Solanum xanthocarpum and Acacia catechu Willd- An Ayurvedic Soothe

[Full title: Solanum xanthocarpum and Acacia catechu Willd- An Ayurvedic Soothe: A Randomized Clinical Trial]

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[Find the meaning and references behind the names: Joshi, Ayu, Main, Pradeep, Anirudh, Thakur, Leena, Med, Good, Shilpa]

1 Journal of Ayurvedic and Herbal Medicine 2021; 7(1): 1-4 Clinical Study ISSN: 2454-5023 J. Ayu. Herb. Med. 2021; 7(1): 1-4 © 2021, All rights reserved www.ayurvedjournal.com Received: 02-02-2021 Accepted: 22-03-2021 *Corresponding author: Dr. Shilpa G. Joshi Post-graduate, Department of Periodontics, S.D.M College of Dental Sciences and Hospital, Dharwad, Karnataka – 580009, India Email: shilpabagalkot 82@gmail.com Solanum xanthocarpum and Acacia catechu Willd- An Ayurvedic Soothe: A Randomized Clinical Trial Shilpa G. Joshi 1 *, Leena G. Shettar 2 , Pradeep S. Agnihotri 3 , Anirudh B. Acharya 4 , Srinath L. Thakur 5 1 Post-graduate, Department of Periodontics, S.D.M College of Dental Sciences and Hospital, Dharwad, Karnataka – 580009, India 2 Professor, Department of Periodontics, S.D.M College of Dental Sciences and Hospital, Dharwad, Karnataka – 580009, India 3 Professor, Department of RS and BK, Ayurveda Mahavidyalaya, Heggeri, Hubli, Karnataka, India 4 University of Sharjah College of Dentistry, Preventive and Restorative Dentistry, University City, Sharjah, AE 5 Professor, Department of Periodontics, S.D.M College of Dental Sciences and Hospital, Dharwad, Karnataka, India ABSTRACT Background: Periodontitis is mainly a microbial disease which commences on accumulation of plaque. Conventional mechanical therapy comprising of scaling in addition to chemical plaque control offers greater benefits to reduce plaque and associated gingivitis. Hence, in our study we have considered the use of relatively safe herbal compounds as an adjunct to scaling. Aims & Objectives of the study were, 1.To assess the antibacterial and anti-inflammatory properties of two herbal mouthrinses ( Solanum xanthocarpum and Acacia catechu Willd) and 2. Compare the efficacy of herbal mouthrinses with Chlorhexidine (Gold standard). Methods: A total of 75 patients diagnosed with moderate to severe gingivitis were randomly assigned to 3 groups. The three groups were group A, Chlorhexidine mouthrinse, group B Solanum xanthocarpum mouthrinse and group C, Acacia catechu mouthrinse. This was a triple blinded study where random allocation was done by coin method. After scaling the clinical parameters namely plaque index, gingival index and sulcus bleeding index were recorded for all the three groups. Individuals were instructed to rinse with their respective mouthwash twice daily. The PI, GI and Sulcus Bleeding Index were recorded at baseline, 14 th day and 21 st day. Results: There was statistical significant difference in three groups in relation to GI, PI and SBI indices. Group C showed statistically significant difference in all the parameters. Conclusion: Acacia catechu and Solanum xanthocarpum were effective as antibacterial and anti-inflammatory agents. Acacia catechu showed better results than Chlorhexidine. Keywords: Clinical Trial, Ayurvedic Soothe, Solanum xanthocarpum, Acacia catechu . INTRODUCTION Ayurveda is a traditional system of Indian medicine evolved around 5000 years ago in India that offers medications using herbs [1] . As, Oral cavity reflects the health of the whole body; mouth is often referred as “mirror of the whole body” and hence one should be aware of the various oral lesions and their management using traditional medicines [2] . In dental sciences bacterial plaque is the paramount in the etiology of periodontal diseases, the extent and severity of which depends on the interaction of host to microbial burden [3] . Regular plaque control measures are used as a main stay to maintain oral hygiene which helps in preventing and controlling the progression of the disease. Scaling and root planing forms the first and indispensable phase of periodontal therapy, but factors such as inaccessibility or plaque retentive areas, can compromise clinical and microbiologic outcomes [4] . Thus chemical agents are advocated as adjuncts to mechanical methods to augment plaque control. Several antibacterial chemicals, such as chlorhexidine (CHX), have been successfully used in prevention and treatment of ginigivitis [5] . However, there are some limiting factors in the extended use of these substances, which demonstrate a need for an antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control [6] . Hence, the natural phytochemicals isolated from plants used in traditional medicine are considered as good alternatives to synthetic chemicals [7] Solanum xanthocarpum , one of the members of Dasamula (ten roots) of the Ayurveda, also recognized as Indian night shade has been used against various diseases like cough, chest pain, vomiting etc and in dentistry the fumigations are used against caries which also helps in wound healing [8] . Dried fruit extracts possesses anti-inflammatory, antimicrobial, antioxidant and antifungal properties. The unsaponifiable

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[Find the meaning and references behind the names: David, Kalpana, Market, April]

2 Journal of Ayurvedic and Herbal Medicine|January-March|2021 matter of fruits contain two sterols, one of which is carpesterol [9] . Kusano et al , reported the following steroidal constituents namely, cycloartanol, sitosterol, stigmasterol, carpesterol, clolesterol, sitosteryl glucoside, stigmasteryl glucoside, soalmargine and beta-solamargine from fruit extracts [10] . Manye et al , showed that fruits have more alkaloids than other organs in the plant species and alkaloid productivity vary under different organic solvents [11] Acacia catechu Willd, known as Khadira in Sanskrit means that which stabilizes the body and diseases. Also known as Dantadhavana in Ayurveda, is useful for cleansing the teeth [12] . It has many properties like antibacterial, anti-inflammatory, astringent, antifungal, antimicrobial, anticancer properties and also helps in wound healing. The bark of the tree contains flavanoids like catechin, epicatechin, epigallocatechin, alkaloids and tannins that act as an antioxidants. Khadira heartwood extract is found to be an effective antibacterial agent. A study conducted in ethanolic and aqueous heartwood extract of khadira, proved its efficacy as a potent antibacterial agent. It is also used as mouthwash for gingivitis, sore throat, dental and oral infections, as stated by David S et al , in the year 1987. As mentioned by Chino K , it is used as a topical agent for mouth ulcers. Antioxidant and astringent are the cardinal properties of Acacia catechu. Acacia species produces gum exudates, traditionally called as gum Arabic or gum acacia which is widely used in food industry. Katha used as a chewing ingredient is a resin part of Acacia catechu used in Ayurveda preparations [13] . Since the dried fruits of Solanum xanthocarpum contain antimicrobial and anti-inflammatory properties and to the best of our knowledge, as there were no studies that have used Solanum xanthocarpum in a mouthwash we, in our study aimed to assess and compare the antibacterial and anti-inflammatory effects of two herbal mouthrinses ( Solanum xanthocarpum and Acacia catechu Willd ) and to compare the anti-inflammatory and antibacterial effects of two herbal mouthrinses ( Solanum xanthocarpum and Acacia catechu Willd ) with Chlorhexidine. MATERIALS AND METHODS Ethical approval was obtained by the Institiutional Review Board of the SDM College of Dental Sciences and Hospital, Dharwad. The randomized trial was registered under the Clinical Trials protocol registration system (CTRI/2019/08/020707). Informed consent was obtained from all the individuals. The null hypothesis H 0 – Acacia catechu and Solanum xanthocarpum were not effective. A total of 75 patients with chronic generalized gingivitis in the age group of 18-55 years were recruited from Outpatient Department of Periodontics, SDM College of Dental Sciences and Hospital, Dharwad, India from February 2019 to April 2019. Group sample sizes were decided by power analysis with 95% power and a significance level of 0.05, based on the formula n=f(α/2,β)×σ2/(µ 1- µ 2 )2. Allocation was done using coin toss method. Tossing was done randomly by the assistant. In each group 25 subjects were allocated. The operator, patient and the statistician were blinded. Patients who were systemically healthy with moderate or severe gingivitis (gingival scores of 1.1-2.0 / 2.1-3.0) were included in the study. Extraneous factors like patients seeking any type of antibacterial mouthwash within 4 weeks of commencement of study, history of any systemic disease, or past illness, history of smoking, tobacco chewing, pregnant and lactating women, use of antibiotics and anti-inflammatory drugs in previous 6 months and subjects who have undergone periodontal treatment in the past 6 months were excluded from the study. A total of 79 individuals were assessed for eligibility, of them 75 met the inclusion criteria and were randomly assigned to one of the three groups using consecutive sampling. Allocation was done using coin toss method of randomization. Scaling was performed for subjects who participated in the study. The clinical parameters were recorded after scaling which included Plaque index (Silness and Loe, 1964), Gingival index (Loe and Silness 1963) and Sulcus bleeding index ( Muhlemann and Son’s, 1973) followed by oral hygiene instructions were given. Prior to the distribution of mouthwashes palatability was checked. Individuals were instructed to use 10 ml of mouthwash twice daily for 30 seconds for a period of 14 days and advised not to rinse with water or drink anything for half an hour [15] Clinical parameters were also recorded during the follow up visits on 14 th day and 21 st day respectively. Chlorhexidine was distributed to group A, Solanum xanthocarpum to B and Acacia catechu to group C respectively. Method of Preparation The herbal extract was prepared in Ayurved Mahavidyalaya, Heggeri, Hubli. The preparation was done in accordance with the standard principles described under Kwatha kalpana by Sharangadharacharya in his classic text “Sharangadhara Samhita” [14] . The dried fruits of Solanum xanthocarpum was available in the local market. It was ground into fine powder and one part of this powder was mixed with 16 parts of water in an earthern pot and boiled over medium flame to reduce the mixture to one eighth part. The mixture was cooled to room temperature and filtered thoroughly after which it was packed and stored. To make it palatable 1% camphor was added and to preserve for longer duration, 0.1% of sodium benzoate was added as a preservative. The same method was utilized for the preparation of Acacia catechu mouthwash which was commercially available in the form of powder. Commercially available 0.2% Chlorhexidine was used. Scaling and root planing was performed for subjects who participated in the study. The clinical parameters were recorded later which included Plaque index (Silness and Loe, 1964), Gingival index (Loe and Silness 1963) and Sulcus bleeding index (Muhlemann and Son’s, 1973) followed by oral hygiene instructions. Prior to the distribution of mouthwashes palatability was checked. Individuals were instructed to use 10 ml of mouthwash twice daily for 30 seconds for a period of 14 days and advised not to rinse with water or drink anything for half an hour. Similar duration and amount was followed in a study by Axelsson and Lindhe [15] . Clinical parameters were also recorded during the follow up visits on 14 th day and 21 st day respectively. Patient evaluation was performed to assess for any adverse effects related to use of respective mouthwashes at the time of follow up visits. Statistical Analysis Analysis of data were carried out using statistical software 23 and Microsoft office 2007. Values of different parameters collected are expressed as mean ± standard deviation. Chi – square test was used for intergroup comparison of Plaque Index, Gingival Index and Sulcus

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3 Journal of Ayurvedic and Herbal Medicine|January-March|2021 Bleeding Index. Repeated measures analysis of variance (ANOVA) and F test was performed for comparison of differences among the three groups. RESULTS Changes in Gingival Index, Plaque Index and Sulcus Bleeding Index among groups Table 1: GINGIVAL INDEX Group-A Group-B Group-C P value Baseline 1.74±0.18 1.72±0.21 1.86±0.29 0.058 14 th day 0.43±0.44 0.74±0.3 0.53±0.42 0.018* 21 st day 0.19±0.29 0.26±0.22 0.17±0.2 0.423 PLAQUE INDEX Baseline 0±0 0±0 0±0 - 14 th day 0.66±0.36 0.85±0.27 0.65±0.38 0.085 21 st day 0.54±0.35 0.63±0.32 0.47±0.31 0.249 SULCUS BLEEDING INDEX Baseline 2.42±0.49 2.39±0.45 2.64±0.7 0.235 14 th day 0.63±0.67 0.95±0.59 0.85±0.76 0.225 21 st day 0.2±0.39 0.27±0.34 0.1±0.23 0.197 Changes in Gingival Index, Plaque Index and Sulcus Bleeding Index over time Table 2: GINGIVAL INDEX Baseline 14 th day 21 st day P value Group-A 1.74±0.18 0.43±0.44 0.19±0.29 <0.001* Group-B 1.72±0.21 0.74±0.3 0.26±0.22 <0.001* Group-C 1.86±0.29 0.53±0.42 0.17±0.2 <0.001* PLAQUE INDEX Group-A 0±0 0.66±0.36 0.54±0.35 <0.001* Group-B 0±0 0.85±0.27 0.63±0.32 <0.001* Group-C 0±0 0.65±0.38 0.47±0.31 <0.001* SULCUS BLEEDING INDEX Group-A 2.42±0.49 0.63±0.67 0.2±0.39 <0.001* Group-B 2.39±0.45 0.95±0.59 0.27±0.34 <0.001* Group-C 2.64±0.7 0.85±0.76 0.1±0.23 <0.001* There was a difference in plaque index, gingival index and sulcus bleeding index in group A, group B and group C at three intervals. The results were not statistically significant. Intergroup comparison showed statistical significant difference in relation to all the three parameters. Group C showed statistically significant values compared to group A. Table 1 presents mean ± Standard deviation values of gingival index, plaque index and sulcus bleeding index at different time intervals among groups. It shows the gingival index values of F test, where we can observe statistically significant difference in gingival values from baseline to 14 th day and more reduction in values can be noted in group A and group C as compared to group B. There was no statistically significant difference noted in plaque index and sulcus bleeding index. Table II presents mean ± standard deviation values of gingival index, plaque index and sulcus bleeding index at different time intervals over time. All the three groups showed gradual decrease in Gingival index, Plaque index and Sulcus bleeding index values from baseline to follow up visits at 14 th day and 21 st day respectively. Therefore the results of our study showed that both the test mouthwashes were equally effective as that of Chlorhexidine suggesting that these mouthwashes can be used safely. DISCUSSION The current study was aimed to assess and compare the antibacterial and anti-inflammatory properties of two herbal mouthrinses (Solanum xanthocarpum and Acacia catechu Willd) with 0.2% Chlorhexidine in individuals with generalized gingivitis. Solanum xanthocarpum , a prickly perennial herb is useful against various diseases like cough, chest pain, vomiting and also in wound healing. As mentioned by Anvikar et al , the dried fruits are smoked in the form of cigarettes to cure dental infection or toothache [16] and this anti-inflammatory effect is due to the presence of a rare sterol i.e, carpesterol [17] . Lupeol also acted as a multi-target agent with immense anti-inflammatory properties [18] . The other herb taken in our study was Acacia catechu, which is beneficial both internally as well as externally. The extract was found to be equally effective against gram positive and gram negative bacteria. A study done by Pawar et al , 2009 stated that herbal dentifrice containing Acacia catechu as a key ingredient helped in the reduction of plaque, gingivitis and calculus within 15 days. The chief major active chemical components of Khadira ( Acacia catechu willd) are flavonoids like catechin which is responsible for dual inhibition of Cyclooxygenase and 5-Lipoxygenase known to decrease the inflammation [19] . Ethanolic and aqueous heartwood extract of Acacia catechu , proved its efficacy as a potent anti-bacterial agent and the

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[Find the meaning and references behind the names: Da Silva, Man, Boudaoud, Raja, Rita, Singh, Silva, Subramanian, Charles, Wang, Kumar, Long, Chaher, Jain, Paul, Prabhu, Sato, Simon, Aravind, Rao, Cheang, Laxmi, James, Lima, Yang, Oliveira]

4 Journal of Ayurvedic and Herbal Medicine|January-March|2021 presence of Taxifolin in Acacia was responsible for its antibacterial activity [20] . Agarwal et al , 2015 conducted a study where Acacia catechu mouthwash was found to be equally effective as an antiplaque and antigingivitis agent in fixed orthodontic appliance patients with no side effects. A herbal oil Irimedadi taila containing Acacia catechu as the key ingredient is equally effective in reducing plaque induced gingivitis, as Chlorhexidine gluconate, used as an adjunct to mechanical plaque control [21] . Acacia catechu can be prescribed to people of all ages and is beneficial and safe even when ingested which is definitely an advantage over Chlorhexidine. In our study we found that Acacia Catechu (Group C) was better antibacterial and anti-inflammatory compared to Chlorhexidine and Solanum xanthocarpum. A study was conducted by Agarwal et al , where Acacia catechu was compared with 0.2% CHX in patients with fixed orthodontic appliances and both showed to be equally effective. Limitations 1 Small sample size 2 Two patients who received Solanum xanthocarpum (group B) expressed that the taste was bitter. Four patients who received Acacia catechu (group C) reported staining of teeth and hence needs to be investigated further. CONCLUSION In modern times because of the awareness amongst people regarding healthy lifestyle, natural products are in demand. Therefore, it becomes necessary to switch on to herbal formulations and relate its efficacy. In our study, Acacia catechu definitely showed better results than Chlorhexidine and Solanum xanthocarpum was same as Chlorhexidine. REFERENCES 1 Cavalcanti A, Da Silva N, Alexandria AF, De Lima A, Claudino L, De Oliveira Carneiro T et al . In vitro antimicrobial activity of mouthwashes and herbal products against dental biofilm-forming bacteria. Contemporary Clinical Dentistry 2012; 3(3):302-305 2 Hosallimath S, Sholapur RV. Role of Ayurveda and its Holistic Approach in Dentistry. Acta Scientific Dental Sciences 2019; 3(4):65-67 3 Vasant Lad. A Brief Introduction and Guide. Ayurveda 1996; 1-5 4 Cobb CM. Non-Surgical Pocket Therapy: Mechanical. Annals of Periodontology 1996; 1(1):443-490 5 Cortelli SC, Cortelli JR, Shang H, James MA, Charles CA. Long-term management of plaque and gingivitis using an alcohol free essential oil containing mouthrinse: a 6 month randomized clinical trial. Am J Dent 2013; 26(3):149-55 6 Brecx M, Macdonald LL, Legary K, Cheang M, Forgay MGE. Long-term Effects of Merldol and Chlorhexidine Mouthrinses on Plaque, Gingivitis, Staining and Bacterial Vitality. Journal of Dental Research 1993; 72(8):1194-1197 7 Prabhu GR, Gnanamani A, Sadulla S. Guaijaverin: A plant flavonoid as potential antiplaque agent against Streptococcus mutans. J Appl Microbiol 2006; 101:487-95 8 Datta AK, Rita Paul. An updated overview on Solanum Xanthocarpum, Schrad and Wendl. International Journal of Research in Ayurveda & Pharmacy 2011; 2(3):730-735 9 Heble MR, Narayanaswami S, Chadha MS. Diosgnin and beta-Sitosterol: Isolation from Solanum xanthocarpum tissue cultures. Science 1968; 161:1145 10 Kusano G, Beisler J, Sato Y. Steroidal constituents of solanum xanthocarpum. Phytochem 1973; 12(2):397-401 11 Manye Y, Xinsheng H, Ming L. A preliminary study on Alkaloids in Solanum Xanthocarpum. Phytochem 1973; 12(2):397-402 12 Khandekar SB, Pansare TA, Satpudke SS. Phytopharmacology of Acacia Catechu Willd: A Review. European Journal of Pharmaceutical and Medical Research 2019; 13 Shen D, Wu Q, Wang M, Yang Y, Lavoie EJ, Simon JE. Determination of the Predominant Catechins in Acacia catechu by Liquid Chromatography / Electrospray lionization – Mass Spectrometry. J Agric Food Chem 2006; 54(9):3219-3224 14 Rao GP. Kvatha Kalpana . Sarangadhara Samhita of Sarangadharacharya . Sanskrit text with English translation , 1 st edition 2:71 . 15 Axelsson P, Lindhe J. Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man. Journal of Clinical Periodontology 1987; 14(4):205- 212 16 Anwikar S, Bhitre M. Study of the synergistic anti-inflammatory activity of Solanum xanthocarpum, Schrad, Wendl and Cassia fistula Linn. Int J Ayurveda Res 2010; 1(3):167-171 17 Bhattacharya TK, Ghosh MN, Subramanian SS. A note on antiinflammatory activity of carpesterol. Fitoterapia 1980; 51(5):265-267. 18 Singh OM, Singh TP. Phytochemistry of Solanum xanthocarpum; an amazing traditional healer. J Sci Ind Res 2010; 69:732-740 19 Atmaini D, Chaher N, Berboucha M, Debbache N, Boudaoud H. Flavonoids in human health: from structure to biological activity. Current Nutrition and Food Science 2009; 5(4):225-37 20 Laxmi T, Aravind kumar S. In vitro Evaluation of Antibacterial Activity of Acacia catechu on oral microbes. International journal of current research and review 2011; 3:4-9 21 Mali GV, Dodamani AS, Karibasappa GN, Vishwakarma P, Jain VM. Comparative evaluation of arimedadi oil with 0.2% chlorhexidine gluconate in prevention of plaque and gingivitis: a randomized clinical trial. J Clin Diagn Res 2016; 10(7):ZC 31-4 HOW TO CITE THIS ARTICLE Joshi SG, Shettar LG, Agnihotri PS, Acharya AB. Solanum xanthocarpum and Acacia catechu Willd- An Ayurvedic Soothe: A Randomized Clinical Trial. J Ayu Herb Med 2021;7(1):1-4.

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