LOCAL USE OF G32: AN AYURVEDIC DRUG IN PREGNANCY GINGIVITIS

(A Clinical Trial)

 

Dr. LOGESWARI, M.B.B.S.,

Dr. MANJULA, B.D.S., Dental Surgeon

Dr. C. R. KANTHAMANI, M.D., D.G.O., Superintendent.

Government Kasturba Gandhi Hospital for Women and Children, Madras 600 005.

 

INTRODUCTION

 

Gingivitis is caused by bacterial Plaque and local irritants. l. However, Pregnancy Gingivitis is mainly attributed to the increased oestrogen and progesterone levels during pregnancy, 2,3, which accentuate gingival response to local irritants precipitating gingival inflammation and associated symptoms. Pregnancy Gingivitis is a fairly common ailment affecting many women. Increase in severity of gingivitis has been reported during pregnancy 4.                                                                         

 

OBJECTIVES OF STUDY

 

The following were the objectives:

 

a) To evaluate the usefulness of local application of G32 in pregnancy Gingivitis.

 

b) To find a practical solution to combat periodontal problem in pregnant women.

 

c) To improve gingival tone, texture, gingival health and Oral Hygiene (OHI) in women suffering from pregnancy Gingivitis.

 

G32 COMPOSITION

 

G32 is an Ayurvedic preparation meant for local use. It is available in easily crushable tablet form for correct usage.

 

Each G32 tablet contains:

 

Bakul (Mimosops Elangi) 80.0 mg.

Chok (Calcium Carbonate). 75.0 mg.

Katho (Acacia catechu) 40.0 mg.

Laving (Myrtus Caryophyllus) 20.0 mg.

Chikani Sopari (Areca catechu) 20.0 mg.

Fatakadi (Alumen) 20.0 mg.

Mayafal (Quercus infectoria) 20.0 mg.

Elaichi (Elettaria Cardamomum) 10.0 mg.

Sonageru (Silicate of Alumina and

Iron Oxide 10.0 mg.

Jiru (Carum Carui) 10.0 mg.

Majith (Rubia cordifolia) 10.0 mg.

Pashanbed (Saxifrua Ligulata) 10.0 mg.

Vavding (Embelia Ribes) 10.0 mg.

Pipala ni Lakh (Ficus Religiosa) 10.0 mg.

Samudrafin (Os sapiae) 10.0 mg.

Vajradanti (Barleria Prioitis) 10.0 mg.

Taj (Cinnamimum cassia) 5.0 mg.

Mari (Piper Nigrum) 5.0 mg.

Sajikhar (Sodium carbonate impura) 5.0 mg.

Kulinjan (Alpinia Chinensis) 5.0 mg.

Pipar (Piper Longum) 5.0 mg.

Kapur (Camphora officinarum) 5.0 mg.

Kuth (Uncaria Gambier) 5.0 mg.

 

ACTIONS OF G32

G 32 is described to have the following actions:

Anti-inflammatory, antiseptic, antacid, antibacterial, astringent, anodyne, styptic, deodorant, aromatic, healing, and cooling.

 

It has non toxic or no side effects, local or systemic and is indicated in all painful conditions of the mouth gums, teeth, buccal mucosa etc.

 

MODE OF APPLICATION OF G32

 

The patient was advised to apply powder of Two G32 tabs. at a time, three times a day for the first week. Then depending upon the improvement, it was gradually reduced during the next weeks: application of powder of Two G32 tabs. two times in a day; application of the powder one G32 tab. three times in a day and later two times in a day.

G32 powder was to be applied to the gums and surrounding parts by finger tip or a soft brush. Gentle massage was to be done if not painful. After 10 minutes the mouth was to be rinsed and gargled with fresh water. This was to be repeated two or three times in a day as necessary.

 

The period of clinical trial was ten weeks for all the patients unless it was interrupted by delivery in those patients who were admitted during the trial in the third trimester.

 

PATIENTS & METHODS

 

This study was conducted on patients who attended the Ante-Natal O.P. Dept. of the Kasturba Gandhi Hospital for Women & Children, Madras, during the years 1983-84. Only those patients suffering from Pregnancy Gingivitis were included in the trial. However, a few patients (9) who gave history of drug induced gingivitis due to the use of Dilantin or Eptoin being epileptic patients, were also included in the trial. Those having other systemic diseases like diabetes were excluded from the study. A large number of patients with pregnancy Gingivitis were taken up for the clinical trial. There were many drop-outs. However, as soon as the number with complete records and follow-up reached 200, no further cases was taken. The trial period was ten weeks for all the patients, except for those admitted in the 3rd trimester, who delivered earlier.

 

Complete medical and obstetric history was recorded on admission. General examination was made. Height and weight were recorded. Examination of mouth and oral tissues was done to assess the extent of gingivitis. Biopsy of the gums was done in a few random cases. Routine blood and urine examination and Blood Group and typing were done as a routine.

 

After all investigations were done, G32 application to the inflamed gingiva was started. The patients were examined after each week for the first four weeks and then at the end of 6 weeks, 8 weeks and finally at the end of 10 weeks. Response to G32 application was assessed after the patient used G32 for ten weeks as already described. The ten weeks period did not apply to those patients who were admitted in the third trimester and who delivered before the expiry of ten weeks. However, these patients were also taken for the assessment of response to G32 application. Gingival Inflammation Index of Loe & Silness was used as a parameter to record the grade of G.LI.

 

 

INVESTIGATIONS                                                                                                                                                 

HB percentage: HB values ranged from 8.2 gm per cent to 11 gms per cent, the mean value being 9.5 gms per cent.

T.C.: It was found within normal limits in all except in a few cases where there was leucocytosis.

B.P.: It was found within normal limits in all patients.

 

BLOOD GROUPING & BLOOD TYPING:          

These were done in all cases.

 

VDRL: It was negative in all the cases.

 

URINE: Those with albumin in urine or sugar in urine were excluded from the study.

 

GINGIVAL BIOPSY

 

It was done in 53 patients taken at random. The general microscopic picture was nonspecific vascularised proliferative inflammation. There was engorgement of capillaries and inflammatory infiltrate with oedema, degeneration of the epithelium and connective tissue. The epithelium was hyperplastic with accentuated reti pegs with infiltration by leucocytes in the inter-cellular and extra cellular spaces. Hyperplastic squamous epithelium was seen in 26 patients (49.1 per cent) and hypertrophic squamous epithelium was seen in 27 patients (50.1 per cent).

 

AGE GROUP

 

The ages of patients with pregnancy Gingivitis ranged from 16 years to 35 years.

 

PERSONAL HABITS

 

All the patients were used to Pan Chewing, but only 20 (10 per cent) of them were Habitual Pan Chewers.

For the purpose of daily cleaning of the mouth, 104 patients (52 per cent) used tooth powder with finger, 93 patients (46.5 per cent) used tooth paste with tooth-brush, and only 3 patients (1.5 per cent) used charcoal powder with finger. (Table I)

 

TABLE I BRUSHING HABITS

 

No. of patients             Cleaning habits                                     % of cases

                                   

104                         Tooth Powder with finger                                 52.0

 

93                           Tooth paste with tooth brush                           46.5

 

3                             Charcoal powder with  finger                           1.5

 

                                               

ORAL HYGIENE (OHI)

 

Before starting G32 application it was found that Oral hygiene was

GOOD in 7 patients (3.5 per cent),

satisfactory in 170 patients (85 per cent), and

Poor in 23 patients (11.5 per cent). (Table II)

 

 

TABLE II ORAL HYGIENE

 

No. of  patients               Oral Hygiene                                        % of   cases                 

7                                              Good                                                   3-5

170                                          Satisfactory                                          85.0

23                                            Poor                                                     11.5

 

PARITY

 

Pregnancy Gingivitis was highest in Primi Gravida where 92 case (46 per cent) were recorded. Pregnancy Gingivitis showed a regular decreasing incidence with the increase in parity and it was the lowest (1 per cent) in Gravida VI. (Table III)

TABLE III  HISTORY OF PARITY IN PREGNANCY GINGIVITIS

           

                                   

Parity                           No. of cases                                                     % of  cases                                                      

Gravida I                                  92                                                        46.0

Gravida II                                 49                                                        24.5

Gravida III                               38                                                        19.0

Gravida IV                               16                                                        8.0

Gravida V                                3                                                          1.5

Gravida VI                               2                                                          1.0

 

ONSET OF PREGNANCY GINGIVITIS                                                                                                                                                                                      

Onset of Pregnancy Gingivitis varied from 2 weeks to 8 months of pregnancy. There was maximum number of cases during 1st trimester (106 cases-53 per cent). The incidence declined during 2nd trimester (27 cases-13.5 per cent), but again rose to 67 patients (33.5 per cent) during the last trimester. Table (IV)                                                                                                                                                                                             

 

TABLE IV ONSET OF PREGNANCY GINGIVITIS                                              

 

Trimester          No. of cases                 % of

1 st                               106                  53.0    

2nd                              27                    13.5    

3rd                               67                    33.5    

 

SIGNS & SYMPTOMS

 

Each patient had more than one symptom. Bleeding Gums, redness and periodontal pockets with depth varying from 1 mm to 2 mm, were present in all 200 patients (100 per cent). There was severe pain in 66 patients (33 per cent). Ulcer Gums was present in 5 patients (2.5 per cent). Pregnancy Epulis was seen in 3 patients 1.5 percent. Mostly the upper and lower anteriors were involved (177 patients88.5 percent). Only in the case of epileptic patients using Dilantin, in addition to anteriors the posterior upper and lower regions were also affected. Dental caries were present in 59 patients (29.5 per cent) showing that caries is common in women unrelated to pregnancy factor. (Table V)

 

TABLE V SIGNS AND SYMPTOMS

 

Complaints       No of patients                % of patients

 

Redness                       200                              100.0                                                              

Bleeding                       200                              100.0                          

Pockets                        200                              100.0                                      

Pain                              66                                33.0

Ulcer Pregnancy           5                                  2.5                                                                                                      

Epulis                           3                                  1.5                                                      

Dental carries               9                                  29.5                

 

G.I. INDEX

 

Gingival Inflammation Index as per LOE & Silness was recorded before starting G32 application and also at the end of clinical trial. It was as follows before starting G32 use:-Grade I-44 patients 22 per cent; Grade II-119 patients (59.5 per cent); Grade III-37 patients (18.5 per cent). Table VI.

 

                                                                                                                                   

 

TABLE-VI TABULATION OF G.I.   INDEX

 

GI                    No. of patients              % of

I                                   44                    22.0

II                                  119                  59.5

III                                37                    18.5

 

                                                                                                           

ASSESSMENT OF RESULTS AFTER 10 WEEKS OF G32 APPLICATION

 

Results were assessed as: -

 

Good when there was complete relief from symptoms, and there was no Gingival Inflammation, no bleeding and pockets disappeared and gingiva reverted to its normal healthy state.

 

Moderate Relief when bleeding stopped and there was no oedema but redness and sponginess persisted.

 

Poor when there was practically no change in the condition.

 

RESPONSE TO G32 APPLICATION IN PREGNANCY GINGIVITIS

 

After starting G32 application, the patients were examined at the end of each week for four weeks and then at the end of 5 weeks, 8 weeks and finally 10 weeks. Complete relief from symptoms and reversal of gingiva to its normal healthy state occurred as follows:

 

1st week 12.5 per cent

2nd week 44.0 per cent

3rd week 64.0 per cent

4th week 79.0 per cent

6th week 86.0 per cent

8th week 92.2 per cent

10th week (final) 95.2 per cent

 

At the end of the trial period of ten weeks except 9 cases (Moderate: 3 cases - 1.5 per cent and poor: 6 cases 3.0 per cent), the rest of 191 cases (95.5 per cent) had complete relief.

 

All the patients were given G32 local treatment for ten weeks, the period of clinical trial. However, 15 patients who were admitted in the 3rd trimester dropped out between 6-10 weeks because of their delivery. However all the 67 patients admitted in the 3rd trimester had complete relief before their delivery and they were applying G32 in a reduced dosage. (Table VII)

 

TABLE VII RESPONSE RATE TO G32 APPLICATION IN PREGNANCY GINGIVITIS

 

Duration                       % of cases with complete relief

 

1 st week                                 12.5

2nd week                                 44.0

3rd week                                  64.0

4th week                                  79.0

6th week                                  86.0

8th week                                  92.2

10th week                                95.5                                                                

 

DISCUSSION

 

The reported incidence of pregnancy Gingivitis is high in Gravida I and the same is observed in our present series.

 

The incidence was highest during 1st trimester (53 per cent) where cases of Primi Gravida alone formed 46 per cent. Most of the cases (79 per cent) had complete relief from symptoms and the gingiva reverted to normal healthy state in four weeks of G32 application. Even in those nine epileptic cases of drug induced gingivitis who were under treatment with Dilantin there was satisfactory improvement.

 

Pregnancy Gingivitis is generally treated with scaling and curetting. These procedures

could be avoided with the application of G32. Pregnancy Epulis if untreated required surgical removal. This was avoided by the local application of G32. Oral Hygiene improved with G32 application and with its improvement pocket depth gradually decreased and finally pockets disappeared.

 

Those 67 patients who were admitted with pregnancy Gingivitis in 3rd trimester got complete relief in 4 weeks of G32 application. However, 15 of them could not complete the 10 weeks stipulated period because they delivered earlier. But at the time of their delivery, they were applying G32 in a reduced dose.

 

CONCLUSIONS

 

By the oral application of G32 for 10 weeks, there was complete Relief in 95.5 per cent, Moderate Relief in 1.5 per cent and Poor relief in 3.0 per cent in Pregnancy Gingivitis.

 

Scaling, curetting or excision could be avoided by the local application of G32 in pregnancy Gingivitis.

 

No toxicity or side effects, local or systemic were observed during treatment or after treatment.

 

ACKNOWLEDGEMENT

 

Our thanks to Alarsin Pharmaceuticals Bombay 400 023 for the co-operation given to us.

 

 

REFERENCES

 

1. Glickman's Clinical Periodontology

 

2. Loe H and Silness J. Periodontal diseases in Pregnancy Prevelence and Severity, Acta odontol Scandinavia 21:533, 1963

 

3. Ga mal H. El-Ahiry Abdal-Hady, ELKafrawy Malmound, F.M. and Nabil, Y. Gingival conditions of Egyptian pregnant women.

 

4. Marier, A.W. and Orban B. Gingivitis in pregnancy - Oral Surgery 2:334, 1949.