Not All Chlorine Dioxide Mouthwashes Are Created Equal: A Clinical Comparison

If you've shopped the oral care aisle lately or explored professional dental products, you've likely encountered familiar names like CloSYS, TheraBreath, and OxyFresh. Perhaps you've heard dental colleagues mention OraCare or ProFresh. All of these products claim to harness the power of chlorine dioxide for oral health benefits, but here's what many clinicians don't realize: not all chlorine dioxide is created equal. These products deliver chlorine dioxide in fundamentally different ways—or in some cases, not at all in its active form.

Understanding the practical differences between stabilized and active chlorine dioxide delivery systems is essential for dental professionals who want to integrate evidence-based antimicrobial protocols into their practice. The chemistry matters, the delivery mechanism matters, and the clinical outcomes depend on both.

The Critical Distinction: Stabilized vs. Active Chlorine Dioxide

The term "chlorine dioxide" can refer to very different chemical formulations and delivery mechanisms. At the core of this distinction lies a fundamental question: Is the chlorine dioxide pre-formed and stabilized for storage, or is it generated fresh at the time of use?

Stabilized Chlorine Dioxide Products (Single-Bottle Systems)

Stabilized chlorine dioxide products are designed to remain chemically stable during storage and activate upon contact with the oral environment. These single-bottle systems typically contain sodium chlorite as a precursor compound that converts to chlorine dioxide through various activation mechanisms.

CloSYS uses a proprietary ingredient called Cloralstan®, which is described as stabilized chlorine dioxide or buffered sodium chlorite. According to the manufacturer, this formulation is engineered to remain stable in the bottle and activate when exposed to amino acids in saliva. The product literature emphasizes that CloSYS kills harmful bacteria without the burning sensation associated with alcohol-based mouthwashes, and clinical studies have demonstrated its effectiveness in reducing plaque and gingivitis.

TheraBreath is powered by OXYD-8®, a pH-balanced formula derived from sodium chlorite. Developed by Dr. Harold Katz, TheraBreath products are specifically marketed for their ability to neutralize volatile sulfur compounds (VSCs) that cause bad breath. The OXYD-8 system activates in the mouth to target sulfur-producing bacteria, providing up to 24 hours of fresh breath protection when used twice daily.

OxyFresh features Oxygene®, described as a patented blend of stabilized chlorine dioxide combined with zinc and essential oils. The company emphasizes that Oxygene uses oxidation to break down odor bonds within 60 seconds, eliminating bad breath at its source rather than masking it. OxyFresh products are alcohol-free and fluoride-free, positioning themselves as gentle yet effective solutions for long-term oral health maintenance.

Active Chlorine Dioxide Products (Multi-Bottle or Activation Systems)

Active chlorine dioxide systems generate chlorine dioxide gas at the time of use, ensuring maximum potency and oxidative capacity. These products require either mixing two separate solutions or activating a single bottle before use.

OraCare employs a two-bottle system specifically designed to create activated chlorine dioxide immediately before rinsing. Solution 1 and Solution 2 are mixed in equal parts, and the chemical reaction generates fresh chlorine dioxide gas that dissolves into the rinse. This approach ensures that the antimicrobial agent is at peak effectiveness when it contacts oral tissues. OraCare is often positioned as a professional alternative to chlorhexidine, offering broad-spectrum antimicrobial activity at just 44 parts per million (ppm) compared to chlorhexidine's 1,200 ppm concentration—without the side effects of staining, altered taste, or microbial resistance. The two-bottle design is necessary because chlorine dioxide is a gas that cannot be contained in a sealed single-bottle system without degradation or leakage.

ProFresh uses a single-bottle activation system where the entire bottle is activated at one time using an activator packet. The sodium chlorite solution is converted to chlorine dioxide, but unlike the two-bottle systems, the entire supply is activated at once. This means the chlorine dioxide concentration gradually degrades over the two-week usage period as the gas dissipates. ProFresh cannot be flavored because added ingredients would interfere with the chlorine dioxide chemistry, and users must prepare a new bottle every two weeks to maintain effectiveness.

Where DioxiCare Fits In: The Frontier Pharmaceutical Legacy

DioxiCare, manufactured by Frontier Pharmaceutical, represents a distinct category in the chlorine dioxide oral care market. The company positions DioxiCare as a proprietary active chlorine dioxide delivery system with deep roots in the scientific development of chlorine dioxide technology. Frontier Pharmaceutical's founder, Howard Alliger, invented the underlying patented delivery technology in 1978, establishing the company as a pioneer in chlorine dioxide applications for antimicrobial use.

DioxiCare's formulation is designed to deliver active chlorine dioxide at the time of use, similar to the OraCare two-bottle system. In fact, OraCare is widely recognized as a copy of Frontier's original DioxiRinse Mouthwash, adapted for broader commercial distribution. The key differentiator for DioxiCare is its emphasis on biofilm disruption and selective oxidative action against anaerobic pathogens—the "Red" and "Orange" complex bacteria associated with periodontal disease.

Frontier Pharmaceutical's research has focused on demonstrating that active chlorine dioxide targets sulfur-containing amino acids vital to the survival of anaerobic pathogens, effectively disrupting biofilm architecture and neutralizing inflammatory volatile sulfur compounds (VSCs) without inducing bacterial resistance. This mechanism of action makes DioxiCare particularly well-suited for integration into structured, repeatable hygiene protocols aimed at managing chronic periodontal conditions.

Why This Matters in Real-World Clinical Protocols

For dental hygienists and clinicians implementing biofilm-focused antimicrobial care, the question isn't simply "Does it say chlorine dioxide on the label?" The critical considerations are:

1. Is it a stabilized precursor system (single bottle) or activated at time of use (two-part or activation system)?
2. How consistently does it deliver the oxidative effect you're trying to achieve?
3. Does the delivery system align with your clinical goals—breath management, biofilm disruption, or periodontal pathogen reduction?

Stabilized systems like CloSYS, TheraBreath, and OxyFresh offer convenience and ease of use for patients seeking daily maintenance and breath management. They activate gradually in the oral environment and are well-suited for long-term home care without complex preparation steps.

Active systems like OraCare, ProFresh, and DioxiCare provide higher concentrations of freshly generated chlorine dioxide, making them more appropriate for intensive antimicrobial interventions, biofilm disruption, and management of active periodontal disease. The trade-off is slightly more complex preparation (mixing or activation), but the clinical benefit is a more potent and immediate oxidative effect.

My Take for Clinical Teams

Each of these products—CloSYS, TheraBreath, OxyFresh, OraCare, ProFresh, and DioxiCare—uses chlorine dioxide-related chemistry in different ways, and each has a role in comprehensive oral care. The choice depends on your clinical objectives:

• For daily maintenance and breath management: Stabilized systems (CloSYS, TheraBreath, OxyFresh) offer patient-friendly, convenient solutions with proven efficacy for reducing VSCs and maintaining oral freshness.
• For intensive biofilm disruption and periodontal pathogen management: Active systems (OraCare, ProFresh, DioxiCare) deliver higher concentrations of freshly generated chlorine dioxide, providing more aggressive antimicrobial action.
• For evidence-based protocols rooted in foundational research: DioxiCare stands out for teams that want an active chlorine dioxide delivery platform with deep roots in the category's technical development and a framework that can be integrated into structured, repeatable hygiene protocols.

Understanding these distinctions empowers you to make informed recommendations tailored to each patient's needs, ensuring that your antimicrobial interventions are both scientifically sound and clinically effective.

About the Author: Janice Rountree, FAAOSH, IAOMT, is a dental hygienist and integrative oral health specialist with over 25 years of clinical experience. She specializes in biofilm disruption protocols and the therapeutic use of chlorine dioxide in periodontal disease management.

References

1. CloSYS Professional - Cloralstan Technology
2. TheraBreath - OXYD-8 Formula
3. OxyFresh - The Science Behind Oxygene
4. OraCare - Two-Bottle Activated System
5. ProFresh - Activation System
6. Frontier Pharmaceutical - Active Chlorine Dioxide Technology
7. Travis BJ, et al. "Significance of chlorine-dioxide-based oral rinses in periodontal therapy." Journal of Periodontology. 2022. PMC9349900
8. Kerémi B, et al. "Effects of Chlorine Dioxide on Oral Hygiene." PubMed Central. 2020. PMC8383470

Ready to Implement Active Chlorine Dioxide in Your Practice?

If you're interested in exploring DioxiCare's active chlorine dioxide delivery system for your clinical protocols, Frontier Pharmaceutical offers a complete product line designed for professional dental applications.

Explore DioxiCare Products →

Frontier Pharmaceutical's DioxiCare line includes:

• DioxiRinse – Two-bottle activated chlorine dioxide mouth rinse system for professional and home use
• DioxiBrite – Active ClO₂ toothpaste for daily biofilm management
• Professional protocols – Evidence-based implementation guidance for dental teams

Visit frontierpharm.com to learn more about integrating active chlorine dioxide technology into your practice's antimicrobial protocols.