Antimicrobial and Anti-Plaque Efficacy of Moringa Oleifera-Based Mouthwashes Compared to Conventional and Herbal Alternatives: A Systematic Review

Abstract

Background: Herbal mouthwashes are being explored to control plaque and gingival inflammation with fewer adverse effects than conventional chemical rinses. Objective: To evaluate the antimicrobial and anti-plaque efficacy of Moringa oleifera (MO)–based mouthwashes.

Methods: This PRISMA-guided systematic review followed a PROSPERO-registered protocol (CRD420251039855). Searches were performed in PubMed, Embase, Scopus, CINAHL, and Google Scholar. Eligible studies included clinical trials and in vitro experiments assessing MO formulations against oral pathogens and/or clinical plaque and gingival outcomes. RoB 2 and QUIN were used for quality appraisal, and GRADE was applied to clinical outcomes.

Results: Seven studies were included (five randomized clinical trials and two in vitro studies). MO concentrations ranged from 0.015% to 15% using aqueous or ethanolic extracts. Compared with chlorhexidine, fluoride mouthwash, saltwater, or other alternatives, MO generally produced significant short-term improvements in microbial measures and in plaque and gingival indices; one trial reported plaque index 1.83→0.98 and gingival index 0.88→0.37. In vitro inhibition zones reached 28 mm against Staphylococcus aureus. Four trials were low risk of bias and one had some concerns; QUIN ratings were low and moderate. GRADE certainty was high for plaque reduction, moderate for gingival and clinical antimicrobial outcomes, and low for acceptability.

Conclusion: MO mouthwashes appear promising for short-term plaque control and gingival health, but standardized formulations and longer trials are required.