Effect of Herbal Water, Ozonated Water, Water, and Chlorhexidine Mouthrinses on Oral Health Status of Children:

Background

Dental plaque and calculus build-up remain leading causes of poor oral health in children, contributing to gum inflammation and tooth decay. Chlorhexidine (CHX) mouthrinse is widely regarded as the standard antimicrobial rinse for controlling plaque and the bacteria linked to cavities, particularly Streptococcus mutans. However, CHX carries drawbacks with regular use, including tooth staining, taste disturbance and mucosal irritation, which limits its suitability for long-term use in children. Researchers have been investigating whether natural alternatives - including herbal rinses and ozonated water - could deliver comparable oral health benefits without these side effects.

Study design

This randomised controlled trial enrolled 100 children aged 10 to 12 years, who were divided into four equal groups of 25. Each group used a different daily mouthrinse for 15 days: herbal water, ozonated water, plain water, or chlorhexidine. Oral health was assessed at the start of the study, after 15 days, and again after 30 days, using three standard clinical measures - the Debris Index-Simplified (a measure of soft plaque), the Calculus Index-Simplified (a measure of hardened tartar), and the Oral Hygiene Index-Simplified (a combined score). Saliva samples were also taken to count colonies of Streptococcus mutans, the bacteria most strongly associated with tooth decay.

Findings

Ozonated water produced the lowest debris (soft plaque) scores of the four groups at both the 15-day and 30-day assessments. Herbal water was the only rinse that produced a meaningful reduction in calculus (hardened plaque). Chlorhexidine remained the most effective rinse at reducing Streptococcus mutans colony counts compared with the other three rinses. Plain water, used as the comparison group, showed the smallest improvements across all three indices.

What the authors concluded

The study authors concluded that herbal water and ozonated water can serve as viable alternatives to chlorhexidine for maintaining children's oral hygiene, particularly for reducing plaque and calculus, while chlorhexidine retains an advantage specifically for suppressing Streptococcus mutans levels. They suggested these natural rinses may offer a way to support paediatric oral hygiene routines with fewer of the side effects associated with long-term chlorhexidine use.

Limitations of this study

The trial ran for only 30 days, so it does not show whether these effects are sustained over months or years of regular use. The sample was drawn from a single age band (10-12 years) and a single study site, which may limit how well the findings generalise to other age groups or populations. Bacterial counts were assessed only for Streptococcus mutans, so effects on the wider oral microbiome were not measured. As with any mouthrinse study, results also depend on how consistently participants followed the rinsing protocol, which can be difficult to verify fully in a paediatric population.