Clinical Oral Investigations

, Volume 23, Issue 10, pp 3833–3842 | Cite as

N-acetyl cysteine versus chlorhexidine mouthwashes in prevention and treatment of experimental gingivitis: a randomized, triple-blind, placebo-controlled clinical trial

  • Ahlam Al-Kamel
  • Wadhah Abdulnaser Al-Hajj
  • Esam HalboubEmail author
  • Saleem Abdulrab
  • Khaled Al-Tahami
  • Nezar Noor Al-Hebshi
Original Article



To compare the efficacy of N-acetyl cysteine (NAC) mouthwash with chlorhexidine (CHX) in prevention and treatment of experimental gingivitis

Materials and methods

Sixty subjects were assigned randomly and blindly into one of three equal groups: NAC, CHX, or placebo group. The study was conducted in two stages: preventive and treatment substudies. Professional prophylaxis was performed ahead of starting the preventive substudy. Then, the subjects were instructed to stop oral hygiene practices and begin rinsing twice/day with 15 ml of the assigned mouthwash (1.25% NAC, 0.2% CHX, or inert base). Plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were measured at baseline, 7, 14, and 21 days. The treatment substudy started on day 21 in which the subjects in the placebo group (now with established experimental gingivitis) were assigned to NAC (n = 10) or CHX (n = 10); the abovementioned indices were measured at 28 and 35 days. Efficacy of these interventions was compared.


All groups accumulated plaque and developed some degree of gingivitis: full-blown in the placebo group and remarkably mild in the CHX group. NAC had slight preventive properties at days 14 and 21. In the treatment substudy, CHX was associated with remarkable reduction in plaque and gingivitis while NAC resulted in insignificant reductions.


1.25% NAC is marginally effective in prevention and treatment of experimental gingivitis.

Clinical relevance

When compared with the placebo, NAC showed promising preventive and treatment effects of gingivitis that deserve further development and studies.

Trial registration



N-acetyl cysteine Chlorhexidine Mouthwash Experimental gingivitis Dental plaque 



The authors wish to thank Shiba-Pharma (Shiba-Pharmaceuticals & Chemicals Mfg. Co. Ltd., Yemen) for it is cooperation and manufacturing of research rinsing. They also thank the students of the University of Science and Technology, Sana’a, Yemen, who volunteered to participate in this study and for their dedication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

“The study protocol was formally approved by the Research Ethics Committee at the Faculty of Medicine and Health Sciences, University of Sciences and Technology, Sana’a, Yemen (No 2016/20). The study has been conducted in full accordance with the World Medical Association Declaration of Helsinki.”

Informed consent

“A written informed consent was obtained from each of the participants.”


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of preventive and biomedical science, Faculty of dentistryUniversity of Science and TechnologySana’aYemen
  2. 2.Department of periodontology, Faculty of dentistryThamar UniversityThamarYemen
  3. 3.Department of Maxillofacial Surgery and Diagnostic Sciences, College of DentistryJazan UniversityJazanSaudi Arabia
  4. 4.Madinat Khalifa Health CenterPrimary Health Care CorporationDohaQatar
  5. 5.Alkhaled pharmaceuticalsSana’aYemen
  6. 6.Maurice H. Kornberg School of DentistryTemple UniversityPhiladelphiaUSA

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