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Evaluation of Herbal Mouthwashes Containing Zataria Multiflora Boiss, Frankincense and Combination Therapy on Patients with Gingivitis: A Double-Blind, Randomized, Controlled, Clinical Trial

Zoleikha Khoshbakht, Ehsan Khashabi, Laleh khodaie, Mohammad Ali Torbati, Farzaneh Lotfipour, Hamed Hamishehkar

Background: Dental plaques as adhesive microbial aggregates on tooth surfaces are considered the first stage of tooth decay as well as gingivitis. Accordingly, the effect of different antimicrobial mouthwashes on removing dental plaques and preventing their formation has been evaluated in various studies. This study aimed to evaluate the efficacy of herbal mouthwashes containing hydro-alcoholic extract of Zataria multiflora (ZM), Frankincense (FR), and a combination of both (ZM+FR) and compare it with chlorhexidine (CHX) mouthwash in subjects with gingivitis. Materials and Methods: In this randomized, controlled, clinical trial a total of 140 patients with gingivitis were divided into four groups including CHX (control group), ZM, FR, and ZM+FR groups. Plaque index (PI), gingival index (GI), and gingival bleeding index (GBI) were measured in days 1, 14, and 21. Results: All three herbal types of mouthwash significantly improved plaque, gingivitis, and gingival bleeding throughout days 14 to 21 (P<0.001). There was no difference between herbal mouthwash with CHX groups. CHX mouthwash showed the most side effects (54.3%), while ZM mouthwash showed the least side effects and the highest consumer satisfaction (5.7% and 94%, respectively). Conclusion: All of the herbal mouthwashes can be good candidates for controlling gingivitis. Comparing with CHX mouthwash, herbal mouthwashes have lower side effects and negligible alcohol content. Among the herbal mouthwashes, ZM outperforms FR and FR+ZM due to its lower side effects and higher levels of patients’ satisfaction. [GMJ.2019;8:e1366]

Frankincense; Zataria multiflora Boiss; Mouthwashes; Chlorhexidine

Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. The lancet. 2005;366(9499):1809-20.

https://doi.org/10.1016/S0140-6736(05)67728-8

Sedigh-Rahimabadi M, Fani M, Rostami-chijan M, Zarshenas MM, Shams M. A Traditional Mouthwash (Punica granatum var pleniflora) for Controlling Gingivitis of Diabetic Patients: A Double-Blind Randomized Controlled Clinical Trial. Journal of evidence-based complementary & alternative medicine. 2017;22(1):59-67.

https://doi.org/10.1177/2156587216633370

PMid:26922436 PMCid:PMC5871205

Van der Weijden G, Hioe K. A systematic review of the effectiveness of self‐performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. Journal of clinical Periodontology. 2005;32:214-28.

https://doi.org/10.1111/j.1600-051X.2005.00795.x

PMid:16128840

Barnett ML. The role of therapeutic antimicrobial mouthrinses in clinical practice: control of supragingival plaque and gingivitis. Journal of the American Dental Association (1939). 2003;134(6):699-704.

https://doi.org/10.14219/jada.archive.2003.0255

Jones CG. Chlorhexidine: is it still the gold standard? Periodontology 2000. 1997;15(1):55-62.

https://doi.org/10.1111/j.1600-0757.1997.tb00105.x

PMid:9643233

Gürgan CA, Zaim E, Bakirsoy I, Soykan E. Short‐term side effects of 0.2% alcohol‐free chlorhexidine mouthrinse used as an adjunct to non‐surgical periodontal treatment: a double‐blind clinical study. Journal of periodontology. 2006;77(3):370-84.

https://doi.org/10.1902/jop.2006.050141

PMid:16512751

Foulkes D. Some toxicological observations on chlorhexidine. Journal of Periodontal Research. 1973;8:55-60.

https://doi.org/10.1111/j.1600-0765.1973.tb02165.x

Van Strydonck DA, Slot DE, Van der Velden U, Van der Weijden F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol. 2012;39(11):1042-55. doi:10.1111/j.1600-051X.2012.01883.x.

https://doi.org/10.1111/j.1600-051X.2012.01883.x

Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. International journal of health sciences. 2017;11(2):72.

Heravi M. Qarabadin-e-salehi. Tehran: Dar-ol-khalafeh. 1765.

Sajed H, Sahebkar A, Iranshahi M. Zataria multiflora Boiss. (Shirazi thyme)--an ancient condiment with modern pharmaceutical uses. Journal of ethnopharmacology. 2013;145(3):686-98. doi:10.1016/j.jep.2012.12.018.

https://doi.org/10.1016/j.jep.2012.12.018

Azizkhani M, Elizaquível P, Sánchez G, Selma MV, Aznar R. Comparative efficacy of Zataria multiflora Boiss., Origanum compactum and Eugenia caryophyllus essential oils against E. coli O157: H7, feline calicivirus and endogenous microbiota in commercial baby-leaf salads. International journal of food microbiology. 2013;166(2):249-55.

https://doi.org/10.1016/j.ijfoodmicro.2013.07.020

PMid:23973836

Farzaei MH, Bahramsoltani R, Ghobadi A, Farzaei F, Najafi F. Pharmacological activity of Mentha longifolia and its phytoconstituents. Journal of Traditional Chinese Medicine. 2017;37(5):710-20.

https://doi.org/10.1016/S0254-6272(17)30327-8

Hamedi A, Zarshenas MM, Sohrabpour M, Zargaran A. Herbal medicinal oils in traditional Persian medicine. Pharmaceutical biology. 2013;51(9):1208-18.

https://doi.org/10.3109/13880209.2013.777462

PMid:23746335

Sajed H, Sahebkar A, Iranshahi M. Zataria multiflora Boiss.(Shirazi thyme)—an ancient condiment with modern pharmaceutical uses. Journal of ethnopharmacology. 2013;145(3):686-98.

https://doi.org/10.1016/j.jep.2012.12.018

PMid:23266333

Thulin M, Warfa AM. The frankincense trees (Boswellia spp., Burseraceae) of northern Somalia and southern Arabia. Kew Bulletin. 1987:487-500.

https://doi.org/10.2307/4110063

Al-Harrasi A, Al-Saidi S. Phytochemical analysis of the essential oil from botanically certified oleogum resin of Boswellia sacra (Omani Luban). Molecules. 2008;13(9):2181-9.

https://doi.org/10.3390/molecules13092181

PMid:18830149 PMCid:PMC6245470

Raja AF, Ali F, Khan IA, Shawl AS, Arora DS, Shah BA et al. Antistaphylococcal and biofilm inhibitory activities of acetyl-11-keto-β-boswellic acid from Boswellia serrata. BMC microbiology. 2011;11(1):54.

https://doi.org/10.1186/1471-2180-11-54

PMid:21406118 PMCid:PMC3066120

Gupta D, Bhaskar DJ, Gupta RK, Karim B, Jain A, Singh R et al. A randomized controlled clinical trial of Ocimum sanctum and chlorhexidine mouthwash on dental plaque and gingival inflammation. Journal of Ayurveda and integrative medicine. 2014;5(2):109.

https://doi.org/10.4103/0975-9476.131727

PMid:24948862 PMCid:PMC4061585

Haerian-Ardakani A, Rezaei M, TALEBI-ARDAKANI M, Valian NK, Amid R, Meimandi M et al. Comparison of antimicrobial effects of three different mouthwashes. Iranian journal of public health. 2015;44(7):997.

PMid:26576378 PMCid:PMC4645771

Löe H, Theilade E, Jensen SB. Experimental gingivitis in man. Journal of periodontology. 1965;36(3):177-87.

https://doi.org/10.1902/jop.1965.36.3.177

PMid:14296927

Löe H, Theilade E, Jensen SB, Schiøtt CR. Experimental gingivitis in man: III. The Influence of Antibiotics on Gingival Plaque Development. Journal of periodontal research. 1967;2(4):282-9.

https://doi.org/10.1111/j.1600-0765.1967.tb01901.x

PMid:4249983

Löe H. The gingival index, the plaque index and the retention index systems. The Journal of Periodontology. 1967;38(6P2):610-6.

Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta odontologica scandinavica. 1964;22(1):121-35.

https://doi.org/10.3109/00016356408993968

PMid:14158464

Jafari S, Amanlou M, Borhan-mojabi K, Farsam H. Comparartive study of Zataria multiflora and Anthemis nobelis extracts with Myrthus communis preparation in the treatment of recurrent aphthous stomatitis. DARU Journal of Pharmaceutical Sciences. 2003;11(1):23-7.

Babaee N, Baradaran M, Mohamadi H, Nooribayat S. Therapeutic effects of Zataria multiflora essential oil on recurrent oral aphthous lesion. Dental research journal. 2015;12(5):456.

https://doi.org/10.4103/1735-3327.166218

PMid:26604960 PMCid:PMC4630710

Aghili H, Nadoushan AAJ, Herandi V. Antimicrobial effect of zataria multiflora extract in comparison with chlorhexidine mouthwash on experimentally contaminated orthodontic elastomeric ligatures. Journal of dentistry (Tehran, Iran). 2015;12(1):1.

Saei-Dehkordi SS, Tajik H, Moradi M, Khalighi-Sigaroodi F. Chemical composition of essential oils in Zataria multiflora Boiss. from different parts of Iran and their radical scavenging and antimicrobial activity. Food and Chemical Toxicology. 2010;48(6):1562-7.

https://doi.org/10.1016/j.fct.2010.03.025

PMid:20332011

Shafiee A, Javidnia K, Tabatabai M. Volatile constituents and antimicrobial activity of Zataria multiflora, population Iran. Iranian Journal of Chemistry and Chemical Engineering (IJCCE). 1999;18(1):1-5.

Sharififar F, Moshafi M, Mansouri S, Khodashenas M, Khoshnoodi M. In vitro evaluation of antibacterial and antioxidant activities of the essential oil and methanol extract of endemic Zataria multiflora Boiss. Food control. 2007;18(7):800-5.

https://doi.org/10.1016/j.foodcont.2006.04.002

Braga P, Dal Sasso M, Culici M, Bianchi T, Bordoni L, Marabini L. Anti-inflammatory activity of thymol: inhibitory effect on the release of human neutrophil elastase. PHARMACOLOGY. 2006;77(3):130-6.

https://doi.org/10.1159/000093790

PMid:16763380

Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: an overview. Indian journal of pharmaceutical sciences. 2011;73(3):255-61. doi:10.4103/0250-474x.93507.

Rijkers T, Ogbazghi W, Wessel M, Bongers F. The effect of tapping for frankincense on sexual reproduction in Boswellia papyrifera. Journal of Applied Ecology. 2006;43(6):1188-95.

https://doi.org/10.1111/j.1365-2664.2006.01215.x

Rahimi R, Shams-Ardekani MR, Abdollahi M. A review of the efficacy of traditional Iranian medicine for inflammatory bowel disease. World journal of gastroenterology. 2010;16(36):4504-14.

https://doi.org/10.3748/wjg.v16.i36.4504

PMid:20857519 PMCid:PMC2945480

Raja AF, Ali F, Khan IA, Shawl AS, Arora DS, Shah BA et al. Antistaphylococcal and biofilm inhibitory activities of acetyl-11-keto-beta-boswellic acid from Boswellia serrata. BMC microbiology. 2011;11:54. doi:10.1186/1471-2180-11-54.

https://doi.org/10.1186/1471-2180-11-54

Raja AF, Ali F, Khan IA, Shawl AS, Arora DS. Acetyl-11-keto-beta-boswellic acid (AKBA); targeting oral cavity pathogens. BMC research notes. 2011;4:406. doi:10.1186/1756-0500-4-406.

https://doi.org/10.1186/1756-0500-4-406

Hamidpour R, Hamidpour S, Hamidpour M, Shahlari M. Frankincense ( ru xiang; boswellia species): from the selection of traditional applications to the novel phytotherapy for the prevention and treatment of serious diseases. Journal of traditional and complementary medicine. 2013;3(4):221-6. doi:10.4103/2225-4110.119723.

https://doi.org/10.4103/2225-4110.119723

Lemenith M, Teketay D. Frankincense and myrrh resources of Ethiopia: II. Medicinal and industrial uses. SINET: Ethiopian Journal of Science. 2003;26(2):161-72.

Vlachojannis C, Chrubasik-Hausmann S, Hellwig E, Al-Ahmad A. A Preliminary Investigation on the Antimicrobial Activity of Listerine(R), Its Components, and of Mixtures Thereof. Phytotherapy research : PTR. 2015;29(10):1590-4. doi:10.1002/ptr.5399.

https://doi.org/10.1002/ptr.5399

Warnakulasuriya S, Parkkila S, Nagao T, Preedy VR, Pasanen M, Koivisto H et al. Demonstration of ethanol‐induced protein adducts in oral leukoplakia (pre‐cancer) and cancer. Journal of oral pathology & medicine. 2008;37(3):157-65.

https://doi.org/10.1111/j.1600-0714.2007.00605.x

PMid:18251940

Seitz HK, Maier H, Stickel F, Simanowski U. Alkohol und Krebs. Handbuch Alkohol–Alkoholismus, alkoholbedingte Organschäden Barth, Leipzig Heidelberg. 1995:349-80.

Hörmann K, Riedel F, Hirth K. Alkohol und Mundhöhle/Pharynx einschließlich schlafbezogener Atmungsstörungen. Alkohol und Alkoholfolgekrankheiten. Springer; 1999. p. 147-57.

Kurkivuori J, Salaspuro V, Kaihovaara P, Kari K, Rautemaa R, Grönroos L et al. Acetaldehyde production from ethanol by oral streptococci. Oral oncology. 2007;43(2):181-6.

https://doi.org/10.1016/j.oraloncology.2006.02.005

PMid:16859955

Salaspuro MP. Acetaldehyde, microbes, and cancer of the digestive tract. Critical reviews in clinical laboratory sciences. 2003;40(2):183-208.

https://doi.org/10.1080/713609333

PMid:12755455

Friedrich RE, Kristen U. In vitro toxicity assessment of mouthwashes in the pollen tube growth test: first results. Anticancer research. 1999;19(4a):2775-7.

PMid:10470240

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