Efficacy of Olive Oil, Ozonated Olive Oil, and Chlorhexidine Gel as an Adjunct to Scaling and Root Planing in Chronic Periodontitis: A Clinical Study

ABSTRACT

Objectives:

The aim of this article is to evaluate and compare the efficacy of subgingival application of ozonated olive oil, plain olive oil, and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis.

Materials and Methods:

One hundred and twenty patients with chronic periodontitis were included in this study and assigned into three groups. In Group I, Group II, and Group III, SRP was done followed by subgingival application of ozonated olive oil, plain olive oil, and chlorhexidine gel in Group I, II, and III, respectively, at baseline 7, 14, and 21 days. Recordings of clinical parameters (gingival index [GI], probing pocket depth [PPD], clinical attachment level [CAL]) were done at baseline and one month.

Results:

The mean GI, PPD, and CAL scores at baseline for Group I was 2.78 ± 0.42, 2.78 ± 0.42, and 2.66 ± 0.38; for Group II was 2.64 ± 0.39, 6.40 ± 0.50, and 6.40 ± 0.50; and for Group III was 6.00 ± 0.00, 6.40 ± 0.50, and 6.40 ± 0.50, and the scores after one month for Group I was 1.10 ± 0.38, 0.21 ± 0.07, and 0.07 ± 0.05; for Group II was 0.05 ± 0.05, 5.40 ± 0.50, and 5.75 ± 0.44; and for Group III was 5.00 ± 0.00, 5.75 ± 0.44, and 5.28 ± 0.45, with the level of significance being (P < 0.001).

Conclusion:

The ozonated olive oil and chlorhexidine gel have shown significant improvement in periodontal health compared to plain olive oil. Ozonated olive oil can be used as local drug delivery (LDD), an adjunct to SRP in chronic periodontitis which is safe and well accepted by patients without any noticeable side effects.

INTRODUCTION

Periodontal diseases are caused by dysbiotic microbiota in dental plaque biofilms. To eliminate pathogenic microorganisms, nonsurgical and surgical methods are used; even though mechanical debridement is considered the gold standard, various factors like tooth variations, deep periodontal pockets, and bacterial tissue-invading ability can decrease the effectiveness of debridement. Antimicrobial agents like olive oil, which contains antioxidants and carotenoids, have been used as adjuncts to mechanical debridement.[1]

Ozone therapy, an allotropic form of oxygen that consists of three oxygen atoms is also effective in treating periodontal diseases. The reaction between ozone and olive oil produces compounds like ozonides, aldehydes, peroxides, and hydroxy peroxides, enhancing its antimicrobial activity. The wide availability of olive oil makes ozonated olive oil an inexpensive antimicrobial agent.[2]

Hence, this research was carried out with the aim to evaluate the clinical efficacy of ozonated olive oil, olive oil, and chlorhexidine gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients.

MATERIALS AND METHODS

This clinical study was conducted in the Department of Periodontology, Rama Dental College Hospital and Research Centre Kanpur, Uttar Pradesh. The ethical approval was taken from Institutional Ethical Committee RDCHRC/ETHICSCOMMITTE/2021-22/0113 and informed written consent was obtained from all study participants.

A total of 120 chronic periodontitis patients, who are aged between 20 and 50 years, were randomly allocated into three groups each having 40 patients, 20 males and 20 females. Group I (SRP + subgingival application of ozonated olive oil), Group II (SRP + subgingival application of plain olive oil), and Group III (SRP + subgingival application of chlorhexidine gel). The clinical efficacy of the LDD agents were assessed by recording the following clinical parameters which are gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). The clinical parameters were assessed at baseline and after one month by using a calibrated University of north Carolina (UNC) 15 periodontal probes. SRP was carried out using ultrasonic scalers and Gracey curettes followed by subgingival application of local drug-delivery agents in each group, respectively, by injecting through a syringe until the overflow of the material from the pocket orifice. Participants were recalled at intervals 7, 14, and 21 days from baseline for performing supragingival scaling, after that the reapplication of local drug-delivery agents.

The inclusion criteria included cooperative chronic periodontitis patients, aged between 20 and 50 years with a PPD of ≥5 mm with at least 20 teeth remaining in the oral cavity. Patients who are on systemic antimicrobial therapy, medically compromised patients, having a history of periodontal surgeries in the past, also who underwent periodontal treatment ≤6 months back, having an allergy to chlorhexidine and olive oil and smokers were excluded.

Statistical analysis

Data collected were statistically analyzed using the statistical package SPSS 23.0 (SPSS Inc., Chicago, IL) and the level of significance was set P < 0.05.

RESULTS

Table 1 assessed GI scores at baseline and one-month follow-up across three groups.

Table 1.

Comparison of the GI among Ozonated Olive Oil (Group I), Plain Olive Oil (Group II), and Chlorhexidine Gel (Group III)

GI	Group I		Group II		Group III		Kruskal–Wallis test
	Mean	SD	Mean	SD	Mean	SD	ꭓ 2	P
Baseline	2.66	0.38	2.65	0.40	2.64	0.39	0.70	0.704
One month	0.07	0.05	0.35	0.28	0.05	0.05	51.78	<0.001

P<0.001 was considered as statistically significant, SD=standard deviation. Bold is statistically significant

Table 2 analyzed PPD among three groups at baseline and a 1-month follow-up using the Kruskal–Wallis test.

Table 2.

Comparison of PPD among Ozonated Olive Oil (Group I), Plain Olive Oil (Group II), and Chlorhexidine Gel (Group III)

PPD	Group I		Group II		Group III		Kruskal–Wallis test
	Mean	SD	Mean	SD	Mean	SD	ꭓ 2	P
Baseline	6.40	0.50	6.40	0.50	6.30	0.46	1.14	0.566
One month	5.40	0.50	5.75	0.44	5.28	0.45	19.29	<0.001

Bold is statistically significant

In Table 3, the differences assessed in CAL among three groups at baseline and a one-month follow-up.

Table 3.

Comparison of CAL among Ozonated Olive Oil (Group I), Plain Olive Oil (Group II), and Chlorhexidine Gel (Group III)

CAL	Group I		Group II		Group III		Kruskal–Wallis test
	Mean	SD	Mean	SD	Mean	SD	ꭓ 2	P
Baseline	6.00	0.00	6.40	0.50	6.40	0.50	21.64	<0.001
One month	5.00	0.00	5.75	0.44	5.28	0.45	50.77	<0.001

Bold is statistically significant

These results emphasize the notable impacts of ozonated olive oil, plain olive oil, and chlorhexidine gel on GI, PPD, and CAL, with significant variations observed both initially and after one month.

DISCUSSION

In this study, the clinical efficacy of three groups—ozonated olive oil (Group I), plain olive oil (Group II), and chlorhexidine gel (Group III)—was compared for GI, PPD, and CAL. Group I showed a reduction in GI from baseline (2.86 ± 0.38) to after one month (0.07 ± 0.05). Similarly, Group II saw a decrease from baseline (2.65 ± 0.40) to one month (0.35 ± 0.28), while Group III experienced a significant reduction from baseline (2.64 ± 0.39) to one month (0.05 ± 0.05). In terms of PPD, Group I reduced from 6.40 ± 0.50 at baseline to 5.40 ± 0.50 after one month. Group II’s PPD decreased from 6.40 ± 0.50 to 5.75 ± 0.44, and Group III’s PPD went from 6.30 ± 0.46 to 5.28 ± 0.45. For CAL, Group I saw a reduction from 6.00 ± 0.00 at baseline to 5.00 ± 0.00 after one month, resulting in a mean attachment gain of 1.00. Group II’s CAL reduced from 6.40 ± 0.50 to 5.75 ± 0.44 with a mean attachment gain of 0.65, and Group III had a significant reduction from 6.40 ± 0.50 to 5.28 ± 0.45, with a mean attachment gain of 1.02.

These findings align with previous research by Katti et al.,[3] explaining the oxidizing mechanism of ozone and its role in free radical-mediated destruction. Dhingra et al.[4] also found similar reductions in clinical parameters, and Hayakumo et al.[5] observed reductions in GI and PPD with ozone water irrigation. Nambier et al.[6] reported similar decreases in clinical parameters after three months. Contrarily, Müller et al.[7] and Dengizek et al.[8] found no significant reductions with ozone use. Tasdemir et al.[9] also reported no reduction in clinical parameters when ozone was used as an adjunct to SRP.

CONCLUSION

The study found that subgingival application of ozonated olive oil, olive oil, and chlorhexidine gel, along with SRP, significantly improved periodontal health. Results showed reduced gingival bleeding, inflammation, PPD, and CAL gain.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.