The Use of Chlorhexidine and a Probiotic Lozenge in the Nonsurgical Therapy of Periodontitis

• active chlorhexidine and placebo probiotic (Combination product): the randomized patients will be receive active chlorhexidine rinse and placebo probiotic
• placebo chlorhexidine and active probiotic (Combination product): the randomized patients will receive placebo chlorhexidine rinse and active probiotic
• active chlorhexidine and active probiotic (Combination product): the randomized patients will receive active chlorhexidine rinse and active probiotic

Primary outcomes

• probing pocket depth [6 months]: the distance between gingival margin and pocket base in millimeters

Secondary outcomes

• percentage of patients in low risk for disease progression [6 months]: having less than 5 sites with probing pocket depth of 5 mm or more at the end of the trial.
• gingival recession [6 months]: the distance between cementoenamel junction and gingival margin in millimeters
• clinical attachment level [6 months]: the distance between cementoenamel junction and pocket base in millimeters
• full mouth bleeding and plaque score [6 months]: the scores of bleeding on probing (positive or negative)
• microbial outcomes [6 months]: pcr analysis of plaque samples (mean log10 cfg/ml)

Sex: All, ages: 18 Years to 70 Years, accepts healthy volunteers

Inclusion Criteria:

* Diagnosed with generalized (>30% of teeth affected) periodontitisstage III and IV periodontitis, grade B or C (C only with smoker modifier) = generalized chronic periodontitis including smokers
* A minimum of three natural teeth in each quadrant, excluding third molars
* Willing and able to give informed consent
* Not more than 50% of the patients in each group will be smokers.
* Smokers should smoke between 10 to 40 cigarettes a day

Exclusion Criteria:

* Patients with localized periodontitis or periodontitis stage I or II or grade A or grade C or grade C with diabetes modifier
* Patients with orthodontic appliances (removable or fixed)
* Pregnant or lactating woman
* Patients with a history of systemic diseases that may correlate with periodontal health, such as diabetesrheumatic fever, liver or kidney disease, and neurological deficiencies
* Patients taking medication which may affect the periodontium (bisphosphonates, phenytoin, cyclosporin, nifidepine, chronic use of non-steroidal anti-inflammatory drugs)
* Patient who had taken systemic antibiotics up to 3 months prior to treatment or medical conditions requiring prophylactic antibiotic coverage
* Participation in any other clinical study
* Tobacco chewing or sniffing