Comparative Efficacy of Probiotic Versus Chlorhexidine Mouthwash as an Adjunct to Scaling and Root Planing in Patients with Chronic Periodontitis: A Randomized Triple-Blind Clinical Trial

Abstract

Background: Periodontitis is a chronic inflammatory disease characterized by the progressive destruction of tooth-supporting tissues, ultimately leading to tooth loss if left untreated. Scaling and root planing (SRP) serves as the standard non-surgical periodontal treatment, but patients receive increased benefits from combining this treatment with antimicrobial agents and probiotics. Objectives: This study aims to provide high-quality evidence on the clinical effectiveness of probiotic mouthwash in periodontal therapy. Methods: In this randomized triple-blind trial, 42 patients with mild to moderate chronic periodontitis [probing pocket depth (PPD) 3 - 7 mm, ≥ 20 teeth, systemically healthy] were enrolled. After SRP, participants were randomly assigned to use 10 mL of either: (1) Lactobacillus salivarius NK02 mouthwash, (2) 0.2% chlorhexidine mouthwash, or (3) normal saline (placebo) twice daily for one minute, 30 minutes after brushing, for one month. Clinical parameters [PPD, Modified Gingival Index (MGI), bleeding on probing (BOP)] were recorded at baseline, 1 month, and 3 months. Results: The periodontal parameters showed significant changes in every treatment group after receiving SRP therapy. Reductions in PPD, MGI, and BOP at the one-month appointment reached their highest levels among participants who received chlorhexidine treatment. At the three-month assessment, inflammatory parameter data failed to show significant differences between the groups. Conclusions: The outcomes showed no substantial distinction between the utilization of probiotic mouthwash compared to placebo. The independent use of SRP delivered improved periodontal health, but chlorhexidine mouthwash added greater short-term advantages to these outcomes. Research indicated that the probiotic mouthwash containing L. salivarius NK02 showed no significant clinical improvements. Further research is needed to determine which probiotic strains are most effective, the proper dosing amounts, and the extended treatment effects necessary to establish their usefulness in periodontal care.