Volume 15 Number 1 - Mahidol University

Research
Herbal Extracts as Adjunct in Periodontal Therapy
Centella asiatica (Baibuabok – Thai name) and Punica granatum
(Tuptim-Thai name) are medicinal herbs that have been reported to promote
tissue healing. While C. asiatica extract has the property to stimulate collagen
synthesis, tannin containing extract from P. granatum possesses astringent action.
It also has the affinity to bind with collagen and, therefore, has the capacity to
stabilize it. A double-blind clinical study carried out by Assoc. Prof. Pusadee
Yotnuengnit, et al., investigated effects of the combined extracts from C. asiatica
and P. granatum pericarp as a locally delivered adjunct on periodontal healing
following scaling and root planing (SRP) in adult periodontitis patients. An
innovative combined herbal medicament was formulated in the form of
biodegradable chips for subgingival application.
Patients with initial PD (pocket depth: the defect between root surface
and the gum resulting from destruction of the disease, with more depth indicating
more advanced disease.) of 5 to 8 mm. were enrolled in the study. In each
subject, two teeth in three out of the four quadrants were selected as target
teeth and randomized into three different treatment groups. After baseline
examination and SRP on non-target teeth, the target teeth in the test group received
SRP followed by subgingival delivery of the medicated chips, while the placebo
group received SRP plus plain (unmedicated) chips, and the control group received
SRP alone. The total follow-up period was six months.
Baibuabok
Better improvements of PD and AL (Attachment Loss: indicating vertical
dimension of attachment loss between root surface of the tooth and the gum at
particular site, with a higher value indicating more advanced disease) in the test
group were detected at both 3 and 6 months. The differences reached significant
levels at 3 months when compared with the placebo group. At 6 months, the test
Tuptim
group showed significant overall PD reduction compared to both placebo and
control groups as well as significant improvement in AL. These differences were even more pronounced among the pockets
with initial PD of 7 to 8 mm. All treatment groups exhibited a similar trend of oral hygiene improvement. The test group,
however, showed less percentage of non-bleeding sites. In all treatment groups, mean PD at 3 and 6 months were found to be
statistically lower from baseline. The effect on PD reduction by SRP in this study is, therefore, in agreement with findings from
other reports in respect to improvement of the periodontal condition obtained following supra- and subgingival debridement. This
confirms the effectiveness of SRP as having been used as the “gold standard” therapy.
When changes in PD and AL are taken into consideration, the test group showed quite impressive effects on PD
reduction. This enhancing effect could result from the astringent property of the tannin containing Punica extract in the medicated
chips. The astringent action is usually accompanied by contraction and wrinkling of the tissue. Local edema, inflammation as
well as exudation are also reduced. As tissue shrinkage naturally occurs after SRP, the additional PD reduction observed in the
SRP+med chip group seemed most likely to be facilitated by the characteristic astringency. On the other hand, the augmenting
effect on AL improvement in the test group could be postulated as a result, at least partially, from the stimulatory property of
Centella asiatica as the extract has been known to increase collagen synthesis. While the investigation focused on examining
the enhancing effects of the combined herbal medicament, the overall results obtained could benefit from some other properties
of C. asiatica and P. granatum. These may include antibacterial activities of both the herbs against some microorganisms and
the enzyme inhibitory properties of tannins contained in the Punica extract.
The study concluded that with the use of the newly formulated adjunctive herbal medicament, periodontal healing was
superiorly augmented following conventional periodontal therapy in the test group as compared to the placebo and control
groups. This may provide a new alternative to the use of adjunctive antibiotics which often induces development of bacterial
resistance, and reduces the need for periodontal surgery. Although the preliminary results from this clinical study appear quite
promising, further investigations are required to explain possible mechanisms responsible for the effects of these medicinal
herbs on periodontal healing.
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SPECTRUM
MAHIDOL UNIVERSITY