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

Table 1

Relevant characteristics of the included randomised controlled trials.

Study

Sample size

Age range

Males (%)

Smokers (%)

Herbal mouthwash(es)

Comparison(s)^#

Relevant clinical measures

Effects

Follow-up

Loss (%)

Side effects

Active pharmaceutical ingredients and dosage^#

Putative chemical properties

Asokan et al. [41]

20

16–18

20 (100%)

NR

100% Sesamum indicum (sesame) oil, a tablespoon (? mL), 60 s, once daily before brushing

Antioxidant, antibacterial, anti-inflammatory, and saponification properties

0.12% CHX, ? mL, 60 s, once daily before brushing

PI, MGI

Significant reductions in plaque and gingivitis were observed in both the herbal and CHX groups, and there was no difference between them.

10 days

0 (0%)

No side effects

Balappanavar et al. [42]

30

18–25

15 (50%)

NR

(i) 2% azadirachta indica (neem) extract, 15 mL, 30 s, twice daily after brushing; (ii) 0.5% camellia sinensis (green tea) extract, 15 mL, 30 s, twice daily after brushing

Neem: antimicrobial and anti-inflammatory properties; Green tea: antioxidant, anti-inflammatory, and antibacterial properties

0.2% CHX, 15 mL, 30 s, twice daily after brushing

PI, GI

Significant reductions in plaque were observed in all groups and the highest being in CHX groups; neem and tea shown comparative effects on gingivitis better than CHX.

2-3 weeks^†

0 (0%)

No side effects

Charles et al. [43]

139

18–61

61 (44%)

17 (12%)

Listerine® essential oil-containing mouthwash, eucalyptol, menthol, methyl salicylate, and thymol, 20 mL, 30 s, twice daily

Antimicrobial, antiplaque, and antigingivitis properties

Placebo, 20 mL, 30 s, twice daily

QHPI, MGI, GBI

Significant greater reductions in plaque, gingivitis, and bleeding were observed in herbal mouthwash group compared with the placebo group.

24 weeks

11 (8%)

No side effects

Charles et al. [24]

165

18–72

69 (42%)

20 (12%)

Listerine® cool mint essential oil-containing mouthwash, 0.092% eucalyptol, 0.042% menthol, 0.060% methyl salicylate and 0.064% thymol, 20 mL, 30 s, twice daily after brushing

Antimicrobial, antiplaque, and antigingivitis properties

Placebo, 20 mL, 30 s, twice daily after brushing; 0.075% CPC, 20 mL, 30 s, twice daily after brushing

QHPI, MGI, GBI

Significantly greater reductions in plaque, gingivitis, and bleeding were observed in herbal mouthwash group compared with placebo and CPC groups.

4 weeks

3 (2%)

Hypogeusia

Chatterjee et al. [20]

45

18–65

NR

0 (0%)

0.19% Azadirachta indica (neem) extract, 15 mL, 60 s, twice daily

Antimicrobial and anti-inflammatory properties

Placebo, 15 mL, 60 s, twice daily; 0.2% CHX, 15 mL, 60 s, twice daily 0.2% CHX, 15 mL, 60 s, twice daily

PI, GI, BI

Significantly greater reductions in plaque, gingivitis, and bleeding were observed in herbal mouthwash group compared with the placebo group, and there was no difference between herbal and CHX mouthwashes.

3 weeks

0 (0%)

NR

Jenabian et al. [17]

50

14–16

0 (0%)

NR

5% Camellia sinensis (green tea) extract, 5 mL, 30 s, twice daily

Antioxidant, anti-inflammatory, and antibacterial properties

Placebo, 5 mL, 30 s, twice daily

PI, GI, MPBI

There was no difference between herbal mouthwash and placebo; however, the changing patterns of indices were significantly different.

6 weeks

NR

Unpleasant taste

Khairnar et al. [18]

240

20–40

NR

0 (0%)

25% Calendula officinalis (marigold) tincture, 8 mL, ? s, twice daily

Antibacterial, antifungal, anti-inflammatory, antioxidant, and immunomodulatory properties

Placebo, 8 mL, ? s, twice daily

QHPI, GI, SBI

Significantly greater reductions in plaque, gingivitis, and bleeding were observed in herbal mouthwash group compared with the placebo group.

3 months

0 (0%)

No side effects

Lauten et al. [21]

20

≥18

3 (15%)

NR

0.67% Melaleuca alternifolia (melaleuca) oil, 0.33% Leptospermum scoparium (manuka) oil, 1% Calendula officinalis (marigold) extract, and 0.5% Camellia sinensis (green tea) extract, 15 mL, 30 s, twice daily

Antimicrobial and anti-inflammatory properties

Placebo, 15 mL, 30 s, twice daily

QHPI, GI

There was no difference between herbal mouthwash and placebo.

3 months

3 (15%)

Lightheadedness

Mahyari et al. [22]

60

18–65

25 (42%)

NR

5% Calendula officinalis (marigold) extract, 5% Zingiber officinale (ginger) extract and 5% Rosmarinus Officinalis L. (rosemary) extract, 10 mL, 30 s, twice daily

Antibacterial, antioxidant, and anti-inflammatory properties

Placebo, 10 mL, 30 s, twice daily; 0.2% CHX, 10 mL, 30 s, twice daily

QHPI, MGI, GBI

Significantly greater reductions in plaque, gingivitis, and bleeding were observed in herbal mouthwash group compared with the placebo group, and there was no difference between herbal and CHX mouthwashes.

2 weeks

0 (0%)

No side effects

Mamgain et al. [44]

60

≥18

NR

0 (0%)

3 g Elettaria cardamomum (ela) seed powder mixed in 100 mL triphala (equal parts of Emblica officinalis, Terminalia chebula, and Terminalia belerica), ? mL, 60 s, twice daily

Antiplaque, antigingivitis, and antihalitosis properties

?% CHX, ? mL, 60 s, twice daily

PI, GI

Significant reductions in plaque and gingivitis were observed in both the herbal and CHX groups, and there was no difference between them.

3 weeks

NR

NR

Meena Priya et al. [47]

30

18–24

NR

NR

5% Camellia sinensis (green tea) extract, ? mL, 30 s, after brushing

Antioxidant, anti-inflammatory, and antibacterial properties

?% CHX, ? mL, 30 s, after brushing

QHPI, GI, BI′

Significant reductions in plaque, gingivitis, and bleeding were observed in both the herbal and CHX groups, and there was a significant greater reduction of bleeding in herbal group compared with CHX.

1 month

NR

NR

Sharma et al. [46]

80

12–20

42 (53%)

0 (0%)

(i) 1% Azadirachta indica (neem) extract, 10 mL, 60 s, twice daily after brushing; (ii) Listerine® essential oil-containing mouthwash, 10 mL, 60 s, twice daily after brushing

Neem: antimicrobial and anti-inflammatory properties; Essential oil: antiplaque and mild anti-inflammatory properties

0.2% CHX, 10 mL, 60 s, twice daily after brushing; 1% PVP-I Povidone iodine, 10 mL, 60 s, twice daily after brushing

PI, GI

No significant reductions were observed in the neem groups, and there was a significant reduction in plaque and gingivitis in essential oil, CHX, PVP-I groups.

2 weeks

0 (0%)

Bitter taste

Than et al. [45]

20

17–20

10 (50%)

0 (0%)

0.2% Ixora coccinea Linn. (Ponna yeik) extract, 20 mL, 60 s, twice daily

Antibacterial and anti-inflammatory (relieving the gum swelling in palate) properties

0.2% CHX, 20 mL, 60 s, twice daily

QHPI, GI, SBI

Significant reductions in plaque, gingivitis, and bleeding were observed in both the herbal and CHX groups, and there was no difference between them.

4 weeks

NR

NR

Note. NR, not reported; CHX, chlorhexidine; CPC, cetylpyridinium chloride; PVP-I, povidone iodine; Plaque-related indices: PI, Plaque Index by Sillness and Loe; QHPI: Turesky modification of Quigley-Hein Plaque Index by Turesky et al.; Gingival inflammation-related indices: Gingivitis indices: GI, Gingival Index by Loe and Silness; MGI, Modified Gingival Index by Lobene et al.; Bleeding indices: BI, Bleeding Index by Sillness and Loe; BI′, Bleeding Index by Ainamo and Bay; GBI: Gingival Bleeding Index by Saxton and van der Ouderaa; SBI, Sulcus Bleeding Index by Mühlemann and Son; MPBI, Modified Papillary Bleeding Index by Barnett et al.; BOMP: Bleeding on Marginal Probing by Vander Weijden et al.; Those two studies marked with grey were excluded in the meta-analyses due to the high risk of bias within studies. ^#The unreported details of mouthwashes in selected studies were described with question marks (e.g. ? mL) in these columns. ^†The follow-up for herbal mouthwash group was up to three weeks, while the follow-up for CHX group was only two weeks.