Antiseptic Mouthwashes After Dental Surgical Procedures: Comparative Antimicrobial and Antibiofilm Efficacy Against Oral Postoperative Pathogens

Abstract

This in vitro study compared the antimicrobial and antibiofilm efficacy of four commercially available chlorhexidine (CHX)-based mouthwashes, with different nominal CHX concentrations, against clinically relevant postoperative oral pathogens, including Staphylococcus aureus, Streptococcus mutans, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and Candida auris. Antimicrobial potency was evaluated using MIC and CEMIC indices, while biofilm thickness reduction was quantified using 3D digital microscopy and custom image analysis software. Among the tested formulations, the excipient-enriched formulation exhibited the lowest MIC values and the most significant reduction in biofilm thickness, particularly against Gram-negative bacteria and Candida species. All mouthwashes achieved CEMIC < 0.1, confirming high theoretical applicability margins; however, CEMIC reflects potential clinical usefulness rather than clinical superiority. The findings demonstrate that the antimicrobial and antibiofilm activity of CHX rinses is formulation-dependent and cannot be predicted solely by CHX concentration. The influence of excipients is discussed as a possible contributing factor, but related mechanisms remain speculative and require direct validation in future studies. This work supports a formulation-driven, evidence-based approach to antiseptic comparison in postoperative dentistry, without assessing clinical wound-healing outcomes.