Effect of Centella asiatica extract mouthwash on oral wound healing following mandibular third molar surgery: Randomized controlled trial

Information from the abstract

Mandibular third molar surgery is commonly associated with postoperative pain, facial swelling, and delayed wound healing. Centella asiatica has demonstrated anti-inflammatory and wound-healing properties in experimental studies, but clinical evidence regarding its use in oral surgery remains limited. This randomized controlled trial evaluated the effect of a 0.12% C. asiatica mouthwash on oral wound healing and salivary biomarkers following mandibular third molar surgery. This randomized, double-blind, placebo-controlled clinical trial included participants undergoing impacted mandibular third molar surgery. Participants were randomly assigned to receive either a 0.12% C. asiatica mouthwash or a placebo mouthwash with an identical base formulation. The primary outcome was oral wound healing assessed on postoperative day 7 using the oral wound healing index. Secondary outcomes included postoperative pain at rest and during maximum mouth opening, facial swelling, and salivary fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor A (VEGF-A). Pain was assessed repeatedly from 6 to 120 h after surgery, while facial swelling was assessed as the change from baseline to postoperative day 7. Salivary biomarkers were measured at baseline and postoperative day 4 and analyzed using baseline-adjusted analysis of covariance. Thirty-six participants were included in the final analysis, comprising 17 participants in the C. asiatica group and 19 in the control group. The distribution of oral wound healing categories did not differ significantly between groups (Fisher–Freeman–Halton exact test, p = 0.105). Good, acceptable, and bad healing occurred in 7 (41.2%), 8 (47.1%), and 2 (11.8%) participants in the C. asiatica group and in 4 (21.1%), 15 (78.9%), and 0 participants in the control group, respectively. Postoperative pain decreased over time in both groups, with no significant time-by-group interaction or overall between-group difference for pain at rest or during maximum mouth opening. No significant between-group differences were observed in facial swelling. In the baseline-adjusted biomarker analysis, postoperative FGF-2 concentrations were lower in the C. asiatica group than in the control group (geometric mean ratio, 0.54; 95% CI, 0.27–1.10; p = 0.088), as were VEGF-A concentrations (geometric mean ratio, 0.71; 95% CI, 0.48–1.04; p = 0.075); neither difference reached statistical significance. Mild transient oral symptoms were reported in a small number of participants, with no serious adverse events or intervention discontinuations. In this randomized controlled trial, 0.12% C. asiatica mouthwash did not demonstrate a statistically significant clinical benefit for oral wound healing, postoperative pain, or facial swelling following mandibular third molar surgery. The observed differences in salivary FGF-2 and VEGF-A were exploratory and did not establish improved wound healing or tissue remodeling. The intervention appeared to be well tolerated over the 7-day study period, although the study was not designed to establish long-term safety. Larger, adequately powered trials with standardized botanical characterization, longer follow-up, and comprehensive clinical and biological outcome assessment are warranted. Thai Clinical Trials Registry (TCTR), TCTR20250909004. Registered on 9 September 2025. https://www.clinicaltrials.in.th/ .

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Related topics: Wound Healing and Treatments · Medicinal Plants and Neuroprotection · Dental Implant Techniques and Outcomes