title: Essential oils-containing mouthwashes for gingivitis and plaque: Meta-analyses and meta-regression.
abstract: To evaluate the efficacy of EO as adjuncts to mechanical plaque control (MPC) on the reduction of plaque and gingivitis when compared to placebo or cetylpyridium chloride (CPC).
  
  
  
  Randomized controlled trials of at least 6 months of follow-up including systemically healthy individuals with gingivitis were included.
  
  
  
  MEDLINE, EMBASE, Lilacs and SCOPUS were searched up to April 2016. From 3045 citations, 16 studies were included. 14 studies assessed the Quigley-Hein Plaque Index (QHI) and 11 studies assessed the Modified Gingival Index (MGI) and were included in meta-analyses and meta-regression.
  
  
  
  The analysis of risk of bias suggested that the quality of the studies ranged from moderate to low. Mean QHI (WMD=-0.86, 95%CI -1.05 to -0.66) and MGI (WMD=-0.52, 95%CI -0.67 to -0.37) were lower for EO+MPC than placebo+MPC. Reductions in plaque and gingivitis were, respectively, 32% and 24% larger for EO+MPC than placebo+MPC. The decreases in QHI (WMD=-0.95, 95%CI -1.26 to -0.63) and in MGI (WMD=-0.34, 95%CI -0.53 to -0.15) observed in the EO+MPC group, compared to placebo+MPC in interproximal areas, were significantly different and in favor to EO+MPC. EO+MPC compared to CPC+MPC resulted in clinically lower levels of plaque and gingivitis. High heterogeneity (I2>95%) was found and explained (MGI-R2=63.6%; QHI-R2=80.1%) by differences between studies in the percentage of males, supervision of the mouthwashes and provision of oral hygiene.
  
  
  
  EO seems to be superior to placebo+MPC and CPC+MPC for reduction of plaque and gingival inflammation in patients with gingivitis. Expected benefits may be clinically relevant and may also reach the interproximal area.
  
  
  
  Mouthwashes containing essential oils should be considered the first choice for daily use as adjuvants to self-performed mechanical plaque control.
authors.affiliation: Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: alexnhaas@gmail.com.
authors.forename: Alex Nogueira
authors.initials: AN
authors.lastname: Haas
authors.affiliation: Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Tassiane Panta
authors.initials: TP
authors.lastname: Wagner
authors.affiliation: Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Francisco Wilker Mustafa Gomes
authors.initials: FWMG
authors.lastname: Muniz
authors.affiliation: Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Fiorini
authors.affiliation: Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Juliano
authors.initials: J
authors.lastname: Cavagni
authors.affiliation: Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Roger Keller
authors.initials: RK
authors.lastname: Celeste
mesh_terms: D000891:Anti-Infective Agents, Local; D003773:Dental Plaque; D003774:Dental Plaque Index; D005891:Gingivitis; D006801:Humans; D008297:Male; D009067:Mouthwashes; D009822:Oils, Volatile; D010512:Periodontal Index
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D009822:Oils, Volatile
keywords: Cetylpyridinium; Dental plaque; Essential oils; Gingivitis; Meta-analysis; Mouthwashes