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Meta-Analysis
. 2022 Feb;20(1):100-111.
doi: 10.1111/idh.12567. Epub 2022 Jan 17.

Efficacy of herbal- versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: A systematic review and meta-analysis

Karthik Kommuri  1 , Dimitrios Michelogiannakis  1 , Basir A Barmak  2 , P Emile Rossouw  1 , Fawad Javed  1
Affiliations
Meta-Analysis

Efficacy of herbal- versus chlorhexidine-based mouthwashes towards oral hygiene maintenance in patients undergoing fixed orthodontic therapy: A systematic review and meta-analysis

Karthik Kommuri et al. Int J Dent Hyg. 2022 Feb.

Abstract

Background and objective: The review aims to fill the gap in literature by comparing the efficacy of herbal and chlorhexidine-based mouthwashes towards oral hygiene maintenance (OHM) in patients undergoing fixed orthodontic treatment (OT).

Methods: Indexed databases were searched electronically to include randomized controlled trials (RCTs) for data gathering. The protocol was registered in PROSPERO (CRD42020182497). Risk of bias assessment, quality of evidence investigation and meta-analysis were performed to evaluate reported OHM-related parameters at time points before and after the use of chlorhexidine (control group) and herbal mouthwashes (intervention group). With 95% confidence intervals, mean difference (MD) or standardized mean difference (SMD) was used to estimate effect size.

Results: Out of eight RCTs, results from one RCT favoured chlorhexidine and the results from a second RCT favoured herbal mouthwashes. Results from three RCTs showed comparable effects for the respective investigated OHM-related parameters. Chlorhexidine demonstrated higher antimicrobial efficacy against Streptococcus mutans (S. mutans) in two studies, and one RCT found comparable antimicrobial efficacies. Risk of bias was low in two studies, and moderate and high in two studies each. Quality of evidence was very low to moderate for the respective investigated parameters. Sub-group analysis for parameters colony forming units (CFU) {SMD (0.40) [95% CI (-0.22, 1.03)], gingival index (GI) {MD (0.06) [95% CI (-0.08, 0.20)]}, plaque index (PI) {SMD 0.22 [95% CI (-0.23, 0.67)]} before the use of chlorhexidine and herbal mouthwashes remained inconclusive.

Conclusion: The comparison between efficacy of herbal and chlorhexidine towards OHM in patients undergoing fixed OT remains debatable.

Keywords: chlorhexidine; herbal; mouthwash; oral rinses; orthodontics.

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References

REFERENCES

    1. Niazi FH, Kamran MA, Naseem M, AlShahrani I, Fraz TR, Hosein M. Anti-plaque efficacy of herbal mouthwashes compared to synthetic mouthwashes in patients undergoing orthodontic treatment: a randomised controlled trial. Oral Health Prev Dent. 2018;16(5):409-416. 10.3290/j.ohpd.a40983. [published Online First: Epub Date].
    1. Mummolo S, Nota A, Albani F, et al. Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study. PLoS One. 2020;15(4):e0228798. 10.1371/journal.pone.0228798. [published Online First: Epub Date].
    1. Farhadian N, Bidgoli M, Jafari F, Mahmoudzadeh M, Yaghobi M, Miresmaeili A. Comparison of electric toothbrush, persica and chlorhexidine mouthwashes on reduction of gingival enlargement in orthodontic patients: a randomised clinical trial. Oral Health Prev Dent. 2015;13(4):301-317. 10.3290/j.ohpd.a33443. [published Online First: Epub Date].
    1. Dehghani M, Abtahi M, Hasanzadeh N, Farahzad Z, Noori M, Noori M. Effect of Propolis mouthwash on plaque and gingival indices over fixed orthodontic patients. J Clin Exp Dent. 2019;11(3):e244-e249. 10.4317/jced.55026. [published Online First: Epub Date].
    1. Menezes SMS, Cordeiro LN, Viana GSB. Punica granatum (Pomegranate) extract is active against dental plaque. J Herb Pharmacother. 2006;6(2):79-92. 10.1080/J157v06n02_07. [published Online First: Epub Date].

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