Title	Antimicrobial Herbal Toothpastes Are More Effective at Controlling Gingivitis in Adults Than Commercial Fluoride Toothpaste with No Antimicrobial Constituent
Clinical Question	Are herbal toothpastes or conventional non-herbal toothpastes more effective for controlling gingivitis in adults?
Clinical Bottom Line	Antimicrobial herbal toothpastes are more effective at controlling gingivitis in adults than are commercial fluoride toothpastes with no antimicrobial constituent. A randomized controlled trial showed that herbal dentifrices exhibited bacteriocidal qualities against most periodontal pathogens without negatively affecting the normal microflora. Antimicrobial herbal toothpastes can be recommended for adults with gingivitis for decreasing gingival inflammation and plaque control.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22013464 Al-Kholani/2011 48 adults with poor oral hygiene and gingival inflammation Randomized Controlled Trial Key results After 14 days, approximal plaque was significantly lower in herbal groups compared to the conventional group (P<0.05). After 28 and 42 days, mean Patient Hygiene Performance Index (PHPI) and Approximal Plaque Index (API) of herbal groups were significantly lower compared to the conventional group (P<0.001). Plaque accumulation decreased on smooth surfaces in herbal groups by 61.2% and 57.2% (Test groups 1 and 2, respectively) compared to a 33.3% decrease in the conventional group. Plaque accumulation decreased on approximal surfaces in herbal groups by 57.4% and 52.8% (Test groups 1 and 2, respectively) compared to a 23.0% decrease in the conventional group. After 14, 28, and 42 days mean Gingival Index (GI) and Sulcular Bleeding Index (SBI) were significantly lower in herbal groups compared to conventional group (P<0.001). After 42 days, GI decreased in herbal groups by 68.0% and 70.6% (Test groups 1 and 2, respectively) compared to a 40.5% decrease in the conventional group. After 42 days, SBI decreased in herbal groups by 79.5% and 81.2% (Test groups 1 and 2, respectively) compared to a 42.1% decrease in the conventional group.
Evidence Search	herbal toothpaste, gingivitis
Comments on The Evidence	Validity: The groups were similar at the start, treated the same, and had adequate compliance and follow-up. No mention was made if any of the volunteers did not complete the study. Patients were randomly divided into treatment groups, but it is unclear if the study was double-blind, or if there were any competing interests (none were indicated). Perspective: Based on this randomized clinical trial, these herbal dentifrices seem like an ideal treatment for adult patients with gingivitis. It would help to confirm if this study was double-blind and if there were any competing interests.
Applicability	Volunteers in this study were Yemeni, between the ages of 20 and 40, and had poor oral hygiene and gingival inflammation indicative of chronic marginal gingivitis. The herbal dentifrices in this study have bacteriocidal qualities against most periodontal pathogens without negatively affecting the normal microflora and can be recommended for adults with gingivitis for decreasing gingival inflammation and plaque control.
Specialty	(Public Health) (General Dentistry) (Periodontics)
Keywords	Toothpaste, Herbal, Dentifrice, Gingivitis, Inflammation
ID#	2872
Date of submission	04/01/2015
E-mail	penakb@livemail.uthscsa.edu
Author	Kelsey Beth Pena
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Mary Norma Partida, DDS, MPH
Faculty mentor e-mail	partidam@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 (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available