Long-Term Clinical Effectiveness of Topical Chlorhexidine as an Adjunct to Non-Surgical Periodontal Therapy: A Narrative Review

Abstract

Background: Mechanical debridement is the cornerstone of non‑surgical periodontal ther-apy. Chlorhexidine (CHX), delivered as a mouthrinse, gel, or by subgingival irrigation, is commonly prescribed adjunctively, but its long‑term clinical effectiveness remains unclear.Aim: To evaluate whether CHX adjunctive to scaling and root planing (SRP) improves healing, plaque control, or microbial reduction, using probing depth (PD) and clinical at-tachment level (CAL) as primary clinical outcomes.Methods: A structured literature search (1998–2024) of PubMed, Embase, and Cochrane Central identified studies assessing CHX (mouthrinse, gel, subgingival irrigation) adjunc-tive to SRP. Ten reports were included: four randomized controlled trials, two systematic reviews, one narrative review, two clinical studies, and one meta‑analysis reporting clinical periodontal outcomes with follow‑up.Results: Adjunctive CHX (mouthrinse or gel) improves plaque control and produces sta-tistically significant short‑term reductions in bleeding on probing. However, consistent long‑term improvements in PD reduction and CAL gain compared with SRP alone were not demonstrated. Subgingival CHX gel or irrigation provided minor early clinical benefits that diminished over time. Overall, additional long‑term benefit beyond SRP alone was limited.Conclusions: CHX adjunctive to SRP may reduce plaque and gingival inflammation in the short term but offers limited evidence for lasting PD or CAL improvements. CHX remains useful in specific situations post‑operative care, patients with poor mechanical plaque con-trol, or those unable to perform adequate oral hygiene—but effective mechanical debride-ment and regular maintenance are the primary determinants of long‑term periodontal sta-bility.