Chlorhexidine vs Essential Oil Mouthwash for Plaque Control

Overview

Dental plaque is a sticky film of bacteria that forms on teeth and can lead to gum disease if it is not removed regularly. Brushing and flossing help control plaque, but many people also use a mouthwash to help clean areas that are hard to reach. This study compares two common types of mouthwash to see which one works better at reducing plaque: a mouthwash containing chlorhexidine (a medicated antibacterial ingredient) and a mouthwash containing essential oils (natural plant-based ingredients). Both are widely used, but they work in different ways and may cause different side effects. Sixty patients between the ages of 15 and 25 who had gum inflammation (gingivitis) took part. Half of the patients used the chlorhexidine mouthwash twice a day, and the other half used the essential oil mouthwash twice a day, for three months. Researchers measured the amount of plaque on each patient's teeth at the start of the study and again after three months, using a standard scoring method. They also recorded how well patients stuck to the mouthwash routine and any side effects they experienced, such as changes in taste, staining of the teeth, or a burning feeling in the mouth. The goal of this study is to help patients and dental care providers understand the benefits and drawbacks of each mouthwash, so they can choose the option that best fits their needs - whether that is stronger plaque control for a short period of time, or a milder option that may be more comfortable for longer-term use.

Dental plaque is one of the main causes of gum inflammation and periodontal (gum) disease. While brushing and flossing remain the primary way to remove plaque, mechanical cleaning alone often cannot fully reach all tooth surfaces. As a result, chemical mouthwashes are commonly recommended as an additional way to control plaque. Chlorhexidine gluconate mouthwash is considered one of the most effective plaque-control products because it kills a broad range of bacteria and stays active in the mouth for an extended period. However, longer-term use has been associated with side effects such as tooth staining and taste changes. Mouthwashes containing essential oils (plant-derived antibacterial ingredients such as thymol and menthol) are often used as a gentler alternative, though their plaque-reducing effect compared to chlorhexidine has varied across previous studies. This randomized clinical trial was conducted at the Department of Periodontics, Rehman College of Dentistry, Peshawar, from February 2026 to August 2026. Sixty participants aged 15-25 years with gingivitis (gum inflammation without bone or attachment loss) were enrolled and divided into two equal groups of 30. Group I used a 0.2% chlorhexidine gluconate mouthwash twice daily, and Group II used an essential oil mouthwash twice daily, both for a period of three months. Participants were selected using a non-probability consecutive sampling method, and all received professional teeth cleaning (scaling and polishing) before starting the study, followed by a 10-day period to allow a consistent starting point for plaque measurement. Plaque levels were measured using the Silness and Löe Plaque Index, a standard scoring method that assesses plaque on six specific teeth at the start of the study and again after three months. The dental examiner who scored the plaque levels was not told which mouthwash each participant had been using, to reduce bias in the assessment. All participants were given the same basic oral hygiene instructions (brushing twice daily), so that any difference in outcomes could be more clearly linked to the mouthwash itself. Researchers compared plaque scores, percentage reduction in plaque, participant compliance with the assigned mouthwash routine, and any reported side effects between the two groups. Statistical methods included ANCOVA to compare three-month plaque scores while accounting for each participant's starting plaque level, along with t-tests and chi-square tests for other comparisons. The findings may help dental care providers and patients weigh the trade-offs between stronger antiplaque effects and a more favorable side-effect profile when choosing a mouthwash for short-term versus longer-term use.