Adjunctive Use of Chlorhexidine and Metronidazole Gels in Periodontal Disease: An Observational Study: Use of Chlorhexidine and Metronidazole Gels in Periodontal Disease

Sitwat Sagheer; Talea Hoor; Farzeen Tanwir; Izrum Shafi Rajput; Syeda Javeria Ikram; Urooj Zafar

doi:10.54393/pjhs.v6i10.3139

Authors

Sitwat Sagheer Department of Pharmacology, Bahria University Health Science Campus, Karachi, Pakistan
Talea Hoor Department of Pharmacology, Bahria University Health Science Campus, Karachi, Pakistan
Farzeen Tanwir Department of Periodontology, Bahria University Health Science Campus, Karachi, Pakistan
Izrum Shafi Rajput Department of Pharmacology and Therapeutics, Baqai Dental College, Baqai Medical University, Karachi, Pakistan
Syeda Javeria Ikram Department of Pharmacology and Therapeutics, Baqai Dental College, Baqai Medical University, Karachi, Pakistan
Urooj Zafar Department of Pharmacology and Therapeutics, Baqai Dental College, Baqai Medical University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i10.3139

Keywords:

Chlorhexidine, Metronidazole, Bleeding on Probing, Probing Depth, Oral Hygiene Index

Abstract

Periodontal inflammation is characterized by gingival bleeding, pocket formation, and compromised oral health. Objectives: To evaluate the periodontal effects of Chlorhexidine (CHX) gel and Metronidazole (MET) gel in individuals with periodontal inflammation. Methods: This observational longitudinal study included a total of 48 participants who were enrolled at the Dental OPD and divided into two groups. Group A received 0.2% CHX gel, and Group B received 0.8% MET gel. Both gels were applied twice daily for 14 days following scaling and root planing. Oral hygiene maintenance and adherence to gel application were monitored through patient diaries and follow-up visits. Clinical parameters, including bleeding on probing (BOP), probing depth (PD), periodontal index score, and oral hygiene index (OHI), were recorded at baseline and after 14 days using a standardized periodontal probe. Results: In the CHX group, BOP significantly reduced from 26.13 ± 8.14 to 15.38 ± 6.36 (p = 0.001), while OHI improved from 22.67 ± 5.55 to 5.71 ± 2.90 (p < 0.001). Similarly, the MET group demonstrated a significant reduction in BOP from 24.67 ± 3.25 to 8.58 ± 3.78 (p < 0.001) and OHI from 24.58 ± 5.11 to 6.71 ± 3.22 (p < 0.001). However, no significant change was observed in probing depth for either group (CHX: p = 0.705; MET: p = 0.705). Conclusions: The use of CHX and MET gels significantly decreases BOP and improves OHI, but no significant change was on probing depth, demonstrating their effectiveness in reducing periodontal inflammation without affecting pocket depth.

References

Nazir M, Al-Ansari A, Al-Khalifa K, Alhareky M, Gaffar B, Almas K. Global Prevalence of Periodontal Disease and Lack of Its Surveillance. The Scientific World Journal. 2020; 2020(1): 2146160. doi: 10.1155/2020/2146160. DOI: https://doi.org/10.1155/2020/2146160

Ilyosovna YS, Sergeyevich LN, Baxodirovich AB, Rustamovich II. Pathogenesis of Periodontal Diseases Caused by Dental Plaque. Multidisciplinary Journal of Science and Technology. 2024 Apr; 4(4): 273-7.

Jakubovics NS, Goodman SD, Mashburn-Warren L, Stafford GP, Cieplik F. The Dental Plaque Biofilm Matrix. Periodontology 2000. 2021Jun; 86(1): 32-56. doi: 10.1111/prd.12361. DOI: https://doi.org/10.1111/prd.12361

Belibasakis GN, Belstrøm D, Eick S, Gursoy UK, Johansson A, Könönen E. Periodontal Microbiology and Microbial Etiology of Periodontal Diseases: Historical Concepts and Contemporary Perspectives. Periodontology 2000. 2023 Jan; doi: 10.1111/prd.12473. DOI: https://doi.org/10.1111/prd.12473

Mishra P, Bhargava A, Nigam-Gupta N. A Pilot Study to Evaluate the Effectiveness of Adjunctive Use of Two Antimicrobial Topical Gels in Chronic Gingivitis. Journal of Clinical and Experimental Dentistry. 2021 Apr; 13(4): e342. doi: 10.4317/jced.57635. DOI: https://doi.org/10.4317/jced.57635

Panhwar M, Manzar N, Bibi B, Baloch MM, Ayub T, Rehman A. Efficacy of Isolated and Combined Application of Topical Metronidazole and Chlorhexidine in the Treatment of Periodontal Inflammation: A Randomized Controlled Trial. Pakistan Journal of Medical and Health Sciences. 2022 Oct; 16(08): 504-. doi: 10.53350/pjmhs22168504. DOI: https://doi.org/10.53350/pjmhs22168504

Ahmadi H, Ebrahimi A, Ahmadi F. Antibiotic Therapy in Dentistry. International Journal of Dentistry. 2021; 2021(1): 6667624. doi: 10.1155/2021/6667624. DOI: https://doi.org/10.1155/2021/6667624

Abid M, Baig MI, Khurshid A, Kumar A, Farooq S, Iqbal Z. Comparing the Efficacy of Chlorhexidine Mouthwash and Natural Honey in Reducing Plaque and Improving Gingival Health: A Randomized Controlled Trial. Pakistan Journal of Health Sciences. 2024 Mar; 5(05): 95-9. doi: 10.54393/pjhs.v5i05.1548. DOI: https://doi.org/10.54393/pjhs.v5i05.1548

Rosa CDDRD, de Luna Gomes JM, de Moraes SLD, Lemos CAA, da Fonte TP, de Oliveira Limirio JPJ, et al. Use of Chlorhexidine Chip After Scaling and Root Planing on Periodontal Disease: A Systematic Review and Meta-Analysis. The Saudi Dental Journal. 2021 Jan; 33(1): 1-10. doi: 10.1016/j.sdentj.2020.11.002. DOI: https://doi.org/10.1016/j.sdentj.2020.11.002

Zhao H, Hu J, Zhao L. Adjunctive Subgingival Application of Chlorhexidine Gel in Nonsurgical Periodontal Treatment for Chronic Periodontitis: A Systematic Review and Meta-Analysis. BMC Oral Health. 2020 Jan; 20(1): 34. doi: 10.1186/s12903-020-1021-0. DOI: https://doi.org/10.1186/s12903-020-1021-0

Abid M, Rauf R, Siddiq A, Mazhar S, Zaidi HA, Zafar U. Comparison of the Side Effects of Chlorhexidine and Honey Mouthwash Among Dental Patients: A Randomized Controlled Trial. Pakistan Journal of Health Sciences. 2025 Jan; 6(1): 75-9. doi: 10.54393/pjhs.v6i1.1970. DOI: https://doi.org/10.54393/pjhs.v6i1.1970

Gandhi UH, Vyas SD, Mane V, Patel SN, Patadiya HH, Kumar S, et al. The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review. Cureus. 2025 Mar; 17(3). doi: 10.7759/cureus.80547. DOI: https://doi.org/10.7759/cureus.80547

Mahmood HT, Fatima F, Fida M, Sukhia RH, Irfan S, Malik D, et al. Effectiveness of Metronidazole Gel and Mobile Telephone Short-Message Service Reminders on Gingivitis in Orthodontic Patients: A Double-Blind Randomized Controlled Trial. The Angle Orthodontist. 2021 Mar; 91(2): 220-6. doi: 10.2319/052920-490.1. DOI: https://doi.org/10.2319/052920-490.1

Mehravani M, Houshyar E, Jamalnia S, Gharaaghaji R. Effects of Local and Systemic Metronidazole as Adjunctive Treatment in Chronic Periodontitis Patients. Clinical and Experimental Dental Research. 2024 Dec; 10(6): e70050. doi: 10.1002/cre2.70050. DOI: https://doi.org/10.1002/cre2.70050

Silva MP, Feres M, Oliveira Sirotto TA, Silva Soares GM, Velloso Mendes JA, Faveri M, et al. Clinical and Microbiological Benefits of Metronidazole Alone or with Amoxicillin as Adjuncts in the Treatment of Chronic Periodontitis: A Randomized Placebo-Controlled Clinical Trial. Journal of Clinical Periodontology. 2011 Sep; 38(9): 828-37. doi: 10.1111/j.1600-051X.2011.01763.x. DOI: https://doi.org/10.1111/j.1600-051X.2011.01763.x

Panhwar M, Rajpar SP, Abrar E, Alqutub M, Abduljabbar T. Effectiveness of Chlorhexidine and Metronidazole Gels in the Management of Gingivitis: A Clinical Trial. Pakistan Journal of Medical Sciences. 2021 Sep; 37(5): 1425. doi: 10.12669/pjms.37.5.4236. DOI: https://doi.org/10.12669/pjms.37.5.4236

Xiao C, Zhang L, Li Z, Xu Q, Lin S, Zheng S, et al. Periodontal Health Intervention for Oral Health-Related Outcomes in Older Type 2 Diabetes Patients: A Randomized Controlled Trial in a Chinese Tertiary Hospital. Scientific Reports. 2025 July; 15(1): 28014. doi: 10.1038/s41598-025-13434-0. DOI: https://doi.org/10.1038/s41598-025-13434-0

Medha V, Nagappa KG, Ankita V, Kulkarni SG, Bharatesh J, Yogita V. Effect of Sterilization on Different Community Periodontal Index of Treatment Needs Probe Ball Dimension: An Analytical Study. Journal of Indian Association of Public Health Dentistry. 2024 Jan; 22(1): 83-8. doi: 10.4103/jiaphd.jiaphd_83_23. DOI: https://doi.org/10.4103/jiaphd.jiaphd_83_23

Badar SB, Zafar K, Ghafoor R, Khan FR. Comparative Evaluation of Chlorhexidine, Metronidazole and Combination Gels on Gingivitis: A Randomized Clinical Trial. International Journal of Surgery Protocols. 2019 Jan; 14: 30-3. doi: 10.1016/j.isjp.2019.04.001. DOI: https://doi.org/10.1016/j.isjp.2019.04.001

Soysa NS, Waidyarathne H, Ranaweera M, Alles CNRA. Clinical Efficacy of Local Application of Sustained-Release Metronidazole in Periodontal Therapy. Dentistry Review. 2021 Dec; 1(1): 100006. doi: 10.1016/j.dentre.2021.100006. DOI: https://doi.org/10.1016/j.dentre.2021.100006

Mombelli A, Zekeridou A. Mystery and Misery of Locally-Delivered Drug Therapy in Periodontics: Historical Concepts and Current State. Periodontology 2000. 2025 May; doi: 10.1111/prd.12630. DOI: https://doi.org/10.1111/prd.12630

Lorenzi C, Lio F, Mazzetti V, Carosi P, Lamelza S, Pistoia ES, et al. Synergistic Effect of Metronidazole and Chlorhexidine Against Porphyromonas Gingivalis Growth: An In Vitro Study. Dentistry Journal. 2024 Sep; 12(10): 307. doi: 10.3390/dj12100307. DOI: https://doi.org/10.3390/dj12100307

Iftikhar B, Jan SM, Behal R. Effectiveness of Different Concentrations of Chlorhexidine and Metronidazole Gels in the Management of Gingivitis: A Randomized Clinical Trial. 2022.