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Effect of Lycopene in the Treatment of Periodontal Disease: A Clinical Study

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  • K. L E Society's Institue of Dental Sciences,Bangalore University

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Purpose: Several epidemiologic studies have suggested a role of tomato products in decreasing the risk of the development of diseases related to oxidative stress (cancer and other chronic diseases). Oxidative stress may result in periodontal tissue damage either directly or indirectly. Lycopene, a powerful antioxidant and the main carotenoid in tomato products possesses the greatest quenching ability of singlet oxygen among the various carotenoids and is effective in protecting blood lymphocytes from NOO-radical damage. Hence, the aim of the present study is to compare the effect of systemically administered lycopene as an adjunct to scaling and root planing in patients with gingivitis and periodontitis. Materials and methods: Twenty systemically healthy patients were involved in a randomized, double-blind, parallel study and based on their clinical signs were divided into two groups of mild to moderate periodontitis (A) and moderate gingivitis (B). The subjects under the groups A and B were randomly distributed between the two treatment groups: test group (n = 5), 4 mg lycopene/day for 2 weeks with oral prophylaxis (full mouth scaling and root planing (SRP) completed within 24 hours) and controls (n = 5), receiving only oral prophylaxis. Pre- and post-therapeutic periodontal parameters were evaluated. Results: In group A, statistically significant improvement in CAL was reported in test group as compared to control group. In group B, the difference between pretreatment and post-treatment bleeding on probing scores was found to be statistically non-significant in both groups. Conclusion: Results show that lycopene is a promising treatment modality as an adjunct to full mouth SRP of the oral cavity in patients with moderate periodontal disease. Clinical significance: Modulation of the free radical production seems to be essential for the inhibition of tissue destruction, and treatment with antioxidants, like lycopene, which is the most potent among them will block the production of free ROS or its effects might prove to be therapeutically valuable.
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Sphoorthi Anup Belludi et al
1054
Original research 
Effect of Lycopene in the Treatment of Periodontal
Disease: A Clinical Study
Sphoorthi Anup Belludi, Shiras Verma, Ruchi Banthia, Prashanth Bhusari, Simran Parwani, Sameer Kedia, SV Saiprasad
10.5005/jp-journals-10024-1450
ABSTRACT
Purpose: Several epidemiologic studies have suggested a role
of tomato products in decreasing the risk of the development of
diseases related to oxidative stress (cancer and other chronic
diseases). Oxidative stress may result in periodontal tissue
damage either directly or indirectly. Lycopene, a powerful
antioxidant and the main carotenoid in tomato products
possesses the greatest quenching ability of singlet oxygen
among the various carotenoids and is effective in protecting
blood lymphocytes from NOO-radical damage. Hence, the aim
of the present study is to compare the effect of systemically
administered lycopene as an adjunct to scaling and root planing
in patients with gingivitis and periodontitis.
Materials and methods: Twenty systemically healthy patients
were involved in a randomized, double-blind, parallel study and
based on their clinical signs were divided into two groups of mild
to moderate periodontitis (A) and moderate gingivitis (B). The
subjects under the groups A and B were randomly distributed
between the two treatment groups: test group (n = 5), 4 mg
lycopene/day for 2 weeks with oral prophylaxis (full mouth
scaling and root planing (SRP) completed within 24 hours)
and controls (n = 5), receiving only oral prophylaxis. Pre- and
post-therapeutic periodontal parameters were evaluated.
Results: In group A, statistically significant improvement
in CAL was reported in test group as compared to control
group. In group B, the difference between pretreatment and
post-treatment bleeding on probing scores was found to be
statistically non-signicant in both groups.
Conclusion: Results show that lycopene is a promising
treatment modality as an adjunct to full mouth SRP of the oral
cavity in patients with moderate periodontal disease.
Clinical signicance: Modulation of the free radical production
seems to be essential for the inhibition of tissue destruction, and
treatment with antioxidants, like lycopene, which is the most
potent among them will block the production of free ROS or its
effects might prove to be therapeutically valuable.
Keywords: Antioxidants, Gingivitis, Periodontitis, Lycopene,
Tomatoes.
How to cite this article: Belludi SA, Verma S, Banthia R, Bhusari
P, Parwani S, Kedia S, Saiprasad SV. Effect of Lycopene in the
Treatment of Periodontal Disease: A Clinical Study. J Contemp
Dent Pract 2013;14(6):1054-1059.
Source of support: Nil
Conict of interest: None
INTRODUCTION
Lycopene belongs to a class of compounds known as the
carotenoids which are the yellow, orange and red pigments
synthesized in plants. The ve principle carotenoids found
in human plasma, as the result of ingesting plants, including
alpha and beta-carotene, beta-cryptoxanthin, lutein and
lycopene. Over 600 carotenoids have been identied to date.
The greatest known source of lycopene is tomatoes, which are
widely employed in cooking.1 There is a positive relationship
between lycopene consumption and a reduction in the risk of
development of degenerative diseases caused by free radicals,
such as cancer, cardiovascular diseases, asthma, arthritis,
stroke, cataractogenesis, hepatitis and also periodontitis.2-4
Lycopene has the uncommon feature of becoming bound to
chemical species that react to oxygen, thus being the most
efcient biological antioxidizing agent.3 Due to this property,
studies have been enthusiastically conducted with lycopene,
in order to nd out whether or not it could be an alternative to
protect patients against the damaging effects of free radicals.3
Literature is decient in the studies regarding the effect of
lycopene on periodontal health, hence the present study aims
to evaluate the effect of lycopene as an adjunct to mechanical
therapy in the management of periodontal disease (gingivitis
and periodontitis).
MATERIALS AND METHODS
Twenty systemically healthy patients (30 + 41.6 years) were
involved in a randomized, double-blind parallel study. The
patients were divided into two groups of mild to moderate
periodontal disease (group A) and moderate gingivitis (group B).
The subjects under the groups A and B were randomly
distributed between the two treatment groups: test group
Effect of Lycopene in the Treatment of Periodontal Disease: A Clinical Study
The Journal of Contemporary Dental Practice, November-December 2013;14(6):1054-1059 1055
JCDP
(n = 5), 4 mg lycopene/day for 2 weeks with oral prophylaxis
(full mouth scaling and root planing completed within
24 hours) and controls (n = 5) receiving only oral prophylaxis.
Inclusion and Exclusion Criteria
Patients who had not been treated for gingival or periodontal
disease, who had not used any medications, such as
antibiotics for past 6 months or over the counter antioxidants
like Vit C, Vit B, β-carotene within past 3 months and did
not report any side effects or drug allergies were included in
this study. Patients with systemic disease, such as diabetes,
cardiovascular diseases, pregnant and lactating women,
current and former smokers and patients with mobile teeth
and abscesses were excluded from the study.
All the patients in the two groups were randomly
assigned into control group (n = 5) received thorough full
mouth scaling and root planing (SRP) completed within
24 hours and test group (n = 5) received thorough full
mouth SRP completed within 24 hours along with lycopene
(Lycotas, Pharma co). Lycopene was prescribed for
2 weeks, twice daily. Each capsule contained lycopene
6%—2000 mcg, Vit C—50 mg, Vit A—2500 IU, zinc sulfate
monohydrate—20.6 mg, chromium picolinate—75 mcg.
Clinical parameters namely PPD (probing pocket depth),
CAL (clinical attachment loss) and BOP (bleeding on
probing) were recorded from Ramfjord’s six teeth (Ramfjord
1959) at baseline (0 day) and then again at 14 days post-
treatment with William’s periodontal probe in patients under
group A. PPD and CAL were measured at four sites per
tooth. Bleeding on probing were recorded from Ramfjord’s
six teeth (Ramfjord 1959) at baseline (0 day) and then again
at 14 days post-treatment with William’s periodontal probe
in patients under group B. Participants were instructed
against changing their oral hygiene habits or taking any other
medication throughout the study period. All procedures were
carried out with adequate understanding and written consent
of all the patients and ethical clearance to conduct this study
was obtained from the ethical committee of Modern Dental
College and Research Centre.
Data thus collected was subjected to unpaired and paired
t-tests. Null’s hypothesis was that adjunctive use of lycopene
along with mechanical therapy resulted in the same clinical
outcome as compared to SRP alone.
RESULTS
Group A
In group A, the pretreatment probing pocket depths of test
and control groups were 5.37 ± 1.52 mm (mean ± standard
deviation) and 5.03 ± 1.56 mm respectively. Difference
between test and control group was found to be statistically
nonsignicant at 0.405 probability (unpaired t-test score
was 0.83). Fourteen days post-treatment probing pocket
depths of test and control groups were 4 ± 1.44 mm (mean
± standard deviation) and 4.10 ± 1.65 mm respectively.
Difference between test and control group was found to be
statistically nonsignicant at 0.918 probability (unpaired
t-test score was 0.10). The difference between pretreatment
and post-treatment probing pocket depths was found to be
statistically highly signicant in both test group (paired t-test
value is 5.76 at 0.00 probability) and control group (paired
t-test value is 4.06 at 0.00 probability).
Pretreatment clinical attachment loss in test and control
groups were 1.67 ± 1.24 and 1.70 ± 1.42 mm respectively.
Difference between test and control group was found to be
statistically nonsignicant at 0.803 probability (unpaired
t-test score was 0.25). Post-treatment clinical attachment
loss in test and control groups were 1.40 ± 1.16 mm and
1.43 ± 1.33 mm respectively. Difference between test and
control group was found to be statistically nonsignicant
at 0.803 probability (unpaired t-test score was 0.25). The
difference between pretreatment and post-treatment clinical
attachment loss was found to be statistically signicant in test
group (paired t-test value is 1.86 at 0.027 probability). The
difference between pretreatment and post-treatment clinical
attachment loss was found to be statistically signicant in
control group (paired t-test value is 2.11 at 0.043 probability).
The difference between post-treatment values was signicant
in test group in comparison to the control group (paired t-test
value is 2.31 at 0.024 probability). The results are depicted
in Tables 1 and 2 and Graphs 1 to 3.
Pretreatment bleeding on probing scores of test and
control groups were 1.2 ± 0.61 mm and 0.60 ± 0.56 mm
respectively. Difference between test and control groups was
found to be statistically nonsignicant at 0.923 probability
(unpaired t-test score was 0.10). Post-treatment bleeding on
Graph 1: Pre- and post-treatment mean values of different
parameters in control group
Sphoorthi Anup Belludi et al
1056
Graph 2: Pre- and post-treatment mean values of different
parameters in test group
Graph 3: Comparison of post-treatment mean values of different
parameters between control and test groups
Graph 4: Comparison of pre and post-treatment mean values of
bleeding index between test and control groups
Table 1: Pre- and post-treatment values of different parameters for test and control groups
Character Pretreatment
Mean ± SD
Post-treatment
Mean ± SD
‘t’ value Probability Signicance
Control group
Probing depth (mm) 5.03 ± 1.56 4.10 ± 1.65 4.06 0.000 HS
Clinical attachment loss (mm) 1.70 ± 1.42 1.43 ± 1.33 2.11 0.043 S
Bleeding on probing 1.60 ± 0.72 0.63 ± 0.67 6.92 0.000 HS
Test group
Probing depth (mm) 5.37 ± 1.52 4.00 ± 1.44 5.76 0.000 HS
Clinical attachment loss (mm) 1.67 ± 1.24 1.40 ± 1.16 1.86 0.027 S
Bleeding on probing 1.20 ± 0.61 0.60 ± 0.56 5.28 0.000 HS
NS: Nonsignicant; S: Signicant; HS: Highly signicant
probing scores of test and control groups were 0.60 ± 0.56
and 0.63 ± 0.67 mm respectively. Difference between test
and control group was found to be statistically nonsignicant
at 1.000 probability (unpaired t-test score was 0.00). The
difference between pretreatment and post-treatment bleeding
on probing was found to be statistically highly signicant in
test group (paired t-test value is 5.28 at 0.000 probability).
The difference between pretreatment and post-treatment
bleeding in probing was found to be statistically highly
signicant in control group (paired t-test value is 6.92 at
0.000 probability).
Group B
In group B, the pretreatment bleeding on probing scores
of test and control groups were 0.87 ± 0.68 mm (mean ±
standard deviation) and 1.17 ± 0.79 mm respectively.
Difference between test and control group was found to be
statistically nonsignicant at 0.121 probability (unpaired
t-test score was 0.10). Post-treatment bleeding on probing
scores of test and control groups were 0.57 ± 0.63 mm and
0.80 ± 0.71 mm respectively. Difference between test and
control group was found to be statistically nonsignicant
at 1.000 probability (unpaired t-test score was 0.00). The
difference between pretreatment and post-treatment bleeding
on probing scores was found to be statistically nonsignicant
in test group (paired t-test value is 0.77 at 0.081 probability).
The difference between pretreatment and post-treatment
Effect of Lycopene in the Treatment of Periodontal Disease: A Clinical Study
The Journal of Contemporary Dental Practice, November-December 2013;14(6):1054-1059 1057
JCDP
Table 2: Comparison of different parameters in test and control groups
Character Control group Test
group
‘t’ value Probability Signicance
Before the experiment
Probing depth (mm) 5.03 ± 1.56 5.37 ± 1.52 0.83 0.405 NS
Clinical attachment loss (mm) 1.70 ± 1.42 1.67 ± 1.24 0.25 0.803 NS
Bleeding on probing 1.60 ± 0.72 1.20 ± 0.61 0.10 0.923 NS
21 days after treatment
Probing depth (mm) 4.10 ± 1.65 4.00 ± 1.44 0.10 0.918 NS
Clinical attachment loss (mm) 1.43 ± 1.33 1.40 ± 1.16 2.31 0.024 S
Bleeding on probing 0.63 ± 0.67 0.60 ± 0.56 0.20 0.835 NS
*Signicant; **Highly signicant; NS: Nonsignicant; S: Signicant
Table 3: Pre- and post-treatment values of bleeding index for test and control groups
Character Pretreatment Mean
± SD
Post-treatment
Mean ± SD
‘t’ value Probability Signicance
Control group 1.17 ± 0.79 0.80 ± 0.71 1.88 0.064 NS
Test group 0.87 ± 0.68 0.57 ± 0.63 0.77 0.081 NS
NS: Nonsignicant; S: Signicant; HS: Highly signicant
Table 4: Comparison of bleeding index values between test and control groups
Character Control group Test group ‘t’ value Probability Signicance
Before the experiment 1.17 ± 0.79 0.87 ± 0.68 1.57 0.121 NS
21 days after treatment 0.80 ± 0.71 0.57 ± 0.63 1.34 0.184 NS
NS: Nonsignicant
bleeding on probing scores was found to be statistically
nonsignicant in control group (paired t-test value is 1.88
at 0.064 probability).
The results are depicted in Tables 3, 4 and Graph 4.
DISCUSSION
Periodontitis is an inammatory condition representing the
response of the periodontal tissues to lipopolysaccharide
derived from Gram-negative anaerobic bacteria. Inammation
is known to be a protective response that focuses on the
removal of the stimuli responsible for damage to the tissues,
thereby leading to the restoration of health.5,6 There is an
increasing body of evidence available to implicate reactive
oxygen species (ROS) in the pathogenesis of variety of
inammatory disorders, of which periodontal disease is no
exception. A variety of ROS (e.g. superoxide and hydroxyl
radicals, hydrogen peroxide, hypochlorous acid and singlet
oxygen) which whilst not radicals in nature, can cause
substantial tissue damage by initiating free radical chain
reaction.7-9 Modulation of the free radical production seems
to be essential for the inhibition of tissue destruction, and
treatment with drugs that block the production of free ROS
or block its effects might be therapeutically valuable.10-12
Recent investigations on animal models suggest that
antioxidant therapies, which interfere with ROS, may be of
benet in the treatment of periodontitis.12
Many chemotherapeutic agents used in periodontics,
in addition to their antiseptic and antimicrobial effects, are
known to have an antioxidative activity against spontaneous
oxidation.13
Among the common carotenoids, lycopene stands as the
most potent antioxidant.12 Lycopene exhibits the highest
physical quenching rate with singlet oxygen11,14 and is atleast
three-fold more effective than β-carotene in preventing cell
death by quenching NOO-radicals.15
Lycopene minimizes cell damage by:
1. Limiting free-radical formation
2. Destroying the free radicals or their precursors
3. Stimulating antioxidant enzyme activity
4. Repairing oxidative damage
5. Stimulating repair enzyme activity
6. Reversing DNA damage induced by H2O2.16
This study compared the effectiveness of lycopene
(Lycotas, Pharma Co.) as an adjunct to mechanical therapy
with that of mechanical therapy alone in patients with
mild to moderate periodontitis (group A) and moderate
gingivitis (group B).17 All the patients enrolled in this study
were compliant to the regimen. No adverse effects in the
Sphoorthi Anup Belludi et al
1058
form of any rashes or allergic reactions were reported by
any of the patients. In group A, improvement in clinical
parameters (PPD and BOP) was found to be statistically
highly signicant in both test and control groups. There
was a signicant improvement in CAL in both test as well
as control groups. When both test and control groups were
compared, PPD and BOP showed no signicant difference,
and only CAL showed statistically signicant improvement.
However, in group B, the difference between pretreatment
and post-treatment bleeding on probing scores was found to
be statistically nonsignicant in both test and control groups
and between the two groups.
Similar results were also reported by Chandra et al11
who concluded that there was a positive correlation between
salivary uric acid levels and gingival parameters in gingivitis
patients treated with lycopene as an adjunct to mechanical
therapy. In this study, it was observed that although the
mean reduction in GI (gingival index) was higher in the
lycopene and SRP group than in the lycopene group, there
were no statistically singnicant differences between these
two groups.
A recent study investigated the relationship between
monthly tomato consumption and serum lycopene levels,
and self-reported history of congestive heart failure (CHF)
in individuals with periodontitis. It was concluded that a
relationship exists between periodontitis and CHF risk, and
high monthly tomato consumption appears to affect this
relationship in a positive direction in periodontitis subjects.18
Recent research suggests that mixtures of antioxidants
are more effective than the single compounds and the
synergistic effect is more pronounced when lycopene lutein
is present.19
CONCLUSION
Results show that lycopene is a promising treatment
modality as an adjunct to full mouth SRP of the oral cavity
in patients with moderate periodontal disease. However,
there is a paucity of studies that utilise potent antioxidants
in the treatment of periodontal diseases and hence deserves
long-term studies for the same.
CLINICAL SIGNIFICANCE
Modulation of the free radical production seems to be
essential for the inhibition of tissue destruction, and
treatment with drugs that block the production of free ROS
or block its effects might be therapeutically valuable. Recent
investigations on animal models suggest that, antioxidant
therapies, which interfere with ROS, may be of benet in
the treatment of periodontal disease. As among the common
carotenoids, lycopene stands as the most potent antioxidant,
it may serve as a valuable therapy in the treatment of
periodontal diseases.
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Effect of Lycopene in the Treatment of Periodontal Disease: A Clinical Study
The Journal of Contemporary Dental Practice, November-December 2013;14(6):1054-1059 1059
JCDP
ABOUT THE AUTHORS
Sphoorthi Anup Belludi (Corresponding Author)
Professor, Department of Periodontics, KLE Society’s Institute of
Dental Sciences, 20, Yeshwanthpur Suburb, 2nd Stage, Tumkur Road,
Bengaluru, Karnataka-560022, India, Phone: 996010380, e-mail:
doc_sphoo@yahoo.com
Shiras Verma
Postgraduate Student, Department of Periodontics, Modern Dental
College and Research Centre, Indore, Madhya Pradesh, India
Ruchi Banthia
Professor, Department of Periodontics, Modern Dental College and
Research Centre, Indore, Madhya Pradesh, India
Prashanth Bhusari
Professor, Department of Periodontics, Modern Dental College and
Research Centre, Indore, Madhya Pradesh, India
Simran Parwani
Senior Lecturer, Department of Periodontics, Modern Dental College
and Research Centre, Indore, Madhya Pradesh, India
Sameer Kedia
Postgraduate Student, Department of Periodontics, Modern Dental
College and Research Centre, Indore, Madhya Pradesh, India
SV Saiprasad
Senior Scientist, Department of Agriculture, IARI Regional Station
Indore, Madhya Pradesh, India
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Clinical decision is often difficult with chlorhexidine mouthwash. The use of antioxidant mouthwashes for the treatment of periodontal disease is in practise. Therefore, it is of interest to collect gleaned information on Antioxidant mouthwashes as periodontal therapy from known literature. Improvement in treatment using antioxidant mouthwashes is reported in several studies. The mouthwash with antioxidants has similar anti-gingivitis, antiplaque and antimicrobial effects as that of chlorhexidine mouthwash
... Lycopene has been investigated for clinical management of periodontitis owing to its inherent antioxidant activity. In a randomized, double-blind study, short-term exposure to lycopene at 4 mg/day for 2 weeks has significantly improved mild periodontitis due to its free radical quenching properties [216]. In periodontitis patients, systemic lycopene (8 mg daily) supplementation for 2 months significantly reduced lipid peroxidation in serum, and prominent improvement was observed in periodontitis parameters such as modified gingival index, probing depth, and clinical attachment loss, and the follow-up of these patients revealed significant improvement with routine scaling and root planning (SRP) for 4 months even after discontinuation of lycopene treatment [217]. ...
... Lycopene has been investigated for clinical management of periodontitis owing to its inherent antioxidant activity. In a randomized, double-blind study, short-term exposure to lycopene at 4 mg/day for 2 weeks has significantly improved mild periodontitis due to its free radical quenching properties [216]. In periodontitis patients, systemic lycopene (8 mg daily) supplementation for 2 months significantly reduced lipid peroxidation in serum, and prominent improvement was observed in periodontitis parameters such as modified gingival index, probing depth, and clinical attachment loss, and the follow-up of these patients revealed significant improvement with routine scaling and root planning (SRP) for 4 months even after discontinuation of lycopene treatment [217]. ...
... (Negri et al., 2020). In a recent clinical trial, lycopene reduced periodontitis by blocking the production of ROS (Belludi et al., 2013). In light of the evidences, it can be suggested that lycopene can be used for treating inflammatory diseases and its associated long-term complications. ...
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Preshaw PM. Definitions of periodontal disease in research. J Clin Periodontol 2008; doi: 10.1111/j.1600-051X.2008.01320.x.
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