Effect of Subgingival Irrigation with Natural Products as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis- A Systematic Review

Abstract

Introduction: Various chemotherapeutic agents such as ‘Chlorhexidine’ (CHX), ‘Metronidazole’, ‘Povidone-iodine’ are used as a subgingival irrigant for management of periodontitis, but they have their own drawbacks. There has been renewed interest in naturally occurring products such as ‘Curcumin’, ‘Honeybee extract’ etc., which claim to have the same or even more anti-microbial effect and anti-inflammatory effect without adding any chemicals. Aim: To systematically review the role of subgingival irrigation of natural products as an adjunct to scaling and root planing in chronic periodontitis based on clinical and microbiological outcomes. Materials and Methods: A Search was performed on electronic databases, such as PUBMED, Cochrane central register of controlled trials, Google scholar and Science, direct using various search terms such as “Sub gingival irrigation”, “Natural products”, “Plant products”, “Herbal products”, “Nonsurgical therapy”, “Scaling and root planing”. Literature search of articles was done from October 2006 to October 2016. No language restrictions were applied during the electronic search to include all the possible clinical trials. The article search was then narrowed down by the reviewer according to the inclusion criteria of the present systematic review to include all the RCTs in English language only and the article involving management of chronic periodontitis by using natural products for subgingival irrigation. Additional search was also carried out in all relevant journals from October 2006 to October 2016. Results: The literature search resulted in 91 articles out of which 87 articles were excluded based on title, in-vitro studies, chemical plaque control used during the study period, studies in which control group was not present. Finally, four studies which satisfied all the inclusion criteria were included and evaluated. Out of four studies, there was lack of homogeneity among the studies, hence pooling of data was not possible. Three studies showed significant difference in clinical parameters on using natural products as subgingival irrigant. Conclusion: Based on the results obtained from present systematic review it can be concluded that natural products when used as a subgingival irrigant along with scaling and root planing in management of chronic periodontitis, there is significant reduction in microbial count (found in three studies) and a significant difference in clinical parameters (found in two studies). But further studies evaluating various other natural products and long term randomised control trial are needed to give strong conclusive evidence.

Keywords

• chemotherapeutic agents
• chlorhexidine
• non-surgical periodontal therapy