Enzyme-Based Mouthwashes for Oral Wound Healing and Xerostomia

Saliva plays an essential role in maintaining oral health by providing antimicrobial protection, regulating inflammation, and supporting tissue repair. Salivary enzymes such as lactoperoxidase, lysozyme, and lactoferrin are central to these protective functions. Conditions associated with reduced salivary flow, including xerostomia and postoperative states, impair these mechanisms and may result in delayed wound healing, microbial imbalance, discomfort, and increased susceptibility to infection. Conventional antiseptic mouthwashes, particularly chlorhexidine, are effective in controlling oral microorganisms but are frequently associated with adverse effects, including mucosal irritation, taste alteration, tooth discoloration, and concerns about long-term use. This structured review summarizes current evidence on natural enzyme-based mouthwashes, focusing on their mechanisms of action, potential benefits for oral wound healing and xerostomia management, and antimicrobial effects, and compares their efficacy and safety with conventional antiseptic agents.

A focused literature search was conducted using PubMed, Scopus, and Web of Science from database inception to December 2025, supplemented by manual screening of reference lists. Peer-reviewed English-language studies, including clinical, experimental, observational, and in vitro research addressing enzyme-based mouthwashes, were considered.

The available literature suggests that enzyme-based mouthwashes exert selective antimicrobial effects by reducing pathogenic microorganisms and biofilm formation while largely preserving the commensal oral microbiota. Lactoperoxidase contributes to antimicrobial activity through hypothiocyanite generation, lysozyme disrupts bacterial cell walls, lactoferrin limits microbial growth through iron sequestration and immunomodulatory effects, and glucose oxidase supports sustained enzymatic activity. Clinical studies report improvements in oral wound healing, relief of xerostomia-related symptoms, enhanced oral comfort, and good tolerability when compared with conventional antiseptic mouthwashes. However, limitations include variability in enzyme stability, a narrower antimicrobial spectrum, and a limited number of long-term clinical trials.

In conclusion, enzyme-based mouthwashes appear to be safe and biocompatible adjuncts for supporting oral wound healing and managing xerostomia. By mimicking natural salivary defense mechanisms, they offer a microbiome-friendly, non-antibiotic alternative to conventional antiseptics in selected clinical situations. Further well-designed randomized clinical trials with standardized formulations and long-term follow-up are required to clarify their effectiveness and optimal clinical indications.