Researchers at the University of Sharjah report that garlic extract mouthwash can provide antimicrobial effects comparable to chlorhexidine, the long‑standing gold standard in oral antiseptic rinses. A new systematic review highlights garlic’s potential as a natural alternative, though it may cause more discomfort even as it appears to offer longer‑lasting residual activity.
Medical researchers at the University of Sharjah have carried out a systematic review comparing garlic extract mouthwash with chlorhexidine, a long‑established gold standard among antimicrobial mouthwashes. The review, published in the Journal of Herbal Medicine in 2025, analyzed clinical studies to assess whether garlic could function as a viable herbal substitute for chlorhexidine.
According to the University of Sharjah team, the review followed the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) 2020 guidelines and used the PICO framework to structure the clinical research questions.
The authors report that a total of 389 articles were identified from six electronic databases searched in January 2024, with an additional 13 articles found through manual citation searching. After removing duplicates and applying inclusion and exclusion criteria, only five randomized controlled trials and clinical studies were ultimately included, and these were judged to carry low‑to‑moderate risks of bias.
Across the selected studies, higher concentrations of garlic extract mouthwash produced antimicrobial effects comparable to chlorhexidine, including significant reductions in bacterial counts from baseline. The review notes that effectiveness varied with mouthwash concentration and duration of application: some studies favored chlorhexidine for maintaining higher plaque and salivary pH, while others found garlic extract more effective at certain concentrations.
However, the authors also found that garlic‑based mouthwash tended to cause greater discomfort than chlorhexidine, with reported side effects including a burning sensation and unpleasant odor or taste. These effects, they caution, could influence patients’ willingness to use garlic‑based products even where antimicrobial performance is similar.
“Chlorhexidine is widely used as a gold standard mouthwash but is associated with side effects and concerns over antimicrobial resistance,” the researchers note. “Garlic (Allium sativum), known for natural antimicrobial properties, has emerged as a potential alternative.”
The review places its findings in the broader context of garlic’s long‑recognized antimicrobial properties. Scientific interest has focused on compounds such as allicin, which laboratory studies have shown to have antibacterial and antifungal activity.
The authors also highlight that garlic extracts have been investigated in several dental contexts beyond routine mouth rinsing, including denture stomatitis, dentinal tubule disinfection and as an intracanal medicament. Much of this work, however, has been conducted in vitro and with differing methodologies, limiting direct comparison and clinical standardization.
“Antimicrobial mouthwashes constitute an essential adjunct element in oral and dental care, acting against oral diseases caused by bacteria, fungi, or viruses,” the review states. While the new analysis supports the clinical antimicrobial activity of garlic extract and suggests it could serve as an alternative to chlorhexidine in some situations—particularly at higher concentrations—the authors stress that further clinical trials with larger sample sizes and longer follow‑up are needed to confirm its effectiveness and improve its clinical applicability.
They conclude that chlorhexidine remains the gold standard antimicrobial mouthwash, but that garlic extract mouthwash shows promise as a natural option that may offer comparable antimicrobial effects, albeit with different side‑effect and acceptability profiles.
