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

He Cai,Xing Liang,Nirmala K Panagodage Perera,Junyu Chen

doi:10.1155/2020/2829854

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).

Highlights

Gingivitis, which has a direct association with dental plaque [1, 2], affects the oral health of 70%–100% of the population across the world [3,4,5]
Significant differences were observed in favour of herbal mouthwashes compared with placebos in both plaque- and inflammation-related indices (Quigley-Hein Plaque Index, QHPI: weighted mean differences (WMDs) − 0.61, 95% confidential intervals (95% CIs) (− 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 difference was observed between herbal and CHX mouthwashes in the selected studies, further high-quality randomised controlled trials (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)

Summary

Introduction

Gingivitis, which has a direct association with dental plaque [1, 2], affects the oral health of 70%–100% of the population across the world [3,4,5]. Toothbrushing is the most popular self-performed oral hygiene method to mechanically remove dental plaque. This mechanical approach by most individuals is often not sufficiently effective [8], suggesting that a chemical plaque control by mouthwashes could be beneficial as a supplement to daily oral care [9]. Chlorhexidine (CHX), a broad-spectrum antiseptic, is considered as the gold standard for chemical dental plaque control [2], but CHX mouthwashes can lead to the staining of teeth and tongue, taste disturbance, and adverse effects on the oral mucosa after prolonged use [10, 11]. Compared with the antimicrobial mechanisms by synthetic chemicals, herbal mouthwashes can have additional anti-inflammatory and antioxidant properties, which could further benefit gingival health [19]

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Conclusion