Table 1.
Clinical trials studying plant-based antimicrobials in periodontal diseases.
| Natural Compound | Study Type | Samples Studied | Methods | Result(s)/Conclusion(s) | Limitations | Ref./Year |
|---|---|---|---|---|---|---|
| Acacia arabica | RCT | Nc: 40 Ns: 40 [Patients with mild–moderate periodontitis] |
Gc: SRP + placebo Gs: SRP + Acacia arabica [PD and CAL were compared at baseline and after 15 and 90 days] |
Acacia arabica’s antiplaque and antigingivitis properties were significantly valuable (p < 0.05). A reduction in sites with moderate PD was observed more among Gs than Gc (p = 0.001). The treatment may be prescribed with SRP for mild to moderate chronic periodontitis. | 1. No assessment of bone defect fill. 2. Short follow-up period. |
[56]/2018 |
| RCT | Nc: 30 Ns: 30 [Patients with gingivitis] |
Gc: Regular toothpaste Gs: Toothpaste containing Acacia arabica [PI, GI, and BOP were compared at the baseline and after 28 days] |
Gs showed statistically significantly better results regarding PI, GI, and BOP (p < 0.001). Gingivitis may be prevented with toothpaste that contains Acacia arabica. Using it daily can help improve oral health. | Not assessing the combination therapy using herbal toothpastes and mouthwashes. | [156]/2012 | |
| Allium sativum | RCT | Nc: 100 Ns: 100 [Patients with mild–moderate periodontitis] |
Gc: Placebo tablets Gs: Tablets containing 300 mg of AGE powder [Subjects were examined at the start and 12 and 18 months post-op. GR and PD were measured] |
The mean value of pocket depth was 1.06 ± 0.49 in comparison with the baseline value of 1.89 ± 0.74 (p < 0.001). The corresponding value was 1.50 ± 0.46 for the placebo group (p < 0.001). Periodontal disease can be prevented or improved with aged garlic extract. | Not determining the exact dosage, required duration of usage, or the principal mode of action. | [83]/2020 |
| Aloe barbadensis Miller | RCT | N1: 10 N2: 10 [Patients with gingivitis] |
G1: First, Aloe vera toothpaste for 14 days, then fluoride toothpaste for another 14 days G2: First, fluoride toothpaste for 14 days, then Aloe vera toothpaste for another 14 days [PI and GI were assessed] |
PI was 2.14 ± 1.3 at baseline and 1.84 ± 1.02 at 30 days (p < 0.098). GI was 0.62 ± 0.74 at baseline and 0.25 ± 0.46 at 30 days (p < 0.068). In comparison with fluoride toothpaste, Aloe vera toothpaste had similar effects on PI and GI, and it seems that it can be used as an alternative. |
1. Small sample size 2. Short follow-up period |
[157]/2021 |
| RCT | Nc: 20 Ns: 20 [Patients with chronic periodontitis] |
Gc: SRP Gs: SRP + Aloe vera gel [GI, PI, and PD were evaluated at baseline and after 15 and 30 days] |
The mean reduction in GI: baseline day, 1.98 ± 0.10; 15 days, 1.6 ± 0.10; 30 days, 1.05 ± 0.10. After and before treatment measurements. Aloe vera treatment significantly reduced PI. The plaque index was meaningfully decreased from 2.15 ± 0.271 to 1.60 ± 0.34 after 30 days. Periodontitis significantly decreased in areas treated with Aloe vera gel. |
1. Small sample size 2. Short follow-up period |
[158]/2019 | |
| RCT | Nc: 18 Ns: 18 [Healthy individuals] |
Gc: Close-up tooth gel Gs: Aloe vera tooth gel [After 3 weeks, PI and GI were measured at baseline] |
It was demonstrated that toothpaste containing Aloe vera significantly improved GI and PI; the results were similar to those achieved with tooth gel applied close up. | 1. Small sample size 2. Short follow-up period |
[159]/2018 | |
| RCT | N1: 130 N2: 130 N3: 130 [Patients with PI > 1.9, and GI > 1.1] |
G1: Aloe vera mouthwash G2: CHX mouthwash G3: Placebo [GI and PI were measured at baseline and after 15 and 30 days] |
Compared to the CHX and Aloe vera groups, all parameters presented considerable reductions (p < 0.05). Neither Aloe vera nor CHX presented a significant difference (p < 0.05). Aloe vera and placebo and CHX and placebo had significantly different mean PI and GI scores (p < 0.000). | Short follow-up period | [160]/2016 | |
| RCT | N1: 30 N2: 30 N3: 30 [Healthy individuals] |
G1: Aloe vera mouthwash G2: CHX mouthwash G3: Placebo (normal saline) [After 15 and 30 days, GI and PI were evaluated at baseline] |
Both Aloe vera and CHX significantly reduced plaque and gingivitis. There was no statistically significant difference between groups (p > 0.05). CHX mouthwash can be replaced with Aloe vera as an affordable and suitable alternative. | 1. Small sample size 2. Short follow-up period |
[161]/2016 | |
| RCT | N1: 30 N2: 30 N3: 30 [Patients with visible plaque and gingivitis in at least 30% of their teeth] |
G1: Aloe vera mouthwash G2: Chlorine dioxide mouthwash G3: CHX mouthwash [GI and PI were evaluated at baseline and after 15 days] |
At follow-up, all three groups had significantly lower plaque and gingival scores than at baseline (p < 0.001). In comparison with Aloe vera, CHX significantly reduced PI and GI (p < 0.05). | 1. Small sample size 2. Short follow-up period |
[162]/2016 | |
| RCT | N1: 30 N2: 30 N3: 30 [Patients with periodontitis] |
G1: 0.2% CHX mouthwash G2: Green tea–Aloe vera mouthwash G3: Distilled water [After 14 days, GI, BI, and PI were evaluated at baseline] |
G1, G2, and G3 reduced the PI by 0.17 ± 0.14, 0.10 ± 0.08, and 0.02 ± 0.18, respectively (p = 0.008). Between G1 and G2 with G3 were a significant difference. BIs between these three groups were significantly different, with p = 0.001 between G2 and G1 with G3. Periodontal health was improved by green tea–Aloe vera mouthwash. This can lead to improved dental and oral health. | 1. Small sample size 2. Short follow-up period |
[163]/2016 | |
| RCT | N1: 115 N2: 115 N3: 115 [Healthy individuals with baseline DMFT index of 2.5 to 5 and baseline PI > 1.5] |
G1: Mouthwash containing Aloe vera G2: CHX mouthwash G3: Placebo mouthwash [After 15 and 30 days, GI and PI were evaluated at baseline and] |
CHX and Aloe vera groups reduced plaque and gingivitis significantly, but there was no statistically significant difference (p > 0.05). The ability of Aloe vera to reduce periodontal indexes makes it an effective mouthwash. |
Short follow-up period | [164]/2014 | |
| RCT | N1: 40 N2: 40 N3: 40 [Healthy individuals] |
G1: 100% Aloe vera mouthwash G2: CHX mouthwash G3: Placebo mouthwash [At 7, 14, and 22 days, GI, BI, and PI were evaluated at baseline] |
The PI, GI, and BI scores of G1 and G2 decreased statistically significantly after rinse regimens were initiated compared with G3. Aloe vera mouthwash significantly decreased gingivitis and plaque, but not as much as CHX. | 1. Canceling regular oral hygiene was an inconvenient and embarrassing prerequisite in this mouth rinse study. 2. Short follow-up period |
[100]/2012 | |
| RCT | Nc: 20 Ns: 20 [Patients with chronic periodontitis] |
Gc: SRP Gs: SRP + local administration of Aloe vera gel [GI, PI, and PD were measured at baseline and after 30 and 60 days] |
There was no statistically significant difference between the control and experimental groups in PI in any of the three stages. Both groups treated with SRP combined with Aloe vera or SRP indicated substantial improvement in all 3 stages regarding GI and PD. As a result, Gs had significantly lower GI than the control group (p = 0.0001) and PD (p = 0.009). | 1. Small sample size 2. Short follow-up period |
[165]/2017 | |
| Berberis vulgaris | RCT | N1: 25 N2: 10 N3: 10 [Patients were healthy dormitory students] |
G1: Barberry gel G2: Placebo gel without an active ingredient G3: Colgate® antiplaque toothpaste [GI and PI were measured at baseline and after 21 days] |
Between placebo and barberry gel groups, Colgate® and placebo groups, there were significant differences in PI and GI (p < 0.01). However, there was no statistically significant difference between barberry and Colgate® groups. By applying barberry dental gel, school-aged children can effectively control microbial plaque and gingivitis. | 1. Lack of randomization 2. Small sample size 3. Lack of blinding 4. Short follow-up period |
[166]/2007 |
| Camellia sinensis | RCT | Nc: 15 Ns: 15 [Patients with generalized gingivitis] |
Gc: Full-mouth prophylaxis Gs: Green tea extract and oral lycopene for 45 days + oral prophylaxis. [BI, salivary UA, and PI levels were measured at baseline and after 45 days] |
After treatment, a comparison of the test and control groups revealed statistically significant results in BI (p ≤ 0.001), salivary UA levels (p ≤ 0.01), and PI (p ≤ 0.001). Gingivitis can be treated with lycopene and green tea extract as adjunctive prophylactic and therapeutic methods. | 1. Small sample size 2. Short follow-up period |
[167]/2019 |
| RCT | Nc: 15 Ns: 15 [Patients with chronic periodontitis] |
Gc: No intervention Gs: Green tea herbal [After six weeks, BI, PI, and PD were evaluated at baseline] |
Before and after SRP, both groups presented significant reductions in PD and BI; the intervention group presented a greater reduction (p = 0.003 and 0.031, respectively). The effect of reducing PI between the two groups was not significant, despite being significant within each group (p = 0.135). According to this study, green tea herbal may effectively treat periodontal diseases and improve the benefits of phase I periodontal therapy. |
1. Lack of blinding 2. Small sample size 3. Lack of randomization 4. Short follow-up period |
[168]/2018 | |
| RCT | Nc: 20 Ns: 20 [Patients with a gingival index ≥ 1] |
Gc: 0.12% CHX mouthwash Gs: Green tea mouthwash with 1% tannin [BI, PI, GI, and staining were measured at baseline and after one and four weeks] |
After 1 and 4 weeks, significant differences were detected between groups, but not between groups, in all indices (p < 0.0001). Significantly less tooth staining was observed with the test mouthwash than with the control mouthwash. An adjunct to mechanical plaque reduction could be 1% tannin green tea mouthwash. | 1. Small sample size 2. Observation bias (Hawthorne effect) 3. Short follow-up period |
[169]/2017 | |
| RCT | Nc: 22 Ns: 23 [Patients with marginal gingivitis] |
Gc: Placebo gum Gs: Chewing gum containing green tea [BI, PI, and salivary IL-1β were measured at baseline and after 7 and 21 days] |
There was a significant impact of chewing gum on BI and PI (p < 0.001). BI and PI mean changes at different observation periods were significantly different between the two groups (p < 0.001). Chewing gum had a significant effect on IL-1 β (p < 0.001). A significant difference in mean IL-1 β changes within 1–21 days was not observed (p = 0.086). | 1. Small sample size 2. Short follow-up period |
[170]/2016 | |
| RCT | Nc: 55 Ns: 55 [Patients with PI and GI of at least 1.5 and 1, respectively] |
Gc: Placebo mouthwash Gs: Mouthwash containing 2% green tea [GI and PI were measured at baseline and after 28 days] |
Between baseline and 28 days, mean GI and PI scores decreased significantly among the test group, but not in the control group (p < 0.05). GI scores in the test group (0.67 ± 0.22) were statistically significantly reduced as compared with the control group (0.05 ± 0.11), and PI scores (1.65 ± 0.68) were statistically significantly reduced as compared to the control group (0.45 ± 0.99). |
1. Short follow-up period 2. Small sample size |
[171]/2015 | |
| RCT | N1: 20 N2: 20 N3: 20 [Patients were healthy dormitory students] |
G1: 0.2% CHX G2: 0.05% sodium fluoride G3: 0.5% Camellia sinensis extract [Salivary pH, PI, GI, and OHI scores were measured at baseline and after one and two weeks] |
The experimental groups showed a reduction in mean PI and GI over the 2-week trial period. In all groups, antiplaque effectiveness was highest in G3 (p < 0.05). G1 and G3 were more effective than sodium fluoride at cleaning gingiva (p < 0.05). As compared to G1, the salivary pH increased in G2 and G3. In G1 and G3, the improvement in oral hygiene was more apparent. Due to its minimal side effects and prophylactic benefits, Camellia sinensis can be utilized as an adjunct to oral self-care. |
1. Small sample size 2. Short follow-up period |
[172]/2015 | |
| RCT | Nc: 25 Ns: 25 [Patients with chronic gingivitis] |
Gc: Normal saline Gs: Mouthwash containing 5% green tea [After five weeks, GI, PI, and BI were measured at baseline] |
The periodontal indices showed significant improvement throughout this study (p < 0.001). The changing alteration patterns of indices were contrasted between two groups (p < 0.05). Even though the mouthwash group showed a greater overall improvement, the differences did not reach statistical significance (p > 0.05, observed power for GI: 0.09, PI: 0.11, and BI: 0.07). Green tea mouthwash is effective and safe for treating inflammatory periodontal diseases. | 1. Short follow-up period 2. Small sample size |
[173]/2012 | |
| RCT | Nc: 10 Ns: 10 [Patients with chronic periodontitis] |
Gc: SRP Gs: SRP + green tea catechin application [GI, PI, and PD were measured at baseline and after one and five weeks. After subgingival plaque sampling, red-complex bacteria were studied via PCR] |
Between baseline and 1 week and baseline and 5 weeks, both study and control groups showed significant differences in PD, GI, and PI and substantial reductions in red-complex organisms. (p < 0.001). PD, PI, and GI did not show statistically significant intergroup differences. In Gs, T. forsythus was significantly reduced at one week and five weeks and P. gingivalis was significantly reduced at one week compared to Gc. Chronic periodontitis can be effectively treated with green tea catechins in combination with SRP. | 1. Short follow-up period 2. Split-mouth design 3. Small sample size |
[174]/2013 | |
| Citrus sinensis | RCT | Nc: 10 Ns: 10 [Patients with moderate-severe gingivitis] |
Gc: 2% CHX mouthwash Gs: Citrus sinensis (4% ethanolic extract) mouthwash [GI, PI, and BI were measured at baseline and after 7 and 14 days] |
A mouthwash containing citrus sinensis 4% reduced PI (p = 0.095) as well as a mouthwash containing CHX 0.2% and BI (p = 0.42). However, the extract was more efficient in lowering GI (p = 0.04). | 1. Lack of blinding 2. Small sample size 3. Lack of randomization 4. Short follow-up period |
[109]/2018 |
| Curcuma longa | RCT | Nc: 15 Ns: 15 [Patients with chronic periodontitis] |
Gc: SRP + CHX gel Gs: SRP + curcumin gel [After 30 and 45 days, GI, PI, BI, and PD were evaluated at baseline] |
A significant difference in PI, PD, BI, and GI was found between Gs and Gc (p < 0.001). SRP can be administered with the control and experimental gel, but curcumin gel performed better than CHX gel in reducing periodontal pockets in mild to moderate cases. | 1. Short follow-up period 2. Lack of microbiological evaluations 3. Small sample size |
[175]/2016 |
| Pilot Study | Ten patients with severe gingivitis | Curcuma gel was consumed orally by the subjects for 21 days; BI was measured after three weeks | Statistical significance was found in the results (p < 0.001). By reducing gingival inflammation, Curcuma longa extract gel was effective. | 1. Short follow-up period 2. Pilot study 3. Small sample size |
[176]/2014 | |
| Garcinia mangostana | RCT | Nc: 25 Ns: 25 [Patients with generalized chronic periodontitis] |
Gc: SRP + placebo gel Gs: mangostana gel + SRP [At baseline and after three months, PI, BI, PD, CAL, and red-complex bacteria were evaluated] |
Between baseline and three months after the study began, Gs had significantly lower PD, CAL, BI, PI, and Treponema denticola values than the placebo group (p ≤ 0.05). | 1. Small sample size 2. Short follow-up period |
[177]/2017 |
| Glycyrrhiza glabra | RCT | Nc: 52 Ns: 52 [Patients with mild–moderate periodontitis] |
Gc: No intervention Gs: 10% G. glabra gum paint [GI, PD, and CAL were evaluated at baseline and after four weeks] |
Patients in the study group showed significant improvements in their periodontal health. G. glabra prevented periodontal diseases. | 1. Small sample size 2. Short follow-up period |
[178]/2019 |
| Juglans regia | RCT | N: 20 [Patients with mild gingivitis] |
2% and 3% ether extracts of Juglans regia, 2% and 3% petroleum extracts of Juglans regia, 2% water-soluble extract of Juglans regia, and propylene glycol vehicles were evaluated. [PI was measured at baseline and after three days] |
There was 32.12% and 31.56% antiplaque activity in 2% and 3% ether fractions of Juglans regia, respectively. Inhibition of plaque was observed in 30.32% of cases with the 2% aqueous solution of Juglans regia, and in 17.62% and 19.45% of cases with the 2% and 3% petroleum ether fractions. A high level of statistical significance was found in all the findings. The researchers concluded that Juglans regia could be used as an adjunct to oral hygiene regimens since it displayed potent anti-plaque properties. | 1. Small sample size 2. Short follow-up period |
[179]/2009 |
| Lippia sidoides | RCT | N1: 10 N2: 10 N3: 10 [Healthy individuals] |
G1: Lippia sidoides EO G2: CHX G3: Placebo [PI and BI were measured at baseline and after three months] |
In the test groups, plaque and gingivitis were significantly reduced (p < 0.05), Statistically, there was no significant differences (p > 0.05). Gel preparations containing Lippia sidoides essential oil were effective against plaque and gingivitis. | 1. Small sample size 2. Short follow-up period |
[180]/2013 |
| RCT | Nc: 28 Ns: 27 [Patients with PI and GI of at least 1.5 and 1, respectively] |
G1: CHX mouthwash G2: Lippia sidoides EO mouthwash [PI, BI, GI, and salivary S. mutans colony counts were measured at baseline and after 7 and 30 days] |
Clinical and microbiological parameters were significantly reduced by both mouth rinses. Both groups showed no significant differences (p > 0.05). Both groups had considerable reductions in the number of colonies of S. mutans (p < 0.05). Although CHX treatment reduced more efficiently than L. sidoides, there was no statistical difference between the two groups, and both treatments reduced the bacteria equally (p = 0.3). The results of this study demonstrate that Lippia sidoides EO mouth rinses reduce gingival inflammation and microbial plaque. | 1. Small sample size 2. Short follow-up period |
[181]/2009 | |
| Mangifera indica | RCT | Nc: 10 Ns: 10 [Healthy individuals] |
Gc: CHX mouthwash Gs: Mango leaf mouthwash [After five days, PI, GI, and salivary S. mutans, S. mitis, and S. salivarius counts were evaluated at baseline] |
Mango leaf and CHX mouthwashes significantly reduced the microbial count and improved gingival health and plaque control, with CHX showing a greater reduction in the microbial count and better plaque control. | 1. Small sample size 2. Short follow-up period |
[182]/2017 |
| Manuka honey | RCT | N1: 7 N2: 7 N3: 6 [Orthodontic patients] |
G1: Honey G2: 10% sucrose G3: 10% sorbitol [Plaque pH, bacterial count, and antibacterial properties of honey against S. mutans, L. acidophilus, and P. gingivalis were measured at baseline and after 2, 5, 10, 20, and 30 min] |
As compared to sorbitol, honey and sucrose had significantly different plaque pH values (p ≤ 0.001). Honey was the only substance that significantly reduced pH after 30 min of exposure, despite sucrose, sorbitol, and honey significantly reducing bacteria recovery (p < 0.001). There was a significant decrease in the growth of all bacterial strains when honey was added (p ≤ 0.001). By applying honey topically, pH can be modified, bacteria counts can be reduced, and bacterial growth can be inhibited. | 1. No follow-up 2. Small sample size |
[183]/2014 |
| Pilot study | Nc: 15 Ns: 15 [Healthy individuals] |
Gc: Sugar-free chewing gum Gs: Manuka honey products [PI and GI were measured at baseline and after 21 days] |
Manuka honey reduced plaque scores and bleeding sites (48% reduced to 17%; p = 0.001) statistically significantly compared to the control group. The results suggest that manuka honey may have therapeutic potential in treating gingivitis and periodontitis. | 1. Short follow-up period 2. Pilot study 3. Small sample size |
[184]/2004 | |
| Matricaria chamomilla | RCT | N1: 25 N2: 25 N3: 25 [Patients with chronic periodontitis] |
G1: SRP + placebo G2: 0.12% CHX + SRP G3: 1% Matricaria chamomilla mouthwash + SRP [PI, BI, GI, PD, CAL, GR, stain index, and microbial colony counts were measured at baseline and after six weeks and three months] |
All parameters (except GR in the placebo group) changed significantly between baseline and three months. Compared to the placebo group, meditative mouth rinses containing chamomilla exhibited significant benefits. In comparison to baseline, the CHX rinse resulted in slightly higher improvements in both PD (3.68 mm vs. 3.36 mm) and CAL (3.00 mm vs. 2.72 mm) than CHX rinse. Non-surgical periodontal therapy for chronic periodontitis can use Matricaria chamomilla as an adjunct to CHX mouthwash. | 1. Small sample size 2. Short follow-up period |
[185]/2020 |
| Pilot study | N1: 10 N2: 10 N3: 10 [Orthodontic patients with fixed appliances] |
G1: Placebo G2: 0.12% CHX G3: 1% Matricaria chamomilla mouthwash [PI and BI were measured at baseline and after 15 days] |
G1 exhibited increases in PI and BI (10.2% and 23.1%, respectively). The PI and BI levels in G3(−25.6% and −29.9%, respectively) and G2 (−39.9% and −32.0%, respectively) were considerably lower than those in the placebo group. Biofilm formation and BI were reduced in gingivitis patients. This was probably a result of Matricaria chamomilla’s anti-inflammatory and antimicrobial properties | 1. Short follow-up period 2. Pilot study 3. Small sample size |
[186]/2016 | |
| Psidium guajava | RCT | N total: 15 patients (30 sites) Nc: 15 sites Ns: 15 sites [Patients with chronic periodontitis] |
Gc: SRP Gs: 3% P. guajava gel [After one and three months, PI, GI, BI, PD, CAL, and colony counts of A. a and P. gingivalis were evaluated at baseline] |
Clinical parameters improved significantly throughout the study. Three months after testing, site-specific indices, PD (2.74 ± 0.283), and CAL (2.8 ± 0.152) showed statistically significant reductions. A. a. (17.4 ± 0.026) and P. gingivalis (22.7 ± 1.225) colony counts were significantly reduced at one and three months in the test sites (p < 0.001). Local delivery of 3% P. guajava gel treated chronic periodontitis with clinical and microbiological parameter improvements. | 1. Short follow-up period 2. Small sample size 3. Split-mouth design |
[187]/2021 |
| Punica granatum | RCT | N total: 10 patients (20 sites) Nc: 10 sites Ns: 10 sites [Patients with moderate–severe chronic periodontitis] |
Gc: Placebo gel Gs: Punica granatum gel [after 15 days, PI, GI, and BI were measured at baseline] |
After 15 days following gel application, mean BI, GI, and PI were significantly reduced. According to microbiological results, Punica granatum oral gel suppresses microbial growth. Test specimens revealed mild perivascular inflammation and increased collagen fibers, while controls showed dense inflammatory infiltration and collagen fiber destruction. In combination with SRP, Punica granatum gel reduced chronic periodontitis clinical symptoms. | 1. Small sample size 2. Short follow-up period |
[188]/2019 |
| RCT | N1: 20 N2: 20 N3: 20 N4: 20 [Healthy individuals] |
G1: Pomegranate extract gel G2: CHX gel G3: Ornidazole–CHX gel G4: Placebo gel [After 14 and 60 days, GI, PI, BOP, PD, and GCF levels of IL-8, IL-1β and chemokine ligand 28 were measured at baseline] |
Inhibition of inflammatory cytokines and chemokines was observed in G1. G1 levels of IL-1β and IL-8 increased less than CCL28 levels (p = 0.003, 0.002), which remained unchanged from baseline (p = 0.15). G1 subjects showed a lower increase in BOP and GI (p = 0.01, 0.05) compared to other groups (p < 0.001) after 14 days. It was similar in terms of PI reduction between G1 and G3 gels (p = 0.96). For the treatment of gingivitis, PEG effectively reduced inflammatory markers. | 1. In an experimental gingivitis model, all products were tested, which may differ from the natural gingivitis model. 2. In order to avoid bias caused by variable host responses, a cross-over design would have been more appropriate. |
[189]/2017 | |
| RCT | Nc: 40 Ns: 40 [Diabetic patients with gingivitis] |
Gc: CHX 0.2% Gs: Punica granatum mouthwash [After 14 days, PI, GI, BI, and PD were measured at baseline] |
Both interventions significantly improved gingival and plaque indices (p < 0.001 for all indices). Primary outcome measures showed no significant differences between Gc and Gs, except for GI, where Gs mouthwash had superiority over Gc after two weeks (p = 0.039). It is safe and effective to use Punica granatum mouthwash as an alternative to CHX for diabetic patients with gingivitis. | 1. Short follow-up period 2. Lack of a placebo group 3. Small sample size |
[190]/2016 | |
| Rosmarinus officinalis | RCT | Nc: 23 Ns: 23 [Patients with moderate chronic periodontitis] |
Gc: SRP + placebo Gs: SRP + EO mouth rinse [After three and six months, PD, CAL, BOP, and BI were evaluated at baseline; the subgingival plaque was sampled to evaluate principal periodontitis-associated bacteria] |
A significant improvement in CAL was observed after 3 and 6 months compared to the control group (p < 0.001). Following SRP, adding essential oils to mouthwashes decreases subgingival bacterial levels and improves clinical outcomes. | Small sample size | [191]/2016 |
| Salvadora persica | RCT | Nc: 47 Ns: 47 [School students] |
Gc: Fluoridated toothpaste + brushing Gs: SP sticks [Baseline, three-week, and 12-week PI measurements were conducted as well as saliva sampling] |
Plaque scores decreased statistically significantly in both groups (p = 0.007 and p = 0.001, respectively). After three months, the number of subjects with abundant S. sanguinis increased from zero to six. | 1. Small sample size 2. Short follow-up period |
[192]/2020 |
| RCT | N total: 44 [Pediatric patients receiving chemotherapy] |
Gc: Normal saline Gs: Persica oral drops [Oral conditions were recorded at baseline and after 8 and 15 days] |
A comparison of the severity of mucositis and oral health status of patients in both examination sessions did not reveal significant differences between treatment groups (p > 0.05). Mucositis, plaque accumulation, and gingival health improved statistically significantly in both treatment groups after 14 days following mouth rinse administration (p < 0.05). SP oral drops significantly improve plaque and gingival health | 1. Small sample size 2. Short follow-up period |
[193]/2020 | |
| RCT | N1: 12 N2: 13 [Patients with grade two or three plaque score] |
G1: Toothpaste with tea tree oil G2: Miswak-based toothpaste [PI was recorded at baseline and after 24 h of follow-up] |
Both herbal-based toothpastes reduced plaque scores, but when compared with G1, G2 resulted in significantly lower plaque scores. | 1. Short follow-up period 2. Lack of gingival inflammation assessment 3. Small sample size |
[194]/2018 | |
| Cross-sectional | N1: 115 N2: 93 N3: 79 |
G1: SP sticks (Miswak) G2: Conventional toothpaste/toothbrush G3: SP sticks + toothbrush [GI, OHI, and PI were recorded] |
G1 had a higher mean GI than G2, and G3 had a lower mean PI than G2. Between G1 and G2, the mean GI score was statistically significant (p = 0.001). Oral hygiene did not differ statistically significantly between groups. | Small sample size | [195]/2012 | |
| Terminalia chebula | RCT | N1: 30 N2: 30 N3: 30 [Healthy students] |
G1: T. chebula mouthwash G2: CHX G3: Distilled water At baseline and after 15 and 30 days, PI and GI were evaluated] |
At 15 and 30 days, PI and GI decreased significantly in G1 and G2 (p < 0.05). There was a significant reduction in G2, but not statistically significant in comparison to G1. The GI between G1 and G2 was not statistically significant (p = 0.837 for 15 days and p = 0.909 for 30 days) and PI (p = 0.592 at 15 days and p = 1.096 at 30 days). Using the T. chebula mouth rinse reduced dental plaque and gingivitis as effectively as CHX without the adverse effects of CHX. |
1. Small sample size 2. Short follow-up period |
[196]/2015 |
| RCT | N1: 26 N2: 26 N3: 26 [Patients with PI > 1.5] |
G1: 0.12% CHX G2: Terminalia chebula 10% mouthwash G3: Saline rinse [At baseline and after 7 and 14 days, PI and GI were evaluated] |
Clinical parameters were significantly reduced in both G1 and G2 even though there were no significant differences between them (p > 0.05). Studies have shown that Terminalia chebula mouth rinses reduce microbial plaques and gingival inflammations, as well as neutralize salivary pH levels. | 1. Small sample size 2. Short follow-up period |
[197]/2014 | |
| RCT | Nc: 40 Ns: 40 [Patients with chronic gingivitis] |
Gc: Oral prophylaxis alone Gs: Oral prophylaxis + gingival massage with T. chebula powder [At baseline and after one month, PI, GI, and BI were measured] |
Significant reductions in the PI, GI, and BI scores were observed after gum massage with T. chebula powder. Chronic gingivitis patients can benefit from T. chebula powder. | 1. Short follow-up period 2. No comparison with other studies 3. Small sample size |
[198]/2017 |
RCT: Randomized Clinical Trial; CAL: Clinical Attachment Level; Nc: Number of Subjects in the Control Group; Ns: Number of Subjects in the Study Group; Gc: Control Group; Gs: Study Group; GI: Gingival Index, GR: Gingival Recession; AGE: Aged Garlic Extract; SRP: Scaling and Root Planning; PD: Pocket Depth; CHX: Chlorhexidine; BI: Bleeding Index; UA: Uric Acid; OHI: Oral Hygiene Index; BOP: Bleeding on Probing; PCR: Polymerase Chain Reaction; EO: Essential Oil; GCF: Gingival Crevicular Fluid; PI: Plaque Index, SP: Salvadora persica.