gingivitis , the mildest form of periodontal disease is generally caused by insufficient oral hygiene . the main cause of gingivitis is plaque that forms on the surface of teeth and gums . as a main stay to maintain oral hygiene , mechanical plaque control measures are used . mechanical plaque control techniques are time consuming and require motivation and skill to be performed well ; hence , antimicrobial agents have been employed extensively as an adjunct to mechanical cleaning . several antimicrobial chemical agents such as chlorhexidine , metronidazole etc . , have been used . however , these artificial drugs have unpleasant side - effects ; so researchers are trying to pay more attention to herbal drugs . plants and plants isolates demonstrates effects that are immune enhancing , anti - inflammatory , anti - cancer etc . development in alternative medicine research has led to many mouthrinses and tooth - pastes based on plant extracts ( ozakietal . , the aim of this clinical study is to verify the efficacy of herbal mouthwash containing pilu , bibhitaka , nagavalli , gandhapurataila , ela , peppermint satva , yavani satva on reduction of plaque and gingivitis . after obtaining the ethical clearance from the a. m. e 's dental college and hospital , raichur , study was conducted . the patients for this study were selected from the out - patient department of periodontics , a. m. e 's dental college and hospital , raichur . the present study was a simple randomized , using tossing a coin method , which included a total 100 patients . healthy patients 20 - 45 years.minimum of 20 teeth should be present in the dentition , no visible signs of untreated caries.patient diagnosed with mild to moderate type of gingivitis.patient with bleeding on probing present , clinically.patient who had not received any periodontal therapy for the past 6 months.patient willing to give the informed consent and willing to comply with the study were selected . minimum of 20 teeth should be present in the dentition , no visible signs of untreated caries . patient willing to give the informed consent and willing to comply with the study were selected . subjects taking antibiotics or any other drugs within last 3 months.pregnant women and lactating mothers.medically compromised patients.smokers.patients who had periodontal pockets in excess of 4 mm.no partial dentures or clinically unacceptable restorations or bridges.patient with orthodontic appliances.patient with a known history of allergic to chemical or any herbal products . materials used were herbal mouthwash ( hiora[fnx01hiora mouthwash regular- manufactured by the himalaya drug company makali , bangalore 562123 ( india ) . ] ) , each gram of hiora fnx01 mouthwash containing pilu ( salvadora persica ) - 5.0 mg , bibhitaka ( terminalia bellerica ) - 10 mg , nagavalli ( piper betel ) - 10 mg , gandhapura taila - 1.2 mg , ela - 0.2 mg , peppermint satva - 1.6 mg , yavanisatva - 0.4 mg . other materials used were mouthmirror , williams periodontal probe , explorer , and ultrasonic scalers . patients were randomly assigned to group a and group b and an informed consent was obtained from all the patients . group a : patients were treated by scaling alone without the use of herbal mouthwash . group b : patients were treated by scaling along with the usage of herbal mouthwash . prior to scaling , patient was subjected to assessment of the following clinical parameters . plaque index ( silness and loe , 1964)gingival index ( loe and silness , 1963)gingival bleeding index ( ainamo and bay , 1975 ) . plaque index ( silness and loe , 1964 ) gingival index ( loe and silness , 1963 ) gingival bleeding index ( ainamo and bay , 1975 ) . after recording the clinical parameters in selected patients , a thorough scaling was carried out using ultrasonic scalers in group a and group b. the recording of clinical parameters was carried out by main investigator and treatment was carried out by co - investigator . after recording of clinical parameters by the main investigator , patients in group b were instructed to use herbal mouthwash 15 ml for 30 s twice daily after food that is after breakfast and dinner in order to reduce the bias following brushing in both groups and more over the mouthwashes serve as a popular and simple delivery method that eliminates the bacteria and rinse the food debris from the mouth thereby preventing plaque formation . data expressed as mean  standard deviation ( sd ) ; comparison of before and after , group a and group b were analyzed using the student 's t - test for normally distributed data and wilcoxson test or mann - whitney u - test for skewed data . data analysis was carried out using the spss version 16.0 . to examine intra - examiner measurement error , the second measurements were compared to the first ones and dahlberg 's formula was used to calculate the error of estimation . the equation for dahlberg 's formula is where d is the difference between two measurements of a pair and n is the number of samples . healthy patients 20 - 45 years.minimum of 20 teeth should be present in the dentition , no visible signs of untreated caries.patient diagnosed with mild to moderate type of gingivitis.patient with bleeding on probing present , clinically.patient who had not received any periodontal therapy for the past 6 months.patient willing to give the informed consent and willing to comply with the study were selected . minimum of 20 teeth should be present in the dentition , no visible signs of untreated caries . patient willing to give the informed consent and willing to comply with the study were selected . subjects taking antibiotics or any other drugs within last 3 months.pregnant women and lactating mothers.medically compromised patients.smokers.patients who had periodontal pockets in excess of 4 mm.no partial dentures or clinically unacceptable restorations or bridges.patient with orthodontic appliances.patient with a known history of allergic to chemical or any herbal products . materials used were herbal mouthwash ( hiora[fnx01hiora mouthwash regular- manufactured by the himalaya drug company makali , bangalore 562123 ( india ) . ] ) , each gram of hiora fnx01 mouthwash containing pilu ( salvadora persica ) - 5.0 mg , bibhitaka ( terminalia bellerica ) - 10 mg , nagavalli ( piper betel ) - 10 mg , gandhapura taila - 1.2 mg , ela - 0.2 mg , peppermint satva - 1.6 mg , yavanisatva - 0.4 mg . other materials used were mouthmirror , williams periodontal probe , explorer , and ultrasonic scalers . patients were randomly assigned to group a and group b and an informed consent was obtained from all the patients . group a : patients were treated by scaling alone without the use of herbal mouthwash . group b : patients were treated by scaling along with the usage of herbal mouthwash . prior to scaling , patient was subjected to assessment of the following clinical parameters . plaque index ( silness and loe , 1964)gingival index ( loe and silness , 1963)gingival bleeding index ( ainamo and bay , 1975 ) . plaque index ( silness and loe , 1964 ) gingival index ( loe and silness , 1963 ) gingival bleeding index ( ainamo and bay , 1975 ) . after recording the clinical parameters in selected patients , a thorough scaling was carried out using ultrasonic scalers in group a and group b. the recording of clinical parameters was carried out by main investigator and treatment was carried out by co - investigator . after recording of clinical parameters by the main investigator , patients in group b were instructed to use herbal mouthwash 15 ml for 30 s twice daily after food that is after breakfast and dinner in order to reduce the bias following brushing in both groups and more over the mouthwashes serve as a popular and simple delivery method that eliminates the bacteria and rinse the food debris from the mouth thereby preventing plaque formation . data expressed as mean  standard deviation ( sd ) ; comparison of before and after , group a and group b were analyzed using the student 's t - test for normally distributed data and wilcoxson test or mann - whitney u - test for skewed data . data analysis was carried out using the spss version 16.0 . to examine intra - examiner measurement error , the second measurements were compared to the first ones and dahlberg 's formula was used to calculate the error of estimation . the equation for dahlberg 's formula is where d is the difference between two measurements of a pair and n is the number of samples . the results showed that there was a significant reduction in plaque scores , gingival index scores , and gingival bleeding index scores both in the group a and the group b following scaling as represented in table 2 ( plaque index scores ) , graph 1 , table 3 ( gingival index scores ) , graph 2 , table 4 ( gingival bleeding index scores ) , graph 3 . however , a greater reduction in plaque index scores , gingival index scores , and gingival bleeding scores were seen in group b compared with the group a as mentioned in table 5 , graph 13 and figures 14 . intra group comparison of plaque index scores before and after treatment interval plot of before and after for plaque index in group a and group b intra group comparison of gingival index scores before and after treatment interval plot of before , after of gingival index for group a and group b intra group comparison of gingival bleeding index scores before and after treatment interval plot of before , after for gingival bleeding index in group a and group b inter group comparison of plaque index , gingival index , and gingival bleeding index preoperative photo at  0 day of group b the chemical plaque control is generally considered to be an adjunct to mechanical oral hygiene practices : agents being most commonly delivered in toothpaste or mouthrinse vehicles . the evaluation of antiplaque agents or formulations typically uses a step - by - step series of clinical study protocols , often supported by laboratory tests , finally culminating in the home - use study(addy 1995 and addy and moran 1997 ) . the classic experiments of loe et al . , ( 1965 ) demonstrated that accumulation of microbial plaque results in the development of gingivitis and its removal and control results in resolution of the lesions in humans , thereby plaque proving as the microbial etiology of the disease as mentioned by page ( 1986 ) . research centers and world health organization prepare lots of programs to make use of plant extracts . finding plants that have antimicrobial effects and using them as mouthwash have advantages , such as a decreased side - effects and also they are more economical . oral rinses made from ayurvedic medicines are used in periodontal therapy to control bleeding and reduce inflammation . dee et al . , ( 1999 ) evaluated 35 different indian spices traditionally used . evidence shows that the herbs such as bibhitaka ( t. bellerica ) one of the ingredients of highly praised ayurvedic compound triphala , used both , internally as well as externally has many of the properties such as astringent , laxative , used in treatment of skin diseases , respiratory diseases etc . , nagavalli ( p. betle ) shows the antioxidant , anti - inflammatory , antiplatelet , antimicrobial etc . , pilu ( s. persica ) shows antioxidant activity , peppermint that contain menthol activates cold - sensitive trpm8 ( family of trasient receptor potential ion channels , m stands for melastatin ) receptors in the skin and mucosal tissues , and is the primary source of the cooling sensation that follows the topical application of peppermint oil also used as a flavoring agent in tooth pastes , ice creams , confectionaries , chewing gums etc . , ela is an effective gargle in bad odor of the oral cavity and dental ailments . the paste is also beneficial in the skin diseases , chronic ulcers , and pruritus . ela oil is used with great benefit in toothache due to infections , gandhapura taila has analgesic , anti - inflammatory effect used in treatment of joint pains . here , a first attempt has been made to use these herbal plants in the form of herbal mouthwash . this study was carried out to see the efficacy of herbal plant mouthwash containing pilu ( s. persica ) , bibhitaka ( t. bellerica ) , nagavalli , gandhapura taila , ela ( cardamomum ) , peppermint satva , and yavani satva in treatment of gingivitis as an adjunct to scaling . earlier studies shows evidence of usage of herbal mouthwashes such as turmeric , neem , and triphala , compared to chlorhexidine showed a significant reduction in plaque indices scores , gingival indices scores , and gingival bleeding index scores as in the present study with a value of plaque index ( pi ) < 0.0001 , gingival index ( gi ) < 0.0014 and gingival bleeding index ( gbi ) < 0.0001 . the effectiveness of herbal mouthrinse likely was due to the ingredients such as bibhitiki , pilu , gandhapura tailum , which has antimicrobial , anti - inflammatory property . moreover , the ingredients ela , nagavelli it has an added effect on reducing the oral malodor . though chlorhexidine was developed in 1950 , which is still considered one of the most effective antiplaque agents in dentistry . however , long - term usage is limited by its disagreeable taste and propensity to stain the teeth brown . therefore , a new formulation with similar or superior efficacy and possible with less side - effects and long effect need to be investigated . this herbal mouthwash showed no adverse effects and no staining of teeth with the usage of mouthwash . limitations of the study were it was dependent on the patient compliance and the study was of short duration . within the limits of this clinical study , it may be concluded that the ingredients in the herbal oral rinse were effective in controlling plaque and gingivitis . furthermore , it may serve as a natural antimicrobial mouthrinse alternative for patients who wish to avoid alcohol , artificial preservatives and artificial flavors and colors . further , clinical and invitro studies are required to clarify and broaden our understanding of the role of this herbal mouthwash in periodontal disease .
background : ayurvedic drugs have been used since ancient times to treat diseases including periodontal diseases . 
 oral rinses made from ayurvedic medicines are used in periodontal therapy to control bleeding and reduce inflammation . 
 the aim of this clinical study is to verify the efficacy of herbal mouthwash containing pilu , bibhitaka , nagavalli , gandhapura taila , ela , peppermint satva , and yavani satva on reduction of plaque and gingivitis.materials and methods : a total of 100 volunteers with clinical signs of mild to moderate gingivitis were selected and assigned to group a ( only scaling done ) and group b ( scaling along with the use of herbal mouthwash ) . after recording the clinical parameters , 
 the patients were instructed to use herbal mouthwash 15 ml for 30 s twice daily after food in group b and oral hygiene instructions were given to all patients . 
 plaque and gingivitis assessment were carried out using the plaque index ( silness nd loe , 1964 ) , gingival index ( loe and silness , 1963 ) , gingival bleeding index ( ainamo and bay , 1975 ) at baseline and at 21 days of the herbal mouthwash use . 
 statistically analysis was carried out using the student 's t - test for normally distributed data and wilcoxson test or mann - whitney u - test for skewed data.results:our results showed that herbal mouthwash was effective in treatment of plaque induced gingivitis in group b when compared with the group a.conclusion:herbal mouthwash is effective in treatment of plaque induced gingivitis and can be effectively used as an adjunct to mechanical therapy with lesser side - effects .