Abstract
BackgroundDespite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive.ObjectiveTo assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults.MethodsWe searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals.ResultsA total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)).ConclusionFor short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.
Highlights
The effective removal of dental plaque is important for maintaining periodontal and oral health [1]
Out of 62 clinical trials, 38 did not meet the inclusion criteria [measured other outcomes [9], follow up period variation [16], variation in Randomised controlled trials (RCTs) design [3], missing values of outcome [6], variation in index used for plaque assessment [1] and full text was not available for two articles] (See Additional file 1: Table S2 for list of excluded trials and reasons)
Our findings suggest that herbal toothpaste (HTP) is superior to non-herbal toothpaste (NHTP) at removing supra-gingival plaque at short term use of 4 weeks, but there is no difference at long-term use of 12 weeks
Summary
The effective removal of dental plaque is important for maintaining periodontal and oral health [1]. Chemical control of dental plaque is an adjunct therapy which may facilitate the removal and prevent the accumulation of microbial plaque, potentially reducing the dependence on mechanical oral care behaviours [2]. Herbal ingredients have been present in oral care products, more commonly in South Asian countries, for some time [7,8,9]. The most common herbal ingredients to be incorporated into oral care products (e.g., toothpaste and mouth rinse) are sanguinarine, propolis, Azadirachta indica (neem), charcoal, Janakiram et al BMC Complementary Medicine and Therapies (2020) 20:43 clove, and miswak [10]. In the rural regions of South Asian countries, use of natural products like neem twigs, charcoal powder, and others have been an important part of regular oral hygiene practice for centuries. Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive
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