JICDRO is a UGC approved journal (Journal no. 63927)

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ORIGINAL RESEARCH
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 32-35

Glycyrrhiza glabra: An efficient medicinal plant for control of periodontitis – A randomized clinical trial


Faculty of Arts, Dayalbagh Educational Institute, Agra, Uttar Pradesh, India

Date of Web Publication24-Jun-2019

Correspondence Address:
Dr. Suman Madan
Faculty of Arts, Dayalbagh Educational Institute, Dayalbagh, Agra - 282 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_7_19

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   Abstract 


Background: Periodontitis is a common oral problem that everyone faces at least once in lifetime. According to the WHO, among all oral diseases, prevalence rate of periodontitis is very high. As definition given by the American Dental Association, periodontitis is a chronic inflammation of the tooth and its supporting structure which leads to loosening of the teeth in their socket and lastly loss of teeth. From ancient times, peoples are using traditional medicines to prevent or cure the disease. Glycyrrhiza glabra is one of the medicinal plants that show the effectiveness for sore throat and other respiratory infections in researches. Thus, the present study is an attempt to check the efficacy of G. glabra in the prevention and cure of periodontitis. Methodology: A randomized clinical control trial was conducted on 104 patients divided into two groups – experimental group and control group. G. glabra gum paint in 10% concentration was given to patients of experimental group for 4 weeks. All patients were instructed to strictly follow good oral hygiene habits. Parameters used for checking the effectiveness of G. glabra were gingival bleeding, loss of attachment, and depth of periodontal pockets. Results: Preintervention and postintervention scores were analyzed by means of mean, standard deviation, and t-test. There is a significant improvement in periodontal status of patients in the experimental group. Conclusions: Results of the present study revealed that G. glabra was effective in preventing periodontal diseases. The present study also motivates to conduct more Medicinal plant-based clinical trial in the prevention of periodontitis so that effective treatment can be provided with a minimal side effect.

Keywords: Glycyrrhiza glabra, mulethi, periodontitis, pyorrhea, Yashtimadhu


How to cite this article:
Madan S, Kashyap S, Mathur G. Glycyrrhiza glabra: An efficient medicinal plant for control of periodontitis – A randomized clinical trial. J Int Clin Dent Res Organ 2019;11:32-5

How to cite this URL:
Madan S, Kashyap S, Mathur G. Glycyrrhiza glabra: An efficient medicinal plant for control of periodontitis – A randomized clinical trial. J Int Clin Dent Res Organ [serial online] 2019 [cited 2019 Nov 11];11:32-5. Available from: http://www.jicdro.org/text.asp?2019/11/1/32/260954




   Introduction Top


Periodontitis is a chronic inflammation of periodontal apparatus which leads to the destruction of surrounding periodontal tissue of teeth which in turn cause loosening of teeth in their socket and eventually loss of teeth.[1] Inflammation of periodontal tissue is caused by the Gram-negative anaerobic bacteria mainly Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythensis. In response of bacterial infiltration and their toxins, inflammatory cells such as lymphocytes and macrophages are activated and secretes cytokines and other biological mediators that are responsible for immunopathologic response in periodontal tissue.[2] According to the WHO, around 15%–35% of adults are suffering from periodontal disease.[3] Classical signs and symptoms of periodontal diseases are bad breath from the mouth, bleeding gums while brushing and chewing, mobile, swollen and tender gingiva, loosening of teeth in their socket and recession of gingiva. In early stages of gingivitis and periodontitis, it can be controlled and reversed by maintaining good oral hygiene habits such as brushing twice a day, use of interdental brush or floss, and use of antibacterial substances such as mouthwash or gum paint, taking balanced diet, and stopping the use of tobacco and tobacco products.[4]

Glycyrrhiza glabra is a medicinal plant belongs to family Leguminosae. Most commonly used a part of G. glabra is root. It is sweet in taste and soothing in nature and possess antibacterial and anti-inflammatory properties.[5] Active phytoconstituents of G. glabra root is a saponin called glycyrrhizin and glycyrrhetic acid due to these saponins G. glabra have a sweet taste.[6] Bioactive phytoconstituents of G. glabra inhibit the growth of periodontopathogen and reduce the inflammatory markers at the site of infection. It also ceases the activity of osteoclasts that are responsible for alveolar bone destruction in periodontitis and promote the synthesis of osteoblasts for new bone formation.[7] Commercially available synthetic products cannot be used for a long time. They can cause mucosal irritation as well as can stain the teeth.[8] Therefore, the present study is planned to evaluate the efficacy of G. glabra on patients suffering from periodontitis.


   Methodology Top


G. glabra roots were purchased from the local shop of Agra city and validated by the botanist. Roots of G. glabra were dried in hot air oven at 37°C to free it from moisture. Dried roots were grounded and macerated in ethanol: Water (30:70) for 1 week with occasional shaking.[9] After 1 week, the extract was filtered first with muslin cloth then finally with Whatman filter paper number 1. The obtained crude extract was dried in the rotatory evaporator. Serial dilutions of crude extract were made from 5 to 30 μl and were analyzed in ultraviolet spectrophotometer for its active phytoconstituent glycyrrhetic acid at ƛmax254 nm.[10] Concentration of glycyrrhetic acid in the extract was 28% which is similar to the study conducted by the Omar et al.[11]

For the development of G. glabra gum paint, pure vegetable food grade glycerin was used. Crude extract of G. glabra in 10% concentration was dissolved in glycerin. [Table 1] shows the formula of G. glabra gum paint for 15 ml bottle pack. 1.5 ml of G. glabra extract or 0.42 ml of glycyrrhetic acid was dissolved in 13.5 ml glycerine.
Table 1: Formula for development of 15 ml Glycyrrhiza glabra gum pain

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To check the efficacy of gum paint, a randomized clinical trial was conducted in the private hospital of Agra city. One hundred and four patients were selected who were having mild to moderate periodontitis. Patients who were systemically healthy were not on antibiotic or on any other medication in the past 6 months were included in the study. For measuring periodontal status, gingival bleeding, periodontal pocket, and loss of attachment parameters were used. Patients were randomly divided into two groups – experimental group (patients who received treatment G. glabra gum paint) and control group (patients who received no treatment). Patients were followed for 1 month. Patients of the experimental group were instructed to massage the gums by G. glabra gum paint two times a day after brushing (morning and night). All patients (experimental and control) were given Colgate toothpaste and brush to exclude biases. Preintervention and postintervention scores were taken.

Statistical analysis

For statistical analysis, SPSS 23 (IBM, Armonk, NY, United States of America) was used. Paired t-test was used to compare the pre- and post-intervention scores. All participants completed the study.


   Results Top


A total of 104 patients consisting of 32 females and 72 males in the age group of 30–45 years participated in the present study. [Figure 1] illustrates the diagrammatic representation of the distribution of patients according to age and gender.
Figure 1: distribution of patients according to age and gender as a percentage of total number of participants

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Parameters of periodontal status (gingival bleeding, periodontal pocket, and sites of loss of attachment) were measured with the help of the WHO probe. In each patient, the average reduction in periodontal parameters was calculated. [Table 2] and [Table 3] show the mean difference in scores pre- and post-intervention in experimental group and control group.
Table 2: Gingival bleeding, periodontal pocket, and loss of attachment in the experimental group

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Table 3: Gingival bleeding, periodontal pocket, and loss of attachment in the control group

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As shown in [Table 2], there is a significant improvement in all parameters. Gingival bleeding, depth of periodontal pocket, and loss of attachment significantly reduced in patients of the experimental group whereas, in patients of the control group [Table 3], mean scores were improved as they were following good oral hygiene as instructed by a specialist but improvement was not significant.


   Discussion Top


The present study was designed to authenticate the efficacy of G. glabra gum paint on periodontal status of patients suffering from periodontitis. G. glabra shows good result with no side effect. G. glabra improved periodontal status due to its antibacterial and antioxidant properties. G. glabra is a commonly used medicinal herb in the kitchen. It is used in herbal preparations as effective remedy for sore throat and respiratory infections. It is cheaper and easily accessible.

Previously, various studies were designed to check the efficacy of G. glabra against oral pathogens.

  1. Rakshanaa and Lakshmi[12] tested the efficacy of Ocimum sanctum and G. glabra mouthwash against chlorhexidine mouthwash and found both were equally effective against oral pathogens
  2. Farhad et al.[13] and Moteshakker et al.[14] conducted randomized triple-blind placebo controlled clinical trial on periodontitis patients. G. glabra capsule in a dosage 400 mg/day was used against doxycycline capsules. Doxycycline capsule was used as positive control, and placebo capsules were used as negative control. Both doxycycline capsule and G. glabra capsules were effective in improving periodontal status
  3. Jain et al.[15] also formulated 10% G. glabra mouthwash and on the clinical trial, there was the improvement in periodontal status but not statistically significant
  4. Hassan and Khalil[16] used G. glabra mouthwash on patients suffering from oral stomatitis. There was significant improvement in the condition of patients.


In the present study, G. glabra significantly improved the parameters of periodontal status such as gingival bleeding, depth of the periodontal pocket, and sites of loss of attachment. These findings were similar to the findings discussed above. G. glabra showed improvement in periodontal status due to its antibacterial activity due to its active ingredient glycyrrhetic acid.


   Conclusion Top


Thus, G. glabra can be used effectively as an alternative for commercially available synthetic agents. It can be used for long duration due to minimal or no side effects for prevention and cure of periodontitis. More and more studies should be conducted based on medicinal plants in treatment or prevention of periodontal diseases so that patients can afford cheaper and effective method for the management of periodontitis.

Acknowledgment

I would like to thank all the patients who had participated in the study and also to all the members of the hospital committee and staff who helped in the completion of the present research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Virtanen E, Söder PÖ, Meurman JH, Andersson LC, Söder B. Chronic periodontal disease: A proxy of increased cancer risk. Int J Cancer Res 2013;47:1127-3.  Back to cited text no. 1
    
2.
Martinez B, Ruiz F. Periodontal diseases as bacterial infection. Av peridoncia Implant 2005;17:111-8.  Back to cited text no. 2
    
3.
World Health Organization. Oral Health. Health Affect. World Health Organization; 2018.  Back to cited text no. 3
    
4.
American Academy of Periodontology. Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. Am Acad Pediatr Dent 2004;39:445-4.  Back to cited text no. 4
    
5.
Zadeh JB, Kor ZM, Goftar MK. Licorice Glycyrrhiza glabra Linn as a valuable medicinal plant. Int J Adv Biol Biomed Res 2013;1:1281-8.  Back to cited text no. 5
    
6.
Roshan A, Verma NK, Kumar CS, Chandra V, Singh DP, Panday MK. Phytochemical constituent, pharmacological activities and medicinal uses through the millenia of Glycyrrhiza glabra linn: A review. Int Res J Pharm 2012;3:45-5.  Back to cited text no. 6
    
7.
Messier C, Epifano F, Genovese S, Grenier D. Licorice and its potential beneficial effects in common oro-dental diseases. Oral Dis 2012;18:32-9.  Back to cited text no. 7
    
8.
Jegathambigai J. Drug for Oral Pathogens from Glycyrrhiza glabra. Shodh Ganga; 2012. p. 143-5.  Back to cited text no. 8
    
9.
Tian M, Yan H, Row KH. Extraction of glycyrrhizic acid and glabridin from licorice. Int J Mol Sci 2008;9:571-7.  Back to cited text no. 9
    
10.
Patil SK, Salunkhe VR, Mohite SK. Development and validation of uv spectrophotometric method for estimation of glycyrrhetinic acid in hydro-alcoholic extract of Glycyrrhiza glabra. Int J Pharm Chem Biol Sci 2012;2:617-1.  Back to cited text no. 10
    
11.
Omar HR, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak HD, et al. Licorice abuse: Time to send a warning message. Ther Adv Endocrinol Metab 2012;3:125-38.  Back to cited text no. 11
    
12.
Rakshanaa TV, Lakshmi T. Antibacterial efficacy of herbal mouthwash against oral microbes –In vitro assay. J Adv Pharm Educ Res 2017;7:31-3.  Back to cited text no. 12
    
13.
Farhad SZ, Aminzadeh A, Mafi M, Barekatain M, Naghney M, Ghafari MR. The effect of adjunctive low-dose doxycycline and licorice therapy on gingival crevicular fluid matrix metalloproteinase-8 levels in chronic periodontitis. Dent Res J (Isfahan) 2013;10:624-9.  Back to cited text no. 13
    
14.
Moteshakker M, Raifiei E, Farhad Z, Aminzadeh A. Comparison of the effect of doxycycline and licorice on chronic periodontitis – A clinical trial study. J Res Dent Sci 2014;11:123-9.  Back to cited text no. 14
    
15.
Jain P, Sontakke P, Walia S, Yadav P, Biswas G, Kaur D. Assessment of the efficacy of licorice versus 0.2% Chlorhexidine oral rinse on plaque-induced gingivitis: A randomized clinical trial. Indian J Oral Heal Res 2017;3:15-8.  Back to cited text no. 15
    
16.
Hassan KA, Khalil S. Liquorice mouth wash as treatment for mouth ulcer. Int J Adv Pharm Sci 2013;4:335.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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