The Effect of Gargling with Aqueous Extract of Dandelion (Taraxa- cum officinale) on the Oral Hygiene Status of Patients Wearing Fixed Orthodontic Appliance: A Clinical Study

Abstract

Background: During the course of fixed orthodontic therapy, it is difficult to maintain high standard oral hygiene care by mechanical tooth cleaning only. Therefore, mouthwashes are commonly used as adjunct for mechanical tooth cleaning. Most of the mouthwashes are chemicals and have a wide range of side effects. Plant extracts have stood the test of time as safe inexpensive and available remedy for providing general health care. Objective: The present study attempted to evaluate the efficacy of gargling with aqueous extract of Dandelion (Taraxacum officinale) on the oral hygiene status of patients wearing fixed orthodontic appliances. Methods: Eleven male patients undergoing orthodontic treatment with fixed appliances were recruited in the study. All patients were given the same oral hygiene regimen during the study period. Clinical evaluation of OPI (orthodontic plaque index) and salivary streptococcus mutans count were recorded at the first activation visit (three weeks after placement of the orthodontic appliances) which considered the baseline visit and after one week of gargling with the extract. The data were statistically analyzed with SPSS (version 21) using Paired Samples t-test. Result: The results of the statistical analysis revealed that, there were highly significant reductions in both OPI and salivary streptococcus mutans count after one week gargling with aqueous extract of Dandelion (Taraxacum officinale). Conclusion: The present finding concluded that, aqueous extract of Dandelion (Taraxacum officinale) could be use as a promising ingredient in manufacturing mouthwashs and other dental supplies that contribute in maintaining good oral hygiene during the course of orthodontic treatment with fixed appliances.

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Iraqi Dental Journal | Volume 40, Issue 1 - Oct. 2018
The Effect of Gargling with Aqueous Extract of Dandelion (Taraxa-
cum officinale) on the Oral Hygiene Status of Patients Wearing Fixed
Orthodontic Appliance: A Clinical Study
Munad Jihad Ashij AL_Duliamy
MSc in Orthodontics
Lecturer - Mustansiriyah University / College of dentistry POP department
ABSTRACT
Background: During the course of fixed orthodontic therapy, it is difficult to maintain high standard oral hygiene care by mechanical
tooth cleaning only. Therefore, mouthwashes are commonly used as adjunct for mechanical tooth cleaning. Most of the mouth-
washes are chemicals and have a wide range of side effects. Plant extracts have stood the test of time as safe inexpensive and
available remedy for providing general health care. Objective: The present study attempted to evaluate the efficacy of gargling with
aqueous extract of Dandelion (Taraxacum officinale) on the oral hygiene status of patients wearing fixed orthodontic appliances.
Methods: Eleven male patients undergoing orthodontic treatment with fixed appliances were recruited in the study. All patients
were given the same oral hygiene regimen during the study period. Clinical evaluation of OPI (orthodontic plaque index) and
salivary streptococcus mutans count were recorded at the first activation visit (three weeks after placement of the orthodontic
appliances) which considered the baseline visit and after one week of gargling with the extract. The data were statistically analyzed
with SPSS (version 21) using Paired Samples t-test. Result: The results of the statistical analysis revealed that, there were highly sig-
nificant reductions in both OPI and salivary streptococcus mutans count after one week gargling with aqueous extract of Dandelion
(Taraxacum officinale). Conclusion: The present finding concluded that, aqueous extract of Dandelion (Taraxacum officinale) could
be use as a promising ingredient in manufacturing mouthwashs and other dental supplies that contribute in maintaining good oral
hygiene during the course of orthodontic treatment with fixed appliances.
KEYWORDS
dandelion (Taraxacum officinale), oral hygiene , fixed orthodontic appliance.
INTRODUCTION
It has long been demonstrated that fixed
orthodontic appliance components create new
retentive sites for plaque formation which preclude
tooth brushing, reduce the self-cleansing effect
of saliva which lead to increase the dental plaque
accumulation as well as an increase in the level of
oral microorganisms (1). This increase in dental
plaque volume and number of bacteria and their by-
products, lead to enamel demineralization, gingival
inflammation and even systemic problems (2,3).
Although dental plaque may harbor 200–300
bacterial species, mutans streptococci has been
considered as important etiological factor for both
dental and gingival diseases (4,5). Moreover, dental
plaque of patients wearing fixed appliances harbor
more Streptococcus mutans than orthodontic patients
without fixed appliances (6,2). The presence of fixed
orthodontic appliances precludes mechanical teeth
cleaning and changes the oral flora. Failure in
maintaining good oral hygiene during the course of
orthodontic treatment adversely affects the treatment
outcome. Therefore, mechanical tooth cleaning is
not enough to control plaque accumulation during
orthodontic treatment with fixed appliances. Hence,
it is crucial to develop measures other than teeth
brushing to control plaque accumulation during
orthodontic treatment with fixed appliances (7,8). One
of these plaque preventive measures is mouthwash.
Many chemical mouthwashes have been sold in
markets for controlling plaque accumulation and
gingival inflammation. All these chemicals have side
effects (9,10). Therefore, using natural products from
plants extract as mouthwash is a promising approach
to overcome the side effects of chemical mouthwashes
(11).
Extract derived from plants have long been used
for curing different types of diseases. Plants represent
natural products that inexpensive and easily collect
from the nature. Furthermore, these natural products
have no side effects as much as chemical drugs (12,13).
Taraxacum Officinale, is flowering perennial
plant grows anywhere in the world and commonly
known as Dandelion (14). Dandelion content is rich
with minerals and vitamins like, sodium, magnesium,
potassium, zinc, iron, phosphorus, and vitamin A, B,
C, D and E. It used to make food salad and considers
an excellent nutrient for honey bees (15).
It has long been used to cure many medical health
problems like depression, diabetes, urinary, digestive
problems, and breast and uterus tumors (16-19).
Abundant of research suggest the antimicrobial,
anti-inflammatory and antiviral activity of Dandelion
(20-25).
Avast array of plant extracts like
Azadirachta Indica, Ocimum sanctum,
Murraya koenigii L., Acacianilotica, Eucalyptus
camaldulensis, Hibiscus sabdariffa, Mangifera indica,
Psidium guajava, Rosa indica, and Aloe barbadensis

2Iraqi Dental Journal | Volume 40, Issue 1 - Oct. 2018
Miller were used to kill microorganism that harmful
for oral health (26).
However, the effect of dandelion on the oral
hygiene status has not yet been examined. Therefore,
this study aimed to evaluate the efficacy of aqueous
dandelion extract on oral hygiene status and the level
of salivary Streptococcus mutans in patients wearing
fixed orthodontic appliance.
MATERIALS AND METHODS
The scientific committee of research
and development of the college of dentistry
ALMustansiriyah University approved the study
protocol. Eleven male patients aged range 19-23
needed orthodontic treatment with fixed appliances
were recruited in the study. The inclusion criteria were
healthy nonsmoker patients with no medications,
full permanent dentition, no caries and no gingival
inflammation. The participants were assigned
informed consents that discuss the study protocol.
After placement of fixed orthodontic appliances,
the NiTi Arch wires (12 inch) were inserted in all
patients' appliances. At the first follow up appointment
(after three weeks of appliance placement), the OPI
scores were measured and salivary samples were
collected from each patient for assessing baseline
data of oral hygiene status and bacterial count before
starting gargling with the extract. At this appointment
the patients were instructed to follow oral hygiene
regimen by using the same type of toothbrush and
paste (Coalgate) which were gifted to all participants
in the study. The participants were instructed to gargle
with the (40 ml) of extract after teeth brushing for one
minute, three times daily for a week.
Plant collection and Preparation of the Gargle
Dandelion (Taraxacum officinale) plant was
collected from public garden in Bagdad city. Plant
identification was performed at the Department
of Biology, College of Science, ALMustansiriyah
University.
The leave and root of the fresh plant were
purified and cleaned with distilled water then left to
dry in shade at room temperature. The dried plant was
grinded into fine powder.
For gargle preparation the extracted powder was
dissolved in sterile water, filtered, and kept in dark
place at 4 °C until gargle preparation. One Liter of
1 mg/ml concentration was poured in a bottle and
dispensed to each participant.
Oral hygiene and bacterial assessment
Orthodontic Plaque Index which developed
by Beberhold et al., (27) was used to assess the oral
hygiene status before and after one week gargling
with Dandelion (Taraxacum officinale) extract.
The antibacterial effect of gargling with extract
was assessed by counting the number of colony-
forming units (CFU) of Streptococcus mutans in
saliva.
Site-specific modified Stripmutans® technique
(Orion Diagnostica, Finland) recommended by
Wallman and Krasse, (28) was used for evaluating
mutans streptococci colonies. Paraffin pellets and
round-tipped strip from the kit were used for collecting
salivary sample. The patient were instructed to chew
a paraffin pellet for 1 minute, swallow any excess
saliva and then put the rough surface of the round-
tipped strip against the patient’s tongue to collect the
remaining saliva. Then the collecting sample removed
gently from the patient mouth. Selective culture vial
was used to incubate the salivary sample at 37º C for
48 hours in a liquid medium. After that the colony-
forming units (CFU) of Streptococcus mutans in a
culture media were counted.
One week after gargling with the extract, the
OPI scores and salivary mutans streptococci coloni
for each patient were calculated to assess the effect of
gargling on these parameters. Data were presented as
OPI scores and coloni forming unit and statistically
analyzed with SPSS (version 21) using student paired
t-test.
RESULT
All eleven sample patients were successfully
participated in the study without any drop out.
The participant not suffer from any adverse effect
accompany the gargling.
Mean scores of OPI and streptococcus mutans
colony’s count were recorded at baseline time and
after one week of gargling with the extract.
The Paired Samples Statistics with their
significant level of both OPI and streptococcus
mutans colony’s count were shown in Table 1 and 2
respectively.
Regarding both OPI scores there were highly
significant differences (P = <0.001) between the
readings at baseline time and after one week of
gargling with the extract. On the other hand there
was highly significant (P = <0.001) reduction in
streptococcus mutans colony’s count after one week
of gargling.

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Iraqi Dental Journal | Volume 40, Issue 1 - Oct. 2018
Table 1
Paired Samples Statistics of OPI scores before and after gargling
Time of reading Mean Std. Deviation P
Baseline reading 2.18 .87 <0.001
After one week of gargling .73 .47
N=11
Table 2
Paired Samples Statistics of the number of Streptococcus mutans colony before and after gargling
Time of reading Mean Std. Deviation P
Baseline reading 4.36 1.36 <0.001
After one week of gargling 2.55 1.13
N=11
DISCUSSION
After placement of fixed orthodontic appliances,
maintaining good oral hygiene being a challenge.
Preventive methods like mechanical tooth brushing,
fluoride application and avoiding cariogenic food
and drinking are insufficient for controlling plaque
accumulation and subsequent bacterial colonization
(29,30) (Jenatschke et al., 2001; Derks et al., 2007).
Therefore, it is crucial for orthodontists to develop
measures in addition to mechanical tooth cleaning
to prevent the accumulation of dental plaque and
decrease the level of oral mutans streptococci.
The present study was carried out to assess the
efficacy of gargling with aqueous extract of Dandelion
(Taraxacum Officinale) plant on the oral hygiene
status and salivary mutans streptoccous count during
orthodontic therapy with fixed appliances. In an
attempt to incorporate this plant in the composition of
mouthwash and other adjunct materials which could
prevent plaque accumulation and subsequent dental
and gingival diseases.
The selected sample was only male to exclude
any hormonal effect on the oral hygiene status (31).
Orthodontic Plaque Index (OPI) recommended
by Beberhold et al. (27) was used for detecting plaque
and gingival status, as it is easy, reliable and more
precise method for evaluating the oral hygiene of
patients wearing fixed orthodontic appliances.
Chair-side kit for detecting mutans streptococci
colony's counts was used because it is easy, reliable,
less time consuming and less costly microbial
examination method.
After one week gargling with aqueous extract
of Dandelion (Taraxacum Officinale), both OPI
(Orthodontic Plaque Index) scores and salivary
mutans streptococci colony's count were significantly
reduced. This in agreement with the result of Kenny
et al. (24) who demonstrated the antibacterial activity
of Dndelion.
In the present study the improvement in the
oral hygiene status and reduction in the number of
Streptococcus mutans colonies in saliva may be
explained by the anti Streptococcus mutans activity of
the polyphenol content of Dandelion this is according
to Chu et al.; Smullen et al. and Han et al. (32,33,23).
Other suggestion regarding antibacterial activity
of Dandelion is the presence of potassium according
to Clare et al. (17) who suggested that the Dandelion
is a source of potassium that inhibits bacterial growth
by inhibiting moisture (34) (Alibasaya et al., 2018).
CONCLUSION
Gargling with aqueous extract of Dandelion
(Taraxacum Officinale) has antiplaque, antigingival
and antistreptococcus mutans effect. Therefore,
Dandelion extract could be used as an active
ingredient for manufacturing different dental supplies
for maintaining good oral hygiene as adjunct to
mechanical plaque control.
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