Issues‎ > ‎SDJ, Vol.4, No.1, 2017‎ > ‎

sdj-10065

Anti-Inflammatory Effects of Prepared Punica Granatum Mouthwash on Patients with Moderate Gingivitis

*Chenar A. Mohammed, **Amal H. Aziz, **Shima G. Thanoon   Y

*   Department of Periodontics, College of Dentistry, Hawler Medical University, Erbil, Iraq.
** Department of Oral Diagnosis, College of Dentistry, Hawler Medical University, Erbil, Iraq.

DOI: https://doi.org/10.17656/sdj.10065

Abstract

Objective: Punica granatum is a herbal product used in the field of dentistry which has many potential effects including  bactericidal, antifungal, antiviral, and immune modulation. This study aimed to evaluate the effect of prepared Punica  granatum as an antiplaque and anti-inflammatory agent in the treatment of gingival inflammation. 

Methods: Sixty patients were enrolled in this study. Fourty five patients with moderate gingivitis were divided randomly into 3 groups; chlorhexidine group included 15 patients received once-daily dose of chlorhexidine mouthwash for 1 day, Punica I group included 15 patients received once-daily dose of Punica mouthwash for 1 day, and Punica II group included 15 patients received once-daily dose of Punica mouthwash for 2 consecutive days. Plaque index, gingival index, and bleeding on probing were assessed before rinsing and after 3 and 7 days of rinsing, also saliva were collected before rinsing and after 1 hour, 2 hrs, 1 and three days of rinsing to estimate the level of interleukine-1β. The rest 15 subjects were with clinically healthy gingiva. 

Results: Punica II group resulted in significant reduction of plaque index, gingival index, and bleeding on probing after 3 and 7 days of rinsing (p≤0.05) but with non-significant differences with chlorhexidine group (p>0.05). It had significant effect in reduction of interleukine-1β which begin after one day of rinsing and continued into three days (p≤0.05).

Conclusions: Punica like chlorhexidine has a positive effect on reduction of plaque accumulation and improvement of gingival inflammation so can be used as an anti-plaque and anti-inflammatory agent in the treatment of gingival inflammation.                                                                                          

                                                                                                                                                                                                                                                                                                                                                      Full Article - PDF

Keywords: Punica Granatum, Gingivitis, Chlorhexidine, Mouthwash, Interleukine-1β.

References:
1. Ahuja S, Dodwad V, Kukreja BJ, Mehra P, Kukreja P. A comparative evaluation of the efficacy of Punica Granatum and chlorhexidine on plaque and gingivitis. J Int Clin Dent Res Organ. 2011;3(1):29-32.
2. Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965;36:177-87. 
3. Turkoglu O, Emingil G, Kutukculer N, Atilla G. Gingival crevicular fluid levels of cathelicidin LL-37 and interleukin-18 in patients with chronic periodontitis. J Periodontol. 2009;80(6):969-76.
4. Yucel OO, Berker E, Gariboglu S, Otlu H. Interleukin-11, interleukin-1β, interleukin-12 and the pathogenesis of inflammatory periodontal diseases. J Clin Periodontol. 2008;35(5):365-7.
5. Orozco A, Gemmell E, Bickel M, Seymour GJ. Interleukin-1β, interleukin-12 and interleukin-18 levels in gingival fluid and serum of patients with gingivitis and periodontitis. Oral Microbiol Immunol. 2006;21(4):256-60.
6. Somu CA, Ravindra S, Ajith S, Ahamed MG. Efficacy of a herbal extract gel in the treatment of gingivitis: A clinical study. J Ayurveda Integr Med. 2012;3(2):85-90.
7. Jolkovsky DL, Ciancio SG. Chemotherapeutic Agents. In: Takei HH, editor. Carranza's clinical periodontology, 10th ed. Missouri: Saunders Company. 2006;798–812.
8. Bonesvoll P, Lökken P, Rölla G, Paus PN. Retention of Chlorhexidine In The Human Oral Cavity After Mouth Rinses. Arch Oral Biol .1974;19(3): 209-12.
9. Abdollahzdeh SH, Mashouf R, Mortazavi H, Moghaddam M, Roozbahani N, Vahedi M. Antibacterial and Antifungal activities of Punica Granatum Peel extracts against Oral Pathogens. J Dent (Tehran). 2011;8(1):1–6. 
10. GomesLivia AP, Mara AF, Ros Ld, rio Palma A, Corr, a Geraldo BM, et al. Punica Granatum L.(Pomegranate) Extract: in vivo study of antimicrobial activity against porphyromonas gingivalis in galleria mellonella model. The Scientific World Journal. 2016; 2016:5.
11. Silness J, Loe H. Periodontal disease in pregnancy. Ii. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand. 1964;22: 121-35.
12. Löe H, Silness J. Periodontal disease in pregnancy. I. Prevelance and severity. Acta Odontolgica Scand. 1963;21:533-51.
13. Löe H. The gingival index, the plaque index, and the retention index systems. J Periodontol. 1967;38(6):610.
14. Newman MG, Taki HH, Klokkevold PR.Caranza FA. Caranza ́s clinical periodontology. 10th ed. Missouri: Saunders Elsevier, Philadelphia, USA. 2007;115-116.
15. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-35.
16. 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
17. Overholser CD, Meiller TF, DePaola LG, Minah GE, Niehaus C. Comparative effects of 2 chemotherapeutic mouthrinses on the development of supragingival dental plaque and gingivitis. J Clin Periodontol. 1990;17(8):575-9.
18. Haffajee AD, Yaskell T, Socransky SS. Antimicrobial effectiveness of an herbal mouthrinse compared with an essential oil and a chlorhexidine mouthrinse. J Am Dent Assoc (1939). 2008;139(5):606-11.
19. Menezes SM, Cordeiro LN, Viana GS. Punica Granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother. 2006;6(2):79-92. 
20. Bhadbhade SJ, Acharya AB, Rodrigues SV, Thakur SL. The antiplaque efficacy of pomegranate mouthrinse. Quintessence Int. (Berlin, German: 1985). 2011;42(1):29-36.
21. Salgado AD, Maia JL, Pereira SL, de 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.:revista FOB. 2006;14(3):162-6.
22. Gracious Ross R, Selvasubramanian S, Jayasundar S. Immunomodulatory activity of Punica Granatum in rabbits--a preliminary study. J Ethnopharmacol.. 2001;78(1):85-7.
23. Jurenka JS. Therapeutic applications of pomegranate (Punica Granatum L.): a review. Alternative medicine review : Altern Med Rev. 2008;13(2):128-44.
24. Ishikawa I. Host responses in periodontal diseases: a preview. Periodontol 2000. 2007;43:9-13. 25. Koide M, Kinugawa S, Takahashi N, Udagawa N. Osteoclastic bone resorption induced by innate immune responses. Periodontol 2000. 2010;54(1):235-46.
26. Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P. Adjunctive periodontal treatment with Centella asiatica and Punica Granatum extracts. A preliminary study. J Int Acad Periodontol. 2003;5(4):106-15.