Comparative Study of Anti-Inflammatory and Antibacterial Effects of Adjunctive Herbal and Phytotherapy in Chronic Periodontitis with Clinical and Microbiological Outcomes

Abstract

Introduction: Periodontal diseases are inflammatory conditions affecting the supporting structures of teeth, often resulting in tooth loss when left untreated. Conventional treatments include mechanical debridement and systemic antibiotics. However, the growing interest in herbal medicine stems from its potential anti-inflammatory and antimicrobial properties. This study evaluated the effects of adjunctive herbal therapy on clinical parameters and microbiological outcomes in patients with periodontal disease.

Materials and Methods: This prospective observational study was jointly conducted at the Department of Periodontology, Lahore Medical and Dental College and Fatima Memorial College of Medicine and Dentistry, Lahore, from January to December 2022. A total of 120 systemically healthy participants with clinically diagnosed moderate to severe chronic periodontitis were enrolled. Participants were equally divided into two groups: Group A (n = 60), who received adjunctive herbal and phytomedicine-based therapy in addition to mechanical debridement through scaling and root planing (SRP), and Group B (n = 60), who received only mechanical debridement (SRP alone). Clinical assessments—including Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL)—were recorded at baseline, 6-month, and 12-month follow-up visits. Microbiological evaluations involved quantification of subgingival bacterial load expressed as colony-forming units per milliliter (CFU/mL) using quantitative polymerase chain reaction (qPCR). Inflammatory status was assessed via enzyme-linked immunosorbent assay (ELISA) of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels in gingival crevicular fluid (GCF) collected from standardized index sites using sterile PerioPaper® strips. Data were statistically analyzed using SPSS version 26, employing paired and independent t-tests, with a p-value < 0.05 considered statistically significant.

Results: At 12 months, the herbal therapy group demonstrated significant enhancements to clinical indicators: Plaque Index (1.4 ± 0.3 vs. 1.9 ± 0.5, p < 0.001), Gingival Index (1.2 ± 0.3 vs. 1.6 ± 0.4, p < 0.001), Probing Pocket Depth (4.2 ± 0.9 mm vs. 4.9 ± 1.0 mm, p = 0.002), and Clinical Attachment Level (4.8 ± 1.0 mm vs. 5.3 ± 1.1 mm, p = 0.027). Bacterial load significantly reduced in the herbal group (2.4 × 10^5 ± 5.3 × 10^4 CFU/mL vs. 1.1 × 10^6 ± 2.5 × 10^5 CFU/mL, p < 0.001).

Conclusion: Herbal therapy, when used as an adjunct to mechanical debridement, significantly improved both clinical and microbiological outcomes in patients with periodontal disease. These findings highlight the therapeutic potential of phytotherapy in periodontal care. Further controlled trials are recommended to validate these results.