Review Article

Efficacy of Probiotics Compared to Chlorhexidine Mouthwash in Improving Periodontal Status: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

First author/yearDesignN
Age range (years)
ExperimentalComparatorClinical parametersFollow-up (days)Main findings

[18]SB-RCT45
18–21
Group A: HiOra regular mouthwash (The Himalaya Drug Company)
Group B: Darolac sachets (Aristo Pharmaceuticals Pvt. Ltd.)
Chlorhexidine gluconate 0.2% c (ICPA Health Products Ltd.)OHI-S
PI
GI
0–7–14Three types of mouthwashes (chlorhexidine, herbal, and probiotic) were equally effective in improving periodontal health
[21]SB-RCT45
10–12
Group A: Bifilac sachets (Allianz Biosciences Pvt Ltd., Puducherry, India) containing the probiotic powder
Group B: sesame oil (Idhayam group of companies, Virudhunagar, India)
Chlorhexidine mouthwash (Rexidin, Warren-Indoco Remedies Ltd., Mumbai, IndiaPI
GI
0–15–30The use of probiotic mouthwash, chlorhexidine mouthwash, and sesame oil pulling therapy was equally effective in the reduction of plaque and the improvement of the gingival status
[19]TB-RCT60
12–15
Group A: tulsi (Ocimum sanctum) extract mouth rinse
Group B: probiotic mouth rinse (Sporlac)
Chlorhexidine mouth rinse
 0.2% (Clohex, concentration 0.2%)PI
GI
0–21All mouth rinses showed a significant reduction in plaque and gingivitis. Probiotic mouth rinse was more effective in reducing gingivitis, followed by chlorhexidine and tulsi mouth rinses
[22]SB-RCT45
20–30
Group A: probiotic mouth rinse (Sporlac Plus® (Sanzyme Ltd. India) + distilled water)

Group B: control (saline)
Chlorhexidine mouthwash 0.02% (Hexidine® (ICPA))OHI-S
PI
GI
0–14–28Probiotic mouth rinse was effective in reducing plaque accumulation and gingival inflammation
[31]DB-RCT40
20–30
Group A: probiotic
Group B: fluoride
Group C: control
ChlorhexidinePI
GI
0–28Probiotic mouth rinse was effective in reducing plaque accumulation and gingival inflammation in 6–10-year-old children
[23]SB-RCT15
2–300
Group A: probiotic (BreathActive Cleanition, Switzerland)
Group B: control (distilled water)
Chlorhexidine 0.2% (Parodontax® Extra, GSK, Germany)OHI-S
PI
GI
OHI-S: 6–12
GI: 6–12
PI: 0–30
Probiotics demonstrated better treatment results when compared to mechanical treatment alone and were comparable to chlorhexidine
[20]DB-RCT45
6–8
Group A: control group (mint water)
Group B: probiotic
ChlorhexidinePI
GI
0–14Probiotic mouth rinse was effective in reducing plaque accumulation and gingival inflammation
[27]SB-RCT60
6–9
Group A: control (distilled water)
Group B: probiotic (Darolac, Aristo Pharmaceuticals, India)
Chlorhexidine 0.02% (Hexidine)PI
GI
0–3–14Extensive research was recommended to determine the strain of probiotics, the appropriate vehicle, and the amount of probiotic administration so that they can be effectively used and recommended by clinicians as an effective tool in plaque control and maintaining periodontal health
[26]DB-RCT60
6–14
Group A: probiotic mint tablet mixed with water (Evora Plustm, Florida, USA)
Group B: herbal oral rinse (Herboral, M-Tech Innovations Ltd., Pune, India)
Chlorhexidine 0.2% (Hexidine, IPCA Health Products Ltd., India)PI0–7Herbal mouth rinse showed an equal antimicrobial effect compared to chlorhexidine digluconate 0.2% in reducing plaque accumulation, whereas probiotic mouth rinse showed less effectiveness
[32]SB-RCT45
20–30
Group A: green tea (Lipton green tea bags)
Group B: probiotic (Darolac, Aristo Pharmaceuticals, India)
ChlorhexidineOHI-S
PI
GI
0–7–14Probiotics and green tea were effective in reducing dental plaque
[28]SB-RCT90
13–15
Group A: placebo mouth rinse (colored distilled water)
Group B: probiotic mouth rinse (Darolac)
Chlorhexidine 0.12% (Carix® KIN S.A. Laboratory, Spain)PI0–14–36Probiotic mouth rinse and chlorhexidine mouth rinse caused significant inhibition of dental plaque accumulation, but probiotic mouth rinse was found to be more effective for inhibition of dental plaque accumulation after 14 days of intervention and 3 weeks after discontinuation of intervention
[25]DB-RCT30
6–8
Group A: control (mint water)
Group B: probiotic (Darolac, Lallemand Health Solutions, India)
ChlorhexidinePI
GI
0–14Probiotic mouth rinse showed a potential therapeutic effect and was an effective and safe alternative to chlorhexidine mouthwash
[33]DB-RCT90
15-16
Group A: probiotic (Darolac, Aristo Pharmaceuticals, India)
Group B: placebo (distilled water)
Chlorhexidine 0.2% (Clohex)PI
GI
0–14There was a statistically significant difference between chlorhexidine and probiotic mouth rinse
[30]SB-RCT60
25–35
Group A: probiotic (Darolac sachets)
Group B: control (saline)
Chlorhexidine 0.2% (Rexidin, Warren-Indoco Remedies Ltd., Mumbai, India)PI
GI
OHI-S
0–14–28Probiotic mouth rinse was effective in reducing plaque accumulation and gingival inflammation
[29]SB-RCT54
8–12
Group A: probiotic lozenge (BioGaia Prodentis)
Group B: control group (only instructed to follow regular oral hygiene measures)
Chlorhexidine 0.05% (Clorasept)PI0–15–30Probiotic lozenges and chlorhexidine significantly reduced plaque accumulation
[24]SB-RCT45
25–35
Group A: control group (mint water)
Group B: probiotic dairy product group
Chlorhexidine 0.02%PI
GI
0–14There was a significant difference in the mean PI and mean GI between the control, chlorhexidine, and probiotic groups after 14 days. However, there were no significant differences in terms of plaque accumulation between the probiotic and chlorhexidine groups on day 14

SB-RCT: single-blinded randomized clinical trial; TB-RCT: triple-blinded randomized clinical trial; DB-RCT: double-blinded randomized clinical trial; OHI-S: oral hygiene index-simplified; PI: plaque index; GI: gingival index.