The effect of pomegranate versus chlorhexidine mouthwash or gel on periodontal disease: a systematic review and meta-analysis

Objective: The aim of current systematic review and meta-analysis study was to evaluate the effect of pomegranate (POM) versus Chlorhexidine (CHX) mouthwashes or gels on periodontal disease. Methods: An electronic search on PubMed, Scopus, Science direct, and Cochrane, as well as manual search was conducted on the studies that were published up until August 2023. Randomised controlled trials studies that had examined the effect of POM versus CHX mouthwash or gel on plaque (PI), gingival (GI), and bleeding (BI) indices after 7 and 14-15 days follow up with 95% confidence interval (CI) were pooled. To assess the heterogeneity of the findings, the I2 test was applied and also publication bias was evaluated by visual examination of the funnel plot symmetry. Results: Seven studies with 330 participants were analyzed. The meta-analysis showed that there was a significant difference between the effects of CHX intervention on PI compared to POM intervention, when the duration of intervention was 14-15 days (standard mean differences [SMD]: -2.25; 95% CI: -4.18 to -0.32, P = 0.02). There was not any significant difference among the effects of CHX and POM intervention on PI when the study duration was up to 7 days. Further, there was not seen any significant differences between the effects of POM and CHX on BI or GI of the subjects. Conclusion: The findings indicated that POM mouthwashes or gel were effective in reducing PI, BI, and GI in patients with periodontal disease. Therefore, it can be suggested as a suitable alternative of CHX for inflammation control.