Evaluation of a mouthrinse containing guava leaf extract as part of comprehensive oral care regimen- a randomized placebo-controlled clinical trial

Abstract

Background: The control of biofilm adherence on tooth surface has always been the keystone of periodontal therapeutic systems. However, prevalence of gingivitis suggest inadequacy of self-performed oral hygiene measures and need for adjunctive aid for mechanical plaque control. Oral rinses containing chlorhexidine, has been widely used however, with certain limitations. Herbal products have been used widely reflecting its action as alternative and complementary remedy. Hence, the purpose of the present study was to evaluate the antimicrobial and antioxidant efficacy of a Guava leaf extract based mouthrinse in patients with chronic generalized gingivitis as an adjunct to oral prophylaxis. Methods: Sixty subjects (n = 20) in compliance with the inclusion criteria were randomly assigned to one of the 3 study groups i.e. Group A-0.15%Guava mouth rinse, Group B-0.2% Chlorhexidine (CHX) mouth rinse, Group C-Distilled water (placebo). All the participants received professional oral prophylaxis and were dispensed with experimental mouth rinses and instructed to use for period of 30 days. Clinical parameters such as gingival index, plaque index along with microbial colony forming units using plaque samples and antioxidant levels in saliva were estimated at baseline, 30 and 90 days' time intervals. Results: All 3 groups showed gradual reduction in GI, PI and microbial counts. Considering the mean scores of recorded parameters at the scheduled time intervals, notable changes were observed between chlorhexidine and guava mouth rinse compared to placebo group. Although there was improvement in the antioxidant status in all study participants, yet there was no statistically significant difference observed. Conclusion: Guava mouth rinse can be used as an empirical adjunct to professional oral prophylaxis owing to its multifactorial properties and favourable acceptance. However, long term studies need to be conducted to validate its use for an extended period of time. Trial registration: The clinical trial has been prospectively registered on 17th February 2017 by the Clinical Trials Registry-India (CTRI/2017/02/007898).

Views on antioxidant mouth washes as adjunct in periodontal therapy

“…However the difference in plaque and gingival index scores between the group using aloe vera, tea tree oil and chlorhexidine, was not statistically significant. Whereas study on guava mouthwash showed that mean plaque index and gingival index scores from baseline to 30 days had notable changes between chlorhexidine and guava mouth rinse compared to placebo [ 47 ]. In 14 studies, 4 studies assessed the total microbial count on administration of antioxidant mouthwashes, one study specifically evaluated the streptococcus mutans level at the baseline and postoperatively, all the 4 studies showed that the microbial counts where reduced on the usage of antioxidant mouth compared to the baseline value, however they had similar microbiological effect has that of the chlorhexidine mouthwash [ 33 , 44 , 46 , 47 ].…”

“…Whereas study on guava mouthwash showed that mean plaque index and gingival index scores from baseline to 30 days had notable changes between chlorhexidine and guava mouth rinse compared to placebo [ 47 ]. In 14 studies, 4 studies assessed the total microbial count on administration of antioxidant mouthwashes, one study specifically evaluated the streptococcus mutans level at the baseline and postoperatively, all the 4 studies showed that the microbial counts where reduced on the usage of antioxidant mouth compared to the baseline value, however they had similar microbiological effect has that of the chlorhexidine mouthwash [ 33 , 44 , 46 , 47 ]. Quality assessment of 14 selected studies was carried out based on CONSORT Guidelines 4 major criteria to evaluate risk of bias: (1) Randomization, (2) Allocation concealment, (3) Assessor blinding and (4) Dropouts.…”

Antifungal Effect of Thymus Vulgaris Essential Oil and Chlorhexidine on Candida Albicans Colonies Accumulated on Removable Orthodontic Appliances: A Double- blinded Clinical Trial.

“…Nonetheless, CHX is a synthetic chemical agent, which can have many side effects following long-term application [18]. Thus, long-term use of chemical agents is not recommended [15]. In the recent years, the demand for alternative plaque removal methods has greatly increased.…”

“…Chlorhexidine (CHX) is the gold standard for chemical removal of microbial plaque, which is often prescribed as an adjunct to mechanical plaque removal methods. However, long-term use of chemical agents is not recommended [15][16][17][18].…”

Curry Leaf Triggers Cell Death of P. gingivalis with Membrane Blebbing

“…In addition, the therapy using natural products is generally less expensive as compared with highly pure chemicals. Moreover, it is likely that a range of natural product-based therapies could become an alternative treatment option for periodontitis [6,7]. Curry leaf (Murraya koenigii)…”