Efficacy of propolis-based mouthwashes on dental plaque and gingival inflammation: a systematic review

Abstract Background This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation. Methods PubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed. Results Nine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results. Conclusions The results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.【背景】本项针对随机对照试验的系统综述旨在评估现有关于蜂胶漱口水（propolis-based mouthwash）改善牙菌斑与牙龈炎症的疗效证据。 【方法】检索截至2019年11月的PubMed、Scopus及Web of Science数据库。纳入对比蜂胶漱口水与氯己定（chlorhexidine, CHX）疗效的随机对照试验。主要结局指标包括牙菌斑及/或牙龈炎症。由2名研究者采用Cochrane偏倚风险评估工具（Cochrane tool）进行偏倚风险评价。鉴于现有数据存在显著异质性，仅对研究进行定性分析，未开展Meta分析（meta-analysis）。 【结果】共有9项符合纳入标准的随机对照试验，涉及333名受试者。纳入的多数研究存在较高偏倚风险。总体而言，所有纳入研究均显示蜂胶漱口水对牙菌斑与牙龈炎具有良好改善效果。在8项报道菌斑指数的研究中，5项发现蜂胶与氯己定在减少牙菌斑方面疗效相当，2项显示氯己定的疗效更优，仅1项证实蜂胶的疗效更佳。另有6项评估牙龈炎症结局的研究，其中4项报道蜂胶漱口水的效果更优，2项显示二者结果无显著差异。 【结论】本研究结果表明，蜂胶漱口水在减少牙菌斑与牙龈炎症方面具有潜在获益。但部分纳入研究存在方法学局限且样本量较小，削弱了证据强度。因此，建议开展样本量更大、设计更严谨且随访周期充足的随机对照试验，以进一步明确蜂胶漱口水改善牙菌斑与牙龈炎的疗效。