Non-Cochrane · intervention · PM42004991
Myrrh in the Management of Periodontal Disease and Gingival Healing: A Systematic Review and Meta-Analysis.
Alnakhli Rabab A, Alqalaleef Saeed S, Alesawi Jinan M, et al. · Journal of International Society of Preventive & Community Dentistry · 2026 · PubMed · doi:10.4103/jispcd.jispcd_160_25
Findings
33 findings
| Population | ||||
|---|---|---|---|---|
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Sensitivity: no splitting, one arm per multi-arm study (Figure 4B, myrrh vs CHX arms) | SMD -0.11 [-0.67, 0.44] GRADE not reported 5 studies · 146 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Sensitivity: excluding small-sample studies (n < 10) | SMD 0.02 [-0.52, 0.56] GRADE not reported 3 studies · 135 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Sensitivity: excluding high risk of bias study | MD -0.10 [-0.23, 0.02] GRADE not reported 3 studies · 104 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) 1 week · Subgroup: follow-up 1 week | MD -0.07 [-0.23, 0.09] GRADE not reported 1 study · 30 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Sensitivity: excluding high risk of bias studies | SMD -0.54 [-1.08, 0.01] GRADE not reported 3 studies · 61 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (plaque control record, %) Follow-up 2 weeks · Overall (multi-arm myrrh groups split) Unresolved: the two extractors disagree on this row. | MD 2.03 [-17.87, 21.92] 21.2 vs 23.2 Very low Downgraded: risk of bias, imprecision 2 studies · 94 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Follow-up 1 to 12 weeks · Overall (multi-arm myrrh groups split) | MD -0.16 [-0.24, -0.08] 0.555 vs 0.395 Moderate Downgraded: risk of bias 4 studies · 134 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Sensitivity: no splitting, alternative arm selection (Figure 4C) | SMD -0.43 [-1.19, 0.33] GRADE not reported 5 studies · 146 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) 2-3 weeks · Subgroup: follow-up 2-3 weeks | SMD -0.36 [-1.01, 0.29] GRADE not reported 4 studies · 136 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Follow-up 48 h to 12 weeks · Overall (multi-arm myrrh groups split) | SMD -0.29 [-0.81, 0.23] Low Downgraded: risk of bias, imprecision 5 studies · 166 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Sensitivity: excluding outlier study | MD -0.19 [-0.28, -0.10] GRADE not reported 3 studies · 104 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Sensitivity: no splitting, alternative arm selection (Figure 7C) | MD -0.16 [-0.27, -0.05] GRADE not reported 4 studies · 120 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Sensitivity: excluding the MGI study | SMD -0.12 [-0.65, 0.41] GRADE not reported 4 studies · 147 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: Gingival Index (GI) | SMD -0.12 [-0.65, 0.41] GRADE not reported 4 studies · 147 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: Modified Gingival Index (MGI) | SMD -0.91 [-2.21, 0.40] GRADE not reported 1 study · 19 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) More than 3 weeks · Subgroup: follow-up more than 3 weeks | Subgroup follow-up more than 3 weeks: not estimable (no studies) No studies found 0 studies · 0 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: moderate risk of bias (some concerns) | SMD -0.54 [-1.08, 0.01] GRADE not reported 3 studies · 61 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) More than 3 weeks · Subgroup: follow-up more than 3 weeks | MD -0.09 [-0.35, 0.17] GRADE not reported 1 study · 62 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Sensitivity: no splitting, one arm per multi-arm study (Figure 7B, myrrh vs CHX arms) | MD -0.13 [-0.22, -0.05] GRADE not reported 4 studies · 120 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) Sensitivity: excluding small-sample study | MD -0.15 [-0.23, -0.07] GRADE not reported 3 studies · 122 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: low risk of bias studies | Subgroup low risk of bias: not estimable (no studies) No studies found 0 studies · 0 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: high risk of bias | SMD 0.09 [-0.60, 0.79] GRADE not reported 2 studies · 105 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Plaque accumulation (Plaque Index) 2-3 weeks · Subgroup: follow-up 2-3 weeks | MD -0.20 [-0.30, -0.11] GRADE not reported 2 studies · 42 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Any control (chlorhexidine, saline/placebo or miswak) | Gingival inflammation (Gingival Index/Modified Gingival Index) 1 week · Subgroup: follow-up 1 week | SMD -0.25 [-0.97, 0.47] GRADE not reported 1 study · 30 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Saline/placebo | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: comparator saline/placebo | SMD -0.71 [-1.62, 0.19] GRADE not reported 3 studies · 45 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Saline/placebo | Plaque accumulation (Plaque Index) Subgroup: comparator saline/placebo | MD -0.09 [-0.24, 0.06] GRADE not reported 2 studies · 36 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Miswak | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: comparator miswak | SMD -0.46 [-1.55, 0.63] GRADE not reported 1 study · 15 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Miswak | Plaque accumulation (Plaque Index) Subgroup: comparator miswak | MD -0.27 [-0.44, -0.10] GRADE not reported 1 study · 15 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Chlorhexidine mouthwash | Plaque accumulation (Plaque Index) Subgroup: comparator chlorhexidine | MD -0.15 [-0.26, -0.05] GRADE not reported 3 studies · 83 participants |
| Patients with gingivitis or periodontal disease | Myrrh (mouthwash, oil or extract) | Chlorhexidine mouthwash | Gingival inflammation (Gingival Index/Modified Gingival Index) Subgroup: comparator chlorhexidine | SMD 0.04 [-0.61, 0.70] GRADE not reported 4 studies · 106 participants |
| Patients after surgical procedures (tooth extraction, implant placement) | Myrrh mouthwash | Control (saline or chlorhexidine) | Gingival healing: swelling reduction Follow-up 1 week · Overall | RR 1.17 [0.74, 1.86] 81 per 100 vs 95 per 100 Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 75 participants |
| Patients after surgical procedures (tooth extraction, implant placement) | Myrrh mouthwash | Control (saline or chlorhexidine) | Gingival healing: color/redness improvement Follow-up 1 week · Overall | RR 1.06 [0.64, 1.77] 78 per 100 vs 83 per 100 Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies · 75 participants |
| Periodontal pathogens (red complex) and Staphylococcus aureus in vitro | Myrrh (Commiphora myrrh) mouthwash or preparation | Chlorhexidine or saline | Effect on periodontal pathogens (red complex and S. aureus) | Risk with myrrh: not pooled; the evidence is very uncertain about the effect of myrrh on periodontal pathogens and S. aureus, even though reported results show possible positive impact (6 non-randomised studies) Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness 6 studies |
Included primary studies 26
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Bassiouny 2014 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Al Eid 2019 Efficacy of Commiphora myrrh mouthwash on early wound healing after tooth extraction: A randomized controlled trial. PMID:33473242 | 2021 | this review only | not stated | not extracted yet |
| Al-Eid 2019 Efficacy of Commiphora myrrh mouthwash on early wound healing after tooth extraction: A randomized controlled trial DOI:10.1016/j.sdentj.2019.11.011 | 2021 | this review only | not stated | not extracted yet |
| Al-Mobeeriek 2011 Effects of myrrh on intra-oral mucosal wounds compared with tetracycline- and chlorhexidine-based mouthwashes DOI:10.2147/cciden.s24064 | 2011 | this review only | not stated | not extracted yet |
| Al-Mobeeriek 2011 Effects of myrrh on intra-oral mucosal wounds compared with tetracycline- and chlorhexidine-based mouthwashes. PMID:23674915 | 2011 | this review only | not stated | not extracted yet |
| Al-Zarea 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| ALHarthi 2021 Myrrh mixed with silver nanoparticles demonstrates superior antimicrobial activity against Porphyromonas gingivalis compared to myrrh and… DOI:10.1016/j.sdentj.2021.09.009 | 2021 | this review only | not stated | not extracted yet |
| ALHarthi 2021 Myrrh mixed with silver nanoparticles demonstrates superior antimicrobial activity against Porphyromonas gingivalis compared to myrrh and… PMID:34938030 | 2021 | this review only | not stated | not extracted yet |
| Alotaibi 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Alqahtani 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Alqahtani 2024 [Long-term results and prognostic factors after mitral valve replacement using the Starr-Edwards 6120 prosthesis]. PMID:2024914 | 1991 | this review only | not stated | not extracted yet |
| Bassiouny 2014 A Brazilian registry of juvenile dermatomyositis: onset features and classification of 189 cases. PMID:20149327 | 2009 | this review only | not stated | not extracted yet |
| Ibraheem 2022 Evaluating Soft Tissue Healing after Implant Placement Using Two Different Mouthwashes (Myrrh and Chlorhexidine Gluconate): A Randomized… PMID:36295512 | 2022 | this review only | not stated | not extracted yet |
| Khalil 2020 Bactericidal activity of Myrrh extracts and two dosage forms against standard bacterial strains and multidrug-resistant clinical isolates… DOI:10.1186/s13568-020-0958-3 | 2020 | this review only | not stated | not extracted yet |
| Khalil 2020 Bactericidal activity of Myrrh extracts and two dosage forms against standard bacterial strains and multidrug-resistant clinical isolates… PMID:31993779 | 2020 | this review only | not stated | not extracted yet |
| Lee 2014 Anti-biofilm, anti-hemolysis, and anti-virulence activities of black pepper, cananga, myrrh oils, and nerolidol against Staphylococcus… DOI:10.1007/s00253-014-5903-4 | 2014 | this review only | not stated | not extracted yet |
| Lee 2014 Anti-biofilm, anti-hemolysis, and anti-virulence activities of black pepper, cananga, myrrh oils, and nerolidol against Staphylococcus… PMID:25027570 | 2014 | this review only | not stated | not extracted yet |
| Lenka 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Saquib 2021 Synergistic antibacterial activity of herbal extracts with antibiotics on bacteria responsible for periodontitis DOI:10.3855/jidc.14904 | 2021 | this review only | not stated | not extracted yet |
| Saquib 2021 Synergistic antibacterial activity of herbal extracts with antibiotics on bacteria responsible for periodontitis. PMID:34898497 | 2021 | this review only | not stated | not extracted yet |
| Xiao 2020 Identification of essential oils with activity against stationary phase Staphylococcus aureus DOI:10.1186/s12906-020-02898-4 | 2020 | this review only | not stated | not extracted yet |
| Xiao 2020 Identification of essential oils with activity against stationary phase Staphylococcus aureus. PMID:32209108 | 2020 | this review only | not stated | not extracted yet |
| Zahid 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Zahid 2019 Transmission of brain activity during cognitive task. PMID:20191316 | 2010 | this review only | not stated | not extracted yet |
| Zahid 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Zahid 2022 Characterization of nonspherical atmospheric aerosol particles with electrooptical nephelometry. PMID:20221039 | 1980 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| The antiplaque/anticariogenic efficacy of Salvadora persica (Miswak) mouthrinse in comparison to that of chlorhexidine: a systematic… (2019) | 1 | 0.02 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Humans with gingivitis/periodontitis; animal models replicating periodontal infection; in vitro assays using isolated periodontal pathogens | Eight RCTs in patients (n=335) with gingivitis, periodontitis or post-surgical wounds; one animal study; six in vitro studies |
| Intervention | Myrrh extract, preparation, or formulation | Myrrh mouthwash, oil drops or extract (RCTs n=8) |
| Comparison | Placebo, control, or other interventions | Chlorhexidine, saline, placebo, miswak (RCTs n=8) |
| Outcomes | Primary: GI, PI, swelling, redness, bleeding, pathogen reduction; secondary: adverse effects | Gingival inflammation GI/MGI (5 RCTs); Plaque Index (4 RCTs); PCR (2 RCTs); gingival color/redness and swelling (2 RCTs); antimicrobial effect (6 in vitro studies); adverse effects |
| Study designs | Peer-reviewed RCTs, animal studies and in vitro studies, English, 2010 to 2025 | RCTs (n=8), animal study (n=1), in vitro studies (n=6) |
| Timing | Not specified | Follow-up 48 hours to 12 weeks |
AMSTAR 2 items
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 | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 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 | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |