|Year : 2015 | Volume
| Issue : 2 | Page : 145-150
Comparative evaluation of turmeric gel with 2% chlorhexidine gluconate gel for treatment of plaque induced gingivitis: A randomized controlled clinical trial
Abhishek Kandwal1, Ravindra Kumar Mamgain2, Pratibha Mamgain2
1 Department of Dental Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Ayurveda, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
|Date of Web Publication||3-Feb-2016|
Dr. Abhishek Kandwal
Asst. Prof., Depatment of Dental Surgery, Himalayan Institute of Medical Sciences, SRHU, Swami Rama Nagar Jolly Grant, Dehradun - 248 016, Uttarakhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Ayurveda is regarded as most ancient traditional system of medicine originated in India having its root back in the Vedas. Medicinal herbs have been long employed to improve the oral health by means of frequently used therapeutic procedures Kavala (gargling) and Gandusha (holding of medicated liquids in the mouth). Gingivitis is most common ailment that results in bleeding gums and halitosis. Aim: To evaluate the efficacy of turmeric gel as an anti-plaque and anti-gingivitis agent compared to chlorhexidine gel. Materials and Methods: Sixty patients with plaque-induced gingivitis were divided into two groups, Group A was given turmeric gel and Group B was given chlorhexidine gel for 21 days in vaccupress trays. Plaque and gingival index were taken at baseline, 14 days and 21 days. Subjective and objective criteria were evaluated at 14 and 21 days. Results: On comparison of Group A and Group B, statistically insignificant difference was observed at 14 and 21 days. Reduction in plaque index at 0 and 21 days was 60.81% and 60.21% for turmeric and chlorhexidine group, respectively. Reduction in the gingival index at 0 and 21 days was 71.79% and 71.20% for turmeric and chlorhexidine group, respectively. Conclusion: Both groups reported a comparable reduction in plaque and gingival index. Turmeric gel reported better acceptance due to pleasant odor and no staining of teeth in comparison to chlorhexidine gel that reported a bitter taste and staining of teeth.
Keywords: Anti-gingivitis, anti-plaque, chlorhexidine, Curcuma longa L., plaque-induced gingivitis
|How to cite this article:|
Kandwal A, Mamgain RK, Mamgain P. Comparative evaluation of turmeric gel with 2% chlorhexidine gluconate gel for treatment of plaque induced gingivitis: A randomized controlled clinical trial. AYU 2015;36:145-50
|How to cite this URL:|
Kandwal A, Mamgain RK, Mamgain P. Comparative evaluation of turmeric gel with 2% chlorhexidine gluconate gel for treatment of plaque induced gingivitis: A randomized controlled clinical trial. AYU [serial online] 2015 [cited 2021 Aug 5];36:145-50. Available from: https://www.ayujournal.org/text.asp?2015/36/2/145/175537
| Introduction|| |
Ayurveda is the ancient Indian system of medicine and is the rich storehouse of time-tested and effective herbal remedies. Since few decades, there is an enormous awareness and scientific trials on medicinal herbs and its formulations worldwide. In recent times, medicinal herbs have received recognition from international researchers and health sectors around the world due to its preventive and comprehensive health care approach.
Dentistry is described in Ayurveda under Shalakya, one among the eight branches of Ayurveda. A lot of emphases has been given to oral health care in Ayurveda. Among the various practices for oral health care in Ayurveda, Gandusha (holding of medicated liquids in the mouth) and Kavala (gargling), are two very important therapeuticprocedures and are studied in the present clinical trial.
The first evidence of the use of turmeric also known as Haridra (Curcuma longa L.) is found in the Atharvaveda and further in Charaka Samhita, Sushruta Samhita and many others.Haridra is a perennial herb of 2–3 feet height found throughout the tropical countries and specially cultivated in Indian sub-continent.
Gingivitis is one of the most common ailment of oral cavity with a prevalence of 85–90%., Gingiva is a investing connective soft tissue surrounding the teeth, inflammation of gingiva is known as gingivitis. Some amount of sub-clinical gingivitis is always present in the oral cavity as soon as the first teeth erupts. Plaque bioflims are bio-aggregation of various bacterial colonies together on teeth, and it is the prime requisite to initiate gingivitis which if left unchecked can lead to periodontitis that is the loss of alveolar bone. All this will finally result in tooth mobility and tooth loss due to loss of surrounding soft and hard tissues. Thus, the foremost aim becomes to control the plaque buildup on teeth (anti-plaque effect) and control the soft tissue inflammation (anti-inflammatory).
Chlorhexidine is a time tested and the gold standard for controlling the gingivitis and is widely used as a chemical plaque control aid for routine oral hygiene maintenance. This study was designed to evaluate the efficacy of C. longa (Curenext gel, Abbott Pharmaceuticals) for its anti-plaque and anti-gingivitis effect using chlorhexidine as control.
| Materials and Methods|| |
Sixty patients with plaque-induced gingivitis reporting to the Department of Dental Surgery were enrolled for this randomized controlled clinical trial. Informed consent was taken, and ethical clearance was obtained from Ethical Committee of Himalayan Institute of Medical Sciences, Dehradun, (Letter No.: HIHTU/HIMS/RC/2013/129) in accordance to Helsinki Declaration.
- Age above 18 years
- Systemically healthy
- Plaque-induced gingivitis.
- Mouthwash use in past 3 months
- Antibiotic therapy in past 3 months
- Orthodontic and prosthetic appliances use
- Systemic disorders such as diabetes mellitus, renal failure, etc
- Chemotherapy and radiotherapy
- Patients with established periodontitis.
Grouping and posology
Two groups of 30 patients each were formed based on randomization by computer allocation In Group A turmeric (10 mg C. longa extract) gel (trade name - Curenext gel manufactured by Abbott Pharmaceuticals, Batch No. IAFA 2017) and in Group B chlorhexidine 2% gel (chlorhex mouthwash manufactured by Dr. Reddys Batch No. BCP2067) was advised for topical application on gums via vaccupress customized applicator trays for 5 min duration, twice daily and 30 min after brushing [Figure 1] Total duration of treatment schedule was 21 days.
|Figure 1: Customized vaccupress application trays and patient model of maxillary and mandibular arch|
Click here to view
Turmeric gel used was commercially available in aqueous form consisted of 10 mg of C. longa extract and artificial sweetener to mask the bitter taste of turmeric.
Criteria for assessment
Clinical data including Silness and Loe plaque index for plaque biofilm and Loe and Silness gingival index for gingival inflammation was recorded for all subjects., After recording all indices, thorough scaling and polishing was carried out to get all subjects at baseline. No antimicrobial therapy was initiated in this period all patients were recalled after 1 month to be enrolled in the study. Scaling was done 1 month before the initiation of study to bring all the subjects to baseline. Plaque build-up and gingivitis onset require roughly a period of 1 month was given to access the anti-plaque and anti-gingivitis efficacy of the turmeric and chlorhexidine gels.
The parameters were recorded for plaque, and gingival index at 0, 14th, and 21st day. Taste, dryness of gingiva, any odor, ulcer, staining of teeth, any oral mucosal reactions were assessed throughout the study.
All data collected was analyzed by statistical software SPSS (BM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY). Student's t-test was used for analysis of intra and intergroup comparison. P < 0.05 was considered as statistically significant difference.
| Observations and Results|| |
Effect of therapy on plaque index
In Group A, the value of mean ± standard deviation (SD) for plaque index at baseline was 2.337 ± 0.192; at 14 days was 1.307 ± 0.222 and at 21 days was 0.913 ± 0.138 [Table 1]. There was statistically significant difference in plaque index from baseline to 14 days and 21 days [Figure 2] and [Figure 3]. In Group B, the value of mean ± SD for plaque index at baseline was 2.32 ± 0.169, at 14 days was 1.27 ± 0.168 and at 21 days was 0.923 ± 0.147 [Table 2]. There was statistically significant difference in plaque index from baseline to 14 days and 21 days [Figure 4] and [Figure 5].
|Table 2: Effect of chlorhexidine gluconate gel on plaque and gingival index in Group B|
Click here to view
On comparison of plaque index in Group A and B, the reduction from baseline to 14 days was 44.20% and 48.69%, respectively, while from baseline to 21 days it was 60.81% and 60.21%, respectively. Both treatment groups reported a significant reduction in plaque index from baseline [Table 3]. There was statistically insignificant difference observed between the two treatment groups [Table 2] and Chart 1]
Effect of therapy on gingival index
In Group A, value of mean ± SD for gingival index at baseline was 1.953 ± 0.281, at 14 days was 1.110 ± 0.158 and at 21st day 0.550 ± 0.145 [Table 1]. There was a statistically significant difference in the gingival index from baseline to 14 and 21 days.
In Group B, the value of mean ± SD for the gingival index at baseline was 1.99 ± 0.283, at 14 days was 1.10 ± 0.146 at 21 days and 0.573 ± 0.170 [Table 2]. There was statistically significant difference in the gingival index from baseline to 14 days and 21 days.
On comparison of the gingival index in Group A and Group B, the reduction in the gingival index from baseline to 14 days was 43.07% and 44.37%, respectively while from baseline to 21 days was 71.79% and 71.20%, respectively [Chart 2].
Both treatment groups reported a significant reduction in plaque index from baseline. There was statistically insignificant difference observed within the two treatment groups.
None of the patients from both the groups were reported ulceration, dryness, and any mucosal reaction during the 21 days course of the trial. Chlorhexidine group reported 14 cases of minor tooth staining while none were reported the same in turmeric group during the study period.
| Discussion|| |
According to Ayurveda turmeric has five qualities, Rasa (taste) - Tikta (bitter) and Katu (pungent); Guna (properties) - Ruksha (dry, rough); Veerya (potency) - Ushna (hot); Vipaka (metabolic property) - Katu (pungent); Karma (actions) - Vishaghna, Varnya, Kushthaghna, Krimighna (anthelmintic)and Pramehaghna (ant diabetic).
Due to Ushna Veerya, it alleviates Kapha and Vata Doshas (humors) and due to Tikta Rasa, it alleviates Pitta Dosha. Being hot, light, acrid, and dry, it is able to reduce corpulence and clear channels. Charaka included Haridra (turmeric) in Lekhaniya group (reducing corpulence).
Sheetada (gingivitis) is an early stage of periodontal diseases, and it occurs mainly due to vitiation of Kapha and Rakta, so mainly considered as Kapha and Rakta Pradhana Vyadhi (disease).
According to Ayurvedic pharamacological properties turmeric is Tridoshahara in nature. Because of its Lekhaniya and anti-Kapha property, turmeric prevents plaque formation and capable of removing the plaques. This could propose the detachment of plaque biofilms and inhibits co-aggregation thus exhibiting the anti-plaque effect. Due to Katu Rasa, it has an anti-inflammatory action that helps in gingivitis. Its anti-Vata property helps in reducing the pain.,
Some of its therapeutic qualities employed in the field of dental surgery are anti-inflammatory, anti-bacterial, antiseptic, anti-tumor, anti-allergic, blood purifier, antioxidant, and detoxifier. The active constituent of turmeric is curcumin and has a wide range of actions. Because of its strong antioxidant values, it protects the free radical damage, these free radical results in faster progression of gingivitis to periodontitis eventually resulting in tooth loss eventually.
Chlorhexidine gluconate has been referred to as a gold standard for treatment of plaque and gingivitis and as an effective chemical plaque control aid. Chlorhexidine is supplied as mouthwash, topical gel and biodegradable chips for local drug delivery in the periodontal pocket, i.e., space between gingival and tooth. Chlorhexidine gluconate efficient broad spectrum antimicrobial agent. It is a cationic molecule that results in bacterial cell wall lysis and rupture. Cationic molecules binds to the negatively charged surfaces such teeth surface, dental pellicle and bacterial cell wall. Chlorhexidine has a substantivity of 12 h and hence is used twice daily. Various studies have quoted the significant reduction in gingivitis by use of 2% chlorhexidine gluconate gel on topical application. Present study also reported a significant reduction in gingival and plaque index on the use of 2% chlorhexidine gel topically twice daily for 5 min.
Results of this study observed a similar findings for turmeric are reported in previous research work, in which herbal mouthwash mixture containing turmeric compared with chlorhexidine mouthwash. A significant reduction noted in the periodontal pocket, gingival index and gingival index compared to control when 2% turmeric gel was used as a local drug delivery in patients with periodontitis. Similar results in terms of reduction of gingival and plaque index was observed in the present study.
Anti-plaque effect of turmeric gel was comparable to chlorhexidine gel, this is in accordance with the results of previous research work. These effects were enhanced as the tray application resulted in longer and closer contact of gels to the site of interest. The anti-inflammatory effect of turmeric gel was similar to reported in previous studies.,, Chlorhexidine group reported a similar reduction in gingival index and plaque index as those reported in previous research works.,
Chlorhexidine group described the gel as colorless, odorless with a bitter taste, few patient reported gagging to the taste. Turmeric group describe turmeric gel (commercially available flavored) as yellow to orange in color with a sweet taste and pleasant odor. The bitter taste of turmeric was masked by the use of artificial sweetener in the commercial preparation while the root property of turmeric that is Katu-Tikta Rasa, anti Kapha and Lekhaniya properties remains unaltered. This was readily accepted by patients, and none reported any gagging while on tray application.
On the basis of the finding of the present study, it is clear that turmeric mouthwash has effective anti-plaque and anti-gingivitis effect similar to chlorhexidine. Both gels were efficient in reducing gingival and plaque index further turmeric gel was more readily accepted due to sweet taste, pleasant odor, and no staining potential of teeth over chlorhexidine gel.
| Conclusion|| |
The observation of this study states that both turmeric and chlorhexidine gel have comparable anti-plaque and anti-gingivitis effect, and both can be efficiently used to control plaque-induced gingivitis. Turmeric gel is biocompatible and free of any adverse effects, it is well-accepted by the patient as it dose not causes dryness, ulceration, and staining of teeth. Five minutes application of turmeric gel with vaccupress tray reported a significant reduction in plaque-induced gingivitis. Further studies are required to identify the minimum dose and duration of application for optimum plaque and gingival inflammation control.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Srikanthamurthi KR, Translator. Astanga Sangraha of Vagbhata, Sutra Sthana. Ch. 3, Ver. 28-30. 4 ed. Varanasi: Chaukhambha Orientalia; 2001. p. 37.
Sharam PV, Translator. Sushruta Samhita of Sushruta. Sutra Sthana Ch. 38, Ver. 54. 1st
ed. Varanasi: Chaukhanbha Vishwabharti; 1999. p. 363.
Sharma P. Dravya Guna Vigyan. Reprint Edition. Vol. 2. Varanasi: Chaukhambha Bharti Academy; 2005. p. 37.
Pihlstrom BL, Ammons WF. Treatment of gingivitis and periodontitis. Research, science and therapy committee of the American academy of periodontology. J Periodontol 1997;68:1246-53.
Löe H, Schiott CR. The effect of mouthrinses and topical application of chlorhexidine on the development of dental plaque and gingivitis in man. J Periodontal Res 1970;5:79-83.
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35.
Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38 Suppl (6):610-6.
Chunekar KC, Commentator, Pandey GS, editor. Bhavprakash Nighantu of Sri Bhav Mishra, Haritakyadi Varga. Ver. 196-197. Reprint Edition. Varanasi: Chaukhambha Bharti Academy Varanasi; 2002. p. 114.
Sharam PV, Translator. Charak Samhita of Agnivesha, Part-I, Sutra Sthana Ch. 4, Ver. 8-9. 7th
ed. Varanasi: Chaukhambha Orientalia; 2001. p. 24-5.
Srikantah Murthy KR, English Translation, Astanga Hridyam. Vol.- III Uttara Sthana. Ch. 21, Ver. 20. 2nd
ed. Varanasi: Krishanadas Academy; 1997. p. 188.
Pendyala G, Thomas B, Kumari S. The challenge of antioxidants to free radicals in periodontitis. J Indian Soc Periodontol 2008;12:79-83.
Jenkins S, Addy M, Wade W. The mechanism of action of chlorhexidine. A study of plaque growth on enamel inserts in vivo
. J Clin Periodontol 1988;15:415-24.
Lindhe J, Hamp SE, Löe H, Schiott CR. Influence of topical application of chlorhexidine on chronic gingivitis and gingival wound healing in the dog. Scand J Dent Res 1970;78:471-8.
Bhandari H, Shankwalkar GB. Clinical Assessment of Action of Combination of Indigenous Drugs on Dental Plaque, Calculus and Gingivitis. Dissertation Submitted to the University of Bombay; 1980.
Behal R, Mali AM, Gilda SS, Paradkar AR. Evaluation of local drug-delivery system containing 2% whole turmeric gel used as an adjunct to scaling and root planing in chronic periodontitis: A clinical and microbiological study. J Indian Soc Periodontol 2011;15:35-8.
Mali AM, Behal R, Gilda SS. Comparative evaluation of 0.1% turmeric mouthwash with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: A clinical and microbiological study. J Indian Soc Periodontol 2012;16:386-91.
Van der Weijden GA, Timmer CJ, Timmerman MF, Reijerse E, Mantel MS, van der Velden U. The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis. J Clin Periodontol 1998;25:399-403.
Leyes Borrajo JL, Garcia VL, Lopez CG, Rodriguez-Nuñez I, Garcia FM, Gallas TM, et al.
Efficacy of chlorhexidine mouthrinses with and without alcohol: A clinical study. J Periodontol 2002;73:317-21.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]
|This article has been cited by|
||Therapeutic effect of curcumin on oral diseases: A literature review
| ||Weilong Tang,Minquan Du,Shuang Zhang,Han Jiang |
| ||Phytotherapy Research. 2021; 35(5): 2287 |
|[Pubmed] | [DOI]|
||The effect of curcumin as an adjunct in the treatment of chronic periodontitis: A systematic review and meta-analysis
| ||Sherry Terby,Mohammed Shereef,Venkitachalam Ramanarayanan,Biju Balakrishnan |
| ||The Saudi Dental Journal. 2021; |
|[Pubmed] | [DOI]|
||Recent Development of Active Ingredients in Mouthwashes and Toothpastes for Periodontal Diseases
| ||Meenakshi Rajendiran,Harsh M Trivedi,Dandan Chen,Praveen Gajendrareddy,Lin Chen |
| ||Molecules. 2021; 26(7): 2001 |
|[Pubmed] | [DOI]|
||Novel natural product-based oral topical rinses and toothpastes to prevent periodontal diseases
| ||Isabelle Laleman,Wim Teughels |
| ||Periodontology 2000. 2020; 84(1): 102 |
|[Pubmed] | [DOI]|
||The Effect of Zufa Versus Chlorhexidine Gluconate Mouthwashes on Oral Flora of Patients Under Mechanical Ventilation in the Intensive Care Unit: A Double-Blind, Randomized Clinical Trial
| ||Abbasali Ebrahimian,Raheb Ghorbani,Mehrooz Alishah,Alieh Zamani,Niloofar Kianvash-Rad,Monir Nobahar |
| ||Iranian Red Crescent Medical Journal. 2019; In Press(In Press) |
|[Pubmed] | [DOI]|
||Clinical efficacy of turmeric use in gingivitis: A comprehensive review
| ||Karissa A. Stoyell,Jennifer L. Mappus,Mona A. Gandhi |
| ||Complementary Therapies in Clinical Practice. 2016; 25: 13 |
|[Pubmed] | [DOI]|