Efficacy of Triphala in treating Gingivitis diseases: A systematic review and meta-analysis

Background and Objective: Triphala facilitates the action of anti-cavities, decreases plaque and has an antibacterial effect. Therefore, the purpose of this study was to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) only to compare the overall effects of Triphala herbal mouthwashes in the treatment of gingivitis as a complement to daily oral hygiene on both plaque and chlorhexidine inflammation regulation.  Methods: Electronic searches in MEDLINE/PubMed, EMBASE and CENTRAL were conducted in databases up to April 2020. Original articles, invivo studies and articles on the efficacy of Triphala on gingivitis were included in the study. 9 RCTs were included in the systematic review and 6 articles were included in meta-analysis. Results: Four included studies showed significantly greater reductions in plaque, gingivitis, and bleeding indices after the use of herbal mouthwashes (Triphala) compared with Chlorhexidine, while five studies reported that no difference was observed between herbal Triphala mouthwash and Chlorhexidine. Considering the effects of Triphala mouthwash on clinical gingival inflammatory parameters, significant heterogeneity for both gingival index (Q=102.55; pQ=0.000; I2=95.12%; T2=0.62; T=0.79) and plaque index (Q=43.83; pQ=0.000; I2=88.59%; T2=0.23; T=0.48) was observed between both Triphala mouthwash and Chlorhexidine groups