Frankincense and Herbal Extracts for Plaque-Induced Gingivitis: A Double-Blind RCT

Official title

The Efficiency of Frankincense and Other Extracts in the Treatment of Mild to Moderate Plaque Biofilm Induced Gingivitis: a Double Blinded Randomized Controlled Trial.

Overview

Frankincense, a natural resin obtained from trees of the Boswellia genus, has been traditionally used for its medicinal properties. It is well-documented for its antibacterial, anti-inflammatory, and analgesic effects, making it a candidate for therapeutic applications beyond its conventional uses. Despite its known pharmacological benefits, scientific evidence supporting the use of frankincense in oral health care, particularly in the management of periodontal diseases, remains limited. Gingivitis is one of the most common forms of gum disease, characterized by inflammation of the gingival tissues due to dental biofilm (plaque) accumulation. If left untreated, it can progress to periodontitis, leading to irreversible damage to the supporting structures of the teeth. Standard treatment approaches typically involve mechanical plaque control and the use of fluoride-based oral health care products, which are effective but may not be well-tolerated or preferred by all individuals. This study aims to explore the potential of frankincense-based oral care products as a natural alternative or adjunct to conventional oral products in the management of gingivitis. By comparing the clinical outcomes of patients using a frankincense-containing oral health care product with those using a commercially available oral care product, the study seeks to evaluate the effectiveness of frankincense in reducing gingival inflammation, dental biofilm (plaque) accumulation, and associated symptoms. Thus, improve oral health mainly by reducing gum inflammation. The findings could provide insights into the viability of incorporating natural products like frankincense into routine oral hygiene practice.

Detailed description

The Randomized Controlled Clinical study with parallel design would be used to assess and compare the efficacy of Frankinscence and coconut oil-based, Frankinscence and Thyme essence-based, and Chlorhexidine mouthwash on gingivitis. Subjects with gingivitis with age group of 18-40 years will be selected for the study as the target population. Subjects who meet the inclusion and exclusion criteria will be selected and screened for the plaque and gingival status before including them in the study. They will be randomly divided into three groups.

Group 1: 30 participants (Frankinscenceand coconut oil-based mouthwash) Group 2: 30 subjects (Frankinscence and Thyme essence-based mouthwash) Group 3: 30 subjects (Chlorhexidine mouthwash)

Interventions

• Other Frankinscence and coconut Oil based mouthwash
  This intervention consists of Frankinscence oil and coconut oil and other herbal extracts. Frankinscence is supposed to have antiinflammatory activity and has been studied for its application in medical sciences for arthritis. Similarly organic virgin and extra virgin coconut oil has shown some inhibitory activity against streptococcus mutans. As per our review of literature and to the best of our knowledge no one has tried a combination of these 2 oils alongwith addition of some other oils to i
• Other Frankinscence and Thyme essence/ water based mouthwash
  This intervention consists of Frankinscence essence and Thyme essence and other herbal extracts. Frankinscence is supposed to have antiinflammatory activity and similarly Thyme is widely used in the pharmaceutical field, mainly due to its germicidal and antiseptic properties of phenolic components. . As per our review of literature and to the best of our knowledge no one has tried a combination of these 2 essences alongwith addition of some other oils to improve palability.
• Drug Chlorhexidine (0.2%)
  Chlorhexidine 0.2% mouthwash is considered the gold standard in dentistry for chemical plaque control and oral health care. It is a broad-spectrum antimicrobial agent effective against Gram-positive and Gram-negative bacteria, fungi, and some viruses. Its key advantage is substantivity, allowing it to bind to oral tissues and release slowly, providing prolonged action for up to 12 hours. This makes it highly effective in reducing plaque accumulation and gingival inflammation, especially in cases

Primary outcome measures

• Change in Plaque Index (PI) [Time frame: Difference in the mean reduction of Plaque score from baseline to 21 days.]
• Change in Gingival Index (GI) [Time frame: Difference for the mean gingival score from baseline to 21 days.]

Eligibility criteria

Inclusion criteria

• Gingival index >1
• Periodontal pocket depth ≤ 3 mm
• Clinical attachment loss "0"
• Provision of written informed consent
• Good systemic health.

Exclusion criteria

• Severe periodontal disease, as characterized by purulent exudates, generalized mobility, and/or severe recession Any condition that requires antibiotic premedication for the administration of a dental prophylaxis.

Self-reported pregnancy, intent to become pregnant during the study, or breast-feeding.

Any diseases or condition that could be expected to interfere with the safe completion of the study.

History of antibiotic use in the previous 3 months. Individuals with orthodontic appliances or prosthetic appliances that would interfere with evaluation.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Triple blind

Primary purpose

Treatment

Study locations

Oman · 1 center

• Oman Dental College — Muscat

Publications

• Soltani R, Saberi Z, Ghanadian SM, Taheri A, Entezarhojjat A. The effectiveness of olibanum orally disintegrating tablet in the treatment of oral aphthous ulcers: A randomized, double-blind, placebo-controlled clinical trial. J Res Med Sci. 2022 Jan 29;27:8. doi: 10.4103/jrms.jrms_247_21. eCollection 2022. PMID 35342437
• Muresan, S.M., Muresan, C.C., Mironescu, A., Surlin, P., Popescu, S.M. and Popescu, D.M., 2023. Dental hydrogels with essential oils with potential activity in periodontitis. Applied Sciences, 13(3), p.1787. https://doi.org/10.3390/app13031787.
• Mohsenzadeh A, Karimifar M, Soltani R, Hajhashemi V. Evaluation of the effectiveness of topical oily solution containing frankincense extract in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. BMC Res Notes. 2023 Mar 4;16(1):28. doi: 10.1186/s13104-023-06291-5. PMID 36869332
• Khosravi Samani M, Mahmoodian H, Moghadamnia A, Poorsattar Bejeh Mir A, Chitsazan M. The effect of Frankincense in the treatment of moderate plaque-induced gingivitis: a double blinded randomized clinical trial. Daru. 2011;19(4):288-94. PMID 22615671
• Daly S, Seong J, Newcombe R, Davies M, Nicholson J, Edwards M, West N. A randomised clinical trial to determine the effect of a toothpaste containing enzymes and proteins on gum health over 3 months. J Dent. 2019 Jan;80 Suppl 1:S26-S32. doi: 10.1016/j.jdent.2018.12.002. PMID 30696552
• Almeida-da-Silva CLC, Sivakumar N, Asadi H, Chang-Chien A, Qoronfleh MW, Ojcius DM, Essa MM. Effects of Frankincense Compounds on Infection, Inflammation, and Oral Health. Molecules. 2022 Jun 29;27(13):4174. doi: 10.3390/molecules27134174. PMID 35807419
• Alghamdi N, Alshamrani L, Alboryah S, Alsenan JF, Alshehri T, Abogazalah NN, Balhaddad AA. The Effect of Coconut and Frankincense Oils on the Biofilm Growth of Streptococcus mutans. F1000Res. 2025 Sep 1;14:846. doi: 10.12688/f1000research.168621.1. eCollection 2025. PMID 41488228
• Khoshbakht Z, Khashabi E, Khodaie L, Torbati M, Lotfipour F, Hamishehkar H. Evaluation of Herbal Mouthwashes Containing Zataria Multiflora Boiss, Frankincense and Combination Therapy on Patients with Gingivitis: A Double-Blind, Randomized, Controlled, Clinical Trial. Galen Med J. 2019 Jul 15;8:e1366. doi: 10.31661/gmj.v8i0.1366. eCollection 2019. PMID 34466501

Identifiers

NCT: NCT07535229 · ODC-2024-AE-220B · BFP/URG/HSS25/293

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗