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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 277-280

Development and stabilization of pH of pomegranate peel mouthwash in oral hygiene: An experimental study


Department of Swasthavritta & Yoga, Government Ayurved College and Hospital, Nagpur, Maharashtra, India

Date of Submission04-Aug-2020
Date of Decision07-Sep-2020
Date of Acceptance09-Dec-2020
Date of Web Publication11-Feb-2021

Correspondence Address:
Dr. Nikeeta Deokinandan Gupta
Department of Swasthavritta & Yoga, Government Ayurved College and Hospital, Vivekanand Colony, Mama Chowk, Behind Dr. Karlekar Hospital, Gondia, 441601, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_74_20

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  Abstract 

Oral hygiene is the key to one’s healthy life. Maintaining oral hygiene is directly related to the body’s first line of defense mechanism. It maintains both oral and systemic health. Oral microflora plays a very important role in oral hygiene. Oral microbiome is a complex ecosystem of several species of microorganisms such as streptococci, Neisseria, Veillonella, Actinomyces, and other obligate anaerobes. This microbiome is mainly affected by acidic diet and acidic environment of the oral cavity. Poor oral hygiene decreases the rate of survival of oral microbiome and causes dental caries, periodontal diseases, halitosis, oral pain, and discomfort. Globally, the prevalence of oral diseases is an increasing burden on the health sector and the economic sector. Research on oral diseases states that it affects around 3.5 billion people. It generally affects the poor and socially disadvantaged members of society. Therefore, it has been necessary to develop a mouthwash to reduce oral disorders through Ayurveda. It is developed by using powder of the pomegranate peel and by maintaining its pH. Further, it is analyzed for its organoleptic property to standardize the principles of Ayurveda. On the basis of these properties, it seems to be effective in the maintenance of oral hygiene and can reduce the chances of oral diseases. Preparation of mouthwash with this method is very easy and can be used by every socio-economic strata of society without any complication. Hence, using this mouthwash is recommended.

Keywords: Gargle, mouthwash, oral hygiene, oral microflora, organoleptic property, pH, pomegranate peel powder


How to cite this article:
Gupta ND, Jain SS, Patrikar VG. Development and stabilization of pH of pomegranate peel mouthwash in oral hygiene: An experimental study. J Indian Sys Medicine 2020;8:277-80

How to cite this URL:
Gupta ND, Jain SS, Patrikar VG. Development and stabilization of pH of pomegranate peel mouthwash in oral hygiene: An experimental study. J Indian Sys Medicine [serial online] 2020 [cited 2021 Mar 4];8:277-80. Available from: https://www.joinsysmed.com/text.asp?2020/8/4/277/309124




  Introduction Top


The oral cavity is a special organ of the human body and it is an entry point to digestive and respiratory tracts. It provides the body’s first and natural defense mechanism against various microorganisms. Hence, oral health is essential for total health and satisfactory quality of life, as it offers clues about overall health.

According to the WHO (2012), oral health is defined as a state of being free of mouth from facial pain, oral infections, oral sores, and other diseases that limit an individual’s capacity in bitting, chewing, smiling, speaking, and psychological well-being.[1] Therefore, a routine oral health checkup is essential, because changing trends of lifestyle and diet patterns increase the risk to poor oral health and hygiene in the community, especially in an urban setup. In general, oral health monitoring is neglected in modern public health.[2]

Oral disorders are among the most prevalent diseases globally, and they have a serious health and economic burden. Although oral diseases are largely preventable, children living in poverty, socially marginalized groups, and older people are most affected by oral diseases and have poor access to dental care.[3] It is stated that approximately 3.5 billion people are affected by oral diseases.[4]

Oral health can be maintained by proper oral hygiene. Oral hygiene means the practice of keeping the mouth and teeth healthy and clean by regular brushing, flossing, and tongue scraping to prevent bad odour and dental problems. Many research studies have shown that people with poor oral hygiene are at more risk of developing various oral health issues. Improper oral hygiene has a direct relationship with an increased rate of dental caries, periodontal diseases, halitosis, oral pain, and discomfort.[5]

Oral microbiome is the principle factor in maintaining both oral and systemic health. It is a complex ecosystem where several species of microorganisms are present. It has been found that around 700 species of bacteria are found in the oral cavity. The predominant group of bacteria present in the oral cavity includes streptococci, Neisseria, Veillonella, Actinomyces, and other obligate anaerobes.[6] These microorganisms are present on mucosal surfaces of the tongue, buccal mucosa, tooth surfaces, and gingival crevices. The oral microbial flora plays a very important role in the normal development of the host defense mechanism and prevents colonization of exogenous organisms.[7]

The pH of the oral cavity is 6.35 to 6.85.[8] This neutral pH and proper oral hygiene are essential for the growth of oral microflora. The acidic diet reduces the pH of the oral cavity to around 5.0. This drop in pH is lethal for bacteria and causes damage to tooth enamel. On the other hand, poor oral hygiene disturbs the function of oral microflora, which leads to gingivitis, periodontal diseases, and dental cavities.[9] In addition, poor oral hygiene has been linked to conditions such as osteoporosis, diabetes mellitus, cardiovascular diseases, infective endocarditis, and bacterial pneumonia.[10]

There are so many clinical entities related to the oral cavity. Among these, Gilayu (Tonsillitis) is the frequently occurring disease in any age group. Etiologically, it is caused by the vitiated Kapha and Rakta Doshas.[11] The prevalence of tonsillitis in the age group 11–20 years is 56% and in the age group 21–30 years it is 20%.[12] However, it is seen that 15% of all visits to the family doctor are due to chronic Tonsillitis.[13]

The causative organisms of Tonsillitis are Staphylococcus, Hemophilus influenza, Diphtheroid, etc. However, 90% of these are caused by Streptococcus pneumoniae (beta hemolytic streptococci), which is a lactobacillus. Poor oral hygiene is one of the predisposing factors for occurrence of Tonsillitis.[14],[15]

In our circumstances, we see that mouthwashes are prescribed very often by the dentist and ENT specialist, to maintain oral hygiene and to treat oral disorders. However, the side effects of mouthwash are also very common, such as taste disturbance, tooth staining, sensation of dry mouth, etc. Alcohol-containing mouthwashes may make dry mouth and halitosis worse, as they dry out the mouth.[16],[17]

Ayurveda is one of the most ancient systems of medicine. Its primary aim is to prevent the occurrence of disease. There are several procedures described in the Ayurveda classical text to maintain oral hygiene, such as Kavalagraha (oil pulling), Gandusha (oil pulls), Nasya (administration of medicine through the nose), Dhumpana (inhalation of smoke through nose), Pratisarana (application of paste or powder of drug into mouth), etc. Among these, Kavalagraha is primarily used for oral hygiene and oral disorders.

Pomegranate peel is a herbal drug; it has Kashaya Rasa, Anushna Virya, and Madhura Vipaka, which are exactly opposite to Doshic configuration of Gilayu (Tonsillitis).[18] It is cheap and easily available to people, as it is best out of waste. With the intention of development of the pomegranate peel mouthwash, standard manufacturing processes were carried out to avoid complications of formulation. Therefore, pomegranate peel mouthwash should be developed to increase its worldwide acceptability.


  Materials and Methods Top


Procurement of Raw Materials

To develop and stabilize the pH of pomegranate peel mouthwash, raw drug was identified and collected in fruit ripening season[19] under the guidance of Dravyaguna department of our institute. After cleaning, the drug was properly dried out and powdered under observation of Rasashastra and Bhaishajya Kalpana department of our Institute. That powder was marked and stored in an airtight container for further procedures. The properties of pomegranate peel powder are depicted in [Table 1].
Table 1: Properties of pomegranate peel powder

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Preparation of Mouthwash

The mouthwash was prepared as per Bhaishajya Ratnawali by the method of Shadangodaka. 1 Karsha (10 g) of pomegranate peel powder is mixed with 1 Prastha (640mL) water and boiled on low flame till half of the mixture remains. Then, the mixture is filtered with a cotton cloth[20] and analyzed for organoleptic properties and physicochemical parameters [Table 2].
Table 2: Organoleptic property and physicochemical parameter of pomegranate peel mouthwash

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The mouthwash prepared as per the method just cited tastes like an astringent having 2.50 pH, that is acidic medium. Due to this, it becomes difficult to use it for gargling as it causes a loss of taste for a short duration and acidic pH is harmful for oral microflora. To avoid this complication of formulation, some samples of mouthwash were prepared with different concentrations of pomegranate peel with water. In this procedure, the quantity of water was maintained as 100mL and the quantity of pomegranate peel powder was changed in every sample.

The samples were prepared by mixing different concentrations of pomegranate peel powder with water in a sterile beaker. This mixture was boiled on a low flame for 10min. It was filtered with a cotton cloth and it was labeled as sample 1, sample 2, sample 3, sample 4, sample 5, sample 6, sample 7, and sample 8. Then, the samples were analyzed for organoleptic and physicochemical properties [Table 3].
Table 3: pH of different concentrations of pomegranate peel mouthwash

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As we have seen, there was no remarkable change in the pH of mouthwash. Turmeric powder was mixed with Pomegranate peel powder. Turmeric is a famous antibiotic that is used daily in the Indian kitchen and it is easily available in all parts of the country. Next, sample 9 and sample 10 were prepared with different concentrations of Pomegranate peel powder and Turmeric powder with water by using the same procedure and they were analyzed for their properties [Table 4] and [Table 5]. Furthermore, a quantity of reduced sample 10 was measured with a measuring flask [Table 6].
Table 4: Organoleptic property and physicochemical parameter of pomegranate peel and turmeric mouthwash

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Table 5: pH of pomegranate peel and turmeric powder mouthwash

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Table 6: Final product proportion (sample 10)

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Instrument

Organoleptic properties such as aspect, color, smell, and taste were analyzed by simple observation and physicochemical properties of pH were checked by “Equiptronic digital pH meter, Model EQ 610 by the process of pH metery.”


  Result Top


Organoleptic properties such as aspect, color, smell, and taste and physicochemical properties of pH are described in [Table 1]. The aspect of the solution is colored liquid characterized by a brown color with the characteristic smell of dried pomegranate peel. The taste of solution is astringent with a pH of 2.50. The mouthwash prepared by mixing different concentrations of Pomegranate peel powder and water (sample 1, sample 2, sample 3, sample 4, sample 5, sample 6, sample 7, sample 8) shows a slight change in taste. Taste becomes slightly astringent, but the other properties (aspect, color, smell) remain the same. Also, a drastic change in pH level is seen in each sample [shown in [Table 3]]. Mouthwash prepared by mixing Pomegranate peel and turmeric powder with water again shows changes in its organoleptic properties and pH [Tables 4] and [5]. The quantity and proportion of the final product (sample 10) is depicted in [Table 6].


  Discussion Top


Mouthwash prepared as per Bhaishajya Ratnawali is very astringent in taste. It is seen that gargling with it causes heaviness of the tongue and loss of taste for a short duration. Also, acidic medium (pH less than 5) is harmful to dental plaque bacteria. Beside this method of preparation of mouthwash, no other specific method is available in our classical texts to prepare a solution of drugs for Kavalagraha. Therefore, mouthwash was analyzed by the physicochemical parameter pH. In Ayurveda classical texts, it is mentioned that Pomegranate peel has the properties of Mukhashuddhi (mouth cleaning) and Kanthashuddhi (throat cleaning). While preparing decoction, it has been observed that its pH is 2.50 [Table 1], which is acidic in nature. Highly acidic pH destroys tooth enamel when used for a longer duration. So, this study has been planned to make the pH of oral cavity friendly. Hence, mouthwash was prepared by taking a different concentration of Pomegranate peel powder with water and analyzed. It is seen that pH does not increase more than 5.0. In earlier studies, it was proved that turmeric has antimicrobial properties and it has been in practice for gargling for many years in our country. Hence, turmeric powder was added to prepare mouthwash.

Oral diseases disproportionately affect the poor and socially disadvantaged members of society.[1] There is a very strong and consistent association between socioeconomic status (income, occupation, and educational level) and the prevalence and severity of oral diseases. Also, in many lower-income and middle-income countries, oral diseases remain largely untreated due to their cost-effectiveness. This imposes a large economic burden on families and the health-care system.[4] The drugs used to prepare mouthwash are Pomegranate peel and turmeric. Pomegranate peel is easily available in any part of the country and it is a waste product having medical properties; turmeric is a kitchen remedy. However, both the drugs are cost-effective and can be used by people of any socioeconomic status.

According to Ayurveda, Gilayu (Tonsillitis) is caused by Vitiated Kapha and Rakta Doshas. Pomegranate peel and turmeric have Katu, Tikta, and Kashaya Rasa, which is Kaphashamaka and Pittashamaka, which exactly correlates with the Doshic configuration of Gilayu.


  Conclusion Top


After permutation and combination of different doses of Pomegranate peel and turmeric powder, it is concluded that a boiled mixture of these ingredients comprising 1 gm of Pomegranate peel powder, 1 gm of turmeric powder, and 100 ml water is considered the best solution as a mouthwash with pH 5.60. This developed combination is supposed to be effective in maintaining oral hygiene. Hence, this preparation is recommended to maintain an oral environment healthy in the form of mouthwash.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sarode DN, Bhole AV Prevalence of chronic tonsillitis at ENT inpatient department: A hospital-based study. Medpulse - Int J 2015;2:766-88.  Back to cited text no. 12
    
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Arun Raj GR, Shailaja U, Rao PN, Debnath P Chronic tonsillitis in children: An ayurvedic bird view. Int Ayu Med J 2013;1:1-7.  Back to cited text no. 13
    
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Bhargava KB, Bhargava SK, Shah TM Tonsillitis. In: A Short Textbook of E.N.T. Diseases. 5th ed. Mumbai: USHA Publications; 1999. Chapter 34, p. 250-4.  Back to cited text no. 14
    
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Philipp J Medications, Diseases Among Factors for Dry Mouth. 2015. Available from: https://www.azcentral.com/story/entertainment/life/health/2015/07/16/medications-diseases-among-factors-dry-mouth-cbt/30270419. [Last accessed on 2020 Aug 01].  Back to cited text no. 17
    
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Chunekar KC BhavprakashNighantu. Varavasi: Chaukhamba Bharti Academy; 2004. p. 582-3.  Back to cited text no. 18
    
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Agnivesha, Charaka , Dhridhabala. Madanakalpadhyaya, Kalpasathana. In: Shukla V, Tripathi R, editors. Charaksamhita of Agnivesa. Delhi: Chaukhamba Sanskrit Pratishthan; 2013. Vol 2, Chapter 1, Verse 10. p. 808.  Back to cited text no. 19
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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