Non-Cochrane · intervention · PM31029127
The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic review and meta-analysis.
Jassoma Elaf, Baeesa Lina, Sabbagh Heba · BMC oral health · 2019 · PubMed · doi:10.1186/s12903-019-0741-5
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
20
current version
GRADE rated
0
No studies
0
Included studies
23
linked below
No studies 0 · 0%Ungraded 20 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Medically healthy individuals in clinical/in-vivo trials | Healthy adults (up to 60 y) and children (6-18 y); 19 trials in qualitative synthesis |
| Intervention | Salvadora persica (miswak) mouthwash/mouthrinse | Salvadora persica mouthrinse (most commonly 7% extract solution) |
| Comparison | Chlorhexidine mouthwash and/or placebo rinse | Chlorhexidine 0.12% and 0.2%; and/or placebo rinse |
| Outcomes | Decrease in mean plaque score (primary); decrease in cariogenic bacterial counts (secondary) | Mean plaque score; Streptococcus mutans count; Lactobacillus count (19 studies qualitative, 18 meta-analyzed) |
| Study designs | Clinical trials / in-vivo studies (RCTs); reviews, case-control, cross-sectional and in-vitro studies excluded | Randomized clinical trials incl. cross-over; 1 non-randomized study excluded from the meta-analysis |
| Timing | Not specified | Mouthwash-use duration subgrouped as <3 weeks vs >=3 weeks; cross-over wash-out 2-10 days to 2-8 weeks |
Search date: December 2018 (articles published up to December 2018). Databases: MEDLINE-PubMed; Cochrane Central Register of Controlled Trials (CENTRAL); Wiley Online Library; ScienceDirect; Google Scholar
Questions and results
Salvadora persica (miswak) mouthrinse vs Chlorhexidine mouthrinse
Population: Medically healthy individuals (adults and children, 6-60 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Post-intervention mean plaque score Post-intervention · Did not refrain from mechanical plaque control When usual mechanical plaque control continued, Salvadora persica and chlorhexidine did not differ significantly for plaque; not GRADE-rated. Source: Fig. 4 (2h); Sensitivity analysis · same question in other reviews | MD 0.17 [-0.08, 0.42] | 11 studies · 594 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Study quality: moderate-quality studies In moderate-quality studies the plaque difference between Salvadora persica and chlorhexidine was not statistically significant; not GRADE-rated. Source: Fig. 7 (2f); Sensitivity analysis · same question in other reviews | MD 0.19 [-0.11, 0.50] | 10 studies · 616 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Duration of mouthwash use: >=3 weeks For use of 3 weeks or longer, Salvadora persica and chlorhexidine did not differ significantly for plaque reduction; not GRADE-rated. Source: Fig. 7 (2g); Sensitivity analysis · same question in other reviews | MD 0.24 [-0.11, 0.60] | 7 studies · 420 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Refrained from mechanical plaque control When mechanical plaque control was withheld, chlorhexidine outperformed Salvadora persica for plaque reduction; not GRADE-rated. Source: Fig. 4 (2h); Sensitivity analysis · same question in other reviews | MD 0.22 [0.05, 0.39] | 7 studies · 308 participants | Ungraded |
Post-intervention mean plaque score Post-intervention Salvadora persica rinse was slightly less effective than chlorhexidine at reducing plaque (favours chlorhexidine); certainty not GRADE-rated (Shekelle grade Ia). Source: Fig. 2a; Results (Meta-analysis results) · same question in other reviews | MD 0.19 [0.01, 0.37] | 18 studies · 902 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Chlorhexidine concentration: 0.2% Salvadora persica was less effective than 0.2% chlorhexidine at reducing plaque (favours chlorhexidine); not GRADE-rated. Source: Fig. 2e; Sensitivity analysis · same question in other reviews | MD 0.12 [0.03, 0.21] | 12 studies · 566 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Duration of mouthwash use: <3 weeks For use shorter than 3 weeks chlorhexidine outperformed Salvadora persica for plaque reduction; not GRADE-rated. Source: Fig. 7 (2g); Sensitivity analysis · same question in other reviews | MD 0.15 [0.01, 0.29] | 11 studies · 482 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Study quality: high-quality studies In high-quality studies Salvadora persica was less effective than chlorhexidine at reducing plaque (favours chlorhexidine); not GRADE-rated. Source: Fig. 7 (2f); Sensitivity analysis · same question in other reviews | MD 0.19 [0.06, 0.31] | 8 studies · 286 participants | Ungraded |
Post-intervention mean plaque score Post-intervention · Chlorhexidine concentration: 0.12% Salvadora persica was less effective than 0.12% chlorhexidine at reducing plaque (favours chlorhexidine); not GRADE-rated. Source: Fig. 2d; Sensitivity analysis · same question in other reviews | MD 0.52 [0.35, 0.69] | 5 studies · 396 participants | Ungraded |
Salvadora persica (miswak) mouthrinse vs Placebo rinse
Population: Medically healthy individuals (adults and children, 6-60 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Post-treatment Streptococcus mutans count Post-treatment Salvadora persica rinse reduced Streptococcus mutans counts more than placebo (favours Salvadora persica); not GRADE-rated. Source: Fig. 4 (3a); Results (Meta-analysis results) · same question in other reviews | MD -1.42 [-2.08, -0.76] | 5 studies · 142 participants | Ungraded |
Post-intervention mean plaque score Post-intervention Salvadora persica rinse reduced plaque more than placebo (favours Salvadora persica); certainty not GRADE-rated (Shekelle grade Ia). Source: Fig. 2b; Results (Meta-analysis results) · same question in other reviews | MD -0.59 [-0.82, -0.35] | 12 studies · 452 participants | Ungraded |
Post-treatment Lactobacillus count Post-treatment Salvadora persica rinse reduced Lactobacillus counts more than placebo (favours Salvadora persica); not GRADE-rated. Source: Fig. 4 (3d); Results (Meta-analysis results) · same question in other reviews | MD -1.12 [-1.45, -0.79] | 2 studies · 60 participants | Ungraded |
Salvadora persica (miswak) mouthrinse vs Pre-treatment (baseline, same group)
Population: Medically healthy individuals (adults and children, 6-60 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Lactobacillus count (pre- vs post-treatment) Pre- vs post-treatment Salvadora persica rinse reduced Lactobacillus counts relative to baseline; not GRADE-rated. Source: Fig. 5 (3e, subgroup 3.1); Results · same question in other reviews | MD 1.54 [0.91, 2.17] | 2 studies · 30 participants | Ungraded |
Streptococcus mutans count (pre- vs post-treatment) Pre- vs post-treatment Salvadora persica rinse reduced Streptococcus mutans counts relative to baseline; not GRADE-rated. Source: Fig. 4 (3b); Results · same question in other reviews | MD 1.82 [1.03, 2.62] | 5 studies · 71 participants | Ungraded |
Mean plaque score (pre- vs post-treatment) Pre- vs post-treatment Salvadora persica rinse reduced plaque relative to its own baseline; not GRADE-rated. Source: Fig. 3 (2c, subgroup 2.1); Results · same question in other reviews | MD 0.46 [0.29, 0.63] | 12 studies · 310 participants | Ungraded |
Chlorhexidine 0.12% mouthrinse vs Pre-treatment (baseline, same group)
Population: Medically healthy individuals (adults and children, 6-60 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean plaque score (pre- vs post-treatment) Pre- vs post-treatment · Chlorhexidine concentration: 0.12% 0.12% chlorhexidine rinse reduced plaque relative to baseline; not GRADE-rated. Source: Fig. 3 (2c, subgroup 2.2); Results · same question in other reviews | MD 1.79 [1.39, 2.19] | 2 studies · 126 participants | Ungraded |
Mean plaque score (pre- vs post-treatment) Pre- vs post-treatment · Chlorhexidine concentration: 0.2% 0.2% chlorhexidine rinse reduced plaque relative to baseline; not GRADE-rated. Source: Fig. 3 (2c, subgroup 2.3); Results · same question in other reviews | MD 0.45 [0.19, 0.70] | 10 studies · 282 participants | Ungraded |
Placebo rinse vs Pre-treatment (baseline, same group)
Population: Medically healthy individuals (adults and children, 6-60 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean plaque score (pre- vs post-treatment) Pre- vs post-treatment Placebo rinse did not significantly change plaque relative to baseline; not GRADE-rated. Source: Fig. 3 (2c, subgroup 2.4); Results · same question in other reviews | MD -0.19 [-0.39, 0.02] | 7 studies · 152 participants | Ungraded |
Streptococcus mutans count (pre- vs post-treatment) Pre- vs post-treatment Placebo rinse did not significantly change Streptococcus mutans counts relative to baseline; not GRADE-rated. Source: Fig. 4 (3c); Results · same question in other reviews | MD 0.34 [-0.07, 0.76] | 5 studies · 71 participants | Ungraded |
Lactobacillus count (pre- vs post-treatment) Pre- vs post-treatment Placebo rinse did not significantly change Lactobacillus counts relative to baseline; not GRADE-rated. Source: Fig. 5 (3e, subgroup 3.2); Results · same question in other reviews | MD 0.34 [-0.50, 1.18] | 2 studies · 30 participants | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Partial Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Partial Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | RCT: Partial Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | No | no |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | Partial Yes | no |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 23
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Abdulbaqi 2016 Evaluation of Salvadora persica L. and green tea anti-plaque effect: a randomized controlled crossover clinical trial. PMID:27903262 | this review only | not stated | not extracted yet | not extracted yet |
| Al-Bayaty 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Al-Dabbagh 2016 Efficacy of Miswak toothpaste and mouthwash on cariogenic bacteria. PMID:27570858 | this review only | not stated | not extracted yet | not extracted yet |
| Bagchi 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Bassiouny 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Bhat 2014 The antiplaque effect of herbal mouthwash in comparison to chlorhexidine in human gingival disease: a randomized placebo controlled… DOI:10.1515/jcim-2014-0002 | this review only | not stated | not extracted yet | not extracted yet |
| Bhat 2014 The antiplaque effect of herbal mouthwash in comparison to chlorhexidine in human gingival disease: a randomized placebo controlled… PMID:24698829 | this review only | not stated | not extracted yet | not extracted yet |
| Bhate 2015 The comparative effects of 0.12% chlorhexidine and herbal oral rinse on dental plaque-induced gingivitis: A randomized clinical trial. PMID:26392686 | this review only | not stated | not extracted yet | not extracted yet |
| Deshmukh 2017 Comparative Evaluation of the Efficacy of Probiotic, Herbal and Chlorhexidine Mouthwash on Gingival Health: A Randomized Clinical Trial. PMID:28511500 | this review only | not stated | not extracted yet | not extracted yet |
| Ghasemi 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Gupta 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Hegazy 2012 Prediction of space motion sickness susceptibility by disconjugate eye torsion in parabolic flight. PMID:2012564 | this review only | not stated | not extracted yet | not extracted yet |
| Jaidka 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Jauhari 2015 Comparative Evaluation of the Effects of Fluoride Mouthrinse, Herbal Mouthrinse and Oil Pulling on the Caries Activity and Streptococcus… PMID:26379378 | this review only | not stated | not extracted yet | not extracted yet |
| Khalessi 2004 An in vivo study of the plaque control efficacy of Persica™: a commercially available herbal mouthwash containing extracts of Salvadora… DOI:10.1111/j.1875-595x.2004.tb00294.x | this review only | not stated | not extracted yet | not extracted yet |
| Khalessi 2004 An in vivo study of the plaque control efficacy of Persica: a commercially available herbal mouthwash containing extracts of Salvadora… PMID:15503853 | this review only | not stated | not extracted yet | not extracted yet |
| Narayan 2012 Comparing the Effect of Different Mouthrinses on de novo Plaque Formation DOI:10.5005/jp-journals-10024-1169 | this review only | not stated | not extracted yet | not extracted yet |
| Narayan 2012 Comparing the effect of different mouthrinses on de novo plaque formation. PMID:23151693 | this review only | not stated | not extracted yet | not extracted yet |
| Prasad 2015 Anti-Plaque Efficacy of Herbal and 0.2% Chlorhexidine Gluconate Mouthwash: A Comparative Study. PMID:26464549 | this review only | not stated | not extracted yet | not extracted yet |
| Rahmani 2005 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Singh 2013 The effect of herbal, essential oil and chlorhexidine mouthrinse on de novo plaque formation DOI:10.1111/j.1601-5037.2012.00556.x | this review only | not stated | not extracted yet | not extracted yet |
| Singh 2013 The effect of herbal, essential oil and chlorhexidine mouthrinse on de novo plaque formation. PMID:22583681 | this review only | not stated | not extracted yet | not extracted yet |
| Vandana 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |