Efficacy of Commiphora myrrha (Myrrh) in Management of Gingivitis: A Systematic Review

Introduction: The oral cavity is the second largest microbial niche in the human body, following the gut. The colonisation of microorganisms on the teeth and gums harbours harmful bacteria, which can trigger inflammation, potentially leading to periodontal breakdown and tooth loss. To eliminate bacterial biofilms, several methods are employed. Among these, the most effective are chemical methods, which include antiseptic and antimicrobial agents. Although these agents can have potential benefits, they also come with side-effects. To minimise the sideeffects of chemical-based plaque control, there is a paradigm shift towards herbal alternatives. One such plant known for its medicinal properties is Commiphora myrrha, which possesses antimicrobial properties that improve plaque control. Aim: To assess the efficacy of Commiphora myrrha in the management of gingivitis. Materials and Methods: A comprehensive search was conducted using Medline via PubMed, Cochrane, ProQuest and Google Scholar. The combination of keywords used was: Myrrh OR Commiphora myrrha OR Herbal extract AND Gingivitis AND Plaque AND Inflammation, Myrrh AND Commiphora myrrha AND Gingivitis. Articles published from January 1, 2014, to December 31, 2024, were included to identify the efficacy of Commiphora myrrha in the management of gingivitis. After a thorough search, a total of five articles were included in the review. The inclusion criteria were: patients aged between 18-35 years, signs of chronic gingivitis in at least six sites, Bleeding on Probing (BOP) and periodontal pockets with a depth of no more than 3 mm. Exclusion criteria included patients with periodontal pockets greater than 3 mm, those with severe malocclusion, use of antibiotic or anti-inflammatory medication, pregnant or breastfeeding women, oral prophylaxis in the past six months, a history of allergy to chemical or herbal products and patients using smoking or smokeless tobacco. The reporting of this systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality assessment of the studies was performed using the Cochrane risk of bias assessment tool for Randomised Controlled Trials (RCT), the Risk of Bias in Non randomised Studies (ROBINS) tool for non randomised trials and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: A total of five studies were included (four randomised and one non randomised controlled trial), comprising 166 patients who met the inclusion criteria. One of these studies was conducted in India, three in the Kingdom of Saudi Arabia and one in Egypt. Diagnoses in all five studies were based on clinical and histological examination. The p-values of the included studies were as follows: p