# Comparative Effectiveness of a Commercial Mouthwash and an Herbal Infusion in Oral Health Care
## 11 A BSTS Method
### Clinical Trial of a Commercial Mouthwash and an Herbal Infusion
The GI scores are: 0 = normal gum without signs of inflammation and without bleeding; 1 = slight inflammation, slight color changes, no bleeding; 2 = moderate inflammation, erythema, edema, bleeding on probing or pressure; 3 = severe inflammation, pronounced redness, edema, spontaneous bleeding, and sometimes ulceration. The GI calculation is identical to the PI calculation [9; 10; 23]. After the initial analysis and examination of 150 patients who were initially included in the study, 90 patients continued (42 males = 46.66% and 48 females =53.33%) until the study endpoint, 37 of research center Targu Mures and 53 of research center Oracle. The 60 participants were eliminated or self-eliminated during the study as follows: 2 women were confirmed pregnant, 14 patients began treatment for acute conditions during the study, 3 patients developed allergic reactions to the commercial mouthwash, 4 patients underwent surgery, 21 patients gave up during the study or did not show up for follow-up, and 13 patients were eliminated because they did not comply with the appropriate oral hygiene rules (brushing and additional mean). The age range of the 90 remaining patients was a median age of 24.5 years and a mean of 24.5 \(\pm\) 4.5 years. The patients in the CM group (45) used a commercial mouthwash without alcohol (ethanol) or dyestuff that included: aqua, glycerin, sorbitol, poloxamer 338, PEG-60 hydrogenated, castor oil, potassium, chloride, aroma, cetyl-pyridinium chloride, sodium fluoride, methylparaben, propylparaben, sodium benzoate, sodium saccharin, disodium phosphate, and sodium phosphate. The patients in the IM group (45) used an infusion of 10 g _Mentha piperita_ Huds., 10 g _Matricaria chamomilla_ L., 10 g _Polygonum aviculare_ L., and 20 g _Glechoma hederacca_ L. in 1 L of water, an infusion that was made in the pharmaceutical laboratory of the Pharmacy Department, Faculty of Medicine and Pharmacy, University of Oradea. Patients were instructed to rinse vigorously for 30 s with approximately 20 mL solution after brushing their teeth, without swallowing, for a maximum of 2 times a day. Patients were instructed not to ingest food or liquids for one hour after rinsing the mouth. The patients were monitored during the period of April 2018-March 2019 in the dental clinics of the faculties for evaluation of PI and GI status. At the first examination (baseline), the determinations of PI and GI were realized. The monitoring examinations were performed after 3 days (first examination session), 7 days (second examination session), respectively, and 2 weeks (third examination session), registering the findings in the patients' record for each session, thus having the possibility to assess the parameters in evolution. In order to create the same conditions for each patient included in the study, we offered the participant patients the same type of toothbrush and fluoride-free toothpaste. All subjects were trained to acquire proper oral hygiene: correct brushing technique (manual brushing, Bass technique) and the proper use of the mouthwash. There were no study sponsorships or other types of third-party funding so that the results of the study would not be influenced. The working protocol that the researchers from all three centers followed consisted of inter-examination calibration; bacterial plaque highlighting with a disclosing agent (erythrosine tablets) to reduce potential drift in scoring; determination of PI and GI at baseline; professional cleaning; individual oral hygiene training with the toothpaste and toothbrush provided by the researchers; the proper use of mouthwash (CM group) or the herbal infusion (IM group) after the distribution in the research groups; and 3 monitoring sessions of PI and GI.