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. 2022 Mar 12;72(3):269–277. doi: 10.1016/j.identj.2022.01.005

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© 2022 The Authors

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Fig — Mechanism of action (MOA) for chlorhexidine. Stage 1: Positively charged chlorhexidine is attracted to the negative charge on the bacterial cell wall.18, 19, 20 Stage 2: Chlorhexidine forms specific and strong adsorption to phosphate-containing molecules that are on the surface of the bacterial cell.¹⁹^,²² Stage 3 (bacteriostatic): Penetration through the bacterial cell wall occurs, damaging it and compromising its integrity. The result is an outflow of low-molecular-weight cytoplasmic components, such as potassium ions, and inhibition in the activity of some of the enzymes associated with the cytoplasmic membrane.¹⁹ Stage 4 (bactericidal): Cytoplasmic coagulation and precipitation occur by forming complexes with phosphorylated compounds, such as adenosine triphosphate (ATP) and nucleic acids.¹⁸^,¹⁹^,²²