Centella mouthwash shows no significant benefit after wisdom tooth surgery

A randomized, double-blind trial found that a 0.12% Centella asiatica extract mouthwash did not significantly improve oral wound healing, postoperative pain, or facial swelling after surgery to remove impacted mandibular third molars. The study included 36 participants in the final analysis, and the mouthwash was generally well tolerated over seven days, but the small sample means the result should not be interpreted as proof that the treatment is ineffective.

Mandibular third molar surgery is commonly associated with postoperative pain, facial swelling, and delayed wound healing. Experimental studies have reported anti-inflammatory and wound-healing properties for C. asiatica, but clinical evidence for oral surgery has been limited. The investigators therefore tested whether a mouthwash containing the extract could improve recovery after surgery to remove impacted lower third molars.

Participants undergoing impacted mandibular third molar surgery were randomly assigned to receive either the 0.12% C. asiatica mouthwash or a placebo mouthwash with an identical base formulation. The trial’s primary outcome was oral wound healing, assessed on postoperative day 7 with the oral wound healing index. Postoperative pain, facial swelling, and two salivary biomarkers were secondary outcomes. The final analysis comprised 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 the groups. Fisher–Freeman–Halton exact testing produced a p-value of 0.105. Good, acceptable, and bad healing occurred in seven, eight, and two participants, respectively, in the C. asiatica group. In the control group, four participants had good healing, 15 had acceptable healing, and none had bad healing. A larger proportion of the extract group therefore fell into the “good” category, but the overall three-category distribution was not statistically distinguishable from that of the placebo group.

Pain was assessed repeatedly from 6 to 120 hours after surgery, both at rest and during maximum mouth opening. Pain decreased over time in both groups, but there was no significant time-by-group interaction and no overall between-group difference for either pain measure. Facial swelling, assessed as the change from baseline to postoperative day 7, also showed no significant difference between groups. Thus, the trial did not demonstrate a significant clinical advantage for the extract mouthwash on the primary wound-healing outcome or the secondary pain and swelling outcomes.

Salivary fibroblast growth factor-2, or FGF-2, and vascular endothelial growth factor A, or VEGF-A, were measured at baseline and on postoperative day 4 using baseline-adjusted analysis of covariance. After adjustment, postoperative FGF-2 concentrations were lower in the C. asiatica group than in controls, with a geometric mean ratio of 0.54, a 95% confidence interval of 0.27–1.10, and a p-value of 0.088. VEGF-A concentrations were also lower, with a geometric mean ratio of 0.71, a 95% confidence interval of 0.48–1.04, and a p-value of 0.075. Neither difference reached statistical significance, and the investigators described the biomarker results as exploratory rather than evidence of improved wound healing or tissue remodeling.

Mild, transient oral symptoms were reported by a small number of participants. No serious adverse events or intervention discontinuations occurred during the study, supporting short-term tolerability within the seven-day observation period. The trial was not designed to establish long-term safety. Its authors called for larger, adequately powered studies with standardized botanical characterization, longer follow-up, and comprehensive clinical and biological outcome assessment.

Overall, the findings do not support describing 0.12% C. asiatica mouthwash as an established treatment for faster or better recovery after mandibular third molar surgery. The intervention produced no statistically significant benefit for the trial’s primary outcome or its measured secondary clinical outcomes, while the exploratory biomarker differences were also uncertain. The result is best understood as a negative small-scale clinical trial rather than a demonstration of no possible effect.

Subject of Research: Randomized clinical trial of Centella asiatica mouthwash for oral wound healing after mandibular third molar surgery

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

Article References: Chaweewattanasakul, P., Tachasuttirut, K., Laosuwan, K., Pongsiriwet, S., & Tipduangta, P. (2026). Effect of Centella asiatica extract mouthwash on oral wound healing following mandibular third molar surgery: Randomized controlled trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05640-8

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05640-8

Keywords: Centella asiatica, oral wound healing, third molar surgery, mouthwash, postoperative pain, facial swelling, FGF-2, VEGF-A, randomized controlled trial, clinical trial, Effect, Centella