Oral bacterial microcosms, established using saliva inocula from three individuals, were maintained under a feast-famine regime within constant-depth film fermenters. Steady-state communities were exposed four times daily, postfeeding, to a chlorhexidine (CHX) gluconate-containing mouthwash (CHXM) diluted to 0.06% (wt/vol) antimicrobial content. The microcosms were characterized by heterotrophic plate counts and PCRdenaturing gradient gel electrophoresis (DGGE). CHXM caused significant decreases in both total anaerobe and total aerobe/facultative anaerobe counts (P < 0.05), together with lesser decreases in gram-negative anaerobes. The degree of streptococcal and actinomycete inhibition varied considerably among individuals. DGGE showed that CHXM exposure caused considerable decreases in microbial diversity, including marked reductions in Prevotella sp. and Selenomonas infelix. Pure-culture studies of 10 oral bacteria (eight genera) showed that Actinomyces naeslundii, Veillonella dispar, Prevotella nigrescens, and the streptococci were highly susceptible to CHX, while Lactobacillus rhamnosus, Fusobacterium nucleatum, and Neisseria subflava were the least susceptible. Determination of the MICs of triclosan, CHX, erythromycin, penicillin V, vancomycin, and metronidazole for microcosm isolates, before and after 5 days of CHXM exposure, showed that CHXM exposure altered the distribution of isolates toward those that were less susceptible to CHX (P < 0.05). Changes in susceptibility distributions for the other test agents were not statistically significant. In conclusion, population changes in plaque microcosms following repeated exposure to CHXM represented an inhibition of the most susceptible flora with a clonal expansion of less susceptible species.Chlorhexidine (CHX), a cationic bis-biguanide biocide with low mammalian toxicity and broad-spectrum antibacterial (6) activity, was first described in 1954 (5). The primary mechanism of action of this biocide is membrane disruption, causing concentration-dependent growth inhibition and cell death (18). Secondary interactions causing inhibition of proteolytic and glycosidic enzymes may also be significant (15). With respect to dental hygiene applications, the cationic nature of CHX enables it to bind to tooth surfaces and oral mucosa, reducing pellicle formation and increasing substantivity through controlled release of the agent (2). The efficacy of CHX in reducing oral bacterial viability (14,36,42), strongly inhibiting plaque regrowth, and preventing gingivitis (25) has been demonstrated in many studies (7). Relatively few investigations have considered longer-term effects of CHX use. An early study, however, demonstrated that oral treatment of human volunteers with CHX resulted in a 30 to 50% reduction in total bacterial counts with an associated reduction in counts of Streptococcus mutans (38).Recent reports have demonstrated that the chlorinated diphenylether antibacterial triclosan (TCS) can select for mutants in the FabI gene of Escherichia coli at sublethal co...