Journal of Clinical and Diagnostic Research. 2018 Dec, Vol-12(12): ZE01-ZE07 1 1 DOI: 10.7860/JCDR/2018/36569.12335 Review Article Dentistry Section Comparative Assessment of the Antibacterial Efficacy of Natural Products and Chlorhexidine Mouthwash against Streptococcus Mutans: A Systematic Review Dentistry Section BENOY JACOB 1 , MS NIVEDHITHA 2 Keywords: Antibacterial effect, Chlorhexidine oral rinse, Dental caries, S. mutans ABSTRACT Introduction: Dental caries is still an existing challenge worldwide and continues to be the most prevalent of all oral infectious diseases. Mutans streptococci have been identified as the causative organism for dental caries and the elimination or reduction of such pathogenic bacteria is beneficial in controlling dental caries. This can be achieved by the addition of an anti-microbial mouth rinse to daily oral hygiene regimens. In accordance with the existing mouth rinses in which the effectiveness has been proved time and again, comes with a set of drawbacks which cannot be overlooked. Hence, natural alternatives have been focused on as the need of the hour. Natural products have been proven to be safe, consisting of biologically active compounds which may have potential therapeutic uses in dentistry. Aim: To compare and evaluate the antibacterial efficacy of natural products and chlorhexidine on Streptococcus mutans. Materials and Methods: The following databases were searched: PubMed, Cochrane Database of Systematic Reviews, LILACS, Science direct, Google scholar until December 2017. The primary outcome was to evaluate antibacterial efficacy of natural products and chlorhexidine mouthwash on Streptococcus mutans. Results: The results showed that natural products exerted almost similar antibacterial effect against Streptococcus mutans when compared with chlorhexidine. Conclusion: The present systematic review does not provide concrete evidence to show increased antibacterial efficacy of natural products as compared to chlorhexidine. INTRODUCTION Dental caries is a worldwide phenomenon defined as the result of a localised chemical dissolution of the tooth surface caused by acid production by the dental plaque biofilm which occurs as a result of persistent exposure to sugars [1]. It is an age old dental phenomenon that has inflicted much harm to the human race throughout history [2]. Teenagers acquire the disease early in childhood and reach a chronic stage at adult life [3]. A vastly diverse category of microorganisms are none other than oral streptococci [4] which are also the predominant pioneer species colonising the oral cavity [5]. Although existing in a symbiotic environment, the oral streptococci are pathogens that are highly capable of giving rise to a host of other diseases pertaining to brain and liver abscesses including infective endocarditis [6]. Clarke JK isolated streptococci from human caries and named it Streptococcus mutans. The pathological process of dental caries is attributed to the ever intense activity of Streptococcus mutans based on microbiological culture interpretation from shallow carious lesions [7]. The key feature in the establishment of a cariogenic dental plaque is the interplay within the dental biofilm [8]. However, loss of tooth structure is attributed to the long process of interaction between host, diet, microbes and time [9]. The prevention and treatment of dental caries is entirely focused upon reducing the oral microflora, maintaining an alkaline environment and to provide appropriate diet counselling thereby, ensuring a safe, effective and predictable outcome [10]. A non- invasive approach in the form of mouthwashes, gels, varnishes, chewing gums can be administered to limit the spread of cariogenic microorganisms. Mouthwashes, in addition to mechanical plaque control measures have been found to be very effective in reducing the oral microbial load. Chlorhexidine mouthwashes are the most effective chemical method in order to minimise plaque accumulation [11]. In the management of dental caries, chlorhexidine has been limited to high caries risk patients [12]. The literature relating to the use of chlorhexidine is immense; the proof of the agent’s efficacy in such a role is beyond dispute. The disadvantages of chemical mouthwashes includes staining of teeth, altered taste perception, metallic taste, burning sensation etc., [13]. The capacity of chlorhexidine to prevent and control caries by its antimicrobial effect, has been controversial and the evidence is still inconclusive [14]. Although fluoride being anti-cariogenic and chlorhexidine, a broad-spectrum anti-microbial agent are effective to varying degrees, however, the long term use of the latter can spark an undesirable transformation of the normal oral and intestinal flora [15]. Tolerance of bacteria and development of stains in addition to vomiting and diarrhoea has been well documented in the past in accordance with the use of the aforesaid antimicrobials [16,17]. The threat of fluorosis in many countries with the frequent use of fluoride containing products has also led to the notion that fluoride alone as a therapeutic agent cannot be banked upon [18]. In contrast, natural products have been proven to be safe, consisting of biologically active compounds which may have potential therapeutic uses in dentistry. Polyphenolic compounds, cited to be the most potent of all natural products attributed to its credible anti-caries actions are derived from diverse food, beverages, traditional herbs. Natural products have been widely