A systematic review published in the Journal of Herbal Medicine in 2025 found that garlic extract mouthwash at higher concentrations produces antimicrobial results comparable to chlorhexidine, the current gold standard in antiseptic mouthwashes. Researchers at the University of Sharjah screened 389 articles from six electronic databases in January 2024 and, after removing duplicates and applying inclusion criteria, included five studies in their final analysis. The review follows PRISMA 2020 guidelines and draws on randomized controlled trials and clinical studies with low-to-moderate risks of bias. Chlorhexidine carries known side effects and raises concerns about antimicrobial resistance, which has prompted interest in plant-based alternatives. Garlic contains allicin, a compound with documented antibacterial and antifungal activity. The review found that some studies favored chlorhexidine for maintaining higher plaque or salivary pH, while others reported garlic extract to be more effective at certain concentrations. Garlic mouthwash also appeared to offer longer-lasting residual activity. The main drawbacks were a burning sensation and unpleasant odor, which may affect patient acceptance. The authors note that most supporting evidence comes from in vitro studies with inconsistent methods, and they call for larger clinical trials with longer follow-up periods before garlic extract can be recommended as a routine clinical substitute for chlorhexidine.