Natural Agents for the Improvement of Gingival Health: Systematic Review and Meta-Analysis of Randomized Clinical Trials

Clinical Snapshot

Key Findings

• P Value: p = 0.0051 (statistically significant, favouring natural ingredients)

• Effect Size: Not reported in abstract — no standardised mean difference, weighted mean difference, or relative risk provided

• Primary Outcome: Improvement in gingival health parameters (Gingival Index and/or Bleeding on Probing) with natural ingredient toothpastes/gels versus control formulations

• Nnt Or Sensitivity: Not calculable from available data — no absolute risk reduction, NNT, or standardised effect size reported; clinical magnitude of benefit cannot be determined

• Confidence Interval: Not reported

Clinical Application

Natural ingredient toothpastes and gels are widely commercially available, generally well-tolerated, and low-cost relative to prescription periodontal therapies. Integration into routine oral hygiene regimens is feasible without significant patient burden. However, the heterogeneity of products studied means clinicians cannot extrapolate findings to any specific commercial formulation without product-level evidence. In Australia, toothpastes and oral gels containing natural ingredients such as Aloe vera and hydroxyapatite are available over-the-counter and are not subject to PBS subsidy, as they are classified as consumer goods rather than therapeutic products unless specific therapeutic claims are made (TGA regulatory framework). Hydroxyapatite-containing toothpastes have attracted increasing interest as fluoride-free alternatives, though the TGA and RACGP currently do not endorse hydroxyapatite as a replacement for fluoride in caries prevention. RACGP oral health guidelines emphasise evidence-based preventive care; this review does not yet provide sufficient certainty of evidence to alter RACGP-aligned clinical recommendations. Clinicians should exercise caution in recommending specific natural ingredient products without product-level RCT evidence. Adult patients with gingivitis or at elevated risk of gingival disease who are seeking adjunctive or alternative oral hygiene products. Applicability to paediatric populations, immunocompromised patients, or those with periodontitis (as distinct from gingivitis) is not established by this review.

Abstract

PURPOSE: This systematic review and meta-analysis evaluated the efficacy of natural ingredients used in toothpastes and gels in improving gingival health. MATERIALS AND METHODS: A comprehensive search strategy using different databases was conducted in accordance with PRISMA guidelines to identify randomized clinical trials (RCTs) on the use of natural ingredients for improving gingival health. Included studies focussed on outcomes measuring gingival health parameters, such as gingival index (GI), or bleeding on probing (BoP). Out of 249 identified studies, 10 RCTs met the inclusion criteria. Formulations included natural ingredients from plant extracts such as Aloe vera or Pudilan, and hydroxyapatite (as tooth-like calcium phosphate). RESULTS: The meta-analysis demonstrated a statistically significant improvement in gingival health when natural ingredients were used compared to control toothpastes and gels (p=0.0051). These findings suggest that natural ingredients may offer comparable or superior efficacy to conventional oral care products in terms of gingival health. Notably, Aloe vera and hydroxyapatite consistently demonstrated clinical benefits. CONCLUSIONS: Natural ingredients used in oral care products represent a promising strategy in gingivitis prevention and management. Their use in toothpastes and gels may therefore provide clinicians and patients with evidence-based, well-tolerated alternatives or adjuncts to conventional formulations for maintaining and improving gingival health.

References

1. 1.Meyer, F., Mohammed, Z. S., Deschner, J., & Enax, J. (2026). Natural agents for the improvement of gingival health: Systematic review and meta-analysis of randomized clinical trials. Oral Health & Preventive Dentistry. https://doi.org/10.3290/j.ohpd.c_2697