Effect of different concentrations of commercially available mouthwashes on wound healing following periodontal surgery: a randomized controlled clinical trial

Study Overview

Antiseptic mouthwashes are routinely prescribed following periodontal surgery to support oral hygiene during the healing period. Chlorhexidine gluconate (CHX) and essential oil-based formulations (EO) represent the two most widely utilized agents in this context.

Despite their clinical prevalence, in vitro evidence has raised concerns that these agents at standard concentrations may exert cytotoxic effects on cells integral to wound repair.

This study sought to evaluate whether such effects were clinically significant in a surgical patient population.

Methodology

Eighty patients indicated for periodontal surgery were randomized into five post-operative rinse groups:

• Sterile water (control)

• Full-strength chlorhexidine gluconate (CHX 0.12–0.2%)

• Full-strength essential oils (EO, standard formulation)

• Diluted chlorhexidine (5% CHX)

• Diluted essential oils (10% EO)

Clinical assessments were conducted at one, two, and three weeks post-operatively, with outcome measures including plaque indices, gingival inflammation scores, and wound closure status.

Key Findings

1. Plaque control: CHX demonstrated superior antiplaque efficacy, producing statistically significant reductions in plaque scores relative to the control group across all three evaluation intervals. The 5% CHX formulation maintained a meaningful advantage over water through the first two post-operative weeks, suggesting that dilution does not fully compromise its antimicrobial benefit.
   
   

2. Gingival inflammation: All groups exhibited progressive improvement in gingival inflammation over the three-week observation period, with no statistically significant intergroup differences. This was interpreted as evidence that neither full-strength nor diluted formulations caused appreciable mucosal irritation or impeded the resolution of post-surgical inflammation.
   
   

3. Wound healing: At the one-week assessment, all surgical sites in the full-strength CHX group demonstrated open wound margins healing by secondary intention — a statistically notable finding suggesting a potential delay in early epithelial closure. By weeks two and three, however, wound healing trajectories across all groups had converged, with no significant differences in closure rates observed.

Clinical Interpretation

The delayed primary closure observed in the CHX group at week one did not translate into any measurable long-term healing deficit. This transient effect on early epithelialization did not compromise overall tissue repair, and all groups achieved comparable outcomes by the conclusion of the study period.

Conclusion

The study found that both full-strength CHX and EO mouthwashes can be considered safe adjuncts following periodontal surgery, with no evidence of clinically significant impairment to wound healing.

CHX continues to demonstrate superior plaque suppression and remains the agent of choice for post-operative chemical plaque control.

Notably, diluted formulations retained meaningful antibacterial activity, presenting a potential strategy to preserve therapeutic efficacy while mitigating well-documented adverse effects associated with CHX, thereby supporting patient adherence in the post-operative period.

Reference Article

Katsaros T, Mayer E, Palaiologou A, Romero-Bustillos M, Evans GH, Lallier TE, Maney P. Effect of different concentrations of commercially available mouthwashes on wound healing following periodontal surgery: a randomized controlled clinical trial. Clin Oral Investig. 2020;24:3587–3595. https://doi.org/10.1007/s00784-020-03232-5