INTRODUCTION
Gingivitis marginalized is an early
stage of periodontal disease in the form of inflammation of the gingiva Analysis of
Cross-Sectional and Retrograde Data on the Prevalence of Marginal Gingivitis (Robo et al., 2020). In general, the main factor causing
gingivitis is plaque (Nataris & Santik, 2017). Plaque is a layer of biofilm on
the tooth surface consisting of microorganisms. Plaque bacteria that are not
cleaned and stick to the surface of the teeth or between the teeth, if left
unchecked, will become a toxin that will irritate the gingiva. Gums cause
infection and bleeding easily (Wijayakusuma, 2002). Tartar and plaque are the
leading causes of bleeding gums. A large amount of tartar, plaque and food
debris attached to the neck of the teeth indicates poor oral hygiene. This is
due to the position of the teeth which makes it difficult to clean. Such as
crowded teeth, so that food is easily tucked in, or a large amount of leftover
food that causes the teeth to be inaccessible with a toothbrush, for example,
the back teeth require a small brush head tip. Brushing teeth that are not
right will make the teeth less clean and even injure the gums. Prevention can
be done by maintaining optimal oral hygiene, including effective tooth brushing
and proper gargling. Good dental care will remove tartar. It was then assisted
with the consumption of vitamins and nutrients such as fruit and vegetables to
restore gum health (Rosmalia, 2021). Gingivitis is a disease that
occurs in more than 90% of the population, regardless of age and gender.
According to the World Health
Organization (WHO), chronic noncommunicable diseases, including cardiovascular
disease, cancer, chronic respiratory disease, and diabetes, remain the leading
cause of death globally, at about 70%. In addition, periodontal disease is one
of the essential oral diseases contributing to the global burden of chronic
disease and is a significant public health problem (Cardoso et al., 2018). The results of Basic Health Research
(RISKESDAS) stated that the prevalence of caries disease was 88.8% followed by
the periodontal disease which was 74.1%. Today, the most prevalent dental and
oral diseases are caries and periodontal disease caused by dental plaque.
Gingivitis marginalized is characterized
by reddish inflammation that is not persistent but prominent in areas where
bacterial plaque is concentrated (Robo et al., 2020). The primary treatment of marginal
gingivitis is maintaining a diet and oral hygiene by removing etiological
factors, such as plaque and skin control, to reduce or eliminate inflammation
and give gingival tissue a chance to heal. Plaque adheres tightly to the
surface of the teeth and can only be removed through mechanical and chemical
cleaning. Mechanical plaque control can be done using cleaning tools such as
toothbrushes, interdental cleaners and gargling, while chemical plaque control
using mouthwash (Riyanti, 2008).
Mouthwash plays an essential role in a
person's oral hygiene. It helps relieve the symptoms of gingivitis. Moreover,
reliably used to destroy pathogenic germs. Most patients use mouthwash to treat
dry mouth (xerostomia), laryngitis and sensitive teeth (Banu & Gayathri, 2016). A non-herbal mouthwash, has
side effects if used for a long time, such as staining of the teeth and the
sensation of malaise (Dwipriastuti et al., 2017). As well as more significant damage to
the sense of taste caused (Khairunnisa, 2019).
So that other alternatives are needed as
raw materials for making a mouthwash with minimal side effects, economical and
efficacious (Dwipriastuti et al., 2017). One effective and efficient effort is to
utilize herbal plants such as turmeric (Curcuma longa). Turmeric is a medicinal
plant material that has anti-inflammatory. Studies have shown that turmeric has
antioxidant, anti-inflammatory, and anti-cancer properties (Augustina et al., 2019). In line with some studies,
states that turmeric has been said to have many pharmacological effects,
including antioxidant, antimicrobial, and anti-inflammatory. Turmeric exhibits
potent antioxidant and anti-inflammatory activity (Rasyadi, 2018).
Turmeric does not cause toxic effects even if given at high doses. Tests of plant safety limits with oral LD50 safety data on rats and mice showed no acute toxic effects in both species, with the highest dose tested is 2000 mg/kg. Rats and mice also did not show any pathological abnormalities during the necropsy. In addition, oral administration of SLC up to 720 mg/kg (the highest dose tested) of body weight per day for 90 days did not cause subchronic toxicity in male and female rats (Nasser, 2020).
Turmeric is a plant widely cultivated in India, South China, Taiwan, the Philippines, and Indonesia, especially the island of Java. The rhizome of this plant is usually widely used as a raw material for kitchen spices, dyes and traditional medicine. For traditional medicine, turmeric can be used as an external or inner medicine, also said to be a ginger-like plant that is sticky and bitter but not toxic (Mutiah, 2015). The active compounds found in turmeric are essential oils, phenols, flavonoids, tannins, and saponins. These five compounds are antibacterial, antioxidant and anti-inflammatory (Kumara et al., 2019).
The
type of research used in this study is experimental Quasy with pretest and
posttesposttestt with control group design, with a sampling technique that is
purposive sampling, which consists of 2 (two) groups, namely the intervention
group and one control group. The design in this study was chosen because it was
done before and after treatment. The intervention carried out in this study was
turmeric extract mouthwash with concentrations of 2.5% and 5%. In comparison,
the control group was given a formula without active ingredients. The
respondents to be used in this study were female dormitory students aged 18
years and over, and as many as 27 people who experienced gingivitis were
marginalized. This research was conducted at the Female Dormitory of Campus 1
Poltekkes Semarang.
RESULTS AND CONCLUSIONS
Results
Based on the research conducted, namely the provision of
turmeric extract and formula without active ingredients. The decrease in
gingivitis marginalized can be seen in table 1.
Table 1. Mean Test
|
No |
Variable |
Mean |
|
|||||||||||
|
Gingival index before treatment |
Day to 1 |
Day to 2 |
Day to 3 |
Day to 4 |
Day to 5 |
|||||||||
|
1 |
Concentration
2,5% |
0,97 |
0,97 |
0,97 |
0,97 |
0,77 |
0,57 |
|
||||||
|
2 |
Concentration
5% |
1,34 |
1,34 |
1,34 |
0,73 |
0,38 |
0,16 |
|
||||||
|
3 |
FTBA |
0,84 |
0,84 |
0,84 |
0,84 |
0,84 |
0,84 |
|
||||||
Table 1. Shows that the mean test for the treatment of giving 2.5%, 5%
turmeric extract mouthwash and a formula without an active ingredient was at a
concentration of 2.5% before treatment and after treatment on day 1 to day 3 of
administration of concentration turmeric mouthwash 2.5% had the same mean value
of 0.97 which means that there had not been a decrease in the gingival index.
On the fourth day, the mean value was 0.77, which meant a decrease in marginal
gingivitis. On the fifth day, the mean value was 0.57. At a concentration of 5%
before and after treatment on day 1 to day 2 of administration, 5%
concentration of turmeric mouthwash had the same mean value of 1.35, meaning
there had not been a decrease in the gingival index. On day three, the mean
value was 0.73, meaning there had been a decrease in marginal gingivitis. On day
4, the mean value was 0.38. On day 5, the mean value was 0.16. The formula
without active ingredients before and after treatment on day 1 to day 5 had the
same mean value of 0.84, which meant no decrease in the gingival index. It can
also be seen from graphs 1,2, and 3.
Graph 1. The mean value of
the Gingival Index changes at a concentration of 2,5%
Graph 2. The mean value of
the Gingival Index changes at a concentration of 5%
Graph 3. The mean value of the Gingival Index change in a
formula without an active ingredient
Table 2. Independent
t-test difference in gingivitis marginal values between turmeric gargling
concentration of 2.5% and concentration of 5%
|
Changes in the gingival index
after treatment for five days |
Concentration 2,5% |
Concentration 5% |
Sig |
||
|
Mean±SD |
Difference (Δ) |
Mean±SD |
Difference (Δ) |
||
|
Day to 1 |
0,97±0,16 |
0,00 |
1,34±0,24 |
0,00 |
0,002 |
|
Day to 2 |
0,97±0,16 |
0,00 |
1,34±0,24 |
0,00 |
0,002 |
|
Day to 3 |
0,97±0,16 |
0,00 |
0,73±0,16 |
5,50 |
0,004 |
|
Day to 4 |
0,77±0,15 |
1,80 |
0,38±0,16 |
8,60 |
0,000 |
|
Day to 5 |
0,57±0,15 |
3,70 |
0,16±0,86 |
10,60 |
0,000 |
Table 2 shows that on days 1 and 2, with a concentration of 2.5%
compared to a concentration of 5% sig value (0.002), there was a significant
difference in marginal gingivitis (p<0.05). On day three, there was a
decrease in marginal gingivitis, and there was a significant difference between
concentration/15% and 5% with sig (0.044) due (p<0.05). P there are days 4
and 5 sig values (0.000) (p <0.05) which means turmeric mouthwash with a
concentration of 2.5% and 5% effective in reducing gingivitis marginalis
evidenced by graph two concentration of 5% effective in reducing gingivitis
marginal compared to concentration 2.5% in graph 2.
Table 3. Independent test
t-test difference in gingivitis marginalized between gargling turmeric
concentration 2.5% and formula without active ingredients
|
Changes in the gingival index after treatment for five
days |
Concentration
2,5% |
FTBA |
Sig |
||
|
Mean±SD |
Difference
(Δ) |
Mean±SD |
Difference
(Δ) |
||
|
Day to 1 |
0,97±0,16 |
0,00 |
0,84±0,21 |
0,00 |
0,901 |
|
Day to 2 |
0,97±0,16 |
0,00 |
0,84±0,21 |
0,00 |
0,901 |
|
Day to 3 |
0,97±0,16 |
0,00 |
0,84±0,21 |
0,00 |
0,901 |
|
Day to 4 |
0,77±0,15 |
1,80 |
0,84±0,21 |
0,00 |
0,044 |
|
Day to 5 |
0,57±0,15 |
3,70 |
0,84±0,21 |
0,00 |
0,000 |
Table 3 shows that on days 1 to 3, with a concentration of 2.5%
compared to formulas without active ingredients sig values (0.901), there was
no significant difference in marginal gingivitis (p>0.05). On day four,
there was a decrease in marginal gingivitis, and there was a significant difference
with the control group of formulas without active ingredients with sig (0.044)
due (p<0.05). On day 5 there was a decrease in marginal gingivitis and there
was a significant difference with the control group formula without active
ingredients with sig values (0.000) due (p<0.05). It was evidenced by graph
one at a concentration of 2.5% effective in reducing gingivitis marginal
compared to formulas without active ingredients in reducing gingivitis
marginalized in graph 3.
Table 4. Independent
t-test difference in gingivitis marginal values between turmeric gargle
concentration of 5% and formula without active ingredients
|
Changes
in the gingival index after treatment for five days |
Concentration 5% |
FTBA |
Sig Mean±SD |
||
|
Mean±SD |
Difference (Δ) |
Mean±SD |
Difference (Δ) |
||
|
Day to 1 |
1,34±0,24 |
0,00 |
0,84±0,21 |
Day to 1 |
1,34±0,24 |
|
Day to 2 |
1,34±0,24 |
0,00 |
0,84±0,21 |
Day to 2 |
1,34±0,24 |
|
Day to 3 |
0,73±0,16 |
5,50 |
0,84±0,21 |
Day to 3 |
0,73±0,16 |
|
Day to 4 |
0,38±0,16 |
8,60 |
0,84±0,21 |
Day to 4 |
0,38±0,16 |
|
Day to 5 |
0,16±0,86 |
10,60 |
0,84±0,21 |
Day to 5 |
0,16±0,86 |
Table 4 shows that on days 1 to 2 with
a concentration of 5% compared to formulas without active ingredients sig
values (0.003), there was a significant difference in marginal gingivitis
(p>0.05). On day three, there was a decrease in marginal gingivitis, and
there was a significant difference with the control group of formulas without
active ingredients with sig (0.011) due (p<0.05). On days 4 and 5, there was
a decrease in marginal gingivitis, and there was a significant difference with
the control group formula without active ingredients with sig values (0.000)
due (p<0.05). It was evidenced by graph two at a concentration of 5%
effective in reducing gingivitis marginal compared to the formula without
active ingredients in graph 3.
Table 5. Test One Way Anova
|
Changes in the gingival index after
treatment for five days |
Sig |
|
Day to 1 |
0,001 |
|
Day to 2 |
0,001 |
|
Day to 3 |
0,006 |
|
Day to 4 |
0,000 |
|
Day to 5 |
0,000 |
Table 5 shows that on days 1 and 2 between the
treatment group turmeric extract mouthwash and the control group, the formula
without the active ingredient had a sig 0.001, meaning that there was a
significant difference between the treatment group and the control group in
reducing marginal gingivitis. On day three, between the treatment group
turmeric extract mouthwash and the control group, the formula without the
active ingredient had a sig 0.006, meaning that there was a significant
difference between the treatment group and the control group in reducing
marginal gingivitis. On days 4 and 5, between the treatment group turmeric
extract mouthwash and the control group, the formula without the active
ingredient had a sig 0.000, meaning that there was a significant difference
between the treatment group and the control group in reducing marginal
gingivitis.
Table 6. Post Hoc Test
|
Changes in the gingival index after 5-day treatment |
I (Group) |
J (Group) |
Sig |
|
|
|
|
5% |
0,003 |
|
|
|
2,5% |
Formula without active ingredients |
1,000 |
|
|
|
|
2,5% |
0,003 |
|
|
Day to 1 |
5% |
Formula without active ingredients |
0,002 |
|
|
|
|
2,5% |
1,000 |
|
|
|
Formula without active ingredients |
5% |
0,002 |
|
|
|
|
5% |
0,003 |
|
|
|
2,5% |
Formula without active ingredients |
1,000 |
|
|
|
|
2,5% |
0,003 |
|
|
Day to 2 |
5% |
Formula without active ingredients |
0,002 |
|
|
|
|
2,5% |
1,000 |
|
|
|
Formula without active ingredients |
5% |
0,002 |
|
|
|
|
5% |
0,014 |
|
|
|
2,5% |
Formula without active ingredients |
1,000 |
|
|
|
|
2,5% |
0,014 |
|
|
Day to 3 |
5% |
Formula without active ingredients |
0,019 |
|
|
|
|
2,5% |
1,000 |
|
|
|
Formula without active ingredients |
5% |
0,019 |
|
|
|
|
5% |
0,000 |
|
|
|
2,5% |
Formula without active ingredients |
0,000 |
|
|
Day to 4 |
2,5% |
0,087 |
||
|
|
5% |
Formula without active ingredients |
0,000 |
|
|
|
2,5% |
0,000 |
||
|
Formula without active ingredients |
5% |
0,000 |
||
|
|
|
5% |
0,000 |
|
|
2,5% |
Formula without active ingredients |
0,903 |
||
|
|
2,5% |
0,000 |
||
|
Day to 5 |
5% |
Formula without active ingredients |
0,001 |
|
|
|
2,5% |
0,903 |
||
|
Formula without active ingredients |
5% |
0,001 |
||
*Independent T-Test **One Way Anova ***PostHoc LSD
Table 6 above shows that the significant value on day one and day two
between the 2.5% and 5% turmeric mouthwash groups was 0.003, meaning that there
was a significant difference (p <0.05) between the two concentration
turmeric mouthwash groups .5% and the formula without active ingredients had a
sig value of 1.000 meaning that there was no significant difference (p>0.05),
05). The significance value on day three between the 2.5% and 5% turmeric
mouthwash group was 0.014, meaning a significant difference (p <0.05)
between the 2.5% turmeric mouthwash group and the formula without active ingredients.
Sig 1.000 means no significant difference (p>0.05) between the 5%
concentration of turmeric mouthwash and formula without active ingredients. The
sig value of 0.019 means a significant difference (p<0.05). Significance
value on day four between the turmeric mouthwash group, the turmeric mouthwash
group with a concentration of 5% and 2.5%, a sig value of 0.087, meaning that
there was no significant difference (p>0.05), in the turmeric mouthwash
group with 5% concentration and formula without the active ingredient the sig
value of 0.000 means that there is a significant difference (p<0.05), the
significance value on day five between the 2.5% and 5% turmeric mouthwash group
is 0.000 meaning there is a significant difference (p<0, 05), between the
2.5% concentration of turmeric mouthwash group and the formula without active
ingredients, the sig value was 0.903, meaning that there was no significant
difference (p>0.05), between the 5% concentration of turmeric mouthwash
group and the formula without active ingredients, the sig value 0.001 means
that there is a significant difference (p <0.05).
Discussion
The results of data collection are obtained in table 1. Namely, the
average value of treatment every day of giving turmeric mouthwash with a
formula without active ingredients had the same mean value before and after the
treatment of turmeric mouthwash, a concentration of 2.5%, namely on days 1-3
and a concentration of 5% on days 1 and 2, while formulas without active
ingredients on days 1-5 mean that there has not been a decrease in gingivitis
marginalized. After the treatment of turmeric mouthwash concentration of 2.5%,
there was a decrease in gingivitis on days 4 and 5, at a concentration of 5%,
there was a decrease in gingivitis on days 3-5.
The effectiveness of giving turmeric extract herbal mouthwash (Curcuma
longa) with a concentration of 2.5%, 5% and a formula without active
ingredients reduces gingivitis marginalized. In the results of data collection,
ANOVA tests showed that the ability of turmeric mouthwash concentrations of
2.5%, 5% and formulas without active ingredients had significant differences,
namely on days 1 and 2, the sig value was 0.001, on day three, the sig value
was 0.006, on days 4 and 5 the sig value was 0.000. This concentration is
classified as reducing gingivitis marginalized. Following Augustina's research,
2019 states that a turmeric concentration of 1% shows promising results for
reducing inflammation in the gingiva (Augustina et al., 2019).
At concentrations of 2.5% and 5%, the formula without active
ingredients was better compared to the control group. The effect of
concentration indicates the concentration and amount of solutes contained in
the mouthwash. The higher the concentration, the greater the number of active
ingredients contained in it, so the more significant the strength of the
preparation that can have an effect, especially against plaque bacteria. The
decrease in the gingival index at these two concentrations shows that the
content in turmeric extract is excellent in reducing inflammation in the gums.
This is due to the mechanism of action of turmeric content, namely essential
oils, phenols, flavonoids, tannins, and saponins. The mechanism of action of
the active compound is as follows:
Essential oil
Essential oils contain monoterpene and sesquiterpene compounds, and yellow
dyes called curcuminoids, phosphorus, protein, iron, potassium, and Vitamin C (Wibowo, 2015). SIt
can denature and destroy the cytoplasmic membrane of the cell. Unstable cell
walls and bacterial cytoplasmic membranes will interfere with the permeability,
active transport function, and protein control of bacterial cells. The impaired
cytoplasmic integrity will cause bacterial cells to undergo lysis.
Fenol
Fenol dapat mendenaturasi protein pada bakteri sehingga sel bakteri
akan mengalami kerusakan. Kerusakan sel bakteri ini terjadi akibat penurunan
permeabilitas dinding sel bakteri yang menyebabkan pertumbuhan sel terhambat
dan akhirnya akan menyebabkan sel mati. Kumara
Flavonoids
Flavonoids can cause damage to bacterial cell walls. The damaged
bacterial cell wall will cause an increase in cell membrane permeability so
that fluid from outside the cell enters the cell and results in the rupture of
the bacterial cell.
Tannin
Tannins can form hydrogen bonds with bacterial cell proteins. If tannin
levels succeed in forming hydrogen bonds with bacterial cell proteins, it will
cause changes in bacterial cell protein molecules. Changes in these protein
molecules can disrupt bacterial cell metabolism.
Saponin
Saponins can increase cell membrane permeability so it becomes
unstable, and cell hemolysis occurs. Saponin levels also can disrupt the
surface tension of bacterial cell walls. When the surface tension of the
bacterial cell wall is disturbed, other antibacterial compounds can quickly
enter the bacterial cell and disrupt cell metabolism resulting in bacterial
death (Mutiah,
2015).
In line with research from Munasyifan 2017 states that a concentration
of 2.5% can reduce the number of polymorphonuclear leukocyte cells in the
healing process of gingivitis Rattus norvegicus (MUNASYIFA,
2017). Research from Tang, 2021 states that
turmeric significantly reduces gingival inflammation and modulates collagen
fibres and alveolar bone loss in vivo (Tang et
al., 2021). According to research from Personal,
2016 states that a concentration of 5% can decrease gingivitis (Pribadi
et al., 2016). Scientific studies reveal that
turmeric is a potent agent in managing and preventing pain and inflammation,
associated with antioxidant, anti-inflammatory, analgesic, antimicrobial, and
neuroprotective effects (Razavi
et al., 2021) A review
of therapeutic potentials of turmeric (Curcuma longa) and its active
constituent, curcumin, on inflammatory disorders, pain, and their related
patents. Research from Majeed,
2020 states that turmeric (Curcuma longa) is also proven to have potential
benefits in relieving pain and healing patients with aphthous ulcers and
gingivitis. The research that is not in line with
the research from the kumara study 2019 states that turmeric extract
concentrations of 5%, 10%, 20%, and 40% cannot inhibit the growth of
Streptococcus mutans bacteria (Rasyadi,
2018). This is because drying with direct
sunlight causes a reduction in the content of active compounds contained in the
extract, while the research I did was drying by not being directly exposed to
sunlight so that the turmeric extract content is maintained.
The results of reducing the gingival index after rinsing with 2.5% and
5% turmeric extract did not cause the gingiva to heal from inflammation because
as long as the tooth surface still has accumulated plaque, the effect of the
activity of the turmeric extract content can only reduce the severity. In
contrast, the formula without the active ingredients cannot reduce gingivitis
because the ingredients contained in this formula do not have active compounds
as antibacterial. The main action in dealing with marginal gingivitis due to
plaque is by mechanical means such as tooth brushing. Turmeric extract
mouthwash can be used as a complement after brushing teeth. Cleaning the mouth
with the use of turmeric mouthwash can clean food debris found between the
teeth so that inflammation of the gingiva can decrease. The way turmeric works
as an antibacterial and anti-inflammatory can reduce inflammation of the
gingiva. Based on the discussion above, turmeric extract mouthwash is
recommended as one of the natural ingredients that can be used to reduce
gingivitis marginalized. Besides that, getting turmeric plants is relatively
easy because they can thrive in tropical countries. Turmeric extract (Curcuma
longa) also has no side effects.
CONCLUSION
This study concludes that turmeric extracts and
herbal mouthwash effectively reduce marginal gingivitis. At a concentration of
2.5%, gingivitis marginalis decreased on days 4 and 5. At a concentration of
5%, gingivitis marginalis decreased on days 3, 4, and 5, while the most
effective mouthwash preparation in reducing gingivitis marginalized was at a
concentration of 5%.
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