What do systematic reviews say?

Herbal mouthwash vs Placebo mouthwash

Herbal mouthwash led to lower volatile sulphur compounds (VSC) compared with placebo mouthwash; GRADE not reported.

• Interventions for managing halitosis 2019 · Cochrane All outcomes

  15 days
  MD -70.29 [-121.01, -19.57]
  1 study · 60 participants
  GRADE not reported

Herbal mouthwash vs placebo

Herbal mouthwash reduced some plaque-related indices versus placebo, with low-certainty evidence.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  PI was significantly reduced compared to placebo [56]; VPI was significantly reduced compared to placebo [41]; PI was insignificantly reduced compared to placebo [19].
  3 studies
  Low

Herbal mouthwash vs placebo

Herbal mouthwash reduced Mutans streptococci versus placebo, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Colony count of MS was significantly reduced compared to placebo [52]; colony count was slightly reduced compared to placebo in a short time in one study [40].
  2 studies
  Very low

Herbal mouthwash vs placebo

Herbal mouthwash reduced gingival inflammation-related indices versus placebo, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  GBI was significantly reduced compared to placebo [41]; GBI was significantly reduced compared to placebo [56]; BI was significantly reduced compared to placebo [40].
  3 studies
  Very low

Herbal mouthwash vs Blank control

Herbal mouthwash reduced several plaque-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  PI was significantly reduced compared to baseline [39; 48; 54; 58]; BBPI was significantly reduced compared to blank control [47]; TI and dental plaque amount were significantly reduced compared to baseline [45; 38].
  8 studies
  Very low

Herbal mouthwash vs Blank control

Herbal mouthwash reduced some gingival inflammation-related indices, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  CPI was significantly reduced compared to baseline [35]; SBI was significantly reduced while MGI was similar compared to baseline [45]; BOP was significantly reduced compared to blank control [39].
  3 studies
  Very low

Herbal mouthwash vs Blank control

Herbal mouthwash showed mixed effects on Mutans streptococci, with very low-certainty evidence.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Colony count of MS was significantly reduced compared to baseline [48]; another study found an insignificant reduction compared to baseline [51].
  2 studies
  Very low

Essential oil mouthwash vs Water

• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  patient level (pharynx; not analysed)
  Bay 1993 compared essential oil mouthwash C (Listerine) with distilled water and reported combined CFUs at different levels using Andersen's air sampler; level 2 (pharynx) was considered patient level and was not…
  1 study
  GRADE not reported
• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  operator level
  At operator level, because of high heterogeneity (I2 = 98%), the results were not meta-analysed (3 studies; Gupta 2014, Nayak 2020, Shetty 2013). No pooled estimate or GRADE rating.
  3 studies
  GRADE not reported
• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  assistant level
  At assistant level, because of high heterogeneity (I2 = 99%), the results were not meta-analysed (3 studies; Gupta 2014, Nayak 2020, Shetty 2013). No pooled estimate or GRADE rating.
  3 studies
  GRADE not reported

Cinnamon herbal mouthwash; Nanosil (hydrogen peroxide) mouthwash; Irsha mouthwash vs Water (negative control) and zinc solution (positive control)

• Interventions for managing halitosis 2019 · Cochrane All outcomes
  Talebian 2009 (cross-over study) tested cinnamon herbal, Nanosil and Irsha mouthwashes versus water (negative control) and zinc solution (positive control); VSC by halimeter. We could not include the results in the…
  1 study
  GRADE not reported

Herbal mouthwash vs Blank control

Herbal mouthwash probably reduces the Gingival Index versus blank control in the short term (WMD -0.20, 95% CI -0.32 to -0.09; moderate certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  WMD -0.20 [-0.32, -0.09]
  3 studies · 132 participants
  Moderate

Chlorhexidine vs Essential oils/herbal mouthwash

Chlorhexidine (CHX) led to lower reduction in level of contamination by particles >5 um (droplets) at… compared with essential oils/herbal mouthwash; GRADE not reported.

• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  15 cm from mouth (essential oil mouthwash B)
  MD -44.1 [-59.12, -29.08]
  1 study · 20 participants
  GRADE not reported
• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  pharynx level (patient level; not analysed)
  Bay 1993 compared 0.12% CHX with essential oil mouthwash C (Listerine) at pharynx level (Andersen's level 2), which was considered patient level and hence was not analysed. No pooled estimate or GRADE rating.
  1 study
  GRADE not reported
• Preprocedural mouth rinses for preventing transmission of infectious diseases through aerosols in dental healthcare… 2022 · Cochrane All outcomes

  assistant level
  MD -12.21 [-15.58, -8.83]
  3 studies · 76 participants
  Low