Keywords
gingivitis
herbal
plaque control
Salvadora persica
scaling
Abstract
Introduction: Mechanical plaque control, despite best efforts, sometimes fails to completely remove dental biofilm. Variety of chemical agents have also been used as an adjunct to those mechanical aids. Among them, Chlorhexidine (CHX) is the most studied and effective agent. However, due to its unwanted side effects, the use of herbal components that are relatively safe are considered these days.
Objective: To compare the effectiveness of Salvadora persica (SP) with Chlorhexidine mouthwash as an adjunct and scaling alone in the treatment of gingivitis.
Methods: A non-randomised clinical trial was done among 63 participants with gingivitis at Periodontology and Oral Implantology Unit, Bir Hospital between 2022 February to 2023 September. Patients recruited after ethical approval, using convenience sampling method, were divided into three groups - CHX, SP, and scaling alone. Plaque index (PI) and Gingival index (GI) for all three groups were recorded at baseline and day 21. Intragroup comparison of PI and GI at baseline and day 21 and intergroup comparisons between each groups were performed.
Results: For CHX, SP, and Scaling alone group, the mean PI and GI was significantly decreased on day 21 (p <0.05). However, on multiple comparisons there were no statistically significant differences between the means of the groups being compared.
Conclusions: The absence of statistically significant differences between the intervention groups suggests a comparable efficacy among the three approaches in treatment of gingivitis.
References
Page RC. Gingivitis. J Clin Periodontol. 1986 may;13(5):345-55.
Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965 May;36(3):177-87.
James P, Worthington HV, Parnell C, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017 Mar 31;2017(3):CD008676.
Ramamurthy J, Mg V. Comparison of effect of hiora mouthwash versus chlorhexidine mouthwash in gingivitis patients: A clinical trial. Asian J Pharm Clin Res. 2018 Jul 7;11:84.
Trombelli L, Farina R, Silva CO, et al. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol. 2018;89(s1):s46-73.
Löe H. The gingival index, the plaque index, and the retention index systems. J Periodontol. 1967 Nov;38(6):610-6.
Oak A, Bachubhai Sapariya D, Nayak C et al. A randomised double-blind clinical trial evaluates the efficacy of alternative herbal mouthwashes. Cureus. 15(6):e40394.
Mathew M, Joyshree C, Ratan VJ, et al. Anti-plaque efficacy of hi-ora mouthrinse and 0.12% chlorhexidine gluconate in patients with chronic gingivitis: A case-control study. J Oral Maxillofac Pathol. 2022;26(1):38-43.
Adam FA, Mohd N, Rani H, et al. A systematic review and meta-analysis on the comparative effectiveness of salvadora persica - extract mouthwash with chlorhexidine gluconate in periodontal health. J Ethnopharmacol. 2023 Feb 10;302:115863.
Ramli H, Nor Aripin KN, Mohd S, et al. The effectiveness of miswak (salvadora persica l. and Azadirachta indica A. juss.) practices in reducing plaque and gingivitis among adults: A systematic review and meta-analysis. J Ethnopharmacol. 2022 Nov;298:115598.
Dizaye KF, Othman ZY. Therapeutic effects of salvadora persica (miswak) on patients with mild to moderate gingivitis. Erbil Dent J. 2020 Dec 6;3(2):119-25.
Deshmukh MA, Dodamani AS, Karibasappa G, et al. Comparative evaluation of the efficacy of probiotic, herbal and chlorhexidine mouthwash on gingival health: a randomised clinical trial. J Clin Diagn Res. 2017 Mar;11(3):ZC13-6.
Akkaloori A, Al Shayeb M, Raman P, et al. Evaluation of efficacy of hi‑ora mouthrinse as against 0.12% chlorhexidine in treatment of patients with chronic gingivitis: A randomised‑controlled trial. Journal of Datta Meghe Institute of Medical Sciences University. 2022 Jul-Sep;17(3):579-83.
Saima S, Ahmed R. Efficacy of chlorhexidine vs herbal mouthwash in college students: A comparative study. Int J Appl Dent Sci. 2019;5(2):403-6.
Oak A, Bachubhai Sapariya D, Nayak C, et al. A randomised double-blind clinical trial evaluates the efficacy of alternative herbal mouthwashes. Cureus. 15(6):e40394.
Irani H, Pishkarmofrad Z, Navidian A. Comparing the effect of salvadora persica chewing stick (miswak) and chlorhexidine mouthwash on oral health in patients hospitalised in intensive care units. 2020;12.
Poppolo Deus F, Ouanounou A. Chlorhexidine in dentistry: Pharmacology, uses, and adverse effects. Int Dent J. 2022 Jun;72(3):269-77.
Lee SY, Nam EJ. Clinical efficacy of 1% chx gluconate gel and 0.12% chx solution: A randomised controlled trial. Int J Environ Res Public Health. 2022 Jan;19(15):9358.
Van der Weijden GA, Timmerman MF, et al. Three different rinsing times and inhibition of plaque accumulation with chlorhexidine. J Clin Periodontol. 2005 Jan;32(1):89-92.
Keijser Jam, Verkade H, Timmerman MF, et al. Comparison of 2 commercially available chlorhexidine mouthrinses. J periodontol. 2003 Feb;74(2):214-8.
Aljarbou F, Almobarak A, Binrayes A, et al. Salvadora persica’s biological properties and applications in different dental specialties: A narrative review. Evid Based Complement Alternat Med. 2022 May 22;2022:8667687.
Esfahani ZJ, Kadkhoda Z, Eshraghi SS, et al. Antibacterial effect of an herbal product persica on porphyromonas gingivalis and aggregatibacter actinomycetemcomitans: An in-vitro study. J Dent (Tehran). 2014 Jul;11(4):464-72.
Haque MM, Alsareii SA. A review of the therapeutic effects of using miswak (salvadora persica ) on oral health. Saudi Med J. 2015 May;36(5):530-43.
Nagori K, Singh M, Alexander A et al. Piper betle l.: A review on its ethnobotany, phytochemistry, pharmacological profile and profiling by new hyphenated technique dart-ms (direct analysis in real time mass spectrometry). J Pharm Res. 2011 Oct 1;4:2991-7.
Aspalli S, Shetty VS, Devarathnamma MV, et al. Evaluation of antiplaque and antigingivitis effect of herbal mouthwash in treatment of plaque induced gingivitis: A randomised, clinical trial. J Indian Soc Periodontol. 2014;18(1):48-52.