A systematic review and meta-analysis on the comparative effectiveness of Salvadora persica - extract mouthwash with chlorhexidine gluconate in periodontal health

• Published in: Journal of ethnopharmacology Vol. 302; p. 115863
• Main Authors: Adam, Fara Azwin, Mohd, Nurulhuda, Rani, Haslina, Mohd Yusof, Mohd Yusmiaidil Putera, Baharin, Badiah
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 10.02.2023
• Subjects: Chlorhexidine; Dental hygiene aid; Dental plaque; Gingivitis; Miswak; Mouth rinse; Dental plaque; Dental hygiene aid; Miswak; Chlorhexidine; Mouth rinse; Gingivitis
• ISSN: 0378-8741; 1872-7573
• DOI: 10.1016/j.jep.2022.115863

Salvadora persica L., also known as miswak, is an indigenous plant most prevalent in the Middle Eastern, some Asian, and African countries. It has medicinal and prophylactics function for numerous illnesses, including periodontal disease. Various trials, apart from World Health Organization encouragement have contributed to the production and use of S. persica in extract form in the formulation of mouthwash. This systematic review and meta-analysis aimed to compare the clinical effect of Salvadora persica-extract mouthwash and chlorhexidine gluconate mouthwash for anti-plaque and anti-gingivitis functions. Using the PRISMA 2020 Protocol, a systematic search of the publications was undertaken from the MEDLINE, CENTRAL, Science Direct, PubMed, and Google Scholars for randomized control trials published through 31st January 2022 to determine the effectiveness of Salvadora persica-extract mouthwash relative to chlorhexidine gluconate as anti-plaque and anti-gingivitis properties. A total of 1809 titles and abstracts were screened. Of these, twenty-two studies met the inclusion criteria for the systematic review while only sixteen were selected for meta-analysis. The overall effects of standardized mean difference and 95% CI were 0.89 [95% CI 0.09 to 1.69] with a χ2 statistic of 2.54, 15 degrees of freedom (p < 0.00001), I2 = 97% as anti-plaque function and 95% CI were 0.12 [95% CI -0.43 to 0.67] with a χ2 statistic of 0.68 with 10 degree of freedom (p < 0.00001), I2 = 89% as anti-gingivitis. This review suggests that Salvadora persica-extract mouthwash causes a significant reduction of plaque and gingival inflammation. While the improvement is inferior to chlorhexidine gluconate mouthwash, S. persica-extract mouthwash may be considered as a herbal alternative to the user pursuing periodontal care with natural ingredients. [Display omitted] •S. persica mouthwash associated with effective control for plaque and bleeding levels.•The superiority of CHX mouthwash is more evident with associated side effects.•S. persica mouthwash is good for herbal alternative with lesser to no side effects.