Histopathological Evaluation of G-32
in Periodontal Disease*
By
K. BASKAR , Department of Dentbtri.
Kilpauk Medical College, Madras (T.N.)
INTRODUCTION
The incidence of Periodontal Disease has been found to be more than 90 % in the adult
Indian Several methods to reduce the incidence or severity of the disease have been tried all over. the world. These included surgical and medical procedures as well as a combination of both. Though the various methods have no doubt helped to control the progress of Periodontal disease to some extent, still the need exists for a drug which will lower the incidence or atleast alleviate the salient features of the periodontal disease.
Among the methods of treatment available now, there are no satisfactory lines of treatment to save the teeth that are affected with advanced ,periodontal disease. The bacterial flora is an .ever present entity in the mouth. Hence the inflammation secondary to bacterial irritation cannot be avoided in the mouth. It has been conclusively proved that the mouth is always ‘ts bacterial flora except for a few hours imnicdiately after birth. It is but fair to explore the possibilities of improving the tissue integrity at a surface level which will make the surface epithelium to resist any form of irritation including the ever present bacterial irritation. The present study aims at exploring the possibility of an Ayurvedic drug G-32 which on topical application can bring about favourable changes in the gingiva with reference to bleeding, halitosis, mobility and pain.
G-32. an Ayurvedic product, was selected for this trial for topical application and massage of the gingivae. It is available in easily crushable tablet form. The composition of each tablet is as follows :
Bakula (Mimisopselingi)
Chok (Calcium carbonate) Katho (Acacia catechu) Laving (Myrtus caryophyllus) Chika ni Sopari (Areca catechu) Fatakadi (Alumen) Mayaphal (Quercus infectoria) Elaichi (Elettaria cardamomum) Sonageru (Silicate of Alumina and Iron Oxide) Jiru (Ca rum carui) Majith (Rubia cordifoiia) Pashanbed (Saxifruga ligulata) Vavding (Embeliaribes) Pipala ni lakh (Ficus religiosa) Samudrafin (Os sapias) Vajradanti (Barleria prionitis) Taj (Cinnamomum cassia) Mari (Pipar nigrum) Sajikhar (Sodium carbonate impura) Kulinjan (Alpinia chinensis) Piper (Piper longum) Kapur (Camphora officinarum) Kuth ( uncaria gambier) Gundar (Acacia arabica)
It is described that this product is for topictLl application and massage to the gingikae etc and has astringent, antiseptic, antiinflammatory, anodyne, styptic, deodarant, aromatic, cooling and healing properties and shows remarkable improvement in 2-3 days of application in periodontal diseases.
G-32 Topical Application and Gum Massage :
One tablet of G-32 was crushed to powder and applied to the gums and gently massaged without causing pain, three times a day, for one week. Patient’s condition as to bleeding, pain, swelling, bad breath, mobility stain, ulceration on the gingival epithelium, Plaque Index and G.I. Index, were evaluated after a week’s application of G-32. Histopathological evaluation by biopsy before and after G-32 treatment was also done in 23 cases, which may throw some light on the nature of inflammatory reaction that is tzyrking place under the epithelium in the gingiva.
MATERIALS AND METHODS
67 patients with clinical features of bleeding gums, pain, swelling, bad breath, stain and mobile teeth, were studied. After recording the personal data, biopsy was done from one of the two areas of gingiva with equal involvement. G-32 was applied for one week by the patient over the gums except at the biopsied site. Patients welere-v. ..’;d after one week with specific reference to bleeding, pain, halitosis, mobility and stain. Repeat biopsy was made from the other side where G-32 was applied. The results were tabu-kited as follows :
TABLE
Symptoms
| Symptoms | No. of cases | % | |
| A | Bleeding | 19 | 28.3% |
| B | Pain | 18 | 26.9% |
| C | Swelling |
4 |
6.0% |
| D | Bad breath | 14 | /0.9% |
| E | Mobility | 3 | 4.5% |
| F | Stain before application
of G-32 |
9 | 13.4% |
| Total | 67 | 100.0% |
RESULTS AND DISCUSSION Index (Mean) :
Plaque Index (Mean) (P.I.) for all the cases was 1.7 before G-32 treatment. After one week’s application of G-32 the P.I. was 1.5, showing that there was an improvement of 0.2 (Mean), that is, an improvement of 11.8 % for a week’s application of G-32.
G.I. Index :
G.I. Index was 1.8 before G-32 treatment and after one week’s use of G-32, the G.I. Index was 1.09, showing an improvement of 0.71, that is 38.8% for a week’s use of G-32. The details P.I. and G.I. Index are given in Table 2.
TABLE 2
Showing improvement in P.I. & G.1. Index (Mean)
| Index | before treatment
(Mean) |
After Treatment
(Mean) |
Improvement
(Mean) |
% of
Improvement |
| Plaque Index | 1.7 | 1.5 | 0.2 |
11.8% |
| G.I. Index | 1.8 | 1.09 | 0.71 | 38.8% |
Clinical Features :
In all the 19 eases of bleeding gums, bleeding stopped after G-32 treatment, giving 100.0% relief. There was ‘complete relief in 13 cases out of ’18 .cases of pain, that is 72.2%. There was complete relief in 7 cases out of 14 cases of bad breath, that is 50.0%. All the 3 cases of mobility showed no improvement. In 3 cases out of 9 cases of stain, that is 33.3 %, there was no stain after G-32 application. Overall, for all the cases, there was Complete Relief • in 44 cases (65.7%) and partial or no relief in 34.3 % after G-32 use for one week. The, maximum improvement was observed in bleeding gums (100.0%) and the next in order Was the relief of pain in 72.2%. Swelling and bad breath each showed 50% of relief. Improvement was poor in stain (30.3%) and Nil in cases of Mobility. The details are given in Table 3.
TABLE 3
Relief of symptoms with G-32 treatment
|
Symptoms |
No of cases before treatment | Complete Relief | % | Moderate or No Relief | % | |
|
A |
Bleeding |
19 | 19 | 100.0% | – | |
| B | Pain | 18 | 13 | 72.2% | 5 | 27.8% |
| C | Swelling | 4 | 2 | 50.0% | 2 | 50.0% |
| D | Bad breath | 14 | 7 | 50.0% | 7 | 50.0% |
| E | Mobility | 3 | – | – | 3 | 100.0% |
| F | Stain | 9 | 3 | 33.3% | 6 | 66.6% |
| Total | 67 | 44 | 65.7% | 23 | 34.3% |
Biopsy Results :
23 patients had gingival biopsies done before and after the application of G-32. On histo-pathological examination, the following changes were observed.
- Keratinisation: Keratinisation was slightly more pronounced in 2 cases in the sections after application of G-32.
- Inflammation : The inflammatory reaction was definitly found to be reduced in 13 cases in the areas where G-32 was applied.
- Granulation tissue : Granulation tissue was visibly seen in all areas where G-32 was applied which is an indication of good healing
- Ulceration : Ulceration on the gingival epithelium which was found in 2 cases was found to have disappeared after application of G-32.
- No change in Biopsy — 2 cases. CONCLUSION
The drug G-32 has been found to be useful in controlling inflammation both clinically and histologically as seen in the present study.
Acknowledgment
This project was permitted by Government of Tamil Nadu vide G.O. Rt. No. 1193, 28-9-77.
My special thanks are due to Dr. V. Murugesan, Professor of Pathology, Kilpauk Medical College, Madras, for reading the slides.
My thanks are particularly due to Shri S. Thirugnanamurthy of Alarsin whose enthusiastic follow up helped in the completion of the project. The drug G-32 was supplied by Alarsin, Bombay.
My thanks are due to Dr. S. Santhanakrishnan who assisted me in the project.
REFERENCES
- Krishna Arjun Rao, C. and Dr. Ramaswamy: Effect of G-32 massage in Gingival inflammation. Current Med. Pract., Vol. 22, No.6, 281, 1978.
Rajasekhar, A.: Therapeutic usefulness of G-32 in various Periodontal conditions. A Clinical Study, 32nd Indian Dental Conf., Guntur: 28-30 Jan., 1978. Miss Shah Kirti, P.: G-32 in acute and Chronic Gingivitis associated with painful teeth. Current Medical Practice, Vol. 21, No. 2, 65-68, 1977.
* Paper at the 33rd Indian Dental Conference, 28-31, December 1978. Madras.