Effectivity of Guava Leaves (Psidium guajava) as Mouthwash for Patients with Aphthous Ulcers

Ferdinand Z. Guintu, MD
Antonio H. Chua, MD

Department of Otorhinolaryngology
Head and Neck Surgery
Jose R. Reyes Memorial Medical Center


Objective: To determine whether Psidium guajava leaves mouthwash is effective in the management of patients with aphthous ulcers.

     Design: Randomized prospective open label clinical study
     Setting: Tertiary Government Training Hospital
     Subjects: Thirty two patients diagnosed with aphthous ulcers were randomly divided into two groups, a treatment group using prepared guava leaves mouthwash, and a control group using isotonic sodium chloride solution mouthwash given thrice a day for seven days. Patients were evaluated using a 10-point Visual Analog Scale. The sizes of the aphthous ulcers were measured using a caliper, and compared on Day 1 and Day 7 for both treatment and control groups. Results were subjected to statistical analysis using T-test, Mann-Whitney U test and Fisher Exact test.
Results: Comparison of VAS scores of guava treatment and NSS control groups showed that there were no differences in pain experienced on Days 1 and 2. However, the VAS scores from Day 3 to 7 had p values ranging from 0.02 – 0.0001 which showed significant differences in resolution of pain. There was statistically significant marked improvement of pain symptoms as early as three days post-treatment among patients who were administered guava leaves mouthwash. Complete resolution of aphthous ulcers in 75% of the study group was observed on Day 7. Mean ulcer size post-treatment with guava gargle was 0.25mm compared to 0.75mm for NSS gargle. The mean size difference at day 7 was 1.44mm for the guava treatment group and 0.88mm for the NSS control group. There was a statistically significant faster resolution of ulcer size on day 7 in 16/16 or 100 % of patients in the treatment group compared with only 10/16 or 62.5% of patients in the control group. Patients who were administered guava leaves mouthwash generally fared better than those administered isotonic sodium chloride solution.

Conclusion: Guava leaves mouthwash was effective for aphthous ulcers in terms of reduction of symptoms of pain and faster reduction of ulcer size. Further clinical trials comparing this mouthwash against other treatment options are recommended.

Keywords: guava leaves (Psidium guajava), aphthous ulcers, mouthwash

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Ferdinand Guintu, MD, DPBOHNS

About Ferdinand Guintu, MD, DPBOHNS

Expert in Diseases of ears, nose and throat; Maxillofacial trauma; Tumors of Head and Neck; Nasal and laryngeal endoscopy