Myrrh in the Management of Periodontal Disease and Gingival Healing: A Systematic Review and Meta-Analysis

Periodontal disease remains a prevalent chronic condition worldwide, and interest has grown in natural adjunctive agents such as Commiphora myrrh for their potential antimicrobial and healing properties. This systematic review evaluated the antimicrobial and clinical effects of myrrh in managing periodontal disease, gingival healing, and pathogen reduction across in vitro, animal, and clinical studies.

A comprehensive search of major databases (2010-2025) was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including randomized controlled trials (RCTs), in vitro, and animal studies. Primary outcomes were gingival and plaque indices, healing parameters (swelling, redness), and antimicrobial efficacy. Risk of bias was assessed using the Cochrane RoB 2, Systematic Review Center for Laboratory Animal Experimentation, and Quality Assessment Tool for in vitro Studies of Dental Materials, with meta-analyses performed for eligible RCTs, and certainty of evidence rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Fifteen studies met the inclusion criteria: six in vitro, one animal study, and eight RCTs. In vitro studies consistently demonstrated strong antimicrobial effects of myrrh, particularly in its essential oil form, against periodontal pathogens and Staphylococcus aureus. The animal study indicated enhanced early wound healing, but also dose-dependent toxicity with prolonged use. Meta-analysis of RCTs revealed a small yet statistically significant reduction in plaque, whereas effects on gingival inflammation and healing were not significant. Reported adverse effects were minimal.

Myrrh shows promising potential as an adjunct in periodontal therapy, supported by in vitro and preclinical findings; however, further well-designed, standardized clinical trials and translational animal studies are essential to confirm its efficacy.