periodontol
    . 1999 Dec;70(12):1443-8. doi: 10.1902/jop.1999.70.12.1443