|Year : 2022 | Volume
| Issue : 2 | Page : 73-78
Sea buckthorn against periodontitis: A clinical and microbiological study
Susmitha Santosh1, GA Babitha1, K Shashanka Holla1, Shobha Prakash1, K Suresh2, G Kishore Bhat3
1 Department of Periodontics, College of Dental Sciences, Davangere, India
2 Department of Microbiology, JJM Medical College and Hospital, Davangere, India
3 Department of Molecular Biology and Immunology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
|Date of Submission||25-Apr-2022|
|Date of Acceptance||25-Aug-2022|
|Date of Web Publication||19-Dec-2022|
Dr. Susmitha Santosh
Department of Periodontics, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Sea buckthorn (SBT) (Hippophae rhamnoides, L., Family Elaeagnaceae) is a small orange yellow-to-red–colored fruit, found on high altitudes in several Asian and European countries. SBT is referred to as “wonder plant” as seed oil is rich in Vitamins A, E, K, carotenoids, and phytosterols. SBT pulp is an excellent source of omega-7 fatty acids, while seed oil has high content of omega-3, 6, and 9 fatty acids. There are limited studies to evaluate its effects on periodontal pathogens.
Objectives: (i) To evaluate the effect of SBT on clinical parameters (plaque index, gingival bleeding index, pocket depth, and clinical attachment level) in periodontitis patients. (ii) To evaluate the effect of SBT on microbiological parameters, i.e., anaerobic culture for Aggregatibacter actinomycetemcomitans (Aa) levels before and after nonsurgical therapy in chronic periodontitis patients. (iii) To compare the efficacy of SBT as an adjunct to nonsurgical therapy and nonsurgical therapy alone on Aa.
Materials and Methods: A total of 24 patients were randomly allocated to control group (12 patients) that underwent scaling and root planing (SRP alone) and test group (12 patients) that underwent SRP along with intrasulcular SBT thixotropic solution delivery as local drug delivery (SRP + SBT). Clinical and microbial parameters are assessed at baseline and after 1 month.
Results: The treatment modality used showed statistically significant improvement in both clinical and microbial parameters in test group compared to the control group.
Conclusion: SBT was an effective adjunct in improving the clinical and microbial parameters compared to SRP alone in periodontitis patients.
Keywords: Aggregatibacter actinomycetemcomitans, anaerobic culture, nonsurgical therapy, sea buckthorn, thixotropic solution
|How to cite this article:|
Santosh S, Babitha G A, Holla K S, Prakash S, Suresh K, Bhat G K. Sea buckthorn against periodontitis: A clinical and microbiological study. Int J Oral Health Sci 2022;12:73-8
|How to cite this URL:|
Santosh S, Babitha G A, Holla K S, Prakash S, Suresh K, Bhat G K. Sea buckthorn against periodontitis: A clinical and microbiological study. Int J Oral Health Sci [serial online] 2022 [cited 2023 Feb 1];12:73-8. Available from: https://www.ijohsjournal.org/text.asp?2022/12/2/73/364220
| Introduction|| |
“Nature itself is the best physician”
People have held to the notion that spending time with nature is healing and restorative. In the past few decades, scientists and researchers have really begun to understand the complex relationships between the natural environment and our health, providing additional support for the need to protect nature and the planet.
Archeological evidence indicates that the use of medicinal plant dates back to the Paleolithic age. The modern medicine has evolved to form numerous synthetic remedies for treating illnesses. However, the World Health Organization estimates that 80% of the population of some Asian and African countries currently use herbal medicine for some aspects of primary healthcare. Some prescription drugs also have a basis as herbal medicine such as artemisinin, aspirin, digitalis, and quinine.
In India, Ayurvedic medicine has quite a complex formulation using over 30 or more ingredients. The Indian book, the Vedas, have mentioned about treatment of many diseases with plants. The Tibetan Medical System called “the Amchi Medical System” prevails in the northern part of India including Ladakh and Lahaul-Spiti. The practitioners of this medical system are called Amchis (meaning “superior to all”).
Sea buckthorn (SBT) is one such wonder berry used by Amchis for treating wounds, ulcers, malnourishment, etc., since centuries. It is known to have high concentrations of Vitamins such as A, B2, and C than in other fruits and vegetables. Vitamin C content ranges from 200 to 2500 mg/100 g berries, which is higher than many other vitamin-rich fruits such as amla, orange, and kiwi. Thus, the berries are storehouses of vitamin in the region where the availability of other vitamin-rich fruits is also limited [Figure 1].
SBT and its derivative products, for instance, juice and oils, have been shown to possess a wide range of beneficial effects that include promoting regeneration of skin and mucous membrane, improving immune functions, reducing oxidation, and strengthening cardiovascular health. It was also found to have antibacterial activity against Pseudomonas aeruginosa, Escherichia More Details coli, Klebsiella pneumoniae, Staphylococcus aureus, Bacillus subtilis, and Streptococcus pneumoniae. This antibacterial effect may be due to its multiple lipophilic bioactive compounds such as fatty acids found in its oil and fruits.
Periodontitis is a chronic inflammatory disease that is caused mainly due to several microorganisms. Porphyromonas gingivalis, Fusobacterium nucleatum, and Aggregatibacter actinomycetemcomitans (Aa) have been considered the main organisms responsible for the progression of this disease. Many synthetic drugs have been used to treat this disease. However, such synthetic drugs come with their own drawbacks because there is a need to formulate new natural drugs that have no cytotoxicity.
SBT has been widely researched for its various medicinal properties since ages. A study by Smida et al. in 2019 has tested an experimental formulation of SBT pulp oil-based mouth rinse to evaluate the antimicrobial, antibiofilm, and antioxidant activities and concluded that the antibiofilm activities against single and multiple oral bacterial species. Sharma et al. in 2016 showed slight significant improvement in probing pocket depth (PPD) using systemic SBT capsules as an adjunct to nonsurgical therapy.
The aim of this study was:
- To evaluate the effect of SBT on clinical parameters (plaque index [PI], gingival bleeding index [GBI], pocket depth, clinical attachment level [CAL]) in periodontitis patients
- To evaluate the effect of SBT on microbiological parameters, i.e., anaerobic culture for Aa levels before and after nonsurgical therapy in chronic periodontitis patients
- To compare the efficacy of SBT as an adjunct to nonsurgical therapy and nonsurgical therapy alone on Aa.
| Materials and Methods|| |
The present study was approved by the institutional ethical board, and written informed consent was obtained from all patients. The randomized control trial was conducted among patients visiting the Outpatient Department of Periodontology, College of Dental Sciences, Davangere, Karnataka.
SBT berries were obtained from Spiti Valley, Himachal Pradesh. An extract was prepared from these berries. The minimal inhibitory concentration (MIC) results showed that P. gingivalis, Tannerella forsythia, and Aa were all sensitive at 25 μg/ml of the extract. Hence, an experimental thixotropic solution of SBT berry was prepared from the same extract consisting of 25 μg/ml [Figure 2].
A total of 30 subjects were chosen based on the inclusion and exclusion criteria, out of which 15 were in the test group and 15 in the control group.
- Control group: 15 patients were treated with scaling and root planning (SRP) [Group 1]
- Test group: 15 patients were treated with SRP with intrasulcular delivery of SBT solution [Group 2].
The patients in the age group of 25–45 years should have mild-to-moderate periodontal pockets (5–7 mm) clinically with radiographic bone loss, according to the AAP 1999 classification (periodontitis stage II [maximum probing depth ≤5 mm and radiographic bone loss of 15%–33%] and periodontitis stage III [PPD ≥6 mm and radiographic bone loss extending to mid-third of root and beyond] according to the 2017 World Workshop Classification). While the patients who were excluded from the study were individuals with systemic conditions including rheumatoid arthritis, inflammatory bowel disease, allergies, etc., patients who have received any antibiotics and/or anti-inflammatory drugs for the past 1 month, individuals who have had periodontal therapy in the previous 3 months, pregnant and lactating females, and individuals who smoke and consume alcohol and if Aa could not be detected at baseline.
Primary outcome measures included:
- Clinical parameters recorded
- PI (Silness and Loe, 1964)
- GBI (Ainamo and Bay, 1975)
- CAL (International workshop, 1999).
- Microbiological parameters
For quantitative analysis of Aa using microbial culture, subgingival plaque sample was collected from the periodontal pocket.
Screening of patients was done, and 30 patients were selected. The chosen subjects were randomly allocated to control group (Group 1) and test group (Group 2). Each group contained 15 subjects.
Subgingival plaque samples were collected from all the subjects using a universal curette, followed by which the clinical parameters were recorded. Collected subgingival plaque samples were subjected to anaerobic culture to find the number of colonies of Aa. Subjects that showed no growth of Aa were excluded from the study.
All the subjects from both the groups then underwent ultrasonic SRP, after which Group 2 (test group) underwent placement of the thixotropic solution of SBT berry in the region of the deepest pocket [Figure 3]a following which periodontal pack was placed [Figure 3]b. Every patient (Group 1 and Group 2) was given oral hygiene instructions. The subjects in Group 2 were recalled after 1 week for pack removal.
|Figure 3: (a) Local drug delivery of sea buckthorn thixotropic solution, (b) periodontal pack placement|
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Every patient was followed up at 1 month from baseline, and the subgingival plaque samples were collected again and clinical parameters were recorded.
All the subgingival plaque samples were carefully collected from the base of the pocket using a sterile curette. These samples were immediately transferred to transport media (reduced transport fluid [RTF). These samples in the transport media were first vortexed and then diluted in RTF 1:10 proportion and inoculated in the blood agar with hemin and Vitamin K (enriched medium) and tryptic soya agar with vancomycin and bacitracin (TSBV) (selective medium) [Figure 4]. Following which it was incubated in CO2 jar for 48-72°C. After completion of incubation, the plates were removed, the colony characters of the required organism were noted, and the colony count was done for quantification.
|Figure 4: Translucent colony of Aggregatibacter actinomycetemcomitans in TSBV agar medium|
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Statistical Software Package SPSS version 22 (IBM SPSS Statistics for Windows, Version 22.0, IBM Corp., released in 2013, Armonk, New York, USA) was used. Inter- and intra-group comparison between the two groups was done using paired and unpaired “t”-test. The level of significance (P value) was set at P < 0.05.
| Results|| |
A total of 30 patients in the age group of 25–45 years were selected initially, out of which 15 were in the control group and 15 in the test group. Six patients were removed from the study as there was no growth of Aa at baseline sample of subgingival plaque. Hence, a total of 24 patients were taken for the study. 12 subjects were allocated randomly in each group.
[Table 1] shows the intragroup comparison of microbial parameters, i.e., the colony forming units (CFUs) of Aa; there was a significant decrease in the CFU in both the groups during follow-up. However, the test group shows statistically significant reduction compared to the control group [Table 1] and [Graph 1].
|Table 1: Comparison of colony forming units count for Aggregatibacter actinomycetemcomitans in Group 1 and Group 2 from baseline to 1 month|
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There is statistically significant improvement in all the clinical parameters recorded (i.e., PI, GBI, PPD, and CAL) in both the groups from baseline to 1 month (P > 0.05). However, the improvement in PI and GBI was similar in both the groups [Table 2], [Table 3] and [Graph 2], [Graph 3]. However, PPD and CAL improvement was statistically more significant in Group 2 than in Group 1 (P < 0.05) [Graph 4] and [Graph 5].
|Table 2: Comparison of clinical parameters in Group 1 at baseline and 1 month|
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|Table 3: Comparison of clinical parameters in Group 2 at baseline and 1 month|
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| Discussion|| |
Local drug delivery (LDD) has been used successfully and studied extensively in the field of periodontics to treat periodontal disease as it has various advantages over systemic drug delivery. One of the advantages is that it does not require a high dose to reach the therapeutic level in the local site (gingival crevice), which intern reduces the toxic effects of the drug.
Synthetic drugs have various side effects or adverse effects of their own. A significant number of people die due to these toxicities every year due to these supposedly “safe” over-the-counter drugs. Death due to herbal formulations is considerably rare and hard to find. Several herbal formulations in the form of LDD have been highlighted lately in the treatment of periodontal diseases as well.
SBT (Hippophae rhamnoides L.) Elaeagnaceae, a unique and valuable plant, has recently gained worldwide attention, mainly for its medicinal and nutritional potential. SBT is a thorny nitrogen-fixing deciduous shrub of cold arid region. All parts of this plant are considered to be a good source of large number of bioactive substances such as vitamins (A, C, E, K, riboflavin, and folic acid), carotenoids (α, β, δ-carotene, lycopene), phytosterols (ergosterol, stigmasterol, lansterol, and amyrins), organic acids (malic acid, oxalic acid), polyunsaturated fatty acids, and some essential amino acids.
There have been numerous studies on the health benefits of SBT. Its antioxidant effect was studied by Olas et al. in 2016; they also reviewed the role of SBT in cardiovascular diseases. Its antibacterial and antiviral effect was described by many studies.,,
Very few studies have described the use of SBT to fight oral pathogens. One such study by Sharma et al. in 2016 showed the effect of systemic administered SBT capsules as an adjunct to nonsurgical therapy in chronic periodontitis. An article by Smida et al. in 2019 studied the antimicrobial, antibiofilm, and antioxidant activities of its mouthwash form (experimentally prepared) and successfully established the antibiofilm activity against select single and multiple oral bacterial species.
Upadhyay et al. in 2010 showed the antibacterial effect of SBT leaf extract against Bacillus cereus, Pseudomonas aeruginosa, S. aureus, and Enterococcus faecalis. An in vitro study by Santosh et al. in 2021 has shown the effect of SBT pulp extract on the periodontal pathogens (P. gingivalis, T. forsythia, and Aa). However, to the best of author's knowledge, there has been no study that has clinically identified the effect of SBT on the well-known periodontal pathogens. Our study differs from the study done by Sharma et al. as we have also considered microbiological parameters and also with the use of LDD system.
On follow-up at 1 month, a marked reduction in the clinical parameters (PI, GBI, PPD, and CAL) in both the groups was observed. However, on comparing the two groups, test group showed slightly higher reduction in the clinical parameters and significantly higher reduction in the microbial parameter (CFU count of Aa); this could be attributed to the antibacterial and antioxidant activity of SBT.
Limitations of the study
- Pressure-sensitive probe can to be used for better measurement of the pockets
- Chronic toxicity study needs to be done. Since SBT is a natural product and has been used in a very minute quantity, it was not done in the study.
| Conclusion|| |
Based on the above findings, SBT can be successfully used as an adjunct to treat periodontitis patients as it improves both clinical parameters such as PPD, CAL, and reduction in microbial load of Aa, considerably better than SRP alone.
SBT has also been studied extensively for its wound-healing, anti-inflammatory, regenerative, and immunomodulatory properties and many other attributes. Hence, there is a high scope for this natural wonder to make its mark in the field of periodontics. We might even see a day where it can set a gold standard for oral hygiene maintenance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]