Efficacy and Safety of Tulsi Extract Mouthwash on Periodontal Health Status of Well-Controlled Type 2 Diabetes Mellitus Patients in India: A Concurrent Parallel Pilot Trial

Authors

  • G V Usha Professor, Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davanagere, Karnataka, India. Author
  • Apoorva Shukla Former Postgraduate Student, Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davanagere, Karnataka, India. Author

DOI:

https://doi.org/10.48165/IRJAY.2023.61206

Keywords:

Chlorhexidine, Dental Plaque, Diabetes Mellitus, Mouthwash, Periodontitis, Tulsi

Abstract

Background: One of the main risk factors for periodontitis is Diabetes Mellitus (DM). In patients with DM,  maintaining optimal oral hygiene is crucial to managing the advancement of periodontitis. The adverse effects of  chlorhexidine limit its long-term use. Tulsi is gaining more popularity due to its anti-inflammatory and antimicrobial  properties. Studies related to Tulsi mouthwash in Type 2 DM patients are lacking. Objective: The aim of the study is to evaluate the efficacy of 6% Tulsi extract and 0.2% chlorhexidine mouthwashes  on the periodontal health status of well-controlled type 2 DM patients. Materials and Methods: The present study is a concurrent, parallel, randomized controlled trial. A total of 38  participants aged 45–55 years were randomly allocated to two different groups. Group A and B participants were  treated with 0.2% chlorhexidine and 6% Tulsi extract mouthwashes, respectively. The assessments of gingivitis  (gingival Index), dental plaque (plaque Index), and periodontal pocket depth (Community Periodontal Index) were  done at baseline and on the 15th day. An unpaired t-test was used to compare the clinical conditions of the two groups. Results: Both groups have individually shown a statistically significant reduction in gingivitis, dental plaque, and  periodontal pocket depth. When both groups were compared on the 15th day, chlorhexidine mouthwash showed a  statistically significant reduction in PI scores (Group A 0.79 vs. Group B 0.86). Conclusion: Tulsi mouthwash is as efficacious as chlorhexidine in reducing dental plaque, gingivitis, and pocket  depth among well-controlled Type 2 DM patients. 

Downloads

Download data is not yet available.

References

Karamanou M, Protogerou A, Tsoucalas G, Androutsos G, Poulakou Rebelakou E. Milestones in the history of diabetes mellitus: The main contributors. World J Diabetes 2016;7:1-7.

Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol 2021;69:2932-8.

Paunica I, Giurgiu M, DumitriuAS, Păunică S, StoianAM, Martu MA, et al. The bidirectional relationship between periodontal disease and diabetes mellitus- A review. Diagnostics (Basel) 2023;13:681.

Wautier MP, Tessier FJ, Wautier JL. Advanced glycation end products: A risk factor for human health. Ann Pharm Fr 2014;72:400-8. 5. Gurav AN. Advanced glycation end products: A link between periodontitis and diabetes mellitus? Curr Diabetes Rev 2013;9:355-61. 6. Li DX, Deng TZ, Lv J, Ke J. Advanced glycation end products (AGEs) and their receptor (RAGE) induce apoptosis of periodontal ligament fibroblasts. Braz J Med Biol Res 2014;47:1036-43. 7. Akash MS, Rehman K, Chen S. Role of inflammatory mechanisms in pathogenesis of type 2 diabetes mellitus. J Cell Biochem 2013;114:525-31.

Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: A two-way relationship. Diabetologia 2012;55:21-31.

Sarmento EB, Gomes CC, Pires FR, Pinto LC, Antunes LA, Armada L. Immunoexpression of bone resorption biomarkers in apical periodontitis in diabetics and normoglycaemics. Int Endod J 2020;53:1025-32.

Stoica SA, Valentini G, Dolci M, D’Agostino S. Diabetes and non-surgical periodontal therapy: What can we hope for? Hygiene 2022;2:85-93.

Ziaei N, Golmohammadi S, Ataee M, Ardalani F, Mesgari Abbasi M. Effect of non-surgical periodontal treatment on three salivary adipokines in diabetic patients with periodontitis. J Dent Res Dent Clin Dent Prospects 2020;14:199-205.

James P, Worthington HV, Parnell C, Harding M, Lamont T, CheungA, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 2017;3:CD008676.

Naiktari RS, Gaonkar P, Gurav AN, Khiste SV. A randomized clinical trial to evaluate and compare the efficacy of triphala mouthwash with 0.2% chlorhexidine in hospitalized patients with periodontal diseases. J Periodontal Implant Sci 2014;44:134-40.

Yaghobee S, Dorkoosh FA, Kouhestani F, Mozafari G, Aslroosta H. Comparison of 0.2% chlorhexidine mouthwash with and without anti-discoloration system in patients with chronic periodontitis: A randomized controlled clinical trial. J Adv Periodontol Implant Dent 2019;11:63-8.

Nair SK, Prasad BM. Holy herb Tulsi as care for oral and periodontal disease: A review. EC Dent Sci 2017;10:106-9.

Sethi J, Sood S, Seth S, Talwar A. Evaluation of hypoglycemic and antioxidant effect of Ocimum sanctum. Indian J Clin Biochem 2004;19:152-5.

Jamshidi N, Da Costa C, Cohen M. Holybasil (tulsi) lowers fasting glucose and improves lipid profile in adults with metabolic disease: A meta-analysis of randomized clinical trials. J Funct Foods 2018;45:47-57.

Cohen MM. Tulsi - Ocimum sanctum: A herb for all reasons. J Ayurveda Integr Med 2014;5:251-9.

Nathan DM, DCCT/EDIC Research Group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: Overview. Diabetes Care 2014;37:9-16.

Kaiafa G, Veneti S, Polychronopoulos G, Pilalas D, Daios S, Kanellos I, et al. Is HbA1c an ideal biomarker of well-controlled diabetes? Postgrad Med J 2021;97:380-3.

Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38:l610-6.

Eswar P, Devaraj CG, Agarwal P. Anti-microbial activity of tulsi {Ocimum sanctum (Linn.)} extract on a periodontal pathogen in human dental plaque: An in vitro study. J Clin Diagn Res 2016;10:C53-6.

WHO. Oral Health Surveys Basic Methods. 5th ed. Geneva: World Health Organization; 2013.

Gupta D, Bhaskar DJ, Gupta RK, Karim B, Jain A, Singh R, et al. A randomized controlled clinical trial of Ocimum sanctum and chlorhexidine mouthwash on dental plaque and gingival inflammation. J Ayurveda Integr Med 2014;5:109-16.

Kelm MA, Nair MG, Strasburg GM, DeWitt DL. Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine 2000;7:7-13.

Singh S, Majumdar DK, Rehan HM. Evaluation of anti-inflammatory potential of fixed oil of Ocimum sanctum (Holybasil) and its possible mechanism of action. J Ethnopharmacol 1996;54:19-26.

Gaur J, Chandra J, Chaudhry S, Vaish S, Dodwad V. Assessment of 4% Ocimum sanctum and 0.2% chlorhexidine irrigation as an adjunct to scaling & root planing in management of chronic periodontitis - a randomized controlled trial. J Dent Specialities 2015;3:146-9.

Nadar BG, Usha GV, Lakshminarayan N. Comparative evaluation of efficacy of 4% tulsi extract (Ocimum sanctum), fluoridated and placebo dentifrices against gingivitis and plaque among 14- 15 years school children in Davangere City, India - A triple blinded randomized clinical trial. Contemp Clin Dent 2020;11:67-75.

Mondal S, Mahapatra SC, Mirdha BR, Naik SN. Antimicrobial activities of essential oils obtained from fresh and dried leaves of Ocimum sanctum (L) against enteric bacteria and yeast. Acta Hortic 2007;756:267-9.

Tailor G, Yadav BL, Chaudhary J, Joshi M, Suvalka C. Green synthesis of silver nanoparticles using Ocimum canum and their anti bacterial activity. Biochem Biophys Rep 2020;24:100848.

Hosadurga RR, Rao SN, Edavanputhalath R, Jose J, Rompicharla NC, Shakil M, et al. Evaluation of the efficacy of 2% Ocimum sanctum gel in the treatment of experimental periodontitis. Int J Pharm Investig 2015;5:35-42.

Mondal S, Varma S, Bamola VD, Naik SN, Mirdha BR, Padhi MM, et al. Double-blinded randomized controlled trial for immunomodulatory effects of Tulsi (Ocimum sanctum Linn.) leaf extract on healthy volunteers. J Ethnopharmacol 2011;136:452-6.

Palma-Duran SA, Vlassopoulos A, Lean M, Govan L, Combet E. Nutritional intervention and impact of polyphenol on glycohemoglobin (HbA1c) in non-diabetic and type 2 diabetic subjects: Systematic review and meta-analysis. Crit Rev Food Sci Nutr 2017;57:975-86.

Ravi V, Iyer U, Mani UV. Effect of Ocimum sanctum leaf powder on blood lipoproteins glycated proteins and total amino acids in patients with non- insulin dependent diabetes mellitus. J Nutr Environ Med 1997;7:113-8.

Rai V, Iyer U, Mani UV. Effect of Tulasi (Ocimum sanctum) leaf powder supplementation on blood sugar levels, serum lipids and tissue lipids in diabetic rats. Plant Foods Hum Nutr 1997;50:9-16.

Downloads

Published

2023-12-31 — Updated on 2024-01-29

Versions

Issue

Vol. 6 No. 12 (2023): International Research Journal of Ayurveda and Yoga (Dec) (2023)

Section

Original Research Paper

How to Cite

Usha, G. V., & Shukla, A. (2024). Efficacy and Safety of Tulsi Extract Mouthwash on Periodontal Health Status of Well-Controlled Type 2 Diabetes Mellitus Patients in India: A Concurrent Parallel Pilot Trial. International Research Journal of Ayurveda & Yoga, 6(12), 39-44. https://doi.org/10.48165/IRJAY.2023.61206 (Original work published 2023)
Crossref
Scopus
Google Scholar
Europe PMC