A Randomized Double-Blind Clinical Trial Evaluates the Efficacy of Alternative Herbal Mouthwashes

Evaluation of a new mouthwash formulated with Chlorhexidine and Cymenol after a scaling and root planing treatment in grade I and II periodontal patients

BACKGROUND

Periodontal disease (PD) is a chronic inflammatory disease of multifactorial origin that affects the supporting tissues of the tooth. According to WHO in 2022, severe periodontal disease will affect around 19% of the adult population worldwide. Its risk factors include the presence of periodontopathogenic bacteria in biofilm and the susceptibility of the host's immune system, among others. Preterm birth is defined as birth occurring before 37 weeks of gestational age. It also has a multifactorial origin and it's associated with risk factors such as intrauterine and extrauterine infections. There is a possibility that periodontal disease in pregnant women increases the risk of preterm birth through hematogenous pathways or the presence and intervention of inflammatory mediators.

MATERIAL AND METHODS

Through a systematic review of existing scientific articles from 2014 to 2024, five randomized clinical trials were selected, including a total of 1984 pregnant patients diagnosed with periodontal disease. Half of these patients received non-surgical treatment, while the other half did not, aiming to evaluate a possible association between periodontal disease and/or its treatment and the occurrence of preterm birth. The risk of bias was assessed using the Cochrane "RoB 2" tool, and finally, a meta-analysis was conducted to compare the results obtained in the selected studies.

RESULTS

Four articles showed a trend favoring non-surgical periodontal treatment as a preventive measure for preterm birth. These articles accounted for 92.2% of the total weight, while the remaining 7.85% corresponded to the single article that did not favor the treatment. However, none of the articles showed statistically significant results.

CONCLUSIONS

There is no demonstrated association between periodontal disease in pregnant women and the incidence of preterm birth. On the other hand, there is a slightly favorable trend towards non-surgical periodontal treatment during pregnancy as a measure to reduce the incidence of preterm birth, but it's not statistically significant. To obtain a definitive answer, more randomized clinical trials following similar study and design parameters are needed.

Formulation of Quercetin Mouthwash and Anti-microbial Potential Against Critical Pathogens: An In-Vitro Evaluation

Introduction Herbal mouthwashes were designed and prepared using essential oils from phytotherapeutic plants, containing active agents such as catechins, tannins, and sterols. Quercetin is one of the most abundant natural flavonoids predominantly found in foods including fruits, and vegetables. It has wide biological effects such as antioxidant, anti-aging, anti-inflammatory, probiotic, and metabolic modulation activities. Research has pointed toward its anti-microbial efficacy and bio-compatibility. Materials and methods A sample of commercially available Himalaya Hiora mouthwash (control) and 0.02 mg of Quercetin (test sample) that is sold commercially were procured. Next, 0.01 grams of sodium lauryl sulfate (SLS), which serves as the foaming agent, 0.001 grams of preservative (sodium methylparaben), and 0.3 grams of sucrose, the sweetening agent, were added to the test sample to formulate the mouthwash. We added 0.5 milliliters of the prepared Quercetin solution to the mixture. The effectiveness of the Quercetin mouthwash formulation as an antimicrobial was evaluated using the Agar-Well Diffusion Method against five oral pathogens and compared to the Hiora mouthwash. Results On quantifying the zone of inhibition, it was observed that at 100 μL of concentration, Staphylococcus aureus shows maximum inhibition rate, i.e., 15 mm when compared to commercially available herbal mouthwash (Himalaya Hiora). Thus, from the results obtained, we found that when concentration increases there is a significant zone of inhibition shown by oral pathogens. Conclusion Quercetin mouthwash formulation has proven to have a good antimicrobial effect when compared to standard mouthwash. The effective antimicrobial activity suggests its potential use as an adjuvant chemical plaque control modality. Further clinical trials would pave the way for its use as a routine or therapeutic antimicrobial agent.