Comparative evaluation of hydrogen peroxide and Chlorhexidine mouthwash on salivary interleukin-1ß levels in patients with type 2 diabetes mellitus and chronic periodontitis: a randomized controlled clinical trial

Swet Nisha; Debanjan Das; Sandip Kulavi; Pratibha Shashikumar

doi:10.17126/joralres.2024.005

Swet Nisha Department of Periodontics, Haldia Institute of Dental Sciences and Research (HIDSAR). Haldia, West Bengal, India. http://orcid.org/0000-0003-2873-5861
Debanjan Das Department of Conservative Dentistry and Endodontics, Haldia Institute of Dental Sciences and Research (HIDSAR). Haldia, West Bengal, India. http://orcid.org/0000-0001-6604-7467
Sandip Kulavi West Bengal Dental Service, Department of Dentistry, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. http://orcid.org/0009-0005-8598-8314
Pratibha Shashikumar Department of Periodontology, J.S.S Dental College and Hospital. JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. http://orcid.org/0000-0001-8062-3539

DOI: https://doi.org/10.17126/joralres.2024.005

Abstract

Introduction: Periodontal inflammation causes dysbiosis and change in the microbiota. Nonsurgical periodontal therapy (NSPT) helps in removal of plaque and restoring periodontal health. Various adjunctive therapy like use of mouthwash helps in maintenance of periodontal health and reducing inflammatory load.
Materials and Methods: A total of 108 subjects diagnosed with type 2 diabetes mellitus and periodontitis were divided into three groups: Group 1 received NSPT and rinsing with 0.2% chlorhexidine mouthwash for 3 months, Group 2 received NSPT and rinsing with 1.5% hydrogen peroxide mouthwash for 3 months, Group 3- received NSPT only (control group). The clinical parameters measured included Plaque Index (PI), Gingival Index (GI), Bleeding on probing (BOP) and probing (PD) at baseline, 1, 2, 3 months follow up. Salivary interleukin 1βlevels were measured at baseline and 3 months interval.
Results: Group 1, 2 and 3 showed significant reduction in PI, GI, BOP and PD at 1 and 3 months follow up (p<0.05). However, Intergroup comparison of clinical parameters showed significant reduction in group 1 and 2 when compared with group 3 (p<0.05). Salivary interleukin 1-β levels showed significant reduction from baseline to 3 months in all the three groups and intergroup comparison didn’t show any significant changes, (p>0.05).
Conclusions: Hydrogen peroxide mouthwash as an adjunct to NSPT can be considered as a safe and effective measure to reduce periodontal inflammation in type 2 diabetes mellitus patients with chronic periodontitis.
Keywords: Chlorhexidine; Hydrogen peroxide; Mouthwashes; Periodontitis; ultrasonics; dental scaling.

References

1. Takenaka S, OhsumiT,Noiri Y. Evidence-based strategy for dental biofilms: Current evidence of mouthwashes on dental biofilm and gingivitis. JPN Dent. Sci. Rev. 2019, 55, 33–40.

2. James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;3(3):CD008676. doi: 10.1002/14651858.CD008676.pub2. PMID: 28362061; PMCID: PMC6464488.

3. Chatzigiannidou I, TeughelsW, Van de WieleT, Boon N. Oral biofilms exposure to chlorhexidine results in altered microbial composition and metabolic profile. NPJ Biofilms Microbiomes 2020, 6, 13.

4. Bescos R, Ashworth A, Cutler C, Brookes ZL, Belfield L, Rodiles A, Casas-Agustench P, Farnham G, Liddle L, Burleigh M, White D, Easton C, Hickson M. Effects of Chlorhexidine mouthwash on the oral microbiome. Sci Rep. 2020;10(1):5254. doi: 10.1038/s41598-020-61912-4. PMID: 32210245; PMCID: PMC7093448.

5. HaydariM, BardakciAG,Koldsland OC, AassAM, SandvikL, Preus HR. Comparing the effect of 0.06%, 0.12% and 0.2% Chlorhexidine on plaque, bleeding and side effects in an experimental gingivitis model: A parallel group, double masked randomized clinical trial. BMC Oral Health 2017, 17; 118.

6. Ortega KL, Rech BO, El Haje GLC, Gallo CB, Pérez-Sayáns M, Braz-Silva PH. Do hydrogen peroxide mouthwashes have a virucidal effect? A systematic review. J Hosp Infect. 2020;106(4):657-662.

7. Jhingta P, Bhardwaj A, Sharma D, Kumar N, Bhardwaj VK, Vaid S. Effect of hydrogen peroxide mouthwash as an adjunct to chlorhexidine on stains and plaque. J Indian Soc Periodontol. 2013 Jul;17(4):449-53.

8. Kocher T, König J, Borgnakke WS, Pink C, Meisel P. Periodontal complications of hyperglycemia/ diabetes mellitus: Epidemiologic complexity and clinical challenge. Periodontol 20002018;78:59‐97.

9. Sedigh-Rahimabadi M, Fani M, Rostami-Chijan M, Zarshenas MM, Shams M. A Traditional Mouthwash (Punica granatum var pleniflora) for Controlling Gingivitis of Diabetic Patients: A Double-Blind Randomized Controlled Clinical Trial. J Evid Based Complementary Altern Med. 2017;22(1):59-67.

10. Badooei F, Imani E, Hosseini-Teshnizi S, Banar M, Memarzade M. Comparison of the effect of ginger and aloe vera mouthwashes on xerostomia in patients with type 2 diabetes: A clinical trial, triple-blind. Med Oral Patol Oral Cir Bucal. 2021;26(4):e408-e413.

11. Raman RP, Taiyeb-Ali TB, Chan SP, Chinna K, Vaithilingam RD. Effect of nonsurgical periodontal therapy verses oral hygiene instructions on type 2 diabetes subjects with chronic periodontitis: a randomised clinical trial. BMC Oral Health. 2014;14:79. doi: 10.1186/1472-6831-14-79. PMID: 24965218; PMCID: PMC4082680.

12. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018. 89 Suppl 1:S159-S172.

13. Löe H, Silness J. Periodontal Disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963; 21:533–51.

14. Silness J, Löe H. Periodontal Disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta. Odontol Scand. 1964;22:121–35.

15. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-35. PMID: 1058834.

16. Păunică I, Giurgiu M, Dumitriu AS, Păunică S, Pantea Stoian AM, Martu M-A, Serafinceanu C. The Bidirectional Relationship between Periodontal Disease and Diabetes Mellitus—A Review. Diagnostics. 2023; 13(4):681.

17. Wu CZ, Yuan YH, Liu HH, Li SS, Zhang BW, Chen W, An ZJ, Chen SY, Wu YZ, Han B, Li CJ, Li LJ. Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health. 2020;20(1):204. doi: 10.1186/s12903-020-01180-w. PMID: 32652980; PMCID: PMC7353775.

18. Raslan SA, Cortelli JR, Costa FO, Aquino DR, Franco GC, Cota LO, Gargioni-Filho A, Cortelli SC. Clinical, microbial, and immune responses observed in patients with diabetes after treatment for gingivitis: a three-month randomized clinical trial. J Periodontol. 2015;86(4):516-26.

19. Hasturk H, Nunn M, Warbington M, Van Dyke TE. Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: a randomized clinical trial. J Periodontol 2004; 75: 57– 65.

20. Hossainian N, Slot DE, Afennich F, Van der Weijden GA. The effects of hydrogen peroxide mouthwashes on the prevention of plaque and gingival inflammation: a systematic review. Int J Dent Hyg. 2011;9(3):171-81.

21. Mathurasai W, Thanyasrisung P, Sooampon S, Ayuthaya BI. Hydrogen peroxide masks the bitterness of chlorhexidine mouthwash without affecting its antibacterial activity. J Indian Soc Periodontol 2019;23:119-23.

22. Saravanamuttu, R. Hydrogen peroxide mouthwash. Br Dent J 228, 734 (2020).

23. Walsh LJ. Safety issues relating to the use of hydrogen peroxide in dentistry. Aust Dent J 2000; 45(4): 257-69.

24. Caruso AA, Del Prete A, Lazzarino AI, Capaldi R, Grumetto L. May hydrogen peroxide reduce the hospitalization rate and complications of SARS-CoV-2 infection? Infect Control Hosp Epidemiol 2020: 1-5.

25. Kamolnarumeth K, Thussananutiyakul J, Lertchwalitanon P, Rungtanakiat P, Mathurasai W, Sooampon S, Arunyanak SP. Effect of mixed chlorhexidine and hydrogen peroxide mouthrinses on developing plaque and stain in gingivitis patients: a randomized clinical trial.Clin Oral Investig. 2021;25(4):1697-1704.

26. Ravi Prabhu, Bhagyashree Kohale, Amit A. Agrawal, Shreeprasad Vijay Wagle, Goovind Bhartiya, Dipali Chaudhari. A comparative clinical study to evaluate the effect of 1.5% hydrogen peroxide mouthwash as an adjunct to 0.2% chlorhexidine mouthwash to reduce dental stains and plaque formation. International Journal of Contemporary Medical Research 2017;4(10):2181-2184.

27. Joshipura KJ, Muñoz-Torres FJ, Morou-Bermudez E, Patel RP. Over-the-counter mouthwash use and risk of pre-diabetes/diabetes. Nitric Oxide. 2017 ;71:14-20.

28. Capetti AF, Borgonovo F, Morena V, Lupo A, Cossu MV, Passerini M, Dedivitiis G, Rizzardini G. Short-term inhibition of SARS-CoV-2 by hydrogen peroxide in persistent nasopharyngeal carriers. J Med Virol. 2021 Mar;93(3):1766-1769. doi: 10.1002/jmv.26485. Epub 2020 Sep 24. PMID: 32881014; PMCID: PMC7891345.

29. Gottsauner MJ, Michaelides I, Schmidt B, Scholz KJ, Buchalla W, Widbiller M, Hitzenbichler F, Ettl T, Reichert TE, Bohr C, Vielsmeier V, Cieplik F. A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2. Clin Oral Investig. 2020;24(10):3707-3713. doi: 10.1007/s00784-020-03549-1. Epub 2020 Sep 2. PMID: 32876748; PMCID: PMC7464055.

30. Dona BL, Gründemann LJ, Steinfort J, Timmerman MF, van der Weijden GA. The inhibitory effect of combining chlorhexidine and hydrogen peroxide on 3-day plaque accumulation. J Clin Periodontol 1998;25(11 Pt 1) 879–83.

31. Romesh A, Thomas J T, Muraliharan N P, Vargese S S. Efficacy of adjunctive use of hydrogen peroxide with chlorhexidine as a procedural mouthwash on dental aerosol. Nat J Physiology, Pharmacy Pharmacology 2015; 5: 431-435.

32. Cheng R, Wu Z, Li M, Shao M, Hu T. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review. Int J Oral Sci. 2020;12(1):2. doi: 10.1038/s41368-019-0068-8. PMID: 31900383; PMCID: PMC6949296.

33. Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis. BMC Oral Health. 2019;19(1):176.