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The Effectiveness of Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea (Hibiscus sabdariffa L) Against the Inhibition of Dental Plaque Formation

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Abstract

BACKGROUND: Dental disease is a significant public health problem. Various efforts have been made to maintain oral health by utilizing natural ingredients from plants. One of the natural ingredients often used among the community is Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea. AIM: The purpose of this study was to analyze the effectiveness of Starfruit and rosella tea (Hibiscus sabdariffa L) on the Inhibition of Dental Plaque Formation. METHODS: Design this research is an experimental study with a post-test design only. The research was conducted in Gampong Batoh, Lueng Bata District, Banda Aceh City, from June 26 to October 04, 2021. The study population was the community of Gampong Batoh, Banda Aceh City. The sample in this study used a purposive sampling technique. The sample in this study met the criteria and was willing to assist in implementing the research by signing the informed consent. The number of research samples was 40 people. RESULTS: The results showed a significant difference in the effectiveness of Starfruit juice and rosella tea on the inhibition of plaque formation based on time duration (p < 0.05). The group that rinsed with rosella tea solution had more effective inhibition than the group that rinsed with vegetable Starfruit juice solution (p < 0.05). Vegetable Starfruit (A. bilimbi) and Rosella Tea contain bioactive compounds such as alkaloids, flavonoids, saponins, and tannins that can act as antibacterial agents in inhibiting the growth of Staphylococcus aureus. CONCLUSION: Vegetable Starfruit Juice (A. bilimbi) and Rosella Tea (H. sabdariffa L) effectively inhibit the formation of dental plaque.
Open Access Maced J Med Sci. 2022 Apr 14; 10(G):599-602. 599
Scientic Foundation SPIROSKI, Skopje, Republic of Macedonia
Open Access Macedonian Journal of Medical Sciences. 2022 Apr 14; 10(G):599-602.
https://doi.org/10.3889/oamjms.2022.8787
eISSN: 1857-9655
Category: G - Nursing
Section: Nursing in Dentistry
The Effectiveness of Vegetable Starfruit Juice (Averrhoa bilimbi)
and Rosella Tea (Hibiscus sabdariffa L) Against the Inhibition of
Dental Plaque Formation
Herry Imran*, Nia Kurniawati, Amiruddin Amiruddin, Nurdin Nurdin, Wirza Wirza, Ratna Wilis
Department of Dental Nursing, Polytechnic of Health, Ministry of Health, Aceh, Indonesia
Abstract
BACKGROUND: Dental disease is a signicant public health problem. Various efforts have been made to maintain
oral health by utilizing natural ingredients from plants. One of the natural ingredients often used among the community
is Vegetable Starfruit Juice (Averrhoa bilimbi) and Rosella Tea.
AIM: The purpose of this study was to analyze the effectiveness of Starfruit and rosella tea (Hibiscus sabdariffa L)
on the Inhibition of Dental Plaque Formation.
METHODS: Design this research is an experimental study with a post-test design only. The research was conducted
in Gampong Batoh, Lueng Bata District, Banda Aceh City, from June 26 to October 04, 2021. The study population
was the community of Gampong Batoh, Banda Aceh City. The sample in this study used a purposive sampling
technique. The sample in this study met the criteria and was willing to assist in implementing the research by signing
the informed consent. The number of research samples was 40 people.
RESULTS: The results showed a signicant difference in the effectiveness of Starfruit juice and rosella tea on the
inhibition of plaque formation based on time duration (p < 0.05). The group that rinsed with rosella tea solution
had more effective inhibition than the group that rinsed with vegetable Starfruit juice solution (p < 0.05). Vegetable
Starfruit (A. bilimbi) and Rosella Tea contain bioactive compounds such as alkaloids, avonoids, saponins, and
tannins that can act as antibacterial agents in inhibiting the growth of Staphylococcus aureus.
CONCLUSION: Vegetable Starfruit Juice (A. bilimbi) and Rosella Tea (H. sabdariffa L) effectively inhibit the formation
of dental plaque.
Edited by: Ana Vucurevic
Citation: Imran H, Kurniawati N, Amiruddin A, Nurdin N,
Wirza W, Wilis R. The Effectiveness of Vegetable Starfruit
Juice (Averrhoa bilimbi) and Rosella Tea (Hibiscus
sabdariffa L) Against the Inhibition of Dental Plaque
Formation. Open Access Maced J Med Sci. 2022 Apr 14;
10(G):599-602.
https://doi.org/10.3889/oamjms.2022.8787
Keywords: Effectiveness; Vegetable starfruit; Rosella tea
*Correspondence: Herry Imran, Department of Dental
Nursing, Polytechnic of Health-Ministry of Health, Aceh,
Indonesia. E-mail: herryimran64@gmail.com
Received: 28-Jan-2022
Revised: 31-Mar-2022
Accepted: 04-Apr-2022
Copyright: © 2022 Herry Imran, Nia Kurniawati,
Amiruddin Amiruddin, Nurdin Nurdin, Wirza Wirza, Ratna
Wilis
Funding: This research did not receive any nancial
support
Competing Interests: The authors have declared that no
competing interests exist
Open Access: This is an open-access article distributed
under the terms of the Creative Commons Attribution-
NonCommercial 4.0 International License (CC BY-NC 4.0)
Introduction
Dental caries affects 60–90% of children and
about 100% of adults worldwide [1], [2]. Periodontal
disease in its simplest form is chronic gingivitis [3].
Regardless of age, sex, or race, periodontal disease
affects more than 90% of the population [4]. Poor oral
and dental health are a major public health problem
in Indonesia, with approximately 89% and 74% of
the population suffering from caries and periodontitis,
respectively [5]. One of the most important measures
to maintain good oral health is regular dental visits to
assess the risk of oral health problems and provide
preventive care [6]. The 2018 national health survey
estimates that 96% of Indonesians have not visited the
dentist in the past year [5]. Several factors inuencing
the utilization of dental services have been identied
in other countries, such as age, gender, marital status,
area of residence, education, income, health insurance,
and individual health needs, including dental pain and
self-perceived oral health [7], [8]. Dental caries is a
disease that is often found in every social stratum of
Indonesian society. Dental plaque is a major etiologic
factor of periodontal disease, especially plaque-induced
gingivitis [9], [10]. Dental plaque is a soft deposit that
forms a biolm layer and adheres tightly to the surface
of the teeth and gums. Effective removal of dental
plaque is important for maintaining periodontal and oral
health [11]. Control of microbial plaque with self-care
efforts is important to prevent plaque accumulation.
Plaque control can be done mechanically or chemically.
Chemical control of dental plaque is an adjunct
therapy that can facilitate the removal and prevent
the accumulation of microbial plaque [12]. Chemical
and mechanical plaque control is recommended for
optimal oral hygiene [13]. Various chemicals have been
used in toothpaste and mouthwashes, and some have
been shown to reduce dental plaque formation [14],
[15]. Increasing resistance to synthetic antimicrobials
have prompted the search for alternative products
with natural ingredients, currently in the manufacture
of drugs and the use of antimicrobials derived from
plant sources. One of them is Starfruit and Rosella.
Starfruit is one of the plants used by the community for
medicine. Starfruit water can be used as a mouthwash
in patients with a sore throat, can overcome bad breath
due to the fragrance from the fruit’s skin, and overcome
G - Nursing Nursing in Dentistry
600 https://oamjms.eu/index.php/mjms/index
inammation. Starfruit is widely used as a dental
treatment containing bioactive compounds that can
act as antibacterial agents in inhibiting bacterial growth
[16]. The Rosella ower is known as a plant with many
properties, one of which is antibacterial [17].
Besides having a delicious taste and being
productive as antioxidants, rosella ower petals
can also produce full pharmacological effects such
as antibacterial, antiseptic, anti-inammatory, and
reducing heat. Rosella owers contain polyphenols,
several vitamins, minerals, and 18 kinds of amino
acids. The effectiveness of vegetable Starfruit juice
and rosella tea on time duration-based inhibition of
plaque formation?
Methods
This study uses an experiment with a post-test
design only design model. The research was conducted
in Gampong Batoh, Lueng Bata District, Banda Aceh
City, from June 26 to October 04, 2021. The research
population was the Batoh village community, Banda
Aceh City. The sample in this study used a purposive
sampling technique. The sample in this study met the
criteria and was willing to assist in implementing the
research by signing the informed consent. The number
of research samples was 40 people. The study sample
was selected with the criteria of permanent teeth, no
missing teeth, calculus index 0, teeth not crowding, not
using ortho or removable dentures, DMF-T index below
5, no dentinal caries or pulp, and people who have age
25–45 years. Research materials include Vegetable
Starfruit Juice (Averrhoa bilimbi), Rosella Tea (Hibiscus
sabdariffa L), Dental examination tools (diagnostic set),
Disclosing solution, cotton, and alcohol, Handschoen,
and masks. The measuring instrument used to assess
plaque scores is the Patient Hygiene Performance
Modied by Martens and Although (PHP-M) Index.
Before the examination, the patient’s teeth were
smeared with disclosing solution and lightly rinsed. The
surface of the teeth examined was the buccal and lingual
surfaces. The entire surface of the teeth was smeared
with disclosing solution, starting from the right lower
back tooth to the right upper back tooth. Examination
using a mouth mirror to see whether there is staining
on the index teeth. The data that have been obtained
from this research is entered into a table for observation
and data assessment. The data were then analyzed
and processed using SPSS. Data usually distributed
and homogeneous, parametric statistical tests are
used: Paired sample t-test for comparative analysis
of pre-test and post-test in each group Independent
sample t-test for comparative analysis of the treatment
and control groups. The Research Ethics Committee
of Polytechnic of Health-Ministry of Health, Mataram,
Indonesia approved this study, with approval number:
LB.02.03/7833/2019.
Results
Data collection was carried out from June to
October for 40 people from Batoh Village, Banda Aceh
City, where samples were given a solution of vegetable
Starfruit juice and a solution of rosella tea by gargling
for 2 min. The data collection results were obtained
based on the examination of the PHP-M index before
and after the solution was given. The results of data
processing obtained when conducting research can be
seen as follows:
Differences in plaque score between
before and after gargling with vegetable Starfruit
juice
The results of the study on samples in looking
at plaque scores using the PHP-M index (Table 1)
showed a decrease, seen before gargling with a
solution of vegetable Starfruit juice had a mean value
of 0.28 with the highest plaque score of 0.50 and the
lowest score of 0.13. After gargling with a solution of
vegetable Starfruit juice, the plaque score decreased
with a mean of 0.14 and the highest score was 0.29,
and the lowest score was 0.02. Before conducting the
paired sample t-test, the normality test was rst carried
out with the Shapiro–Wilk test. The test results before
and after gargling showed p > 0.05, which means that
the data were normally distributed. The results of the
statistical test with the paired sample t-test obtained
p = 0.000 where p < 0.05, which means that there is
a signicant effect of gargling a solution of vegetable
Starfruit juice on decreasing plaque scores.
Table 1: Plaque scores before and after gargling with vegetable
Starfruit juice for the Batoh village community, Banda Aceh
City
Plaque Score Shapiro–Wilk Mean Maximal Minimal p-value
Before 0.860 0,28 0.50 0.13 0.000
After 0.696 0.14 0.29 0.02
Source: Primary data, 2019.
Differences in plaque score between
before and after gargling rosella tea solution
The study results on samples in viewing plaque
scores using the PHP-M index (Table 2) showed a
decrease, seen before gargling with rosella tea solution
had a mean value of 0.29 with the highest plaque score
Table 2: Plaque score before and after gargling rosella tea
solution
Plaque Score Shapiro–Wilk Mean Maximal Minimal p-value
Before 0.667 0.29 0.45 0.13 0.000
After 0.244 0.09 0.20 0.04
Imran et al. The Effectiveness of Vegetable Starfruit Juice and Rosella Tea Against the Inhibition of Dental Plaque Formation
Open Access Maced J Med Sci. 2022 Apr 14; 10(G):599-602. 601
of 0.45 and the lowest score of 0.13. After gargling with
rosella tea solution, the plaque score decreased with a
mean of 0.09 and the highest score was 0.20, and the
lowest score was 0.04. The normality test results using
the Shapiro–Wilk test showed p>0.05, where the data
were normally distributed. The statistical tests with the
paired sample t-test obtained p = 0.000 where p < 0.05,
which means that there is a signicant effect of gargling
rosella tea solution on decreasing plaque scores.
Differences in inhibition of plaque
formation between gargling with vegetable
Starfruit juice and gargling rosella tea solution
Based on Table 3, it is known that the plaque
score after gargling with vegetable Starfruit juice
solution obtained a mean value of 0.14, and the plaque
score after gargling with rosella solution obtained a
mean value of 0.09. The results of statistical tests using
the independent sample t-test showed that the post-
test p-value was 0.015 and p-value of the difference
before and after rinsing was 0.046 where p < 0.05,
it can be concluded that there is a difference in the
inhibition of plaque formation between gargling with
a water solution. Vegetable Starfruit juice and rosella
tea solution were more effective at inhibiting plaque
formation than vegetable Starfruit juice solution.
Table 3: Differences in the inhibition of plaque formation
between gargling with vegetable Starfruit juice and gargling
with rosella tea solution for the Batoh village community,
Banda Aceh city
Variable Mean p-value post test p-value difference
Vegetable Starfruit Juice 0.14 0.015 0.046
Rosella tea solution 0.09
Discussion
The study results found a signicant difference
in the effectiveness of vegetable Starfruit juice and
rosella tea on the inhibition of plaque formation
based on time duration (p < 0.05). The group that
rinsed with rosella tea solution was more effective in
inhibiting plaque formation than the group that rinsed
with Starfruit juice solution (p < 0.05). In the treatment
group, gargling with rosella tea solution resulted in a
more signicant mean reduction in plaque scores than
the group given a vegetable Starfruit solution. The
decrease in plaque index scores may be due to rosella
tea containing polyphenols which have antibacterial
activity by inhibiting the development of streptococcus
sanguis bacteria which triggers the formation of dental
plaque. The antibacterial effect of rosella tea solution
can suppress plaque bacteria and its products to
reduce the average plaque index score. In addition,
there is a avonoid content in the rosella tea solution
that works by denaturing bacterial cell proteins. The
mechanism of plaque formation is through internal
cleavage and surface deposition. Rosella owers
have some antibacterial properties against plaque-
causing bacteria [17]. The chemical content of rosella
ower petals consists of organic acids, phenolic
compounds, avonoids, and anthocyanins [18]. Water
extract of rosella petals at a concentration of 10% with
the diffusion method was able to inhibit gram-positive
bacteria Staphylococcus aureus and Streptococcus
pyogenes [19]. Starfruit was used as comparative
test material in this study, because they both contain
bioactive compounds that can act as antibacterial
agents. In inhibiting bacterial growth, Starfruit extracted
using the maceration method with ethanol solvent
was found to contain bioactive compounds such as
alkaloids, avonoids, saponins, and tannins that can
act as antibacterial agents in inhibiting the growth of
S. aureus, Escherichia coli, Salmonella typhi, and
Pseudomonas aeruginosa [20]. Starfruit extracted
using the maceration method with aquadest-ethanol
solvent contains tannins and terpenoids that can inhibit
the growth of Bacillus subtilis, S. aureus, E. coli, Listeria
monocyte gene, and Enterobacter aerogenes [21].
Starfruit extracted using the soxhletation method with
methanol solvent showed the presence of avonoid
compounds, phenols, tannins, and alkaloids that could
inhibit the growth of S. aureus, B. subtilis, Klebsiella
pneumoniae, and Serratia marcescens [22], [23].
Conclusion
There was a signicant difference in the
effectiveness of vegetable Starfruit juice and rosella
tea on the inhibition of plaque formation based on
time duration (p < 0.05). Hence, it can be concluded
that the group that rinsed with rosella tea solution was
more effective in inhibiting plaque formation than the
group that rinsed with vegetable Starfruit juice solution
(p < 0.05).
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Evid Based Complement Alternat Med 2020;2020:5351318.
https://doi.org/10.1155/2020/5351318
... In the field of dental health, rosella flower extract has an anti-bacterial effect against streptococcus mutans. [18][19][20] To develop the benefits of rosella flower extract in the field of preventing dental and oral diseases, one of them is by making disclosing solution preparations. Disclosing agent or disclosing agent is a material or substance used to reveal or show plaque that is clearly visible to the eye. ...
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Over the last hundred years, groundbreaking research in oral microbiology has provided a broad and deep understanding about the oral microbiome, its interactions with our body, and how the community can affect our health, be protective, or lead to the development of dental diseases. During this exciting journey, hypotheses were proposed, and concepts were established, discarded, and later revisited from updated perspectives. Dental plaque, previously considered a polymicrobial community of unspecific pathogenicity, is recognized as microbial biofilms with healthy, cariogenic, or periodontopathogenic profiles, resulting from specific ecologic determinants and host factors. The “one pathogen, one disease” paradigm of oral infections has been replaced by a holistic concept of a microbial community as the entity of pathogenicity. Cutting-edge technology can now explore large microbial communities related to different clinical conditions, which has led to finding several novel disease-associated species and potential pathobionts and pathobiomes. This vast amount of data generated over time has widened our view of the etiology of caries and periodontal and peri-implant diseases and has promoted updated strategies to treat and prevent the oral diseases. © International & American Associations for Dental Research 2019.
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AimThe aim of this systematic review was to evaluate the efficacy of adjunctive chemical plaque control for managing gingivitis, in 6-month, home-use, randomised clinical trials (RCT).Material and MethodsA protocol was designed, including inclusion and exclusion criteria to identify RCT assessing gingival and/or bleeding indexes. Electronic and hand-search identified relevant papers, that were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indexes), including quality and risk of bias aspects. Mean treatment effects were calculated to obtain weighted mean differences (WMD) and 95% confidence intervals.ResultsAfter the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The added benefit of the tested products was statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD -0.217), modified gingival index (n=23, -0.415), gingivitis severity index (n=26, -14.939%) or bleeding index (n=23, -7.626%), with significant heterogeneity. For plaque, additional benefits were found for Turesky (66 studies, WMD -0.475), Silness & Löe (n=26, -0.109), and plaque severity (n=12, -23.4%) indexes, with significant heterogeneity.Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant benefits in terms of gingival, bleeding and plaque indexes.This article is protected by copyright. All rights reserved.