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Table 4 Natural anti-biofilm agents under clinical evaluation with outcomes

From: Developing natural products as potential anti-biofilm agents

Studies Condition Intervention Outcome References
Randomized controlled clinical trials Denture wearers with denture stomatitis (n = 64) Control, 0.85% saline
SH1, 0.25% sodium hypochlorite
SH2, 0.5% sodium hypochlorite
RC, 10% Ricinus communis
Ricinus communis showed antimicrobial activity against S. mutans and Candida spp. [90]
A randomized crossover clinical trial Denture wearers with denture stomatitis (n = 50) Control, 0.85% saline
SH1, 0.1% sodium hypochlorite
SH2, 0.2% sodium hypochlorite
RC, 8% Ricinus communis
Ricinus communis alleviated the symptom of denture stomatitis, however anti-biofilm effect was not evident [91]
Randomized controlled trials Dental plaque (n = 14) Control, 0.12% chlorhexidine
Test formulation containing 0.25 g/ml green tea and 7.82 g/ml Salvadora persica L. aqueous extracts
Placebo mouthwashes
The test mouthwash significantly has positive effect on disrupting plaque colonization when compared with placebo and control group for short time treatment (24 h) [92]
Randomized, double-blind controlled study Patients undergoing orthodontic treatment with fixed appliances (n = 30) C: Placebo
T1: mouthwash containing 1% Matricaria chamomilla L. (MTC) extract
T2: 0.12% chlorhexidine (CHX)
MIC could suppress biofilm development and gingival bleeding [93]
Randomized controlled clinical trials Patients with moderate chronic periodontitis after scaling and root planing (SRP) (n = 46) Placebo mouthwashes (n = 23)
Essential oil mouthwash consisting of essential oils (Cymbopogon flexuosus, Thymus zygis and Rosmarinus officinalis) (n = 23)
The combined use of a mouthwash containing essential oils following SRP was well tolerated and had anti-biofilm effect in the subgingival for 14-day treatment [94]
Randomized double-blind clinical study Oral malodour (n = 20) Lemongrass oil (LG) mouthrinse LG mouthwash showed selective anti-bacteria effect against Aggregatibacter actinomycetemcomitans ATCC43718 and Porphyromonas gingivalis W50 and could reduce oral malodour for 8-day treatment [95]
Randomized controlled trials Orthodontic patients (n = 34) Melaleuca gel: Gel developed with the essential oil of Melaleuca alternifolia
Colgate total
The melaleuca gel was more effective in decreasing the dental biofilm and the numbers of bacteria colonies [96]
Randomized controlled trials Caries and periodontal diseases (n = 30) G1: A commercially available dentifrice
G2: Dentifrice containing mineral oil (Nujol®)
G3.: Dentifrice containing vegetable oil (Alpha Care®)
Both mineral oil and vegetable group exhibited improved biofilm control and could significantly decrease dental biofilm formation in clinical [97]
Randomized controlled trials Patients with subclinical or uncomplicated recurrent UTI (r-UTI) (n = 72) Placebo (n = 36)
Cranberry extract (PAC-A, proanthocyanidin-A) (n = 36)
The overall efficacy and tolerability of standardized cranberry extract containing (PAC-A) as a food supplement were superior to placebo in terms of reduced bacterial adhesion; biofilm development; urine pH reduction; and in preventing r-UTI (dysuria, bacteriuria and pyuria) [98]
Single-blinded, randomized and controlled pilot study Patients with indwelling urinary catheters (n = 83) Control (n = 35)
CISTIMEV PLUS®: Solidago, orthosiphon, birch and cranberry extracts (n = 48)
CISTIMEV PLUS® significantly reduced microbial accumulation in patients [99]
A pilot randomized controlled trial P. aeruginosa related lung cystic fibrosis (n = 34) Placebo group
Garlic or olive oil treatment group
Both garlic and olive oil capsules were tolerated, but no significant effect was found in antibacterial activities [100]