The Effectiveness of Herbal Versus Non-Herbal Mouthwash for Periodontal Health: A Literature Review

Dental plaque is a biofilm of microorganisms that present naturally on the exposed tooth surface; it is the main etiological factor for many periodontal conditions and other oral health issues and its regular removal from the oral cavity can prevent many periodontal problems. Despite several experiments using herbal oral care products to reduce dental plaque or gingivitis, the findings remain inconclusive. We performed a systematic literature search on PubMed and Cochrane Library for randomized controlled trials (RCTs) dating from 2001 up to and including the year 2021. The keywords and Medical Subject Headings (MeSH) terms comprised combinations of the following: herbal, clove oil, peppermint oil, ginger, basil, ajwain, betel leaf extract, neem, lavender, non-herbal, chlorhexidine, fluorides, hydrogen fluoride, hydrogen fluoride, stannous fluoride, and mouthwashes. Each of the titles that the search elicited was screened and duplicates were removed from the gathered results. The full-text versions of the remaining articles were downloaded and examined by title and abstract. Handsearching was not carried out. We initially identified 21 studies; 14 studies, which did not fulfill the selection criteria, were excluded. All the included studies reported a reduction in plaque index (PI) and gingival index (GI) scores in both herbal and non-herbal groups. Two studies reported the superiority of the non-herbal mouthwash over the herbal one while five of the studies showed no significant difference in PI and GI scores between herbal and non-herbal mouthwash, implying equal efficacy of both, i.e., Triphala, aloe vera, tea tree, and polyherbal groups like Zingiber officinale, Rosmarinus officinalis, and Calendula officinalis, and chlorhexidine. Current research suggests that herbal mouthwashes are as effective as non-herbal mouthwashes for reducing dental plaque in the short term; however, the evidence is based on low-quality trials.