Research Article
Volume 19 Issue 5 - 2020
Clinical Efficacy of Hyaluronic Acid Gel Compared to Chlorhexidine Mouthwash in the Management of Plaque-Induced Gingivitis in Orthodontic Patients: A Randomized Clinical Trial
Jana Alqefari1*, Faten Alsoweed1, Wesam Fathi2 and Rabia Bilal3
1Intern Dentist, College of Dentistry, Qassim University, Saudi Arabia
12Assistant Professor, Department of Periodontology and Oral Medicine, College of Dentistry, Qassim University, Saudi Arabia
13Associate Professor, Department of Pedodontic and Orthodontic, College of Dentistry, Qassim University, Saudi Arabia
*Corresponding Author: Jana Alqefari, Senior Year Student, College of Dentistry, Qassim University, Saudi Arabia.
Received: March 31, 2020; Published: April 25, 2020


Aims and Objectives: Patients with fixed orthodontic appliances are at high risk of developing gingival and periodontal diseases. In general, mechanical plaque control is usually inadequate to control plaque and maintaining optimal oral health for long periods, therefore, incorporating chemical agents had shown better efficacy in controlling plaque-mediated diseases. This study aims to assess the impact of hyaluronic acid gel in improving gingival parameters by comparing the efficacy of hyaluronic acid gel (HA) and chlorhexidine mouthwash (CHX) in the management of plaque-induced gingivitis.

Study Design: Randomized control clinical trial.

Place and Duration of Study: Qassim University Female Dental Clinics, Qassim University Melida, Saudi Arabia, from November 2018 to January 2019.

Subjects and Methods: This randomized clinical trial included 15 female patients wearing full-mouth fixed orthodontic appliances and having plaque-induced gingivitis, the age range was between 16 - 30 years old. Subjects were allocated into two groups; group A receiving hyaluronic acid gel and group B taking chlorhexidine mouth wash. Gingival health was evaluated using clinical indices; gingival index (GI), plaque index (PI), papillary bleeding index (PBI). Data were collected at baseline and after 3 weeks and were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0.

Results: A total of 14 subjects have completed the trial. Intragroup comparison revealed a positive response to the treatment for group A and group B with clinical indicators; GI (P < 0.000), PI (P < 0.000), PBI (P < 0.000), and GI (P < 0.000), PI (P < 0.038), PBI (P < 0.010) respectively. Nevertheless, PI and PBL were lower in group A. Intergroup comparison demonstrated no significant difference between the groups, however, group B has reported some negative effects related to the use of chlorhexidine mouth wash.

Conclusion: The hyaluronic acid gel has shown a comparable effect to chlorhexidine mouthwash in the management of plaque-induced gingivitis in fixed orthodontic appliance patients. This study recommends considering hyaluronic acid gel as the first treatment option in controlling plaque-induced gingivitis.

Keywords: Gel; Gingivitis; Hyaluronan; Chlorhexidine; Orthodontic Brackets; Fixed Orthodontic Appliances


  1. Ammons WF., et al. “Host tissue response in chronic periodontal disease”. Journal of Periodontology 2 (1972): 34-131.
  2. Albandar JM and Rams TE. “Global epidemiology of periodontal diseases”. Periodontology 29 (2002): 7-10.
  3. Idrees M., et al. “Prevalence and severity of plaque-induced gingivitis in a Saudi adult population”. Saudi Medical Journal 11 (2014): 1373-1377.
  4. Page RC and Kornman KS. “The pathogenesis of human periodontitis: An introduction”. Periodontology 2000 14 (1997): 9-11.
  5. Boyd RL and Baumrind S. “Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissue versus those of adolescents”. The Angle Orthodontist 62 (1992): 117-126.
  6. Boke F., et al. “Relationship between orthodontic treatment and gingival health: A retrospective study”. European Journal of Dentistry3 (2014): 373-380.
  7. Mazin H., et al. “The Effect of Fixed Orthodontic Appliances on Gingival Health”. IOSR Journal of Dental and Medical Sciences11 (2016): 82-88.
  8. Grimsdottir MR., et al. “Cytotoxic effect of orthodontic appliances”. European Journal of Orthodontics 14 (1992): 47-53.
  9. Spalj S., et al.In-vitro assessment of oxidative stress generated by orthodontic archwires”. American Journal of Orthodontics and Dentofacial Orthopedics 141 (2012): 583-589.
  10. Rosen PS. “Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions”. The Pediatric Dental 2008-2009 30.7 (2001): 253-262.
  11. Socransky SS and Haffajee AD. “Periodontal microbial ecology”. Periodontology 2000 38 (2005): 135-187.
  12. Moran JM. “Chemical plaque control - Prevention for the masses”. Periodontology 2000 15 (1997): 09-17.
  13. Sikka G., et al. “Comparative Anti-plaque and Anti-gingivitis Efficacy of Two Commercially Available Mouthwashes - 4 Weeks Clinical Study”. Journal of Oral Health and Community Dentistry 3 (2011): 110-112.
  14. Mathur S., et al. “Chlorhexidine: The gold standard in chemical plaque control”. National Journal of Physiology, Pharmacy and Pharmacology 1 (2011): 45-50.
  15. Mendigeri V., et al. “Clinical effects of different antiplaque agents on patients undergoing fixed orthodontic treatment- A comparative study”. Indian Journal of Orthodontics and Dentofacial Research 1 (2017): 43-47.
  16. Moseley R., et al. “Hyaluronan and its Potential Role in Periodontal Healing”. Dental Update 29 (2002): 144-148.
  17. Dahiya P and Kamal R. “Hyaluronic Acid: A Boon in Periodontal Therapy”. North American Journal of Medical Sciences 5 (2013): 309-315.
  18. Sapna N and Vandana KL. “Evaluation of hyaluronan gel (Gengigel®) as a topical applicant in the treatment of gingivitis”. Journal of Investigative and Clinical Dentistry 2 (2011): 162-170.
  19. Eick S., et al. “Hyaluronic Acid as an Adjunct After Scaling and Root Planing: A Prospective Randomized Clinical Trial”. Journal of Periodontology7 (2013): 941-949.
  20. Pilloni A., et al. “Evaluation of the efficacy of an hyaluronic acid-based biogel on periodontal clinical parameters. A randomized-controlled clinical pilot study”. Annali di Stomatologia3-4 (2011): 3-9.
  21. Sahayata VN., et al. “An Evaluation of 0.2% Hyaluronic Acid Gel (Gengigel®) in the Treatment of Gingivitis: A Clinical and Microbiological Study”. Oral Health and Dental Management 3 (2014): 779-785.
  22. Polepalle T., et al. “Local delivery of hyaluronan 0.8% as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A clinical and microbiological study”. Journal of Indian Society of Periodontology1 (2015): 37-42.
  23. Batavia PD., et al. “Use of hyaluronan (Gengigel) in the treatment of gingivitis in orthodontic patients: A clinical, biochemical, and microbiological study”. Journal of the International Clinical Dental Research Organisation 8 (2016): 44-50.
  24. Löe H. “The Gingival Index, the Plaque Index and the Retention Index Systems”. Journal of Periodontology 6 (1967): 610-616.
  25. Saxer UP and Mühlemann R. “Motivation und Aufklärung”. Schweizer Monatsschrift Fur Zahnheilkunde 85 (1975): 905-919.
  26. Kloehn JS and Pfeifer JS. “The effect of orthodontic treatment on the periodontium”. The Angle Orthodontist 44 (1974): 127-134.
  27. Trombelli L., et al. “Clinical efficacy of a chlorhexidine‐based mouthrinse containing hyaluronic acid and an antidiscoloration system in patients undergoing flap surgery: A triple‐blind, parallel‐arm, randomized controlled trial”. International Journal of Dental Hygiene 16 (2018): 541-552.
  28. Rincic Mlinaric M., et al. “Effect of oral antiseptics on the corrosion stability of nickel‐titanium orthodontic alloys”. Materials and Corrosion 69 (2018): 510-518.
Citation: Jana Alqefari., et al. “Clinical Efficacy of Hyaluronic Acid Gel Compared to Chlorhexidine Mouthwash in the Management of Plaque-Induced Gingivitis in Orthodontic Patients: A Randomized Clinical Trial”. EC Dental Science 19.5 (2020): 124-132.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 21, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to