Garlic shows promise as a mouthwash alternative to standard chemical compounds
Edited by Sadie Harley, reviewed
by Robert Egan
.webp)
Published in the Journal of Herbal Medicine, the study suggests that
while garlic-based
mouthwash may cause more discomfort than chlorhexidine, it offers
longer-lasting residual effects.
"Chlorhexidine is widely used as a gold standard
mouthwash but is associated with side effects and concerns over antimicrobial
resistance," the authors note. "Garlic (Allium sativum), known
for (its) natural antimicrobial properties, has emerged as a potential
alternative."
The findings are based on a systematic review of the literature in which the authors compare the antimicrobial efficacy of garlic extract with chlorhexidine in clinical practice, assessing its viability as a herbal substitute.
The study adhered to the Preferred Reporting Items for
Systematic Reviews and Meta-analyses 2020 guidelines, which are specifically
designed to enhance the credibility, completeness, and transparency of
meta-analyses and systematic reviews.
The paper also utilized the PICO framework, a structured
approach that helps authors design clinical research questions to guide their
systematic reviews.
How the systematic review was conducted
"A total of 389 articles were identified from six
electronic databases in January 2024, and an additional 13 articles were
included through manual citation searching. After removing duplicates and
applying inclusion and exclusion criteria, only five articles were
included," the authors report.
The literature analyzed included randomized controlled
trials and clinical studies, characterized by variable designs and
low-to-moderate risks of bias. Findings indicate that higher concentrations of
garlic extract mouthwash demonstrated antimicrobial
efficacy comparable to chlorhexidine.
"The effectiveness varied based on mouthwash
concentration and duration of application, contributing to differences in
outcomes," the review revealed.
"Some studies favored chlorhexidine for maintaining
higher plaque/salivary pH, while others reported garlic extract to be more
effective at certain concentrations. However, garlic mouthwash may cause
greater discomfort."
Side effects and clinical implications
Although garlic extract is not without side effects, they
are generally less severe than those associated with chemical compounds.
Reported adverse
reactions include a burning sensation and
unpleasant odor, which may affect patients' willingness to replace
chlorhexidine with garlic-based alternatives.
Despite these limitations, the review provides substantial
evidence of garlic extract's clinical antimicrobial effectiveness, "with
significant reductions in bacterial counts from baseline … suggesting the
possible use of garlic extract mouthwash as a viable alternative to
chlorhexidine in certain contexts."
The authors emphasize the need for further clinical research
involving larger sample sizes and extended follow-up to confirm the
"effectiveness and improve clinical applicability" of using garlic as
an alternative mouthwash to the currently widely used chlorhexidine, which
remains the gold standard antimicrobial mouthwash.
Garlic's broader role in health and industry
Research has established garlic as one of nature's most
potent antibacterial and antifungal crops. For decades, scientists have sought
to harness one of its compounds, called allicin, which exhibits strong
antimicrobial properties. Although botanically classified as a vegetable,
garlic is widely used both as a herb and a spice.
Global consumption of garlic reached approximately 30
million metric tons in 2024, with China dominating both consumption and
production, accounting for nearly 80% of the global supply. In the same year,
the worldwide garlic extract market was valued at over $15 billion.
Garlic extracts have found applications in various health
products and are available over-the-counter. In contrast, synthetic agents such
as chlorhexidine typically require a prescription from a dentist or physician.
Antimicrobial mouthwashes in dental care
"Antimicrobial mouthwashes constitute an essential
adjunct element in oral and dental care, acting
against oral diseases caused by bacteria, fungi, or viruses attacking oral hard
or soft tissues," according to the review.
"Different antimicrobial mouthwashes, whether available
over-the-counter or on prescription, can be used in the management of
gingivitis, dental caries, periodontal diseases, halitosis, etc."
The review cites a host of studies demonstrating the
antimicrobial activity of garlic extracts against numerous bacteria, fungi, and
viruses. Additionally, it shows that garlic extracts have been investigated in
different contexts, such as denture stomatitis, dentinal tubule disinfection,
and as an intracanal medicament.
"These studies have contributed to understanding the
antimicrobial role of garlic extract in comparison to synthetic agents
like chlorhexidine,"
the authors note.
"However, most studies are in vitro, vary in methods,
and lack clinical standardization, highlighting the need for further research
to confirm garlic's efficacy in dental practice. This uncertainty presents a
significant gap in the literature on evidence-based antimicrobial
therapies."
More information: Youmna Ahmed Abdelaal et al,
The Clinical Antimicrobial Efficacy of Garlic Extract (Allium sativum) Compared
to Chlorhexidine Mouthwash: A Systematic Review, Journal of Herbal
Medicine (2025). DOI:
10.1016/j.hermed.2025.101053