Essential oils (EOs) are organic compounds found in nature in

Transcription

1 REVIEW ARTICLE Role of Dentifrices With Essential Oil Formulations in Periodontal Healing Fawad Javed, PhD, Khalid Al-Hezaimi, MSc and Georgios E. Romanos, DDS, PhD Abstract: Introduction: Essential oil (EO) formulated dentifrices have significant effectiveness in reducing periodontal inflammation. This study aimed to review the role of dentifrices with EO formulations in periodontal healing. Methods: Databases were explored from 1968 until March The focused question was what is the impact of dentifrices with EO formulations on periodontal wound healing? Databases were searched using the following terms in various combinations: "essential oil," "periodontal healing," mouthrinse, mouth-wash and periodontitis. Results: Twenty studies were included. The numbers of participants ranged from 20 to 316 individuals (aged years) and were rinsing with the EO-formulated dentifrices at least twice daily for 1 week to 48 weeks. Fourteen clinical studies showed reduced periodontal inflammatory conditions in the test group (individuals using EO dentifrices) compared with the placebo group. Three studies showed a reduction in periodontal pathogens in the test group compared with the placebo group. In 1 study, the microbiological findings remained inconclusive between the 2 groups. Conclusion: EO-formulated dentifrices have beneficial effects on the clinical and microbiological parameters of periodontal inflammation. Key Indexing Terms: Dentifrice; Essential oil; Periodontal healing; Mouthrinse; Periodontitis. [Am J Med Sci 2012;343(5): ] Essential oils (EOs) are organic compounds found in nature in the glands, veins, sacs and glandular hairs of aromatic plants. 1 Several studies from the medical and dental science have demonstrated the popular and escalating usage of EOs as an adjunct to the conventional medical and dental treatments The oral biofilm (dental plaque), which contains a variety of native oral microbiota, plays an essential role in the initiation and progression of oral inflammatory conditions, including dental caries and periodontal disease Mechanical debridement of dental plaque is usually performed for plaque removal and control. 10 This treatment strategy aims at reestablishing periodontal health by reducing the bacterial load in periodontal pockets and intraoral sites. However, the above protocol does not always yield promising results. Under certain circumstances (for example in patients with periodontitis and in medically compromised individuals), 14,15 additional agents are used as adjuncts to mechanical plaque control to enhance periodontal healing. Use of mouthrinses is by far the most frequently tested vehicle for chemical plaque control by self-care. This product has been used for centuries as a breath freshener and as an antiseptic. Two chemotherapeutic mouth-washes, chlorhexidine (CHX) and EO-formulated mouthrinses, are commonly used for the control of supragingival plaque and gingivitis. 1 Although From the Eng. A. B. Research chair for Growth Factors and Bone Regeneration (FJ, KA-H,), College of Dentistry, King Saud University, Riyadh, Saudi Arabia; and Eastman Institute for Oral Health (GER), Division of Periodontology, University of Rochester, Rochester, New York. Submitted May 27, 2011; accepted in revised form August 12, Correspondence: Fawad Javed, PhD, Eng. A. B. Research Chair for Growth Factors and Bone Regeneration, College of Dentistry, King Saud University, PO Box 60169, Riyadh 11545, Saudi Arabia ( fawjav@ gmail. com). CHX, a bis-guanide antiseptic, seems to be an effectual agent in use, its long-term use has been associated with several side effects, including staining of teeth and taste alteration. 1 Studies have reported that EO-formulated dentifrices and its flavor variants had significant effectiveness in long-term clinical trials showing reduction of existing plaque and gingivitis. This may be explained by the ability of EOs to penetrate mucous membranes and their antimicrobial, tissue conditioning, connective tissue rebuilding and antihalitosis properties. 19 However, limited data exist on the efficacy of EO-formulated dentifrices in connection to periodontal inflammatory conditions. Because many EOs have been used as adjuncts in conventional medical therapies and have shown beneficial effects on periodontal healing, the aim of the current study was to review the impact of dentifrices with EO formulations on periodontal healing. MATERIALS AND METHODS Objective and Focused Question The objective of the current literature review was to evaluate the impact of dentifrices with EO formulations on periodontal wound healing. In this regard, the addressed focused question was what is the impact of dentifrices with EO formulations on periodontal wound healing? Eligibility Criteria The following eligibility criteria were imposed: (a) original studies and randomized control trials; (b) experimental studies; (c) control group: use of dentifrices without EO formulations; (d) reference list of potentially relevant original and review articles; (e) intervention: impact of dentifrices containing EO formulations in periodontal healing; (f) use of statistical analysis; and (g) articles published only in English language. Letters to the editor, historic reviews and unpublished papers were excluded. Search Strategies The authors searched the MEDLINE/PubMed (National Library of Medicine, Bethesda, Maryland), Google Scholar and Cochrane library databases for appropriate articles addressing the focused question. Titles and abstracts of articles obtained using the criteria described above were then screened by the authors and checked for agreement. The full text of the articles judged by title and abstract to be relevant were read and independently evaluated against the stated eligibility criteria. Databases were searched from 1968 up to and including March 2010 using the following terms in various combinations: dentifrice; essential oil; periodontal healing; mouthrinse; and periodontitis. Hand-searching of the reference lists of original and review studies that were found to be relevant in the previous step was performed, and any disagreement between the authors was resolved through discussion. The initial search strategy initially yielded 41 articles. Scrutiny of the titles and abstracts reduced the number of articles to 20, which were processed for The American Journal of the Medical Sciences Volume 343, Number 5, May

2 412 Volume 343, Number 5, May 2012 TABLE 1. Author(s), aim, study design, participants, essential oil used in study, statistical analysis and main results of selected studies Study participants (mean age/range in years) Rodrigues et al 5 To assess the antiplaque and antigingivitis effect of an EO in vivo Haffajee et al 7 Botelho et al 8 Gursoy etal 9 Cavalca Cortelli et al 12 Amini et al 16 Sharma et al 17 Tufekci et al 18 To test the antibacterial and anti- inflammatory effects of mouthrinses with different formulations in patients with periodontitis To compare the efficacy of an EO mouthrinse with 0.12% CHX mouthrinse To investigate the bacterial growth inhibiting and antibiofilm effects of five Eos To assess the clinical and microbiological longterm effects of an EOcontaining mouthrinse in patients with periodontitis To compare the antiplaque and antigingivitis efficacy of EO- containing mouthrinses with 2 mouthrinses without EO content To assess the effect of various mouthwashes on clinical and laboratory markers (interleukin-2 and interferon-g) of periodontal inflammation in patients with chronic gingivitis To assess the effect of an EO- containing mouthrinse to the standard oral hygiene in patients undergoing orthodontic therapy Generic name of essential oil(s) Statistical analysis Main results Clinical 26 (NA/19 25) 10% LS Mann-Whitney U test; and Wilcoxon signedranks test Clinical 116 NA Wilcoxon signed-ranks test and ANCOVA Clinical 55 (31/18 69) 1% LS Fisher s exact test; Mann-Whitney U test and Wilcoxon signedranks test Experimental LSL, MCL, SFM, Student s t test SHL, JCL Clinical and experimental 120 (NA/31 70) Thymol, eucalyptol, methyl salicylate and menthol Clinical 159 (NA/18 58) Thymol, eucalyptol, methyl salicylate and menthol ANOVA, Student s t test and Wilcoxon tests Bonferroni adjustment 10% LS was more effective in reducing GI compared with the placebo gel Veillonella parvula was reduced in the EO- and CHX-containing rinses, whereas CHX and herbal rinses reduced the PI 1% LS was more effective in reducing GI compared with 0.12% CHX SHL prevents the growth of periodontal bacteria The EO-formulated rinse showed improvements in periodontal inflammatory parameters. Microbiological findings were inconsistent The EO mouthrinse showed significantly greater antiplaque and antigingivitis efficacy compared with mouthrinses without EO formulation Clinical 80 (16/ ) Azadirachta indica ANCOVA CHX, EO and iodine mouthwashes are more effective in reducing PI, GI and levels of proinflammatory cytokines in gingival tissues compared with Azadirachta indica Clinical 50 (16.6/10 64) Thymol, eucalyptol, methyl salicylate and menthol Names of statistical tests were not available Using an EO-formulated mouthrinse can reduce the PI and GI in patients undergoing orthodontic treatment Study participants (mean age/range in years) Generic name of essential oil(s) Statistical analysis Main results Javed et al

3 Ó 2012 Lippincott Williams & Wilkins 413 TABLE 1. Fine et al 20 Lauten et al 21 Witt et al 22 Charles et al 23 Soukoulis and Hirsch 24 Sharma et al 25 Pretty et al 26 To investigate the effect of rinsing with an EOcontaining mouthrinse on levels of subgingival bacteria in patients with periodontitis To assess the clinical and microbiological effects of a mouthrinse containing EOs from four plant species To compare the antiplaque and antigingivitis efficacies of mouthrinses with and without EO formulations To compare the antiplaque and antigingivitis effectiveness of an EO-containing mouthrinse with a CHX-containing mouthrinse To assess the antiplaque and antigingivitis efficacy of topically applied 2.5% tea tree oil containing gel in patients with chronic gingivitis To test the antiplaque and antigingivitis efficacy of EOcontaining mouthrinse in patients who brush and floss regularly To determine the antiplaque and antimicrobial effects of dentifrices containing olive oil Study participants (mean age/range in years) Generic name of essential oil(s) Statistical analysis Main results Experimental 37 (35.4/23 54) Thymol, eucalyptol, methyl Clinical 20 (NA/at least 18 years and older) Clinical 78 (38.8/ ) Thymol, eucalyptol, methyl Clinical 108 (32/20 57) Thymol, eucalyptol, methyl ANCOVA Subgingival organisms were significantly reduced in the EO group compared with the control group Melaleuca and Manuka oils ANCOVA There were no significant differences in PI, GI and bacterial species between the test and control groups ANCOVA One-way ANOVA, Fischer s exact test and x 2 square test Clinical 49 (45.5/18 60) NA One-way ANOVA, Scheffe s test and paired t test Clinical 246 (37/18 64) Thymol, eucalyptol, methyl Clinical and experimental One-way ANOVA, Fischer s exact test and x 2 square test There were no significant differences between the antiplaque and antigingivitis activities of the mouthrinses with and without EO formulations There were no significant differences between the antiplaque and antigingivitis activities EO- containing and CHX mouthrinses The test group had a significant reduction in PI and GI scores compared with the control group Subjects who used the EOcontaining mouthrinse had significantly lower scores of PI and GI compared with the control group 20 (35/ ) Olive oil Turesky index Individuals using the olive oil product showed a significant decrease in plaque and bacterial regrowth compared with the control group Study participants (mean age/range in years) Generic name of essential oil(s) Statistical analysis Main results Role of Essential Oils in Periodontal Healing

4 414 Volume 343, Number 5, May 2012 TABLE 1. Bruhn et al 27 Coelho et al 28 Charles et al 29 Kohut et al 30 McKenzie et al 31 To compare the antiplaque and antigingivitis efficacy of a fluoride toothpaste containing 0.3% triclosan and an EO with a control toothpaste in patients with periodontitis To assess the antiplaque and antigingivitis properties of a dentifrice formulated with the fixed combination of Eos To compare the efficacy of an EO-containing antiseptic mouthrinse with an antiplaque/ antigingivitis dentifrice To assess the utility of a short- term brushing model for assessing the inhibition of supragingival plaque and gingivitis by an EOcontaining dentifrice To compare the antiplaque/ antigingivitis efficacies of a 0.12% CHX mouthrinse and an EO mouthrinse in mentally handicapped adults over a 1- year period Study participants (mean age/range in years) Clinical 120 (NA/31 70) Mentha avensis, M viridis, M piperita and eucalyptol Clinical 234 (35/18 63) Thymol, eucalyptol, methyl Generic name of essential oil(s) Statistical analysis Main results Mann-Whitney U test and Wilcoxon signed- ranks test One-way ANOVA and ANCOVA and Fischer s exact test Clinical 316 (34.9/18 65) NA One-way ANOVA, Fischer s exact test and x 2 square test Clinical 42 (35.5/18 65) NA One-way ANOVA, ANCOVA, Fischer s exact test and paired t test Clinical 29 (41.8/25 64) Thymol, eucalyptol, methyl ANOVA and paired t test After 28 wk, the PI and GI in the triclosan group were significantly lower compared with the control group At 6 mo, the EO-containing dentifrice group had significantly lower PI and GI compared with the control dentifrice At 6 mo, the EO-containing dentifrice group had significantly lower PI and GI compared with the control dentifrice The EO-containing dentifrice group had significantly lower PI and GI compared with the control dentifrice At 12 mo, no significant changes in the PI or GI occurred in the test and control groups. The probing depths remained the same over the 12-mo period ANOVA, analysis of variance; ANCOVA, analysis of covariance; CHX, chlorhexidine; EO, essential oil; GI, gingival index; JCL, Juniperus communis Linnaeus; LS, Lippia sidoides; LSL, Lavandula stoechas Linnaeus; MCL, Myrtus communis Linnaeus; NA, not available; PI, plaque index; SFM, Salvia fruticosa Miller; SHL, Satureja hortensis Linnaeus. Javed et al

5 Role of Essential Oils in Periodontal Healing data extraction (Table 1). Twenty-one studies, which did not comply with the selection protocol, were excluded as shown in Table 2 (also see Appendix). RESULTS All studies 5,7 9,12, were either performed at universities or oral healthcare centers and were double-blinded randomized control trials. Of these, 18 studies 5,7,8, ,21 31 were clinical and 2 studies 9,20 had an experimental research design. In the clinical studies, 5,7,8,12,16 18,21 31 the numbers of participants ranged from 20 to 316 individuals and their age ranged from 18 to 70 years. In these studies, the participants were rinsing with the EO-formulated dentifrices at least twice daily, and the duration of use of EO-formulated dentifrices ranged from 1 week to 48 weeks. In 5 clinical studies, 16,21 24 there were more female participants compared with male participants, whereas in the remaining clinical stud-ies, 5,7,8,12,16 18,21 31 there was no difference in sex. Fourteen studies 5,7,8,12,16 18,24 30 showed a reduction in clinical parameters of periodontal inflammation (plaque index, gingival index and probing depth) in the test group (individuals rinsing with EO-formulated dentifrices) compared with the placebo group. Four clinical studies 21 23,31 reported no significant differences in parameters of periodontal inflammation in the test and placebo groups. The duration of rinsing ranged from 30 to 60 seconds. Results from 3 studies 9,20,26 showed a reduction in periodontal pathogens in the test group compared with the placebo group. Even though the results by Cavalca Cortelli et al 12 showed a reduction in periodontal inflammatory parameters in the test group compared with the placebo group, the microbiological findings remained inconclusive. DISCUSSION Over the years, several strategies have been adopted to assist in the removal of plaque because tooth brushing alone does not adequately control, especially in patients with periodontal inflammatory conditions. 13 In 1987, the approval of EO-formulated dentifrices was based on clinical studies satisfying the criteria set by the American Dental Association. 32,33 The incorporation of EO-formulated dentifrices as adjuncts to conventional periodontal maintenance programs has gained importance with the recognition that EO-formulated dentifrices enhance the periodontal healing process. 34 In addition to their antiplaque and antigingivitis properties, EO-formulated dentifrices have also been shown to have a protective effect on the enamel and dentin. Wiegand et al 35 investigated the effect of TABLE 2. List of excluded studies and main reason for exclusion Main reason for Author(s) (yr) Title exclusion Teles and Teles (2009) Antimicrobial agents used in the control of periodontal biofilms: Review effective adjuncts to mechanical plaque control? Gutkowski S (2009) Keeping your mouth squeaky clean. New products that can help Review Tonkal and Morsy (2008) An update review on Commiphora molmol and related species Review Patel and Malaki (2008) The effect of a mouthrinse containing essential oils on dental Review plaque and gingivitis Haffajee et al (2008) Antimicrobial effectiveness of an herbal mouthrinse compared with an essential oil and a chlorhexidine mouthrinse Statistical analysis unavailable Nomicos (2007) Myrrh: medical marvel or myth of the Magi? Review Botelho et al (2007) Antimicrobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens Statistical analysis unavailable von Fraunhofer et al (2006) The effect of a mouthrinse containing essential oils on dental restorative materials Inconsistent with our objective Yengopal (2004) Essentials oils for implant maintenance: an evidence based appraisal Review Battino et al (2002) In vitro antioxidant activities of mouthrinses and their components Review Schechter (1998) Time-tested botanical remedies for modern periodontal therapy Review Jackson (1997) Metal salts, essential oils and phenols old or new? Review Osawa et al (1990) Studies of the antibacterial activity of plant extracts and their Review constituents against periodontopathic bacteria Lyon (1988) Essential oils Review Leger (1986) Aromatherapy in dentistry Article in French Danilevskǐ and Antonishin (1982) Antimicrobial activity of a tincture of Japanese pagoda tree (Sophora Article in Russian japonica) and of the essential oil of sweet flag (Acorus calamus) Markovska and Stoianova (1975) Comparative clinical laboratory investigations on the effect Article in Bulgarian of certain essential oils in the complex therapy of periodontal hemorrhage Scopp et al (1971) Corn germ extract in the treatment of periodontal diseases Article in Italian Lattes (1970) Clinical study of the effect of nonsaponifiable fractions of soy Article in French oil and avocado in dentistry Calandriello and Bar (1969) The surgical treatment of marginal periodontal diseases Article in Italian Schach (1968) Simplified method of preparation of the zinc oxide-bergamot oil gingival dressing Article in German The complete details of the 21 excluded studies are given in the Appendix. Ó 2012 Lippincott Williams & Wilkins 415

6 Javed et al olive oil and an olive oil-containing fluoridated mouthrinse on enamel and dentin erosion. The results showed that olive oil offered protection against enamel and dentin erosion when applied as 2% emulsion or 2% olive oil-containing mouthrinse. 35 The mechanisms of action of EO-formulated dentifrices against bacteria are complex. The EOs penetrate the plaque biofilm, thereby exerting a bactericidal activity against embedded bacteria and retarding their multiplication. At high concentrations, there is disruption of the cell wall and precipitation of cell proteins, whereas at lower concentrations, EOs inactivate the bacterial enzymes. 36 From the literature reviewed, we observed that the participants using EO-formulated dentifrices were recommended to use the vehicle at least twice daily for at least 30 seconds. In an in vitro study, Ross et al 37 reported that rinsing for at least 30 seconds with EO-formulated dentifrices kills a wide range of microorganisms. Although the longterm use of CHX has been associated with occurrences of side effects, the use of EO-formulated dentifrices has been shown to be safe without any undesirable side effects or shifts in the supragingival microbial composition in the long run. 29,38 In addition to reducing periodontal inflammatory conditions, the use of EO-formulated dentifrices also helps to reduce halitosis. Yaegaki and Sanada 39 investigated the effect of an olive oil-containing mouthrinse on oral malodor and found that more than 80% of volatile sulfides were removed compared with only 30% when using the placebo. CONCLUSION EO-formulated dentifrices have beneficial effects on the clinical and microbiological parameters of periodontal inflammation. However, the use EO-formulated dentifrices cannot be considered as a substitute to the daily oral hygiene maintenance protocols. APPENDIX The complete details of the list of 21 excluded studies mentioned in Table 2 are as follows: a. Teles RP, Teles FR. Antimicrobial agents used in the control of periodontal biofilms: effective adjuncts to me chanical plaque control? Braz Oral Res 2009;23(suppl 1): b. Gutkowski S. Keeping your mouth squeaky clean. New products that can help. Diabetes Self Manag 2009;26:8, c. Tonkal AM, Morsy TA. An update review on Commiphora molmol and related species. J Egypt Soc Parasitol 2008;38: d. Patel RM, Malaki Z. The effect of a mouthrinse containing essential oils on dental plaque and gingivitis. Evid Based Dent 2008;9:18 9. e. Haffajee AD, Yaskell T, Socransky SS. Antimicrobial effectiveness of an herbal mouthrinse compared with an essential oil and a chlorhexidine mouthrinse. J Am Dent Assoc 2008;139:606-ll. f. Nomicos EY. Myrrh: medical marvel or myth of the Magi? Holist Nurs Pract 2007;21: g. Botelho MA, Nogueira NA, Bastos GM, et al. Antimi crobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens. Braz J Med Biol Res 2007;40: h. von Fraunhofer JA, Kelley JI, DePaola LG, et al. The effect of a mouthrinse containing essential oils on dental restorative materials. Gen Dent 2006;54: i. Yengopal V. Essentials oils for implant maintenance: an evidence based appraisal. SADJ 2004;59: j. Battino M, Ferreiro MS, Fattorini D, et al. In vitro antioxidant activities of mouthrinses and their components. J Clin Periodontol 2002;29: k. Schechter B. Time-tested botanical remedies for modern periodontal therapy. Dent Today 1998;17: l. Jackson RJ. Metal salts, essential oils and phenols old or new? Periodontol ;15: m. Osawa K, Matsumoto T, Maruyama T, et al. Studies of the antibacterial activity of plant extracts and their constituents against periodontopathic bacteria. Bull Tokyo Dent Coll 1990;31: n. Lyon KF. Essential oils. J Vet Dent 1988;5: o. Leger J. Aromatherapy in dentistry. Chir Dent Fr 1986; 56: p. Danilevskii NF, Antonishin BV. Antimicrobial activity of a tincture of Japanese pagoda tree (Sophora japonica) and of the essential oil of sweet flag (Acorus calamus). Mikrobiol Zh 1982;44:80 2. q. Markovska V, Stoianova O. Comparative clinical laboratory investigations on the effect of certain essential oils in the complex therapy of periodontal hemorrhage]stomatologiia (Sofiia) 1975;57: r. Scopp IW, Kumar W, Kassouny DY, et al. Corn germ extract in the treatment of periodontal diseases. Minerva Stomatol 1971;20: s. Lattes GA. Clinical study of the effect of nonsaponifi-able fractions of soy oil and avocado in dentistry. Rev Stomatol Chir Maxillofac 1970;71: t. Calandriello M, Bar U. The surgical treatment of marginal periodontal diseases. Minerva Stomatol 1969;18: u. Schach H. Simplified method of preparation of the zinc oxide-bergamot oil gingival dressing. Zahnarztl Welt Zahnarztl Rundsch ZWR Zahnarztl Reform 1968;69: REFERENCES 1. Stoeken JE, Paraskevas S, van der Weijden GA. The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review. J Periodontol 2007;78: Cuttle L, Kempf M, Kravchuk O, et al. The efficacy of Aloe vera, tea tree oil and saliva as first aid treatment for partial thickness burn injuries. Burns 2008;34: Lusby PE, Coombes AL, Wilkinson JM. A comparison of wound healing following treatment with Lavandula x allardii honey or essential oil. Phytother Res 2006;20: Orafidiya LO, Agbani EO, Abereoje OA, et al. An investigation into the wound-healing properties of essential oil of Ocimum gratissimum linn. J Wound Care 2003;12: Rodrigues IS, Tavares VN, Pereira SL, et al. Antiplaque and antig ingivitis effect of Lippia Sidoides: a double-blind clinical study in humans. J Appl Oral Sci 2009;17: Al-Waili NS. Mixture of honey, beeswax and olive oil inhibits growth of Staphylococcus aureus and Candida albicans. Arch Med Res 2005; 36: Haffajee AD, Roberts C, Murray L, et al. Effect of herbal, essential oil, and chlorhexidine mouthrinses on the composition of the subgingival microbiota and clinical periodontal parameters. J Clin Dent 2009;20: Botelho MA, dos Santos RA, Martins JG, et al. Comparative effect of an essential oil mouthrinse on plaque, gingivitis and salivary Strep 416 Volume 343, Number 5, May 2012

7 Role of Essential Oils in Periodontal Healing tococcus mutans levels: a double blind randomized study. Phytother Res 2009;23: Gursoy UK, Gursoy M, Gursoy OV, et al. Anti-biofilm properties of Satureja hortensis L. essential oil against periodontal pathogens. An aerobe 2009;15: Ozbaldş Dengiz G, Gürsan N. Effects of Momordica charantia L. (Cucurbitaceae) on indomethacin-induced ulcer model in rats. Turk J Gastroenterol 2005;16: Wikén Albertsson K, Persson A, Lingström P, et al. Effects of mouthrinses containing essential oils and alcohol-free chlorhexidine on human plaque acidogenicity. Clin Oral Investig 2010;14: Cavalca Cortelli S, Cavallini F, Regueira Alves MF, et al. Clinical and microbiological effects of an essential-oil-containing mouth rinse applied in the one-stage full-mouth disinfection protocol a random ized doubled-blinded preliminary study. Clin Oral Investig 2009;13: Qadri T, Poddani P, Javed F, et al. A short-term evaluation of Nd: YAG laser as an adjunct to scaling and root planning in treatment of periodontal inflammation. J Periodontol 2010;81: Javed F, Näsström K, Benchimol D, et al. Comparison of periodontal and socioeconomic status between subjects with type 2 diabetes mellitus and non-diabetic controls. J Periodontol 2007;78: Javed F, Romanos GE. Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic litera ture review. J Periodontol 2009;80: Amini P, Araujo MW, Wu MM, et al. Comparative antiplaque and antigingivitis efficacy of three antiseptic mouthrinses: a two week randomized clinical trial. Braz Oral Res 2009;23: Sharma S, Saimbi CS, Koirala B, et al. Effect of various mouthwashes on the levels of interleukin-2 and interferon-gamma in chronic gingivitis. J Clin Pediatr Dent 2008;32: Tufekci E, Casagrande ZA, Llndauer SJ, et al. Effectiveness of an essential oil mouthrinse in improving oral health in orthodontic pa tients. Angle Orthod 2008;78: Shuman IE. The gentle art of periodontal maintenance. A protocol using essential oils. Dent Today 2003;22: Fine DH, Markowitz K, Furgang D, et al. Effect of rinsing with an essential oil-containing mouthrinse on subgingival periodontopathogens. J Periodontol 2007;78: Lauten JD, Boyd L, Hanson MB, et al. A clinical study: Melaleuca, Manuka, Calendula and green tea mouth rinse. Phytother Res 2005;19: Witt JJ, Walters P, Bsoul S, et al. Comparative clinical trial of two antigingivitis mouthrinses. Am J Dent 2005;18:15A 17A. 23. Charles CH, Mostler KM, Bartels LL, et al. Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial. J Clin Periodontol 2004;31: Soukoulis S, Hirsch R. The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Aust Dent J 2004;49: Sharma N, Charles CH, Lynch MC, et al. Adjunctive benefitofan essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study. J Am Dent Assoc 2004;135: Pretty IA, Gallagher MJ, Martin MV, et al. A study to assess the effects of a new detergent-free, olive oil formulation dentifrice in vitro and in vivo. J Dent 2003;31: Bruhn G, Netuschil L, Richter S, et al. Effect of a toothpaste containing triclosan on dental plaque, gingivitis, and bleeding on probing an investigation in periodontitis patients over 28 weeks. Clin Oral Investig 2002;6: Coelho J, Kohut BE, Mankodi S, et al. Essential oils in an antiplaque and antigingivitis dentifrice: a 6-month study. Am J Dent 2000;13: 5C 10C. 29. Charles CH, Sharma NC, Galustians HJ, et al. Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice. A six-month clinical trial. J Am Dent Assoc 2001; 132: Kohut B, Coelho J, Sharma NC, et al. A short-term brushing model for assessing antiplaque/antigingivitis dentifrice effectiveness: a pilot study. J Clin Dent 1999;10: McKenzie WT, Forgas L, Vernino AR, et al. Comparison of a 0.12% chlorhexidine mouthrinse and an essential oil mouthrinse on oral health in institutionalized, mentally handicapped adults: one-year results. J Periodontol 2009;80: Council on Dental Therapeutics. Guidelines for acceptance of chemotherapeutic agents for the control of supragingival plaque and gingivitis. J Am Dent Assoc 1986;112: Overholser CD, Meiller TF, DePaola LG, et al. Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingi val dental plaque and gingivitis. J Clin Periodontol 1990;17: Mandel ID. Chemotherapeutic agents for controlling plaque and gingivitis. J Clin Periodontol 1988;15: Wiegand A, Gutsche M, Attin T. Effect of olive oil and an oliveoil- containing fluoridated mouthrinse on enamel and dentin erosion in vitro. Acta Odontol Scand 2007;65: Fine DH, Letizia J, Mandel ID. The effect of rinsing with Listerine antiseptic on the properties of developing dental plaque. J Clin Peri odontol 1985;12: Ross NM, Charles CH, Dills SS. Long-term effects of Listerine antiseptic on dental plaque and gingivitis. J Clin Dent 1989;l: Walker CB. Microbiological effects of mouthrinses containing antimi crobials. J Clin Periodontol 1988;15: Yaegald K, Sanada K. Effects of a two-phase oil-water mouthwash on halitosis. Clin Prev Dent 1992;14:5 9. Ó 2012 Lippincott Williams & Wilkins 417