Comparative efficacy of herbal mouthwashes and chlorhexidine on plaque index and gingival index reductions: A Narrative Review

Herbal mouthwashes have gained increasing attention as alternatives to chlorhexidine (CHX) due to growing concerns regarding the long-term side effects associated with chemical antimicrobials. Dental plaque and gingivitis represent early stages of periodontal disease and pose significant risks to oral and systemic health, underscoring the need for effective and well-tolerated plaque-control strategies. This narrative review aims to compare the antibacterial effectiveness of herbal mouthwashes and CHX by synthesizing findings from four recent clinical studies evaluating Triphala, lemongrass, neem–miswak–clove oil, and green tea–ginger formulations. The reviewed studies consistently demonstrated that herbal rinses produced meaningful reductions in Plaque Index (PI) and Gingival Index (GI), with several formulations achieving outcomes comparable to, and in some studies slightly exceeding, those of CHX. Antiplaque effects were observed across all herbal formulations, while reductions in gingival inflammation were particularly notable in neem–miswak–clove and green tea–ginger combinations, attributed to bioactive constituents such as polyphenols, flavonoids, gingerol, citral, and eugenol. Although variations existed in study duration, sample size, and standardization of herbal preparations, the collective evidence supports herbal mouthwashes as effective and safe alternatives to CHX, particularly for long-term use. These findings align with increasing patient preferences for natural oral care products and highlight the potential role of herbal formulations in modern preventive dentistry.