COMPARATIVE EVALUATION OF ANTI-MICROBIAL EFFICACY OF

Sant et al. IEJDTR, 2017; 6(1): 386-389 386

ISSN: 2454-311X

COMPARATIVE EVALUATION OF ANTI-MICROBIAL EFFICACY OF CURCUMA ORAL GEL

AND CHLORHEXIDINE GEL ON THE PERIODONTAL PATHOGENS: AN IN-VITRO STUDY

ANKIT SANT1, DEEPAK DAVE2, PHORAM PATEL1, HARSHIL ZAVERI1

1 Post Graduate student, Department of Per iodontology, K. M. Shah Dental College, Vadodara, 2 Professor and HOD,

Department of Per iodontology, K. M. Shah Dental College, Vadodara, Gujarat, India. Corresponding Author: Dr Ankit Vilas

Sant, Depar tment of Per iodontology. M. Shah Dental College, Vadodara, Gujarat , India. Email: sant.ankit@gmai l.com,

Contact: +917600490588

ABSTRACT

Aim: To comparatively evaluate the antimicrobial efficacy of 1% Curcuma Oral Gel with 2% Chlorhexidine Gluconate gel

on gram negative per iodontal pathogens: Porphyromonas Gingival is (P. Gingivalis), Prevotella Intermedia (P. Intermedia),

Fusobacter ium Nucleatum (F. Nucleatum) and Aggregat ibacter Act inomycetemcomitans (A. Actinomycetemcomitans) in

in-vitro condi tions.

Materials and Method: Nutrient agar plates were inoculated by rubbing ster ile cotton swabs dipped into bacter ial

suspensions of P. gingivalis, P. intermedia, F. nucleatum and A. actinomycetemcomitans over the entire surface of the plate.

Three such sets were prepared. After inoculation, 10 mm diameter five wells were cut into the surface of each agar plate.

1% Curcuma Oral gel and 2% Chlorhexidine gel were added into wells in 4 different plates containing above mentioned 4

different bacter ia and dist i l led water was used. Plates were incubated and the diameter of zone of inhibition was

measured. The mean score of zones of inhibition were calculated and statist ical analysis was done.

Results: 2% Chlorhexidine gel had edge over 1% Curcuma gel in inhibiting the growth of micro-organisms. 1% Curcuma

gel was more effective against P.intermedia compared to P.gingivalis, F.nucleatum and A.act inomycetemcomitans. 2%

Chlorhexidine gel was more effective against A.actinomycetemcomitans and F.nucleatum compared to P.gingivalis and

P.intermedia.

Conclusion: 1% Curcuma oral gel can create a new hor izon in the field of chemical agents that can be used as an adjunct to

mechanical per iodontal therapy and can serve as a cheaper al ternative compared to 2% Chlorhexidine gel .

Keywords: Chlorhexidine gel , Per iodontal Pathogens, Turmer ic gel

INTRODUCTION

Periodontal disease eventually leads to tooth loss, if left

untreated. It is among the most widespread oral

bacter ial disease.1,2 Al though bacter ia belonging to more

than 630 different taxa exist in the oral cavity, only 10–

15 bacter ial species are recognised as potential

periodontal pathogens.3 Of them, Porphyromonas

gingivalis, Fusobacterium nucleatum, Prevotella

intermedia and Aggregatibacter actinomycetemcomitans are recognised as the major pathogens for initiation and

progression of destruction of tooth support ing

structures. The levels of P. gingivalis, P. intermedia and

other anaerobic bacter ia are seen to increase in adult

onset per iodontitis. While P. gingivalis and A.

actinomycetemcomitans are strongly associated with

localised aggressive per iodont itis, P. intermedia is

predominantly associated wi th the development of

necrotising ulcerative gingivi tis.4 Longitudinal and

retrospective studies have demonstrated an increased

r isk of per iodontal breakdown in A.

actinomycetemcomitans and P. gingivalis positive sites

and better post-treatment results in their absence.5

India has a r ich history of using plants for medicinal

purposes. Turmer ic (haldi), a rhizome of Curcuma longa,

is a common antisept ic used in traditional system of

Indian medicine. It may be a more acceptable and viable

option for the common man. It has proven proper ties

l ike anti-inflammatory, antioxidant, antimicrobial,

hepatoprotective, immunostimulant, antiseptic,

antimutagenic, and i t also accelerates wound heal ing.6

Curcumin, the main yellow bioactive component of

turmer ic, has been shown to have a wide spectrum of

biological actions.7 Li terature reports have shown that

curcumin has anti-inflammatory and ant ibacter ial

activi ties, suggesting i ts potential to be used as a

subgingival agent.7 Safety evaluation studies have

indicated that both turmer ic and curcumin are well

tolerated at a very high dose w ithout any toxic effects.7

To the best of our knowledge, there are currently no

studies assessing the efficacy of turmer ic gel with the

var ious per iodontal pathogens, using the disc diffusion

method. Hence, the present study will comprehensively

report the antimicrobial potential of turmer ic gel on

these key per iodontal pathogens. I t wil l also assess and

compare the in vitro efficacy of turmer ic gel w ith the gold

standard 2% chlorhexidine gel .

Sant et al. IEJDTR, 2017; 6(1): 386-389 387

MATERIALS AND METHODS

The study was designed as an in vitro study. Before

conduct ing the study, necessary ethical approval was

obtained from the Inst itutional Ethics Committee. Other

related approvals from the concerned author it ies were

obtained for the necessary microbial analysis. Mater ials

used in the study were 1% turmer ic gel , 2%

chlorhexidine gel and disti l led water. Microorganisms

included were P. gingivalis, P. intermedia, F. nucleatum

and A. actinomycetemcomitans strains. Test mater ials

included blood agar plates, Petr idishes and a digital

Vernier caliper . A total of 60 samples were taken.

Samples were divided into 3 reagent groups, as

ment ioned above ×4 strains of microorganisms ×3

repeti tions.

Disc diffusion method

The antibacter ial activity of 1% turmer ic gel and 2%

chlorhexidine gel was determined by disc di ffusion

method. Culture medium used was blood agar. A loop or

swab method was used to t ransfer microbial colonies to

the agar plates. Turbidity was visual ly adjusted wi th the

broth to equal that of a 0.5 McFar land turbidity standard

that had been vortexed. Alternatively, the suspension

was standardised wi th a photometr ic device. Within 15

min of adjusting the inoculums to a McFar land 0.5

turbidi ty standard, a ster i le cotton swab was dipped into

the inoculum and rotated against the tube wall above the

liquid to remove excess inoculum. Then, swabbing the

entire surface of the agar plate was done thr ice, rotat ing

plates approximately 60° to ensure even distr ibution.

Care was taken to avoid extra hi tting of the sides of the

plates to prevent creating aerosols. Inoculated plates

were allowed to stand for at least 3 min, but no longer

than 15 min before making wel ls. A hollow tube of 5 mm

diameter was heated and pressed above the inoculated

agar plates and was removed immediately, making a well

in the plate. Likewise, four wells of 5 mm diameters each

were made on each plate. 1% turmer ic gel, 2%

chlorhexidine gluconate gel and disti l led water were

added in the wells assigning each plate for each of the

solution. Within 15 min of compound application, plates

were shi fted to an anaerobic jar , which was kept in an

incubator for 48 hours. After incubation was complete,

plates were read only if the lawn of growth was

confluent or near ly confluent. The diameter of zones of

inhibition was measured for al l the wells using a digital

Vernier caliper . The mean score of zones of inhibit ion

was calculated for each solution, respectively.

Table 1: Mean zone of inhibi tion compar ing Curcuma

gel and chlorhexidine gel for

Porphyromonas gingivalis (Pg),

Prevotella intermedia (Pi),

Aggregat ibacter actinomycetemcomitans (Aa),

Fusobacter ium nucleatum (Fn)

Figure 1: Zone of inhibition for Fn compar ing

1% Curcuma oral gel and 2% Chlorhexidine gel

Figure 2: Zone of inhibition for Aa compar ing


Figure 3: Zone of inhibition for Pg compar ing


Microor

ganism

Curcum oral

gel (1% )

D/W Chlorhexidine

gluconate gel (2%)

Pg 12mm R 16mm

Pi 13mm R 16mm

Aa 12mm R 18mm

Fn 12mm R 18mm

Sant et al. IEJDTR, 2017; 6(1): 386-389 388

Figure 4: Zone of inhibition for Pi compar ing


RESULTS

2% Chlorhexidine gluconate gel showed the greatest

zone of inhibition against all per iodontal pathogens. 1%

turmer ic gel showed 13 mm zone of inhibit ion against P.

intermedia whereas 12 mm zone of inhibit ion was seen

against P. gingivalis, A. actinomycetemcomitans and F.

nucleatum. (Table-1)

DISCUSSION

The consensus report of the American Academy of

Per iodontology proved that the micro-organisms

responsible for per iodontitis are A.

actinomycetemcomitans, P. gingivalis, P. intermedia,

F.nucleatum.8 According to specific plaque hypothesis, by

eliminating above mentioned species, per iodontal

disease would regress.9 Thus per iodontal health of the

individual can be establ ished with the help of the agents

like turmer ic gel along with the use of mechanical plaque

control therapy.

The combination of microorganisms and inflammatory

response are the cause of many diseases, including

periodont itis, for which compounds having a dual anti-

inflammatory and antimicrobial activity can be desirable

therapeut ic agents.10 The results of this study

corroborate with the findings of study by Mandrol i et al,

which was done to evaluate the abili ty of curcumin to

exert antibacter ial activity against common endodontic

bacter ia l ike Streptococcus mutans, Actinomyces viscosus,

Lactobacillus casei, P. gingivalis, Prevotella intermedia

and Enterococcus faecalis.11 I t was, therefore, suggested

that curcumin has the ability to kil l several Gram-

posi tive and Gram-negative bacter ia.

A study by Rai et al (2008)12 suggested that curcumin

may inhibit bacter ial cell proli feration by inhibi ting the

assembly dynamics of FtsZ (a bacter ial protofilament),

which polymer izes to form a Z-r ing at the midcell that

orchesterates bacter ial cell division. The assembly and

stability of FtsZ protofilaments have been shown to play

cr itical roles in bacter ial cytokinesis. Thus, FtsZ may be

considered as an important antibacter ial drug target.

Another reason which might be suggested for the

antibacter ial potential of curcumin is that curcumin is a

polyphenolic compound, also having substantial

antibiofi lm act ivity.13 It inhibits the product ion of biofi lm

and disperses the biofilm made by many

microorganisms.14

Owing to the plaque biofi lm acting as the main etiological

factor in the per iodontal diseases, curcumin’s antibiofi lm

activi ty would also account for i ts antibacter ial activi ty

against per iodontal pathogens. Apart from the

antibacterial property, curcumin is a molecule known to

demonstrate antifungal act ivity15 and antivi ral activity as

wel l.16 Further, curcumin has long been touted as a

powerful anti-inflammatory and immunomodulatory

agent.17

Curcumin has been shown to regulate numerous

t ranscr iption factors, cytokines, protein kinases,

adhesion molecules, redox status and enzymes that have

been linked to inflammation.13 The ant i-inflammatory

activi ty of curcumin was first reported in 1971.17 It

reduces inflammat ion by effect ively inhibi ting

t ranscr iptional and translational expression of

proinflammatory cytokines like Inter leukin – 6 (IL – 6)

and Tumour Necrosis Factor – alpha (TNF – α). Curcumin

also demonstrated dose dependent attenuation of

nuclear factor kappa-light-chain-enhancer of activated B

cells (NF-kb) activation in the gingival tissue of rats

suffer ing from exper imental per iodontal disease. It,

fur ther, reduced the inflammatory infi lt rate, increased

collagen content, and increased fibroblastic cell numbers

in gingival tissues.17

Despite extensive research and development, poor oral

bioavai labi l ity of curcumin remains one of the major

concerns for i ts use as a therapeutic agent. This poor oral

bioavai labi l ity of curcumin can be att r ibuted to its poor

absorption, high rate of metabolism in the intestines and

rapid systemic elimination from the body. Thus,

attempts have been made to improve curcumin’s

bioavai labi l ity by use of adjuvants that can block the

metabol ic pathway of curcumin. This has been achieved

through encapsulation in l iposomes, biodegradable

microspheres, cyclodextr in, and hydrogels. Also, var ious

control led del ivery forms, such as polymer ic

micro/ nanospheres, l iposomes, micel les, parenteral

emulsion, and prodrugs have been investigated to

increase its solubili ty.

Maintenance or improvement of oral health by use of

natural products that also form a part of habi tual diet

seems to be a suitable way to preserve oral health.

Patients wi ll tend to be compl iant as they are not

burdened wi th added cost or t ime. However, this cannot

be confi rmed without appropr iate studies. Additionally,

proper util ization of available natural resources to

reduce the ever increasing prevalence of oral diseases in

rural parts of developing countr ies can help to diminish

the dangers of a poor dentist-populat ion rat io.

Active ingredients from such potent natural resources

should also be evaluated for their anti-inflammatory and

immune-modulatory properties. It is recommended that

the readily accessible natural products may be

integrated wi th presently avai lable synthetic mater ials

that are used to maintain the oral hygiene.

However, any natural product should be assessed for its

safety and cl inical applicat ion should not be done

wi thout sufficient scientific evidence. The mechanism of

action of a particular natural product needs to be studied

at a molecular level in order to assure the accuracy of

appl ication and consequently, the outcomes. Although

none of the neutraceuticals used in this study are known

Sant et al. IEJDTR, 2017; 6(1): 386-389 389

to have side effects, oral retention and duration of action

of these phytoplants is an important factor that needs

fur ther exploration.

Thus, from this study one could say a wide plethora of

new dimension in nonsurgical per iodontal therapy can

open up, if turmer ic gel can be used as adjunct to

nonsurgical per iodontal therapy along with

chlorhexidine digluconate.

CONCLUSION

The var ious in-vitro and cl inical studies have shown that

curcuma oral gel has the potential to inhibit var ious

micro-organisms which cause per iodontit is. Curcuma

oral gel does not have any adverse reactions reported ti l l

date. Thus, i ts use should be increased for the patients

with hypersensit ivity towards chlorhexidine, which

would give the per iodontist another adjunctive

treatment option along with scaling and root planing. 2%

Chlorhexidine gel is better than 1% Curcuma gel but

looking at the cost factor curcuma gel can be a cheaper

alternat ive to chlorhexidine gel .

However, more microbial as well as clinical studies

should be undertaken to establish the results of the

present study. Cl inical tr ial should be encouraged so as

to reap the benefi ts of natural products like turmer ic,

especially in the field of per iodontal local drug del ivery

and non surgical per iodontal therapy in the management

of per iodontitis.

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COMPARATIVE EVALUATION OF ANTI-MICROBIAL EFFICACY OF