Effect of curcumin compared to chlorhexidine on clinical variables of periodontal health: A systematic review and meta-analysis of randomized controlled trials

Background: Chlorhexidine is effective in managing periodontal diseases but has side effects. Curcumin is a natural alternative with anti-inflammatory properties. This meta-analysis aimed to compare the efficacy of curcumin and chlorhexidine on clinical variables in periodontal diseases. Methods: This study included only randomized controlled trials. The primary outcomes were differences in mean plaque index (PI) and gingival index (GI); the secondary outcomes were differences in probing depth (PD), attachment loss (AL), and bleeding index (BI). Data were analyzed by Stata software. Results: Twenty-six randomized controlled trials comprising 1266 subjects were included. Twenty-four studies had a high risk of bias, and 2 studies had some concerns. The pooled data revealed comparable efficacy of curcumin and chlorhexidine in reducing PI ( I 2 = 83.3%; standardized mean difference [SMD]: −0.041, 95% confidence interval [CI, −0.245–0.163], P = .692), GI ( I 2 = 87.8%; SMD: 0.033, 95% CI [−0.216–0.281], P = .797), and BI ( I 2 = 77.7%; SMD: −0.044, 95% CI [−0.208–0.295], P = .735). However, the efficacy of chlorhexidine was found to be superior to curcumin in reducing PD ( I 2 = 93.7%; SMD: 0.883, 95% CI [0.419–1.347], P < .001) and AL ( I 2 = 90.1%; SMD: 0.539, 95% CI [0.019–1.058], P = .042). As for the subgroup analyses of follow-up term, there was a nonsignificant difference between curcumin and chlorhexidine in PI, GI, and BI. As for PD and AL, the subgroup analyses of follow-up term showed different results from the overall pooled analysis: the short term (≤ 1 month) showed the superior efficacy of chlorhexidine over curcumin; however, the long term (> 1 month) showed similar efficacy. Conclusion: Curcumin could be an alternative to chlorhexidine and adjunctively used in reducing clinical variables of periodontal diseases, especially with regard to plaque accumulation and gingival inflammation.