Title Neem Powder is a Better Alternative to a Chemically Derived Mouthwash Against Dental Plaque
Clinical Question Is there an effect on dental plaque using a neem powder mouthwash vs. a chemically derived mouthwash?
Clinical Bottom Line Neem showed effectiveness on gingiva better than chlorhexidine.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23852229Balappanavar/2013 30 healthy human volunteers of age group 18-25 years were carried out.Randomized Controlled Trial
Key resultsMean plaque and gingival scores were reduced over the 3 week trial period for experimental and control groups. Anti-plaque effectiveness was observed in all groups and the highest being in group C (tea) (P < 0.05). Neem and tea showed comparative effectiveness on gingiva better than chlorhexidine (P < 0.05). The salivary pH rise was sustained and significant in Group B (neem) and C (tea) compared to Group A (chlorhexidine). Oral hygiene improvement was better appreciated in Group B (neem) and Group C (tea).
Evidence Search ("Dental Plaque"[Mesh]) AND "Azadirachta"[Mesh]
Comments on
The Evidence
Validity: The groups were similar at start. There was more than 80% completion rate. The groups were treated the same but Group A (chlorhexidine) skipped the third week of assessment. There was adequate follow up. 80% subjects had no problem in using the chlorhexidine mouthwash followed by tea (78%) and neem (60%). The study claims to be triple blind however the patients were able to distinguish the bitter taste of tea and neem from the chlorhexidine mouthwash. Recall bias is unlikely. No competing interests are known. Perspective: Group A subjects were told to use the mouthwash for 14 days (2 weeks) whereas Group B and Group C subjects were told to use the given mouthwashes for 21 days (3 weeks).
Applicability The study claims the promotion of botanical herbs with fewer side-effects may motivate the patient for oral hygiene maintenance. Neem has been found to be used for multiple purposes such as diabetes, skin ulcers, the stomach, cardiovascular diseases, gingivitis, and the liver. However if neem is taken in large doses for long periods of time, then it might harm the kidneys and liver. Chlorhexidine also reduces gingivitis but may cause an allergic reaction, stain the teeth, mouth, tooth fillings and dentures or other oral appliances. Neem is not as easily accessible or ordered as chlrohexidine is to a typical American patient or dentist. Yet, due to the increase number of patients from Indian decent and patients who do prefer a botanical treatment instead of using a chemical, neem may be an option and is available to order online.
Specialty (General Dentistry) (Interprofessional CATs)
Keywords Chlorhexidine gluconate, gingivitis, neem, oral hygiene, plaque, salivary pH, tea
ID# 2835
Date of submission 04/14/2015
E-mail mathews2@livemail.uthscsa.edu
Author Sharon Mathew
Co-author(s) e-mail
Faculty mentor Georgiana S. Gross, MPH
Faculty mentor e-mail grossg@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available