Comparative Evaluation of the Antimicrobial Effects of Different Mouthrinses against Streptococcus Mutans: An in Vitro Study

Purpose: To assess the antimicrobial effects of different natural and semi-natural mouthrinses on isolates of S. mutans obtained from the saliva of Saudi children and reference strains of S mutans (ATCC 25175). Study design: Saliva samples were collected from 20 children. Natural and semi-natural mouthrinses included were herbal mix mouthrinse, cranberry mouthrinse, chlorhexidine digluconate mouthrinse, cranberry extract mixed with chlorhexidine digluconate mouthrinse, chlorhexidine digluconate mouthrinse with alcohol (positive control), and distilled water (negative control). The microbiological examination tests were minimal inhibitory concentration, minimal bactericidal concentration, and zone of inhibition for the saliva isolates of S. mutans while zone of inhibition test only for reference strain of S. mutans. Results: For reference strain in a comparison with the distilled water, the herbal mix, cranberry, cranberry mixed with chlorhexidine, chlorhexidine, and chlorhexidine with alcohol showed significantly increased zones of inhibition by 36.38, 36.25, 26.13, 17.75, and 12.38, respectively. For saliva isolates in a comparison with the distilled water, the herbal mix, cranberry, cranberry mixed with chlorhexidine, chlorhexidine, and chlorhexidine with alcohol showed significantly increased zones of inhibition by 38.00, 34.25, 22.94, 16.50, and 16.44, respectively. Chlorhexidine with alcohol showed significantly lower minimum inhibitory and bactericidal concentration than the other groups. Conclusions: Herbal mix and cranberry mouthrinses could be effective natural alternative to chlorhexidine mouthrinse with or without alcohol in affecting tested parameters.

Chlorhexidine; Cranberry; Herbal; Mouthrinses; Streptococcus Mutans

1. Yadav K, Prakash S. Dental Caries: A Review’, Asian Journal of Biomedical and Pharmaceutical Sciences;53(6):1–7.2. 2016.

2. Selwitz R, Ismail A, Pitts N. Dental caries. The Lancet;369(9555): 51–59. 2007.

3. Chandki R, Banthia P, Banthia R. Biofilms: a microbial home. J Indian Soc Periodontol;15(2):111–114. 2011.

4. Hamada S, Slade H. Biology, immunology, and cariogenicity of Streptococcus mutans. Microbiological reviews;44(2):331–384. 1980.

5. Sharma U, Jain RL, Pathak A. A clinical assessments of effectiveness of mouthwashes in comparison to toothbrushing in children. J Indian Soc Pedod Prev Dent ;22:38–44. 2004.

6. Van der Weijden FA, Van der Sluijs E, Ciancio SG, Slot DE. Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control? Dent Clin North Am;59(4):799-829. 2015.

7. James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev;3:CD008676. 2017.

8. Fltötra L, Gjermo P, Rölla G, Waerhaug J. Side effects of chlorhexidine mouth washes. Scand J Dent Res;79(2):119–125. 1971.

9. Ernst C, Canbek K, Dillenburger A, Willershausen B. Clinical study on the effectiveness and side effects of hexetidine and chlorhexidine mouthrinses versus a negative control. Quintessence international;36(8):641–652. 2005.

10. Groppo F, Bergamaschi C, Cogo K, Franz-Montan M, Motta RH, de Andrade ED. Use of phytotherapy in dentistry. Phytother Res;22(8):993– 998.11. 2008.

11. Newman D. Natural products as drug leads: an old process or the new hope for drug discovery? J Medicinal Chem;51(9):589–2599. 2008.

12. Bonifait L, Grenier D. Cranberry Polyphenols : Potential Benefits for Dental Caries and Periodontal Disease. J Can Dent Assos;76:a130. 2010.

13. Khairnar M, Karibasappa G, Dodamani A, Vishwakarma P, Naik R, Deshmukh M. Comparative assessment of Cranberry and Chlorhexidine mouthwash on streptococcal colonization among dental students: A randomized parallel clinical trial. Contemporary Clin dent; 6(1): 35–39. 2015.

14. Neto C. Cranberry and It’s Phytochemicals: A Review of In Vitro Anticancer Studies. J Nut;137:186S-193S. 2007,

15. Srinidhi K. Cranberry and its Antibacterial Activity–A Review. J Pharm Sci & Res;6(1):41 – 44. 2014.

16. Viuda-Martos M, Fernández-Lóaez J, Pérez-álvarez J. Pomegranate and its Many Functional Components as Related to Human Health: A Review. Comprehensive Reviews in Food Science and Food Safety; 9(6): 635–654. 2010.

17. Umar D, Dilshad B, Farhan M, Ali A, Baroudiet K. The effect of pomegranate mouthrinse on Streptococcus mutans count and salivary pH: An in vivo study. J Adv Pharm Technol Res;7(1):13-16. 2016.

18. Sambawa Z, Alkahtani F, Aleanizy F, ALqahtani F. Comparison of antibacterial efficacy chlorhexidine gluconate and Saudi Myrrh mouthwashes in the oral cavity. Oriental J Chem;32(5):2605–2610. 2016.

19. Gardiner P. Complementary, holistic, and integrative medicine: chamomile. Pediatr Rev;28(4):e16– 8. 2007.

20. Pourabbasa R, Delazarb A, Chitsaza M. The Effect of German Chamomile Mouthwash on Dental Plaque and Gingival Inflammation. Iranian J Pharmaceutical Res;2:105-109. 2005.

21. Ooi LS, Li Y, Kam SL, Wang H, Wong EY, Ooi VE. Antimicrobial activities of cinnamon oil and cinnamaldehyde from the Chinese medicinal herb Cinnamomum cassia Blume. Am J Chin Med;34(3):511-22. 2006.

22. Burt S. Essential oils: their antibacterial properties and potential applications in foods-a review. Int J Food Microbiol;94(3):223-253. 2004.

23. Al-Joubori S, Al-Obaidi W. Effect of cinnamon extracts on streptococci and mutans streptococci, in comparison to chlorhexidine gluconate. J Baghdad College Dent;23(1):141-145. 2011.

24. Frankl S, Shiere F, Fogels H. Should the parent remain with the child in the dental operatory? J Dent Child; 29: 150-163. 1962.

25. al Ghanim NA, Adenubi JO, Wyne AA, Khan NB. Caries prediction model in pre-school children in Riyadh, Saudi Arabia. Int J Paediatr Dent;8(2):115–122. 1998.