A clinical trial evaluates the effect of pomegranate extract as a mouth wash for gingivitis in type 2 diabetic patients
DOI:
https://doi.org/10.15218/edj.2020.04Keywords:
gingivitis, pomegranate peel, chlorhexidine.Abstract
Background and Objectives: Type-2 diabetes mellitus (T2DM) is a systemic disease which have higher incidence of gingivitis and periodontitis. Pomegranate peel has higher content of phenolic compounds with potent anti-inflammatory, antioxidant and antibacterial activity. The aim is to evaluate the efficacy of pomegranate peel extract on the clinical and biochemical measures of (IL-1β) and the enzyme (AST) in saliva of (T2DM) patients suffering from gingivitis in comparison with chlorhexidine.
Patients and Methods: A randomized controlled clinical trial on 45 (T2DM) patients, both sexes with moderate gingivitis, age 40-55 years, (Hb1Ac) < 7%. They were randomly assigned to 3 groups undergo scaling and polishing, (15) for each group, group 1 used chlorhexidine mouthwash (0.12%), group 2 used pomegranate peel extract (6.25%) and group 3 pomegranate peel extract (12.5%). Before and after 14 days, PI, GI, BOP, salivary IL-1β and AST were evaluated.
Results: All the results for both biochemical and clinical parameters in the three groups showed significant reduction after 14 days of treatment except for the salivary IL-1β in group 1. No significant difference between group1 and group 2 except for PLI and group1 and group 3 except for IL-1β, while significant differences between group 2 and 3 after 14days of treatment except for the salivary AST, with no side effects associated with the use of pomegranate peel extract as a mouthwash at both concentrations.
Conclusion: pomegranate peel extract could be considered more effective in treating gingivitis especially at the high concentration with no considerable side effects comparing to chlorhexidine.
References
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12. Saad S, Ali MN, Dahamm SS. Studies on antibacterial and antifungal activity of pomegranate. American-Euroasian J Agric and Environ Sci 2010; 9(3):273-81.
13. Prakash CVS, Prakash I. Bioactive chemical constituents from pomegranate (Punica granatum) juice, seed and peel- A Review. Int J Res Chem Environ 2011; 1:1-18.
14. Li y, Guo C, Yang J, Wei J, XU J, Cheng S. Evaluation of antioxidant properties of pomegranate peel extract in comparison with pomegranate pulp extract. Food chemistry 2006; 96(2):254-60.
15. Park S, Seok JK, Kwak JY, Suh H, Kim YM, Boo CY. Anti-inflammatory effects of pomegranate peel extract in THP-1 cells exposed to particulate matter PM10. Evidence-Based Complementary and Alternative Medicine 2016; e6836080. doi.org/10.1155/2016/6836080.
16. Sherwanin SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights 2016; 11: 95–104. doi.org/10.4137/BMI.S38440.
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20. Nobrega MDR, Santos RL, Soares RSC, Alves PM, Medeiros ACD, Pereira JV. A randomized controlled clinical trial on the clinical and microbiological efficacy of Punica granatum Linn mouthwash. Braz Res Pediat Dent and Integrated Clinic 2015; 15(1):301-8.
21. Badawi ME, Gomaa AM. Influence of diets supplemented with pomegranate peel extract on performance in Oreochromus niloticus. Japanese Journal of Veterinary Research 2016; 64(Suppl2): S87-S94.
22. Rasheed Z, Akhtar N, Anbazhagan AN, Ramamurthy S, Shukla M, Haqqi TM. Polyphenol-rich pomegranate fruit extract (POMx) suppresses PMACI-induced expression of proinflammatory cytokines by inhibiting the activation of MAP Kinases and NF-κB in human KU812 cells. J Inflamm (Lond) 2009; 6: 1. doi.org/10.1186/1476-9255-6-1.
23. Noda Y, Kaneyuki T, Mori A, Packer L. Antioxidant activities of pomegranate fruit extract and its anthocyanidins: delphinidin, cyanidin, and pelargonidin. J Agric Food Chem 2002; 50(1):166-71.
24. Bhavna, JK, Vidhya D. Herbal mouthwash - A gift of nature. Int J Pharma and Bio Sci 2012; 3(2):47-52.
25. Kote S, Kote S, Nagesh L. Effect of pomegranate juice on dental plaque microorganisms. Anc Sci Life 2011; 31(2):49-51.
26. Menezes SM, Cordeiro LN, Viana GS. Punica granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother 2006; 6(2):79-92.
27. Leo H, Schiott C. The effect of mouthrinse and topical application of chlorhexidine on the development of dental plaque and gingivitis. J Periodontol Res 1970; 5:79-83.
28. Cascaes AM, Clark VL, Barros AJ. Effectiveness of motivational interviewing at improving oral health: a systematic review. Rev Saude Publica 2014; 48(1):142-53.
29. Zannatta FB, Antoniazzi RP, Rosing CK. Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial. J Appl Oral Sci 2010; 18(5):515–21.
30. Prakash J, Bhatnagar V, Nath S, Pulikkotil S, Prajapati VK. Effect of punica granatum extract gel on gingival crevicular fluid levels of interleukin1β, interleukin-8 and CCL28 levels: Randomized controlled clinical trial. Journal of Clinical and Diagnostic Research 2017; 11(11): ZC12-ZC1712.
31. Rahimabadi MS, Fani M, Rostami M, Zarshenas MM, Shams M. A traditional mouthwash (Punica granatum var pleniflora) for controlling gingivitis of diabetic patients. J Evid Based Complementary Altern Med 2017; 22(1):59–67.
32. Vechis BS. 0.1% chlorhexidine mouthwash for gingival inflammation in diabetic adults: double blind study. J Periodontol 1989; 8(3):299-310.
33. Ahuja S, Dodwad V, Kukreja BJ, Mehra P, Kukreja P. A comparative evaluation of efficacy of Punica granatum and chlorhexidine on plaque and gingivitis. J Int Clin Dent Res Organ 2011; 3(1):29-32.
34. Houri HY, Halabi A, Soskolne WA. Inflammatory response to chlorhexidine, minocycline HCl and doxycycline HCl in an in vivo mouse model. J Clin Periodontol 2008; 35(9):783-8. doi.org/10.1111/ j.1600-051X.2008.01290.x.
35. Vaughan ME, Garnick JJ. The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery. J Periodontol 1989.; (12):704-08.
36. Sastravaha G, Gassmann G, Sangtherapitikul P, Grimm WD. Adjunctive periodontal treatment with centella asiatica and punica granatum extracts in supportive periodontal therapy. J Int Acad Periodontol 2005; 7(3):70-9.
37. Türkoğlu O, Becerik S, Emingil G, Kütükçüler N, Baylas H, Atilla G. The effect of adjunctive chlorhexidine mouthrinse on clinical parameters and gingival crevicular fluid cytokine levels in untreated plaque-associated gingivitis. Inflamm Res 2009; 58(5):277-83.
38. Andriankaja OM, Barros SP, Moss K, Panagakos FS, DeVizio W, Beck J, Offenbacher S. Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E (2) among non-smoking subjects with gingivitis and type 2 diabetes. J Periodontol 2009; 80(2):307-16. doi.org/10.1902/jop.2009.080385.
39. Shukla M, Gupta K, Rasheed Z, Khan AK, Haqqi TM. Bioavailable constituents/metabolites of pomegranate (Punica granatum L) preferentially inhibit COX2 activity ex vivo and IL-1betainduced PGE2 production in human chondrocytes in vitro. J Inflamm (Lond) 2008; 5:9
40. Deepali C Mahajan, Usha SS, Pratima AT, Vikram AN. Evaluation of punica granatum fruit peels extract for its free radical scavenging and antiinflammatory activity. International Journal of Pharmacy and Pharmaceutical Sciences 2015; 7.
2. Radhika T, Kannan R. Diabetes mellitus and oral health. J Orofac Sci 2012; 4(1): 7-10.
3. Naemiratch B, Manderson L. Lay Explanations of type2 diabetes in Bangkok, Thailand. Anthropology and Medicine 2007; 14(1):83-94.
4. Katagiri S, Nitta H, Nagasawa T, Izumi Y, Kanazawa M. Effect of glycemic control on periodontitis in type 2 diabetic patients with periodontal disease. J Diabetes Investig 2013; 4(3):320–5.
5. Salgado AD, Maia JL, Pereira SL, Lemos TL, Mota OM. Antiplaque and antigingivitis effects of a gel containing punica granatum linn extract: a double - blind clinical study in humans. J Appl Oral Sci 2006; 14:162-66.
6. Orzoco A, Gemmell E, Bickel M, Seymour GJ. Interleukin-1beta, interleukin-12 and interleukin-18 levels in gingival fluid and serum of patients with gingivitis and periodontitis. Oral Microbial Immunol 2006; 21 (4):256-60.
7. Michael W. Salivary biomarker of periodontal disease in response to treatment. J Clin Periodontol 2011; 38(5):434-41.
8. Totan A, Greabu M, Totan C, Spinu T. Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases. Clin Chem Lab Med 2006; 44(5):612-5.
9. Dabra S, China K, Kaushik A. Salivary enzymes as diagnostic markers for detection of gingival/ periodontal disease and their correlation with the severity of the disease. J Indian Soc PeriodontoL 2012; 16(3):358-64. doi.org/10.4103/0972-124X.100911.
10. Zhang L, Henson BS, Camargo PM, Wong DT. The clinical value of salivary biomarkers for periodontal disease. J Periodontol 2009; 51:25- 37.
11. Lee CJ, Liang WL, Chen LG, Wang CC. Anti inflammatory effects of punica granatum linne in vitro and vivo. J Food Chem 2010; 118:315-22.
12. Saad S, Ali MN, Dahamm SS. Studies on antibacterial and antifungal activity of pomegranate. American-Euroasian J Agric and Environ Sci 2010; 9(3):273-81.
13. Prakash CVS, Prakash I. Bioactive chemical constituents from pomegranate (Punica granatum) juice, seed and peel- A Review. Int J Res Chem Environ 2011; 1:1-18.
14. Li y, Guo C, Yang J, Wei J, XU J, Cheng S. Evaluation of antioxidant properties of pomegranate peel extract in comparison with pomegranate pulp extract. Food chemistry 2006; 96(2):254-60.
15. Park S, Seok JK, Kwak JY, Suh H, Kim YM, Boo CY. Anti-inflammatory effects of pomegranate peel extract in THP-1 cells exposed to particulate matter PM10. Evidence-Based Complementary and Alternative Medicine 2016; e6836080. doi.org/10.1155/2016/6836080.
16. Sherwanin SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights 2016; 11: 95–104. doi.org/10.4137/BMI.S38440.
17. Silness J, Loe H. Periodontal disease in pregnancy ІІ. Correlation with oral hygiene and periodontal condition. Acta Odont Scand 1964; 22:121-35.
18. Ainamo D, Bay I. Problems and protocols for recording gingivitis and plaque. Int Dent D 1975; 25(4):229-35.
19. Loe H and Silness J. Periodontal disease in pregnancy 1. Prevalence and severity. Acta Odont Scand 1963; 21:533-37.
20. Nobrega MDR, Santos RL, Soares RSC, Alves PM, Medeiros ACD, Pereira JV. A randomized controlled clinical trial on the clinical and microbiological efficacy of Punica granatum Linn mouthwash. Braz Res Pediat Dent and Integrated Clinic 2015; 15(1):301-8.
21. Badawi ME, Gomaa AM. Influence of diets supplemented with pomegranate peel extract on performance in Oreochromus niloticus. Japanese Journal of Veterinary Research 2016; 64(Suppl2): S87-S94.
22. Rasheed Z, Akhtar N, Anbazhagan AN, Ramamurthy S, Shukla M, Haqqi TM. Polyphenol-rich pomegranate fruit extract (POMx) suppresses PMACI-induced expression of proinflammatory cytokines by inhibiting the activation of MAP Kinases and NF-κB in human KU812 cells. J Inflamm (Lond) 2009; 6: 1. doi.org/10.1186/1476-9255-6-1.
23. Noda Y, Kaneyuki T, Mori A, Packer L. Antioxidant activities of pomegranate fruit extract and its anthocyanidins: delphinidin, cyanidin, and pelargonidin. J Agric Food Chem 2002; 50(1):166-71.
24. Bhavna, JK, Vidhya D. Herbal mouthwash - A gift of nature. Int J Pharma and Bio Sci 2012; 3(2):47-52.
25. Kote S, Kote S, Nagesh L. Effect of pomegranate juice on dental plaque microorganisms. Anc Sci Life 2011; 31(2):49-51.
26. Menezes SM, Cordeiro LN, Viana GS. Punica granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother 2006; 6(2):79-92.
27. Leo H, Schiott C. The effect of mouthrinse and topical application of chlorhexidine on the development of dental plaque and gingivitis. J Periodontol Res 1970; 5:79-83.
28. Cascaes AM, Clark VL, Barros AJ. Effectiveness of motivational interviewing at improving oral health: a systematic review. Rev Saude Publica 2014; 48(1):142-53.
29. Zannatta FB, Antoniazzi RP, Rosing CK. Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial. J Appl Oral Sci 2010; 18(5):515–21.
30. Prakash J, Bhatnagar V, Nath S, Pulikkotil S, Prajapati VK. Effect of punica granatum extract gel on gingival crevicular fluid levels of interleukin1β, interleukin-8 and CCL28 levels: Randomized controlled clinical trial. Journal of Clinical and Diagnostic Research 2017; 11(11): ZC12-ZC1712.
31. Rahimabadi MS, Fani M, Rostami M, Zarshenas MM, Shams M. A traditional mouthwash (Punica granatum var pleniflora) for controlling gingivitis of diabetic patients. J Evid Based Complementary Altern Med 2017; 22(1):59–67.
32. Vechis BS. 0.1% chlorhexidine mouthwash for gingival inflammation in diabetic adults: double blind study. J Periodontol 1989; 8(3):299-310.
33. Ahuja S, Dodwad V, Kukreja BJ, Mehra P, Kukreja P. A comparative evaluation of efficacy of Punica granatum and chlorhexidine on plaque and gingivitis. J Int Clin Dent Res Organ 2011; 3(1):29-32.
34. Houri HY, Halabi A, Soskolne WA. Inflammatory response to chlorhexidine, minocycline HCl and doxycycline HCl in an in vivo mouse model. J Clin Periodontol 2008; 35(9):783-8. doi.org/10.1111/ j.1600-051X.2008.01290.x.
35. Vaughan ME, Garnick JJ. The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery. J Periodontol 1989.; (12):704-08.
36. Sastravaha G, Gassmann G, Sangtherapitikul P, Grimm WD. Adjunctive periodontal treatment with centella asiatica and punica granatum extracts in supportive periodontal therapy. J Int Acad Periodontol 2005; 7(3):70-9.
37. Türkoğlu O, Becerik S, Emingil G, Kütükçüler N, Baylas H, Atilla G. The effect of adjunctive chlorhexidine mouthrinse on clinical parameters and gingival crevicular fluid cytokine levels in untreated plaque-associated gingivitis. Inflamm Res 2009; 58(5):277-83.
38. Andriankaja OM, Barros SP, Moss K, Panagakos FS, DeVizio W, Beck J, Offenbacher S. Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E (2) among non-smoking subjects with gingivitis and type 2 diabetes. J Periodontol 2009; 80(2):307-16. doi.org/10.1902/jop.2009.080385.
39. Shukla M, Gupta K, Rasheed Z, Khan AK, Haqqi TM. Bioavailable constituents/metabolites of pomegranate (Punica granatum L) preferentially inhibit COX2 activity ex vivo and IL-1betainduced PGE2 production in human chondrocytes in vitro. J Inflamm (Lond) 2008; 5:9
40. Deepali C Mahajan, Usha SS, Pratima AT, Vikram AN. Evaluation of punica granatum fruit peels extract for its free radical scavenging and antiinflammatory activity. International Journal of Pharmacy and Pharmaceutical Sciences 2015; 7.
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2020-06-06
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Ghazi S, Baban DA, Aziz SM. A clinical trial evaluates the effect of pomegranate extract as a mouth wash for gingivitis in type 2 diabetic patients. EDJ [Internet]. 2020 Jun. 6 [cited 2024 Apr. 19];3(1):24-32. Available from: https://edj.hmu.edu.krd/index.php/journal/article/view/76
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