Khozeimeh Faezeh, Ghadiri Negar, Zolfaghari Behzad, Tahani Bahareh
Department of Oral and Maxillofacial Medicine, Dental Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Oral Public Health, Dental Students' Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
Dent Res J (Isfahan). 2025 Jun 27;22:23. doi: 10.4103/drj.drj_415_24. eCollection 2025.
Oral candidiasis is one of the most common fungal infections affecting the oral mucosa. It is usually managed by taking antifungal medication that might result in side effects such as toxicity and drug resistance. Therefore, consumption of herbal medicine with antifungal activity and fewer side effects has become popular. This study is a systematic review to investigate the improvement and reduction of oral candidiasis symptoms by herbal compounds compared to conventional antifungal drugs.
PubMed, Scopus, Web of Science, Cochrane, and Magiran databases were searched from 1995 to 2021 based on the keywords of the question formula - oral candidiasis (P), herbal compounds (I), antifungal drugs (C), and improvement of clinical symptoms and laboratory tests (O) - to find related randomized controlled trials (RCTs) in English and Persian languages. Related articles were extracted based on inclusion and exclusion criteria and critically appraised using the modified-CONSORT checklist. The risk of bias was also assessed using the Cochrane tool.
After removing duplicates and checking the title and abstract of the articles, 98 articles from 1995 to November 2021 of 715 were reviewed. 83 RCTs were excluded due to non-relevancy and 15 remained for critical appraisal, of which 5 articles were rejected. Finally, 10 articles were included in the systematic review. Based on the risk of bias assessment, one article had low risk, 6 articles had unclear risk, and 3 articles had a high risk of bias. Herbal compounds were applied in the form of gel in 3 articles, in the form of ointment and mouthwash in 1 and 6 articles, respectively. In terms of clinical improvement and laboratory findings, herbal compound mouthwashes and ointment did not have a significant difference from conventional antifungal drugs, but the articles related to compound gels reported variable effects (better, similar, and weaker). Furthermore, herbal compounds generally had more patient satisfaction than antifungal drugs.
It seems that herbal compounds have clinical applications in the treatment of oral candidiasis and gained more patients' satisfaction. To achieve more valid results, it is suggested to conduct more RCTs with a low risk of bias.
口腔念珠菌病是影响口腔黏膜的最常见真菌感染之一。通常通过服用抗真菌药物进行治疗，但这些药物可能会产生诸如毒性和耐药性等副作用。因此，服用具有抗真菌活性且副作用较少的草药变得流行起来。本研究是一项系统评价，旨在调查与传统抗真菌药物相比，草药化合物对口腔念珠菌病症状的改善和减轻情况。
基于问题公式的关键词——口腔念珠菌病（P）、草药化合物（I）、抗真菌药物（C）以及临床症状和实验室检查的改善（O），在1995年至2021年期间对PubMed、Scopus、Web of Science、Cochrane和Magiran数据库进行检索，以查找英文和波斯文的相关随机对照试验（RCT）。根据纳入和排除标准提取相关文章，并使用改良的CONSORT清单进行严格评估。还使用Cochrane工具评估偏倚风险。
在去除重复项并检查文章标题和摘要后，对1995年至2021年11月的715篇文章中的98篇进行了审查。由于不相关，排除了83项RCT，15项留作严格评估，其中5篇文章被拒绝。最终，10篇文章纳入系统评价。基于偏倚风险评估，1篇文章风险低，6篇文章风险不明确，3篇文章偏倚风险高。草药化合物在3篇文章中以凝胶形式应用，在1篇文章中以软膏形式应用，在6篇文章中以漱口水形式应用。在临床改善和实验室检查结果方面，草药化合物漱口水和软膏与传统抗真菌药物没有显著差异，但与化合物凝胶相关的文章报告了不同的效果（更好、相似和较弱）。此外，草药化合物总体上比抗真菌药物获得了更多患者的满意度。
草药化合物似乎在口腔念珠菌病的治疗中具有临床应用价值，并获得了更多患者的满意度。为了获得更有效的结果，建议进行更多偏倚风险低的RCT。
