Review on the effect of systemic melatonin in periodontal disease

It is of interest to determine the efficacy of adjunctive systemically administered (via oral route) melatonin compared to a placebo, on changes in clinical parameters in patients with periodontitis undergoing periodontal therapy. Literature search was performed systematically after searching with 4 electronic databases until December 2022. Primary outcome measures were changes in Probing Pocket Depth (PPD) and bleeding on probing (BOP%). Secondary outcome measures taken were Clinical attachment Level (CAL) gain and level of Tumor Necrosis Factor-alpha (TNF-α). Risk of bias analysis was done for all the studies. With the adjunctive use of melatonin, improved probing depth reduction and gain in clinical attachment levels was observed in all four studies and was found to be statistically significant compared to the placebo group, suggesting that melatonin administered systemically was able to exert a positive effect at diseased sites. Melatonin drug administered at 10 mg dosage for 2 months showed a significant decrease in TNF-α levels; but showed no significant difference between TNF-α levels in the test and control group at 6 mg administration for 2 months. Systemically administered melatonin as an adjunct in treating periodontal disease could potentially be used due to its antioxidant, anti-inflammatory and bone remodelling properties from increasing evidence. However, a lack of proper guidelines, side effects, standardization of dosage for treating periodontitis and its long-term effect on various other systems in the body, patient related outcome factors and the effect of increased dietary melatonin efficacy have yet to be taken into consideration. Due to the lack of homogeneity, differences in dosage uniformity, and varying follow up intervals, more randomized controlled trial protocols are required to fill the lacunae and better improve our understanding.