Antimicrobial efficacy of irrigation with 4.8% bromelain extract against Porphyromonas gingivalis in the periodontal pockets: a randomized controlled trial

Background and Objective: Bromelain, extracted from pineapple, is one of the best-known plant proteases. It has been shown to inhibit the growth of Porphyromonas gingivalis in vitro. The study's objective was to evaluate and compare the antimicrobial effect of subgingival irrigation with 0.2% chlorhexidine and 4.8% bromelain extract on P. gingivalis levels in the periodontal pockets. Methodology: A randomized controlled clinical trial with a parallel-group design was conducted involving 24 adults with a periodontal pocket of 5 mm or more depth, who were randomly allocated to the two interventional groups. In each individual, the pocket of the selected tooth was irrigated with 3 ml of interventional irrigants (0.2% chlorhexidine and 4.8% bromelain extract) once, 24 h after supragingival scaling. The baseline subgingival sample was collected using paper points before irrigation, and the second sample was collected on the 7th day after irrigation. Real-time polymerase chain reaction quantitative microbial analysis was done. The Mann–Whitney U-test and Wilcoxon signed-rank test were employed for statistical analysis. Results: There was a significant postirrigation reduction in the level of P. gingivalis counts within Group A (P = 0.002) and Group B (P = 0.002). On intergroup comparison, a statistically significant (P = 0.05) higher reduction in the level of P. gingivalis counts was observed in the chlorhexidine group (35.40 × 105 ± 34.71 × 105 CFU) compared to the bromelain group (36.20 × 105 ± 29.75 × 105 CFU). Conclusion: Periodontal pocket irrigation with 4.8% bromelain resulted in a clinically significant reduction of P. gingivalis counts.