|Year : 2011 | Volume
| Issue : 1 | Page : 25-28
Comparative evaluation of effectiveness between Aloe vera and two commercially available mouth rinses on plaque and gingival status: A randomized control trial
Sujal Parkar, Upasna Janu
Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gujarat, India
|Date of Web Publication||29-Jul-2013|
B-25 Krishna Bunglows-I, Motera, Gandhinagar Highway, Ahmedabad - 380 005
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: Aloe vera has been suggested for a wide variety of ailments, but its use in dentistry is limited. The purpose of the study was to evaluate the effect of A. vera on the reduction of plaque and gingivitis. This effect was evaluated by randomized, parallel and double-blind clinical trial. Materials and Methods: Total 30 subjects were randomly allocated into three groups; 10 in each for (i) chlorhexidine, (ii) tea tree leaves and (iii) A. vera. Plaque index and gingival index were assessed at days 0 and 21. Subjects were asked to rinse their mouth with the mouth rinse, twice a day, during a 21-day period. Paired t-test was used test the mean difference at 0 day and 21 days. One way analysis of variance was used to check the mean difference among three mouth rinses. Results: All three mouth rinses shows a significant reduction from 0 day to 21 days (P < 0.05). However, no difference was observed when the mouth rinses were compared at 0 and at 21 days (P > 0.05). Conclusion: A. vera mouth rinse was as effective as two commercially popular mouth rinses in controlling plaque and gingivitis.
Keywords: Aloe vera , chlorhexidine, gingivitis, plaque, tea tree leaves
|How to cite this article:|
Parkar S, Janu U. Comparative evaluation of effectiveness between Aloe vera and two commercially available mouth rinses on plaque and gingival status: A randomized control trial. J Int Clin Dent Res Organ 2011;3:25-8
|How to cite this URL:|
Parkar S, Janu U. Comparative evaluation of effectiveness between Aloe vera and two commercially available mouth rinses on plaque and gingival status: A randomized control trial. J Int Clin Dent Res Organ [serial online] 2011 [cited 2019 Aug 20];3:25-8. Available from: http://www.jicdro.org/text.asp?2011/3/1/25/115773
| Introduction|| |
Dental plaque is the main etiological factor for periodontal disease. Plaque control is a critical component of dental practice, permitting long term success of periodontal and dental care. There is a growing interest throughout the oral health care profession in therapeutic agents that compliments and enhances the mechanical removal of biofilms in the oral cavity.  Various chemical methods of reducing plaque, such as mouth rinses, are used as they can provide significant benefits to patients who cannot maintain adequate mechanical plaque control.  Most of the mouth rinses contain modern chemicals like chlorhexidine, triclosan ,, have undesirable side effects, such as staining of teeth and taste alteration. Hence, there has been increased interest in plants with antibacterial and anti-inflammatory activity.  There is scarcity of evidence demonstrating the efficacy of A. vera on the plaque and gingivitis. There is only one study available evaluating the clinical effects of A. vera showing a significant reduction of gingivitis and plaque accumulation.  The purpose of this present study was to assess the effectiveness of this phytotherapic agent in dental plaque and gingivitis control in comparison with two commercially available mouth rinses.
| Materials and Methods|| |
The study protocol was approved by The Institutional Ethical Committee of Ahmedabad Dental College and Hospital (ADCH) before commencing the study. Thirty volunteer subjects from ADCH (15 males and 15 females, with a mean age of 19.67 ± 1.54 years) were enrolled in this double-blind, parallel, controlled clinical trial. All randomly screened participants were informed about the nature of the study and an informed consent was obtained.
- All subjects had at least 28 natural teeth, normal occlusion; absence of caries and/or restorations on the facial, lingual and proximal surfaces and a healthy state of periodontium.
- None of the subjects were wearing fixed or removable orthodontic appliances or partial dentures.
- A history of any systemic disorders like hypertension, liver disease, epilepsy, convulsion or fainting spells.
- Allergy or hyper sensitivity to any mouth rinses used in the study.
- Use of antibiotics within 7 days of the baseline.
- Presence of periodontal tissue breakdown or pathological lesion.
A total 30 dental students were enrolled in the study. All the subjects were randomly assigned into three groups: 10 subjects per group. The three different mouth rinses were randomly allocated to each group. The detail of each mouth rinses is shown in the [Table 1].
The clinical examination was carried out by a single trained examiner (Janu Upasna) under the direction of (Parkar Sujal M.) in the Department of Public Health Dentistry, ADCH. The intra variability for the observation was analyzed by using Kappa variability test. k co-efficient was found to be 0.82, reflecting a high degree of conformity in observations. The clinical parameters like plaque and gingival status was assessed by using Silness and Loe plaque index  and Loe and Silness gingival index  respectively.
After collection of data at baseline (0 day), the subjects were given any one of the three mouth rinses using lottery method. The mouth rinses were filled in identical but coded bottles to warrant that neither the examiner nor the subjects knew their content, which was revealed only after completion of the study. During 21-day experimental period, the subjects were instructed to rinse the mouth with 10 ml mouth rinse twice daily, after breakfast and after dinner, for 1 min. The subjects were told to refrain from all other oral hygiene measures like dental floss, chewing gum except the directed ones and routine tooth brushing habits and to avoid eating or drinking for at least 30 min after using the mouth rinse. The subjects were recalled after 21 days for recording all the clinical parameters.
SPSS statistical package version 17  was used for the entire analysis. In each group, the mean scores of plaque and gingival index were compared between baseline (0 day) and the end of the trial (21 days) by the Paired t test. One way analysis of variance (ANOVA) was used to compare the mean difference between the groups. All analysis was made at 5% level of significance.
| Results|| |
There was good acceptance for A. vera mouth rinse and did not show adverse effects, such as the formation of abscess and ulcerations or allergic reactions.
The mean plaque score and gingival score was compared at baseline (0 day) and at the end of the trial (21 days) for all the three mouth rinses. All the mouth rinses shows a significant reduction in plaque score [Table 2] and gingival score [Table 3] from baseline (0 day) to 21 days. However, [Table 3] shows that there was no significant difference observed for Emoform® mouth rinse when the gingival score was compared.
|Table 2: Comparison of mean plaque score at baseline (0 day) and after 21 days|
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|Table 3: Comparison of mean gingival score at baseline (0 day) and after 21 days|
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One way ANOVA was applied to check the mean difference of plaque score [Table 4] and gingival score [Table 5] among different groups both at baseline (0 day) and after 21 days. The results obtained were not significant statistically (P > 0.05).
|Table 4: Comparison of mean plaque score at baseline (0 day) and 21 days for different mouth rinses|
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|Table 5: Comparison of mean gingival score at baseline (0 day) and 21 days for different mouth rinses|
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| Discussion|| |
Despite it's free commercial use, A. vera does not have sufficient data to support its antigingivitis and antiplaque claims.  To the best of our knowledge, the present study is the 1 st report about the effect of a mouth rinse containing A. vera on plaque and gingivitis. Hence, the comparison with the previous research pertaining to A. vera is difficult. However, there are two studies , had been conducted to check the effect of dentifrice containing A. vera on plaque and gingivitis; both studies showed a significant reduction in plaque and gingivitis. The results of the present study showed that all the mouth rinses used in the study were efficient on plaque reduction and gingivitis except Emoform® rinse which showed no significant reduction in gingivitis at the end of the trial.
The findings of the present study are in agreement with those of Villalobos, et al.  who observed a significant reduction on plaque and gingivitis after a 30-day use of mouth rinses containing A. vera associated to tooth brushing. Although the concentration of A. vera (98%) used in the present study was higher as compared to study conducted by Villalobos, et al.  having 50% concentration, which could explain the better effect of this phytotherapic agent.
The anti-microbial effects of A. vera have been attributed to the plant's natural anthraquinones: aloe emodin, aloetic acid, aloin, anthracine, anthranol, barbaloin, chrysophanic acid, ethereal oil, ester of cinnamonic acid, isobarbaloin, and resistannol.  In relatively small concentrations together with the gel fraction, these anthraquinones provide analgesic, antibacterial, antifungal, and antiviral activity; in high concentrations, they can be toxic. 
Chlorhexidine-based formulas are currently the golden standard for anti-microbial mouthrinsees. Chlorhexidine gluconate is a cationic biguanide with broad-spectrum antimicrobial action. It's mechanism of action is that the cationic molecule binds to the negatively-charged cell walls of the microbes, destabilising their osmotic balance causing concentration-dependent growth inhibition and cell death. Secondary interactions causing inhibition of proteolytic and glycosidic enzymes may also be significant. 
Tea tree oil is effective against a high number of gram-positive and gram-negative bacteria as well as fungi. It's efficacy is due to its ingredients such as terpene hydrocarbons, mainly monoterpenes, sesquiterpenes, and their associated alcohols. These include a terpinen-4-ol chemotype, a terpinolene chemotype, and four 1, 8-cineole chemotypes. With biological activity, the anti-microbial activity of tea tree oil is attributed mainly to terpinen-4-ol, a major component of the oil. The anti-microbial activity of tea tree oil is due to hydrocarbons which preferentially partition the biological membranes and disrupt their vital functions. 
Furthermore, subjects enrolled in oral hygiene studies usually improve their oral hygiene practice, irrespective of the product they receive. , Although the volunteers of the present study were not aware of which mouth rinse they were using, another crucial factor is the Novelty effect, which is the motivation of oral hygiene practice by the use of a new substance.
An experimental period of 21 days was chosen for permitting comparison to other studies. However, to guarantee these results and the effectiveness of this mouth rinse, additional long-term clinical trials should be performed that incorporate more isolates from clinical samples. If it's real benefit is confirmed, the use of A. vera should be advantageous in cases where patients have little motor skills and tooth brushing is compromised.
| Conclusion|| |
Within the limitation of this preliminary clinical study, it can be conclude that A. vera mouth rinse was as effective as two commercially popular mouth rinses in controlling plaque and gingivitis.
| References|| |
|1.||Madianos PN, Bobetsis YA, Kinane DF. Generation of inflammatory stimuli: How bacteria set up inflammatory responses in the gingiva. J Clin Periodontol 2005;32 Suppl 6:57-71. |
|2.||Barnett ML. The role of therapeutic antimicrobial mouthrinses in clinical practice: Control of supragingival plaque and gingivitis. J Am Dent Assoc 2003;134:699-704. |
|3.||Moran J, Addy M, Newcombe RG, Marlow I. A study to assess the plaque inhibitory action of a newly formulated triclosan toothpaste. J Clin Periodontol 2001;28:86-9. |
|4.||Nogueira-Filho GR, Toledo S, Cury JA. Effect of 3 dentifrices containing triclosan and various additives. An experimental gingivitis study. J Clin Periodontol 2000;27:494-8. |
|5.||Palomo F, Wantland L, Sanchez A, Volpe AR, McCool J, DeVizio W. The effect of three commercially available dentifrices containing triclosan on supragingival plaque formation and gingivitis: A six month clinical study. Int Dent J 1994;44 Suppl 1:75-81. |
|6.||Lee SS, Zhang W, Li Y. The antimicrobial potential of 14 natural herbal dentifrices: Results of an in vitro diffusion method study. J Am Dent Assoc 2004;135:1133-41. |
|7.||Villalobos OJ, Salazar CR, Sánchez GR. Effect of a compound mouthwash Aloe vera in plaque and gingival inflammation. Acta Odontol Venez 2001;39:16-24. |
|8.||Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35. |
|9.||Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51. |
|10.||Statistical Package for Social Science (SPSS) version 17. SPSS Inc. Chicago, Ill. |
|11.||Wu CD, Savitt ED. Evaluation of the safety and efficacy of over-the-counter oral hygiene products for the reduction and control of plaque and gingivitis. Periodontol 2000 2002;28:91-105. |
|12.||de Oliveira SM, Torres TC, Pereira SL, Mota OM, Carlos MX. Effect of a dentifrice containing Aloe vera on plaque and gingivitis control. A double-blind clinical study in humans. J Appl Oral Sci 2008;16:293-6. |
|13.||George D, Bhat SS, Antony B. Comparative evaluation of the antimicrobial efficacy of Aloe vera tooth gel and two popular commercial toothpastes: An in vitro study. Gen Dent 2009;57:238-41. |
|14.||Wynn RL. Aloe vera gel: Update for dentistry. Gen Dent 2005;53:6-9. |
|15.||Davis RH. Aloe vera: A Scientifc Approach. New York: Vantage Press; 1997. |
|16.||Hugo WB, Longworth AR. The effect of chlorhexidine on the electrophoretic mobility, cytoplasmic constituents, dehydrogenase activity and cell walls of Escherichia coli and staphylococcus aureus. J Pharm Pharmacol 1966;18:569-78. |
|17.||Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) oil: A review of antimicrobial and other medicinal properties. Clin Microbiol Rev 2006;19:50-62. |
|18.||Owens J, Addy M, Faulkner J. An 18-week home-use study comparing the oral hygiene and gingival health benefits of triclosan and fluoride toothpastes. J Clin Periodontol 1997;24:626-31. |
|19.||Pannuti CM, Mattos JP, Ranoya PN, Jesus AM, Lotufo RF, Romito GA. Clinical effect of a herbal dentifrice on the control of plaque and gingivitis: A double-blind study. Pesqui Odontol Bras 2003;17:314-8. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]