Australian Dental Journal 2010; 55: 65–69

SCIENTIFIC ARTICLE

doi: 10.1111/j.1834-7819.2009.01180.x

Short-term clinical effects of commercially available gel
containing Acacia arabica: a randomized controlled clinical
trial
AR Pradeep,* D Happy,* G Garg*
*Department of Periodontics, Government Dental College and Research Institute, Fort, Bangalore, Karnataka, India.

ABSTRACT
Background: Certain plants used in folk medicine serve as a source of therapeutic agent by having antimicrobial and other
multi-potential effects. This prospective, randomized, placebo and positively controlled clinical trial was designed to
evaluate the short-term clinical effects of a commercially available gel containing Acacia arabica in the reduction of plaque
and gingival inflammation in subjects with gingivitis.
Methods: Ninety subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into three
groups: Group I – placebo gel, Group II – gumtone gel and Group III – 1% chlorhexidine gel. Clinical evaluation was
undertaken using the gingival index of Loe and Silness and the plaque index at baseline, 2 weeks, 4 weeks and 6 weeks.
A subjective evaluation was undertaken by questionnaire.
Results: Gumtone gel showed significant clinical improvement in gingival and plaque index scores as compared to a placebo
gel. This improvement was comparable to 1% chlorhexidine gel. Unlike chlorhexidine gel, gumtone gel was not associated
with any discolouration of teeth or unpleasant taste.
Conclusions: Gumtone gel may be a useful herbal formulation for chemical plaque control agent and improvement in
plaque and gingival status.
Keywords: Herbal, Acacia arabica, chlorhexidine, antiplaque effect, clinical trial.
Abbreviations and acronyms: ANCOVA = analysis of covariance; ANOVA = analysis of variance; CHX = chlorhexidine.
(Accepted for publication 27 May 2009.)

INTRODUCTION
Bacterial plaque is the primary aetiological agent in
periodontal diseases.1,2 Experimental gingivitis studies
have proved the role of plaque in the aetiology of
periodontal infections and demonstrated the direct
relationship between plaque levels and the development
of human gingivitis.1,2 The accumulation of bacterial
plaque associated with gingivitis and periodontitis
indicates the basis for reducing plaque to lower the
risk of periodontal destruction. Mechanical plaque
control, like scaling and root planing, is the first
recommended step in the management of gingivitis
and periodontitis and is an indispensable phase of
periodontal therapy,3 but there are factors, such as
accessibility or presence of plaque retentive areas, that
can limit the clinical and microbiological response.
Many chemical agents have been tested as adjuncts to
ª 2010 Australian Dental Association

mechanical methods which can reduce plaque and its
associated gingivitis. Several antibacterial chemicals,
like chlorhexidine, have been used. However, sideeffects such as discolouration of teeth and unpleasant
taste can occur when these chemicals are prescribed for
an extended period.4,5 There is still a need for an
antiplaque agent that can be used on a daily basis with
minimal side-effects.
Certain plants used in folk medicine serve as a source
of therapeutic agent by having multi-potential effects in
addition to their antimicrobial activity. Herbal formulations can provide an option for safe and long-term
use.6 Gumtone gel (Charak Pharma Pvt. Ltd, India) is
one such polyherbal formulation with Acacia arabica as
its main ingredient.
Acacia arabica gum is a traditional oral hygiene
substance which has been used for centuries by many
communities in the Middle East and North Africa.7
65

Subjects were assessed for gingivitis using the gingival index (GI) (Loe and Silness)10 and for plaque. There was no significant difference between Groups I. in all three groups (Table 1). aged 25–40 years. magnesium and potassium salts of arabic acid. Government Dental College and Research Institute.8 Clark et al. subjective evaluation was also undertaken at each visit. cyanogenic glycosides. chewing gum or oral rinse during the study. has reported the antibacterial and antiprotease activities of Acacia arabica. There was a gradual decrease in the PI and GI scores by the 2 week. Each subject was randomly assigned to one of the three groups (30 subjects in each group) after informed consent was obtained: Group I – placebo gel (Charak Pharma Pvt. including dental floss. Intra-examiner calibration was performed on 20 patients before the study and the intra-examiner agreement was 95.12 in the same dental unit under identical conditions at baseline. A significant reduction in PI and GI scores was observed for Groups II and III at all time intervals. Immediately after the completion of six weeks.AR Pradeep et al. pocket probing depth £ 3 mm.34 years) who reported to the Department of Periodontics. prescription gel containing Acacia arabica in the reduction of plaque and gingival inflammation in subjects with gingivitis. the participants were asked to return their assigned gel tubes. so that the investigator could verify the amount of gel that was used. all of which have been shown individually to exhibit antimicrobial properties. with no history of periodontal therapy or previous use of antibiotics or anti-inflammatory medication within the preceding six months were included in the study. The reductions from baseline to 2 week. a complex mixture of the calcium. peroxidases and pectinases. (Tables 2 and 3). respectively. II and III with respect to PI and GI scores at baseline. Ltd. subjects received a professional prophylaxis. using the plaque index (PI) (Tureskey et al. 4 and 6 weeks as compared to baseline but not between 4 and 6 weeks. No oral hygiene instructions like brushing and flossing were given to the patients to exclude the influence of improved oral hygiene practices on the results. 42 females. oxidases. the present study was carried out as a prospective. conducted all the examinations and scorings. Group I showed a significant reduction in GI scores at all time intervals and PI scores at 2. 2 weeks. Apart from clinical evaluation. India).905). respectively.2% (j = 0. and Group III – 1% chlorhexidine (CHX) gel (Hexidine gel. no significant difference was found between Group II (gumtone gel group) and Group III (CHX gel group) for both the parameters (Tables 4 and 5). Subjects were also asked to refrain from all other unassigned forms of oral hygiene aids. who was blinded to the groups assigned to the subjects. Group II – gumtone gel (Charak Pharma Pvt. 4 week and 6 week followups in PI and GI scores were statistically tested by using Wilcoxon matched-pairs rank-sum test and students paired t-test. 90 dentate subjects (48 males. 4 week and 6 week PI and GI scores by taking baseline scores as covariates by analysis of covariance (ANCOVA). undergoing orthodontic treatment and with smoking habits were excluded. Statistical analysis All three groups were compared with variation in baseline PI and GI scores by one-way analysis of variance (ANOVA). Subjects diagnosed with chronic generalized gingivitis. clinical attachment loss = 0. The gels were dispensed to subjects by a dental assistant not involved in the study. To check for compliance. There was a significant difference with respect to reduction in PI and GI in Group I (placebo group) as compared to Group II (gumtone gel group) and Group III (CHX gel group). It consists mainly of arabica. ª 2010 Australian Dental Association . 66 The same clinician. modification of Quigley Hein Index)11. RESULTS Five subjects did not complete the study and were excluded from the analyses. All patients fulfilled the clinical criteria of the gingival index (Loe and Silness10) > 1. ICPA Health Products Ltd. No prophylaxis was undertaken prior to commencement of the study. having at least 20 natural teeth. using a questionnaire relating to the taste and flavour of the gels or any adverse effect experienced after use. India) (similar to gumtone gel without the active ingredients). 4 weeks and 6 weeks. India). Bangalore were recruited for the study conducted in January to March 2008. However. Subjects were instructed to apply a pea-sized amount of gel gently by finger or soft brush to the gums for about an hour after regular brushing and to leave it for five minutes before rinsing. haematological disorders or other systemic illness. with no evidence of radiographic bone loss. 4 week and 6 week time interval. There are also other constituents such as tannins. randomized.9 Thus. Ltd. MATERIALS AND METHODS After ethical approval was granted. The three groups were compared with respect to 2 week. mean age 30. Subjects with known allergies to the constituents of the formulation. placebo and positively controlled clinical trial designed to evaluate the short-term clinical effects of a commercially available.

6917 0.12* 0.3451 14.97 ± 0.30# 1.57* 0.46 45.99* 0.8075 135.05 ± 0.001 between Groups I and II at same time interval.20 37.8216 0.0001* 0.13* 1.37 21.04 ± 0.06 ± 0.4797 0.99 ± 0.5662 0.0000* 0.08 0.05.3268 *p < 0.51* 0. On subjective evaluation. alteration of taste or paraesthesia were not reported after use of the gumtone and placebo gels.47* 2.23 0.29# 1.73* 0.52* 0. Inter-group comparison of reduction in gingival index scores F-value P-value P-value of Wilcoxon matched paired rank sum test Groups I–II Groups I–III Groups II–III Baseline – 2 weeks Baseline – 4 weeks Baseline – 6 weeks 2 weeks – 4weeks 2 weeks – 6 weeks 4 weeks – 6 weeks 150.0000* 0.08 ± 0.28* 1.16 ± 0.94* 0.15 ± 0.0001* 0.3208 0. Intra-group comparison of reduction of gingival index scores Baseline – 2 weeks Baseline – 4 weeks Baseline – 6 weeks 2 weeks – 4 weeks 2 weeks – 6 weeks 4 weeks – 6 weeks % % % % % % Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Group I 0.24* 0.43 ± 0.0001* 0.83 ± 0.28 ± 0.75# 4.44 ± 0.38 ± 0.28* 1.49 ± 0.06 ± 0.26 5.29* 0. Table 5.9107 *p < 0.4210 60.03 ± 0.52 ± 0.37 ± 0.21 3.72 ± 0.02 ± 0.26 53.12 ± 0.21* *p < 0.0000* 0.70 ± 0.51 ± 0.06 3.72 4.0001* 0.99 ± 0.58 ± 0.54* 1.38* 0.36 29.0001* 0.61 ± 0.27 0.0001* 0. Adverse reactions like discolouration of teeth.05 4.24 ± 0. Note: No significant difference between Groups II and III at any time interval.6025 0.32 0.75* 2.7023 32.86* 0.19 0.38 2.05.55 ± 0.34 ± 0.72* 1.75# 4.26* Group III 0.23 17.90* 0.79 0.12 ± 0.94 ± 0.19 2.31 1.0001* 0.59 4.00 ± 0.0001* 0.72* 2.25 39.65* 0.9824 31.7875 0.24 15.13 ± 0.72 3.84 ± 0.1145 0.0001* 0. However.47 ± 0.57* 0.49* 0.66 ± 0.49* Group III 0.0001* 0.5942 143.0419* 78.36 22.12 24.92 ± 0.83* 0.35 ± 0.97* 0.82 ± 0.72 ± 0. Table 4.16 20.60 ± 0.0001* 0.12 ± 0.0001* 0.65 2.26 17.25 0.12 0. # p < 0.07 8.41 35.06 1. Table 2.0000* 0.0000* 0.40 ± 0.0000* 0.02 ± 0.21* 1.24 ± 0.Antiplaque effect of Acacia arabica Table 1.0001* 0.02 ± 0.41* Group II 0.8340 0.14* 0. Table 3.92* 1.24# *p < 0.0001* 0.6239 60.26 0.17* 0. Intra-group comparison of reduction of plaque scores Baseline – 2 weeks Baseline – 4 weeks Baseline – 6 weeks 2 weeks – 4 weeks 2 weeks – 6 weeks 4 weeks – 6 weeks % % % % % % Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Mean ± SD reduction Group I 0.40 Group II 0. Several studies have shown that CHX gel is significantly 67 .27 ± 0.0000* 0. Plaque index and gingival index scores of all groups at different follow-ups Group Plaque scores at baseline and different follow-ups I II III Gingival index scores at baseline and different follow-ups Baseline 2 weeks 4 weeks 6 weeks Baseline 2 weeks 4 weeks 6 weeks 4.0001* 0.0001* 0.7058 140.26 15.06 6.32 1. about 44% of subjects reported an unpleasant taste and discolouration of teeth following the use of CHX gel.92* 0.0000* 0.27* *p < 0.72# 1.25 ± 0.22 0.0000* 0.0000* 0.32 1.50 45.06 ± 0. all the subjects gave positive responses regarding the taste and flavour of the gumtone and placebo gels.0000* 0.32 1.33 1.05 3.10 22. Both the gumtone gel group and the CHX gel group showed significant improvement over the placebo gel group.0001* 0.0001* 0.35* 1.85 ± 0.64 4.0325 0.8999 0.0001* 0.44 5.0000* 0.0001* 0.05.51 ± 0.73* 3.001 between Groups I and III at same time interval.12 ± 0.39 35.07 ± 0.24 ± 0.45* 0.27 ± 0.2927 0.0001* 0.64 ± 0.77 ± 0.44 ± 0.67 2. ª 2010 Australian Dental Association DISCUSSION The purpose of this investigation was to determine the effectiveness of gumtone gel in reducing plaque scores and gingival inflammation in gingivitis subjects.25* 0.6404 39. Inter-group comparison of reduction in plaque scores F-value P-value P-value of paired t-test Groups I–II Groups I–III Groups II–III Baseline – 2 weeks Baseline – 4 weeks Baseline – 6 weeks 2 weeks – 4 weeks 2 weeks – 6 weeks 4 weeks – 6 weeks 73.0001* 0.05.53 ± 0.78 ± 0.38 29.0001* 0.0001* 0.

Ochiai K. Miyata T. coumarine derivatives etc. Griffiths AA. patients frequently appear to improve merely from the effects of being placed in a clinical trial). more active than placebo. Ltd. Experimental gingivitis in man. Brecx M. Its efficacy is comparable to CHX.159:281– 285. Mimusops elengi. Apart from this. Legary K.16 However. Charak Pharma Pvt.22 Therefore. This study was partly funded by Charak Pharma Pvt. Cobb CM. Theilade E. II. Loe H. Ann Periodontol 1996. 5. the extract of which strongly inhibits growth. its unpleasant taste and discolouration of teeth limits its long-term use. Extrinsic tooth discoloration by metals and chlorhexidine. Forgay MG.1:1–13. sucrose induced adherence and glucan induced aggregation of Streptococcus mutans. staining.9 This inhibitory effect on periodontal pathogens along with the inhibition of protease production by them can be attributed to active constituents like arabica.26 Various components of Melia azadirachta are responsible for this activity. Further long-term prospective studies are needed to confirm the results achieved in this short-term study. 3. It has been found that 68 10% mouthrinse of Terminalia chebula inhibits total salivary bacterial count. In our study.25 In a six-week clinical trial. Considered as a gold standard antiplaque agent. histamine and dextran along with the inhibition of vascular permeability. All these herbal ingredients have been used for many centuries without any reported side-effects. antigingivitis and antiplaque effects of Acacia arabica. 5% extract of Melia azadirachta resulted in a significant reduction of plaque and gingivitis scores compared to the placebo. J Periodontol 2003.AR Pradeep et al. cyanoglycosides. is proved by Singh et al. Cheang M. ‘TAF’. gingivalis is recognized as a potential virulence factor.7 The discolouration of teeth after the use of CHX gel may have affected the blinding to a certain extent.27 while nimbidin and sodium nimbidinate are responsible for its anti-inflammatory activity. ACKNOWLEDGEMENTS We would like to thank Mr RR Bellary (Business Development Manager. peroxidase and pectinases present in Acacia. Experimental gingivitis in man. 2. in which oral prophylaxis was carried out prior to the experimental phase.24 Another constituent of formulation is Terminalia chebula. Loe H. Surface protein denaturation or dietary precipitation? Br Dent J 1985. flavoglycosides. an active fraction from the plant Barleria prionitis.20 The anti-inflammatory activity of Barleria prionitis. The reduction in plaque and gingivitis scores in Group I (placebo) can be attributed to the Hawthorne effect (i.7. Gazi concluded that Acacia gum has the potential to inhibit early plaque formation although the long-term effect may not be there. exhibited significant anti-inflammatory activity against different inflammagens like carrageenan. The use of natural herbal preparations in health care continues to be popular and gumtone gel may be a useful addition. Long-term effects of Meridol and chlorhexidine mouthrinses on plaque.4 Porphyromonas gingivalis and Prevotella intermedia are strongly implicated in the pathogenesis of chronic periodontitis21 and the proteolytic activity of P.17 Similar to studies by Lindhe et al. Theilade E. 4. India.8 Tannins are also found to be present in Acacia leading to its astringent and haemostatic effects. unlike other studies by Gazi et al. Ltd. and bacterial vitality. Wills-Wood NJ. Barleria prionitis. Jensen SB. CHX is used as a positive control in the present study. The positive clinical effects of gumtone gel can be attributed to its main ingredients. J Periodontal Res 1966. I. mutans and salivary glycolysis for up to three hours after rinsing. Non-surgical pocket therapy: mechanical. Macdonald LL. J Dent Res 1993. the in vitro inhibitory action of acacia gum against these organisms and their enzymes is of possible clinical significance.20 and Brecx et al.. the reduction in GI and PI scores by gumtone gel was significantly higher than the placebo gel group and similar to the CHX gel group. or a control substance. A pilot study on antiplaque effects of mastic chewing gum in the oral cavity.28 Other constituents which can add to its activity include azadirachtins.18 and Triratana et al. Moran J. Jensen SB. especially S. for his kind cooperation and support throughout the study. Tetraterpenoid mahmoddin present in Melia azadirachta is responsible for its antibacterial properties. Fukazawa M.36:177–187. Motohira H. India).74:501– 505.19 prophylaxis and scaling were not carried out prior to the experimental phase of the present clinical study. oxidases. Wright WH. Addy M. therefore it could be used for the improvement of plaque and gingival status. such as Acacia arabica. nimbolides. REFERENCES 1. another ingredient of gumtone gel. gumtone gel can be used for an extended period of time unlike CHX which causes tooth discolouration and has an unpleasant taste. 6.. J Periodontol 1965.23 All these properties may be responsible for the antimicrobial.1:443–490. ª 2010 Australian Dental Association . gingivitis. These active constituents result in almost similar antiplaque and antigingivitis efficacy of gumtone gel compared to CHX which is a gold standard antiplaque agent. in controlling plaque in different patient groups13–15 and the improvement seen in the CHX gel group was in accordance with all those previous studies.5.e. Takahashi K. A longitudinal clinical and bacteriological investigation. Nishikawa H.72:1194–1197. Terminalia chebula and Melia azadirachta.

Bani S. Petrone M. Indian edn. Kaul A. J Ethnopharmacol 1999. The effect of partial dentures and chlorhexidine gluconate gel on plaque accumulation in the absence of oral hygiene.26:195–212. Cox SW.90:99–103. 13. 11. 25. Planta Med 1981. Gazi MI. The effect of a triclosan containing dentifrice on established plaque and gingivitis. Dyrssen NG.21:533–551.20:238– 243. Udupa N. J Periodontal Res 1987. DeVizio W. ª 2010 Australian Dental Association 28. India Email: periodontics_gdc@yahoo.18:75–77. Reduced plaque formation by chloromethyl analogue of vitamin C. Clark DT. Chandan BK. J Periodontal Res 1991. Anti-arthritic and anti-inflammatory actions of nimbidin. Siddiqui S. Haffajee AD. 18. 15. Gilmore ND. Microbial mechanisms in the pathogenesis of destructive periodontal diseases: a critical assessment. J Clin Periodontol 1991. 17. 12. 1983:94. Trimen H. 16. The finding of antiplaque features in Acacia Arabica type of chewing gum. Acharya LD. 9. Moore WEC. J Clin Periodontal 1993. naheendin. Brady L. Karkera SG. Hellstrom P.in 69 . J Am Dent Assoc 2002. Jones C. 41:41–43. Basu BD.4:41–47. Principles and pitfalls of clinical trials design. and a new protolimonoid. Periodontal diseases in pregnancy. Ramberg P. 2nd edn. I. Comparative cleansing efficiency of manual and power brushing. Tyler V.69: 105–108. 19. Silness J. 26. Siddiqui BS. Jeffcoat MK. Turesky S. Addy M. Ghiasuddin. Volpe AR. J Periodontol 1970. Lindhe J. Constituents of Azadirachta indica: isolation and structure elucidation of a new antibacterial tetranonriterpenoid. J Am Dent Assoc 1962. mahmoodin. 20. Lindhe J. Hein J. Prevalence and severity. Jagtap AG. Address for correspondence: AR Pradeep Professor and Head Department of Periodontics Government Dental College and Research Institute Fort. J Clin Periodontol 1993. 1984:919–935. Anti-inflammatory activity of ‘TAF’ an active fraction from the plant Barleria prionitis Linn. Indian medicinal plants. Philadelphia: Lea & Febiger. 22. Chlorhexidine: is it still the gold standard? Periodontol 2000 1997. J Clin Periodontol 1977. 14. 27. J Nat Prod 1992. J Clin Periodontol 2004. The effect of a chlorhexidine regimen on de novo plaque formation.85:187–193. Acta Odontol Scand 1963. 24.43:59–63. Potential of the aqueous extract of Terminalia chebula as an anticaries agent. 23. Gupta DK. Kirtikar KR.15:55–62. Triratana T. Pai MR. Tinsley GF. A clinical study of the anti-plaque capacity of chlorhexidine gel. Socransky SS. Glickman I. J Ethnopharmacol 2004.Antiplaque effect of Acacia arabica 7.65:26–29. 7th edn.133:219–225.31:609–614. Clinical effect of a new liquid dentifrice containing triclosan ⁄ copolymer on existing plaque and gingivitis. 1977:64–68. Eley BM. 10. Gazi MI. Pharmacognosy. J Ethnopharmacol 2003.22:335–341. Bentley R. Sekino S. Robbers J. 8.62:1045–1051. Rosling B. Volpe AR. Microbiology of periodontal disease. London: J & A Churchill. Vol 2. Uzel NG. Socransky S. 21.20:327–334. Socransky SS. Bergstrom J. Bangalore-560002 Karnataka. Rustogi KN. Faizi S. Giniger M. Santhakumari G. J Periodontol 1992. Singh B. The effects of Acacia arabica gum on the in vitro growth and protease activities of periodontopathic bacteria. Allahabad: Lalit Mohan Basu. Quigley G. Bates JE.68:299–306. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel–a 6-week clinical study. Medicinal plants. Loe H. Vol 2. Swed Dent J 1976.co.55:303–310. Pillai NR.

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