Evaluation of Antiplaque Efficacy of Licorice Extract Mouthrinse & HSS and Their Comparison With EO & CHX Mouthrinse
Condition: Mild Gingivitis; Periodontal Diseases; Plaque
MeSH terms: Gingivitis; Periodontal Diseases
Study type: Interventional

Summary: 
      Periodontal disease is a multifactorial disease caused by mainly bacterial, genetic,
      immunological, and environmental factors. Chronic periodontitis, one of the widely prevalent
      forms of periodontal disease, is characterized by loss of attachment apparatus of the tooth;
      it can lead to tooth loss. Many non surgical and surgical approaches have been adapted time
      and again to prevent, intercept, and to treat the various forms of chronic periodontitis.
      But, these treatment modalities are not approachable by all individuals, because of the
      various factors such as: low socioeconomic status, illiteracy, high cost of the treatment, no
      availability of easy and uncomplicated treatment nearby etc. Considering these factors, there
      are still a need of preventive, practical, and affordable treatment options specially for the
      population of underdeveloped and developing countries.
    

Detailed description: 
      Periodontal disease is a chronic inflammatory process accompanied by destruction of
      attachment apparatus of tooth and may lead to loss of teeth. It is a multifactorial disease,
      dental plaque being considered as primary etiologic factor in initiation and progression of
      disease. Control of periodontal disease by eliminating all pathogenic organisms of the
      microflora is, as yet, impossible but, it is theoretically an attractive aspect. Based on
      epidemiological studies there is a very strong correlation between the localization of
      dentogingival plaque and periodontal disease. Studies have clearly demonstrated that the
      ability to control the onset or progression of periodontal diseases is improved by regular
      plaque control practices. Although data shows that oral health can be improved through
      effective plaque control by mechanical means of cleaning but it fails to deliver optimal
      levels of oral health because the techniques are not being practiced consistently or
      thoroughly by all the individuals.

      Over the past decade, various antimicrobial compounds have been investigated for their
      effectiveness to control plaque, but, chlorhexidine digluconate (CHX) is still being
      considered to be the most effective plaque inhibitor against which other antiplaque agents
      are measured. Chlorhexidine mouthwash is regarded as Gold standard mouthwash but has many
      local side effects: extrinsic brown staining of teeth and tongue, taste disturbance, enhanced
      supragingival calculus formation, desquamation of oral mucosa, and even liver damage in rats.

      Cost effectiveness of chlorhexidine also matters especially in underdeveloped and developing
      countries where prevalence ratio of periodontal diseases are very high. The prevalence of
      gingivitis and periodontitis, along with their severity and rate of progression is found to
      vary worldwide; high in developing countries with approximately 80% prevalence in India.

      Plant essential oils (EO) have the potential to be used as therapeutic agents for chronic
      gingivitis and periodontitis conditions that have both bacterial and inflammatory components.
      These are useful as their long term daily use has no adverse effects on the health of an
      individual. Also, these are more cost-effective and easily available as over-the-counter
      products.

      It is need of the hour / high time to conduct the research work on various traditional oral
      hygiene practices / medicines to see their efficacy in the field of periodontics, as various
      uses of traditional medicine are still untouched & unexplored and few/no any such scientific
      documents are available, worldwide. And thus, attempts should be made to search for an
      alternative; Antiplaque, Plaque inhibitory, Anti gingivitis, Host modulating agent, and any
      other way acting on various levels of prevention of Gingival / Periodontal diseases by using
      traditional oral hygiene practices/ indigenous products/ homemade remedies/ medicines for
      maintenance of oral hygiene. Such research work may not only give an alternate antiplaque /
      plaque inhibitory, and anti-gingivitis agents but, at the same time may give different
      avenues in imparting treatment modalities on various levels of prevention of Gingival and
      Periodontal diseases. They may be more effective, more practical, less time consuming, and
      within the reach of each & every individual of the world in comparison to gold standard
      'Chlorhexidine Gluconate Mouthrinse' and various other expensive therapeutic procedures.

      Glycyrrhiza glabra (Licorice) (Family: Fabaceae) is one of the most important herbs and has
      been commonly utilised as ayurvedic medicine. It has been described as 'The grandfather of
      herbs' (Ody, 2000). In almost every Indian household you may find this herb chewed whenever
      someone's voice goes down. The earliest evidence regarding the use of licorice comes from the
      samples of licorice found in the tombs of Egyptian pharaohs, including those found in tomb of
      King Tut (1343 to 1325 BC). The main usage of licorice as a medicinal plant in European
      culture have been in the treatment of peptic ulcers and bronchial catarrhs. In Chinese herbal
      medicine, licorice is used as an expectorant, an analgesic, drug to treat asthma, drug to
      alleviate abscesses and abdominal pain. Licorice, since years is known for its
      anti-inflammatory, antimicrobial, antiviral, antiprotozoal, antioxidative, hepatoprotective,
      cardioprotective, immunomodulatory and antitumour activity.

      There has been some indications that suggests licorice can be beneficial for oral health. One
      of the most important research has focussed on the benefits of water extract of licorice root
      for treatment of apthous ulcers. Glycyrrhizin, the sweet component of licorice root has
      antiplaque property. Pterocarpenes isolated from G. uralensis root extract exerts an
      antibacterial activity against Streptococcus mutans. So far, hardly any study has been
      conducted to see the antiplaque and antigingivitis effect of licorice as a traditional
      medicinal herb.

      Life cannot exist without salt. Salt in various forms is being used since ages. 'Salt water'
      has been used by many cultures over countless generations to clean wounds and rinse mouths.
      Use of hot salt water rinsing is in practice to reduce the symptoms of pain in both gums and
      throat. It is also being routinely recommended following dental extraction, to keep food
      debris out of healing wounds and to reduce the incidence of alveolar osteitis. The antiseptic
      and bactericidal qualities of salt help in removing plaque which is a cause of gingivitis and
      caries. Warming water with a pinch of table salt can reduce or even be an alternative to
      anti-inflammatory drugs intra-orally. Its high osmolality reduces inflammation and can be
      microbicidal. Moreover, efficacy of luke warm hypertonic salt solution has shown
      antimicrobial, anti-inflammatory and immunomodulatory properties but its antiplaque efficacy
      is yet to be established with stabilised formula.

      Above stated background have stimulated and encouraged us to conduct the study so,
      theinvestigators hypothesized the antiplaque efficacy of Licorice extract mouthrinse (LE) ,
      5% Hypertonic salt solution (HSS) as mouth rinses. Hence, the investigators planned this
      study titled "Evaluation of Antiplaque Efficacy of Licorice Extract Mouthrinse & 5%
      Hypertonic Salt Solution and their Comparison with Essential Oil & Chlorhexidine
      Mouthrinses-An Invitro & Invivo Study" with aforementioned aims and objectives.
    

Intervention name(s): Licorice; Hypertonic salt solution; Essential oil; Chlorhexidine Gluconate; Distilled water
Intervention type(s): Other; Other; Other; Other; Other
Intervention description(s): Licorice, since years is known for its anti-inflammatory, antimicrobial, antiviral, antiprotozoal, antioxidative, hepatoprotective, cardioprotective, immunomodulatory and antitumour activity. Licorice can be beneficial for oral health. Glycyrrhizin, the sweet component of licorice root has antiplaque property. Pterocarpenes isolated from G. uralensis root extract exerts an antibacterial activity against Streptococcus mutans.; The antiseptic and bactericidal qualities of salt help in removing plaque which is a cause of gingivitis and caries. Warming water with a pinch of table salt can reduce or even be an alternative to anti-inflammatory drugs intra-orally. Its high osmolality reduces inflammation and can be microbicidal. Moreover, efficacy of luke warm hypertonic salt solution has shown antimicrobial, anti-inflammatory and immunomodulatory properties.; Essential oils have a wide application in folk medicine, food flavoring and preservation as well as in fragrance industries. The antimicrobial properties of essential oils have been known for many centuries. In recent years, a large number of essential oils and their constituents have been investigated for their antimicrobial properties against some bacteria and fungi. Essential oils have the potential to be used as therapeutic agents for chronic gingivitis and periodontitis conditions that have both bacterial and inflammatory components.; Chlorhexidine is a symmetrical bisbiguanide synthetic antiseptic. It is available in three forms, digluconate, acetate and hydrochloride salts. Which have broad spectrum antimicrobial activity; it is effective against both Gram-positive and Gram-negative bacteria including aerobes and anaerobes, yeasts, fungi and lipid enveloped viruses. Chlorhexidine is considered to be the most effective plaque inhibitor against which other antiplaque agents are measured.; Distilled water is commonly placebo in various research projects and it is also useful in as placebo treatment.
Other intervention name(s): Glycyrrhiza; Chlorhexidine
Intervention MeSH terms: Chlorhexidine; Chlorhexidine gluconate
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: 5x5 latin cross over study
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Plaque; Plaque regrowth; Licorice extract; Mouthrinse; Chlorhexidine mouthrinse; Hypertonic salt solution; Essential oils