# Antibacterial and Anti-Inflammatory Potential of Mouthwash Composition Based on Natural Extracts
## 4 Discussion  
This study was performed to test the antibacterial and anti-inflammatory potential of mouthwash composition based on natural extracts for oral healthcare. Mouthwash can be used for a variety of purposes such as sterilization and disinfection of the mouth and throat, antiseptic effect, deodorant effect, cold prevention, sore throat, tonsillitis, other periodontitis, stomatitis, halitosis, tooth extraction, disinfection and sterilization after implant surgery, and prevention of caries. For its advantage of being easy to use by individuals, its use is increasing significantly. Most mouthwash is reported as generally acidic with a pH of 3.45-6.75 [58]. The pH efficacy may vary depending on the ingredients of the mouthwash [59]. It was confirmed in previous in situ results that mouthwash with a low pH of 4.0 or less may cause dental erosion [60], and mouthwash with a low pH of 3.45 was found to decrease the microhardness of teeth [58]. According to the experimental results of this study, using M2, M3, M4, M5, GA, LIS, PG (pH 4.0-4.7), and SG (pH 8.0) as mouthwash had a low impact on enamel corrosion, and CSK and M1, which were below pH 4.0, were considered to have a high possibility of causing dental erosion due to pH action. Phytochemicals are responsible for the biological activity of plants, and the major constituents of plants, such as flavonoids, terpen, and phenolic acids, could be effective for oral antibacterial action. Examples of mouthwashes containing natural extracts include _Camabis sativa_ L. and the spirulina plant. Cannabinoid is a naturally occurring compound found in _Camabis sativa_ L. and is known to exhibit bactericidal efficacy similar to 0.2% of chlorhexidine, even though it does not contain any kind of fluorine or alcohol [61]. _Arthospira platensis_ (spirulina plant) is a dietary supplement that is gaining popularity as a source of protein, vitamins, micro- and macronutrients, but it was reported that spirulina supplements contained high levels of fluoride [62]. [PERSON] et al. (2021) found that patients with periodontitis had higher levels of IL-6 in saliva than healthy subjects, and that a proportional increase in IL-6 was also related to PT and tooth loss [63]. It was suggested that unbalanced IL-6 levels can accurately predict the early appearance of PT and that serum IL-6 levels may be helpful in assessing the severity of PT [64]. In addition, it was reported that the serum and saliva galectin-3 levels of patients with periodontitis and periodontitis + CHD were higher compared to those of CHD patients and healthy controls [65]. The results of the present study indicated that patients who had PT presented higher salivary IL-6 compared to healthy subjects. Figure 4: Nitric oxide (NO) assay ELISA statistical graph. (**a**) Non- lipopolysaccharideacharide (LPS) treatment; (**b**) LPS treatment. All experimental groups were compared to the negative controls, GA and LIS, and the positive control RAW 264.7 cells. * vs. Con. \(p<0.5\), *** vs. Con. \(p<0.001\), # vs. GA. \(p<0.5\), *** vs. GA. \(p<0.01\), *** vs. GA. \(p<0.001\), *** vs. LIS. \(p<0.5\), *** vs. LIS. \(p<0.01\), *** vs. LIS. \(p<0.001\). Furthermore, the proportional increase of salivary IL-6 was associated with the extent of PT and tooth loss [63]. Some preliminary evidence described that patients with periodontitis had increased GCF and salivary galectin-1 levels [66], through a pathway arranged also by soluble urokinase plasminogen activator receptor (suPAR) and tumor necrosis factor-\(\alpha\) (TNF-\(\alpha\)). More specifically, it has been shown that galectin-1 and -3 could interfere with PT progression through a signaling mediated by \(\beta\)1-integrin in the lipopolysaccharidesaccharides of certain periodontal pathogens such as _Porphyomonas gingivalis_[67], and could also induce the upregulation of IL-1, matrix metalloproteinases, and some growth factors [68].