Comparative Clinical Evaluation of Chamomile, Sage, and Ginger Mouthwashes in Reducing Plaque and Gingival...

Despite mechanical hygiene, plaque-related illnesses like gingivitis and periodontitis affect over 3.5 billion people globally. Natural mouthwashes are becoming increasingly popular as consumers shift toward plant-based alternatives to chlorhexidine, which may have drawbacks that limit long-term acceptability. This study aimed to evaluate the short-term clinical potential of three herbal mouthwashes-Matricaria chamomilla (chamomile), Salvia officinalis (sage), and Zingiber officinale (ginger)-in reducing dental plaque and clinical signs of gingival inflammation in young adults. (2) Materials and Methods. A randomised controlled clinical trial was conducted on 175 systemically healthy participants, allocated equally into five groups (three herbal groups, placebo, and chlorhexidine). Each herbal group used a 2% aqueous infusion three times daily for twelve weeks. The 2% aqueous infusion concentration was selected based on commonly reported concentrations in previous phytotherapeutic and clinical studies evaluating herbal mouthwashes, balancing potential efficacy with safety and tolerability. The plant materials were sourced from certified suppliers, and standardized dried plant parts were used under controlled preparation conditions. Clinical assessments were performed at baseline (T0), week 1 (T1), week 5 (T2), and week 9 (T3), corresponding to the beginning of each evaluation interval within the 12-week study, using the Silness-Löe Plaque Index and the modified Löe-Silness Gingival Index. Data were analyzed using repeated-measures ANOVA with Bonferroni post hoc correction. (3) Results. Repeated-measures ANOVA revealed a significant main effect of time for both plaque accumulation and gingival index scores. For the Silness-Löe Plaque Index, a marked time-dependent reduction was observed across the active treatment groups (p < 0.001; η²_p = 0.56), with a significant time × group interaction (p < 0.001; η²_p = 0.49). Similarly, the modified Löe-Silness Gingival Index showed a significant reduction over time (p < 0.001; η²_p = 0.22), with a significant interaction effect between time and mouthwash type (p < 0.001; η²_p = 0.17). No statistically significant differences were found among the three herbal mouthwashes in post hoc Bonferroni comparisons (all p > 0.05), whereas all active treatments showed significantly better outcomes compared with the placebo. (4) Discussion. All three rinses showed similar clinical effects on plaque and gingival scores. However, without mechanistic assays, no claims can be made about comparable antibacterial or anti-inflammatory activity. Compared with conventional antiseptics such as chlorhexidine, herbal rinses offer important advantages in terms of biocompatibility, safety, and tolerability, with no staining, taste alteration, or mucosal irritation reported. At T3, the correlation between plaque and gingival indices was weak (Spearman's ρ = 0.18, p = 0.09), suggesting limited linear association; this finding should be interpreted cautiously, as the low end-range values and limited variability of both indices at this time point may have masked a true association. This exploratory observation raises, but does not confirm, the possibility that factors other than plaque reduction may contribute to gingival improvement. (5) Conclusions. Significant reductions in dental plaque and clinical signs of gingival inflammation were observed following regular use of chamomile, sage, and ginger mouthwashes for twelve weeks. All herbal formulations exhibit similar clinical results. Longer-term controlled trials incorporating microbiological and phytochemical analyses are recommended to validate these findings further.