Tikrit Journal for Dental Sciences 6(1) (2018)64-71 Tikrit Journal for Dental Sciences http://tjds.tu.edu.iq The Use of Arabic Gum in Treatment of Patients with Chronic Gingivitis: A Clinical Trial Husamuldeen S. Mohammed Saeed Department of Basic Medical Sciences, College of Nursing, Tikrit University, Iraq. Article Info: Abstract Chronic gingivitis is a well known periodontal disease. -Article History: Bacterial plaque plays a key role in the pathogenic initiation -Received: 14/12/2017 and progression of periodontal disease. More attention -Accepted: 9/1/2018 directed toward the use of herbal drugs to treat them. Arabic -Available Online: or Acacia gum as mouthwash pharmaceutical preperation 11/6/2018 Keywords: used in this study to manage thirty patients complaining from Periodentitis, Chronic chronic gingivitis, age range from 20 to 45 years old with Gingivitis, Arabic Gum, strict inclusion and exclusion criteria. The study was a randomized placebo controlled clinical trial. The patients Dental Plaque. th th th Corresponding Author: followed at baseline, day 7 , 30 and 60 . Results show that Arabic gum mouthwash found to be effective in controlling Name: Husamuldeen Salim dental plaque level and inflammation those causing Mohammed Saeed periodentitis. E-mail: [email protected] Tel: 009647730101516 Affiliation: Ass. Prof. Clinical Pharmacology,Department of Basic Medical Sciences , College of Nursing ,Tikrit University , Iraq. Introduction: Bacterial plaque is considered to be a plaque, then it will lower the risk for both primary contributing agent in periodontal the initiation and progression of gingivitis. disease. There have been various Various methods such as scaling and root experimental gingivitis studies that have planning are ideal in relation to plaque been conducted, which have proven that removal. However, factors such as the bacterial plaque plays a key role in the inaccessibility or plaque retentive areas initiation and also progression of normally compromise both the clinical and periodontal disease. This shows that there microbiologic outcomes. Alternatively, the is a direct relationship in terms of the use of chemical plaque treatment can be plaque levels and also the development of seen to be an ideal method in relation to gingivitis (1). Therefore, it means that if an mechanical plaque control therapy, and individual who previously had a high level therefore, the treatment of gingivitis (1). of plaque accumulation in his or her teeth, There are several existing antibacterial uses the right methods to remove the chemicals such as chlorhexidine (CHX) 46 The Use of Arabic Gum in Treatment ….6(1) (2018)64-71 that have previously been successfully structure of the Arabic Gum is complex, used in both the prevention and also the and various researchers are still trying to treatment of gingivitis. However, there are determine it. However, a comprehensive patients who have high accumulation analysis using various methods such as the levels of bacterial plaque in their teeth NMR spectra show that the backbone of who may not prefer the use of CHX its chemical structure comprises of because of its associated side effects. D-galactose units with the side chains of These side effects include, discoloration of D-glucuronic acid with either L-rhamnose teeth, and an unpleasant (metallic) taste or L-arabinose terminal units. after using this product. Therefore, there is the need of developing or finding an Materials and methods: effective antiplaque agent that has minimal side effects, and one that can be A total of thirty patients that had used as an effective adjunct to the previously been diagnosed with Chronic mechanical plaque control. The unpleasant Periodontal disease were recruited in this side effects from the use of artificial drugs, study using a simple randomized control and inaccessibility of some of the areas clinical trial (tossing a coin) from the Al- where plaque has accumulated in the teeth, Ebtessama clinic of periodontics in Tikrit has made researchers to pay more city - Iraq. There was also a written attention to the use of herbal drugs to treat agreement and signed informed consent periodontal disease. Phytotherapy is a form from all the participants that were medical practice that has been used since recruited in this study. the ancient times, and by people from different cultures such as the Egyptians Inclusion Criteria (2) and Arabic people . In particular, the During the recruitment period, the Egyptians used the Arabic or Acacia gum participants background check was as a pain reliever, while the Arabic conducted, and after their medical history physicians used it to treat various ailments was determined. In addition to that a of the body including bleeding gums. clinical and radiological examination, Various plants and plants isolates have patients who satisfied the following been known to produce medicinal effects criteria were selected. Only healthy that such anti-inflammatory, and immune- patients of the ages of 20 to 45 years were (3) enhancing . The purpose of this study is considered for this study. They had to to evaluate the efficacy of Arabic Gum have a minimum of 20 teeth present in the (Sengalia Senegal) as a mouthwash in the dentition, and no visible signs of untreated reduction of plaque and therefore, leading caries. Also, the clinical parameters for to the treatment of Chronic Periodontal inclusion purposes included: a gingival disease. The Senegalia Senegal (Arabic index that is greater than1, pocket probing Gum) is popularly identified by the depth of less than or equal to 3 mm, and a symbol SESE16, and it is in the dicot clinical attachment loss of 0 (5). The group. Table (1), provides a detailed participants were not supposed to display overview of the plant classification. Eighty any evidence of radiographic bone loss, five percent of the total world production and this was assessed by ensuring that the of Arabic gum come from Sudan and it distance between the Cemento enamel has the following properties, it is brittle, junction and crestal bone was less than or odorless and it is tasteless. It contains equal to 1 mm. In addition to that, the various neutral sugars, acids, calcium, and participants that were considered for this electrolytes. The molecular weight of the study needed not to have received any Arabic gum is estimated to be periodontal therapy for the past six approximately 200,000 to 600,000 daltons. months. It is also very soluble in water, however, it (4) does not dissolve in alcohol . It has been Exclusion Criteria determined that the main component of the The participants who were excluded from gum is the Arabian- calcium salt of the this study included, people who were polysaccharide Arabic acid. The chemical 46 The Use of Arabic Gum in Treatment ….6(1) (2018)64-71 taking any form of medicinal drugs such prepared by using distilled water, as antibiotics for the past three months. Glycerine, and Pudin Hara. The Pregnant women or even lactating mothers medications were then put in brown were also excluded from this study (6). colored opaque bottles, which were market Also, upon medical examination, patients distinctively in accordance to the two who were found to have a certain medical participating groups in this study. It is condition such as diabetes or heart disease important to point out that a baseline were not included in the study. In addition examination was conducted to the 30 smokers, alcoholics, patients with participants of this study. During the orthodontic appliances, and the ones who examination, each participant was have a known history of allergic reactions provided with the instructions to refrain to chemical or herbal products were from any type of oral hygiene for a period excluded from this study. of 8 hours. The different clinical parameters such as Plaque Index (PI), Study Design and Treatment Protocol gingival index (GI), oral hygiene index- The design of the current study was a simplified (OHI-S) were recorded. After randomized, placebo controlled clinical the examination, all the participants trial. There were a total of 75 individuals received scaling and polishing to remove that were assessed for eligibility purpose, plaque, calculus and extrinsic stains. The and out of this, only 30 individuals met the brown colored opaque bottles were then criteria that had been set. Due to the small distributed to all the participants of the number of participants for this study, a study in relation to their group number. coin toss was used by the researcher in The participants were provided with the order to assign the participants to one of instructions to use 15 ml mouthwash twice the two groups of this study. The on a daily basis- at morning before they characteristics of the two groups has been had their breakfast, and at night before shown below: they went to sleep. It is also important to Group 1- 15 participants (8 males point that during this study, all the and 7 females, mean age 30.7 +/- participants were instructed against using 6.1 years). They are undergoing any forms of oral hygiene aids including scaling and prescribed to use chewing gums and dental floss. As it was Placebo mouthwash. pointed out before, examination and Group 2- 15 individuals (9 recordings were conducted at the baseline. females and 6 males, mean age Other periods when the participants were 32.5 +/-6.3 years) undergoing examined and their data recorded (plaque scaling and prescribed Arabic level) was on days 7, 30 and 60 Gum solution mouthwash. respectively. There was also subject evaluation, which was performed through a written questionnaire in order to assess Preparation and Usage of the Arabic whether the participants had any adverse Gum Mouthwash effects in relation to their mouthwashes. In this study, Arabic gum prepared as a 6% Arabic Gum mouthwash. This was Primary and Secondary Outcome achieved by dissolving 60 grams of Arabic Measures Gum powder in a 1 L distilled water.