GUM ASTRINGENTS MYTH OR REALITY ?

Dr. Richard Pereira* Abstract Plaque and calculus are established local etiologic factors resulting in periodontal disease. Removal of these local irritants and oral hygiene maintenance are the mainstay of routine periodontal therapy. Several measures in the form of astringents are also available and are promoted to serve as adjuncts to oral prophylaxis. The purpose of our study was to compare 2 proprietary gum astringents and evaluate their efficacy and also to find out whether these astringents are useful adjuncts to scaling and root planing. ! patients were divided into groups using the 2 different astringents and this was compared to a control group of "! patients who underwent only oral prophylaxis. The results after the # day study showed that gum astringents can serve as useful adjuncts to routine scaling and root planing. Introduction It has been well documented that local actors es!ecially dental !la"ue is one o the main actors or the initiation o #in#ival and !eriodontal disease$. Su!ra#in#ival !la"ue control is undoubtedly an e ective method o controllin# #in#ivitis %&oe et al '()*+ ' and is an im!ortant com!onent o !eriodontal thera!y. ,owever- there are also several chemothera!eutic astrin#ents available in the mar.et which are routinely !romoted as e ective adjuncts to oral !ro!hyla/is and mechanical !la"ue control0. 1inc sul!hate is available as $2 solution while. 3um #el is a herbal ormulation- both o which are recommended as anti4in lammatory dru#s or #in#ivitis. Dr. Soumya J. Shetty* Dr. Vijay K. Chava**

* Post#raduate students **Reader S.D.5. Colle#e o Dental Sciences- Dharwad '

6he aim o the study was there ore to evaluate and com!are the e icacy o a $2 7inc sul ate lotion and 3um #el as adjuncts to thera!y over a one wee. !eriod. Materials and Methods 8ach tube o 3um #el %,imalaya Dru# Co.+ contained a ormulation with !otent herbs- com!risin# mainly o 9antho/ylym alatum- 6ri!halaPunica #ranatum- Vite/ ne#unda- 8mbelia ribes and :l!enia #alan#a. 6he $2 7inc sul!hate lotion used was mar.eted under the name o 1in#isol %$;ml- ICP: health !roducts &td.+. Experimental design 0 #rou!s o 0; subjects were entered into a randomi7ed double blind- !arallel desi#n ty!e o study. 6he se/tant under study was the %&+ anteriors %00 to <0+. Subject selection criteria: 6he ollowin# subjects were entered into the study= subjects with> 4 4 4 4 ?o history o systemic disease. ?o history o any dru# inta.e in the last 0 months. ?o history o any local dru# a!!lication in last 0 months. 5oderate #in#ivitis with a #in#ival inde/ score o '.'4$.'. %&oe and Silness+ : ter selection- subjects received oral !ro!hyla/is and were randomly allotted to one o the ollowin# #rou!s> 3rou! I @ Control > Aral !ro!hyla/is B #um massa#e with water. 3rou! II @ 6est : > Aral !ro!hyla/is B 1nSA< a!!lication. 3rou! III @ 6est C > Aral !ro!hyla/is B 3um #el a!!lication.

6he !atients were then instructed in the Cass method o brushin#- to be !racticed twice daily alon# with the a!!ro!riate instructions accordin# to the #rou! allotted. Method and duration of application of astringents: 6he a!!ro!riate subjects were instructed to use either the 7inc sul ate D #um #el thrice daily by massa#in# the same on the #ums or ' minute daily. 6hey were instructed not to eat- drin. or rinse or 0; minutes a ter a!!lication. Com!liance was maintained by as.in# the !atient to return with the allotted sam!les- durin# recall visits. Clinical indices Clinical inde/ scorin# was carried out by one investi#ator. 6he area assessed was the lower anterior re#ion rom 00 to <0. :ll !atients were assessed at baseline ' D $ D 0 D ) days or the #in#ival inde/ %&oe and Silness- '()0+. 3in#ival inde/ $%oe and Silness& "'# ( ; 4 ' 4 $ 4 0 4 ?ormal #in#iva. 5ild in lammation- sli#ht chan#e in colour- sli#ht edema= no bleedin# on !al!ation. 5oderate in lammation- redness- edema and #la7in#= bleedin# on !al!ation. Severe in lammation- mar.ed redness and edema- ulcerations= tendency to s!ontaneous bleedin#.

Results
Com!arin# the results on day ' a ter a!!lication we ound that there was a si#ni icant di erence between the #um !aint #rou! %3P+ and control #rou!. 6here was hi#hly si#ni icant di erence between 3um #el %33+ and control #rou!s. ,owever there was no si#ni icant di erence between the two astrin#ents namely 33 and 3P #rou!s. Table sho in! co"#arison o$ "ean di$$erence bet een !rou#s $ro" baseline to da% &
Period Group I II ;4' I III II III Mean ;.$) ;.0) ;.$) ;.<( ;.0) ;.<( S.D. ;.;E< ;.;() ;.;E< ;.$;G ;.;() ;.$;G p- alue F;.;* Significance S

F;.;;'

,S

H;.;*

?S

Gr aph I : Showing compar ison of mean difference between gr oups from baseline to day 1
0.49 0.5 0.45 0.4 0.35 0.3 Mean 0.25 0.2 0.15 0.1 0.05 0 Group I Group II Groups Group III 0.26 0.36

<

Similarly on day $ a ter a!!lication- there was si#ni icant di erence between #um astrin#ents and control #rou! while a#ain there was no si#ni icant di erence between either #um astrin#ents. Table sho in! co"#arison o$ "ean di$$erence bet een !rou#s $ro" baseline to da% '
Period Group I II ;4$ I III II III Mean ;.)' ;.E< ;.)' ;.E; ;.E< ;.E; S.D. ;.$'0 ;.$$G ;.$'0 ;.'00 ;.$$G ;.'00 p- alue F;.;* Significance S

F;.;*

H;.;*

?S

Gr aph II : Showing c ompar ison of mean differ ence between gr oups fr om baseline to day 2

0.9 0.8 0.7 0.6 Mean 0.5 0.4 0.3 0.2 0.1 0 Group I 0.61

0.84

0.8

Group II Groups

Group III

An day 0- once a#ain similar results were observed- with #um astrin#ents !rovin# to be better than the control #rou!. Table sho in! co"#arison o$ "ean di$$erence bet een !rou#s $ro" baseline to da% '
Period Group I II ;40 I III II III Mean ;.E$ ;.(( ;.E$ '.;0 ;.(( '.;0 S.D. ;.'(E ;.'() ;.'(E ;.;(< ;.'() ;.;(< p- alue F;.;* Significance S

F;.';

H;.;*

?S

Gr aph III : Showing c omparison of mean differenc e between gr oups from baseline to day 3

1.2 1 0.8 Mean 0.6 0.4 0.2 0 Group I

0.99 0.82

1.03

Group II Groups

Group III

: ter ' wee. o a!!lication yet a#ain- #um astrin#ents consistently o ered si#ni icantly better results than the control #rou! but a#ain- no di erence in e icacy was seen between either #um #el or 1nSo <. Table sho in! co"#arison o$ "ean di$$erence bet een !rou#s $ro" baseline to da% '
Period Group I II ;4) I III II III Mean '.;E '.0* '.;E '.$( '.0* '.$( S.D. ;.$;( ;.'*; ;.$;( ;.'E* ;.'*; ;.'E* p- alue F;.;;' Significance S

F;.;*

H;.;*

?S

Gr aph IV : Showing compar ison of mean differ ence between gr oups fr om baseline to day 6 1.35 1.4 1.2 1 0.8 Mean 0.6 0.4 0.2 0 Group I Group II Groups Group III 1.08 1.29

(iscussion
:strin#ents are a#ents which act by !reci!itatin# blood !roteinscausin# a mechanical obstruction to hemorrha#e rom injured blood vessels. Various astrin#ents li.e tannic acid- 7inc sul!hate and herbal ormulations are !romoted in the mar.et to aid as adjuncts to routine oral !ro!hyla/is. 1inc salts !ossess astrin#ent- corrosive and wea. antise!tic !ro!erties. 8/ternally 7inc sul!hate is used as an astrin#ent lotion to assist #ranulation ormation. 3um #el is a herbal ormulation also !romoted to have an astrin#ent e ect and meant or treatment or #in#ivitis. Cein# a herbal derivative- it is believed to be sa er with lesser adverse e ects. Removal o local irritants by scalin# and root !lanin# is

undoubtedly the mainstay o initial !eriodontal thera!y. 6he aim o this study was to evaluate whether these astrin#ents could be used as adjuncts to thera!y. Interestin#ly results showed that astrin#ents did show a si#ni icant reduction in in lammation as com!ared to only oral !ro!hyla/is. ,owever there was no si#ni icant di erence between the $ astrin#ents at any !oint in time durin# the ) day study !eriod.

)onclusion
:strin#ents showed si#ni icant reduction in lammation as com!ared to !lain oral !ro!hyla/is but no si#ni icant di erence was seen between the two astrin#ents tested. 6hese indin#s rom the above study #o to !rove that #um astrin#ents can serve as e ective adjuncts to thera!y. 6hey may there ore not be a !lain myth but !ossibly a reality.

Re$erences
'. Loe H*+ Theilade E*+ ,a"es S*-* > 8/!erimental #in#ivitis in man. )ournal of Periodontology& '()*= 0) > 'GG4'EG. $. List!arten M*A* > 6he role o dental !la"ue in #in#ivitis and !eriodontitis. )ournal of *linical Periodontology& '(EE= '* > <E*4 <EG. 0. Mandel I*(* .&/001 > Chemothera!eutic a#ents or controllin# !la"ue and #in#ivitis. )ournal of *linical Periodontology& '* > <EE4 <(E. <. Satos2ar R*S*+ -handar2ar S*(*+ Aina#ure S*S* > Pharmacolo#y and Pharmacothera!eutics. ')th 8dition- '(((.