Comparative Effects of Breadfruit Leave (Artocarpus altilis) and Betel Leaves (Piper betle) Gargles on Salivary pH and Plaque: A Clinical Study
Downloads
The high incidence of dental caries in Indonesia (90%) is attributed to a combination of diets high in sugar and poor oral hygiene. Furthermore, the lack of access to preventive products remains a major barrier to improving national oral health outcomes. Decoctions made from breadfruit leaves (Artocarpus altilis) and betel leaves (Piper betle) are known to have antibacterial properties. This study aimed to compare the efficacy of breadfruit leaf (Artocarpus altilis) and betel leaf (Piper betle) decoctions in terms of their effects on salivary pH and plaque scores and to determine whether their effects were equivalent. This study used a pretest–posttest design with two groups, involving 30 respondents aged 30–40 years who were divided into two groups: the first group used breadfruit leaf decoction (n = 15), and the second group used betel leaf decoction (n = 15). Respondents gargled with 20 mL of the assigned solution for 30 seconds. Salivary pH was measured using a pH meter, while plaque scores were assessed using the Simplified Oral Hygiene Index (OHI-S). Data were analyzed using paired t-tests and independent t-tests, with a significance level of p < 0.05. Gargling with both breadfruit and betel leaf decoctions significantly increased salivary pH from acidic to neutral and reduced plaque scores (p< 0.05). The flavonoids, tannins, and alkaloids in breadfruit leaves, as well as the phenolic compounds in betel leaves, contribute to these antibacterial effects. However, the groups did not differ significantly in the increase in salivary pH or the reduction in plaque scores (p > 0.05). Decoctions of breadfruit and betel leaves may serve as natural mouthwashes for maintaining oral health. Further research is needed to develop commercial formulations and assess their long-term effectiveness.
Abadi, A., Mahirawatie, I. C., Prasetyowati, S., & Hadi, S. (2025). Comparison of the Effectiveness of Betel Leaf and Basil Leaf Decoctions on Plaque Index Reduction in Pregnant Women in Pemekaan , Indonesia. International Journal of Advanced Health Science and Technology, 5(3), 309–315. https://doi.org/10.35882/ijahst.v5i6.506
Alam, M. B., Park, N. H., Song, B. R., & Lee, S. H. (2023). Antioxidant Potential-Rich Betel Leaves (Piper betle L.) Exert Depigmenting Action by Triggering Autophagy and Downregulating MITF/Tyrosinase In Vitro and In Vivo. Antioxidants, 12(2). https://doi.org/10.3390/antiox12020374
Andini, P., Firdaus, A., Candra, N. D. A., Salamah, N., & Mulyaningisih, S. (2026). Formulation And Antibacterial Activity Test Of Betel Leaf (Piper Betle L.) Essential Oil Mouthwash Against Streptococcus mutans. Jurnal Ilmu Farmasi Dan Farmasi Klinik, 23(1), 185–196. https://doi.org/10.31942/jiffk.v23i1.13872
Bencze, B., Temesfői, V., Das, S., Papp, H., Kaltenecker, P., Kuczmog, A., Jakab, F., Kocsis, B., & Kőszegi, T. (2023). Development of a novel, entirely herbal-based mouthwash effective against common oral bacteria and SARS-CoV-2. BMC Complementary Medicine and Therapies, 23(1), 1–17. https://doi.org/10.1186/s12906-023-03956-3
Brookes, Z., Teoh, L., Cieplik, F., & Kumar, P. (2023). Mouthwash Effects on the Oral Microbiome: Are They Good, Bad, or Balanced? International Dental Journal, 73, S74–S81. https://doi.org/10.1016/j.identj.2023.08.010
Cendekiawan, K. A., Kintoko, K., Yuliani, S., Anggraeni, L. S., Wardhani, F. A., & Poerwahyuningrum, N. (2025). Antidiarrhoeal Potential of Secondary Metabolites in Betel Leaf (Piper betle): A Systematic Review with Radar Chart Analysis and AUC Evaluation. MEDFARM: Jurnal Farmasi Dan Kesehatan, 14(2), 527–539. https://doi.org/10.48191/medfarm.v14i2.594
Czerkas, K., Olchowik-Grabarek, E., Łomanowska, M., Abdulladjanova, N., & Sękowski, S. (2024). Antibacterial Activity of Plant Polyphenols Belonging to the Tannins against Streptococcus mutans—Potential against Dental Caries. Molecules, 29(4). https://doi.org/10.3390/molecules29040879
Dunleavy, D. G., Kebschull, P. M., Pitts, P. N., Chapple, P. I., Verma, N., Jain, S., Hofmeister, J., Chilikova, K., Cook, R., & West, P. N. (2023). Inequalities in oral health: The economic burden of dental caries. International Dental Journal, 73, S20. https://doi.org/10.1016/j.identj.2023.07.239
Eka Putri, C. N. A., Masyhudi, M., & Listiyawati, L. (2024). Testing the Antibacterial Activity of Black Betel Leaf Extract (Piper betle L. Var Nigra) on Streptococcus mutans, Porphyromonas gingivalis, and Enterococcus faecalis. Jurnal Impresi Indonesia, 3(7), 497–513. https://doi.org/10.58344/jii.v3i7.5269
Florenly, F., Novelya, N., Janiar, M., Miranda, M., Hai, L. Q. P. D., & Quang, P. M. (2022). Nano-Green Betel Leaf Extracts (Piper betle L.) Inhibits the Growth of Streptococcus mutans and Staphylococcus aureus. E-GiGi, 10(2), 154. https://doi.org/10.35790/eg.v10i2.39014
Hasan, F., Yuliana, L. T., Budi, H. S., Ramasamy, R., Ambiya, Z. I., & Ghaisani, A. M. (2024). Prevalence of dental caries among children in Indonesia: A systematic review and meta-analysis of observational studies. Heliyon, 10(11), e32102. https://doi.org/10.1016/j.heliyon.2024.e32102
Heliawati, L., Lestari, S., Hasanah, U., Ajiati, D., & Kurnia, D. (2022). Phytochemical Profile of Antibacterial Agents from Red Betel Leaf (Piper crocatum Ruiz and Pav) against Bacteria in Dental Caries. Molecules, 27(9). https://doi.org/10.3390/molecules27092861
Jalil, V., Khan, M., Haider, S. Z., & Shamim, S. (2022). Investigation of the Antibacterial, Anti-Biofilm, and Antioxidative Effect of Piper betle Leaf Extract against Bacillus gaemokensis MW067143 Isolated from Dental Caries, an In Vitro-In Silico Approach. Microorganisms, 10(12). https://doi.org/10.3390/microorganisms10122485
Khairi, N., Aisyah, A. N., Indrisari, M., Sukmawati, S., & Nisa, M. (2026). Effectiveness of breadfruit leaf extract in mouthwash formula to inhibit the bacteria of Streptococcus mutans that causes caries. Media Penelitian Dan Pengembangan Kesehatan, 36(1), 12–23. https://doi.org/10.34011/jmp2k.v36i1.2722
Li, Z., Yu, C., & Chen, H. (2025). Global, regional, and national caries of permanent teeth incidence, prevalence, and disability-adjusted life years, 1990-2021: analysis for the global burden of disease study. BMC Oral Health, 25(1). https://doi.org/10.1186/s12903-025-06086-z
Liu, Y., Zhu, J., Liu, Z., Zhi, Y., Mei, C., & Wang, H. (2025). Flavonoids as Promising Natural Compounds for Combating Bacterial Infections. International Journal of Molecular Sciences, 26(6), 1–20. https://doi.org/10.3390/ijms26062455
Maramis, J. L., Kundimang, F. A., Ratuela, J. E., & Koch, N. M. (2024). Effectiveness of Gargizing With Balance Leaf Boiling (Syzygium Polyanthum) and Guava Leaf Boiling (Psidium Guajava Linn) With Plaque Accumulation. JDHT Journal of Dental Hygiene and Therapy, 5(1), 60–65. https://doi.org/10.36082/jdht.v5i1.1583
Mashal, S., Siddiqua, A., Ullah, N., Baloch, R., Khan, M., Hasnain, S. Z. U., Imran Aziz, M., Huseynov, E., Selakovic, D., Rosic, G., Makhkamov, T., Yuldashev, A., Islamov, S., Abdullayeva, N., Khujanazarov, U., & Amin, A. (2024). Bioactive plant waste components targeting oral bacterial pathogens as a promising strategy for biofilm eradication. Frontiers in Chemistry, 12(August), 1–18. https://doi.org/10.3389/fchem.2024.1406869
McGrath, C., Clarkson, J., Glenny, A. M., Walsh, L. J., & Hua, F. (2023). Effectiveness of Mouthwashes in Managing Oral Diseases and Conditions: Do They Have a Role? International Dental Journal, 73, S69–S73. https://doi.org/10.1016/j.identj.2023.08.014
Ni Wayan Rika, K. D., Putu Yudha, U., & Dyah Ratna Ayu, P. S. (2023). Antibacterial Potential of Red Betel Leaves (Piper crocatum Ruiz and Pav): Literature Review. Journal Pharmactive, 2(1), 39–44. https://doi.org/10.64036/pharmactive.v2i1.31
Nurzilullahningtiyas, A., & Prasetyowati, S. (2023). Comparative Effectiveness of Binahong Decoction and Betel Leaf Decoction Solutions on Plaque Index in Deaf Children : A Study at SDLB Karya Mulia Surabaya. 180–185.
Nwaneri, M. G., Ilechukwu, O. A., & Ugo, U. A. (2025). Antimicrobial activity of endophytic fungal metabolites from breadfruit (Artocarpus altilis) leaves against multidrug-resistant Staphylococcus aureus and Klebsiella spp. Mediterranean Journal of Medicine and Medical Sciences, 1(3), 23-30. http://dx.doi.org/10.5281/zenodo.17611720
Osorio, M., Carvajal, M., Vergara, A., Butassi, E., Zacchino, S., Mascayano, C., Montoya, M., Mejías, S., Martín, M. C. S., & Vásquez-Martínez, Y. (2021). Prenylated flavonoids with potential antimicrobial activity: Synthesis, biological activity, and in silico study. International Journal of Molecular Sciences, 22(11). https://doi.org/10.3390/ijms22115472
Rahayu, E. S., Salfiyadi, T., & Reca, R. (2024). Effectiveness of Gargling with Lemon Juice (Citrus lemon) and Betel Leaf Decoction on Debris Index and Saliva pH of Elementary School Students in Aceh Besar District. Journal of Health Science and Medical Therapy, 2(03), 249–258. https://doi.org/10.59653/jhsmt.v2i03.1139
Rahmawati, F., Silaban, H., & Azriza, C. Z. (2025). Bioactivity of Breadfruit Leaf Extract (Artocarpus Altilis). Indonesian Journal of Global Health Research, 7(3), 577–588.
Refaey, M. S., Abosalem, E. F., Yasser El-Basyouni, R., Elsheriri, S. E., Elbehary, S. H., & Fayed, M. A. A. (2024). Exploring the Therapeutic Potential of Medicinal Plants and Their Active Principles in Dental Care: A Comprehensive Review. Heliyon, 10(18), e37641. https://doi.org/10.1016/j.heliyon.2024.e37641
Rudin, L., Roth, N., Kneubühler, J., Dubey, B. N., Bornstein, M. M., & Shyp, V. (2023). Mutans Biofilm Formation. 11(5), 1–17.
Sarkar, S., Biswas, B., Barman, R., Chaudhary, M., Singh, M., & Abhinav, A. (2024). A literature review on various agents which can be used as a mouthwash for effective oral care. The Journal of Dental Panacea, 6(1), 3–5. https://doi.org/10.18231/j.jdp.2024.002
Singh, T., Singh, P., Pandey, V. K., Singh, R., & Dar, A. H. (2023). A literature review on bioactive properties of betel leaf (Piper betel L.) and its applications in food industry. Food Chemistry Advances, 3(April), 100536. https://doi.org/10.1016/j.focha.2023.100536
Soifoini, T., Donno, D., Jeannoda, V., Rakoto, D. D., Msahazi, A., Farhat, S. M. M., Oulam, M. Z., & Beccaro, G. L. (2021). Phytochemical composition, antibacterial activity, and antioxidant properties of the artocarpus altilis fruits to promote their consumption in the comoros islands as potential health-promoting food or a source of bioactive molecules for the food industry. Foods, 10(9). https://doi.org/10.3390/foods10092136
Ulandari, S., Hidayanty, H., Jafar, N., Indriasari, R., Taslim, N. A., & Riskiyani, S. (2023). The Effect of Breadfruit Leaf Extract (Artocarpus Altilis) on Fasting Blood Sugar Levels among Diabetes Mellitus (DM) Type 2 Outpatient at Biru Public Health Center of Bone Regency, Indonesia. Biomedical and Pharmacology Journal, 16(1), 559–565. https://doi.org/10.13005/bpj/2637
Copyright (c) 2026 JURNAL INFO KESEHATAN
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright notice
Ownership of copyright
The copyright in this website and the material on this website (including without limitation the text, computer code, artwork, photographs, images, music, audio material, video material and audio-visual material on this website) is owned by JURNAL INFO KESEHATAN and its licensors.
Copyright license
JURNAL INFO KESEHATAN grants to you a worldwide non-exclusive royalty-free revocable license to:
- view this website and the material on this website on a computer or mobile device via a web browser;
- copy and store this website and the material on this website in your web browser cache memory; and
- print pages from this website for your use.
- All articles published by JURNAL INFO KESEHATAN are licensed under the Creative Commons Attribution 4.0 International License. This permits anyone to copy, redistribute, remix, transmit and adapt the work provided the original work and source is appropriately cited.
JURNAL INFO KESEHATAN does not grant you any other rights in relation to this website or the material on this website. In other words, all other rights are reserved.
For the avoidance of doubt, you must not adapt, edit, change, transform, publish, republish, distribute, redistribute, broadcast, rebroadcast or show or play in public this website or the material on this website (in any form or media) without appropriately and conspicuously citing the original work and source or JURNAL INFO KESEHATAN prior written permission.
Permissions
You may request permission to use the copyright materials on this website by writing to [email protected].
Enforcement of copyright
JURNAL INFO KESEHATAN takes the protection of its copyright very seriously.
If JURNAL INFO KESEHATAN discovers that you have used its copyright materials in contravention of the license above, JURNAL INFO KESEHATAN may bring legal proceedings against you seeking monetary damages and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of JURNAL INFO KESEHATAN copyright materials that contravenes or may contravene the license above, please report this by email to [email protected]
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to [email protected].
