Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial

Abstract

BackgroundIn the author’s earlier in vitro investigation, a combination of 0.25 mg/ml green tea and 7.82 mg/ml Salvadora persica L. aqueous extracts was found to exhibit significant synergistic anti-bacterial and anti-adherence effects against primary plaque colonizers biofilm. A clinical trial was needed to support these preliminary in vitro results and to investigate its efficacy as a mouthwash in the control of dental plaque.MethodsA 24 h plaque re-growth, double-blinded, randomized crossover trial was carried out. Participants (n = 14) randomly rinsed with test formulation, 0.12% chlorhexidine (control) and placebo mouthwashes for 24 h. A week before the trial, all participants received scaling, polishing and oral hygiene education. On the trial day, the participants received polishing at baseline and rinsed with 15 ml of randomly allocated mouthwash twice daily without oral hygiene measures. After 24 h, plaque index was scored and then the participants entered a 6-days washout period with regular oral hygiene measures. The same protocol was repeated for the next 2 mouthwashes.ResultsThe results were expressed as mean (±SD) plaque index. The test mouthwash (0.931 ± 0.372) significantly reduced plaque accumulation when compared with placebo (1.440 ± 0.498, p < 0.0167) and chlorhexidine (1.317 ± 0.344, p < 0.0167) mouthwashes. No significant difference was found between chlorhexidine and placebo (p > 0.0167).ConclusionsThe test mouthwash has an anti-plaque effect for a 24 h period. Longer-term clinical studies are highly encouraged to investigate its anti-plaque effect for longer periods.Trial registrationThis study was registered in ClinicalTrials.gov as NCT02624336 in December 3, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1487-0) contains supplementary material, which is available to authorized users.

The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis

“…The studies were mostly performed in adult patients, up to 60 years old, whereas five studies were performed in children between the ages of 6 and 18 years [20–22, 27, 29, 36]. Some studies were of cross-over nature, with a washout period ranging from 2 to 10 days [28, 31, 35] and 2 to 8 weeks [9, 23, 29]. The inclusion and exclusion criteria of the eligible studies are listed in Additional file 4: Table S4.…”

“…Although the quality of studies varied due to the use of different criteria, none were excluded based on quality level. Seven papers were regarded as high quality [25, 31, 32, 34, 35, 41], while the remaining papers were of moderate quality [9, 20–24, 26–30, 36] . As for the risk of bias,…”

“…However, in terms of which antimicrobial agent being regarded as more effective, some studies indicated that Salvadora persica and chlorhexidine rinses showed similar antiplaque effects [23–27], while others favored the use of chlorhexidine [28–34]. On the other hand, interestingly, two studies had reported that the mean plaque index of Salvadora persica was significantly lower than that observed with chlorhexidine [35, 36].…”

Novel natural product‐based oral topical rinses and toothpastes to prevent periodontal diseases

“…In vitro results showed the antibacterial effect of the two‐component mouthwash against Streptococcus mitis , Streptococcus sanguinis , and Actinomyces viscosus , as well as an anti‐adhesive effect . The clinical trial found less plaque regrowth detected with a green tea and Salvadora persica mouthwash than with a chlorhexidine or placebo (distilled water) mouthwash . However, the effect on gingival parameters was not examined in this study.…”

“…There are several recently reported controlled clinical trials comparing green tea with chlorhexidine mouthwashes. Although these studies differ in design, such as the patient population, the treatment duration, and the green tea concentration, they all show that green tea reduces plaque and gingivitis scores . Additionally, these effects are comparable with those observed with chlorhexidine mouthwashes.…”