Anti–Plaque Efficacy of cure next Gel, Hoira-sa gel in Comparison with Chlorhexidine Gel. A Randomised Control trial Study

 

Janani¹, Priya Lochana Gajendran²

¹Graduate Student, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India

²Senior Lecturer, Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India

 

ABSTRACT:

AIM: To compare anti plaque efficacy of Cure next gel, Hoira-SA gel (Natural Herb Extracts) with Chlorhexidine gel among patients with mild to moderate gingivitis. OBJECTIVE: The objective of the study is to compare the anti-plaque efficacy of Natural Herb Extract Gels (Cure Next gel and Hoira-SA Gel) with Chlorhexidine gel in reducing plaque accumulation, gingival inflammation among patients with mild to moderate gingivitis. MATERIALS AND METHOD: 45 systemically healthy mild to moderate gingivitis patients are to be selected from the outpatient department of Saveetha Dental College. Patients were divided into three groups where in Group 1 (GP1) included 15 patients provided with Cure Next Sample, Group 2 (GP2) included 15 patients provided with Chlorhexidine sample; Group 3 (GP3) included 15 patients with Hoira-SA gel sample. Following randomization, the baseline values were recorded and supra gingival scaling and polishing was done. Patient was allotted in one of the three groups and instructions about usage of gel were given. Postoperative assessment was done after two weeks using Plaque Index and Bleeding Index. RESULT: There was a significant reduction found in the levels of mean plaque and bleeding scores assessed post operatively after two weeks of administration of gel samples in all the three groups. The plaque and bleeding scores were compared between the groups to assess the anti-plaque efficacy of the gel samples in comparison with chlorhexidine gel. CONCLUSION: This study revealed that all the three gels (Cure next gel, Chlorhexidine gel and Hoira gel) can be effectively used in plaque control for mild to moderate gingivitis patients. But while comparing Cure Next gel with Hoira gel, Cure next gel administration showed significant reduction in plaque accumulation similar to that of Chlorhexidine gel.

 

 

 

 

 

INTRODUCTION:

Maintenance of satisfactory gingival and periodontal health is essential to control inflammation and prevention of recurrence of periodontal diseases in dentistry^[1]. Thus, personal oral hygiene care forms one of the most important aspects of periodontal maintenance. Poor oral hygiene may result in marginal gingival inflammation thus paving way for increased periodontal destruction which in latter stages can manifest as periodontitis^[2]. Hence good oral hygiene maintenance in combination with proper professional care is necessary forachieving a good periodontal health along with prevention of gingival diseases^[3]. The conventional method for oral hygiene maintenance is the mechanical method of plaque control which requires motivation and proficiency for maintaining optimal oral hygiene^[4]. Mechanical plaque control methods form an established conventional means of oral hygiene maintenance, yet it does not tend to be an ideal method in plaque control due to patient’s compliance^[5]. Hence Chemical agents have been evolved to control plaque accumulation. Chlorhexidine gluconate gel is the gold standard chemotherapeutic agent used in chemical methods of plaque control^[6]. Though Chlorhexidine gel being the gold standard it has its own side effects which include staining of teeth and altered taste sensation^[7]. To overcome these side effects, the Natural Herb Extract gels like Hoira-SA Gel (Jasmine Topical) and Cure Next gel (Turmeric topical) can be used as alternatives if they found to have same efficacy as that of Chlorhexidine  gel ^[8].

 

Hence Chemical agents has been introduced which could be used as an adjunct to mechanical methods of plaque control^[9]. Among the various Chemical agents in use, Chlorhexidine gluconate forms the gold standard anti plaque agent^[10]. However, there are certain side effects observed on a long term usage of Chlorhexidine which included staining of teeth, altered taste sensations and resistance developed by certain microorganisms against the chemical agent^[11]. This forms the necessity to develop an alternative strategy that acts as an effective plaque control agent with least adverse effects ^[12]. Plant medicines with their naturally occurring active ingredients obtained from natural herbs could be used as an evolving strategy which has the major advantage of having no side effects along with effective efficacy in reduction of plaque accumulation and gingival inflammation^[13]. The aim of the study is compare the anti-plaque efficacy of two such natural herb extract gels, Cure Next gel which is a curcumin extract and Hoira-SA gel which is a Jasmine extract with Chlorhexidine gel in a randomized control trial.

 

MATERIALS AND METHODS:

The present study was a randomized, clinical trial done to compare the anti-plaque efficacy of Cure next gel and Hoira-SA gel with Chlorhexidine gel after supra gingival scaling and polishing. The study participants were selected after obtaining written information consent. The selected patients were also informed about the objective, methodology and risks and benefits of the research study before obtaining the informed consent. A total 60 patients who walked in outpatient department of Saveetha Dental College were assessed for eligibility out of which 45 patients were randomized based on the inclusion and exclusion criteria.

 

INCLUSION CRITERIA:

·        Patients aged between 20-45 years.

·        Free from systemic disorders.

·        Patients having a minimum of twenty permanent teeth

·        Should be diagnosed with mild to moderate gingivitis with mean plaque and bleeding score of 1.5

·        Patients who offer willing informed consent to complete the research.

 

EXCLUSION CRITERIA:

·        Patients of older age group.

·        Patients with partially edentulous ridges.

·        Patients with systemically and medically compromised disorders.

·        Patients diagnosed with chronic periodontitis with deep periodontal pockets exceeding 6mm.

·        Patients with allergy to any chemical or herbal products.

·        Patients with habits of chewing tobacco or pan and smoking.

·        Patients with orthodontic fixed or removable appliance.

·        Denture wearers.

 

Out of 60 patients assessed for eligibility based on inclusion and exclusion criteria, 45 participants were selected for the research study and they were randomly grouped in one of the three groups where in Group 1 patients (GP1) were given Cure Next gel sample; Group 2 patients (GP2) were given Hoira gel sample and Group 3 patients were given Chlorhexidine gel sample. The baseline values were assessed using Plaque Index and Bleeding Index where in all four surfaces of each tooth present were examined and over all scoring was obtained by calculating the average of all scores in both Gingival and Plaque Index. Following which, supragingival scaling and polishing was done. Patients were allotted in one of the three mentioned groups and instructions about the usage of gel were given where in patient was advised to use 2cm of gel on a moistened toothbrush and apply evenly all over the surface of the mouth and spit the gel out after brushing twice a day as per manufacturer’s guidance for period of 20 days. The post interventional plaque and bleeding scores were again assessed after a time of 20 days and the results were statistically analyzed.

 

The results were statistically analyzed using one way ANOVA test and Friedman test. The statistical significance value was fixed at 0.05

 

RESULTS:

A total of 45 participants completed the research study. Table 1 represents the age and gender distribution of study participants. There was a significant reduction in plaque accumulation of patients between baseline and post-operative intervention in each group as shown in table 2 and figure 1. There was a significant reduction in bleeding score of patients between baseline and post-operative intervention in each group as shown in table 3 and figure 2. None of the participants had side effects such as burning sensation, altered taste sensation and ulcerations during the process of study.

 

Table1: Age and gender distribution of study participants.

Name of the group	n	Mean Age	Std. deviation	Gender
				Males	Females
Group 1(GP1)	15	31.40	6.854	5(33%)	10(77%)
Group 2(GP2)	15	34.20	6.646	6(40%)	9(60%)
Group 3(GP3)	15	36.27	6.386	11(73%)	4(27%)
Total	45	33.96	6.786	22(49%)	23(51%)

*ANOVA and Chi Square Test Applied

 

Table 2: Mean plaque score.

Table 2 Groups	Mean±SD			Statistical Inference
	Baseline value		Post-Operative
GP 1	1.63+0.21	0.75+0.20		0.00
GP 2	1.71+0.22	1.2+0.25		0.00
GP 3	1.92+0.42	0.83+0.19		0.00

*Paired Sample Test Applied(p value≤0.05)

Table 2 represents the mean plaque score obtained before and after treatment which shows there is a statistical significant difference in all the three groups thus suggesting all the three gels can be used effectively in plaque control for gingivitis patients.

 

TABLE 3: MEAN BLEEDING SCORE:

Groups	Mean±SD		Statistical Inference
	Baseline value	Post-Operative
GP1	2.18+0.44	1.32+0.15	0.00
GP2	2.47+0.47	1.7+0.38	0.00
GP3	2.52+0.35	1.49+0.40	0.00

*Paired Sample Test Applied (p value≤0.05)

 

Table 3 represents the mean bleeding score obtained before and after treatment which shows there is a statistical significant difference in all the three groups thus suggesting all the three gels in preventing gingivitis when used along with mechanical plaque control.

 

 

 

 

 

 

 

Figure 1: bar graph representation of plaque index before and after treatment of all three groups.

 

 

Figure 2: Bar Graph Representation Of Bleeding Index Before And After Treatment

 

 

 

DISCUSSION:

Periodontal diseases refer to the conditions affecting the supporting apparatus of the tooth structure^[14]. Gingivitis forms the mildest or initial stage of the disease affecting the gums whose etiology in general is due to improper oral hygiene maintenance. The foremost sign of Gingivitis is bleeding gums with evident plaque and calculus accumulation. On a longer duration, gingivitis when left treated may progress to periodontitis which is a condition of irreversible destruction of periodontal structures leading to tooth loss ^[15]. Thus plaque control methods were introduced to minimize the bacterial effect on tooth structure and to improve oral hygiene maintenance ^[16].

 

Mechanical method of plaque control forms an established method of oral hygiene maintenance. But due to patient’s compliance, complete plaque eradication is difficult to achieve in majority of the population^[17]. For this reason, there were many chemotherapeutic agents evolved to control plaque accumulation with the objective of improving oral hygiene maintenance of the patient. These chemotherapeutic agents on a longer run produce certain adverse effects which include staining of the teeth, altered taste sensation, oral ulcers and induce microbial resistance. Hence there were lot of researches carried on active ingredients obtained from plant and its by products which has anti-bacterial and anti-inflammatory properties for the treatment of gingival and periodontal diseases^[18].

 

In this study, anti-plaque efficacy of two natural herb extract gels which included Cure Next gel and Hoira gel were compared with chemical extract Chlorhexidine gel for a period of two weeks. There was a significant reduction in plaque accumulation assessed with the help of plaque and bleeding index detected in patients with mild to moderate gingivitis compared to the baseline values in all the three groups. This signifies the antibacterial efficacy of these gels when used along with mechanical debridement.

 

CONCLUSION:

The statistical analysis along with the results obtained in this study indicates that these gels can be used as auxiliary aid to mechanical methods of plaque control. However, the ant plaque efficacy of these gels in patients with advanced form of periodontal disease requires consideration.

 

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Accepted on 18.06.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(8): 3689-3692.