Electrolyzed saline as an alternative to chlorhexidine : antimicrobial and biofilm volume outcomes in a 4-day non-brushing randomized controlled clinical trial

Povšič, Katja (author), Munjaković, Haris (author), Seme, Katja (author), Zayed, Naiera (author), Teughels, Wim (author), Fidler, Aleš (author), Gašperšič, Rok (author)

Background: The biofilm-inhibitory effects of electrolyzed saline (EOS) vary widely due to differences in formulations and treatment methods. This study analyzed the impact of EOS on key oral microbial species and used serial 3D-intraoral scans to evaluate its effects on de novo biofilm formation. Methods: This was a double-blind, randomized, placebo-controlled, cross-over, 4-day, non-brushing, plaque-regrowth study on periodontally healthy individuals. Each subject participated in three trial arms. During each 4-day arm, the subjects refrained from mechanical oral hygiene. Instead, they rinsed their oral cavities twice-daily with EOS, 0.12% chlorhexidine (CHX), or placebo. De novo plaque accumulation after 4 days was assessed as the primary outcome using the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) and the volumetric plaque index (VPI). qPCR analyses of key-microbial species and measurements of active-matrix-metalloproteinase-8 (aMMP-8) in gingival crevicular fluid were performed to complement the clinical data. Results: The biofilm-inhibitory effect of CHX was superior to that of EOS at the level of TMQHPlI and VPI, although both significantly reduced biofilms compared with placebo. The broad-spectrum antimicrobial effect of CHX caused significant reductions in overall bacterial loads, while the action of EOS was more selective. Both CHX and EOS markedly reduced the bacterial loads of Tannerella forsythia; CHX remained more effective against Treponema denticola. In contrast, only EOS demonstrated stronger antimicrobial effects against Fusobacterium nucleatum and Prevotella intermedia while showing no significant impact on periodontal commensals. No significant effects on aMMP-8 were observed. Conclusions: EOS showed substantial, but inferior biofilm-inhibitory, effects compared with CHX. However, EOS had more selective and dysbiosis-controlling effects than CHX. The clinical trial was registered at Clintrials.gov under no. NCT05709015.

• Language: English
• Keywords: antiseptics, chlorhexidine, dental biofilm, electrolyzed saline, mouthwash, oral microbiology
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2026
• Number of pages: Str. 1231–1242
• Numbering: Vol. 97,
• PID: 20.500.12556/RUL-184599
• UDC: 616.31
• ISSN on article: 0022-3492
• DOI: 10.1002/jper.70070
• COBISS.SI-ID: 268126211
• Publication date in RUL: 10.07.2026

Record is a part of a journal

• Title: Journal of periodontology
• Shortened title: J. periodontol.
• Publisher: Wiley & Sons
• ISSN: 0022-3492
• COBISS.SI-ID: 1138191

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: antiseptiki, klorheksidin, zobni biofilm, elektrolizirana fiziološka raztopina, ustna vodica, oralna mikrobiologija

Projects

• Funder: Slovenia, Ministry of Higher Education, Science and Innovation
• Project number: 3-0293

• Funder: Slovenia, Ministry of Higher Education, Science and Innovation
• Project number: TP-2023026