Background: Chlorhexidine (CHX) is considered the gold standard in chemical plaque control; however, its long-term use is associated with adverse effects such as tooth staining and altered taste. Botanical alternatives containing plant-derived antimicrobials may provide similar efficacy with fewer side effects. Methods: A randomized, double-blind, parallel-group clinical trial was conducted with 60 systemically healthy participants exhibiting mild to moderate gingivitis. Participants were randomly assigned into two groups (n = 30 each): Group A—botanical oral rinse, Group B—0.12% CHX. Baseline Plaque Index (PI) and Gingival Index (GI) scores were recorded, and mouthwashes were used twice daily after brushing for 21 days. Outcomes were assessed on day 7, day 14, and day 21. Data were analyzed using repeated measures ANOVA and independent t-tests. Key Findings: Both groups showed significant reductions in PI and GI from baseline to day 21 (p < 0.001). At day 21, PI reduction was 41.8% in Group A (from 1.92 ± 0.22 to 1.12 ± 0.20) and 44.5% in Group B (from 1.95 ± 0.24 to 1.08 ± 0.19), with no significant intergroup difference (p = 0.14). GI reduction was 39.7% in Group A (from 1.82 ± 0.18 to 1.10 ± 0.16) and 42.3% in Group B (from 1.84 ± 0.19 to 1.06 ± 0.15), with no significant intergroup difference (p = 0.12). Conclusion: The botanical oral rinse demonstrated comparable efficacy to 0.12% CHX in reducing plaque and gingivitis over 21 days, suggesting it may be a viable herbal alternative for routine oral hygiene.
Dental plaque is a complex biofilm that is the primary etiological factor for gingivitis and periodontitis [1]. While mechanical plaque removal through toothbrushing and interdental cleaning remains the cornerstone of oral hygiene, adjunctive chemical plaque control agents can enhance biofilm management [2].
Chlorhexidine digluconate (CHX) is widely regarded as the gold standard chemical antiplaque agent due to its broad-spectrum antimicrobial activity and substantivity [3]. However, prolonged use of CHX is associated with undesirable effects such as extrinsic tooth staining, mucosal irritation, altered taste sensation, and increased calculus formation [4,5]. These limitations have driven interest in herbal or botanical mouth rinses as alternative or adjunctive solutions.
Phytochemicals such as polyphenols, flavonoids, and essential oils exhibit antimicrobial, antioxidant, and anti-inflammatory properties [6]. Punica granatum (pomegranate) extract has demonstrated inhibitory effects against Streptococcus mutans and Porphyromonas gingivalis, and has been shown to reduce plaque accumulation in vivo [7]. Grapefruit seed extract contains bioactive compounds like naringin and ascorbic acid, which possess antimicrobial potential against oral pathogens [8]. Thymol, a monoterpenoid phenol derived from thyme oil, has potent antiseptic and plaque-inhibitory properties and is widely used in commercial mouthwashes [9].
Although studies have evaluated the effects of individual plant-based agents, there is limited clinical evidence comparing a combined botanical formulation with CHX under controlled conditions. This study aimed to compare the efficacy of a botanical oral rinse containing Punica granatum, grapefruit seed extract, and thymol with 0.12% CHX mouthwash in reducing plaque and gingivitis over a 21-day period.
Study Design: A randomized, double-blind, parallel-group clinical trial was conducted over 21 days.
Participants: Sixty systemically healthy volunteers (aged 18–35 years) with mild to moderate gingivitis (GI score 1.1–2.0) and PI score ≥ 1.5 were enrolled.
Inclusion Criteria:
Exclusion Criteria:
Randomization and Blinding: Participants were randomly allocated to two groups (n = 30 each) using a computer-generated list. Mouthwashes were dispensed in identical bottles coded by an independent researcher to ensure blinding.
Intervention:
Clinical Assessments: Plaque Index (Silness and Löe) and Gingival Index (Löe and Silness) were recorded at baseline, day 7, day 14, and day 21 by a calibrated examiner.
Statistical Analysis: Data were analyzed using SPSS v27. Intragroup changes were assessed with repeated measures ANOVA, and intergroup comparisons at each time point were performed with independent t-tests. Significance was set at p < 0.05.
Table 1. Mean Plaque Index Scores at Different Time Points
|
Time Point |
Group A (Botanical) Mean ± SD |
Group B (CHX) Mean ± SD |
p-value |
|
Baseline |
1.92 ± 0.22 |
1.95 ± 0.24 |
0.58 |
|
Day 7 |
1.52 ± 0.20 |
1.46 ± 0.18 |
0.21 |
|
Day 14 |
1.28 ± 0.19 |
1.21 ± 0.17 |
0.17 |
|
Day 21 |
1.12 ± 0.20 |
1.08 ± 0.19 |
0.14 |
Table 2. Mean Gingival Index Scores at Different Time Points
|
Time Point |
Group A (Botanical) Mean ± SD |
Group B (CHX) Mean ± SD |
p-value |
|
Baseline |
1.82 ± 0.18 |
1.84 ± 0.19 |
0.64 |
|
Day 7 |
1.48 ± 0.16 |
1.42 ± 0.15 |
0.12 |
|
Day 14 |
1.26 ± 0.15 |
1.19 ± 0.14 |
0.10 |
|
Day 21 |
1.10 ± 0.16 |
1.06 ± 0.15 |
0.12 |
Table 3. Percentage Reduction in PI and GI from Baseline to Day 21
|
Parameter |
Group A (Botanical) |
Group B (CHX) |
p-value |
|
PI |
41.8% |
44.5% |
0.14 |
|
GI |
39.7% |
42.3% |
0.12 |
Interpretation: Both groups showed significant reductions in PI and GI over time (p < 0.001 intragroup), with no statistically significant intergroup differences at any time point.
This study demonstrated that a botanical oral rinse containing Punica granatum, grapefruit seed extract, and thymol was as effective as 0.12% CHX in reducing plaque and gingivitis over 21 days.
Our findings are in line with previous studies evaluating herbal mouthwashes. Pomegranate extract has been shown to significantly reduce dental plaque and gingival inflammation due to its antimicrobial and antioxidant properties [10]. Similarly, grapefruit seed extract exhibits broad-spectrum antibacterial activity and has been proposed as a natural oral antiseptic [11]. Thymol, a key constituent of essential oils, disrupts bacterial cell membranes and has demonstrated plaque-inhibitory effects comparable to CHX in short-term trials [12].
In the present study, both mouthwashes produced over 40% reductions in PI and GI scores, consistent with the efficacy range reported for CHX in prior research [13]. The lack of statistically significant difference between the groups suggests that the botanical combination may serve as a viable herbal alternative for short-term plaque and gingivitis control.
One notable advantage of botanical rinses is their lower incidence of adverse effects. While this study did not formally assess side effects, none of the participants in the botanical group reported tooth staining or taste alteration—common complaints with CHX use [14-15].
Limitations include the relatively short duration (21 days) and the absence of microbiological assessment of plaque composition. Long-term studies are warranted to evaluate sustained efficacy and safety, particularly with regard to stain formation, calculus build-up, and patient compliance
The botanical oral rinse containing Punica granatum, grapefruit seed extract, and thymol demonstrated plaque- and gingivitis-reducing efficacy comparable to 0.12% CHX over 21 days. This suggests that botanical formulations could be considered as effective and potentially safer alternatives for short-term chemical plaque control.
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