Clinical applicability of natural product(s)-containing mouthwashes as adjunctive treatment of biofilm-induced gingivitis: a systematic review

Abstract

RESUMO: Aplicabilidade clínica de colutórios à base de produtos naturais como tratamento adjuvante da gengivite induzida por biofilme: uma revisão sistemática. Os produtos naturais têm surgido como alternativa eficaz e de baixo custo para o tratamento de várias doenças da cavidade oral. Objetivou-se avaliar, a partir de revisão sistemática da literatura, se há evidências científicas garantindo a utilização segura e eficaz de antissépticos bucais contendo produto(s) natural(is) como tratamento adjuvante da gengivite induzida por biofilme. Foram realizadas buscas nas bases de dados Medline, SciELO, LILACS e Cochrane Library, através de combinações usando as palavras-chave gengivite/produtos naturais/ fitoterápicos/ bochechos, em Inglês, Português e Espanhol. Consideraram-se os estudos publicados até setembro de 2010. Quatro examinadores analisaram separadamente: desenho e fase do estudo, qualidade metodológica (escala de Jadad -EJ), produto experimental e a concentração, intervalo de administração e tempo de uso, bem como a análise estatística empregada e os resultados clínicos de interesse. Foram encontrados 503 artigos dos quais 08 foram incluídos na revisão final como sendo ensaios clínicos fase II, controlados, randomizados e cegos, marcando 4 (25%) e 5 (75%) na EJ. Os principais produtos naturais avaliados foram Azadirachta indica, Garcinia mangostana, Lippia sidoides, Salvadora persica e Sesamum indicum, cuja concentração, intervalo de administração, tempo de uso, e efeitos adversos, variaram de acordo com cada estudo. Índice de placa e Índice Gengival foram os mais utilizados, bem como =5% e testes t-pareado, tStudent, Wilcoxon e Mann-Whitney. 62,5% e 50% dos produtos reduziram significativamente a presença de bioflme supragengival e gengivite, respectivamente. Os colutórios contendo o óleo essencial das folhas de L. sidoides (1%) e o extrato das folhas de A. indica (25%) podem ser indicados como tratamento adjuvante da gengivite induzida por biofilme.Palavras-chave: produtos naturais, gengivite, biofilmes, ensaios clínicos, enxaguatório bucal ABSTRACT: Natural products have emerged as an effective and low-cost alternative for treating various diseases of the oral cavity. This study aimed to evaluate, through a systematic literature review, if there is scientific evidence ensuring the safe and effective use of natural product(s)-containing mouthwashes as adjunctive treatment of biofilm-induced gingivitis. Searches were conducted in the databases Medline, SciELO, LILACS and Cochrane Library, by using combinations of the key words gingivitis/natural products/phytotherapy/mouthwash, in English, Portuguese and Spanish. Studies published until September 2010 were considered. Four examiners analyzed independently: study design and phase, methodological quality (Jadad scale -JE), experimental product and its concentration, dosing interval and time of usage, as well as employed statistical analysis and clinical outcome of interest. From the 503 articles found, 08 were included in the final review as phase II, cont...

Antibacterial Activity of Essential Oils and Their Isolated Constituents against Cariogenic Bacteria: A Systematic Review

“…According to our analysis, the mouthwash of thymol- and carvacrol-rich L. sidoides EO (ethanol-free) rinsed twice a day is an effective agent to prevent/disrupt the accumulation of cariogenic biofilm [ 36 ]. Furthermore, in a previous systematic review [ 76 ] we also found that such experimental mouthwash was effective against biofilm-induced gingivitis in adults. Altogether, these findings highlight the therapeutic potential of L. sidoides EO for dental care, but it is important to note that further studies are needed to investigate its effects on other aspects related to tooth decay, such as bacterial acid production, biofilm formation, enamel de- and remineralization, inhibition of glycosyltransferase production/activity, among others.…”

Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review

“…However, side effects like mucosal irritation, burning sensation and altered taste perception have been reported with short‐term (1 week) usage of non‐alcohol‐based 0.2% chlorhexidine mouthrinse . Thus, there exists a need for safer and cheaper alternatives to existing mouthrinses (especially chlorhexidine) with equivalent antimicrobial action and potency . In this regard, the natural compounds (plant extracts) containing/herbal mouthrinses have been suggested as probable alternatives based on encouraging results from various clinical trials .…”

“…Apart from the chemical agents containing mouthrinses (bisguanide antiseptics, phenolic antiseptics, quaternary ammonium compounds, hexetidine, povidone iodine, triclosan, delmopinol, salifluor, metal ions, and oxygenating agents), natural compounds (plant extracts) containing/herbal mouthrinses such as sanguinarine and propolis are commercially available and have been evaluated in clinical trials for controlling plaque and gingivitis . In recent years, numerous natural compounds containing mouthrinses have been introduced in dentistry and are being claimed to be efficacious in plaque and gingivitis control . Of various plant extracts used as a base for mouthrinses, Azadirachta indica (neem), a medicinal herb native of India and naturalized in most of the tropical and subtropical countries, deserves a special mention as it has been used as a chewing stick for maintaining oral hygiene in traditional Indian medicine .…”

“…In dentistry, the A. indica extract has been recently introduced as gel and mouthrinses for prevention and control of periodontal disease . Although the clinical trials have shown the antiplaque and antigingivitis efficacy of A. indica mouthrinses , yet concerns are being raised about the inconclusive evidence to add herbal extracts in mouthrinses .…”

“…In dentistry, the A. indica extract has been recently introduced as gel and mouthrinses for prevention and control of periodontal disease . Although the clinical trials have shown the antiplaque and antigingivitis efficacy of A. indica mouthrinses , yet concerns are being raised about the inconclusive evidence to add herbal extracts in mouthrinses . In view of the uncertainty regarding the use of herbal mouthrinses, this systematic review attempted to ascertain the efficacy and safety of neem mouthrinses that have been evaluated in randomized controlled trials for the improvement of oral hygiene and the reduction of gingival inflammation in patients with gingivitis as a whole, in comparison with chlorhexidine mouthrinses.…”