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Effect of triphala mouthrinse on plaque and gingival inflammation: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES
To assess the efficacy of triphala mouthwash (TRP-MW) in being equally effective to chlorhexidine mouthwash (CHX-MW) in the treatment of plaque-induced gingivitis.


MATERIALS AND METHODS
Electronic searches in MEDLINE/PubMed, EMBASE and CENTRAL were conducted in databases up to April 2020. Randomized clinical trials (RCTs) comparing clinical efficacy of TRP-MW (test group) in comparison to CHX-MW in treating plaque-induced gingivitis were considered. The primary outcome was gingival index (GI), whereas the secondary outcome was plaque index (PI).


RESULTS
Seven RCTs were included. All studies showed that TRP-MW administration was significantly effective as compared to CHX-MW in the treatment of plaque-induced gingivitis. Considering the effects of TRP-MW on clinical gingival inflammatory parameters, significant heterogeneity for both GI (χ2 =72.77, P<0.0001, I2 =91.76%) and PI (χ2 =153.67, P<0.0001, I2 =96.10%) was observed between both TRP-MW and CHX-MW groups. The overall mean difference for both GI (WMD= -0.29, 95% CI= -0.40 to -0.17, p<0.001) and PI (WMD= -0.43, 95% CI= -0.54 to -0.31, p<0.001) were statistically significant between TRP-MW and CHX-MW at follow-up, respectively.


CONCLUSION
TRP-MW seem to significantly improve the clinical gingival inflammatory parameters in plaque induced gingivitis with equal clinical efficacy as CHX-MW. TRP is a cost-effective alternative and is easily available with limited side-effects on periodontal tissues.