Dr. A. RAJASEKHER

G 32 IN VARIOUS PERIODONTALCONDITIONS
(A CLINICAL STUDY)

Dr. A. RAJASEKHER, B.D.S., M.D.S., F.I.C.D., M.Sc., (London)
Assistant Professor in Periodontia, Dental Wing,

Dr. K. RAMACHANDRAN, B.Sc., B.D.S., F.D.S.R.C.S., (Eng.), F.I.C.D.,
Dr. D.C. MIGLANI, M.S.D., M.I.C.D.

AND

Dr. C.S. PRASAD M.D.S.,

Madras Medical College & Govt. General Hospital, Madras-3

INTRODUCTION:–

Gingival diseases are quite rampant in India since early childhood, and its severity increases with age. Thus the periodontal diseases have a high prevalence rate (as much as 100 per cent) beyond 40 years of age. Several routes of approach to this public health problem have been tried by the recent research works in modern dentistry. Since plaque has been incriminated as the vital local factor in the pathogenesis of inflammatory periodontal diseases, plaque control has been the sheet anchor in prevention and treatment.

Although many methods of dental cleansing using various agents have been advocated and other auxiliary adjuncts to oral hygiene and plaque control have been tried, so far none of these agents, seem to clean the teeth adequately while simultaneously providing adequate stimulation and massage to gingival tissue.

Several ayurvedic drugs are successfully used in general medical practice and yet they have not been adopted in modern dental practice. Recently G32, an ethical ayurvedic research product of Alarsin was introduced as a dentifrice cum media for gum massage, with proven therapeutic properties of its constituent ingredients against gingival disorders. Hence this study is designed to evaluate clinically the therapeutic usefulness of G32 in various periodontal conditions.

Composition of G-32:

 (a) Bakul 80.0 mg., (b) Chok 75.0 mg., (c) Katho 40.0 mg. (d) Laving 20.0 mg., (e) Chikani Sopari 20.0 mg., (f) Fatakadi 20.0 mg., (g) Mayaphal 20.0 mg., (h) Elaichi 10.0 mg., (i) Sonageru 10.0 mg., (j) Jiru 10.0 mg., (k) Majith 10.0 mg., (I) Pashanbhed 10.0 mg., (m) Vavading 10.0 mg., (n) Pipda Lakh 10.0 mg., (o) Samudraphen 10.0 mg., (p) Vajradanti 10.0 mg., (q) Taj 5.0 mg., (r) Mari 5.0 mg., (s) Sajikhar 5.0 mg., (t) Kulinjan 5.0 mg., (u) Pipar 5.0 mg., (v) Kapur 5.0 mg., (w) Kuth: 5.0 mg

Material and methods:

Patients attending the periodontia clinic of the Dental Wing, Government General Hospital, Madras, were selected at random. Each patient was examined with a mouth mirror and probe. The patient’s chief complaint, habits and the diagnosis were recorded in a specially designed proforma. Their oral hygiene and gingival status were assessed using PLI, G.I. and Anug criteria (Scores) respectively.

At the initial visit each patient was given 12 tablets of G32 for 2 days use. The patient was instructed to crush 2 tablets at a time into powder form and use it as a tooth powder and also as a medium for gum massage followed by rinsing of the mouth. This was repeated thrice daily, i.e. in the morning, evening and at night and they were asked to report after 2 days and 4 days. On the third and fifth day of the clinical trial 12 tablets of G-32 were given at each visit and a follow-up assessment was made and the PLI and GI or ANUG scores were recorded. Patients were also questioned as to how their gums were feeling with any change in their bleeding tendency or whether they experienced any untoward reactions or side effects to the drug, etc. and other subjective remarks were recorded in the remarks coloum.

RESULTS :– In all, one hundred patients were included in the clinical trial, Table I shows the distribution of cases iin various periodontal conditions.

TABLE I Showing the different periodontal conditions 

   No 

               Periodontal conditions

 Number of patients
1st day 3rd day 5th day
1.   Periodontal conditions 16 15 14
2.  Chronic periodontitis 24 22 22 ‘
3.  Anug 18 18 18
4. Acute mixed gingival infections 34 32 29
5.  Pregnancy gingivitis 4 4 4
6. Dilantin gingival enlargement 1 1 1
7.   Gingival fibromatosis 1 1 1
8.  Idiopathic gingival enlargement 1 1 1
9.  Post gingivectomy hyperaemia 1 0 0
Total 100 94 90

  Six of these patients did not turn up on the third day and ten of them did not turn up on fifth day for follow up assessment.

The therapeutic effect of G-32 on oral hygiene and gingival status in various periodontal conditions are shown in Tables II to VII in 2 days and 4 days schedules.

TABLE II Chronic gingivitis

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 1.8 1.2 1.05 33.3%  41.6%
Average G.I. scores 1.9 1.3 1.09 31.5% 42.1%

TABLE III Chronic periodontitis

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 1.7 1.2 0.8 29.4% 48%
Average G.I. scores 1.8 1.2 0.8 27.7% 55%

 

TABLE IV Anug

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 1.9 1.4 1.2 26.3%   41.2%
Average G.I. scores 2.2 1.4 1.2 36.3%   45.4%

TABLE V Acute mixed gingival infection

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 2.09 1.5 1.1 28.85%   47.6%
Average G.I. scores 2.1 1.5 1.1 28.85%   47.6%

TABLE VI Gingival enlargements

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 1.7 1.03 0.9 39%   47%
Average G.I. scores 1.9 1.2               1.03 36.8%   42%

TABLE VII Pregnancy gingivitis

Particulars            1st day 3rd day  5th day Percentage  on 3rd day  Improvement on 5th day
Average plaque scores 1.8 1.5 1.2 16.6%   33.3%
Average G.I. scores 2.1 1.5 1.2 27.50%   42%

From this data it is evident, that in both acute and chronic periodontal conditions, there appears to be a definite improvement of plaque scores (16.6% – 39.0%) as well as gingival status (27.5 – 42.0%) in two day schedule and further improvement of plaque scores (33.3% – 48%) as well as gingival status (36.8% – 55%) in four day schedule.

Subjective improvement was reported by almost all the patients and neither toxic nor harmful effects were reported. Patients who had marked halitosis reported that this symptom had either disappeared or was reduced, Very few patients complained of external staining of teeth which was removed by polishing. Some complained of earthy feeling of the crushed powder, while one female patient complained of vomiting sensation during its use.

In acute girigival conditions, where the gums were edematous, spongy and enlarged with tendency for bleeding, there was a reduction of gingival inflammation and bleeding resulting in shrinkage of gingiva and improvement of tissue tone and texture. Furthermore, the drug appears to be useful in cases of gingival enlargement, reducing the super added gingival inflammation and bringing about shrinkage.

Discussion:

 The fact that, in general. the patients consistently felt better and that the clinical assessment showed a definite improvement in oral hygiene and gingival status. clearly indicates the therapeutic usefulness of G-32 in both acute and chronic gingival inflammation. There was resolution of gingival inflammation. with shrinkage of gums and reduction of pain and bleeding tendency. Although the exact mode of action of the drug is yet to be elucidated., the anti-inflammatory, astringent, antiseptic. stypic. analgesic properties of the constituent ingredients may contribute to the therapeutic usefulness of G-32 in all gingival and periodontal conditions. The deodorant action of the aromatic constituents help prevent halitosis, in addition to combating the acute infection, and removing the debris and plaque.

Considering the therapeutic usefulness of G-32 in bleeding, swollen, spongy and painful gingival conditions, and also in cases of halitosis, the drug can effectively and rationally be used as an adjunct after oral prophylaxis and curettage to improve the tissue tone and to bring about shrinkage. In post­operative cases,and in those where there is persistent gingival edema, massage with G-32 may help restore health to the gums.

G-32 is non-toxic, non-abrassive and a safe adjunct in oral physiotherapy not only to improve tissue tone and texture but also to restore and maintain gingival health. A futher long term double blind study using a placebo may shed light on its therapeutic usefulness in cases of gingival enlargements and other gingival lesions.

Summary and Conclusions:

 G-32, an Ayurvedic Research Product was clinically tried as dentifrice cum media for gingival massage in hundred patients with acute and chronic periodontal conditions. Their oral hygiene and gingival status were assessed on third and fifth day using standard criteria. From the foregoing study the following conclusions were drawn:

  1. G-32 is a safe. and effective ayurvedic drug and is useful as a dentifrice producing adequate gingival massage.
  2. G-32 not only reduces gingival edema, bleeding, pain, but also brings about restoration of gingival health.
  3. No side effects or untoward reactions were noticed.
  4. G-32 can be considered as an useful adjunct in oral physiotherapy and thus for restoration and maintenance of gingival health.

Acknowledgements:

We wish to thank Mr. P.G. Shukla of Manthan Research division of Alarsin Pharmaceuticals for the adequate supply of their product, G-32 for the clinical study and his untiring enthusiasm and help in executing the clinical trial. We wish to thank Professor K. Ramachandran and the Tamilnadu Government for providing us adequate facilities and for according permission to conduct the clinical trial. Mr. Thirugnanamurthy of Alarsin deserves our special thanks for his timely and enthusiastic co­operation and help.