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ORIGINAL ARTICLE
Year : 2017  |  Volume : 35  |  Issue : 2  |  Page : 162-166
 

Comparative evaluation of effect of use of toothbrush with paste and munident on levels of Streptococcus mutans and gingival health in children: An in vivo study


1 Department of Pedodontics and Preventive Dentistry, A.J Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Periodontology and Implantology, A.J Institute of Dental Sciences, Mangalore, Karnataka, India
3 Department of Oral Pathology, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

Date of Web Publication10-May-2017

Correspondence Address:
Rashmi N Shetty
Department of Pedodontics and Preventive Dentistry, A.J Institute of Dental Sciences, Kuntikana, Mangalore - 575 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_265_16

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   Abstract 

Aim: Dental caries is a multifactorial disease which has a deleterious effect on the oral cavity. Improper oral hygiene habits are a cause for the same. The aim of this study was to compare the antibacterial efficacy of Munident, an Ayurvedic (herbal) dentifrice with commercially available toothpaste. Materials and Methods: A total of forty subjects between the age group 9 and 12 years, resident of Bala Yeshu Nilaya Bhavan, Mangalore, Karnataka, India, were chosen for our study. They were divided into two groups containing twenty subjects in each; Group 1 for standard toothpaste and Group 2 for Munident. The decayed, missing, and filled teeth scores were noted from each subject. Group 1 was instructed to brush the teeth using commercially available toothpaste and Group 2 was instructed to brush using commercially available Munident (herbal) dentifrice. Both the groups brushed the teeth using soft variety of tooth brush. The gingival bleeding index and salivary Streptococcus mutans count were noted pre- and post-brushimg for both groups. The results obtained were subjected to statistical analysis. Results: Munident (herbal) dentifrice showed better efficacy in comparison to toothpaste in terms of gingival bleeding index and salivary S. mutans count. Conclusion: Munident (herbal) dentifrice has better gingival bleeding index compared to standard formulation of toothpaste. Hence, the practice of using herbal dentifrice should be encouraged.


Keywords: Munident, toothbrush, toothpaste


How to cite this article:
Shetty RN, Shetty SB, Janardhanan S, Shetty S, Shetty S, Raj K. Comparative evaluation of effect of use of toothbrush with paste and munident on levels of Streptococcus mutans and gingival health in children: An in vivo study. J Indian Soc Pedod Prev Dent 2017;35:162-6

How to cite this URL:
Shetty RN, Shetty SB, Janardhanan S, Shetty S, Shetty S, Raj K. Comparative evaluation of effect of use of toothbrush with paste and munident on levels of Streptococcus mutans and gingival health in children: An in vivo study. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2019 Jul 18];35:162-6. Available from: http://www.jisppd.com/text.asp?2017/35/2/162/206037



   Introduction Top


Dental caries is one of the most common infectious microbial diseases of the world since ages. It has an increased incidence in the recent years due to varied changes in lifestyle habits. Caries is avoidable by simple inexpensive and easy to practice personal hygiene habits. Most effective is habit of using tooth brush.[1] Toothpaste is a semisolid or gel dentifrice used with a toothbrush as an accessory to clean and maintain the esthetics and health of the teeth which promotes oral hygiene.[2]

An upsurge of herbal products in various catalogs of fast-moving consumer goods is evident. Ayurvedic science is one of the great legacies of Indian antiquity. Since last two decades, the interest in alternative medical system is increasing in all over the world. Ayurvedic (herbal) products are getting attention not only from the common people of country but also from the global scientific community. Ayurveda laid a great deal of emphasis on the preservation and promotion of positive health, which is the primary objective, whereas prevention and cure of disease is only secondary.[3] Traditional medicine is the sum total of knowledge, skills, and practices based on theories, beliefs, and experiences which is indigenous to different cultures that are used to maintain health as well as to prevent, diagnose, improve or treat physical and mental illness.

In Ayurveda, dental health (danta swasthya in Sanskrit) is held to be very individualistic, varying with each person's constitution (prakriti), and climatic changes resulting from solar, lunar, and planetary influences (kala-parinama).[4]

Mechanical plaque removal is one of the most accepted methods of controlling plaque and gingivitis. However, it is expected that less than one-third of the population can effectively perform mechanical plaque removal. Several chemical preventive agents have beneficial effects in the control of plaque and to reduce or prevent oral disease. Hence, various chemical formulations were tried in dentifrices. Chemicals, mainly triclosan and chlorhexidine, have been added in mouth rinses and dentifrices to prevent plaque and gingivitis.[5]

Hence, the aim of this study was to compare the efficacy of commercially available toothpaste with munident on salivary Streptococcus mutans count and gingival bleeding index.


   Materials and Methods Top


The study was conducted after obtaining ethical clearance from the Institute (IEC/Rev/25/2015-2016). Informed consent was obtained from the guardians of the subjects. A total of forty subjects between the age group 9 and 12 years, resident of Bala Yeshu Nilaya Bhavan, Mangalore, Karnataka, India, were chosen for our study based on inclusion and exclusion criteria.

Inclusion criteria

  • Systemically healthy controls
  • Atleast, three restored/decayed and/or missing teeth (decayed, missing, and filled teeth [dmft/DMFT]).


Exclusion criteria

  • Subjects who cannot expectorate completely
  • Subjects who could not brush their teeth on their own
  • Subjects with a history of taking antibiotics 3 months before and during the study period
  • Subjects undergoing orthodontic treatment or with an intraoral prosthesis
  • Presence of any intra oral pathology
  • Medically compromised subjects.


They were divided into two groups containing twenty subjects in each; Group 1 for standard toothpaste and Group 2 for Munident. The DMFT scores were noted from each subject. Group 1 was instructed to brush with commercially available toothpaste, and Group 2 was instructed to brush using Munident (herbal) dentifrice. Both the groups brushed the teeth using soft variety of tooth brush. The gingival bleeding index and salivary S. mutans count were noted pre- and post-brushing for both groups. Each tooth was divided into four parts – disto facial papilla, midfacial papilla, mesiofacial papilla, entire lingual gingival margin, and scored according to gingival index (Loe and Silness, 1967).

Simplified oral hygiene index

Simplified oral hygiene index (OHI-S) index as described by John C Greene and Jack R Vermillion in 1964 was followed in our study.

Instruments used were mouth mirror and explorer.

Teeth selected were 16, 11, 26, 36, 31, and 46.

Surface examination

Four posterior and two anterior teeth were selected. The buccal surface of selected upper molar and lingual surface of selected lower molar and incisors were examined.

Criteria followed for classifying debris

  • Score 0: No debris or stains
  • Score 1: Soft debris covering not more than one-third of the tooth surface, or presence of extrinsic stains without other debris regardless of surface area covered
  • Score 2: Soft debris covering more than one-third, but not more than two-third of exposed tooth surface
  • Score 3: Soft debris covering more than one-third of exposed tooth surface.


Criteria followed for classifying calculus

  • Score 0: No calculus present
  • Score 1: Supragingival calculus covering not more than one-third of the exposed tooth surface
  • Score 2: Supragingival calculus covering more than one-third but not more than two-third of the exposed tooth surface or the presence of individual flecks of subgingival calculus around the cervical portion of the tooth or both
  • Score 3: Supragingival calculus covering more than two-third of the exposed tooth surface or the continuous heavy band of subgingival calculus around the cervical portion of the tooth or both.


OHI-S score for each individual was calculated by the debris and calculus scores which were totaled and divided by the number of tooth surfaced scored.

An average of each individual debris and calculus, i.e., simplified debris index (DI-S) and simplified calculus index (CI-S) was scored from range of 0 to 3.

  • Good: 0.0–0.6
  • Fair: 0.7–1.8
  • Poor: 1.9–3.0.


Sum of the DI-S and CI-S will give the OHI-S values ranging from 0 to 6.

  • Good: 0.0–1.2
  • Fair: 1.3–3.0
  • Poor: 3.1–6.0.


The subjects in the Group 1 were asked to brush daily with the toothpaste which was provided to them. The children in the Group 2 was asked to brush with Munident (herbal) product and instructed to crush the tablet and add two drops of water to make it as a paste. Both groups used soft variety of toothbrush to brush the teeth. Both groups were instructed to brush the teeth once daily for 30 days.

A baseline nonstimulated whole salivary sample (2 ml) was collected in the morning by asking the subjects to drool passively into a sterile plastic bottle for 5 min. Subjects were informed not to eat or drink (except water) 1 h before saliva collection to minimize possible contamination from food debris and stimulation of saliva that may interfere in the results of the sample. The samples were collected in sterile bottles and were stored and carried in an ice-containing box (used as transport media). All samples were tested for the number of colony forming units (CFUs) for S. mutans using mitis salivarius bacitracin agar.

Laboratory procedure

The sample was vortexed to get uniform mix of saliva and media using a Cyclo mixer. Vortexed sample was streaked in duplicate on mitis salivarius bacitracin agar selective for S. mutans using an inoculation loop (standard loop with 4 mm diameter). The mitis salivarius agar plates were incubated in aerobic conditions for 48 h at 37°C in an incubator. The plates were opened after 48 h. The counts were made from the colonies with morphologic characteristics of S. mutans (0.5 mm raised convex undulated colonies of light blue color with rough margins, granular frosted glass appearance) on the plates using a magnifying lens and were expressed as number of CFU/ml of saliva. Semiquantitation of the number of colonies was done by multiplying the actual colony count with 1 × 103 as the sample was diluted one thousand times (1:5 dilution). The baseline scores were noted both pre and post rinse [Figure 1] and [Figure 2].
Figure 1: This is the image of Streptococcus mutans on mitis salivaris agar prerinse, baseline sample

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Figure 2: This is the image of Streptococcus mutans on mitis salivaris agar postrinse using munident and toothpaste with toothbrush

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Statistical analysis

To assess the gingival bleeding index, paired t-test was used.

To assess S. mutans count, Mann–Whitney U-test was used.


   Results Top


A total of forty subjects participated in our study. At baseline, Group 1 had a mean S. mutans count of 73,800 counts/ml, and Group 2 had 75,608 counts/ml. When Mann–Whitney U-test was performed with the results, the P value was not significant. Hence, it can be inferred that the statistic difference was not significant [Table 1].
Table 1:  Streptococcus mutans Scientific Name Search nt>

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The gingival bleeding index in Group 1, prebrushing was 1.8050 using toothpaste and Group 2 using Munident (herbal) was 1.5450 with P value (0.008) showing significance [Table 2]. The gingival bleeding index postbrushing was 1.6700 for Group 1 and 1.4300 for Group 2 with P value (0.009) showing significance.
Table 2: Gingival bleeding index

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   Discussion Top


Dental caries being a multifactorial disease process requires a multimodal approach to treatment and control. In our study, both Munident and toothpaste were found to be useful in effectively reducing the S. mutans count and also gingival bleeding index score after usage for 30 days.

It is very difficult to attribute efficacy to individual ingredient of a compound preparation like Munident (herbal) even though it has when compared to standard formulation of toothpaste. Ayurvedic product claims to be having less or no side effects compared to modern medicine due to the absence of harmful chemicals.

By comparing the change score between the two groups in our study, it can be said that the difference in score of Munident group (Group 2) was slightly more than that in positive control group (Group 1), but the difference between the two groups was not statistically significant (P > 0.05), and thus superiority cannot be claimed as such.

The limitation of the study is selection of small sample size, and thus, it was not powered to show a statistically significant difference between the two groups even though both has shown efficacy in action. However, further studies are needed to ascertain the exact mechanism and role of Munident product in reducing S. mutans count and also gingival bleeding index score on larger samples to get statistically significant difference.

Constituent herbs and their medicinal uses

Composition of Munident tablet (each 500 mg contains)




   Conclusion Top


India is a country where the use of traditional medicine is accepted widely. The practice of using dentifrice-like Munident which is made of natural ingredients should be encouraged keeping the potential benefits in mind. Publicity of its use using appropriate media would benefit the general population by giving more confidence in the ancient practices, thus preventing tooth decay and loss.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[25]

 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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