Effect of chlorhexidine, povidone-iodine, and hydrogen peroxide irrigation on pain and swelling after mandibular third molar surgery: randomized controlled trial

The objective of this study was to compare the effects of irrigation solutions containing chlorhexidine, povidone-iodine, or hydrogen peroxide on pain and swelling following mandibular third molar surgery. This prospective randomized controlled trial employed a single-blind design. Overall, 112 patients were randomized to four groups based on the antiseptic assigned for the intervention: control, chlorhexidine (CHX), povidone-iodine (PI), and hydrogen peroxide (HP). The patients were followed up on days 1, 3, 7, and 15 after surgery, and pain and swelling were assessed. Data were analysed using ANOVA and post hoc multiple comparison tests. The CHX and HP groups demonstrated significantly lower mean pain scores compared to the control group on days 3 (P = 0.021, P = 0.033) and 7 (P = 0.002, P = 0.017). Regarding the difference in swelling from baseline (before surgery) on each follow-up day, the CHX and HP groups showed significantly less swelling compared to the control group on days 1 (P = 0.023, P = 0.012), 3 (P = 0.007, P = 0.001), and 7 (P = 0.002, P = 0.018). Moreover, the CHX and HP groups demonstrated significantly lower mean swelling changes from baseline compared to PI: CHX vs PI on day 7 (P = 0.032), HP vs PI on day 1 (P = 0.037). In conclusion, chlorhexidine and hydrogen peroxide solutions are highly beneficial options for socket irrigation following mandibular third molar surgery. This study showed a more prominent reduction in pain and swelling with chlorhexidine and hydrogen peroxide solutions compared to povidone-iodine solution.