doi 10.1515/jcim-2014-0002 J Complement Integr Med.

2014; 11(2): 129–137

Nagesh Bhat, Ruchi Mitra*, Swapnil Oza, Vinayak Kumar Mantu, Sharda Bishnoi,
Mandeepsinh Gohil and Rupam Gupta

The antiplaque effect of herbal mouthwash in

comparison to chlorhexidine in human gingival
disease: a randomized placebo controlled
clinical trial
Abstract Vinayak Kumar Mantu, Department of Oral and Maxillofacial
Background: The aim of this study was to compare the Pathology, Darshan Dental College and Hospital, Loyara, Udaipur
313011, Rajasthan, India
efficacy, safety, antiplaque and antigingivitis properties
Sharda Bishnoi, Mandeepsinh Gohil, Rupam Gupta, Department of
of a herbal mouthwash with chlorhexidine mouthwash. Public Health Dentistry, Darshan Dental College and Hospital, Loyara,
Methods: A double-blinded randomized clinical trial was Udaipur 313011, Rajasthan, India
conducted among 72 undergraduate students with age group
18–24 years. They were randomly divided into three
mouthwash group with 24 participants in each group. Introduction
Group A (herbal), Group B (chlorhexidine) and Group C
(normal saline).The Turesky et al. 1970 plaque index and Dental plaque is a film of microorganisms found on the
Loe and Silness 1963 gingival index was recorded. tooth surface embedded in a matrix of polymers of salivary
Student’s t-test and one-way ANOVA were used to test the and bacterial origin. Dental plaque develops naturally on
significance. tooth surface and forms part of host defences of the oral
Results: A statistically highly significant difference was cavity by acting as a barrier to colonization by exogenous
obtained between mouthwash B and C (p ¼ 0.00) and a microorganisms [1]. The gram-positive and gram-negative
significant difference between mouthwash A and C bacteria that compose oral biofilms produce many meta-
(p ¼ 0.004), showing that chlorhexidine was superior to her- bolites that induce gingivitis [2]. Dental plaque has been
bal mouthwash and saline. However, there was a nonsigni- proved by extensive research by Harold Loe in 1965 [3] to
ficant difference between mouthwash A and B (p ¼ 0.435) be paramount factor in initiation and progression of gingi-
showing that herbal and chlorhexidine mouthwash was val and periodontal diseases. A direct relationship has
equally effective in reducing plaque and gingivitis. been demonstrated between plaque levels and the severity
Conclusions: The efficacy of herbal mouthwash was equally of gingivitis. Since plaque is the principal causative factor
effective in reducing plaque and gingivitis as compared to in gingival and periodontal diseases, the most rational
chlorhexidine mouthwash and may be considered as a good methodology towards the prevention of periodontal dis-
alternative. The chlorhexidine mouthwash was reported with eases would be regular effective removal of plaque by
many side effects which limits its acceptability and long-term personal oral hygiene [3]
use, whereas the presently tested herbal mouthwash had no Supragingival plaque control is largely the responsi-
side effects apart from mild burning sensation. bility of the individual, using tooth brushes and inter-
dental cleaning devices. The majority of the population
Keywords: chlorhexidine, gingivitis, gingival index, her- may not perform mechanical plaque removal sufficiently.
bal, plaque, plaque index Thus, antimicrobial mouthrinses that augment daily
home care may provide an effective means of removing
or controlling bacterial plaque to limit gingivitis and
*Corresponding author: Ruchi Mitra, Department of Public Health periodontitis [4].
Dentistry, Darshan Dental College and Hospital, Loyara, Udaipur The incorporation of chemical agents with antiplaque or
313011, Rajasthan, India, E-mail: drruchimitra@gmail.com
antimicrobial activity into dental products has been pro-
Nagesh Bhat, Swapnil Oza, Department of Public Health Dentistry,
Darshan Dental College and Hospital, Loyara, Udaipur 313011, posed as a potential prophylactic method of reducing pla-
Rajasthan, India que-mediated conditions. A number of chemical agents

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130 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash

which have antiseptic or antimicrobial action have been and antigingivitis properties of a herbal mouthwash with
used, with variable success, to inhibit supragingival plaque chlorhexidine mouthwash among the study participants.
formation and the development of gingivitis. Several chemi-
cal antiplaque agents have been tested but none has shown
equal or better results than chlorhexidine without eliciting
unfavourable side effects [5, 6].
Materials and methods
In order to overcome such side effects, the World
Health Organization (WHO) advice researchers to investi- Study population
gate the possible use of natural products such as herb
and plant extracts. Plants and naturally derived products The present study was a double-blinded, parallel
from plants have been used to enhance health and have designed randomized clinical trial carried out in the
been used for medicinal purposes for thousands of year. Department of Public Health Dentistry, Darshan Dental
Most herbal supplements have been utilized for centuries College and Hospital, Udaipur, Rajasthan, India. It
based on empirical and testimonial support for their included a total of 72 undergraduate students (37 males
efficacy. Development in alternative medicine research and 35 females in the age group of 18–24 years). The
has led to many mouthrinses and toothpastes based on ethical clearance was obtained from the Ethical Review
plant extracts [4]. Committee of the institution and a written informed con-
A number of clinical studies have shown the effects sent was obtained from the study participants after
of using mouth washes extracted from herbs such as explaining in detail about the study.
Sanguinarina, Myrtus communis, Quercus infectoria,
Capparis spinosa and Cinnamon in the prevention of den-
tal plaque accumulation [7, 8]. Recently, a herbal Inclusion criteria
mouthwash has been introduced in clinical practice,
which consists of the extracts of Salvadora persica, The dental students with age group of 18–24 years, stu-
Terminalia bellerica, Piper betle, essential oils namely dents willing to participate and with dentition of ≥20
Gaultheria fragrantissima, Elettaria cardamomum, fla- teeth and a minimum of 5 teeth per quadrant, no relevant
vouring agents Mentha and Trachyspermum ammi. The medical history and no periodontal treatment during past
natural herb S. persica is a medicinal plant whose roots 3 months were included.
have been used by many people in Africa, South
America, Middle East and Asia. The precise method for
use of Miswak was recorded by Babylonian 5000 B.C. and Exclusion criteria
the fashion ultimately spread throughout the Greek and
Romanian empire. S. persica has anticariogenic and anti- Students with orthodontic appliances or severe misa-
plaque effects [9]. P. betle and E. cardamomum have ligned teeth, receiving antibiotic therapy or medication
antibiotic action. T. bellerica is an anti-inflammatory within past 6 months, presence of any systemic illness,
and immunity booster. Also, Mentha and T. ammi which subjects availing oral prophylaxis since past 6 months
are naturally flavouring agents prevent halitosis. and students unable to comply with study appointment
The widespread use of mouthwashes as an aid to oral schedule were excluded.
hygiene is a relatively recent phenomenon in the devel-
oping countries of the world. Also, the cost-effectiveness
of the herbal mouthwash is less as compared to other Test solutions
commercially available chemical-based mouthwashes.
Hence, herbal dental products are becoming popular Group A (Herbal Mouthwash) Hiora® mouthwash
among general public. (Himalaya Drug Company, Bangalore, India). Each gram
The in vitro studies conducted on the efficacy of the of herbal mouthwash contains extracts of Pilu (S. persica)
herbal mouthwash suggest that the herbal mouthwash 5.0 mg, Bibhitaka (T. bellerica) 10.0 mg, Nagavalli (P.
may be used as compared to chlorhexidine mouthwash. betle) 10.0 mg, oils Gandhapura taila (G. fragrantissima)
Hence clinical trials are being conducted to see the efficacy 1.2 mg, Ela (E. cardamomum) 0.2 mg, flavouring agents
of herbal mouthwash in the oral cavity. In this study, an Peppermint satva (Mentha spp.) 1.6 mg and Yavani satva
attempt was made to compare the efficacy on plaque, safety (Trachyspermum ammi) 0.4 mg.

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 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash 131

Group B (Chlorhexidine Mouthwash) ClohexPlus® intraexaminer was 0.90 and 0.94 respectively showing
mouthwash (Dr Reddy’s Lab Ltd. Hyderabad, India) contain- high degree of conformity in observational judgment.
ing 0.20% w/v chlorhexidine was used in the present study. All recordings were made by a single examiner. Plaque
Group C (Normal Saline) Nirlife® mouthwash (Inven was assessed on the labial, buccal and lingual surfaces of
Pharmaceuticals Pvt. Ltd.; Dhar, Madhya Pradesh, India) all teeth after using disclosing agent (Two-tone dye). The
containing 0.05% saline was used in the present study. severity of gingivitis was scored by examining the tissues
Normal saline was coloured to resemble the surrounding each tooth that were divided into four gingi-
mouthwashes. val scoring units: distal-facial papilla, facial margin,
mesial-facial papilla and the entire lingual gingival
margin.
Study design All the participants were instructed to follow their
routine oral hygiene practices along with the assigned
In order to check the feasibility and validity of the study, regimen and to maintain a reminder sheet on daily pro-
a pilot study was carried out. It also meant to assess the duct use. Each one of the daily rinses was supervised on
acceptability and regularity of using these mouthwashes. each weekday and also supervised by a daily recall mes-
From the pilot study, it was found that the overall pre- sage for reminding them to use the assigned mouthwash.
valence of plaque and gingivitis was 80%. Considering The compliance was checked with the help of a reminder
for the dropouts logistic and technical problems the sam- sheet by the examiner during surprise recall of the parti-
ple size was inflated by 20%, hence the sample size was cipants. Also, the participants were recalled along with
72 with 24 participants in each group. A self-designed the mouthwash bottles assigned to check for the
pretested proforma which consisted of three parts: First mouthwash volume used by the participants.
demographic information like name, age, sex and
informed written consent. Second part gingival index
and plaque index recorded at baseline and after 1- Statistical analysis
month trial. The third part a questionnaire related to the
complaints or discomfort like pain, burning sensation/ The obtained data were compiled systematically. Data
itching, dryness of mouth, taste disturbance and disco- collected were coded, computerized and analyzed using
loration of teeth if any. Statistical package for Social Sciences (SPSS version
The assignment of the participants to the groups and 17.0). One-way ANOVA and Student’s t-test were used to
the codes to the product was done by a person not compare the means of plaque and gingival index values
involved in the examination. All the subjects were pro- between the three mouthwashes.
vided with their assigned mouthrinses and were divided
into Group A, Group B and Group C randomly using
simple lottery method with 24 participants in each Results
group. All the mouthrinses were dispensed in the identi-
cal bottles and thereby ensuring a total subject masking. The study participants were selected according to the
The examiner and the participants were also blinded with inclusion and exclusion criteria. A total of 72 students
regard to the mouthrinse allocated to them thereby ensur- participated in the study out of which 37 were males and
ing a double-blinded study. Subjects were provided with 35 were females with 24 students in each group in the
measuring cups of 10 mL and were instructed to use beginning of the study. However, two students did not
10 mL of mouthwash for 1 min carried out twice a day report after 1 month in spite of several recalls, three
after tooth brushing for a period of 4 weeks (1 month). students were irregular in using mouthwash found dur-
The gingival index Loe and Silness 1963 and ing surprise visit and one of the students became ill and
Turesky–Gilmore–Glickman 1970 modification of had to quit the study due to antibiotic coverage. Hence, a
Quigley–Hein plaque index were used to record the effi- total of 66 students participated of which 32 were females
cacy before rinsing (at baseline) and after 1 month. Prior and 34 were males with 22 students in each group. The
to the start of the study training and calibration was done mean age for herbal group, chlorhexidine group and
in order to check the feasibility and reliability of the saline group was 20.2  0.7, 20.95  .1 and 20.79±1.2
study. The Kappa statistical analysis for interexaminer respectively. There was statistically no significant differ-
variability for Turesky et al. plaque index and Loe and ence (p ¼ 0.356) in the mean age of herbal (Group A),
Silness gingival index was 0.89 and 0.97, whereas the chlorhexidine (Group B) and saline groups (Group C).

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132 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash

Table 1 Comparison among the three mouthwashes on plaque index using one-way ANOVA.

Prerinsing PI (Baseline)

Source of variation df Sum of squares Mean square F-Value p-Value

Between groups A, B, C 2 0.068 0.032 0.052 0.87 (NSa)

Within groups 63 4.23 0.023
Total 65 4.29

Postrinsing PI

Source of variation df Sum of squares Mean square F-Value p-Value

Between groups A, B, C 2 8.51 4.29 30.62 0.000 (HSb)

Within groups 63 8.76 0.14
Total 65 17.26
a
NS, statistically non significant; bHS, statistically highly significant.

Table 2 Comparison among the three mouthwashes on gingival index using one-way ANOVA.

Prerinsing (Baseline)

Source of variation df Sum of squares Mean square F-Value p-Value

Between groups A, B, C 2 0.006 0.008

Within groups 63 2.54 0.062
Total 65 2.55 0.063 0.92 (NS)

Postrinsing

Source of variation df Sum of squares Mean square F-Value p-Value

Between groups A, B, C 2 2.56 1.28

Within groups 63 1.91 0.03
Total 65 4.51 42.78 0.001(HS)

There was no statistically significant difference between the Group A mouthwash showed the highest mean dif-
baseline plaque scores as compared to the three mouthwash ference of gingival scores between baseline and after 1
groups (p=0.87), but there was statistically highly significant month (0.34) while the least was 0.12 observed in saline
difference (p=0.00) observed between the three mouthwash group. Group A and Group C showed a statistically sig-
when compared after 1 month. nificant difference (p ¼ 0.003), statistically highly signifi-
The baseline gingival index scores between the three cant difference between Group B and Group C (p ¼ 0.001)
mouthwashes were statistically nonsignificant (p ¼ 0.92), but statistically no significant difference between Group
whereas after 1 month, there was statistically highly sig- A and Group B (p ¼ 0.229) (Table 4).
nificant (p ¼ 0.001) difference (Table 1 and 2).
The mean difference between the baseline plaque
index and postrinsing plaque index after 1 month was Mean values of plaque index
highest in Group A (0.74) and least in Group C (–0.09). A
statistically significant difference (p ¼ 0.004) between The mean plaque index scores of the mouthwashes at
Group A and Group C and a statistically highly significant baseline were 1.5±0.32, 1.22±0.25 and 1.34±0.48 respec-
difference (p ¼ 0.00) was observed between Group B and tively. The highest mean plaque index after 1 month
Group C but statistically no significant difference between was in Group C (1.46±0.19), the least mean plaque scores
Group A and Group B (p ¼ 0.435) (Table 3). after 1 month was 0.68±0.14 in Group B. The range for

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 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash 133

Table 3 Comparison of the plaque index between mouthwashes by 1 respectively, whereas after 1 month the range observed
unpaired Student’s t-test. for postrinsing gingival index was 0.68, 0.42 and 2.4
respectively (Figure 2).
Groups Mean Mean df t-Value p-Value

A and B 0.74 0.56 42 1.43 0.435 (NS)

A and C 0.74 −0.09 43 7.10 0.004 (S) The adverse effects related to the
B and C 0.56 −0.09 41 7.32 0.00 (HS)
mouthwash

A majority of the adverse effects resulted in Group B. It

Table 4 Comparison of the gingival index between mouthwashes was observed that most of the study participants in Group
using Student’s t test paired. B complained of mild discoloration 18(81.8%), moderate
discoloration 2(9.1%) and dry mouth 18(81.8%), whereas
Groups Mean Mean df t-Value p-Value
taste disturbance was highest in Group C 14(63.6%) as
A and B 0.34 0.32 42 1.26 0.229 (NS) compared to Group B 10(45.4%). The least taste distur-
A and C 0.34 −0.12 43 7.89 0.003 (S) bance was seen in Group A 2(9.1%). The burning sensa-
B and C 0.32 −0.12 41 7.92 0.001 (HS) tion was highest in Group B 11(50%) as compared to
Group A 9(40.9%) and absent in Group C (Figure 3).

plaque index at baseline was 1.9, 1.8 and 2.1 in

Group A, B and C respectively and after 1 month it was Discussion
1.23, 1.07 and 3.0 in Group A, B and C respectively
(Figure 1). A thorough exploration of the available literature revealed
few studies in which different herbal mouthwashes were
compared with chlorhexidine mouthwash. The sample size,
Mean values of gingival index design, the study period, the indices and the technique used
in those studies highly varied from one study to another
The mean gingival index score of the mouthwashes at study. A sincere attempt has been made to compare the
baseline was 0.62  0.52, 0.77  0.43 and 0.91  0.84 available results wherever possible maintaining the validity
respectively. The highest mean gingival index after 1 of the comparisons to the possible extent.
month was 1.02  0.79 in group C and the least mean The distribution of the study participants according
gingival index was 0.35  0.46 in group A. The range for to the age was between 18 and 24 years with the mean
prerinsing gingival scores at baseline was 0.94, 0.68 and age of herbal group, chlorhexidine group and saline

Figure 1 The distribution of the postrinsing plaque index scores of different groups after 1 month.

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134 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash

Figure 2 The distribution of the postrinsing gingival index scores after 1 month.

Figure 3 Comparison of the adverse effects of the mouthwashes.

group was 20.2±0.7, 20.95±1.1 and 20.79±1.2 respectively. Persica mouthwash with that of a placebo using Silness
There was no significant difference (p ¼ 0.356) between and Loe plaque index.
the mean age of the three groups. The study shows As evident from the result of the present study, there
population selected was homogeneous which was similar was no significant difference in baseline plaque index
to other studies [10, 11]. (p ¼ 0.87) between the three mouthwashes. In the present
As compared to the present study, few studies have study, the herbal mouthwash showed plaque inhibition
been done with relatively favourable results as exhibited which lay between the negative and positive control
by herbal mouthrinses. Similar to our study, studies con- (Table 2). A statistically significant suppression of plaque
ducted by Parwani et al. [12] and Sikka et al. [13] com- formation was seen with herbal formulation as compared
pared chlorhexidine and herbal mouthwash using Loe to placebo solution (p ¼ 0.004) and statistically nonsigni-
and Silness gingival index and Turesky et al. plaque ficant result with chlorhexidine mouthwash (p ¼ 0.435)
index. Whereas study done by Scherer et al. [14] com- showing that chlorhexidine and herbal mouthwash had
pared herbal mouthwash and distilled water using Loe a comparable effect on plaque formation. The plaque
and Silness gingival index. Another study conducted by preventing potential of herbal mouthwash, demonstrated
Khalessi et al. [15] compared the oral health efficacy of in the present investigation, can be attributed to its

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 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash 135

constituents like S. persica, P. betle, T. bellerica, E. carda- with a substantivity of 8–12 h is considered highly effec-
momum and others. S. persica, toothbrush tree, locally tive [28], whereas Hiora herbal mouthwash substantivity
called “Miswak” has been proven as an antiplaque agent is not yet known. On other hand, Jenkin et al. stated that
by numerous studies [12, 16]. Its antiplaque activity might chlorhexidine had immediate bactericidal action on pla-
be due to its antimicrobial activity against early and late que bacteria and plaque fungi and was among the most
plaque formers. Sofrata et al. [17] reported antibacterial effective active agents to reduce and inhibit plaque accu-
effect of S. persica against oral pathogens such as mulation. It was able to kill both gram-positive and gram-
Streptococcus mutans, Lactobacillus acidophilus, negative microbes. This could be due to the mechanism
Actinobacillus actinomycetemcomitans, Porphyromonas of action of chlorhexidine on bacteria, which involves the
gingivalis and Haemophilus influenza. These findings are disruption of bacterial cell membrane [31]
also supported by the studies of Darout et al. [18] and In the past, many studies suggested that chlorhexi-
Almas et al. [19]. However, when antimicrobial effect of S. dine had the ability to reduce plaque formation and also
persica and CHX against S. mutans was compared, chlor- improved the gingival status. The Hiora mouthwash used
hexidine was found to be more potent in reducing the in this study is a new commercially available mouthwash
number of S. mutans colonies [20]. Another constituent of with many components having antimicrobial, antifungal,
the herbal mouthwash, P. betle, has been documented to antiseptic properties which have been considered in
reduce significantly the cell-surface hydrophobicity of reducing plaque and gingival scores over a period of
three early plaque settlers such as Streptococcus mitis, time. Khalessi et al. [19] in their study compared the
Streptococcus sanguis and Actinomyces species [21, 22]. oral health efficacy of persica mouthwash (herbal
This cell-surface hydrophobicity was well established as mouthwash) containing an extract of S. persica with
a factor involved in the adherence of bacteria to the host that of a placebo. Plaque accumulation and gingival
tissues [23]. Furthermore, E. cardamomum has been bleeding were measured before and immediately follow-
reported to significantly inhibit the growth of oral micro- ing the examination period. They concluded that herbal
flora in in vitro studies [24, 25]. Besides the above-men- mouthwash resulted in improved gingival health when
tioned ingredients, T. bellerica, Mentha Spp. and compared with prerinsing values. Moran et al. [32] con-
G. fragrantissima has also proven to possess antimicro- ducted a study on comparison of a natural product,
bial activity that might contribute to the antiplaque triclosan and chlorhexidine mouthwashes in a 4 day
activity exhibited by the herbal mouthwash [26–28]. plaque regrowth model. They concluded that the natural
Our study was consistent with a study done by Rahmani product was second to chlorhexidine in plaque inhibi-
et al. [29] which assessed the effects of S. persica and tion. Studies on the plant extract sanguinarine chloride
CHX on plaque formation and noted a comparable mouthwash and toothpaste have shown that it produces
plaque inhibition by both the solutions. In our study, moderate reduction in plaque and gingivitis.
there was a statistically highly significant suppression Although the plaque regrowth and antigingivitis
of plaque by chlorhexidine as compared to placebo effect of the chlorhexidine mouthwash was superior to
which was similar to other studies conducted by Gazi that of herbal mouthwash over placebo, the response of
et al. [30]. participants to the herbal product, as evaluated by ques-
The mean gingival index at baseline was statistically tionnaire, was good. There was mild transient burning
nonsignificant between the three mouthwashes (p ¼ 0.92) sensation with intake of herbal mouthrinse which could
which was consistent with other studies [10, 11]. be explained due to its concentrated nature. No other
However, the mean gingival index after 1 month was side effects had been noticed at the end of the study,
highly significant between chlorhexidine group and sal- which might add to its clinical usage as an adjunct to
ine group (p ¼ 0.001), statistically significant between mechanical oral hygiene measures, whereas chlorhexi-
herbal group and saline group (p ¼ 0.003), whereas the dine mouthwash showed many adverse effects. A major-
herbal and chlorhexidine group were potentially equiva- ity of participants in chlorhexidine group (81.8%)
lent in reducing gingivitis (p ¼ 0.229). Our results were complained of mild discoloration, moderate discoloration
similar to the results of other studies conducted by (9.1%), dry mouth (81.8%), transient taste disturbance
Parwani et al. [12] where herbal and chlorhexidine (45.4%) and burning sensation (50%). These results
mouthwashes showed a comparable antigingivitis effect were similar to other studies [10, 22].
(p ¼ 0.244). Lang LP stated that the substantivity of an On the basis of the results obtained, it can be stated
antimicrobial agent needs sufficient contact time with a that the herbal mouthwash had a promising plaque inhi-
microorganism in order to inhibit or kill it. Chlorhexidine bitory potential. However, studies of longer duration with

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136 Bhat et al.: Antiplaque effect of herbal and chlorhexidine mouthwash

cross-over study design and wash out period would have in Xerostomics, sugar as in patients suffering from
been more authenticating as it eliminates the bias of Diabetes and people who wish to avoid any artificial pre-
viable host. Further studies where safety and microbiolo- servatives and artificial colours. Also when socioeconomic
gical parameters would be evaluated are essential to factor, side effects of chlorhexidine and liking of the peo-
establish the true effectiveness of the mouthrinse and ple for natural product need consideration, the herbal
its position among the other rinses that are used adjunc- mouthwash can serve as a good alternative.
tively to mechanical oral hygiene procedure. However, safety and microbiological parameters
Hence, the discovery of bioactive natural products need be evaluated that are essential to establish the
which can reduce the oral diseases may serve as leads true effectiveness of this mouthrinse and its position
in the development of new pharmaceuticals that will be among other rinses that are used adjunctively to mechan-
able to address the unmet therapeutic needs in the treat- ical oral hygiene procedures. There is need for hour to
ment of various oral diseases at low costs and can be investigate other upcoming mouthwashes so as to prove
used as alternatives to chemical mouthwashes. their efficacy as equivalent in reducing the plaque scores
and gingival inflammation. Hence from public health
point, the findings of the present study suggest that the
Conclusions herbal mouthwash can serve as a better alternative and
can be prescribed in clinical practice.
The efficacy of herbal mouthwash was equally effective in
reducing plaque and gingivitis as compared to chlorhex- Conflict of interest statement
idine mouthwash. Though chlorhexidine mouthwash con-
sidered as a gold standard, it was reported with a number Authors’ conflict of interest disclosure: The authors sta-
of local side effects including extrinsic tooth and tongue ted that there are no conflicts of interest regarding the
brown staining, taste disturbance, dryness of mouth, burn- publication of this article.
ing sensation. These side effects limit its acceptability to Research funding: None declared.
users and its long-term use. Whereas Hiora Herbal Employment or leadership: None declared.
mouthwash due to its natural ingredients had no reported Honorarium: None declared.
side effects apart from mild burning sensation. In public
health point of view, the herbal mouthwash can serve as a Received January 11, 2014; accepted March 8, 2014; previously
good alternative to patients who wish to avoid alcohol as published online April 3, 2014

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