# Antibacterial and Anti-Inflammatory Potential of Mouthwash Composition Based on Natural Extracts
## 1 Introduction  
In modern times, since health includes more than just disease-free conditions, it has become essential to emphasize the maintenance of oral health in general health conditions and relationships [1]. Removal of dental plaque which causes oral diseases leads to effective oral health care. Brushing teeth is most efficient for removing dental plaque, butas it is difficult to manage oral health only by brushing, use of appropriate oral hygiene products for each individual could effectively manage dental plaque [2]. Despite the proven effectiveness and necessity of oral hygiene products other than toothbrushes, many people use them less frequently and often use products that are not suitable for an individual's oral condition. For effective oral care, it is desirable to select brushing methods, toothpaste, and oral hygiene aids according to the personal conditions of individuals, including age and oral health status [3]. Mouthwash used to clean bacteria in the mouth are known to prevent microorganisms in the oral cavity from attaching to the dental pellicle or the surface of the teeth and act as a bacteriostatic agent to suppress buildup of dental plague [4]. The ingredients of mouthwash include chlorohexidine (CHX), cetylpyridinium chloride (CPC), benzethenium chloride, benzylamin hydrochloride, and fluoride. Especially, chlorohexidine is known as a plaque control substance that inhibits the adhesion of microbes in the oral cavity and the surface of the teeth [5]. If these components are used in high concentrations, it may cause discoloration and pigmentation of teeth and buildup of calculus [6]. Long-term use of chemical compound mouthwash is not safe, and criticism has been raised for its widespread use. Chemical compound mouthwash contains preservatives, artificial colors, flavoring agents, and other various chemicals. Its short-term use can be effective in wound healing, oral ulcers, gingivitis, and periodontitis, but long-term use has been reported to lead to taste disorders, staining of hard and soft tissues, allergic reactions, and oral cancer [7]. According to a retrospective study on the role and other factors of mouthwash in oral cancer, an excessive risk was observed in women who used mouthwash daily, but no excessive risk was observed in men, and it was also dangerous to use mouthwash daily even for women who did not smoke or drink alcohol [8]. Moreover, daily use of chemical compound mouthwash can negatively affect the oral mucosa [9], and it can damage the cheek cell membrane and destroy the double helix, causing DNA damage [10]. Particularly, in the case of mouthwash-contained chemical substances that require prescription, long-term use of mouthwash develops resistance due to various kinds of antibiotics contained for effective inhibition of oral microbes [11]. Moreover, NO is involved in a wide range of physiological processes in almost all organs and tissues [12]. However, it was considered that the use of mouthwash may lead to extinction of oral bacteria, and this may lead to disturbances in the enterosaliv nitrate-nitrite-NO pathway. It had been reported that this could lead to defects in NO bioavailability and promote the development of cardiovascular diseases and sepsis [13]. More than 600 kinds of bacteria reside in the human oral cavity, which is known to suffer from dental caries and periodontal diseases, which are representative oral diseases [14]. _Streptococcus constellatus_ preferentially inhabits subgingival dental plaque biofilms intraorally on interproximal tooth surfaces in patients with untreated periodontitis [15]. _Streptococcus sanguinis_ is known to form biofilms on implant surfaces [16; 17], and it is reported that the incidence of peri-implant complications increases significantly in patients with periodontitis [18]. _Streptococcus mutans_ is one of the most common acid producers and has important influence in affecting most caries [19].