Effectiveness and safety of aqueous neem leaf extract versus chlorhexidine mouthwash in post-operative care of dis-impacted third molars: a randomised controlled clinical trial

Background: Chlorhexidine is usually used as a mouth disinfectant after third molar surgery however; it lacks anti-inflammatory and analgesic properties. There is a possibility that neem leaf extracts, with analgesic, anti-inflammatory properties and can serve as a disinfectant, will be a better alternative. We aimed to evaluate the effectiveness and safety of neem leaf extract in controlling postoperative complications after third molar surgeries in comparison to chlorhexidine mouthwash. Methods: This was a randomised clinical trial that enrolled patients who had impacted mandibular third molars and were randomly assigned to the control (chlorhexidine) or experimental (neem leaf extract) groups using simple randomisation method. We collected data on patients' clinical demographic, type of mouthwash, pain, facial swelling, trismus, wound healing, acute alveolar infection, localised alveolitis and adverse effects. Both descriptive and inferential statistics were performed and p-values < 0.05 were considered significant. Results: 48 patients were randomly divided into control and neem groups (n = 24 each). There was no significant difference in clinical demographic characteristics between the two groups. Post-operative pain was significantly lower in the neem group at post-operative day (POD) 3 (p = 0.001) and POD 7(p = 0.001). Facial swelling reduced significantly at POD 7 in the neem group (p=0.02). There was significant decrease in trismus at POD 3(p = 0.01) and POD 7 (p = 0.004) in the neem group. Wound healing was better among those who rinsed with neem (p=0.03). Neem mouthwash did not reduce incidence of localised alveolitis (p = 0.595), acute alveolar infection (p = 0.346) and adverse effects (p = 0.257) than chlorhexidine mouthwash. Conclusion: Neem mouthwash was more effective in the control of pain, facial swelling, trismus and poor wound healing compared to chlorhexidine mouthwash but has same effect as chlorhexidine mouthwash in the control of localised alveolitis, acute alveolar infection and adverse effects.