Essential Oils Compared to Chlorhexidine With Respect to Plaque and Parameters of Gingival Inflammation: A Systematic Review

Clinic for Periodontology, Amersfoort, The Netherlands.
Journal of Periodontology (Impact Factor: 2.71). 11/2010; 82(2):174-94. DOI: 10.1902/jop.2010.100266
Source: PubMed


The purpose of this review is to systematically evaluate the effects of an essential-oil mouthwash (EOMW) compared to a chlorhexidine mouthwash with respect to plaque and parameters of gingival inflammation.
PubMed/MEDLINE and Cochrane CENTRAL databases were searched for studies up to and including September 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility by two reviewers. Articles that evaluated the effects of the EOMW compared to chlorhexidine mouthwash were included. Where appropriate, a meta-analysis was performed, and weighted mean differences (WMDs) were calculated.
A total of 390 unique articles were found, of which 19 articles met the eligibility criteria. A meta-analysis of long-term studies (duration ≥ 4 weeks) showed that the chlorhexidine mouthwash provided significantly better effects regarding plaque control than EOMW (WMD: 0.19; P = 0.0009). No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash (WMD: 0.03; P = 0.58).
In long-term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.

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    • "Various agents that are antimicrobial and prevent the bacterial proliferation phase of plaque development have been introduced to the market [3]. Chlorhexidine (CHX), a cationic bisbiguanide is a gold standard among all mouthwashes [4,5,6,7,8], particularly because of its substantivity and broad-spectrum antibacterial activity [9,10,11]. However, CHX has been reported to have a number of side effects like brown discoloration of teeth, salt taste perturbation, oral mucosal erosions, and enhanced supragingival calculus formation, which limit its long-term use [3,12,13,14]. "
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    ABSTRACT: Purpose: Triphala is a combination of three medicinal plants, extensively used in Ayurveda since ancient times. Triphala mouthwash is used in the treatment of periodontal diseases because of its antimicrobial and antioxidant properties. The aim of this study is to compare the efficacy of triphala mouthwash with 0.2% chlorhexidine in hospitalized periodontal disease patients. Methods: In this double-blind, randomized, multicenter clinical trial, 120 patients were equally divided into three groups. Patients in group A were advised to rinse their mouths with 10 mL of distilled water, group B with 0.2% chlorhexidine, and group C with triphala mouthwash for 1 minute twice daily for two weeks. The plaque index (PI) and the gingival index (GI) were recorded on the first and the fifteenth day. Results: There was no significant difference when the efficacy of triphala was compared with 0.2% chlorhexidine in hospitalized patients with periodontal disease. However, a statistically significant difference was observed in PI and GI when both group B and group C were compared with group A and also within groups B and C, after 15 days (P<0.05). Conclusions: The triphala mouthwash (herbal) is an effective antiplaque agent like 0.2% chlorhexidine. It is significantly useful in reducing plaque accumulation and gingival inflammation, thereby controlling periodontal diseases in every patient. It is also cost effective, easily available, and well tolerable with no reported side effects.
    Full-text · Article · Jun 2014 · Journal of periodontal & implant science
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    • "As a consequence, a number of rinsing agents for daily use have been developed, of which the essential oil product Listerine Ò is the most studied and celebrated. Listerine Ò is a group of alcohol containing mouthwashes suggested to be potent inhibitors of plaque formation [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18]. However, most of the scientific documentation of Listerine Ò has been obtained with 5% hydro-alcohol solutions as the negative control [9,10,12–17]. "
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    ABSTRACT: Abstract Background. Studies have reported commercially available essential oils with convincing plaque and gingivitis preventing properties. However, no tests have compared these essential oils, i.e. Listerine®, against their true vehicle controls. Objective. To compare the plaque and gingivitis inhibiting effect of a commercially-available essential oil (Listerine® Total Care) to a negative (22% hydro-alcohol solution) and a positive (0.2% chlorhexidine (CHX)) control in an experimental gingivitis model. Materials and methods. In three groups of 15 healthy volunteers, experimental gingivitis was induced and monitored over 21 days, simultaneously treated with Listerine® Total Care (test), 22% hydro-alcohol solution (negative control) and 0.2% chlorhexidine solution (positive control), respectively. The upper right quadrant of each individual received mouthwash only, whereas the upper left quadrant was subject to both rinses and mechanical oral hygiene. Plaque, gingivitis and side-effects were assessed at day 7, 14 and 21. Results. After 21 days, the chlorhexidine group showed significantly lower average plaque and gingivitis scores than the Listerine® and alcohol groups, whereas there was little difference between the two latter. Conclusion. Listerine® Total Care had no statistically significant effect on plaque formation as compared to its vehicle control.
    Full-text · Article · May 2013 · Acta odontologica Scandinavica
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    • "Furthermore, several studies have demonstrated that EO and CHX rinses were equally effective in reducing gingival index scores and the number of bleeding sites [9,12,37]. Finally, in a recent systematic review [38], the authors concluded that although the effects of CHX ensure higher control of plaque, there are no marked differences in the control of gingival inflammation. Therefore, the EO mouthwash appears to be a reliable alternative to the CHX mouthwash in those cases where the dental professional has judged that long-term anti-inflammatory oral care may be beneficial, while for indications where plaque control is the focus, a CHX mouthwash remains the first choice. "
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    ABSTRACT: The aim of this study was to evaluate the antiplaque effect of a new alcohol free essential oil mouthwash with respect to a control of an essential oil with alcohol mouthwash, using an in vivo plaque regrowth model of 3-days. The study was designed as a double-masked, randomized, crossover clinical trial, involving 30 volunteers to compare two different essential oil containing mouthwashes, during a 3-day plaque accumulation model. After receiving a thorough professional prophylaxis at the baseline, over the next 3-days each volunteer refrained from all oral hygiene measures and had two daily rinses with 20 ml of the test mouthwash (alcohol free essential oil) or the control mouthwash (essential oil with alcohol). At the end of the each experimental period, plaque was assessed and the panelists filled out a questionnaire. Each subject underwent a 14 days washout period and there was a second allocation. The essential oil mouthwash with ethanol shows a better inhibitory effect of plaque regrowth in 3-days than the mouthwash test with only essential oil in the whole mouth (plaque index = 2.18 against 2.46, respectively, p < 0.05); for the lower jaw (plaque index = 2.28 against 2.57, respectively, p < 0.05); for the upper jaw (plaque index = 2.08 against 2.35, respectively, p < 0.05); for the incisors (plaque index = 1.93 against 2.27, respectively, p < 0.05); and the canines (plaque index = 1.99 against 2.47, respectively, p < 0.05). The essential oil containing mouthwash without alcohol seems to have a less inhibiting effect on the plaque regrowth than the traditional alcoholic solution.
    Full-text · Article · Dec 2011 · Trials
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