Comparative Evaluation of Effects of Kavala Gandusha with Rice Bran Oil and Mustard Oil on Unstimulated Salivary pH, Dental Plaque and Gingivitis - A Clinico–Biochemical Double Blind Study

Introduction

Periodontal diseases reflect interaction amongst a pathogenic bacterial biofilm that is existing on the tooth/root surface of periodontal pocket, host-derived inflammatory cells and particles from the periodontal tissue.¹ While gingivitis does not disturb the fundamental auxiliary structure of the teeth and is rescindable, if not preserved fittingly, it can progress to periodontitis.²

Countless measures have been found in literature with erratic notches of suggestion concerning plaque control methods.³ As an adjunct to the mechanical cleansing of teeth using toothbrush, chemotherapeutic agents such as mouthwashes consisting of chlorhexidine have been endorsed for inhibiting the plaque formation in the oral cavity, and these chemotherapeutic agents have definite objectionable adverse effects.^4,5

A novel, revisited traditional Indian method of plaque control called "oil pulling" is regaining popularity in scientific literature. Oil pulling is a procedure that involves swishing oil in the mouth, also known as kavala gandusha and kavala graha in Ayurvedic texts.^6,7-10 Oil pulling therapy is usually done using edible oils such as sunflower oil, sesame oil.¹¹ In this study, rice bran oil¹² and mustard oil were used. It has been testified to provide health benefits and meets the WHO standards.^11,12 Therefore the present study was steered with an aim to understand the consequence of oil pulling using rice bran oil and mustard oil on dental plaque, salivary pH, and gingivitis. Oral microflora is complex with heterogeneous microbial colonies of hundreds of diverse bacterial, viral and fungal species.¹³ Over 700 species of bacteria prevail in the oral cavity, colonizing over hard surfaces of the teeth and the soft tissues of oral mucosa.^14,15 The number and type of these microbes vary with age, diet and personal hygiene of an individual.^16,17

Materials and Methods

Study design

The patients were enlisted from the out-patient Department of Periodontics and Oral Implantology, Hazaribag College of Dental Sciences and Hospital, Demotand, Hazaribag, Jharkhand, India. Each participant included in the study signed a consent form prior to partaking and study protocol was permitted by the Institutional Ethical Committee. It was a clinico-biochemical, double blinded, randomized controlled clinical trial. A total number of 60 subjects with gingivitis were enrolled in the study and were randomly divided into two groups.¹⁵

GROUP 1: Mustard oil group [n=30]

GROUP 2: Rice bran oil group [n=30]

Procedure

The study period was six months and duration of the study was 21 days. Estimation of salivary pH, dental plaque, and gingivitis was done at baseline 0, after 7, 14, and 21 days. After recording baseline data, patients underwent thorough scaling and root planing. Patients were randomly allocated to Group 1 and Group 2 and were given bottles of mustard oil and rice bran oil, respectively. Patients were asked to swish the given 10 mL (two tea spoons) solution every day in the morning and night after dinner for about three to four minutes. During this study period, patients were asked to clean their teeth using only the tooth brush without any tooth paste with modified Bass technique. The patients were counseled to follow vegetarian diet and were forbidden from using any other oral rinses, except plain water which was permitted for rinsing the mouth.

Microbiological analysis

The supragingival plaque samples were collected from the tooth surface with the help of sterile cotton pellet or tooth pick. The samples were transferred to Thioglycollate broth transport media (2 mL) and were sent to the laboratory on the same day of gathering.

Inclusion criteria

1. Patients in the age group of 20 - 50 years.

2. Patients with good systemic health.

3. Patients with mild to moderate gingivitis and plaque accumulation.

4. Patients who had not received periodontal therapy in the past six months.

5. Patients who had not received antibiotic therapy in the past six months.

6. Patients with at least 20 natural teeth present.

7. Patients willing to refrain from any other dental treatment during the course of study.

8. Patients with no abusive habits.

Exclusion criteria

1. Patients with systemic diseases.

2. Pregnancy or lactating women.

3. Systemic bacterial, viral, or fungal infections.

4. History of periodontal treatment in the past six months.

5. Patients allergic to oil used for study

6. Patients following any other chemical method of mouth rinsing.

7. Patients undergoing any orthodontic treatment or using any prosthesis.

Statistical analysis

The data was tabulated in Microsoft Excel software and analyzed with SPSS V.24 software. Paired t test and Independent t test was used for the comparisons between the groups. p value ≤0.05 was considered as statistically significant.

Results

The comparison of microbial colonies (CFU/mL x 10³) of S. mutans at different time intervals between the groups demonstrated the baseline values to be nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the colonies of S. mutans was found to be greater in Group 2 in comparison with Group 1 showing that rice bran oil was more effective in reducing the colonies of S. mutans than mustard oil. The difference in the colonies of S. mutans between the groups after 14 days and 21 days was statistically significant (p <0.05) (Figure 1).

The comparison of microbial colonies (CFU/mL x 10³) of S. mitis at different time intervals between the groups showed that the baseline values were nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the colonies of S. mitis was found to be greater in Group 2 in comparison to Group 1 indicating that rice bran oil was more effective in reducing the colonies of S. mitis compared to mustard oil. The difference in the colony counts of S. mitis between the groups after 21 days was statistically significant (p <0.05) (Figure 2).

The comparison of microbial colonies (CFU/mL x 10³) of S. sanguis at different time intervals between the groups showed that the baseline values were nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the colonies of S. sanguis was found to be greater in Group 2 compared to Group 1 showing that rice bran oil was more effective in reducing the colonies of S. sanguis than mustard oil. The difference in the colony counts of S. sanguis between the groups after 21 days was statistically significant (p <0.05) (Figure 3).

The comparison of microbial colonies (CFU/mL x 10³) of S. salivarius at different time intervals between the groups demonstrated the baseline values to be nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the colonies of S. salivarius was found to be greater in Group 2 in comparison to Group 1 showing that rice bran oil was more effective in reducing the colonies of S. salivarius compared to mustard oil. The difference in the colony counts of S. salivarius between the groups after 14 days and 21 days was statistically significant (p <0.05) (Figure 4). 

The comparison of plaque index scores at different time intervals between the groups showed that the baseline values were nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the plaque index scores was found to be greater in Group 2 in comparison to Group 1 indicating the effectiveness of rice bran oil in reducing the plaque index scores compared to mustard oil. The difference in the plaque index scores between the groups after 14 days and 21 days was statistically significant (p <0.05) (Figure 5).

The comparison of modified gingival index scores at different time intervals between the groups showed that the baseline values were nearly same in both the groups and the values decreased after 7 days, 14 days and 21 days. The reduction in the modified gingival index scores was found to be greater in Group 2 in comparison to Group 1 showing that rice bran oil was more effective in reducing the modified gingival index scores than mustard oil. The difference in the modified gingival index scores between the groups after 21 days was statistically significant (p <0.05) (Figure 6).

The comparison of pH at different time intervals between the groups showed that the baseline values were nearly same in both the groups and the values increased after 7 days, 14 days and 21 days. The increase in the pH scores was found to be nearly equal in the groups showing that rice bran oil is as effective in increasing pH as mustard oil (Figure 7).

Discussion Oil pulling is an outmoded Indian folk method of plaque control which encompasses whooshing oil in the mouth for oral and systemic health benefits. Oryzanol and Vitamin E found in these oils were found to be compelling antioxidants which have constructive role in immunity.^7-12 It is designated in almost all diseases of oral cavity including stomatitis, glossitis, apthous ulcers, dental caries, periodontitis, gingivitis, and hyperemia of gingiva.¹⁸ The microbial colony count in the present study was estimated by assessing aerobic and anaerobic bacteria of the oral cavity. Among the aerobic bacteria, Streptococcus mitis, Streptococcus sanguis and Streptococcus salivarius were studied for colony count and among the anaerobic bacteria, Streptococcus mutans was studied for colony count. The initial colony count of S. mitis was 462.9±42.1x103 CFU/mL and after treatment with mustard oil, it was 455.1±40.5x103 CFU/mL at 7 days, 448.8±37.2x103 CFU/mL at 14 days and 436.2±32.8x103 CFU/mL at 21 days. Similar decline in the colony counts of S. mitis was observed when the patients were treated with rice bran oil where the initial colony count of S. mitis was 464.2±43.4x103 CFU/mL and after treatment with rice bran oil, it was 431.6±39.7x103 CFU/mL at 7 days, 426.2±30.6x103 CFU/mL at 14 days and 417.5±28.3x103 CFU/mL at 21 days. But the reduction in the colony count at each time interval was greater with rice bran oil compared to treatment with mustard oil. The initial colony count of S. sanguis was 348.2±38.2x103 CFU/mL and after treatment with mustard oil, it was 342.7±31.5x103 CFU/mL at 7 days, 337.5±30.6x103 CFU/mL at 14 days and 324.9±24.7x103 CFU/mL at 21 days. Similar decline in the colony counts of S. sanguis was seen when the patients were treated with rice bran oil where the initial colony count of S. sanguis was 350.5±39.7x103 CFU/mL and after treatment with rice bran oil, it was 339.1±28.9x103 CFU/mL at 7 days, 326.4±22.1x103 CFU/mL at 14 days and 321.5±19.4x103 CFU/mL at 21 days. But the reduction in the colony counts at each time interval was greater in treatment with rice bran oil in comparison to treatment with mustard oil.

The initial colony counts of S. salivarius was 415.6±22.4x103 CFU/mL and after treatment with mustard oil, it was 409.3±19.9x103 CFU/ mL at 7 days, 401.5±17.3x103 CFU/mL at 14 days and 396.6±14.2x103 CFU/mL at 21 days. Similar decline in the colony counts of S. salivarius was seen when the patients were treated with rice bran oil where the initial colony counts of S. salivarius was 412.1±21.8x103 CFU/mL and after treatment with rice bran oil, it was 405.7±18.2x103 CFU/mL at 7 days, 398.4±15.9x103 CFU/mL at 14 days and 382.9±13.5x103 CFU/mL at 21 days. But the reduction in the colony counts at each period was greater with rice bran oil in comparison to treatment with mustard oil. The initial colony counts of S. mutans was 581.9±53.7x103 CFU/mL and after treatment with mustard oil, it was 436.1±37.1x103 CFU/mL at 7 days, 422.7±35.2x103 CFU/mL at 14 days and 416.8±30.1x103 CFU/mL at 21 days. Similar decline in the colony counts of S. mutans was seen when the patients were treated with rice bran oil where the initial colony counts of S. mutans was 578.4±51.5x103 CFU/mL and after treatment with rice bran oil, it was 411.4±33.6x103 CFU/mL at 7 days, 407.2±29.4x103 CFU/mL at 14 days and 401.5±25.7x103 CFU/mL at 21 days. The reduction in the colony counts at all observed time intervals was greater with rice bran oil compared to treatment with mustard oil.

Similar studies have been conducted by several authors like Pavithran et al., (2017),¹⁹ Yanti et al., (2019)²⁰ Another study displayed decline in the mean number of colonies of microorganisms after 45 days of sesame oil pulling therapy.^{21, 22,23,24,25}

According to Peterson et al., (2015)²⁶ the oils with lower molecular weight (115 g/mol) have a better penetration ability in the existed biofilm. These existed biofilms are more impervious to the antimicrobial agents which was proved with chlorhexidine (20 μg/mL). Antimicrobial activity may diminish the total viable cell within the biofilm, thereby reducing the biofilm integrity (Steinberg et al., 2004).²⁷

Singla et al., (2014)²⁸ in their study observed reduction in Streptococcus mutans and Lactobacillus species count in saliva sample after ten minutes of oil gingival massage therapy with sesame oil, olive oil, and coconut oil.

Maria Ibrahim (2013)²⁹ studied the antimicrobial effect of coconut oil. The inhibitory effect of coconut oil on the growth of S. mutans, Lactobacillus fermentum and S. mitis strains was minimal compared to other solutions, both using the serial dilution and the agar well diffusion methods.^30,31

Asokan et al., (2009)³² compared the effect of oil pulling on plaque induced gingivitis and found a statistically significant difference between the pre-and post-values of the plaque index scores and the modified gingival index scores in the control group.

Conclusion

Oil pulling with both rice bran oil and mustard oil was found to be effective in the maintenance of oral health. However, rice bran oil was found to be more effective than mustard oil in reducing the oral microbial colony count, plaque and gingivitis. Oil pulling therapy promises to be an improved, preventive, economical home remedy which can be used as an adjunct to routine oral hygiene practices in both rural as well as urban areas.

Ethics approval

Institutional Ethical Board, Hazaribag College of Dental Sciences & Hospital

Consent to participate

Informed consent was taken from the patients

Consent for publication

NA

Availability of data and material Yes

Funding: Self Funding

Conflicts of interest

None