Alcohol-free mouthwashes containing essential oils may taste better but may be less effective at removing plaque than their alcohol-based counterparts, a systematic review found.
However, an alcohol-free essential oil mouthwash (EOalc−) and an alcohol-containing essential oil mouthwash (EOalc+) showed similar results in reducing bleeding gums and gingivitis, the authors wrote.
“When using mouthwash without brushing or in situations where brushing is done with little or moderate confidence, EOalc- provides less plaque control than EOalc+,” the authors from the Vrije Universiteit Amsterdam in the Netherlands wrote.
A search strategy was developed to compare EOalc− and EOalc+ in terms of plaque, bleeding, gingivitis, taste perception, taste change and residual taste after rinsing, and a clinical trial was conducted using Medline-PubMed and the Cochrane Central Register of Controlled Trials databases covering studies published up to March 2024.
Inclusion criteria required randomized controlled trials or controlled clinical trials in adults without systemic disorders, fixed orthodontic appliances, dental implants, or removable dentures. A systematic electronic search identified seven eligible studies. A meta-analysis was then conducted to evaluate the effectiveness of EOalc− versus EOalc+.
Descriptive analysis revealed a significant improvement in plaque scores after use of EOalc+. This was further confirmed by a meta-analysis of both the no-toothbrush (mean difference [DiffM] = 0.40; 95% confidence interval [CI] 0.27-0.53; p <0.00001) and toothbrush (DiffM = 0.05; 95% CI 0.01-0.10; p = 0.01) studies.
However, a meta-analysis of gingival bleeding and condition scores in toothbrushing studies did not reveal significant differences between the products. According to the authors, in terms of user preference, EOalc− was preferable for taste perception (DIFF = 1.63; 95% CI 0.72-2.55; p = 0.0004).
However, the study had limitations, including that most of the included studies had small sample sizes. The authors write that larger studies may be needed to better identify potential differences.
“EOalc− may be considered a reasonable recommendation due to its purported better taste, which may meet patient demand,” they wrote.