Comparative Evaluation of Pomegranate and Grapefruit Seed Extract Mouthwash Versus Chlorhexidine in Gingivitis Management: A Clinical Trial

Abstract

Introduction Plaque-induced gingivitis is typically managed with mechanical plaque control and adjunctive chemotherapeutic rinses. Chlorhexidine (CHX) is considered the gold standard antiplaque agent, but its adverse effects such as staining and taste alteration limit its long-term use.¹ Natural extracts, including pomegranate (Punica granatum) and grapefruit seed extract (GSE), have demonstrated antimicrobial, antioxidant, and anti-inflammatory activities.²⁻⁴ This study evaluated the effectiveness of a pomegranate–GSE herbal mouthwash compared with 0.2% CHX in adults with gingivitis.

Objectives: The objective of the study is to compare the effectiveness of a pomegranate–grapefruit seed extract (GSE) herbal mouthwash with 0.2% chlorhexidine (CHX) in reducing clinical signs of plaque-induced gingivitis in adults..

Methods: Thirty systemically healthy subjects (18–40 years) with gingivitis were randomly allocated to two groups (n=15). Group A rinsed with a herbal formulation containing 10% Punica granatum peel extract and 0.5% GSE, while Group B used 0.2% CHX. Both groups rinsed with 15 mL twice daily for 14 days. Plaque Index (PI), Gingival Index (GI), Probing Depth (PD), and Clinical Attachment Level (CAL) were recorded at baseline and 14 days. Data were analyzed using paired and independent t-tests (α=0.05).

Results: Significant intragroup reductions were observed in both groups for PI and GI (p<0.05). Group A showed PI reduction from 2.40 ± 0.60 to 1.80 ± 0.60 and GI from 1.45 ± 0.25 to 1.20 ± 0.18. Group B reduced PI from 1.80 ± 0.30 to 1.55 ± 0.28 and GI from 1.60 ± 0.22 to 1.45 ± 0.20. Intergroup comparisons at day 14 revealed no statistically significant differences (p>0.05). No adverse effects were reported with the herbal rinse.

Conclusions: A pomegranate–GSE mouthwash demonstrated plaque- and gingivitis-reducing effects comparable to 0.2% CHX over two weeks, without reported side effects. Herbal rinses may represent a safe and effective alternative in gingivitis management.