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Effectiveness of combination herbal mouthwash for gingivitis.

Mahyari S, Mahyari B, Emami SA, Malaekeh-Nikouei B, Jahanbakhsh SP, Sahebkar A, Mohammadpour AH. 2016. Evaluation of the efficacy of a polyherbal mouthwash containing Zingiber officinale, Rosmarinus officinalis, and Calendula officinalis extracts in patients with gingivitis: A randomised double-blind placebo-controlled trial. Complement Ther ClinPract; 22:93-98.

Gingivitis is a highly prevalent periodontal disease, characterised by bleeding, plaque formation and gum inflammation, and occurs when subgingival bacteria impair the barrier function of the sulcular epithelium, causing subsequent inflammation. Prior research has demonstrated elimination of microbial dental plaque biofilm prevents gingivitis and dental cavities. Whilst mechanical controls such as twice daily brushing and daily flossing can help control the microbial populations, it has been proposed that additional methods are required to control bacterial plaque formation, such as with the use of antimicrobial dentrifices or anti-plaque mouthwashes. With previous studies having demonstrated efficacy of some plant extracts reducing microbial growth in subgingival plaques leading to reduction of symptoms, authors of the present study aimed to assess the therapeutic effect of a polyherbal mouthwash formulation containing Rosmarinus officinalis (rosemary), Zingiber officinale (ginger) and Calendula officinalis (marigold) in patients with gingivitis.

This randomised, double blind, placebo-controlled trial was conducted in Iran in 2015. In total, 60 participants aged 18-65 years were randomly assigned to receive the polyherbal mouthwash (n=20, placebo mouthwash (n=20) or 0.2% (w/v) chlorhexidine gluconate mouthwash (n=20). Chlorhexidine gluconate is a commonly used oral antiplaque and antiseptic mouthwash and was used as a positive control. Patients were instructed to use the mouthwash for a period of 14 days, by rinsing their mouth and teeth with 10mL of assigned mouthwash for approximately 30 seconds twice daily after breakfast and dinner. All patients also received dental advice to observe oral hygiene. The polyherbal mouthwash contained hydro-ethanolic extracts of rosemary, ginger and marigold. Each 280ml mouthwash formulation contained 14g of the dried hydro-ethanolic extract of each plant (5% w/v) to 197.2 mL of water. Active and placebo mouthwash preparations (containing no plant extract) were prepared for comparison.

Dental examinations were performed at baseline, day 7 and day 14 of the trial. For inclusion, participants were to have been diagnosed with gingivitis, have at least 18 natural teeth, a Modified Gingival Index (MDI) score between 1.3 and 2.75 and a Modified Quiqley-Hein (MQH) plaque score of at least 1.5. Exclusion criteria included need for antibiotic therapy, and recent or current use of antibiotics, anti-inflammatory, anticoagulant and immunosuppressive drugs, advanced periodontal or orthodontic disease, pregnancy and lactation, and Sjogren's Syndrome. Gingival and plaque indices were assessed using MGI, MQH and Gingival Bleeding Index (GBI) scores as assessed by the same dentist at the three time points.

All participants completed the two-week trial with no complaints of side effects from the polyherbal mouthwash. Significant improvements were observed in all efficacy measures, MGI, MQH and GBI, from baseline to the end of trial at day 14 for both the polyherbal and chlorhexidine mouthwash groups. No statistically significant change was observed in the placebo group. At days 7 and 14, both the polyherbal and chlorhexidine had significantly lower scores compared to the control group. The efficacy of the polyherbal mouthwash was comparable to the chlorhexidine mouthwash with no significant difference between them.

Whilst this is a small study of short duration, the results suggest a potential benefit of the polyherbal mouthwash in improving gingivitis as reflected by the decreased scores of MGI, MQH and GBI. There are limitations to the study including potential for selection and measurement bias, so the results should be interpreted with this in mind. Future studies with larger sample sizes and for longer duration will provide more insight about a potential role of a polyherbal mouthwash containing rosemary, ginger and marigold, specifically with regard to efficacy, outcome measures and tolerance over a longer period.

Jodie Tester

These abstracts are brief summaries of articles which have appeared in recent issues of herbal medicine journals, some of which may be held in the NHAA library.
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Article Details
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Author:Tester, Jodie
Publication:Australian Journal of Herbal Medicine
Article Type:Report
Geographic Code:8AUST
Date:Jun 1, 2016
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