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Pomegranate and Chamomile Extracts Help Reduce Bleeding in Patients with Gingivitis

Reviewed: Batista ALA, Lins RDAU, de Souza Coelho R, do Nascimento Barbosa D, Moura Belém N, Celestino FJA. Clinical efficacy analysis of the mouth rinsing with pomegranate and chamomile plant extracts in the gingival bleeding reduction. Complement Ther Clin Pract. February 2014;20(1):93-98.

Poor oral hygiene can lead to gingivitis and painful, inflamed, and bleeding gums. Gingivitis results from the buildup of a biofilm of bacteria, polysaccharides, and glycoproteins on the teeth and most often is treated by the mechanical removal of this biofilm (scaling and root planing [SRP]) in conjunction with antimicrobial mouthwash use. Chlorhexidine is the most common therapeutic ingredient in commercial antimicrobial mouthwashes, but it has a number of negative side effects that include tooth and mouth staining, loss of taste sensation, and allergic reactions. Extracts of pomegranate (Punica granatum, Punicaceae) fruit and common chamomile (Matricaria recutita, Asteraceae) flowers — also known as German or Hungarian chamomile — have been proposed as mouthwash ingredients to treat gingivitis due to their antimicrobial and anti-inflammatory properties. The goal of this randomized, reference-controlled, double-blind study was to compare the efficacy of pomegranate and chamomile extracts to chlorhexidine mouthwash in treating gingival bleeding.

The study was conducted from October 2010 to June 2011 at the Department of Clinical Dentistry at Paraíba State University in Brazil. Participants were 18 years of age or older and had gingivitis and chronic periodontitis (gum disease that can result in tooth loss and major health problems, including increased risk of heart attack). Patients were excluded if they had braces, diabetes, were pregnant or lactating, required antibiotics, or were immunocompromised. Fifty-five patients were randomly assigned to one of the following three mouthwash treatment groups: chlorhexidine (0.12% solution, n=18), pomegranate extract (n=19), and chamomile extract (n=18). The extracts were made with 100 mg of dry plant material extracted in ethanol. Antimicrobial activity was evaluated, and the extracts were diluted to 5% solutions with sterile, distilled water.

On the first day of the study, patients underwent SRP, began mouthwash treatment, received a dental hygiene orientation, and were evaluated for gingival bleeding with the Gingival Bleeding Index (GBI) — presented as a percentage of areas that bled after probing. Patients were instructed to rinse with the treatment mouthwash 30 minutes after brushing their teeth in the morning and in the evening for 15 days. GBI was evaluated seven and 15 days after treatment began. The data were evaluated by analysis of variance (ANOVA), student t-tests, and Tukey tests.

The patients’ ages ranged from 18 to 56, and 86% of the patients were women. Each of the treatments resulted in a significant reduction in gingival bleeding at seven and 15 days (all P values < 0.001). While the treatments showed differing efficacy in reducing bleeding, there were no significant differences among treatments at any of the time points measured. The chlorhexidine treatment reduced bleeding from 67.37% to 9.93%; the chamomile rinse from 76.08% to 26.68%; and the pomegranate rinse from 65.44% to 18.93% (percentages are median values). The greatest reduction in bleeding for each treatment was seen in the first seven days of the study.

Each of the mouthwashes used in this study resulted in a significant reduction in gingival bleeding. The chlorhexidine rinse resulted in the greatest reduction in bleeding, followed by pomegranate extract, but there were no significant differences in bleeding reduction among treatment groups. These results suggest that both pomegranate and chamomile extracts could be used in conjunction with SRP to reduce gingivitis. Patients did not note any adverse side effects with the treatments. Since there is evidence that chlorhexidine has limited adverse effects within the first two weeks of use, a future study in which treatment is continued for a longer period of time would be useful to assess potential adverse effects of chlorhexidine and the extracts used in this study.

—Cheryl McCutchan, PhD