Tuesday, 21 March 2017

Re: Aloe Vera Mouthwash Is at Least as Effective as Chlorhexidine in Limiting Plaque Growth in Healthy Subjects

  • Aloe Vera (Aloe vera, Asphodelaceae)
  • Chlorhexidine
  • Plaque Formation
Date: 03-15-2017HC# 081624-564

Chhina S, Singh A, Menon I, Singh R, Sharma A, Aggarwal V. A randomized clinical study for comparative evaluation of aloe vera and 0.2% chlorhexidine gluconate mouthwash efficacy on de-novo plaque formation. J Int Soc Prev Community Dent. May-June 2016;6(3):251-255.

Periodontal health is a vital part of overall dental health and dependent on regular cleaning of the teeth and mouth to control bacterial activity that can lead to dental caries and tooth loss. Removal of dental plaque is accomplished through a personal hygiene routine, which includes brushing, flossing, and rinsing with mouthwash, and through professional mechanical cleaning. Chlorhexidine gluconate mouthwash is one of the most commonly used mouthwashes to inhibit bacterial growth and plaque formation. Use of chlorhexidine is often accompanied by staining of the teeth and changes in the sensation of taste, leading to the desire for a natural plant-based alternative. The mucilaginous gel from the leaves of aloe vera (Aloe vera, Xanthorrhoeaceae) has been used to treat burns, assist wound healing, and as a laxative, and has antimicrobial, antioxidant, and anti-inflammatory properties. The goal of this single-blind, randomized, placebo-controlled study was to compare the efficacy of aloe vera mouthwash to chlorhexidine gluconate in controlling dental plaque formation.
Ninety subjects between the ages of 18 and 40 were recruited for the study and divided randomly among 3 groups—an aloe vera group, a chlorhexidine group, and a placebo group. Subjects were included if they were generally healthy and had 20 natural teeth and no supragingival plaque or calculus retentive areas. Subjects were excluded if they had dental pockets that were deeper than 3 mm; used antibiotics within the last month; used mouthwash with antimicrobial properties; were smokers; were pregnant; had orthodontics, dentures, or crowned teeth; or had severely misaligned teeth. The aloe vera mouthwash (Patanjali Ayurved Ltd; Haridwar, Uttarakhand, India) contained 99.6% aloe vera leaf gel. The chlorohexidine was a 0.2% hexidine mouthwash (ICPA Health Products; Ankleshwar, Gujarat, India). The placebo was flavored distilled water. Three weeks prior to the start of the study, subjects had their teeth professionally cleaned and polished. Subjects visited the dental office at 1-week intervals during the 3 weeks prior to the study to have their teeth cleaned as needed. A baseline plaque measurement was taken using a 5-point plaque index scale. Subjects rinsed with 10 ml of mouthwash for 1 minute 2 times per day for 4 days. They were not allowed to eat or drink for 2 hours after using the mouthwash. Subjects were asked not to brush or floss their teeth for the 4 days of the study. At the end of the 4-day period, plaque index was measured again. Data were analyzed with analysis of variance and post hoc least significant difference tests.
All subjects started the study with a baseline plaque index between 2.6 and 2.8. There were significant time and treatment effects (P < 0.001 and P = 0.002, respectively). The plaque index decreased significantly in both the aloe vera and chlorhexidine groups (P < 0.001 for both). Plaque index increased significantly in the placebo group (P < 0.001). In addition, the aloe vera treatment decreased the plaque index (−1.22 ± 0.09) to a greater extent than did the chlorhexidine treatment (−1.21 ± 0.07, P = 0.046). Chlorhexidine resulted in tooth staining in 40% of the subjects and changes in taste sensation in 25% of the subjects. Aloe vera did not stain subjects' teeth, but did result in a change in taste in 4% of the subjects.
Aloe vera mouthwash was as effective as chlorhexidine at reducing plaque formation over 4 days. Both aloe vera and chlorhexidine were significantly better than placebo at reducing plaque formation. Aloe vera has antimicrobial properties, and these properties likely helped limit the growth of bacteria and plaque formation. Also, aloe vera did not stain the teeth and altered taste in very few subjects. This study provides evidence that short-term use of aloe vera mouthwash helps limit bacterial populations. Future studies should be of longer duration in order to fully evaluate aloe vera's effect on plaque formation and any adverse effects. The study was limited by the small sample size and lack of double-blinding.
Cheryl McCutchan, PhD