Aloe vera: It's effect on gingivitis

Abstract

Aloe vera is the oldest medicinal plant that has maintained its popularity over the course of time. It is widely known for its medicinal uses in wound healing, as an analgesic, and for its anti-inflammatory properties.
The aim of this study is to evaluate the anti-inflammatory property of aloe vera mouthwash on plaque-induced gingivitis.
Forty-five patients who were diagnosed with plaque-induced gingivitis were included in the study. They were divided into three groups with fifteen patients in each group. Group 1 was asked to rinse with 10 ml of aloe vera mouthwash twice daily for three months. Group 2 were treated with scaling only. Group 3 patients were asked to rinse with aloe vera mouthwash and scaling was done. The clinical changes were evaluated with Loe and Silness gingival index (1963) and Muhlemann and Son's Sulcus bleeding index (1971) at baseline, after one month and three months, respectively.
The data obtained was compared statistically. The paired 't' test was done for intragroup comparison and one-way analysis of variance with a post hoc Tukey test was used for intergroup comparison. The data was obtained at the baseline, end of first month, and end of the third month. The result suggested reduction in gingival inflammation in all the three groups, but it was more in the aloe vera mouthwash and scaling group. Hence, it was concluded that aloe vera had a significant anti-inflammatory property. Thus, it can be used as an adjunct to mechanical therapy for treating plaque-induced gingivitis.

Full text

Journal of Indian Society of Periodontology - Vol 17, Issue 4, Jul-Aug 2013 435
Original Article
Address for
correspondence:
Dr. Neha Ajmera,
Department of
Periodontics, Vaidik Dental
College and Research
Center, Daman - 396 210,
Union Territory, India.
E-mail: drneha_pearls@
yahoo.co.in
Submission: 21-03-2011
Accepted: 17-07-2013
Departments of
Periodontics, and
2Orthodontics, Vaidik
Dental College and
Research Center,
Daman, Union Territory,
1Department of
Periodontics,
Oxford Dental
College, Bangalore,
Karnataka, India
Aloe vera: It’s effect on gingivitis
Neha Ajmera, Anirban Chatterjee,1 Vikas Goyal2
Abstract:
Objective: Aloe vera is the oldest medicinal plant that has maintained its popularity over the course of time.
It is widely known for its medicinal uses in wound healing, as an analgesic, and for its anti‑inammatory
properties. Aim: The aim of this study is to evaluate the anti‑inammatory property of aloe vera mouthwash on
plaque‑induced gingivitis. MaterialsandMethods: Forty‑ve patients who were diagnosed with plaque‑induced
gingivitis were included in the study. They were divided into three groups with fteen patients in each group.
Group 1 was asked to rinse with 10 ml of aloe vera mouthwash twice daily for three months. Group 2 were treated
with scaling only. Group 3 patients were asked to rinse with aloe vera mouthwash and scaling was done. The
clinical changes were evaluated with Loe and Silness gingival index (1963) and Muhlemann and Son’s Sulcus
bleeding index (1971) at baseline, after one month and three months, respectively. Results: The data obtained
was compared statistically. The paired ‘t’ test was done for intragroup comparison and one‑way analysis of
variance with a post hoc Tukey test was used for intergroup comparison. The data was obtained at the baseline,
end of rst month, and end of the third month. The result suggested reduction in gingival inammation in all the
three groups, but it was more in the aloe vera mouthwash and scaling group. Hence, it was concluded that aloe
vera had a signicant anti‑inammatory property. Thus, it can be used as an adjunct to mechanical therapy for
treating plaque‑induced gingivitis.
Key words:
Aloe vera, gingivitis, periodontal inammation
INTRODUCTION
Aloes have been used therapeutically,
certainly since the Roman times and
perhaps long before.[1,2] Aloe vera (synonym:
Aloe barbadensis Miller) belongs to the Liliaceae
family, of which there are about 360 species.
Aloe vera is a cactus-like plant that grows readily
in hot, dry climates, and currently, because
of demand, is cultivated in large quantities.
Cosmetics and some medicinal products are
made from the mucilaginous tissue in the center
of the aloe vera leaf, which is called aloe vera gel.
The peripheral bundle sheath cells of aloe vera
produce intensely bitter, yellow latex, commonly
termed as ‘aloe juice’, ‘sap’ or ‘aloes’. Aloe vera
sap and aloe vera gel are often confused. Unlike
aloes, aloe vera gel contains no anthraquinones,
which are responsible for the strong laxative
effects of aloes. However, the total leaf extracts
may contain anthraquinones.
The pharmacological actions of aloe vera,
as studied in vitro or in animals (in most
cases the total leaf extract was used), include
anti-inammatory and anti-arthritic activity, and
antibacterial and hypoglycemic effects. Aloe vera
contains 75 potentially active constituents:
Vitamins, enzymes, minerals, sugars, lignin,
saponins, salicylic acids, and amino acids.
Polysaccharides are considered to be the active
ingredients of Aloe’s anti-inflammation and
immune-modulation effects. Inammation is a
tissue reaction by the body to injury and typically
follows burns or other skin insults. It is classically
characterized by swelling (tumor), pain (dolor),
redness (rubor), and heat (calor), as well as loss
of function.[3]
It is thus a complex process and investigations
into the therapeutic properties of the gel should
take account of its effects on these various
symptoms. In addition, the gel may have more
than one active constituent, which may be
addressing different parts of the healing process.
Although inammatory processes are a natural
response to injury and may hinder healing, it
may also be undesirable to suppress them in
an unstructured manner before their purpose
is accomplished. Hence, the aim of the present
study is to evaluate the anti-inflammatory
property of aloe vera gel in plaque-induced
gingivitis.
MATERIALS AND METHODS
The study design was a double-blind,
randomized, placebo-controlled clinical study
for a period of three months. It was approved
by the Ethical Committee of the Institute of
Dental Sciences, Bareilly. Informed consent
was taken from all patients. Forty-ve subjects
with plaque-induced gingivitis were included,
within the ages of 18 and 65 years; they were
systemically healthy individuals, had not
undergone prophylaxis for the last six months,
and were with at least 20 teeth present. Patients
on antibiotics/anti-inammatory therapy for
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DOI:
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Ajmera, et al.: Aloe vera - It’s effect on gingivitis
436 Journal of Indian Society of Periodontology - Vol 17, Issue 4, Jul-Aug 2013
Table 2: Paired ttestforintragroupcomparisonbetweenallthreegroupsatdifferenttimes
Dependentvariable IGroup JGroup Onemonth Threemonths
Meandiff(I-J) Std.error Sign Meandiff(I-J) Std.error Sign
Gingival index 1 2 0.066 0.50 0.385 –0.038 0.58 0.791
3 0.20 0.50 0.001 0.293 0.58 <0.001
2 1 –0.066 0.50 0.385 0.038 0.58 0.791
3 0.133 0.50 0.029 0.331 0.58 <0.001
3 1 –0.20 0.50 0.001 –0.293 0.58 <0.001
2 –0.133 0.50 0.029 –0.331 0.58 <0.001
Sulcus bleeding index 1 2 0.073 0.52 0.347 –0.031 0.47 0.785
3 0.213 0.52 0.001 0.306 0.47 <0.001
2 1 –0.031 0.52 0.347 0.031 0.47 0.785
3 0.14 0.52 0.027 0.338 0.47 <0.001
3 1 –0.213 0.52 0.001 –0.306 0.47 <0.001
2 –0.14 0.52 0.027 –0.338 0.47 <0.001
Table1:OnewayANOVAintergroupforGingivalindexandSulcusbleedingindex
Group Time df Gingivalindex Sulcusbleedingindex
Mean SD tvalue Sign(two-tailed) Mean SD tvalue Sign(two-tailed)
1 0 vs. 1 14 0.70 0.16 16.90 <0.001 0.70 0.16 16.90 <0.001
0 vs. 3 14 0.94 0.19 18.96 <0.001 0.94 0.19 18.96 <0.001
1 vs. 3 14 0.24 0.09 10.21 <0.001 0.24 0.09 10.21 <0.001
2 0 vs. 1 14 0.86 0.15 22.17 <0.001 0.866 0.15 21.75 <0.001
0 vs. 3 14 0.995 0.17 21.78 <0.001 1.00 0.17 22.17 <0.001
1 vs. 3 14 0.135 0.06 7.74 <0.001 0.135 0.05 9.33 <0.001
3 0 vs. 1 14 0.93 0.20 18.10 <0.001 0.95 0.31 11.85 <0.001
0 vs. 3 14 1.27 0.21 22.50 <0.001 1.28 0.20 24.12 <0.001
1 vs. 3 14 0.33 0.19 6.74 <0.001 0.33 0.19 6.61 <0.001
ANOVA–Analysis of variance
the last six months, pregnant females, those with a history
of allergy to aloe vera, and patients unwilling to complete
treatment were excluded from the study. The patients were
divided into three groups.
The first group with 15 patients was given aloe vera gel
mouthwash. The subjects were asked to rinse with 15 ml of
solution for one minute twice daily[4] for 90 days and not to
refrain from routine oral hygiene procedures. Group two
subjects were treated with scaling and root planing only.
Group three subjects were treated with scaling and root
planing and were asked to rinse with aloe vera mouthwash
twice daily for three months. Full mouth gingival index and
sulcus bleeding indices were recorded at the rst month as
well as the third month for all subjects and were compared to
baseline recordings.
Statistical analysis
The data obtained was compared statistically. The paired ‘t’
test was carried out for intragroup comparison and one-way
ANOVA with post hoc Tukey test was used for intergroup
comparison. A P≤ 0.05 was considered statistically signicant.
RESULTS
Forty-ve subjects were enrolled in the study. The result
obtained was uneventful. Table 1 shows the one-way ANOVA
between all the three groups at baseline, rst month, and third
month for Loe and Sillness gingival index and Sulcus bleeding
index. There is suggestion of a reduction in gingival index and
sulcus bleeding index in all groups in the rst month and then
in the third month. However, this reduction was not seen in
the control group. This reduction was also seen when group
comparisons were done at the baseline, rst month, and third
month within all the groups. Similar results were obtained in
the Sulcus bleeding indices [Table 2].
Table 3 shows post hoc tests for multiple comparisons and shows
a statistically signicant reduction in the gingival and sulcus
bleeding indices at the end of the rst month and third month,
when Figure 1 was compared with Figure 2. Reduction was
also statistically signicant when Figure 3 was compared with
Figure 2 at the end of the third month.
DISCUSSION
Although inammation is a necessary defensive mechanism
it can lead to host-tissue destruction when the response is
exaggerated. Thus, newer therapies must aim at moderating
excessive inammation. A similar attempt has been made in
this study to treat gingivitis by aloe vera extract. The gingival
index score and sulcus bleeding score are signicantly reduced
in all groups at the end of the rst month (P < 0.01) with
subsequent reduction at the end of the third month, suggestive
of an anti-inammatory effect of the ‘aloe vera mouth wash
only’, ‘scaling only’, and ‘scaling and aloe vera mouthwash’
groups, with greater reduction in the gingival index and
sulcus bleeding index in the ‘scaling and aloe vera mouthwash
group’, as compared to both groups, at the end of one month.
Reduction was more in the ‘scaling with mouthwash’ group
as compared to the ‘scaling only’ and ‘aloe vera mouthwash
only’ groups at the end of the third month. The results of the
gingival index and sulcus bleeding index of the ‘scaling only’
and ‘aloe vera mouthwash only’ groups are suggestive of a
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Ajmera, et al.: Aloe vera - It’s effect on gingivitis
Journal of Indian Society of Periodontology - Vol 17, Issue 4, Jul-Aug 2013 437
Table 3: Post hocTukeyHSDtestformultiplecomparisons
Time Group NGingivalindex Sulcusbleedingindex
Mean SD FSign Mean SD FSign
Baseline 1 15 1.89 0.24 0.507 0.606 2.29 0.24 0.508 0.605
2 15 1.98 0.24 2.38 0.24
3 15 1.93 0.28 2.33 0.27
One month 1 15 1.19 0.14 8.29 0.001 1.59 0.14 8.63 0.001
2 15 1.12 0.15 1.52 0.16
3 15 0.99 0.10 1.38 0.12
Three months 1 15 0.95 0.11 19.52 <0.001 1.50 0.11 31.38 <0.001
2 15 0.99 0.11 1.60 0.12
3 15 0.66 0.21 1.40 0.14
Baseline 1 15 1.89 0.24 0.507 0.606 2.29 0.24 0.508 0.605
2 15 1.98 0.24 2.38 0.24
3 15 1.93 0.28 2.33 0.27
One month 1 15 1.19 0.14 8.29 0.001 1.59 0.14 8.63 0.001
2 15 1.12 0.15 1.52 0.16
3 15 0.99 0.10 1.38 0.12
Three months 1 15 0.95 0.11 19.52 <0.001 1.50 0.11 31.38 <0.001
2 15 0.99 0.11 1.60 0.12
3 15 0.66 0.21 1.40 0.14
HSD–Honest signicant difference; SD–Standard deviation
Figure 3: Group 2 – Only scaling (a) Baseline; (b) One month; (c) Three months
c
b
a
Figure 2: Group 3 – Aloe + Scaling (a) Baseline; (b) One month; (c) Three months
c
b
a
Figure 1: Group 1 – Only aloe vera mouth wash. (a) Baseline; (b) One month; (c) Three months
c
b
a
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Ajmera, et al.: Aloe vera - It’s effect on gingivitis
438 Journal of Indian Society of Periodontology - Vol 17, Issue 4, Jul-Aug 2013
decrease in gingival inammation at the end of the rst and
third months. However, both groups had a similar degree of
reduction, suggesting that the aloe vera mouthwash can be
used as an adjunct to scaling, with better resolution of the
inammation.
Acceptability of the test product – reported unpalatable by few
subjects. No itching, burning or other adverse effects on oral
mucosa reported.
Davis et al. (1989),[5] tested the action of topical/injected
aloe vera gel against inammation produced by a variety
of agents that were considered to induce different types of
inammation.
Davis et al. (1994)[6] – tested the anti-inammatory and wound
healing activity of aloe vera due to presence of growth
substance mannose-6 phosphate.
Within the limitations of the study, it was found that aloe
vera had a signicant anti-inammatory property. Thus, it
can be used as an adjunct to mechanical therapy for treating
plaque-induced gingivitis.
Hence, it can be concluded that the present study has an
important impact to create an effective and inexpensive oral
health intervention for low socioeconomic communities.
REFERENCES
1. Crosswhite FS, Crosswhite CD. Aloe vera, plant symbolism and
the threshing oor. Desert Plants 1984;6:43-50.
2. Morton JF. Folk uses and commercial exploitation of Aloe leaf
pulp. Econ Bot 1961;15:311-9.
3. Macpherson G, editor. Inammation, Black’s Medical Dictionary.
London: A and C Black; 1992. p. 296.1.
4. Villalobos OJ, Salazar CR, Sánchez GR. Efecto de un enjuague
bucal compuesto de aloe vera en la placa bacteriana e inamación
gingival. Acta Odontol Venez 2001;39:16-24.
5. Davis RH, Rosenthal KY, Cesario LR, Rouw GA. Processed Aloe
vera administered topically inhibits inammation. J Am Podiatr
Med Assoc 1989;79:395-7.
6. Davis RH, Donato JJ, Hartman GM, Haas RC. Anti-inammatory
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J Am Podiatr Med Assoc 1994;84:77-81.
How to cite this article: Ajmera N, Chatterjee A, Goyal V. Aloe vera:
It’s effect on gingivitis. J Indian Soc Periodontol 2013;17:435-8.
Source of Support: Nil, Conict of Interest: None declared.
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