A COMPARATIVE ANALYSIS ON EFFICACY OF HERBAL EXTRACTS AND CHLORHEXIDINE ON CLINICAL AND MICROBIOLOGICAL PARAMETERS IN CHRONIC PERIODONTITIS- A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: To assess effect of herbal medicines compared to 0.12% chlorhexidine (CHX) in periodontitis
Materials and Methods: Review was adhered with Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) guidelines and registered in PROSPERO- CRD42024506918. From January 2000 to January 2025, research on the benefits of herbal medicines vs 0.12% CHX on periodontitis in terms of plaque index (PI), gingival index (GI), clinical attachment level (CAL), deep pocket (PPD), and colony forming unit (CFU) was found by searching electronic databases. Using Review Manager (RevMan) software version 5.3, the Cochrane risk of bias (ROB) -2 tool for randomized controlled trials (RCT) was employed to evaluate quality in all of its domains. The
standardized mean difference (SMD) was used as a brief statistic measure with a random effect model (p<0.05).
Results: Meta-analysis was suitable for nine out of the fourteen studies that satisfied the criteria for selection in the
qualitative synthesis. The quality evaluation determined that the risk of bias was moderate to low. A variety of herbs
like Punica granatum, Herborals, Morus alba, Natural curcumin, Salvadora persica, Khadiradi vati, Dashansanskar
churana, Neem and Apamarga, Ferula assa-foetida, Aloe vera, tea tree oil, Guava leaf extract, Ocimum sanctum were
described. The pooled estimate through SMD suggested that herbal medicines were clinically and statistically superior
to 0.12% CHX for parameters assessed at 15th and 30th day (p<0.05). There was no asymmetry or heterogeneity in the funnel plot, which suggests that publication bias is not present.
Conclusion: It was observed that herbs showed gradual improvement and are equally effective as CHX and could be
used as an excellent adjunct to CHX in treating moderate to advanced periodontitis due to its minimal side effects.