Though Chlorhexidine (CHX) is becoming an accepted mouth rinse for reducing mutans streptococci (MS) levels in the mouth, many people do not show significant response to the usual two week every three months regimen. Objectives: To evaluate the effectiveness of a modified CHX regimen on reducing the load of cariogenic bacteria over the usual CHX regimen. Also, to determine other factors, including compliance and multidimensional health locus of control, associated with being a non-responder. Methods: In a three year clinical trial, subjects (n=62) were randomized to an intervention group with a specialized treatment plan including CHX and fluoride mouth rinses to reduce caries incidence or to a control group with usual care (n=52). Periodic salivary sample assays measured MS and lactobacilli (CFU), as well as fluoride (ppm). Most subjects showing little response to the CHX were switched to a modified one week every month CHX regimen. Log₁₀ values of MS CFU before and after regimen change for responders (n=25) and non-responders (n=24) were analyzed to determine effectiveness of the modified regimen. Baseline and final questionnaires provided information on oral hygiene and lifestyle habits. Results: Non-responding subjects receiving the modified CHX regimen experienced a mean log₁₀MS drop from baseline of 1.35, while non-responders under the original regimen increased 0.24 (mean difference 1.59; 95%CI: -0.15, 3.34; p=0.072). Analysis of questionnaire items showed a positive correlation between frequency of flossing and log₁₀MS drop from baseline (p=0.047) for intervention group subjects. Conclusions: The modified CHX regimen may be more effective at reducing MS levels in non-responding subjects than the traditional regimen; more frequent flossing is significantly associated with increased CHX mouth rinse reduction in MS levels. Supported by US DHHS NIH/NIDCR grant R01DE12455

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