[Downloaded free from http://www.jiaphd.org on Wednesday, April 21, 2021, IP: 103.124.147.

45]

ORIGINAL ARTICLE

Effectiveness of herbal and nonherbal fluoridated toothpaste on

plaque and gingivitis: A randomized controlled trial
Roopali Gupta, Navin Anand Ingle, Navpreet Kaur, Pramod Yadav, Ekta Ingle1, Zohara Charania2
Departments of Public Health Dentistry, K. D. Dental College and Hospital, Mathura, Uttar Pradesh, 2Guardian Dental College,
Amarnath, Mumbai, 1Department of Oral Medicine and Radiology, Vasantdada Patil Dental College, Sangli, Maharashtra, India

Address for correspondence:

Dr. Roopali Gupta, Department of Public Health Dentistry, K. D. Dental College and Hospital, Mathura, Uttar Pradesh, India. E‑mail: lovelyrupal88@gmail.com

ABSTRACT:
Introduction: Dental plaque is a well‑known etiologic factor for gingivitis. Ayurvedic drugs have been used since ancient times
to treat diseases including periodontal diseases. Toothpastes made from herbal medicines are used in periodontal therapy to
control bleeding and reduce inflammation. Aim: To compare the effectiveness of herbal and nonherbal fluoridated toothpaste on
plaque and gingivitis among residents of ladies hostel in Mathura City. Materials and Methods: A randomized controlled clinical
trial was carried out on 60 participants aged 18–30 years residing in a ladies hostel of Mathura City. The 60 participants were
randomly allocated into two groups: Group‑I: Experimental group using herbal toothpaste, Group‑II: Control group using fluoridated
toothpaste. The subjects were asked to brush twice daily with the assigned dentifrice using standardized brushing technique
for 46 days. The plaque and gingival indices were recorded according to Silness and Loe (1964) and Loe and Silness (1963),
respectively. These parameters were assessed at baseline, 3 weeks, and 6 weeks. Data were analyzed by Student paired t‑test
and unpaired t‑test using Statistical Package for the Social Sciences version 21 manufactured by IBM Corporation – Armonk,
New York, US. Results: Baseline plaque and gingival scores were found 1.02 ± 0.02 and 0.88 ± 0.06 for the experimental group
and 1.02 ± 0.03 and 0.81 ± 0.08 for control group, respectively. After 6 weeks plaque and gingival scores were found 0.77 ± 0.07
and 0.72 ± 0.08 for experimental group and 0.78 ± 0.07 and 0.73 ± 0.11 for control group, respectively. Statistically significant
differences were obtained before and after intervention in both groups (P ≤ 0.05). Conclusion: The herbal toothpaste was as
effective as the conventionally formulated fluoride dentifrice in controlling plaque and gingivitis.
Key words:
Dental plaque, dentifrice, fluoride, gingivitis, herbal toothpaste

INTRODUCTION theory created a boom in the toothpaste industries, with

Dental caries and periodontal diseases, the two arch
criminals of the oral cavity, are essentially caused by
the microorganisms present in the dental plaque.[1] The
use of toothpaste has ancient roots. Ancient Greeks,
Egyptians, and Roman civilization were known to develop
their own tooth “powder” containing pumice, talcum,
coral powder.[2] W.D. Miller ushered a new era in the
science of preventive dentistry in 1890 when he described
his chemicoparasitic theory of tooth decay. This new
Access this article online
Quick Response Code:
Website:
www.iaphd.org
each manufacturer adding special agent/agents. The
more modern aspect of dentifrice came after the second
world war and with greater understanding about the
pathogenesis of periodontal disease.[2]
Dental plaque is mainly composed of bacterial
aggregations and pellicle. It is well‑known that the
microorganisms in plaque produce numerous enzymes,
toxins, and lipopolysaccharides. These are known to
This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as the
author is credited and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Gupta R, Ingle NA, Kaur N, Yadav P, Ingle E,
DOI: Charania Z. Effectiveness of herbal and nonherbal fluoridated toothpaste on
10.4103/2319-5932.165207 plaque and gingivitis: A randomized controlled trial. J Indian Assoc Public
Health Dent 2015;13:218-21.

© 2015 Journal of Indian Association of Public Health Dentistry | Published by Wolters Kluwer - Medknow 218
[Downloaded free from http://www.jiaphd.org on Wednesday, April 21, 2021, IP: 103.124.147.45]
Gupta, et al.: Effectiveness of herbal and nonherbal fluoridated toothpaste on plaque and gingivitis
cause substantial changes in the periodontal tissues.[2]
There is ample evidence to implicate dental plaque as
the primary etiological agent responsible for periodontal
disease and caries. [3] Various studies conducted
throughout the world have proven that the incidence
and prevalence of periodontal disease are high and
dental plaque is virtually associated to it.[4] Clinical
studies related to the removal of plaque and remission
of gingivitis had been accepted as support for a definite
relationship between plaque and gingivitis and for the
belief that a significant factor in the maintenance of
gingival health.[5]
More recently it has been found that the chemical
antimicrobials and metal ions have their own gross
limitations. Thus, it may be seen that the alternative
approach are undoubtedly very much essential for the
control and understanding the nature of inhibition of
the plaque.[6] The studies conducted for evaluating the
efficacy of the herbal dentifrices in plaque control and
gingivitis prevention, and their comparison with other
conventional dentifrices are few in number. Hence, the
aim of this study was to compare the efficacy of an herbal
dentifrice with a fluoridated dentifrice in plaque control
and gingivitis prevention.
Objectives
• To record plaque and gingivitis scores of the study
participant at baseline, 3 weeks, and 6 weeks among
18–30‑year‑old women in ladies hostel in Mathura
City
• To compare the efficacy of herbal and fluoridated
toothpastes in controlling plaque and gingivitis.
MATERIALS AND METHODS
A double‑blind, randomized controlled clinical trial was
carried out on 60 participants aged 18–30 years residing
in a ladies hostel of Mathura city. The pilot study was
conducted among 10 participants to test the applicability
and feasibility of the protocol. Based on the results of the
pilot study, some minor modifications were made in the
protocol and used in the main study. Ethical approval
was taken from the Institutional Review Board and also
necessary permissions were taken from the head of the
institution. Informed consent was obtained from all the
study participants. The participants and the outcome
assessor were blinded as to the actual toothpaste received
by the participants.
The inclusion criteria includes willing participants with
good general health, a regular user of toothbrush and
toothpaste, baseline plaque score should be >1–1.9.
The exclusion criteria includes participants undergone
any recent antibiotic therapy, history of early onset
periodontitis, acute necrotizing ulcerative gingivitis,
gross oral pathology, treatment for cancer, participants
219
who wore orthodontic appliances, fixed or removable
prosthetic appliances.
A total of 85 hostlers were present at the time of study
but based on inclusion and exclusion criteria only 60
participants were eligible to participate and then they
were randomly allocated into two different groups that
is, control group (fluoridated dentifrice [n = 30]) and
experimental group (herbal dentifrice [n = 30]) by a toss
of a coin method. The random allocation sequence was
generated and concealed from the main investigator. The
investigator and the study participants were unaware of
allocated groups of both toothpaste.
Participants in control group received a Close‑up Anticavity
toothpaste in which each tube contains 100 g (water,
sorbitol, calcium carbonate, hydrated silica, sodium
lauryl sulfate, trisodium phosphate, benzyl alcohol,
sodium monofluorophosphate, cellulose gum, PEG‑32)
and participants in experimental group received a
Himalaya Dental Cream and each tube contains
100 g (Punica granatum ‑ 2.57 mg, Zanthoxylum
alatum ‑ 1–0.8 mg, Acacia Arabica ‑ 1.71 mg, Embelia
ribes ‑ 1.71 mg, Vitex negundo ‑ 1.14 mg, Vaikranta
bhasma ‑ 2 mg, Azadirachta indica ‑ 1.44 mg, Carum
Copticum ‑ 1 mg, Pilu, Irimeda, Saccharine sodium).
Study was conducted between 4 pm and 6 pm in girls’
hostel. The questionnaire consisted of Part I about the
participant’s demographic profile. Part II comprised
questions assessing participant’s oral hygiene practices.
Part III aimed at evaluating the food habits and sweets
intake of the participants. Part IV included clinical
examination for assessing plaque and gingivitis by using
indices according to  Silness and Löe (1964)[7] and Loe
and Silness (1963), respectively. These parameters were
assessed at baseline, 3 weeks, and 6 weeks.
The subjects were asked to brush twice daily with the
assigned dentifrice using a standardized brushing
technique with a soft bristled adult toothbrush for 46
days. The dentifrices were distributed to the subjects.
They were also told to refrain from other toothpastes
except the directed ones. They were also given an
additional toothpaste if in case their first toothpaste get
over. At the end of the study, all the subjects were given
a thorough, and complete oral prophylaxis including the
removal of supragingival and subgingival plaque and
calculus deposits and then the teeth were polished. The
subjects were educated to use the same toothpaste and
technique for brushing provided to them for 46 days.
They were educated and reinforced regarding this on a
regular basis by the examiner who visited to the hostel
every 3rd day for the education purpose and to confirm
whether instructions were followed.
The data obtained from the study were compiled,
tabulated, and subjected to statistical analysis. Data
Journal of Indian Association of Public Health Dentistry
Vol. 13, Issue 3, | July-September 2015
[Downloaded free from http://www.jiaphd.org on Wednesday, April 21, 2021, IP: 103.124.147.45]
Gupta, et al.: Effectiveness of herbal and nonherbal fluoridated toothpaste on plaque and gingivitis
obtained were analyzed using Statistical Package
for the Social Sciences version 21 manufactured by
IBM Corporation –Armonk, New York, US. Student
paired t‑test and unpaired t‑test was applied to assess
between‑group differences. A P ≤ 0.05 had been
considered as statistically significant.
RESULTS
A total of 60 participants were taken 30 in each group on
whom the final statistical analysis was done. Age range
for the control group and experimental group were 22.8
and 22.6, respectively. Frequency of brushing: Once daily
in the experimental group was 18 (60%) and control group
it was 15 (50%). Frequency of brushing: Twice daily in
the experimental group was 7 (23.3%) and in the control
group it was 8 (26.7%). Use of oral hygiene aids was 12
(40%) in the experimental group and 17 (56.7%) in the
control group. Frequency of changing of the toothbrush
was 4–6 months in experimental group 11 (36.7%) and in
the control group it was 10 (33.3%). Use of mouth rinse
after eating in the experimental group was 8 (26.7%) and
in the control group it was 5 (16.8%) [Table 1].
Mean plaque scores for the control group were
1.02 ± 0.03, 0.8 ± 0.09, and 0.7 ± 0.07 at baseline,
3 weeks, and 6 weeks, respectively. Mean gingival scores
for the control group were 0.8 ± 0.08, 0.7 ± 0.11, and
0.7 ± 0.11 at baseline, 3 weeks, and 6 weeks, respectively.
Mean plaque scores for the experimental group were
1.02 ± 0.02, 0.8 ± 0.09, and 0.7 ± 0.07 at baseline, 3
weeks, and 6 weeks, respectively. Mean gingival scores
for the experimental group were 0.8 ± 0.06, 0.7 ± 0.11,
Table 1: Distribution of participants according to their
oral hygiene practices
Experimental
group
Total number of participants 30
Mean age (range 18-27 years) 22.6
Frequency of brushing: Once daily 18
Frequency of brushing: Twice daily 7 8
Frequency of changing of 11
toothbrush: 4-6 months
Other oral hygiene aids used 12
Rinsing habit 8 5
Table 2: Mean plaque and gingival scores at different time intervals
Variables Time interval
Mean plaque score Baseline
3 weeks
6 weeks
Mean gingival score Baseline
3 weeks
6 weeks
Journal of Indian Association of Public Health Dentistry
Vol. 13, Issue 3, | July-September 2015
and 0.7 ± 0.08 at baseline, 3 weeks, and 6 weeks,
respectively. An unpaired t‑test was applied; there was
no statistically significant difference found among the
groups [Table 2].
When a paired t‑test was applied within the groups,
differences between mean plaque scores at baseline
versus 3 weeks and baseline versus 6 weeks were
found to be statistically highly significant (P ≤ 0.001)
in control group and mean plaque score at baseline
versus 3 weeks and baseline versus 6 weeks were
found to be statistically highly significant (P ≤ 0.001) in
experimental group. Gingival score in the experimental
group at baseline versus 6 weeks were found to be
statistically highly significant (P ≤ 0.001). Except the
gingival scores at baseline versus 3 weeks and baseline
versus 6 weeks in control group and gingival scores in
baseline versus 3 weeks in experimental group were
found to be statistically significant (P ≤ 0.05) [Figure 1].
DISCUSSION
Maintenance of good oral hygiene is the key to prevent
dental diseases. The activities of the oral microflora are
the cause for most oral disease and mouth odor. The
addition of antibacterial agents in the production of
toothpaste aids in keeping these oral organisms to a level
consistent with oral health.[8]
In the present study, the plaque scores at baseline
for control group were 1.02 ± 0.03, 0.8 ± 0.09,
and 0.7 ± 0.07 at baseline, 3 weeks, and 6 weeks,
respectively, and plaque scores for the experimental
group were 1.02 ± 0.02, 0.8 ± 0.09, and 0.7 ± 0.07 at
baseline, 3 weeks, and 6 weeks, respectively. Gingival
scores for control group were 0.8 ± 0.08, 0.7 ± 0.11,
and 0.7 ± 0.11 at baseline, 3 weeks, and 6 weeks,
Control respectively, and gingival scores for experimental
group group were 0.8 ± 0.06, 0.7 ± 0.11, and 0.7 ± 0.08 at
30 baseline, 3 weeks, and 6 weeks, respectively, which is
22.8 in accordance with the standard protocol to examine
15 plaque and gingival scores. When an intergroup
plaque and gingival score comparison was done, no
10 statistically significant difference found. Similar results
were obtained in studies conducted by Ozaki et al.,[9]
17
Pannuti et al.,[10] Shama Rao et al.[11] In contrast to this
study, significant differences in gingival and plaque
Experimental group Control group Significance (two-tailed)
1.02±0.02 1.02±0.03 0.52
0.8±0.09 0.8±0.09 0.30
0.7±0.07 0.7±0.07 0.59
0.8±0.06 0.8±0.08 0.34
0.7±0.11 0.7±0.11 0.26
0.7±0.08 0.7±0.11 0.53
220
[Downloaded free from http://www.jiaphd.org on Wednesday, April 21, 2021, IP: 103.124.147.45]

Gupta, et al.: Effectiveness of herbal and nonherbal fluoridated toothpaste on plaque and gingivitis

plaque scores of experimental and control gingival scores of experimental and control
0.6 group at different intervals group at different intervals
0.2
0.5 0.11
0.24 0.18

Mean differences
0.16

Mean differences
0.4 0.21
0.14
0.3 0.12 0.05
0.1
0.24
0.2 0.08 0.07
0.19 0.06
0.06
0.1 Experimental 0.04 Experimental
0.02
Control Control
0 0
Plaque scores, baseline Plaque scores, baseline Gingival scores, baseline vs 3 Gingival scores, baseline vs 6
vs 3 weeks vs 6 weeks weeks weeks

Figure 1: Comparison of gingival and plaque scores of groups at different intervals

indices were obtained for the experimental group and Financial support and sponsorship
not for the control group in a study conducted by Nil.
George et al.[12]
Conflicts of interest
In this study, when intragroup comparison was done
There are no conflicts of interest.
within the groups, differences between mean plaque and
gingival scores at baseline, 3 weeks, and 6 weeks were
found to be statistically highly significant (P ≤ 0.001) in REFERENCES
both experimental and control groups. Similar results
were obtained in the studies conducted by Ozaki et al.[9] 1. Sweta RG, Rahul AG. Comparison of effectiveness of two herbal
mouthrinses on plaque and gingival scores among 12‑15 years old
and Shama Rao et al.,[11] George et al.[12] It is evident in
school children in Belgaum City: A randomized controlled field trial.
the present study that the plaque and gingival scores at
Pat Off J 2014;33:29.
3 and 6 weeks were reduced when compared to baseline
2. Silje Storehagen, Nanna Ose SM. A Textbook of Dentifrices and
in both groups. This could be attributed to the fact that Mouthwashes ingredients and their use. In: Ebers Papyrus, 1st ed.,
both groups received toothpaste with active ingredients Vol 26. An Egyptian medical reference book 2003:1-49.
to reduce plaque and gingivitis. 3. Kadam A, Prasad BS, Bagadia D, Hiremath VR. Effect of Ayurvedic
herbs on control of plaque and gingivitis: A randomized controlled
As both groups received health education regarding trial. Ayu 2011;32:532‑5.
brushing techniques and toothpastes with active 4. Listgarten MA. The role of dental plaque in gingivitis and
ingredients, the possibility of the Hawthorne effect due periodontitis. J Clin Periodontol 1988;15:485‑7.
5. Pradeep AR, Garima G, Swati P. Short‑term clinical effects of a herbal
to being singled out or made to feel important is very
based toothpaste: A randomized controlled clinical trial. J Int Clin
minimal if at all present it would be distributed equally
Dent Res Organ 2009;1:1‑10.
in both the groups. Females are chosen as participants 6. Mohanty, Devapratim. Comparative study of plaque and gingivitis
because being female examiner it was convenient prevention by triclosan containing dentifrices and herbal based
to perform the study and follow‑up, and also some dentifrice. Rajiv Gandhi University of Health Sciences University
hormonal influence occurs at puberty, which leads to 2006:1-2.
gingivitis. 7. Silness J, Loe H. Periodontal disease in pregnancy:II- Correlation
between oral hygiene and periodontal condition. Acta Odontol Scand
A limitation of this study is that small sample size of the 1964;22:121.
8. Nwankwo IU, Ihesiulo SC. Comparative analysis of the antibacterial
study might have influenced the study results. Hence,
potentials of some brands of toothpaste commonly used in Umuahia
further studies are recommended to include larger
Abia State. Int J Pharm Biol Sci 2014;9:50‑4.
sample size with both the gender are suggested to test
9. Ozaki F, Pannuti CM, Imbronito AV, Pessotti W, Saraiva L, de
the herbal based product as an efficacious alternative to Freitas NM, et al. Efficacy of a herbal toothpaste on patients with
conventional dentifrice formulations. established gingivitis – A randomized controlled trial. Braz Oral Res
2006;20:172‑7.
10. Pannuti CM, Joyce PM, Paula NR, Alberto M, Roberto FM, Giuseppe
CONCLUSION AR. Clinical effect of herbal dentifrice on the control of plaque and
gingivitis. A double‑blind study. Pesqui Odontol Bras 2003;17:1‑6.
Herbal dentifrice showed no significant clinical advantage
11. Shama Rao HN, Avinash S, Rimpal R, Pralhad SP, Mitra SK. A
over the conventional toothpaste with fluoride. However, randomized single blind trial to evaluate the safety and efficacy of
there was a reduction in the plaque and gingivitis index himalaya herbal dental cream. Antiseptic 2003;105:601‑2.
scores when a comparison was done from the baseline 12. George J, Hegde S, Rajesh KS, Kumar A. The efficacy of a
to 3 weeks and from 3 weeks to 6 weeks in both control herbal‑based toothpaste in the control of plaque and gingivitis: A
and test groups. clinico‑biochemical study. Indian J Dent Res 2009;20:480‑2.

221 Journal of Indian Association of Public Health Dentistry

Vol. 13, Issue 3, | July-September 2015