Comparative analysis of the effect of 20% Curcumin mouthwash and 0.2% Chlorhexidine mouthwash on dental plaque and gingival inflammation: a randomized clinical trial

Statement of the Problem: Ultra-soft bristles are recommended for individuals with gingival recession, dentinal hypersensitivity, and patients who have undergone periodontal surgeries. However, comparative effectiveness of ultra-soft toothbrushes on dental plaque and bleeding indices has not extensively been studied, and a consensus has yet to be reached on their efficacy.Purpose: The aim of this study was to investigate the effect of ultra-soft toothbrushes with different commercial brands on plaque and bleeding indices.Materials and Method: In this crossover randomized clinical trial, 30 participants were selected using convenience sampling method. The subjects were randomly divided into three groups (n=10). In the first session, the bleeding index was recorded. Then each subject was given a toothbrush (Oral B, GUM, or Fuchs), asked to brush at least twice a day using the Bass technique, then avoid brushing for 24 hours after a week and refer for recording the indices. During the second session, bleeding on probing was recorded before brushing, and plaque indices were recorded before and after brushing. Plaque indices before brushing were considered the baseline plaque indices. After one week of washout, each subject used the next toothbrush in terms of the group involved. Turesky plaque index, O’Leary plaque index, and bleeding index were evaluated. The distribution of data was normal. Therefore, ANOVA, t-test, and post hoc tests were used for the analysis of data.Results: The bleeding and plaque indices decreased significantly compared to the baseline with the use of all the three ultra-soft toothbrushes evaluated (p< 0.05), with no significant differences between the three brands (p> 0.05) except for the superiority of Fuchs toothbrush in decreasing the Turesky plaque index.Conclusion: Ultra-soft toothbrushes can reduce plaque index compared to the baseline, but they do not decrease the plaque index up to the optimal level, which might affect their prescription.

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.

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&lt;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]

Oral conditions such as gingivitis and oral malodor are commonly reported globally. Objective: This investigation clinically stratified subjects to healthy, malodor and gingivitis groups and enumerated oral polymorphonuclear leukocytes (PMN) as a measure of inflammation prior to and after rinsing with a chlorhexidine (CHX) mouthwash. The study also assessed clinical outcomes (dental plaque and gingival bleeding indices), malodor (halimeter scores, organoleptic and tongue coat index and microbiological parameters (anaerobic and malodor organisms of dental plaque, tongue surface and saliva) for a comprehensive assessment of the oral inflammatory burden. Methods: Consenting adults were stratified into control (n = 17), gingivitis (n = 19) and halitosis (n = 17) groups based on clinical criteria. At baseline, oral samples were examined for PMN in addition to microbiological analysis of dental plaque, saliva and tongue scrapings for anaerobic and malodor bacteria. Subjects were issued a commercially available fluoride toothpaste and a chlorhexidine mouthwash for two-week use prior to post-treatment assessments identical to baseline. Results: At baseline, PMN were lowest in the control that increased amongst the halitosis subjects, with the gingivitis group registering the highest levels (p < 0.05) with these outcomes corresponding with clinical parameters (p < 0.05). CHX use improved outcomes with a 56–61% reduction in PMN with significant differences between groups (p < 0.05). Dental plaque and bleeding indices were lower by 57–78% with oral malodor, demonstrating reductions of 33–59% (p < 0.05). Significant reductions in anaerobic and malodor organisms ranging from 78–96% and 76–94%, respectively, were noted after CHX use (p < 0.05). Conclusions: At study enrollment, PMN scores were lowest in healthy subjects, with increasing numbers amongst halitosis followed by gingivitis. Amongst all subject groups, CHX use significantly reduced oral PMN and corroborated with corresponding decreases in clinical, malodor and bacterial outcomes. Together, these results demonstrate the significant reductions in the oral inflammatory burden following CHX use.

Effect of chlorhexidine mouthwashes on periodontal parameters and extrinsic tooth staining in orthodontic patients

Effect of aloe vera mouthwash on dental plaque and gingivitis indices in children: A randomized controlled clinical trial

Aim: The aim of the study is evaluation of safety and efficacy of complete Care Herbal Toothpaste in controlling dental plaque, gingival bleeding and periodontal diseases. Materials and methods: A hundred subjects of both sex with dental plaque and other dental problems in the age group of 18-60 years, who willing gave informed written consent, were included in the study. All the subjects were given Complete Care Herbal Toothpaste and advised to brush the teeth twice daily for 6 weeks and to come for follow up visits at 2nd week, 4th week and 6th week. Improvement in plaque index, oral hygiene status and gingival index was evaluated in these patients. Results: Ninety-two out of hundred subjects who were included in the trial completed till the six weeks of followup, there was significance of p<0.05 reduction in gingival index, plaque index, bleeding index and overall response in individuals with plaque. No clinically significant adverse reactions, were reported or observed, during the entire study period and overall compliance to the treatment was excellent. Therefore, Complete Care Herbal Toothpaste is effective and safe against gingivitis, plaque, bleeding of gums and other oral problems. Conclusion: The effectiveness of Complete Care Herbal Toothpaste was evaluated in subjects with plaque. At the end of the study, Complete Care Herbal Toothpaste showed significant reduction in gingival index, plaque index, bleeding index and overall improvement towards the oral problems of the subjects included in the study. A significant symptomatic relief was seen after treatment for 6 weeks with Complete Care Herbal Toothpaste. No clinically significant adverse reactions, were reported or observed, during the entire study period and overall compliance to the treatment was good.

Fixed orthodontic appliances facilitate microbial adhesion and plaque accumulation. Although chlorhexidine has proven to be the most effective antiplaque and antigingivitis agent, it has several side effects. The present study aims to evaluate and compare the effectiveness of silver nanoparticles (SNP) and Chlorhexidine (CHX) mouthwash on reducing the microbial count and improving oral health during fixed orthodontic treatment. 4-arm parallel, placebo-controlled, double-blind randomized clinical trial with an allocation ratio of 1:1:1:1. Microbial count of Streptococcus spp., Plaque Index, Gingival Index, Gingival Bleeding Index and Pocket Probing Depth were evaluated in 80 orthodontic patients at T0 (Pretreatment), T1 (four weeks after bonding) and T2 (four weeks after mouthwash prescription). Then patients were randomized into four groups: G1) NanOlife (containing SNP), G2) Chlorhex (containing 0.2% chlorhexidine), G3) Placebo, and G4) negative control (no mouthwash prescription) (n=20 each group). The effects of orthodontic treatment and mouthwashes were analyzed statistically. The microbial count and all the four indices increased between T0 and T1 (P<0.05). They decreased below the baseline levels in Gp2, and back to baseline levels in Gp1 at T2 (P<0.05), except Gingival Bleeding index and Pocket Probing Depth. Both mouthwashes showed significantly improved therapeutic effects compared to placebo and negative control. Although SNP mouthwash was effective in the reduction of all the assessed parameters, it could not decrease them to the baseline levels, suggesting its limited efficacy. CHX mouthwash proved to be extremely effective by decreasing the microbial count, plaque index and gingival index below the baseline level.

Aims and objectives: To determine and compare the effect of Triphala, Tulsi extract and chlorhexidine gluconate in gingivitis. Materials and Methods: This study is a double blind randomized clinical trial of 60 individuals were randomly allocated into the study groups of triphala, tulsi mouthwash, chlorhexidine mouthwash. Results: Our result showed that ocimum sanctum mouth rinse is equally in reducing plaque and gingivitis as chlorhexidine. The results demonstrated a significant reduction in gingival bleeding and plaque indices in Group 1and Group 2 over a period of 15 and 30 days as compared to chlorhexidine group. Conclusion: Although chlorhexidine group proved to be the best effective anti-plaque agent and anti-gingivitis agent, it was found that triphala and tulsi prove to be an effective mouth washes by reducing plaque accumulation and gingival inflammation.

Background: Supragingival plaque control is elementary to the prevention and management of periodontal diseases. Conversely, significant proportions of all individuals fail to practice a high standard of plaque removal. The adjunctive use of chemicals would therefore appear a way of overcoming deficiencies in mechanical tooth cleaning habits. This prospective, randomized positively controlled clinical trial was aimed to evaluate the short-term clinical effects of a licorice oral rinse in the reduction of plaque and gingival inflammation in individuals with gingivitis. Materials and Methods: A total of 104 individuals, 12–15 years of age diagnosed with chronic generalized gingivitis, were selected and randomly divided into two groups: Group 1: chlorhexidine mouthwash and Group 2: licorice mouthwash. Clinical evaluation was undertaken using the gingival index, the plaque index, and bleeding on probing at baseline, 1st, 2nd, and 4th week. Results: Both chlorhexidine and licorice mouthwash showed a significant reduction in plaque and gingival index scores from baseline to 1st, 2nd, and at 4th week. However, the improvement in plaque and gingival index scores were better in chlorhexidine group than herbal mouthwash. Both mouthwashes were found to be equally effective in reducing bleeding on probing. Conclusion: Unlike chlorhexidine mouthwash, licorice mouthwash was not associated with any discoloration of teeth or unpleasant taste and was effective in reducing plaque accumulation and gingival inflammation. However, chlorhexidine still remains a gold standard in reducing plaque, gingivitis, and bleeding on probing.

BackgroundOrthodontic treatment can cause traumatic ulcers within the first month due to friction and irritation. Curcumin, a turmeric extract, exhibits analgesic, anti-inflammatory, antibacterial, and wound-healing properties. This study investigated the effectiveness of curcumin mouthwash in preventing traumatic ulcers in fixed orthodontic patients during the first month of treatment.MethodsIn this double-blind, placebo-controlled, randomized clinical trial, 70 patients aged 12–30 years were assigned to curcumin or placebo mouthwash, used twice daily for 28 days after bracket cementation. Primary outcomes were (1) incidence and (2) duration of traumatic ulcers. Secondary outcomes included pain scores, ulcer sites, adverse effects, plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and patient feedback. Data were analyzed using descriptive statistics and SPSS software.ResultsAll 70 patients completed the trial, with 35 participants in the curcumin group (mean age 20.88 ± 4.87 years) and 35 in the placebo group (mean age 18.60 ± 4.20 years). No significant between-group differences were observed in the incidence or duration of traumatic ulcers (p > 0.05). Patients in the curcumin group reported significantly lower pain scores compared with those in the placebo group during the first and second weeks (p < 0.05), indicating an early analgesic effect; however, no significant differences were observed thereafter. The buccal mucosa was the most frequent ulcer site, and orthodontic wax use did not differ significantly between groups (p > 0.05). No adverse effects were reported in the curcumin group, and participants rated its smell as more pleasant. Baseline PI was lower in the curcumin group (p < 0.05), but no post-intervention differences were observed (p > 0.05). Within-group analyses showed a PI reduction in the placebo group and a GI reduction in the curcumin group (both p < 0.05), while GBI remained unchanged.ConclusionsAlthough ulcer prevention was not observed, curcumin mouthwash may serve as an adjunct for early pain relief in orthodontic patients.Trial registrationClinicalTrials.gov (Identifier: NCT05147376), registered on December 7, 2021. Available at: https://clinicaltrials.gov/study/NCT05147376.

Background: Dental plaque and gingival inflammation are key etiological factors in the progression of periodontal diseases. While fluoride-based toothpastes are widely used for their anti-caries benefits, their role in controlling gingivitis is limited. Herbal formulations containing neem and clove have shown promising antiplaque and anti-inflammatory effects, but robust clinical comparisons with fluoride toothpastes remain scarce. Objective: To compare the efficacy of a neem–clove herbal toothpaste with a conventional fluoride toothpaste in reducing plaque index (PI) and gingival bleeding index (GBI) over an 8-week period in adults with mild to moderate gingivitis. Methods: A randomized, examiner-blinded, parallel-arm comparative clinical study was conducted involving 70 systemically healthy adults aged 18–65. Participants were randomly assigned to use either a herbal toothpaste containing standardized neem and clove extracts (n = 35) or a conventional fluoride toothpaste (1,450 ppm sodium fluoride, n = 35). Clinical parameters, including PI and GBI, were recorded at baseline, Week 4, and Week 8 by a calibrated examiner using standard indices. Compliance and safety were monitored throughout the study. Results: Both groups demonstrated significant reductions in PI and GBI from baseline to Week 8 (p &lt; 0.001). However, the herbal group showed statistically greater reductions in mean PI at Week 4 (1.48 ± 0.34 vs. 1.57 ± 0.36; p = 0.042) and Week 8 (0.92 ± 0.30 vs. 1.03 ± 0.33; p = 0.028). Similarly, GBI scores were significantly lower in the herbal group at both Week 4 (30.6% ± 5.2% vs. 32.5% ± 5.5%; p = 0.037) and Week 8 (19.7% ± 4.6% vs. 22.3% ± 5.0%; p = 0.025). Compliance exceeded 90% in both groups, and no serious adverse events were reported. Conclusion: The neem–clove herbal toothpaste demonstrated superior efficacy in reducing plaque and gingival bleeding compared to a fluoride toothpaste over 8 weeks. The findings support the use of standardized herbal formulations as an effective and safe alternative for managing plaque-induced gingivitis. Keywords: Herbal toothpaste, fluoride toothpaste, gingivitis, plaque index, gingival bleeding index, neem, clove, oral hygiene, clinical trial

Dental plaque provides a proper environment for the growth and activity of bacteria responsible for periodontal diseases and caries. As a result, it should be removed by individuals to prevent periodontal diseases and caries. There are different mechanical and chemical plaque control methods. In one study is shown that dental plaque removal efficacy of dentifrice containing Ethylenediaminetetraaceticacid(EDTA)/Methylsulfonylmethane(MSM) was nearly five times that of commercially available fluoride toothpaste. In another study, authors found that xylitol-containing chewing gums caused a marked reduction in the count of Streptococcus Mutans compared to conventional ones. This difference was highly prominent in individuals with poor oral hygiene. In this study we assessed the synergic effects of Xylitol, EDTA and MSM in a chewing gum in comparison with chlorhexidine mouthwash. This study was a crossover, randomized clinical trial. Twenty-four patients were divided in two groups randomly. At the baseline scaling and root planing was done for each patient. Group1 used chlorhexidine mouthwash twice a day. Group2 used novel chewing gum for 15 min twice a day. After 14 days, for every patient O’leary plaque index, gingival index and sulcus bleeding index were reevaluated and recorded. Professional brushing was done for patients. 14 days were considered as wash-out period. After that, method of plaque control of groups was changed. After 14 days, all patients were reevaluated and recorded and were compared with previous data. Samples in 2 groups had no significant difference in age and sex. Paired sample t test revealed that there were significant differences between first and second period for O’leary plaque index, gingival index and sulcus bleeding index in Group1 (P < 0.05). But in Group2 there were no differences between first and second period for all indexes. Also independent sample t test showed that there were no significant differences between baseline, after first treatment and after second one for all indexes in both groups (P > 0.05). According to regression model results, type of treatment had no effect on mean of all indexes. According to our findings which showed the similar efficiency of novel chewing gum and chlorhexidine mouthwash in improving and reducing plaque and gingival indexes, we can conclude that novel chewing gum can be introduced as an effective, cheap and accessible tool for dental plaque control.

BackgroundOrthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment.MethodsA single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software.ResultsThe water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group.ConclusionBoth water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients.

Gingival health status in individuals using different types of toothpaste