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 with 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 (chi(2) = 72.77, P < .0001, I-2 = 91.76%) and PI (chi(2) = 153.67, P < .0001, I-2 = 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 < .001) and PI (WMD = -0.43, 95% CI = -0.54 to -0.31, P < .001) was statistically significant between TRP-MW and CHX-MW at follow-up, respectively. Conclusion Triphala mouthwash seems 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.