Prevention and control of plaque are important for the prevention of gingivitis. Mechanical removal by toothbrushing, floss use, interdental sticks and brushes oral irrigators are used to reduce plaque. However, there approached are not effective with all patients so antimicrobial mouth washes are a potential alternative and while chlorhexidine mouthwashes have been shown to be effective side effects have been noted with long term use. Aloe vera has been used to manage a number of conditions and a number of trials have evaluated its effect on plaque.
The aim of this review was to compare the efficacy of aloe vera mouthrinse on plaque and gingival inflammation.
Methods
Searches were conducted in the PubMed/Medline, Scopus, Embase and ISI Web of Science databases. Additional searches were undertaken in the Journal of Periodontology, Periodontology 2000, Journal of Clinical Periodontology, Journal of Periodontal Research, Oral Diseases, International Journal of Dental Hygiene, Journal of Public Health Dentistry and International Dental Journal. Randomised controlled trials (RCTs) published in English comparing aloe vera with chlorhexidine were considered.
Two reviewers independently extracted studies and the Cochrane risk of bias tool was used to assess study quality. The outcomes considered were plaque index, gingival index, bleeding index and adverse effects. Meta-analysis was not conducted because of significant heterogeneity in the available studies.
Results
- 6 RCTs involving a total of 1358 patients were included.
- 2 studies were considered to be at high risk of bias, 2 at unclear risk and 2 at low risk.
- All of the included studies were conducted in India.
- Follow up times ranges from 4 to 30 days
- Patients age ranged between 18-40 years.
- 5 studies compared aloe vera with chlorhexidine and placebo
- 3 studies used 100% aloe vera 3 used 99%.
- 3 studies used 0.2% chlorhexidine, 3 used 0.12%.
- Plaque index
- 4 studies reported aloe vera to be as effective as chlorhexidine in reducing plaque index, 2 studies found chlorhexidine more effective
- Gingival index
- 3 studies found aloe vera and chlorhexidine equally efficient in reducing gingival inflammation. One study found chlorhexidine more effective.
- On 1 study reported on bleeding index showing chlorhexidine to be more effective.
- Just 3 studies reported on adverse effects which were mainly related to staining and taste change.
Conclusions
The authors concluded: –
The available evidence remains inconclusive but suggests that aloe vera mouthwash is comparable to chlorhexidine in reducing gingival inflammation but inferior to chlorhexidine in reducing plaque. These findings are preliminary and further high-quality studies with adequate sample sizes are highly recommended
Comments
A broad search has been undertaken for this review and 6 RCTs have been identified. While the findings suggest a benefit from aloe vera mouthwash in terms of plaque scores and gingival inflammation the studies are all short term with the longest only reporting after 30 days. In addition, only two of the included studies were considered to be at low risk of bias. Another point to highlight is to the generalisability of the studies as all the included studies were carried out in a single country, India.
The review findings provide very low quality evidence to suggest a possible benefit from the use of aloe vera mouthwash in the short term. However well conducted and reported high quality studies of longer duration are needed to properly assess both the efficacy and any adverse effects of this mouthwash.
Links
Primary Paper
Al-Maweri SA, Nassani MZ, Alaizari N, Kalakonda B, Al-Shamiri HM, Alhajj MN, Al-Soneidar WA, Alahmary AW. Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review. Int J Dent Hyg. 2019 Mar 4. doi:10.1111/idh.12393. [Epub ahead of print] Review. PubMed PMID: 30829440.
