A Survey on Dental Health Care and Formulation of Dental Emulgel Containing Herbal Actives for the Treatment of Dental Disease

Introduction

Worldwide, periodontal disease is acknowledged as a serious public health problem, affecting 19% of population across all ages, ethnicities, genders, and socioeconomic backgrounds. It is characterised by an accumulation of bacterial pathogens, mostly in the periodontal pockets, redness and deterioration of gums. It also affects supportive bone, periodontal ligament, and cementum. Periodontal disease is a term used to describe inflammatory conditions caused by plaque, including periodontitis and gingivitis. Natural remedies have been in use for a very long time and are well-accepted by the general public and patients. The utilization of herbal medicine in dentistry is beneficial in reducing inflammation and controlling plaque formation. According to the reports, Triphala, clove oil, and neem oil outperformed traditional dentifrices in reducing tooth plaque and gingival irritation.¹ Oral disorders have been successfully treated using traditional plants and natural remedies, according to several reports. One such product with many advantages is clove oil, which has grown significantly in relevance to clinical studies. Due to its low intrinsic toxicity and several biological benefits, such as pain-relieving, antibacterial, spasmolytic, anti-neuralgic, carminative, anti-infectious, antiseptic, stimulant, and stomachic properties, clove oil is also highly valuable in dentistry. 

When alternative medication delivery methods are ineffective or problematic for skin conditions, the topical drug delivery system is the dose form that is applied topically. Emulgel compositions are mostly utilised for topical administration. Emulgel, is a novel drug delivery system (NDDS), also known as emulsion-infused gel, which exhibits dual control release property. Emulgel is used to relieve aches and pains, such as arthritis, backache, and muscle pains.²

The emulgel is a type of formulation primarily used for topical delivery, with a dual control release property. When emulsion is incorporated into gel, it is called as emulgel, and it is the recent topical NDDS technology. Emulgel is used to treat pains and aches such as muscle ache, backache, and arthritis.

Emulgel is one example of a combination formulation that can occasionally be used in conjunction with other formulations to enhance medication delivery. It is a blend of gel and emulsion. Emulgel is prepared by mixing the gel with both water-in-oil and oil-in-water emulsions. Drugs that are hydrophilic are delivered by oil-in-water type, while lipophilic medications are delivered by water-in-oil type.³

The emulgel is a thixotropic, greaseless, readily spreadable, easily removable, emollient, which is non-staining, biocompatible, translucent in nature and is aesthetically acceptable. It also has a long shelf life and good skin penetration ability.⁴ Nevertheless, the gels' hydrophobic drug delivery has certain drawbacks. Emulgel helps to overcome this restriction. Classical emulsion can be transformed into emulgel by using a gelling agent.

The objective of the present work was to develop and evaluate dental emulgel containing herbal ingredients such as clove oil, neem oil, Triphala extract and camphor for the treatment of periodontal disease. Clove oil has a wide spectrum of antibacterial activity against a number of periodontal pathogens, and is the strongest pain relieving agent. Herbals such as neem oil has anti-bacterial, anti-inflammatory activity. Triphala extract has been used as a gargling agent in dental diseases.⁵

Camphor is a well-established folk remedy, and is commonly used for pulpitis, periodontal issues, and dental pain. Hence it is used for the treatment of periodontitis.⁶ Good dental care is crucial for maintaining overall health and well-being. Understanding the importance of dental care and the effectiveness of various dental care products is crucial for making informed choices. In the present work, an initial survey was conducted using a Google form. In this survey, we aimed to explore people's experiences with dental care and dental care products, as well as their preferences, challenges, and needs in this area. By gathering this information, we aimed to gain valuable insights into improving dental care practices and products for the benefit of people's oral health.

Materials and Methods

Materials

Tween 80, propylene glycol, methyl and propyl parabens were obtained from Loba Cheme Pvt. Ltd., while ethanol, triethanolamine, clove oil were obtained from Fine Chemical Co. Ltd. All the other chemicals, reagents and solvents used were of analytical grade.

Preparation of Triphala Aqueous Extract

Ten parts distilled water was mixed with one-part Triphala powder. After that, the mixture was heated over a water bath at 65°C for fifteen to twenty minutes, stirring occasionally. The mixture was allowed to cool until it reached room temperature. To filter the solid particles, the liquid was strained using a cheesecloth or a fine mesh strainer. After the extract was filtered, it was poured into a fresh, airtight bottle and placed in the refrigerator.

Methods

Dental Health Care Survey

This report presents the findings of a survey conducted to assess the current state of dental health care, individuals’ attitude towards it, and their dental care practices. The survey was conducted using questionnaires designed and distributed through Google forms.

Survey Design

The survey consisted of 10 questions covering various aspects of dental health care, including, frequency of dental visits, oral hygiene practices, perceptions and attitudes towards dental health, barriers to accessing dental care, requirement of herbal care products, etc.

Study population

The survey was conducted online and responses were collected from 50 participants aged 18 years and above.

Formulation of Emulgel

Preparation of Emulsion

Emulsion containing clove oil and neem oil was prepared using a method described by Ali Khan et al., with modification. The water phase consisted of tween 80 and distilled water. The mixture was kept under stirring for 3–5 min. A solution of water, tween 80 was mixed with the weighed proportions of methyl and propyl paraben. Ethanol was used to solubilize Triphala extract and camphor, which were then continuously stirred into the water phase. Glycerine was then added to the water phase, and the mixture was agitated at a moderate pace. Neem oil was dissolved in clove oil to prepare the oil phase. Subsequently, each phase was heated at 70°C independently, and the oil phase was gradually added to the water phase. For fifty to sixty minutes, the mixture was rotated at 1500 rpm. Table 1 provides information on the formulation's optimum composition.

Gel Preparation

Carbopol 934 was used as gelling agent. 2 g of gelling agent was dissolved in 100 mL of purified water, with constant stirring. The pH was adjusted to 5-6 by adding a sufficient amount of triethanolamine dropwise.

Emulgel Preparation

The emulsion was mixed in the gel base in a 1:1 ratio to form a viscous gel network. Peppermint oil was added in the resultant emulgel as a flavouring agent.

Evaluation

Physicochemical characteristics

The clove and neem oils were characterized for their physicochemical characteristics like, ester value, acid value, solubility, density, refractive index. Understanding these characteristics ensure that oils are used safely,effectively, and in ways that optimize their benefits in desired application.

Physical appearance

The optimal formulation was chosen based on physical characteristics, and it was then incubated at 25 °C for 28 days and assessed for grittiness, cream/phase separation, colour change, and homogeneity.

pH determination

Using a digital pH meter, the pH of the optimized emulgel mixture was determined. The average values were determined after the test was run in triplicate.

Viscosity

The viscosity of the selected formulation was determined with Brookfield viscometer at room temperature. To ensure that the spindle was not in contact with the beaker's bottom, it was brought down vertically into the middle of the beaker holding the optimised emulgel. The test was conducted in triplicates and the average values were calculated.

Spreadability study

Using a drag and slip device, the spreadability of emulgel was measured according to the methodology modified by Akram et al.⁸ The device was made from a wooden block with a glass slide installed over it and a pulley fastened to one edge of the block. A glass slide with the exact same dimensions as the fixed glass slide was placed on top of the glass slide that was fastened to the wooden block, covering about 2 g of emulgel. A hook was used to secure to the upper glass slide so that an 80 g weight could be suspended and carried over using the pulley.

The slide's time in seconds required to move 7.5 cm on the fixed glass slide was noted. Following this, the spreading co-efficient was then calculated using the following formula:

Spreadability = M×L/T

where,

M = weight tied to upper glass slide,

L = glass slide length,

T = time taken by slides to separate from each other.

Extrudability test

The purpose of the extrudability test was to determine how much force is needed to extrude the emulgel from a collapsible tube. The amount of emulgel extruded from aluminium collapsible tubes was used to determine the formulation's extrudability. The weight in grams of emulgel ribbon extruded at least a 0.5 cm from the tube in 10 seconds was calculated. Three duplicates of this test were run, and the average was noted.

The extrudability of the formed emulgel was then determined by using the following formula:

Extrudability = Weight (in grams) required to extrude emulgel/Area (cm2)

Results

Responses to dental health care survey conducted online using Google forms

The survey results have led to recommendations for better dental health care, including raising awareness and using herbal actives in dental care products. Herbal actives offer variable therapeutic benefits, like anti-inflammatory, antimicrobial, and antioxidant properties, which make them effective in a range of dental applications.

The survey offers insightful information about the status of present day oral health care. Though the value of dental health is quite recognized, improvement is needed in many aspects, most notably in terms of maintaining consistency in oral hygiene habits and also in improving accessibility to the herbal formulations.

Preparation of emulsion

The formulations have been designed using Carbopol 934 at various concentrations and clove oil at the same concentration. Table 1 lists the composition of the formulation. The physical characteristics of the batches were assessed. Each formulation had a distinctive clove oil smell and a pale-yellow colour.

Physicochemical characteristics

The physicochemical characteristics of oils, such as ester value, acid value, solubility, density, refractive index were evaluated, the results of which are represented in Table 2. The results indicated that the oils are safe to be used in the formulation.

Physical Appearance

The formulated emulgel exhibited a smooth, homogeneous texture as shown in Figure 2.

Measured pH

The pH of the emulgel was found to be between 6.2 and 6.7, which is suitable for topical application and was within the acceptable pH range of buccal cavity, i.e., 6-7.

Viscosity

The viscosity of the emulgel was measured using a Brookfield viscometer, and was found to be in the range of 3000-5000 cps, indicating appropriate consistency for topical application.

Spreadability

The emulgel demonstrated excellent spreadability, measured as the area covered by a fixed amount of emulgel under a certain load. This ensures ease of application over the skin or mucosal surfaces.

Extrudability

Extrusion of gel from tube is crucial for application and patient acceptance. High consistency gels may not extrude, while low viscous gels flow quickly. The formulation showed good extrudability. Suitable consistency is required to extrude the gel from the tube. Extrudability of gel formulations was found to be good, and reported as 19 g/cm².

Discussion

The dental health survey offered insightful information on the dental health practices and issues that the survey participants were concerned about. Data on dental hygiene habits, dental treatment experiences, and opinions regarding oral health were gathered from a wide range of respondents in the study.

The study could aid in guiding targeted campaigns and outreach activities to support improved oral health outcomes in the community through analysis of the survey data. The survey's findings can help health educators and healthcare professionals create efficient plans to deal with the issues related to dental health and enhance oral health in general. According to the survey, most participants demonstrated a clear understanding of the significance of dental health, as reflected in their consistent brushing routines and emphasis on maintaining good oral health.

Nevertheless, the survey also identified a number of areas requiring effort, such as the fact that a significant number of respondents do not visit the dentist on a regular basis and the need for tooth care products that can maintain freshness for a longer period.

In order to maximise the therapeutic effects, the current work aimed to develop improved formulations using additional natural extracts. The emulgel's composition enables the gradual release of Triphala extract, neem oil, and clove oil, preserving therapeutic concentrations for an extended period of time. The outcome of the survey indicated a trend or preference for the use of herbal remedies in dental care. This could suggest that respondents may be choosing natural or alternative options for maintaining oral health or addressing dental issues. Methyl cellulose was used as the gelling agent, clove oil was used as the therapeutic agent, polyethylene glycol was used as a cosolvent, methyl and propyl paraben were used as preservatives, and the required quantities were added.

Padmawar et al., and Telrandhe et al. explored the use of neem, clove, and Triphala in the broader context of phytodentistry, discussing these ingredients for their effectiveness in reducing gum inflammation and dental problems.^9,10 Maurya R et al. focused on innovative approaches aimed at upgrading traditional Ayurvedic oil preparations into advanced gel formulations to increase their therapeutic efficacy.¹¹ Although herbal ingredients have long been used for their therapeutic benefits, their conversion into gel-based compositions is a modernisation tactic for maximising their potential. This progression involves employing scientific discoveries to transform these conventional herbal ingredients into more sophisticated and widely available gel compositions. Improving their use, absorption, and efficacy in treating a range of medical diseases is the main goal. These innovative approaches seek to improve the stability, bioavailability, and targeted distribution of ingredients by encapsulating their advantageous constituents within gel formulations, thus optimising their medicinal effect.

Because of its gel-like consistency, the developed formulation is easier to apply, adheres better to skin or mucosal surfaces, and is more palatable to users. Triphala extract, neem oil, and clove oil offer a safe and efficient means for improving dental health. Its antibacterial and anti-inflammatory qualities can lessen mouth infections, promote good oral hygiene, and enhance dental health in general. The emulgel formulated in the present work can be used topically on a regular basis and may serve as a beneficial supplement in regular oral hygiene practices.

Conclusion

Traditionally, Triphala extract, neem oil, and clove oil have shown promise as practical and effective solutions for dental treatment. The emulgel composed of above herbal ingredients along with emulsifying agent, tween 80 showed good stability and physical characteristics. With its high level of user satisfaction and antibacterial, analgesic, and anti-inflammatory qualities, it is an acceptable selection for topical dental treatments. This comprehensive study highlights the potential of emulgel formulations in dental care, offering a safe and efficient alternative to traditional procedures. By bridging the gap between contemporary pharmaceutical developments and traditional Ayurvedic knowledge, this research promises a paradigm shift in the application and efficacy of these age-old treatments in healthcare.

Conflict of interest

Nil