Chlorhexidine Oral Rinse vs Povidone

Iodine

Lexee, Cassandra, Megan, Yufumi

 PICO Question
In adults with periodontal disease (P), does the
use of Chlorhexidine (I) compared with povidone
iodine (C ) reduce bacterial infections and
promote healing (O)?
 Chlorhexidine Povidone Iodine
Benefits: Benefits:

Antiseptic irrigant Long term usage

Can reduce microbe levels in deep pockets Antimicrobial Effects

70% alcohol content No extrinsic staining

Can reduce microbe levels in deep pockets
More pleasant flavor
Disadvantages:
Disadvantages:

Stains teeth (Temporary) Can’t use with shellfish or iodine allergy

Short term usage Pregnant in 1st Trimester

Bacterial resistance Stain clothes and counter if spilled

Study 1

Efficacy of 1% Povidone Iodine Irrigation Vs. 0.2% Chlorhexidine Irrigation in Prevention of Dry Socket After

Mandibular Third Molar Surgery

● Method: Selected 150 patients who needs an extraction on impacted third molar under local anesthesia. The group
was divided into two groups of 75 participants each. Group A was irrigated using 1% povidone iodine and 0.2%
chlorhexidine irrigation was used for group B for 7 days. Pain, swelling, trismus, dry socket and food
accumulation was assessed on the 2nd and 7th post-operative days.

● Results: Patients in Group A had less pain discomfort and improved mouth opening on 2nd and 7th postoperative
days when compared to group B (P < 0.05). In group A, 3 patients presented with food accumulation and 2
patients developed dry socket while 9 patients presented with food accumulation and 13 patients developed dry
socket in Group B.

● The peer-reviewed article “concluded that povidone iodine irrigation was more efficacious in reducing pain,
swelling and trismus, accumulation of food was also less and the incidence of dry socket significantly low when
compared to chlorhexidine irrigation” (Balamurugan & Pushpa, 2022).
 Study 2
Adjunctive Subgingival Application of Chlorhexidine Gel in Nonsurgical Periodontal Treatment for chronic Periodontitis: A Systematic Review and Meta-

Analysis

Methods: An electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical

outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were

probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.

Results: Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15 mm). However,

no difference was found in CAL gain.

● The authors all come from reputable schools and have long backgrounds in the dental industry. H. Zhao works at a multi-disciplinary treatment center, a stomatological hospital,

now practicing in the department of periodontology at a university in Germany. Hu worked in the department of periodontology at a school of stomatology in Germany and China.

L. Zhao was part of the department of prosthodontics at a stomatological hospital, a laboratory of oral diseases and biomedical sciences and oral laboratory of biomedical

engineering, both based in China.

● The article only exists to confirm the effects of chlorhexidine as a subgingival irrigant and its effects. The article is still useful with the metrics and conclusion it provides. It

provides an expansive list of references and is peer-reviewed, adding to its credibility.

Study 3

Comparative Evaluation of Three Different Ultrasonic Liquids on Microorganisms in Dental Aerosols

● Method: This study was conducted on thirty patients of both genders with age range of 22-55 who are having a
minimum of twenty permanent functional teeth with mean probing depth >5 mm and Clinical attachment loss >3 mm.
The closed dental operatory was disinfected for 48 h before. one blood agar plate was kept for 10 min in the disinfected
closed chamber. Three blood agar plates were kept at a distance of one foot away on either side of the patient and 6ft
behind the patient's mouth during ultrasonic scaling. The patient's ultrasonic scaling was executed for 20 min by the
clinician using distilled water, povidone-iodine and CHX groups. To ensure that the room was free from aerosols, only
one patient was treated per day. After the treatment, three coded blood agar plates were left uncovered for 20 min. plates
were incubated at 37°C for 48 hrs. All the patients were treated by a single operator to prevent the inter-operator bias.

● Result: Group with Chlorhexidine had effective bacterial reduction (29.2 [+ or -] 1.47CFU) when compared to distilled
water (126.8 [+ or -] 24.02CFU) and povidone-iodine (70.1 [+ or -] 2.13 CFU).

● “CHX is more effective in reducing dental aerosols compared to povidone-iodine, and distilled water in this povidone-

iodine is also better than distilled water” (Mehta et al. 2021).

 Our opinion
● We believe that chlorhexidine is most beneficial.

● The prescription requirement for chlorhexidine and the fact that it was developed and marketed to be an oral

disinfectant would make it a more effective co-therapy to periodontal surgery than it’s over-the-counter competitor,

povidone iodine.
 Conclusion
● Our group maintained our initial position that Chlorhexidine is a more effective antibacterial than povidone iodine.

● Our final conclusion was cemented after reading the research done on aerosols; chlorhexidine was more successful at

reducing bacteria.

● Both agents are effective NSPT co-therapies

 References
Amtha, R., & Kanagalingam, J. (2020). Povidone-iodine in dental and oral health: A narrative review. Journal of International Oral Health, 12(5), 407.

https://www.proquest.com/docview/2532781857?parentSessionId=%2FoPX17ZqZ9181qxchIseSAOB8%2Fs%2BWHcjwKiO2Z8Pdyg%3D&pq-origsite=summon&acc

ountid=2664&sourcetype=Scholarly%20Journals

Balamurugan, R., & Pushpa, S. (2022). Efficacy of 1% Povidone Iodine Irrigation Versus 0.2% Chlorhexidine Irrigation in Prevention of Dry Socket After Mandibular Third Molar

Surgery. International Journal of Clinical Dentistry, 15(2), 357–364.

https://www.proquest.com/docview/2685683398?parentSessionId=lVbldQUyqzs0NB4g0i2nr4f%2BGbVY%2Bz4NOIGxmOJ39xY%3D&pq-origsite=summon&accoun

tid=2664&sourcetype=Scholarly%20Journals
Mehta, R., Kathad, S., Girdhar, G., Bhakkad, S., Patel, C., Joshi, S., Kumar, S., & Irfan, M. (2021). Comparative evaluation of three different ultrasonic liquid on microorganisms in
dental aerosols. Advances in Human Biology, 11(3), 234.
https://link-gale-com.ezp.mesacc.edu/apps/doc/A675171991/AONE?u=mcc_mesa&sid=bookmark-AONE&xid=061314ea

Moskowitz, H. (2019). CHX: WE DON’T LIKE IT! Why are we still using it? RDH, 39(7), 30–33.

https://web-p-ebscohost-com.ezp.mesacc.edu/ehost/detail/detail?vid=6&sid=6574c4e1-a3b8-4e67-98f7-f8c2965f24fb%40redis&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%

3d%3d#AN=137491419&db=aph

Zhao, H., Hu, J., & Zhao, L. (2020). Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and