Antimicrobial effect of garlic-based mouthwash on dental caries-related oral microorganisms: A systematic review and meta-analysis.

OBJECTIVE

This systematic review and meta-analysis (SRM) investigated the potential of garlic (Allium sativum) against cariogenic oral microorganisms.

DESIGN

The SRM was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251133140). Randomized clinical trials (RCTs) evaluating garlic or garlic-derived compounds on cariogenic oral microorganisms were included. A literature search was performed in the main scientific databases. Meta-analyses were performed using RevMan software, with standardized mean difference (SMD) as the effect measure, and a random-effects model was applied with 95 % confidence intervals. Risk of bias was assessed using the Cochrane tool, and the certainty of evidence was graded according to the GRADE approach.

RESULTS

Nine RCTs fulfilled the inclusion criteria, predominantly assessing S. mutans, followed by Lactobacillus spp. and C. albicans. All included trials employed garlic-based mouthwashes as the intervention and consistently demonstrated significant antimicrobial activity. In meta-analysis, compared to chlorhexidine, garlic reduced S. mutans at 1 week (SMD = -0.73, 95 % CI = -1.39 to -0.07, I² = 73 %; p = 0.03), had a slightly lower effect at 2 weeks (SMD = 1.27, 95 % CI = 0.09-2.44, I² = 90 %; p = 0.03), and showed no difference at 1 month (SMD = -0.54, 95 % CI = -2.78-1.70, I² = 96 %; p = 0.64). Compared to sodium fluoride, it demonstrated superior activity at 2 weeks (SMD = -0.79, 95 % CI = -1.22 to -0.36, I² = 0 %; p = 0.0003). Most studies had a low risk of bias, and the certainty of the evidence was rated low.

CONCLUSIONS

Garlic-based mouthrinses show significant antimicrobial activity against cariogenic microorganisms, supporting their potential as a phytotherapeutic strategy for biofilm control. However, the evidence remains limited, demonstrating the need for further high-quality clinical trials to confirm long-term efficacy.