Effects of Herbal Mouthwashes on Plaque and Inflammation Control for Patients with Gingivitis: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials

Abstract

Objective. The aim of this study was to evaluate the overall effects of herbal mouthwashes as supplements to daily oral hygiene on plaque and inflammation control compared with placebos and chlorhexidine (CHX) mouthwashes in the treatment of gingivitis. Methods. PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and grey literature databases were searched. Only randomised controlled trials (RCTs) comparing herbal mouthwashes with placebos or CHX in the daily oral hygiene of patient with gingivitis were included to compare the effect of different mouthwashes on plaque and inflammation control. Results. A total of 13 studies satisfied the eligibility criteria, and 11 studies were included in meta-analyses. Significant differences were observed in favour of herbal mouthwashes compared with placebos in both plaque- and inflammation-related indices (Quigley-Hein Plaque Index, QHPI: WMD = −0.61, 95% CI (−0.80, −0.42), P<0.001; Gingival Index, GI: −0.28 (−0.51, −0.06), P=0.01; Modified Gingival Index, MGI: −0.59 (−1.08, −0.11), P=0.02; Gingival Bleeding Index, GBI: −0.06 (−0.09, −0.04), P<0.001). No significant difference was found between herbal and CHX mouthwashes. Conclusions. Herbal mouthwashes have potential benefits in plaque and inflammation control as supplements to the daily oral hygiene of patients with gingivitis. Although no difference was observed between herbal and CHX mouthwashes in the selected studies, further high-quality RCTs are needed for more firm support before advising patients with gingivitis about whether they can use herbal mouthwashes to substitute for CHX mouthwashes or not (PROSPERO registration number: CRD42019122841).

Effectiveness of alcohol-free mouth rinse containing essential oils and fluoride as an oral hygiene adjunct among pregnant Thai women: A randomized clinical trial

“…[ 30 ] Evidence from the literature shows the short-term and long-term efficacy of using adjunctive anti-plaque chemical agents. [ 20 21 , 31 ] A systematic review of clinical studies also confirmed the improvement of gingival health and the safety of alcohol-free, EO mouth rinses in comparison to other mouth rinses. [ 17 20 ] The efficacy of EO mouth rinse with and without alcohol did not show a significant difference concerning the reduction of plaque and gingivitis.…”

“…[ 16 17 18 ] Various anti-plaque agents with different formulation such as chlorhexidine, stannous fluoride, essential oils (EO), cetylpyridinium chloride (CPC), and tricosan have been assessed. [ 19 20 21 22 23 ] Systematic review and meta-analysis have also indicated that mouth rinses significantly improved gingival inflammation, bleeding on probing, and plaque scores. [ 20 21 ] In addition, several studies have shown that EO containing mouth rinse has superior anti-plaque and antigingivitis effects than other mouth rinses and could be an alternative to chlorhexidine rinse as adjuncts to oral hygiene.…”

“…[ 19 20 21 22 23 ] Systematic review and meta-analysis have also indicated that mouth rinses significantly improved gingival inflammation, bleeding on probing, and plaque scores. [ 20 21 ] In addition, several studies have shown that EO containing mouth rinse has superior anti-plaque and antigingivitis effects than other mouth rinses and could be an alternative to chlorhexidine rinse as adjuncts to oral hygiene. [ 20 22 , 24 ] The effectiveness of alcohol-based EO on plaque and gingival inflammation parameters did not differ from water-based EO.…”

Awareness on oral hygiene among Ayurveda practitioners

“…28,29,30 The herbal mouthwashes and chemical mouthwashes have been proved to be equally effective in reducing plaque and gingivitis. 31,32 In a systematic review done by Jangid et al in 2014, among 17 articles, 14 showed similar efficacy of the mouthwashes, one study showed better result with Triphala mouthwash and two studies showed better result with chlorhexidine.Chlorhexidine is the gold standard mouthwash used in dentistry. On long term use, it causes staining of teeth and restorations.…”

Effect of green tea, ginger plus green tea, and chlorhexidine mouthwash on plaque-induced gingivitis: A randomized clinical trial

“…However, this method lacks complete and efficient removal of plaque, especially from the interproximal areas of the teeth. [ 4 5 ] This can be attributed to poor manual dexterity and lack of motivation, especially among children. [ 6 ] Bacteria colonizing on soft tissues also serve as a major source of micro-organisms on the tooth surface.…”