The Journal of Contemporary Dental Practice

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 8 ( August, 2021 ) > List of Articles

ORIGINAL RESEARCH

Efficacy of Licorice on Salivary Streptococcus mutans Levels vs Chlorhexidine Mouthwash in High Caries Risk Patients: A Randomized Clinical Trial

Nancy Helmy, Shereen Hafez, Amira Farid

Keywords : Chlorhexidine mouthwash, Herbal licorice mouthwash, High caries index, Randomized clinical trial, Salivary Streptococcus mutans level

Citation Information : Helmy N, Hafez S, Farid A. Efficacy of Licorice on Salivary Streptococcus mutans Levels vs Chlorhexidine Mouthwash in High Caries Risk Patients: A Randomized Clinical Trial. J Contemp Dent Pract 2021; 22 (8):914-921.

DOI: 10.5005/jp-journals-10024-3156

License: CC BY-NC 4.0

Published Online: 09-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim: To evaluate the efficacy of an innovative herbal licorice mouthwash on reducing salivary Streptococcus mutans levels versus chlorhexidine mouthwash in high caries risk patients. Methodology: A total number of 52 high caries risk patients were assigned to this study. Patients were randomly divided into two groups (n = 26) according to the type of mouthwash (G): Patients in group G1 used the mouthwash containing chlorhexidine, while patients in group G2 used the mouthwash containing the innovative licorice extract. Afterward, each group was further divided into three subgroups according to the time (T): T0 represents the baseline, T1 represents the time immediately after using the mouthwash, and T2 represents the time 1 week after using the mouthwash. Furthermore, pH and plaque index were recorded. Data were statistically analyzed using a Chi-square test for categorical data, Shapiro-Wilk test for numerical data, and one-way repeated measures ANOVA followed by Bonferroni post hoc test for intragroup comparisons. The significance level was set at p ≤0.05 for all tests. Statistical analysis was performed with IBM® SPSS® Statistics version 26 for Windows. Results: It was found that in high caries risk patients, there was no significant difference between licorice and chlorhexidine mouthwashes regarding Streptococcus bacterial count. Moreover, it was found that licorice mouthwash stimulates salivary flow, and thus, it raises salivary pH in patients with high caries risk. However, the plaque index of chlorhexidine showed better results. Additionally, there was a positive weak correlation between bacterial count and plaque index. Conclusions: Licorice mouthwash may demonstrate a promising antibacterial effect that can be a suitable alternative for current synthetic mouthwashes. Clinical significance: Natural herbal mouthwash could be incorporated in dental preventive measures and could be used as cavity-fighting compound. It introduces a minimal health hazard substitute for conventional synthetic preventive measures.


HTML PDF Share
  1. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of untreated caries: a systematic review and metaregression. J Dent Res 2015;94(5):650–658. DOI: 10.1177/0022034515573272.
  2. Abbass MM, Mahmoud SA, El Moshy S, et al. The prevalence of dental caries among Egyptian children and adolescents and its association with age, socioeconomic status, dietary habits and other risk factors. A cross-sectional study. F1000 Res 2019;8(8):1–9. DOI: 10.12688/f1000research.17047.1
  3. Ozer S, Sen Tunc E, Bayrak S, et al. Evaluation of certain risk factors for early childhood caries in Samsun, Turkey. Eur J Paediatr Dent 2011;12(2):103–106. PMID: 21668281.
  4. Chung JY, Choo JH, Lee MH, et al. Anticariogenic activity of macelignan isolated from Myristica fragrans (nutmeg) against Streptococcus mutans. Phytomedicine 2006;13(4):261–266. DOI: 10.1016/j.phymed.2004.04.007.
  5. Almaz ME, Sönmez IŞ, Ökte Z, et al. Efficacy of a sugar-free herbal lollipop for reducing salivary Streptococcus mutans levels: a randomized controlled trial. Clin Oral Investig 2017;21(3):839–845. DOI: 10.1007/s00784-016-1827-y.
  6. Messier C, Epifano F, Genovese S, et al. Licorice and its potential beneficial effects in common oro-dental diseases. Oral Dis 2012;18(1):32–39. DOI: 10.1111/j.1601-0825.2011.01842.x.
  7. Kwon YJ, Son DH, Chung TH, et al. A review of the pharmacological efficacy and safety of licorice root from corroborative clinical trial findings. J Med Food 2020;23(1):12–20. DOI: 10.1089/jmf.2019.4459.
  8. Jain E, Pandey RK, Khanna R. Licorice root extracts as potent cariostatic agents in pediatric practice. J Indian Soc Pedod Prev Dent 2013;31(3):146–152. DOI: 10.4103/0970-4388.117964.
  9. Peters MC, Tallman JA, Braun TM, et al. Clinical reduction of S. Streptococcus mutans in pre-school children using a novel licorice root extract lollipop: a pilot study. Eur Arch Paediatr Dent 2010;11(6): 274–278. DOI: 10.1007/BF03262762.
  10. Öznurhan F, Buldur B, Cart Ö, et al. Antimicrobial efficacy of chlorhexidine and licorice mouthwashes in children. Med Dent J 2019;20(1):13–20. DOI: 10.4274/meandros.galenos.2018.79663.
  11. Hu CH, He J, Eckert R, et al. Development and evaluation of a safe and effective sugar-free herbal lollipop that kills cavity-causing bacteria. Int J Oral Sci 2011;3(1):13–20. DOI: 10.4248/IJOS11005.
  12. Almosa NA, Lundgren T, Al-Mulla A, et al. Caries risk profiles in orthodontic patients: a 4-year follow-up study using the Cariogram model in governmental vs. private clinics. Saudi Dent J 2018;30(2):166–174. DOI: 10.1016/j.sdentj.2018.02.001.
  13. Yu IC, Tsai YF, Fang JT, et al. Effects of mouthwash interventions on xerostomia and unstimulated whole saliva flow rate among hemodialysis patients: a randomized controlled study. Int J Nurs Stud 2016;63:9–17. DOI: 10.1016/j.ijnurstu.2016.08.009.
  14. Rowe RC, Sheskey P, Quinn M. Handbook of pharmaceutical excipients. 6th ed. Libros Digitales-Pharmaceutical Press; 2009; p. 1–917.
  15. Malvania EA, Sharma AS, Sheth SA, et al. In vitro analysis of licorice (Glycyrrhiza glabra L) root extract activity on Streptococcus mutans in comparison to chlorhexidine and fluoride mouthwash. J Contemp Dent Pract 2019;20(12):1389–1394. PMID: 32381838.
  16. Mohammadi SN, Prashant GM, Kumar PN, et al. Effect of different sugar free flavoured chewing gums on salivary pH-a double blinded, parallel arm randomized clinical trial. J Adv Med Med Res 2016;13(3):1–6. DOI: 10.9734/bjmmr/2016/23388.
  17. Kumar S, Sogi SH, Indushekar KR. Comparative evaluation of the effects of xylitol and sugar-free chewing gums on salivary and dental plaque pH in children. J Indian Soc Pedod Prev Dent 2013;31(4): 240–244. DOI: 10.4103/0970-4388.121822.
  18. Ajagannanavar SL, Battur H, Shamarao S, et al. Effect of aqueous and alcoholic licorice (Glycyrrhiza glabra L) root extract against Streptococcus mutans and lactobacillus acidophilus in comparison to chlorhexidine: an in vitro study. J Int Oral Health 2014;6(4):29–34. PMID: 25214729. PMCID: PMC4148569.
  19. Becerik S, Türkoğlu O, Emingil G, et al. Antimicrobial effect of adjunctive use of chlorhexidine mouthrinse in untreated gingivitis: a randomized, placebo-controlled study. APMIS 2011;119(6):364–372. DOI: 10.1111/j.1600-0463.2011.02741.x.
  20. Thomas A, Thakur SR, Shetty SB. Anti-microbial efficacy of green tea and chlorhexidine mouth rinses against Streptococcus mutans, Lactobacilli spp. and Candida albicans in children with severe early childhood caries: A randomized clinical study. J Indian Soc Pedod Prev Dent 2016;34(1):65–70. DOI: 10.4103/0970-4388.175518.
  21. Ghezzi EM. Developing pathways for oral care in elders: evidence-based interventions for dental caries prevention in dentate elders. Gerodontology 2014;31(1):31–36. DOI: 10.1111/ger.12081.
  22. Sidhu P, Shankargouda S, Rath A, et al. Therapeutic benefits of licorice in dentistry. J Ayurveda Integr Med 2020;11(1):82–88. DOI: 10.1016/j.jaim.2017.12.004.
  23. Touyz LZ. Licorice health check, Oro-dental implications, and a case report. Case Rep Med 2009;1–6:170735. DOI: 10.1155/2009/170735.
  24. Mentes JC, Kang S, Spackman S, et al. Can a licorice lollipop decrease cariogenic bacteria in nursing home residents? Res Gerontol Nurs 2012;5(4):233–237. DOI: 10.3928/19404921-20120906-07.
  25. Ahn SJ, Park SN, Lee YJ, et al. In vitro antimicrobial activities of 1-methoxyficifolinol, licorisoflavan A, and 6,8-diprenylgenistein against Streptococcus mutans. Caries Res 2015;49(1):78–89. DOI: 10.1159/000362676.
  26. Söderling E, Karjalainen S, Lille M, et al. The effect of licorice extract-containing starch gel on the amount and microbial composition of plaque. Clin Oral Investig 2006;10(2):108–113. DOI: 10.1007/s00784-006-0040-9.
  27. Khairnar MR, Dodamani AS, Karibasappa GN, et al. Efficacy of herbal toothpastes on salivary pH and salivary glucose – a preliminary study. J Ayurveda Integr Med 2017;8(1):3–6. DOI: 10.1016/j.jaim.2016.12.004.
  28. Qinna NA, Mallah EM, Arafat TA, et al. Effect of licorice and grapefruit juice on paracetamol pharmacokinetics in human saliva. Int J Pharm Pharm Sci 2012;4(4):158–162.
  29. Kumar P, Ansari SH, Ali J. Herbal remedies for the treatment of periodontal disease – a patent review. Recent Pat Drug Deliv Formul 2009;3(3):221–228. DOI: 10.2174/187221109789105603.
  30. Farhad SZ, Aminzadeh A, Mafi M, et al. The effect of adjunctive low-dose doxycycline and licorice therapy on gingival crevicular fluid matrix metalloproteinase-8 levels in chronic periodontitis. Dent Res J (Isfahan) 2013;10(5):624. PMID: 24348620. PMCID: PMC3858737.
  31. Bhadoria N, Gunwal MK, Suryawanshi H, et al. Antiadherence and antimicrobial property of herbal extracts (Glycyrrhiza glabra L and Terminalia chebula) on Streptococcus mutans: an in vitro experimental study. J Oral Maxillofac Pathol 2019;23(1):73–77. DOI: 10.4103/jomfp.JOMFP_103_18.
  32. Yamashita T, Kawada-Matsuo M, Katsumata T, et al. Antibacterial activity of disodium succinoyl glycyrrhetinate, a derivative of glycyrrhetinic acid against Streptococcus mutans. Microbiol Immunol 2019;63(7):251–260. DOI: 10.1111/1348-0421.12717.
  33. Bajaj N, Tandon S. The effect of Triphala and Chlorhexidine mouthwash on dental plaque, gingival inflammation, and microbial growth. Int J Ayurveda Res 2011;2(1):29–36. DOI: 10.4103/0974-7788.83188.
  34. De Oliveira Carvalho I, Purgato GA, Píccolo MS, et al. In vitro anticariogenic and antibiofilm activities of toothpastes formulated with essential oils. Arch Oral Biol 2020;117:104834. DOI: 10.1016/j.archoralbio.2020.104834.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.