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Efficacy of Barberry Aqueous Extracts Dental Gel on Control of Plaque and Gingivitis

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Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The aim of this study was to evaluate the clinical effects of a dental gel containing barberry extracts (from Berberis vulgaris) on gingivitis and microbial plaque control. A double blind clinical trial study was conducted in a dormitory on 45 boys aged 11-12 years having the same socioeconomic conditions. These students were divided into 3 groups; the first group (25 students) using barberry gel, and the second group (10 students) using placebo gel without active ingredient. To compare the activity of our gel with an active antiplaque, a third group of 10 students using Colgate® antiplaque toothpaste was also considered. At the beginning all subjects were examined for plaque index (PI) and gingival index (GI). These tests were re-evaluated after 21 days of using the above mentioned dentifrices. The results showed that barberry gel has reduced the PI for about 56%. This reduction was 18.5% for placebo and 44% for Colgate® antiplaque groups. Considering means of PI (ΔPI) and GI (ΔGI) of different groups, there was significant difference between barberry and placebo gel's groups and between placebo and Colgate® groups, but the difference between barberry and Colgate® groups was not significant. This study indicates that the barberry dental gel effectively controls microbial plaque and gingivitis in the school aged children; therefore, the use of barberry dental gel is strongly recommended.
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EFFICACY OF BARBERRY AQUEOUS EXTRACTS DENTAL
GEL ON CONTROL OF PLAQUE AND GINGIVITIS
A. Makarem*, N. Khalili and R. Asodeh
Department of Pediatric Dentistry, School of Dentistry, Medical Sciences/University of Mashhad,
Mashhad, Iran
Abstract- Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial
plaque agents. The aim of this study was to evaluate the clinical effects of a dental gel containing
barberry extracts (from Berberis vulgaris) on gingivitis and microbial plaque control. A double blind
clinical trial study was conducted in a dormitory on 45 boys aged 11-12 years having the same
socioeconomic conditions. These students were divided into 3 groups; the first group (25 students)
using barberry gel, and the second group (10 students) using placebo gel without active ingredient. To
compare the activity of our gel with an active antiplaque, a third group of 10 students using Colgate®
antiplaque toothpaste was also considered. At the beginning all subjects were examined for plaque
index (PI) and gingival index (GI). These tests were re-evaluated after 21 days of using the above
mentioned dentifrices. The results showed that barberry gel has reduced the PI for about 56%. This
reduction was 18.5% for placebo and 44% for Colgate® antiplaque groups. Considering means of PI
(ΔPI) and GI (ΔGI) of different groups, there was significant difference between barberry and placebo
gel’s groups and between placebo and Colgate® groups, but the difference between barberry and
Colgate® groups was not significant. This study indicates that the barberry dental gel effectively
controls microbial plaque and gingivitis in the school aged children; therefore, the use of barberry
dental gel is strongly recommended.
Acta Medica Iranica, 44 (2): 91-94; 2007
© 2007 Tehran University of Medical Sciences. All rights reserved.
Key words: Barberry gel, barberry dentifrice, gingival index, plaque index
INTRODUCTION
Gingivitis is the most common periodontal disease in
children and adolescents. Clinically, it involves an
inflammation of the gingival tissues next to the
tooth. Microscopically, it is characterized by the
presence of an inflammatory exudate and edema,
destruction of collagenous gingival fibers, and
ulceration and proliferation of the epithelium facing
the tooth and attaching the gingival to it (1).
Despite of the changing concepts on the etiology
Received: 12 Oct. 2004, Revised: 20 Nov. 2005, Accepted: 10 Dec. 2005
* Corresponding Author:
A. Makarem, Department of Pediatric Dentistry, School of Dentistry,
Medical Sciences/ University of Mashhad, Mashhad, Iran
Tel: +98 511 8819314
Fax: +98 511 8829500, 8810713
E-mail: a-makarem@mums.ac.ir
of periodontal disease, bacterial plaque is still
considered as an etiologic factor for periodontal
diseases(1), and oral self care (for plaque control) is
still an essential step in the prevention and treatment
of gingivitis (2).
Bacterial plaque is composed of soft bacterial
deposits that adhere firmly to the teeth and form a
complex, metabolically interconnected, highly
organized bacterial system consisting of dense
masses of microorganisms embedded in an inter
microbial matrix. In sufficient concentration, this
microbial matrix can disturb the host-parasite
relationship and cause dental caries and periodontal
diseases (1).
Due to the difficulties in achieving perfect plaque
control, the administration of some antiplaque agents
was suggested as an adjuvant treatment to tooth
Effect of barberry dental gel on plaque and gingivitis
92 Acta Medica Iranica, Vol. 45, No. 2 (2007)
brushing. Makerem et al. has shown that herbal
agents have effective antiplaque characteristics
which make them appropriate as possible antiplaque
and tooth cleansing agents (3).
Berberine is an alkaloid agent which has
previously shown high antimicrobial effects (4). This
alkaloid is the most active alkaloid (isoquinolines
group) extracted from the root and stem of the plant
barberry which grows in Europe, Africa, America
and central Asia and also Iran (4-7). Besides
antimicrobial effects, berberine is also effective in
the treatment and control of gastroenteritis bacterial
infections. It has been also approved by the Indian
Institute of Medical Sciences, New Delhi as an
intraconjunctival injection for the treatment of
chronic trachoma (7).
The aim of this study was to evaluate the clinical
effectiveness of a dental gel containing barberry
aqueous extract (1% berberine) on gingivitis and
microbial plaque in a group of children in Mashhad,
Iran.
MATERIALS AND METHODS
Plant material
The Berberis vulgaris plant was collected from the
heights of village “Baghmich” 60 kilometers from
the city of Mashhad in December 1997 (Fig. 1).
Preparation of test Material
A dental gel was prepared (using Soxhlet method)
with alkaloids extract of root and barks of barberry
plant as the test material. The aqueous extract was
estimated according to berberine contents of the gel
which contained equivalent to 1% berberine that was
Fig.1. Berberis vulgaris.
formulated at pH=5 in Mashhad School of Pharmacy
(8). A placebo gel (the dental gel without barberry
extract) and a commercial dentifrice (Colgate®
toothpaste) was also prepared. Neither the barberry
gels nor the placebo gels had any abrasive or
detergent components.
Study design
A double blind clinical trial study was conducted on
45 boys (aged 11-12 years) who were residents in a
dormitory and had the same socioeconomic
condition. None of the subjects had systemic
problems or had undergone any kind of orthodontic
treatment. We obtained informed consent from all of
the participants and their parents.
These students were divided into three groups. The
first group (25 students) was given the dental gel
with barberry extracts, the second group (10
students) the normal dental gel (placebo) and the
third group of 10 students the regular Colgate®
antiplaque toothpaste. None of the subjects use any
mouth rinse or any other toothpaste during the study
period and they all used the same type of toothbrush
(Mina, Ghoods Plastic Co. Iran) and they all were
given the same type of food during the study
period.
Before starting therapy, all subjects were
examined for plaque index [PI, Turesky method (9)]
and gingival index [GI, Leo and Silness method (10,
11)]. These tests were repeated after 21 days of using
the above mentioned dentifrices. The subjects were
asked to brush their teeth with a half covered brush
with a gel or the toothpaste for 3 minuets, three
times a day under the supervision of their parents’.
The data were collected and subjected
statistically to ANOVA test and Tukey-HSD
procedure.
RESULTS
The mean plaque index before and after using
barberry gel, placebo and Colgate® is shown in
Figure 2. According to data, the barberry gel has
reduced the PI for about 56%. This reduction was
18% for placebo and 44% for Colgate® groups. The
mean differences of plaque Indices (ΔPI) of case,
control and Colgate® groups are shown in Table 1.
A. Makarem et al.
Acta Medica Iranica, Vol. 45, No. 2 (2007) 93
Fig. 2. Mean and SD of plaque index of 11-12 years old boys
before and after using barberry gel, placebo gel and
Colgate®.
The results show that there were significant
differences between mean differences of PI in all
groups (P < 0.001). The Tukey-HSD procedure
showed that there was significant difference between
barberry and placebo gel’s groups (P < 0.001). Also
there was a significant difference between mean Δ PI
in placebo and Colgate® groups (P < 0.001), but the
difference between mean Δ PI of barberry and
Colgate® was not significant.
The mean gingival index before and after using
barberry gel, placebo gel and Colgate® groups in the
3 groups is shown in Figure 3. According to these
data, the barberry gel has reduced the GI, for about
33.55 %. This reduction was 18.50% for placebo and
37.37% for Colgate® groups. The mean difference
of gingival index between barberry gel, placebo and
Colgate® groups is shown in Table 2. There were
significant differences between mean differences of
gingival index (ΔGI) in all three groups (P =
0.0019). The Tukey-HSD procedure showed that
there was significant difference between mean ΔGI
of barberry and placebo gel groups (P < 0.01). Also
there was a significant difference between mean ΔGI
of Colgate® and placebo groups (P < 0.001), but the
difference between mean ΔGI in barberry gel and
Colgate® groups was not significant.
Table 1. Mean differences of plaque indices (Δ PI) of 11-12
year- old boys, before and after using test gel, placebo gel and
Colgate®.
Group N
Mean
difference PI SD Std Err
Barberry gel 25 1.545 0.5311 0.1062
Placebo gel 10 0.559 0.2360 0.0787
Colgate® 10 1.405 0.6605 0.2089
Abbreviation: N, number; GI, gingival indices; SD, standard
deviation, Std Err, standard error.
Fig. 3. Mean and SD of gingival index (GI) of 11-12 years
old boys before and after using barberry gel, placebo gel and
Colgate®.
DISCUSSION
In this study it has been observed that the placebo
gel could control the plaque index (PI) and the
gingival index (GI) and it can reduce each of them
up to 18.5%. This reduction of both indices may be
partially due to the mechanical brushing which to
some extent eliminates and controls the microbial
plaque. In a previous study done by Makarem et al.
on the efficacy of a dentifrice containing 3 herbal
extracts (on dental plaque and gingivitis) in 12-13
year old boys, it was observed that both the plaque
index and gingival index decreased significantly in
test compared to placebo group (3). The efficacy of
herbal extract’s dentifrice in the previous study was
higher than the present study which could be
explained by the simultaneous use of toothpaste
during brushing.
Despite the fact that toothpaste requires a certain
degree of abrasion in order to reduce or prevent
extrinsic stains from forming and a low or
nonabrasive paste is unable to prevent extrinsic
stains, in our study neither the dental gel with
barberry nor the placebo dental gel had no abrasive
or detergent (12). However, the dental gel with
barberry reduced the PI in the testing group up to
Table 2. Mean differences of gingival indices (Δ GI) of 11-
12 year- old boys, before and after using test gel, placebo and
Colgate®.
Group N
Mean
difference GI SD Std Err
Barberry gel 25 0.4621 0.2007 0.0410
Placebo gel 10 0.2740 0.0936 0.0296
Colgate® 10 0.5680 0.1682 0.0532
Abbreviations: N, number; GI, gingival indices; SD, standard
deviation, Std Err, standard error.
Effect of barberry dental gel on plaque and gingivitis
94 Acta Medica Iranica, Vol. 45, No. 2 (2007)
56% which was significantly different from the PI in
the placebo group (P < 0.001). This could be
explained by the antimicrobial property of berberine.
On the other hand, the effectiveness of the dental gel
with barberry on decreasing PI was not significantly
different with that of Colgate® antiplaque toothpaste
(Table 1).
Petal had studied effect of Cichorium intybus on
the PI in 20-50 years aged persons with periodontitis
for 21 days treatment. The results showed 11.7%
reduction, which is lower than the results of our
study. The low results may be related to the low
antibacterial activity of the Cichorium intybus
extract and formulation of the paste (13). Mullally
and co-workers studied the effects of 3 herbal extract
in Paradontax toothpaste on controlling of the PI and
GI in 70 volunteers for 28 days comparing the
results with Colgate® regular toothpaste. At the end
of 28 days application they found that there was no
significant difference between the PI and GI in both
case and control groups (14). These results
were similar to that of barberry gel and that of
Colgate® antiplaque toothpaste. These findings
show the role of toothpaste and mechanical
brushing.
In conclusion, this study indicates that the
barberry dental gel is effective in controlling
microbial plaque and gingivitis in school aged
children; considering the fact that we did not
observed any side effect with the dental gel with
barberry during the study period, this gel may be
recommended to be used as a dentifrice but further
studies are needed.
Acknowledgement
The authors would like to acknowledge the financial
support of the vice chancellor for research of
Mashhad University of medical sciences (Mums),
and also thank Mr. Ebrahimzadeh and Dr. Karimi for
the assistance with the data analysis.
Conflict of interests
The authors declare that they have no competing
interests.
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A double-blind controlled clinical trial with parallel groups was designed to investigate the effectiveness of a herbal-based toothpaste in the control of plaque and gingivitis as compared with a conventional dentifrice. 70 subjects with gingivitis completed the 6-week study. All participants had at least 20 natural teeth with no probing depths greater than 3 mm and a plaque index of 2 or more at baseline. At baseline, both groups were balanced for the parameters measured: plaque index, plaque vitality, gingival index, bleeding on probing and gingival crevicular fluid flow. At the end of the trial, there were reductions within both groups, however, there were no significant differences between the groups. It was concluded that the herbal based toothpaste was as effective as the conventionally formulated dentifrice in the control of plaque and gingivitis.
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Introduction. Gingivitis is the most common periodontal disease in children and adolescents. Inspite of changing concepts on the etiology and caltural history of periodontal disease over the last few decades, plaque control by self care is still regarded as an essential step in the prevention and treatment of gingivitis. Since most individuals, especially children and adolescent seem to have difficulty in achiving perfect plaque control by mechanical means, investigations has been directed towards the development of safe and effective antiplaque dentifrices. Herbal components have been successfully used in dentistry as tooth cleaning and antiplaque agents. The objective of present study is to evaluate the clinical effects of a dentifrice containing the extracts of sages chiory and siwak on gingivitis and plaque control amongst a group of adolescents in Mashhad. Methods. A double-blind clinical trial was designed to evaluate the effects of a dentifrice containing Sage, Chicory and Siwak extracts on the control of plaque and gingival inflammation in 12-13 years old boys. Sixty students were divided into two groups. One group used test dentifrice and the other used placebo dentifrice daily. At the begining of the trial each subject was scored for plaque and gingival indices (PI and GI) clinical evaluation were examined after 28 days. Results. Analyzing the baseline data showed no significant defference between the PI and GI indices in the test and control groups. But at the end of the trial, there was highly significant difference (P < 0.001) between the mean value of GI in two groups. The effect of test dentifrice on the reduction of GI versus the palcebo dentifrice was 54.21%. Also at the end of the trial there were significant difference (P < 0.004) between the mean value of PI in two groups. The effect of test dentifrice on the reduction of PI compare to the placebo dentifrice was 2.3%. Discussion. It was concluded that the herbal dentifrice was effective in the control of plaque and gingivitis and it have not been associated with side effects.