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Effectiveness of tea tree oil versus chlorhexidine in the treatment of periodontal diseases: a systematic review


Background Plaque biofilm that adheres to tooth surfaces and gingiva is the main aetiology of periodontitis. Chlorhexidine (CHX) is considered as a gold standard anti-plaque and anti-gingivitis agent but it has side effects such as permanent staining of teeth and dysgeusia. Tea tree oil (TTO) is an essential oil extracted from the leaves of Melaleuca alternifolia. Many studies have reported that TTO exerts strong antibacterial, antifungal, antiviral and anti-inflammatory activities.

Primary study objective The review aims to answer the question of whether TTO (intervention) is a viable alternative to CHX (comparator) for the management of gingival and periodontal disease (outcomes) in adolescents and adults (population).

Methods/design The following search terms were used in PubMed, Scopus, Proquest, Web of Science, EBSCO (dentistry and open access), Cochrane database, and to search for relevant articles: patients with periodontal disease; OR periodontitis; OR gingivitis; OR gingival inflammation; AND essential oil; OR tea tree oil; OR Melaleuca alternifolia; AND chlorhexidine; AND reduction in gingival index; OR reduction in plaque index; OR reduction in bleeding from gums. The initial check for the title and abstract screening followed by removal of duplicates in Mendeley Reference Manager (version 1.19.4) based on the inclusion and exclusion criteria were performed.

Primary outcome measures Parameters such as plaque index (PI), plaque surface score, gingival index (GI), bleeding index or bleeding as measured by % of sites with bleeding on probing (BOP) or bleeding scores, papillary bleeding index (PBI), were the primary outcomes considered.

Results TTO is found to be superior to CHX in reducing signs of gingival inflammation; however, CHX is superior to TTO in inhibiting plaque formation, probably due to its increased substantivity.

Conclusion TTO may be used as an alternative to CHX for reduction of gingival inflammation in conjunction with efficient plaque control measures.

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Niharika Singh contributed to conception and design of the work, data collection, drafting the article, critical revision of the article and gave final approval of the version to be published. Lakshmi Puzhankara contributed to conception and design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article and gave final approval of the version to be published. Madhurya N. Kedlaya contributed to drafting the article, designing images in the article, critical revision of the article and gave final approval of the version to be published. Venkitachalam Ramanarayanan contributed to data analysis and interpretation, drafting the article, critical revision of the article and gave final approval of the version to be published.

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Correspondence to Lakshmi Puzhankara.

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Singh, N., Puzhankara, L., Kedlaya, M. et al. Effectiveness of tea tree oil versus chlorhexidine in the treatment of periodontal diseases: a systematic review. Evid Based Dent (2022).

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