Efficacy of 1% povidone-iodine mouthwash combined with scaling and root planing in the treatment of periodontitis: a randomized, controlled trial

doi:10.7518/hxkq.2025.2024326

Abstract

Abstract:

Objective This study aimed to evaluate the therapeutic effect of 1% povidone-iodine mouthwash combined with scaling and root planing in patients with stage Ⅰ/Ⅱ class A/B periodontitis, and to provide a basis for the clinical application of povidone-iodine mouthwash. Methods Seventy-five subjects were included in this trial and randomly divided into three groups. After full-mouth ultrasonic supragingival cleansing, scaling and root planing, the placebo group was treated with sodium chloride injection (NaCl group), the control group was treated with compound chlorhexidine mouthwash (CHX group), and the experimental group was treated with 1% povidone-iodine mouthwash (PVP-I group), and rinsed their mouths for 1 week, respectively. Subjects were tested at 1, 4, and 12 weeks after dosing for clinical indicators, microbial composition of supragingival plaque, gingival crevicular fluid inflammatory marker levels, and patient-reported outcomes. Results Sixty-three subjects completed the follow-up. After treatment, the clinical indicators, microbial indicators, and inflammatory indicators were all significantly improved (P<0.05). Comparisons among the groups showed that one week after treatment, the bleeding index and plaque index of the CHX group and the PVP-I group were lower than those of the NaCl group, and the plaque index of the CHX group was lower than that of the PVP-I group (P<0.05). There were no statistically significant differences in the other clinical indicators among the groups (P>0.05). Twelve weeks after treatment, the Shannon index of the CHX group was lower than that of the NaCl group (P<0.05), and there were no statistically significant differences in the other microbial indicators among the groups (P>0.05). Twelve weeks after treatment, the interleukin-10 concentration of the CHX group was higher than that of the NaCl group (P<0.05), and there were no statistically significant differences in the other inflammatory indicators among the groups (P>0.05). The PVP-I group had the highest scores in terms of taste and oral odor. There was no obvious staining on the tooth surfaces and mucosa in all three groups. Conclusion 1% PVP-I mouthwash combined with scaling and root planing can effectively reduce gingival inflammation and dental plaque, improve clinical symptoms in the short term. While its efficacy is not significantly inferior to that of chlorhexidine, PVP-I mouthwash is more acceptable to patients than chlorhexidine.

Key words: initial periodontal therapy, scaling and root planing, povidone-iodine, supragingival plaque, gingival crevicular fluid

CLC Number:

R781.4

Liu Enyan, Duan Dingyu, Xie Xudong, Li Haolai, Li Maoxue, Ding Yi. Efficacy of 1% povidone-iodine mouthwash combined with scaling and root planing in the treatment of periodontitis: a randomized, controlled trial[J]. West China Journal of Stomatology, 2025, 43(3): 362-369.

Figures/Tables 4

Tab 1

Fig 1

Tab 2

Tab 3

References 32

1	Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions[J]. J Periodontol, 2018, 89(): S173-S182.
2	Petersilka GJ, Ehmke B, Flemmig TF. Antimicrobial effects of mechanical debridement[J]. Periodontol 2000, 2002, 28: 56-71.
3	Gomes EWB, Casarin M, Martins TM, et al. Local deli-very therapies as adjuvants to non-surgical periodontal treatment of periodontitis grade C: a systematic review[J]. Clin Oral Investig, 2020, 24(12): 4213-4224.
4	Zhao H, Hu J, Zhao L. Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis[J]. BMC Oral Health, 2020, 20(1): 34.
5	Rams TE, Sautter JD, van Winkelhoff AJ. Comparative in vitro resistance of human periodontal bacterial pathogens to tinidazole and four other antibiotics[J]. Antibio-tics (Basel), 2020, 9(2): E68.
6	Lepelletier D, Maillard JY, Pozzetto B, et al. Povidone iodine: Properties, mechanisms of action, and role in infection control and Staphylococcus aureus decoloni-zation[J]. Antimicrob Agents Chemother, 2020, 64(9): e00682-e00620.
7	Eggers M. Infectious disease management and control with povidone iodine[J]. Infect Dis Ther, 2019, 8(4): 581-593.
8	Selvaggi G, Monstrey S, Van Landuyt K, et al. The role of iodine in antisepsis and wound management: a reappraisal[J]. Acta Chir Belg, 2003, 103(3): 241-247.
9	James P, Worthington HV, Parnell C, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health[J]. Cochrane Database Syst Rev, 2017, 3(3): CD-008676.
10	Batista AL, Lins RD, de Souza Coelho R, et al. Clinical efficacy analysis of the mouth rinsing with pomegranate and chamomile plant extracts in the gingival bleeding reduction[J]. Complement Ther Clin Pract, 2014, 20(1): 93-98.
11	Steinberg D, Heling I, Daniel I, et al. Antibacterial synergistic effect of chlorhexidine and hydrogen peroxide against Streptococcus sobrinus, Streptococcus faecalis and Staphylococcus aureus [J]. J Oral Rehabil, 1999, 26(2): 151-156.
12	Mazza JE, Newman MG, Sims TN. Clinical and antimicrobial effect of stannous fluoride on periodontitis[J]. J Clin Periodontol, 1981, 8(3): 203-212.
13	Quigley GA, Hein JW. Comparative cleansing efficiency of manual and power brushing[J]. J Am Dent Assoc, 1962, 65: 26-29.
14	Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C[J]. J Periodontol, 1970, 41(1): 41-43.
15	Lobene RR. Effect of dentifrices on tooth stains with controlled brushing[J]. J Am Dent Assoc, 1968, 77(4): 849-855.
16	Marchetti E, Casalena F, Capestro A, et al. Efficacy of two mouthwashes on 3-day supragingival plaque regrowth: a randomized crossover clinical trial[J]. Int J Dent Hyg, 2017, 15(1): 73-80.
17	Khatri M, Malik AS, Bansal M, et al. Effect of supragingival oral irrigation as an adjunct to toothbrushing on plaque accumulation in chronic generalized gingivitis patients[J]. J Indian Soc Periodontol, 2017, 21(4): 296-302.
18	Marchetti E, Tecco S, Caterini E, et al. Alcohol-free essential oils containing mouthrinse efficacy on three-day supragingival plaque regrowth: a randomized crossover clinical trial[J]. Trials, 2017, 18(1): 154.
19	Pizzo G, La Cara M, Licata ME, et al. The effects of an essential oil and an amine fluoride/stannous fluoride mouthrinse on supragingival plaque regrowth[J]. J Perio-dontol, 2008, 79(7): 1177-1183.
20	Van Strydonck DA, Slot DE, Van der Velden U, et al. Effect of a chlorhexidine mouthrinse on plaque, gingi-val inflammation and staining in gingivitis patients: a systematic review[J]. J Clin Periodontol, 2012, 39(11): 1042-1055.
21	Santos A. Evidence-based control of plaque and gingivitis[J]. J Clin Periodontol, 2003, 30(): 13-16.
22	Brookes ZLS, Bescos R, Belfield LA, et al. Current uses of chlorhexidine for management of oral disease: a narrative review[J]. J Dent, 2020, 103: 103497.
23	Sindhura H, Harsha RH, Shilpa RH. Efficacy of subgingival irrigation with 10% povidone-iodine as an adjunct to scaling and root planing: a clinical and microbiological study[J]. Indian J Dent Res, 2017, 28(5): 514-518.
24	Denez EM, Toma S, Lasserre JF, et al. Evaluation of a unique subgingival irrigation with 10% povidone-iodine after scaling and root planing: a randomized clinical trial[J]. Quintessence Int, 2016, 47(7): 549-558.
25	Perayil J, Menon KS, Biswas R, et al. Comparison of the efficacy of subgingival irrigation with 2% povidone-iodine and tetracycline HCl in subjects with chronic mo-derate periodontitis: a clinico microbiological study[J]. Dent Res J (Isfahan), 2016, 13(2): 98-109.
26	Kessler S, Lasserre J, Toma S. Evaluation of multiple subgingival irrigations with 10% povidone-iodine after scaling and root planing: a randomized clinical trial[J]. Quintessence Int, 2021, 52(6): 496-504.
27	Grossi SG, Skrepcinski FB, DeCaro T, et al. Treatment of periodontal disease in diabetics reduces glycated hemoglobin[J]. J Periodontol, 1997, 68(8): 713-719.
28	do Vale HF, Casarin RC, Taiete T, et al. Full-mouth ultrasonic debridement associated with povidone iodine rinsing in GAgP treatment: a randomised clinical trial[J]. Clin Oral Investig, 2016, 20(1): 141-150.
29	Kamolnarumeth K, Thussananutiyakul J, Lertchwalita-non P, et al. Effect of mixed chlorhexidine and hydrogen peroxide mouthrinses on developing plaque and stain in gingivitis patients: a randomized clinical trial[J]. Clin Oral Investig, 2021, 25(4): 1697-1704.
30	Hooshyarfard A, Poormoradi B, Olad F, et al. Comparative effects of Kemphor and chlorhexidine mouthwashes on tooth staining and gingivitis: a randomized controlled crossover clinical trial[J]. Front Dent, 2022, 19: 30.
31	Tribble GD, Angelov N, Weltman R, et al. Frequency of tongue cleaning impacts the human tongue microbiome composition and enterosalivary circulation of nitrate[J]. Front Cell Infect Microbiol, 2019, 9: 39.
32	Bescos R, Ashworth A, Cutler C, et al. Effects of ch-lorhexidine mouthwash on the oral microbiome[J]. Sci Rep, 2020, 10(1): 5254.

项目		NaCl组	CHX组	PVP-I组
年龄/岁		35.4（24.8，48.4）	29.2（25.3，47.5）	33.6（28.5，53.0）
性别（男/女）		8/12	7/16	7/13
BI	基线	1.9±0.5	1.7±0.4	1.8±0.4
	治疗后1周	1.7±0.7	1.3±0.4*^&&	1.2±0.5*^&&
	治疗后4周	1.1±0.5^&&&▲	1.1±0.5^&&&	1.1±0.6^&&&
	治疗后12周	0.8（0.7，1.1）^&&&▲▲▲	0.9（0.4，1.1）^&&&▲▲	1.0（0.5，1.2）^&&&
PLI	基线	2.9±0.4	2.6±0.5	2.9±0.5
	治疗后1周	2.9（2.6，3.0）	1.5（1.3，2.0）**^&&&	2.1（1.7，2.4）**^##&&&
	治疗后4周	2.8（2.8，3.1）	2.7（2.5，2.8）^▲▲▲	2.8（2.4，3.2）^▲▲▲
	治疗后12周	3.0±0.5	2.7±0.4^▲▲▲	3.0±0.4^▲▲▲
SI	基线	0.2（0.0，0.3）	0.0（0.0，0.3）	0.1（0.0，0.4）
	治疗后1周	0.0（0.0，0.1）	0.1（0.0，0.2）	0.1（0.0，0.4）
	治疗后4周	0.0（0.0，0.1）	0.0（0.0，0.2）	0.1（0.0，0.2）
	治疗后12周	0.0（0.0，0.1）	0.0（0.0，0.1）	0.0（0.0，0.2）
PPD/mm	基线	2.6±0.3	2.6±0.5	2.7±0.3
	治疗后4周	2.4±0.9	2.4±0.4	2.5±0.4
	治疗后12周	2.4（2.3，2.6）	2.4（2.0，2.7）	2.5（2.3，2.7）
CAL/mm	基线	1.0（0.7，1.2）	1.1（0.7，1.6）	0.9（0.7，1.5）
	治疗后4周	0.8（0.4，1.1）	0.7（0.4，1.3）	0.7（0.4，1.3）
	治疗后12周	0.6（0.3，1.1）	0.6（0.5，1.1）	0.8（0.4，1.1）

项目		NaCl组	CHX组	PVP-I组
IL-1β/（pg/mL）	基线	46.5±3.5	46.6±23.4	45.5±3.7
	治疗后1周	44.4±5.1	45.9±4.7	45.9±5.9
	治疗后4周	44.6±2.4^#	45.2±2.5	44.4±4.3
	治疗后12周	45.1±5.7^#	41.9±4.3^##&	41.8±4.4^#&
IL-6/（pg/mL）	基线	31.5±1.5	31.2±2.3	30.3±5.8
	治疗后1周	30.6±2.3	30.9±2.0	31.1±2.3
	治疗后4周	31.0±1.8	28.5±2.5	30.4±1.5
	治疗后12周	29.7±2.6	27.1±2.2^#&	29.6±2.7
IL-10/（pg/mL）	基线	474.2±24.0	469.1±26.9	464.9±105.7
	治疗后1周	489.4±37.8	476.3±27.0	497.7±33.8
	治疗后4周	477.3±18.8	481.7±40.2	500.0±43.1
	治疗后12周	495.9±39.0	540.1±55.5*^###&▲	523.7±32.8^##
MMP-8/（ng/mL）	基线	24.2±1.9	24.6±1.7	24.3±2.0
	治疗后1周	22.9±1.4	24.2±2.1	23.0±1.8
	治疗后4周	23.4±0.9	22.7±1.0	22.1±1.7
	治疗后12周	21.8±2.0^###	20.6±2.0^###&&&	20.2±1.9^###

问卷题目	NaCl组	CHX组	PVP-I组
Q3您认为此漱口水口感怎样？	2.0（1.0，7.8）	6.0（5.0，8.0）*	8.0（8.0，8.8）**^#
Q4使用此漱口水以后，您感觉在正常进食或进饮等情况下，口腔中味道怎样？	2.5（1.0，8.0）	5.0（4.0，8.0）*	8.0（8.0，9.8）**^##
Q5使用此漱口水后，您感觉口内牙齿及黏膜的舒适度？	3.0（2.0，8.0）	7.0（5.0，10.0）*	8.0（8.0，10.0）**
Q6您认为使用此漱口水后，牙齿着色与染色情况的严重程度怎么样？	9.0（6.0，10.0）	8.0（5.0，10.0）	8.5（8.0，9.0）
Q7您认为使用此漱口水对您口腔健康的改善情况怎么样？	2.0（1.0，7.0）	8.0（5.0，10.0）**	9.0（8.0，9.0）**
Q8使用此漱口水后，您的总体满意度？	6.5（2.0，9.0）	8.0（5.0，9.0）	8.0（7.0，10.0）*

[1]	Fu Lanqing, Hao Xinyu, Qian Wenbo, Sun Ying. Effects of initial periodontal therapy on the formation of neutrophil extracellular traps in gingival crevicular fluid in patients with severe periodontitis [J]. West China Journal of Stomatology, 2025, 43(1): 46-52.
[2]	Zhang Yangheng, Li Houxuan, Yan Fuhua, Tan Baochun. Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study [J]. West China Journal of Stomatology, 2020, 38(5): 532-536.
[3]	Chang Yaqin, Fang Fangfang, Qin Shasha, Dong Yingchun, Chen Bin. Effect of scaling and root planing on serum C-reactive protein levels in patients with moderate to severe chronic periodontitis: a systematic review and Meta-analysis [J]. West China Journal of Stomatology, 2020, 38(4): 385-392.
[4]	Shi Jiahong, Xia Jiaojiao, Lei Lang, Jiang Sheng, Gong Hongchun, Zhang Ye, Cheng Yan, Li Houxuan. Efficacy of periodontal endoscope-assisted non-surgical treatment for severe and generalized periodontitis [J]. West China Journal of Stomatology, 2020, 38(4): 393-397.
[5]	Xu Gao, Mei Liu, Cuiling Liu. Healing of the periimplant mucosal tissue injury after placing retraction cord subgingivally in beagle dogs [J]. West China Journal of Stomatology, 2018, 36(3): 287-290.
[6]	Yang Xi, Dai Hongwei, Wang Bin, Huang Lan. Preliminary study on the best-exerted force chance in the female menstrual cycle [J]. West China Journal of Stomatology, 2014, 32(3): 252-255.
[7]	Yuan Haibo, Jin Jing, Xu Chunjiao, Qiu Xili, Wang Lu, Lü Fengyuan, Liu Tingting, Wu Yingfang, Yin Xiaomin, Fang Changyun, Que Guoying, Peng Jieying. Exploring the relationship between secreted frizzled-related protein 1 and chronic periodontitis [J]. West China Journal of Stomatology, 2013, 31(6): 615-618.
[8]	Zhao Huaqiang, Mu Pingping, Wei Lingling, Hou Meng, Sun Qinfeng, Song Hui, Yang Pishan. Expression of high mobility group box 1 in gingival tissues of chronic periodontitis [J]. West China Journal of Stomatology, 2013, 31(2): 191-194.
[9]	Xu Weixing1, Su Jiansheng2. Determination of the dynamic levels of interleukin-8 in gingival crevicular fluid of porcelain teeth with three different alloys [J]. West China Journal of Stomatology, 2012, 30(3): 255-258.
[10]	Yuan Tangxia, Zhang Yanbiao, Wu Zhenghua. Effect of different porcelain-fused-to-metal crown inner metal materials on the level of soluble intercellular adhesion molecule-1 and interleukin-1β in gingival crevicular fluid [J]. West China Journal of Stomatology, 2011, 29(05): 477-480.
[11]	ZUO Zhi-gang1, HU Min1, JIANG Huan1, TIAN Li2. Relationship between orthodontics root resorption following experimental tooth movement and the level of dentin sialoph-osphoprotein and dentin sialoprotein in gingival crevicular fluid [J]. West China Journal of Stomatology, 2011, 29(03): 294-298.
[12]	MIAO Yu, LIU Ling-jun, ZHANG Xiao-min, LI Li. Influence of cobalt-chromium alloy ceramics crown on aspartate transaminase and alkaline phosphatase of gingival crevicular fluid [J]. West China Journal of Stomatology, 2010, 28(06): 580-583.
[13]	SUN Xue - wu1, SUN Gui - lan2, XIAO Li - jing1. Evaluation of gingival inflammation r elated to differ ent r etr action agents [J]. West China Journal of Stomatology, 2008, 26(01): 53-55.
[14]	IAN Yu-lou1, XIE Jiang-chun2, ZHAO Zhen-jin1，ZHANG Yang1. Changes of Interlukin-1β and Tumor Necrosis Factor-α Levels in Gingival Crevicular Fluid during Orthodontic Tooth Movement [J]. West China Journal of Stomatology, 2006, 24(03): 243-245.
[15]	XU Yi1,Frentzen M2,JervΦe-Storm P-M2.. Clinical Study of Hyaluronic Acid in the Treatment of Chronic Periodontitis [J]. West China Journal of Stomatology, 2004, 22(01): 32-34.