Evaluation of Herbal Mouthwashes Containing Zataria Multiflora Boiss, Frankincense and Combination Therapy on Patients with Gingivitis: A Double-Blind, Randomized, Controlled, Clinical Trial

Abstract

Background: Dental plaques as adhesive microbial aggregates on tooth surfaces are considered the first stage of tooth decay as well as gingivitis. Accordingly, the effect of different antimicrobial mouthwashes on removing dental plaques and preventing their formation has been evaluated in various studies. This study aimed to evaluate the efficacy of herbal mouthwashes containing hydro-alcoholic extract of Zataria multiflora (ZM), Frankincense (FR), and a combination of both (ZM+FR) and compare it with chlorhexidine (CHX) mouthwash in subjects with gingivitis. Materials and Methods: In this randomized, controlled, clinical trial a total of 140 patients with gingivitis were divided into four groups including CHX (control group), ZM, FR, and ZM+FR groups. Plaque index (PI), gingival index (GI), and gingival bleeding index (GBI) were measured in days 1, 14, and 21. Results: All three herbal types of mouthwash significantly improved plaque, gingivitis, and gingival bleeding throughout days 14 to 21 (P<0.001). There was no difference between herbal mouthwash with CHX groups. CHX mouthwash showed the most side effects (54.3%), while ZM mouthwash showed the least side effects and the highest consumer satisfaction (5.7% and 94%, respectively). Conclusion: All of the herbal mouthwashes can be good candidates for controlling gingivitis. Comparing with CHX mouthwash, herbal mouthwashes have lower side effects and negligible alcohol content. Among the herbal mouthwashes, ZM outperforms FR and FR+ZM due to its lower side effects and higher levels of patients’ satisfaction. [GMJ.2019;8:e1366]

Frankincense (Boswellia serrata) Extract Effects on Growth and Biofilm Formation of Porphyromonas gingivalis, and Its Intracellular Infection in Human Gingival Epithelial Cells

“…However, because the authors used a mix of five natural products, it is not possible to conclude whether B. serrata extracts play a role in the improvement of clinical symptoms. Another study showed that mouthwashes containing natural products, including one with frankincense extracts, improved plaque, gingivitis, and gingival bleeding [64]. These initial studies are encouraging and suggest that clinical trials with larger sample populations and only one natural product (frankincense) are needed to confirm the effects of frankincense against periodontal disease.…”

“…Several studies describe clinical trials using frankincense extracts to treat several conditions, such as knee pain [59,60], hepatic inflammation and lipid metabolism [61], and chronic low back pain [62]. Regarding oral health, three publications report the effects of B. serrata extracts in the treatment of periodontitis [63][64][65]. Ardakani et al showed that patients using a mouthwash consisting of five herbal extracts (including B. serrata extracts) improved their periodontal condition in plaque-induced gingivitis comparable to the effect of 0.2% chlorhexidine mouthwash [63].…”