# Efficacy of Pomegranate Mouthrinse Compared to Chlorhexidine on Plaque Accumulation, Gingival Inflammation, and Salivary Bacterial Count: A Randomized Controlled Trial

## TL;DR

This study compares pomegranate mouthrinse to chlorhexidine in reducing dental plaque and gum inflammation, finding pomegranate to be equally effective with fewer side effects.

## Contribution

The study introduces pomegranate peel extract as a natural, effective alternative to chlorhexidine for oral care.

## Key findings

- Pomegranate mouthrinse showed greater short-term plaque reduction than chlorhexidine.
- Both mouthrinses significantly reduced plaque, gum inflammation, and bacterial counts over 21 days.
- Pomegranate rinse had lower salivary bacterial count immediately after use.

## Abstract

Introduction

Dental plaque is a primary etiological factor in the development of gingivitis and periodontitis. Chlorhexidine is widely regarded as the gold standard antiplaque agent; however, its long-term use is associated with undesirable side effects, such as tooth staining, altered taste sensation, and mucosal irritation. Natural agents with antimicrobial and anti-inflammatory properties are being explored as safer alternatives. This study aimed to compare the efficacy of a 30% pomegranate peel extract (PPE) mouthrinse with 0.12% chlorhexidine (CHX) mouthwash in reducing dental plaque, gingival inflammation, and salivary bacterial count.

Methodology

A parallel-group, double-blinded, randomized controlled trial was conducted involving 60 participants aged over 18 years with baseline gingival and plaque index scores ≥1 and at least 12 gradable teeth. Participants were randomly allocated to either the experimental group (30% PPE mouthrinse) or the control group (0.12% CHX). Subjects rinsed twice daily with 10 ml of their respective mouthwash for 21 days. Plaque index (Silness and Loe) and gingival index (Loe and Silness) were assessed at baseline, 5 days, and 21 days, whereas salivary bacterial counts were assessed at baseline, half an hour after rinsing, 5 days, and 21 days. Data were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests with statistical significance set at p<0.05.

Results

Both groups exhibited significant intra-group reductions in plaque index, gingival index, and bacterial counts at 5 and 21 days compared to baseline. The PPE group demonstrated a significantly greater reduction in plaque index at both 5 days (mean: 1.16 ± 0.26) and 21 days (mean: 0.79 ± 0.27) compared to the CHX group (1.40 ± 0.30 and 1.05 ± 0.29), respectively. No statistically significant intergroup differences were observed for the gingival index and long-term bacterial count. However, the PPE group showed a lower salivary bacterial count at half an hour post-rinsing (p=0.008).

Conclusion

Both 30% pomegranate and 0.12% CHX mouthrinses are effective in reducing plaque, gingival inflammation, and bacterial count over 21 days, with the PPE showing a superior short-term antiplaque effect. PPE represents a cost-effective and accessible alternative, warranting further long-term evaluation as a preventive and curative agent for oral care.