Comparison of the anti-plaque and anti-gingivitis efficacy of Chlorhexidine and Malva mouthwashes: Randomized crossover clinical trial

Abstract

Objectives: Although mechanical oral hygiene is widely practiced, it faces several challenges. Mouthwashes, such as chlorhexidine (CHX), are being explored as adjuncts to biofilm control, but their prolonged use has several side effects. Consequently, there is ongoing research into natural alternatives. This randomized crossover clinical study aimed to compare the antiplaque and antigingivitis efficacy of 0.12 % CHX and a 5 % Malva sylvestris.

Methods: Forty-four participants were involved in two phases, each comprising three stages with variations in the mouthwash solution used only. During the study, participants refrained from mechanical plaque removal for seven days. At first day, they received whole-mouth prophylaxis and oral health assessment. After three days, gingival inflammation assessment and prophylaxis in were performed in contralateral quadrants. Participants then used a randomly assigned mouthwash solution for four days. On the 7^th day, they completed a questionnaire about their perception and appreciation of the mouthwash. Additionally, gingival inflammation and plaque index were also performed by a calibrated examiner. After a minimum 21-day washout period, participants entered the second phase, repeating the three stages.

Results: Results showed no statistically significant differences between the Malva sylvestris and CHX groups regarding inflammation and plaque formation. However, CHX demonstrated a significantly greater mean reduction (7^th - 4^th day) in gingival inflammation compared to Malva (p = 0.02) (0.01 ± 0.19 and 0.00 ± 0.19, respectively). Additionally, participants using CHX reported a more pleasant taste and considered higher plaque control perception (p < 0.05).

Conclusions: In conclusion, both products exhibited similar antiplaque effects, but CHX outperformed Malva in controlling gingival inflammation.

Clinical significance: Mouthwashes with Malva sylvestris may be a good alternative, in a short-term period, to control biofilm. However, lower antigingivitis efficacy may be expected when compared to chlorhexidine.

Keywords: Chlorhexidine; Clinical trial; Dental plaque; Gingivitis; Malva; Periodontal diseases.