Antibacterial Effect of Moringa Mouthwash in Children With Mixed Dentition Wearing Orthodontic Appliances (MOR-MW)

Microbiological Evaluation of Mornga Mouth Wash in Children With Mixed Dentition Wearing Removable Orthodontic Appliances: A Randomized Controlled Study

This randomized controlled study aims to evaluate the microbiological effectiveness of Moringa mouthwash in children with mixed dentition wearing removable orthodontic appliances. The study compares Moringa mouthwash with a control mouthwash in reducing oral microbial load and improving oral hygiene. Children will be followed for a specified period, and microbiological samples will be collected and analyzed to assess changes in bacterial levels

Study Overview

• Status: Completed
• Conditions: Oral Microbial Load
• Intervention / Treatment: Other: Moringa mouthwash; Behavioral: Oral Hygiene Routine

Detailed Description

Oral diseases, such as gingivitis and dental caries, remain among the most prevalent public health issues worldwide despite significant advancements in dentistry. Children and adolescents are commonly affected by various periodontal conditions, including gingivitis, periodontitis, and periodontal diseases linked to systemic disorders. Epidemiological studies indicate that gingivitis of varying severity is widespread in this populatio. Removable orthodontic appliances provide favorable environments for pathogenic microorganisms due to biofilm accumulation on their surfaces and retentive sites like clamps, elastomeric rings, wires, and acrylic bases. The introduction of these devices creates new retentive areas in the oral cavity that facilitate bacterial adherence and biofilm growth . Oral microorganisms can be classified by their biological characteristics and location. The supragingival biofilm comprises six main microbial groups: red, orange, yellow, green, and purple complexes, along with the Actinomyces group and cariogenic species. Among these, the red and orange complexes are strongly associated with periodontal disease . The bacterial microflora plays a crucial role in maintaining oral health by preventing colonization of potentially pathogenic exogenous microorganisms and regulating the host's inflammatory response to commensal bacteria . Previous studies provide moderate-to-high evidence that orthodontic appliances significantly alter oral microbiota composition, particularly increasing Streptococcus mutans (S. mutans) and Lactobacilli levels. Moreover, many children wearing removable orthodontic appliances exhibit imperfect oral hygiene compliance, often due to limited manual dexterity. Therefore, auxiliary antimicrobial agents are clinically recommended to control microbial contamination of these appliances and reduce the risk of dental caries and

periodontal disease during orthodontic treatment . Although mechanical cleaning remains the gold standard for preventing microbial colonization in the oral cavity, its effectiveness can be compromised by patient compliance, improper technique, and the complexity of appliances or prostheses. Consequently, chemotherapeutic agents are often advised to support oral hygiene and provide antibacterial effects . Herbal mouthwashes and toothpaste have gained popularity for their beneficial effects on dental health. Several herbal products exhibit antibacterial properties that inhibit acid production by cariogenic bacteria and limit plaque formation . Among herbal options, Moringa oleifera is notable for its rich composition of bioactive phytochemicals, including phenolic acids, flavonoids, alkaloids, phytosterols, vitamins, minerals, and organic acids. It is also a significant source of antioxidants such as tocopherols, carotenoids, polyunsaturated fatty acids, ascorbic acid, and folate . Importantly, Moringa oleifera contains saponins, terpenoids, and alkaloids with anti-inflammatory effects. These compounds modulate transcription factors like nuclear factor kappa B (NF-kB) and nuclear factor erythroid-derived 2, which are implicated in the pathogenesis of chronic inflammatory diseases such as periodontitis . This study will be performed to evaluate the microbiological effects of Moringa mouthwash on Streptococcus and Lactobacillus bacteria in children with mixed dentition who are wearing removable

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt, 11528
      • Al-Azhar University - Faculty of Dentistry for Girls

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

The inclusion criteria are :

• Age from 8 to 12 years old.
• Both sexes.
• Children with mixed dentition wear removable orthodontic appliances. The exclusion criteria are :
• Children suffering from systemic illness.
• Children who are previously using mouthwashes.
• Oral prophylaxis history within the previous six months.
• Chronic periodontitis.
• Presence of other prosthetic rehabilitations.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Moringa Mouthwash Group; Participants in this group used Moringa mouthwash daily in addition to standard oral hygiene practices to evaluate its effect on oral microflora.	Other: Moringa mouthwash; Herbal mouthwash prepared from Moringa extract used daily to evaluate its effect on oral microflora in children.
Active Comparator: Control Group; Participants followed standard oral hygiene routine without the use of Moringa mouthwash	Behavioral: Oral Hygiene Routine; Standard oral hygiene practices including tooth brushing instructions followed by participants.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Salivary Streptococcus mutans and Lactobacillus counts	Salivary samples will be collected from children wearing removable orthodontic appliances at baseline and after the intervention period. The samples will be microbiologically analyzed to determine the colony-forming units (CFU/mL) of Streptococcus mutans and Lactobacillus spp. using standard culture methods. Changes in bacterial counts before and after using moringa mouthwash will be used to evaluate its antimicrobial effect.	Baseline, 1 week, 1 month after intervention
Change in Oral Microbial Count	Reduction in the bacterial load of Streptococcus and Lactobacillus in the oral cavity.	4 weeks

Collaborators and Investigators

• Sponsor: Al-Azhar University
• Investigators: Study Director: Mohamed Hassan Mostafa, Associate Professor, Al-Azhar University

Study record dates

Study Major Dates

• Study Start (Actual): July 28, 2025
• Primary Completion (Actual): March 1, 2026
• Study Completion (Actual): March 30, 2026

Study Registration Dates

• First Submitted: April 11, 2026
• First Submitted That Met QC Criteria: April 11, 2026
• First Posted (Actual): April 17, 2026

Study Record Updates

• Last Update Posted (Actual): April 22, 2026
• Last Update Submitted That Met QC Criteria: April 18, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: salivary microbiology
• Other Study ID Numbers: ID P-PE-25-04

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No