Propolis versus chlorhexidine mouthwash following impacted mandibular third molar surgery: A randomized clinical trial

Introduction: Propolis has anti-inflammatory, antimicrobial, and wound-healing properties. This study compared the effects of propolis and chlorhexidine mouthwash on the gingival index (GI), plaque index (PI), and incidence of dry socket (DS) after surgical extraction of impacted lower third molars. Methods: This randomized, double-blind, parallel-group clinical trial included ۳۲ patients aged ۱۵-۳۰ years undergoing surgical extraction of an impacted mandibular third molar. Patients were randomly allocated to receive either a propolis mouthwash (test group) or ۰.۲% chlorhexidine mouthwash (control group). The primary outcome was GI severity. Secondary outcomes included PI and DS severity, which were evaluated at baseline, day ۷, and day ۱۴. Statistical analyses were performed using SPSS version ۲۶ by Fisher’s exact test, the chi-Square test, and an ordinal mixed-effects model to analyze categorical variables. Results: A total of ۳۲ participants, with ۱۶ in each group, completed the study. Generalized linear mixed model analysis indicated no statistically significant between-group differences in GI (P = ۰.۷۸۳) or PI (P = ۰.۷۹۳) over the ۱۴-day follow-up. Similarly, DS severity showed no drug difference (P = ۰.۹۰۶), although both groups improved significantly over time (P = ۰.۰۴۵). Notably, tooth discoloration was descriptively more frequent and severe in the chlorhexidine group, whereas no severe discoloration occurred in the propolis group; however, the difference was not statistically significant (P = ۰.۱۸۵). Conclusion: Propolis mouthwash demonstrated comparable clinical outcomes to chlorhexidine in reducing gingival inflammation, plaque accumulation, and DS incidence, with a potentially lower incidence of side effects. However, more studies with larger sample sizes are required to confirm the results.