Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : ZC21 - ZC26 Full Version

Effect of Oil Pulling on pH, Buffering Capacity and Total Antioxidant Capacity of Saliva in Children: A Randomised Control Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55365.16487
Faizal C Peedikayil, Neethu Diwakar, TPremkumar Chandru, Soni Kottayi, YShibu Vardhanan, Dhanesh Narasimhan

1. Professor, Department of Paediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India. 2. PG Scholar, Department of Paediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India. 3. Professor, Department of Paediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India. 4. Professor, Department of Paediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India. 5. Associate Professor, Department of Zoology, Calicut University, Kozhikode, Kerala, India. 6. Reader, Department of Paediatric and Preventive Dentistry, Kannur Dental College, Kannur, Kerala, India.

Correspondence Address :
Dr. Faizal C Peedikayil,
Department of Paediatric Dentistry, KDC, Kannur-670 612, Kerala, India.
E-mail: drfaizalcp@gmail.com

Abstract

Introduction: Saliva is emerging as a diagnostic tool in the field of dentistry. The changes in salivary composition, its physical and chemical properties determine the state of both oral and general health. Chemical plaque control measures improve oral health, by effectively controlling the microbial load in the dental plaque and these agents are thought to alter the properties of saliva. Oil pulling with edible oils has proved to be an adjunct to routine oral hygiene methods to improve oral health.

Aim: To evaluate and compare the effect of oil pulling therapy with sesame oil and virgin coconut oil with Chlorhexidine (CHX) gargling and plain water gargling on pH, buffering capacity, and total antioxidant capacity of saliva.

Materials and Methods: A four armed randomised controlled study was conducted in 80 female children in the age group of 12-14 years from July 2019 to December 2019 in Department of Paediatric and Preventive Dentistry, Kannur Dental College, Anjarakandy, Kannur, Kerala, India. Children with mild to moderate gingivitis were selected and assigned into four groups to use different types of mouth rinsing (Group A: chlorhexidine, Group B: sesame oil , Group C: virgin coconut oil and Group D: plain water as control) for one month. Unstimulated whole saliva, collected from these participants were evaluated for the changes in pH, buffering capacity and total antioxidant capacity, at baseline and at 30 days. The data were tabulated and statistical analysis was done using ANOVA (Post-hoc), followed by Dunnet t-test, using Statistical Package for Social Sciences (SPSS) 25.0 version. Tukey post-hoc test was done to identify the significant pairs.

Results: The mean age of the study participants was 13.4 years. Intragroup comparisons showed there were statistically significant changes in the baseline to 30th day values of gingival index, values, antioxidant capacity and buffering capacity for all the experimental groups (p<0.05). Coconut oil pulling (p=0.0345) and sesame oil pulling (p=0.026) and CHX gargling (p=0.045) showed statistically significant changes in salivary buffering capacity when compared to the control. On intergroup comparisons of experimental groups, there was no statistical difference in antioxidant capacity, salivary buffering capacity and pH of the saliva (p>0.05).

Conclusion: Oil pulling with coconut oil and sesame oil had equal effectiveness as CHX on the antioxidant capacity and buffering capacity of saliva.

Keywords

Gingivitis, Oral hygiene, Plant oil, Plaque control, Potential of hydrogen

Saliva is one of the most important components in the oral environment and an integral component of oral health (1). It plays a critical role in oral homeostasis, by modulating the ecosystem within the oral cavity (2). The The main functions of the saliva are lubrication, protection, buffering action and clearance, maintenance of tooth integrity, antibacterial activity, taste perception, and digestion (3).The buffer systems, bicarbonates, and phosphates present in saliva help in the maintenance of the pH of the oral cavity between six to seven by neutralizing the acids produced by the plaque microorganisms (4).

Salivary antioxidants aids in protection against bacterial metabolic products and oxidative stress produced by these microorganisms (4). Saliva is intended to be the first line of defence against free radicals associated with diseases in the oral cavity (5),(6). Therefore, the initiation and progression of such diseases can be prevented by these antioxidants thereby controlling the plaque microorganisms which are the primary etiologic agents (7).

Oral hygiene measures are an important preventive measure to control plaque induced diseases. CHX is one of the gold standard plaque control agents but it is associated with slightly lower compliance due to its unpleasant taste and unwanted effects like staining (7). To overcome these disadvantages, attention is being given to exploring natural alternatives for oral hygiene maintenance (8).

Oil pulling or oil gargling or oil swishing is one such practice that involves placing a tablespoon of edible oils like sesame, olive, sunflower, coconut, sipped into the mouth, and swished or pulled through the teeth and oral cavity for 1-5 minutes. This system had been practiced in India as a traditional health remedy (8). Numerous studies have been conducted recently supporting this technique of oil pulling and is found to have a definite antibacterial and anti-plaque activity (9),(10). In addition to these beneficial effects, these oils also contain natural antioxidants like sesamol, sesamin, and sesamolin and polyphenols which can help in disease prevention (11),(12).

Sesame oil is an edible cooking oil derived from sesame seeds whereas Virgin Coconut Oil (VCO) is obtained from fresh and mature kernel of the coconut without undergoing chemical refining, bleaching or deodorizing (8),(9). Both oils were found to reduce the plaque related gingivitis and has been comparable to CHX (10). Therefore these oils were used in this study to know more about physiochemical changes in oral cavity by its use. The effectiveness of all these agents on oral health status can be assessed by evaluating the changes they bring about in the saliva. But literature is scarce on the comparison of the action of oil pulling therapy with other chemical plaque control agents, on salivary parameters such as buffering capacity and total antioxidant capacity. Therefore this study aims to evaluate and compare the effect of oil pulling and CHX gargling on salivary pH, buffering capacity, and total antioxidant capacity of saliva in children.

Material and Methods

A four arm randomised control study was conducted from July 2019 to December 2019 among 80 children in the age group of 12-14 years by Department of Paediatric and Preventive Dentistry, Kannur Dental College, Anjarakandy, Kannur, Kerala, India. The saliva samples were analysed for pH , buffering capacity and total antioxidant capacity at Toxicology and Biochemistry laboratory division, Department of Zoology ,Calicut University, Thenhipalam, Malappuram , Kerala state, India. The selected subjects of the study were the residents of the female residential sports school. The study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments, involving humans. Ethical clearance for the study was obtained from the Institutional Ethics Committee of Dental College (KDC/2019/221) and informed consent was taken before the study

Inclusion and Exclusion criteria: The inclusion criteria of study participants were those who were caries free with mild to moderate gingivitis. Children with caries, severe gingivitis, or any systemic diseases, history of dental treatment in previous three months and participants on regular use of mouth wash before the study were excluded from the study.

Sample size calculation: The number of samples for the study was calculated using the formula:

Where n=sample size per group Z=Normal distribution to give required power of distribution according to the pilot study, α= significance level (0.05), β power determined at 90%, Δ= size of difference. The value obtained was 18 and was rounded off to 20 per group.

The screening of the population was done by a single examiner. Gingival index by Loe and Silness was used to select the participants (13). The CONSORT 2010 guidelines were followed in this randomized control trial (Table/Fig 1). The observer who checked the subjects and the lab analysis personal was blinded regarding the intervention. The study population was divided into four groups, ie three experimental groups, and one control group, with 20 children in each group. The subjects were allotted to each group by a computer generated random number table.

Group A: CHX mouthwash (Clohex, Dr Reddy’S Laboratories Ltd. India)
Group B: Sesame oil (Pavithram , Pazhangadi Oil Industries, Kerala, India)
Group C: VCO (Nutriko , Rubco Kerala India)
Group D: Plain Water as control

Study Procedure

Baseline unstimulated salivary samples by spitting method were collected from all four groups, and pH, buffering capacity and total antioxidant capacity were checked (14). The experimental groups were advised to do CHX gargling or oil pulling under the supervision of trained observers at the residential school. The salivary samples were collected to checked at day 30, for pH, buffering capacity and total antioxidant capacity. Gingival Index was also checked at baseline and 30th day to check for changes in gingival health of each subjects.

Group A participants, were advised to dilute 5 mL of 0.2% CHX with an equal volume of water and swished in the mouth after routine tooth brushing. Group B and C were advised to sip and pull one teaspoon of sesame oil and virgin coconut oil between the teeth for five minutes, after brushing till the oil turns thin and milky white. Whereas the control group group D participants were asked to gargle with plain water after routine tooth brushing .

Unstimulated whole saliva was collected from the participants by draining method within 15-30 minutes of oil pulling or CHX gargling. The participants were advised not to eat or drink before sample collection. The collected samples were transferred to the laboratory in cryovials, placed in a mini cooler at -20 degree celsius, within a hermetically sealed box . In the laboratory, the salivary samples were immediately centrifuged at 9000 rpm, at -4 degree celsius for 12 minutes, and samples were separated into aliquots and stored under -20 degree celsius, until analysis (15).

Parameters Measured

The pH and buffering capacity were evaluated by Ericsson’s method, 1 mL of saliva was taken in a test tube, and the initial pH was measured using the digital pH meter (Eutech pH tutor) (16). After transferring 1.0 mL of the saliva to 3.0 mL (0.0033 mol per liter) HCl, and mixing thoroughly for 20 minutes to remove CO2, the final pH of the saliva was measured. The buffering capacity of the salivary samples was measured by assessing the final pH value as given in (Table/Fig 2).

The total antioxidant capacity of saliva was measured by (1,1-Diphenyl-2-picrylhydrazyl solution (DPHH) radical scavenging assay) using a microplate reader (17). This method is based on the reduction of DPPH alcoholic solution in the presence of hydrogen donating antioxidants. The reduction of DPPH radical leads to a colour change from deep violet to light yellow.

Around 150 μL of freshly prepared DPPH solution in methanol was added to 50 μL of centrifuged saliva in the wells of the microplate. The scavenging activity was assessed by using chemical and biometric assays (Biotek-Synergy). The samples were kept in darkness for 30 minutes at room temperature and the absorbance was then measured at 517 nm (AS) against methanol as blank. The absorbance of the methanol solution of DPPH was taken as control (Ac).

Free radical scavenging activity was calculated using the following relationship(18):

DPPH radical scavenging activity (%) = [(Ac – AS) /Ac] × 100.
Ac- absorbance of control
As- absorbance of the sample

The percentage scavenging of DPPH radical denotes the antioxidant activity of the sample.

Statistical Analysis

Data analysis was done using SPSS 25. ANOVA test was used to compare the means of difference in the dimensions between and within the groups. Leven’s homogeneity of variance test was done to check that homogeneity of variance. Dunnet t-test was applied to find the statistical significance between the groups, Tukey post-hoc test done to identify the significant pairs. A p-value less than 0.05 was considered statistically significant at a 95% confidence interval.

Results

About 80 female subjects in the age group of 12-14 years took part in the study. The mean age of the participants was 13.4 years. (Table/Fig 3) shows comparison of pre (at baseline) and post (at 30th day) gingival scores within the groups. A significant decrease in gingival scores was noted on CHX gargling, sesame oil, and virgin coconut oil pulling in groups, and the results were statistically significant (p<0.05). The control group did not show any significant changes.

The mean of values and the mean difference of salivary parameters between baseline and 30th day for the experimental groups CHX, coconut oil, and the control group are seen in (Table/Fig 4). Leven’s Homogeneity of variance test showed that homogeneity of variance has not been violated and is fit for parametric test using One way ANOVA.

The intragroup comparison of mean pH values of different groups at baseline and at 30th day (Table/Fig 5). The results show that values obtained were not statistically significant (p>0.05).

The intragroup comparison of comparison of mean buffering capacity values of different groups at baseline and at 30th day is seen in (Table/Fig 6). The results show that there was no statistical difference in p-values for CHX, sesame oil, coconut oil groups (p<0.05) whereas for control group there was no statistical difference (p>0.05).

(Table/Fig 7) shows the intragroup comparison of antioxidant capacity values of different groups at baseline and at 30th day. The results show that there was a statistical difference in p values for CHX, sesame oil and coconut oil groups (p<0.05), whereas for control group there was no statistical difference.

Multiple comparisons of experimental groups with that of the control (Table/Fig 8). The results showed that salivary buffering capacity of CHX (p=0.045), mean sesame oil (p=0.026) and VCO (p=0.034) were statistically significant when compared to the control. When the pH of the experimental groups were compared to the controls, no statistically significant results are obtained whereas when anti-oxidant capacity of the experimental groups were compared with the control, statistically significant results were obtained (p<0.05).

Intergroup comparisons of the experimental groups (Table/Fig 9). A Tukey post-hoc test revealed that the salivary buffering capacity, pH and free radical scavenging scores were not statistically significant (p>0.05) between the experimental groups.

Discussion

The changes in the physicochemical properties of saliva can determine the health status of an individual. Hence, it is emerging as a diagnostic tool for many oral and systemic diseases (18). In the present study, the saliva was taken as a tool, and the changes in its property like pH, buffering capacity, and total antioxidant capacity was evaluated to assess the effectiveness of oil pulling with two different oils and CHX gargling.

Oil pulling therapy has been used as a traditional Indian folk remedy to prevent tooth decay, halitosis, bleeding gums, dryness of throat, and cracked lips. The exact mechanism of oil pulling therapy on plaque inhibition is not clear. The viscosity of oil probably inhibits bacterial adhesion and plaque co-aggregation and the soap forming effect of oil produces a cleansing action over the tooth surface (19). The results of the present study showed that there was an improvement in the gingival health following oil pulling therapy with coconut oil and sesame oil. Asokan S et al., had shown sesame oil pulling is as effective as CHX in reducing plaque-induced gingivitis (20). Studies by Sheikh FS et al., and Kohle SA et al., showed the effectiveness of sesame oil on halitosis and reducing the microbial load respectively (21),(22). Peedikayil FC et al in two different studies (19),(23). had shown coconut oil pulling, reduced S.mutans count, and plaque-induced gingivitis as compared to CHX mouth wash.

Salivary parameters also get altered in oral diseases and also in patients with poor oral hygiene status (24). In the present study, the salivary pH, increased from baseline, to 30th day on CHX gargling and oil pulling. Singh S et al., had shown that the increase in salivary pH might be due to improvement in oral hygiene by controlling and reducing the microbial load in the plaque (25). Velmurugan A et al., had shown that CHX gluconate, which is charged positively, shows a high affinity for negative ions found in the cell membranes of microorganisms resulting in the disruption of the cell membrane, that resulted in a definite reduction in the microbial activity and an increase in the pH (26).

In the oral cavity, any pathology may be associated with oxidative stress. Free radicals continuously produced by the body play an important role in cellular response, like defense against an infectious agent, but in high concentrations, it damages cell structure and results in oxidative stress (27). This oxidative imbalance leads to damage of important biomolecules and cells, and their elimination is achieved by protective mechanisms referred to as antioxidants (28). In the present study, the change in antioxidant capacity of saliva with CHX gargling and oil pulling was evaluated by the free radical scavenging activity of the saliva. The study showed that CHX mouth wash and oil pulling had a statistically significant effect when compared to plain water gargling. The studies conducted by Battino M et al., and Yeung SY et al., (29),(30). Respectively, showed that CHX exhibited antioxidant properties. Besides this effect, CHX was found to inhibit superoxide radical production by neutrophils by scavenging effect or inhibition of NADPH oxidase, which mediates neutrophil Reactive Oxygen Species (ROS) production. Even though the mechanism of antioxidant activity of oils on saliva is not clear , it may be inferred that it may be due to the contribution by the phenolic compound like protocatechuic, vanillic, caffeic, syringic, ferulic and p-coumaric acids in virgin coconut oil and sesamin, sesamolin, and sesamol in sesame oil and tocopherols present in both (31). The virgin coconut oil produced through the fermentation method had also shown the strongest scavenging effect than the refined coconut oil. Phenolic antioxidants present in these oils can react directly with free radicals and convert them into stable products (32). The antioxidant activity of the tocopherols is mainly due to their ability to donate their phenolic hydrogens to free radicals (33). The studies by Nagarajappa AK et al., and Battino M et al., had shown that when mouth rinses supplemented with exogenous antioxidants, they have topical effects in the oral cavity (34),(35). This also could be the reason for the increase in the antioxidant activity of saliva by oil pulling.

Salivary buffer capacity is important because it shows the effectiveness of saliva in neutralizing acids in the oral environment (36). The results of the study shows significant decrease in buffering action of CHX, coconut oil and sesame oil after 30 days of intervention. There was a paucity of literature regarding the alteration in salivary buffering capacity following oil pulling therapy. The reason might be due to low bicarbonate concentrations in unstimulated saliva (37). Some literature have indicated that CHX has a neutralizing effect on saliva (7),(38).

Chlorhexidine on long term use alters taste sensation and produces brown staining on the teeth which is very difficult to remove and some of its constituents can cause allergic reactions. The advantages of oil pulling over CHX are that there is no staining or lingering taste, no allergy, cost effective, readily available in households and can be used for life time (39),(40). Previous studies about oil pulling were mostly comparative studies regarding the gingival health, plaque formation and microbial growth and taste perceptions as shown in (Table/Fig 10) (9),(19),(20),(23),(39),(41),(42),(43),(44).

The present study was the first study to compare the physiochemical properties such as buffering capacity and total anti-oxidant capacity of oil pulling with sesame oil and coconut oil. Due to the absence of high quality evidence in the literature regarding oil pulling, the systematic reviews and meta-analysis called for more well-designed randomised controlled trials to determine the impact of oil pulling with coconut oil on oral health (9),(10). The findings of this study will improve the quality of evidences.

Limitation(s)

Even though the study was done under supervision, there may be variations in the use of plaque control measures by the participants which may reflect in the results. Another drawback of this study is that it was conducted in a limited number of participants and for a short period of time. The fact that both genders are not included in selection of the subjects is a major drawback of this study.

Conclusion

The present study shows that coconut oil and sesame oil were effective as CHX in relation to buffering capacity, and total antioxidant capacity of saliva and could be a natural choice as an adjuvant in oral health care. Therefore it can be concluded that oil pulling reduces the risk factors for oral diseases, moreover, the buffering capacity and antioxidant activity of oil pulling contributes to salivary antioxidant system which helps in improving the defensive action of saliva against the initiation and progression of diseases in the oral cavity. Further studies with a large number of subjects and randomized controlled clinical trials using various chemotherapeutic agents can improve the quality of evidence.

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DOI and Others

DOI: 10.7860/JCDR/2022/55365.16487

Date of Submission: Feb 01, 2022
Date of Peer Review: Feb 28, 2022
Date of Acceptance: Aprl 19, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 06, 2022
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• iThenticate Software: May 25, 2022 (20%)

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