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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 155-158

Comparative evaluation of 3% Ginkgo biloba gel with 1% chlorhexidine gel as an adjunct to ultrasonic scaling in the treatment of gingivitis


Department of Periodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Submission07-Feb-2022
Date of Decision11-May-2022
Date of Acceptance23-May-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Malik Abdul Waheed
Department of Periodontics, Pacific Dental College and Hospital, Airport Road, Debari, Udaipur - 313 024, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_28_22

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  Abstract 


Objectives: The aim of this study was to compare and evaluate the efficacy of 3% Ginkgo biloba (Gb) gel with 1% chlorhexidine (CHX) gel as an adjunct to ultrasonic scaling (US) in patients having moderate-to-severe gingivitis. Materials and Methods: Forty subjects with moderate-to-severe gingivitis were selected and randomly divided into two groups: test (Gb) and control (CHX). The test subjects received 3% Gb gel along with US and the control subjects received 1% CHX along with US. Clinical parameters such as plaque index, gingival index, and papillary bleeding index were recorded at baseline (before US), 15th-day, and 30th-day posttreatment. Results: Both the groups presented significant reductions in the clinical parameters at 30th-day post-US when compared within the group. However, Gb gel group showed better results compared to CHX in intergroup comparison on 30th day. Conclusion: Gb gel shows similar results when compared to CHX as an adjunct to US in cases of gingivitis suggesting that it can be used as a herbal alternative to CHX.

Keywords: Anti-inflammatory, chlorhexidine, gingivitis, Ginkgo biloba, herbal


How to cite this article:
Waheed MA, Pandya R, Shetty N, Mathur A, Bali A, Pal PC. Comparative evaluation of 3% Ginkgo biloba gel with 1% chlorhexidine gel as an adjunct to ultrasonic scaling in the treatment of gingivitis. J Dent Res Rev 2022;9:155-8

How to cite this URL:
Waheed MA, Pandya R, Shetty N, Mathur A, Bali A, Pal PC. Comparative evaluation of 3% Ginkgo biloba gel with 1% chlorhexidine gel as an adjunct to ultrasonic scaling in the treatment of gingivitis. J Dent Res Rev [serial online] 2022 [cited 2022 Oct 2];9:155-8. Available from: https://www.jdrr.org/text.asp?2022/9/2/155/354202




  Introduction Top


Gingival diseases as well as periodontal diseases are among the most prevalent oral cavity-related diseases which in severe situations can lead to worsening of the oral health. Gingivitis is a disease of the gingiva which is caused by inflammation, and the signs include redness, bleeding, and swelling of the gingiva, and if left untreated, may lead to periodontal disease. Dental plaque accumulation is one of the main causative factors for gingivitis. Mechanical means of plaque removal either by the patient or by professional scaling and root planing (SRP) are one of the best methods to achieve the elimination of microbes.

The use of herbal medicines and products in dentistry and other diseases has been going on since centuries. Herbal products are more commonly used nowadays because of their bioavailability and actions such as antimicrobial, anti-inflammatory, antiseptic, and antioxidant. Ginkgo biloba (Gb) leaf extract is one of the most commonly used herbal extracts, which comprises flavone glycosides (24%), terpenoids (6%), and <5 ppm of ginkgolic acid.[1] It contains ginkgolic acid C15:1 which has shown to have antibacterial and antibiofilm activities. It has shown beneficial actions such as hunting of free radicals, thus reducing oxidative stress as well as anti-inflammatory effect.[2] It has demonstrated antioxidant and vasoactive properties as well as beneficial clinical effects in several conditions such as ischemia, epilepsy, and brain injury associated with peripheral nerve damage and has also been commonly used as an anti-inflammatory agent and available in the form of tablets, capsules, and supplements such as colas, extracts, teas, sprays, and bars.[3]

Although the anti-inflammatory effect of Gb has been explored, not much research has been done so far on the effect of Gb gel as a topical application for use in patients with gingivitis. Hence, the current study was designed with an aim to compare and evaluate the efficacy of 3% Gb gel with 1% chlorhexidine (CHX) gel as an adjunct to ultrasonic scaling (US) in patients with moderate-to-severe gingivitis.


  Materials and Methods Top


Study population and selection criteria

In a single-center, parallel-arm, randomized, double-blind, prospective study, 40 patients, comprising males and females with ages ranging between 18 and 45 years were enrolled from the outpatients reporting to the department of periodontics. Patients with chronic periodontitis, systemic illness, known or suspected allergy to the medications, smokers, alcoholics, immunocompromised individuals, and those who had underwent periodontal therapy in the past 6 months were excluded from the study. The included patients comprised systemically healthy individuals with moderate-to-severe gingivitis with plaque index (PI) score >1, gingival index (GI) >1, and papillary bleeding index (PBI) >1 and who consented to be part of the study.

The randomization was done using the coin toss method, and the patients were allotted into two groups, i.e., test group (3% Gb gel) and control group (1% CHX gel) with 20 patients, respectively. The institutional ethical committee approved the study and was conducted between December 2020 and March 2021 (PDCH/21/EC-288). All the patients were verbally informed about the study and written informed consent was obtained from them.

Preparation of Ginkgo biloba gel

The gel preparation was done according to the procedure described by Mahendra et al.,[4] and it was prepared at the College of Pharmacy, PAHER, Udaipur. Gb extract powder was obtained and it was mixed with Carbopol 940p (gelling agent) and distilled water. Methylparaben was added as a preservative along with a sweetening agent sucralose (Sugar Free™). The gel was kept at a 3% weight/volume concentration.[4]

As a control, 1% CHX gel (commercially available as Hexigel™, ICPA Health Products Limited) was used. The Gb gel and 1% CHX gel were dispensed into similar containers to the patients.

Study protocol

After the initial assessment of the patients and determination of moderate or severe gingivitis, they underwent US, instructions regarding oral hygiene were given, and the patients were allotted into the groups and the gel was dispensed. Patients were instructed to apply the gel topically on the gingiva twice daily for 15 days. They were asked not to spit or rinse the gel for 15 min after application. All the procedures such as SRP and recording of clinical parameters were carried out by different examiners. The clinical parameters checked were PI (Silness and Loe, 1964), GI (Loe and Silness, 1963), and PBI (Muhlemann, 1977). These parameters were assessed at baseline (before US), 15th day, and 30th day after US. Oral hygiene instructions were reinforced at the recall appointments.

Statistical analysis

All the clinical parameters were entered into an Excel sheet and analysis for statistical significance for intragroup and intergroup comparison was performed using the paired t-test and unpaired t-test. The statistical analysis was conducted using the SPSS Statistical Software (version 25, IBM, Chicago, IL, USA). The level of significance was kept at P ≤ 0.05.


  Results Top


The total number of patients assessed was 55, out of which 40 patients were selected for the study based on the inclusion and exclusion criteria. The age ranged between 19 and 45 years with a mean age being 32 years. The study comprised 54% of males and 46% of females. No patients reported with any adverse signs or symptoms. All 40 patients were assessed for the clinical parameters (PI, PBI, and GI) at baseline, 15th day, and 30th day. No patients were lost on follow-up till 30 days.

No patients reported with any adverse reactions associated with the application of the gel. On intragroup comparison, of both the test [Table 1] and control groups [Table 2], a statistically significant reduction in PI, GI, and bleeding index was found in both the groups (P < 0.001).
Table 1: Intragroup comparison of 3% Ginkgo biloba gel (test) group at different time intervals

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Table 2: Intragroup comparison of 1% chlorhexidine gel (control) group at different time intervals

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The PI showed no statistically significant difference in test and control groups when compared from baseline to 15th day (P = 0.629), whereas it presented a statistically significant difference at 30th day (P = 0.001). The GI scores did not show any statistically significant difference in the parameter when compared from baseline to 15th (P = 0.386) and 30th day (P = 0.026) in both the groups. On intergroup comparison of PBI, the results did not show a statistically significant difference in both groups at 15th (P = 0.079) and 30th day (P = 0.023) when compared to baseline [Table 3].
Table 3: Intergroup comparison between the 1% chlorhexidine and 3% Ginkgo biloba group

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  Discussion Top


Gb herb is commonly used in various parts of the Asian subcontinent, namely, China and other countries. It is known for its effectiveness as an anti-inflammatory agent. Ginkgo has been widely used for the treatment of conditions such as Alzheimer's,[5] dementia,[6] and depression,[7] being given as a supplement in these neurological conditions. It has also shown its effect as an antiatherogenic drug for various conditions related to the cardiovascular system[8] and has shown efficacy for the treatment of asthmatic patients.[9] Gb has been known to exhibit a strong action of scavenging of free radicals. Hence, due to this action of Gb, it can be very useful in the treatment of conditions which are related to the production of these free radicals, for instance, periodontitis.

Gingivitis is the inflammation of the gingiva due to local factors and caused by substances related to plaque accumulation at or around the marginal gingiva and the sulcus.[10] Various studies in the past have tried to find the correlation between plaque accumulation and gingivitis with varied results; however, Ash et al. in 1964 conducted a study and found a positive correlation between plaque and gingivitis.[11] Hence, it can be taken into consideration that the removal of plaque and maintaining of oral hygiene can account for a significant reduction of inflammation in patients with gingivitis.

CHX is one of the primary agents used for the purpose of chemical plaque control, and its clinical efficiency and side effects are well assessed over the years. CHX has shown antibacterial and antiplaque activities[12] and also it has shown to have potent antifungal activity.[13] The potential action of CHX in different concentrations as well as various forms such as gels, mouthwash, and sprays, having excellent results in patients with gingival as well as periodontal diseases. Hence, CHX is considered a gold standard agent in chemical plaque control in periodontics.

In the present study, 3% Gb gel was used for topical application after SRP in patients having moderate-to-severe gingival inflammation and compared to commercially available 1% CHX gel. The results of the study show both Gb gel and CHX gel showing significant reduction in the PI, GI, and PBI when compared within the individual groups. However, on comparing intergroup, the results did not show statistically significant results at baseline and 15th-day post-SRP, but it showed a significant reduction in clinical parameters at 30th day in the Gb gel group as compared to CHX group in PI. These results are similar to a previous study with the use of 3% Gb gel as local drug delivery in cases of periodontitis patients.[4]

A study conducted by Singh et al.,[14] in 2008, on the biological and chemical properties of Gb suggested that it has potent activity against Gram-positive and Gram-negative bacteria. Gb contains polyprenols which are lipids and has been shown to increase the efficacy of various antibiotics against different bacteria. It also increases the duration of action and reduces the dosage of antibiotics when Gb was used along with it.[15] Gb extracts have been shown to have antibacterial effects due to the presence of ginkgolic acid C15:1 and other molecules which have been shown to have inhibitory effects on Streptococcus pyogenes, Cutibacterium acnes, Staphylococcus aureus,[16] Treponema denticola, Tannerella forsythus, Prevotella intermedia, and Porphyromonas gingivalis.[17]


  Conclusion Top


The present study showed that Gb gel when used as a topical delivery as an adjunct to US has shown to have significant results in reducing the PI, GI, and PBI after 30 days. It has shown similar efficacy as compared to CHX gel in the treatment of gingivitis patients along with routine nonsurgical therapy. Further long-term evaluation with a microbiological and physiological analysis of the effects of Gb gel is needed with a larger sample size to get a better overview of the effects of Gb in the treatment of periodontal diseases.

Ethical clearance

This study was approved by the the Ethical Review Committee, Pacific Dental College and Hospital, Udaipur. (PDCH/21/EC-288).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shankland WE 2nd. Four common herbs seen in dental practice: Properties and potential adverse effects. Cranio 2009;27:118-24.  Back to cited text no. 1
    
2.
Yuan F, Yu R, Yin Y, Shen J, Dong Q, Zhong L, et al. Structure characterization and antioxidant activity of a novel polysaccharide isolated from Ginkgo biloba. Int J Biol Macromol 2010;46:436-9.  Back to cited text no. 2
    
3.
Thorpe LB, Goldie M, Dolan S. Central and local administration of Gingko biloba extract EGb 761® inhibits thermal hyperalgesia and inflammation in the rat carrageenan model. Anesth Analg 2011;112:1226-31.  Back to cited text no. 3
    
4.
Mahendra J, Kumari BN, Mahendra L, Yagnik K. Antimicrobial efficacy of 3% Ginkgo biloba gel as a local drug delivery agent in the treatment of chronic periodontitis: A cross sectional comparative clinical study. Biomedicine 2020;40:324-30.  Back to cited text no. 4
    
5.
Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998;55:1409-15.  Back to cited text no. 5
    
6.
Ernst E, Pittler M. Ginkgo biloba for dementia. Clin Drug Investig 1999;17:301-8.  Back to cited text no. 6
    
7.
Hemmeter U, Annen B, Bischof R, Brüderlin U, Hatzinger M, Rose U, et al. Polysomnographic effects of adjuvant Ginkgo biloba therapy in patients with major depression medicated with trimipramine. Pharmacopsychiatry 2001;34:50-9.  Back to cited text no. 7
    
8.
Mahady GB. Ginkgo biloba for the prevention and treatment of cardiovascular disease: A review of the literature. J Cardiovasc Nurs 2002;16:21-32.  Back to cited text no. 8
    
9.
Babayigit A, Olmez D, Karaman O, Ozogul C, Yilmaz O, Kivcak B, et al. Effects of Ginkgo biloba on airway histology in a mouse model of chronic asthma. Allergy Asthma Proc 2009;30:186-91.  Back to cited text no. 9
    
10.
Page RC. Gingivitis. J Clin Periodontol 1986;13:345-59.  Back to cited text no. 10
    
11.
Ash MM Jr., Gitlin BN, Smith WA. Correlation between plaque and gingivitis. J Periodontol 1964;35:424-9.  Back to cited text no. 11
    
12.
Jones CG. Chlorhexidine: Is it still the gold standard? Periodontol 2000 1997;15:55-62.  Back to cited text no. 12
    
13.
Machado FC, Portela MB, Cunha AC, Souza IP, Soares RM, Castro GF. Antifungal activity of chlorhexidine on Candida spp. biofilm. Rev Odontol UNESP 2010;39:271-5.  Back to cited text no. 13
    
14.
Singh B, Kaur P, Gopichand, Singh RD, Ahuja PS. Biology and chemistry of Ginkgo biloba. Fitoterapia 2008;79:401-18.  Back to cited text no. 14
    
15.
Tao R, Wang C, Ye J, Zhou H, Chen H. Polyprenols of Ginkgo biloba enhance antibacterial activity of five classes of antibiotics. Biomed Res Int 2016;2016:4191938.  Back to cited text no. 15
    
16.
Chassagne F, Huang X, Lyles JT, Quave CL. Validation of a 16th century traditional Chinese medicine use of Ginkgo biloba as a topical antimicrobial. Front Microbiol 2019;10:775.  Back to cited text no. 16
    
17.
Cheng Q, Gao WM, Cao B, Liu YM, Lin M, Zhang LQ, et al. Effects of Ginkgo biloba extract on periodontal pathogens and its clinical efficacy as adjuvant treatment. Chin J Integr Med 2014;20:729-36.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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