Long-Term Clinical Effectiveness of Topical Chlorhexidine as an Adjunct to Non-Surgical Periodontal Therapy: A Narrative Review

Abstract

Abstract

Background: Mechanical debridement remains the foundation of non-surgical periodontal therapy. Chlorhexidine, an antiseptic widely used in dentistry and delivered as a mouthrinse, gel, or subgingival irrigation, is widely prescribed following treatment. Its primary purpose is to aid in the management of periodontal diseases such as gingivitis and periodontitis, as well as conditions like gingival recession.  However, evidence regarding its long-term clinical effectiveness is inconsistent, with studies reporting contradictory results.

Aim: To evaluate whether treatment with chlorhexidine following scaling and root planning leads to marked healing, plaque control or reduction in microbial activity. This was done by using parameters like improvement in Probing depth (PD) and Clinical attachment level (CAL), during follow-up.

Methods: A structured literature search was conducted using PubMed, Embase, and Cochrane Central to identify relevant studies evaluating chlorhexidine (CHX) as an adjunct to scaling and root planing (SRP) in periodontal therapy. Studies assessing CHX delivered as mouthrinse, gel, or subgingival irrigation were considered. Randomized controlled trials (RCTs), controlled clinical trials(CCTs), systematic reviews, and meta-analyses reporting clinical periodontal outcomes with follow-up were reviewed.

Results: The reviewed studies suggest that adjunctive chlorhexidine (CHX) mouthrinse/gel improves plaque control and is associated with short-term reductions in bleeding on probing (BOP). However, consistent improvements in probing depth (PD) reduction or clinical attachment level (CAL) gain compared with scaling and root planing (SRP) alone were not demonstrated at longer follow-up periods. Subgingival CHX gel or irrigation showed minor early clinical benefits, although these effects tended to diminish over time. Overall, long-term differences between adjunctive CHX use and SRP alone in terms of disease progression appear limited.

Conclusions: The available literature suggests that the adjunctive use of chlorhexidine with scaling and root planing provides limited additional clinical benefit beyond conventional mechanical therapy. While its antimicrobial and anti-plaque properties do contribute to plaque control during the early phases of treatment, the long-term therapeutic value of topical chlorhexidine in periodontal therapy remains uncertain. These findings indicate that effective mechanical debridement and regular periodontal maintenance continue to be the primary determinants of long-term periodontal stability.