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1. GUM ASTRINGENTS – MYTH OR REALITY ?
Dr. Richard Pereira* Dr. Soumya J. Shetty* Dr. Vijay K. Chava**
Abstract
Plaque and calculus are established local etiologic factors resulting
in periodontal disease. Removal of these local irritants and oral hygiene
maintenance are the mainstay of routine periodontal therapy. Several
measures in the form of astringents are also available and are promoted to
serve as adjuncts to oral prophylaxis. The purpose of our study was to
compare 2 proprietary gum astringents and evaluate their efficacy and
also to find out whether these astringents are useful adjuncts to scaling
and root planing. 30 patients were divided into 3 groups using the 2
different astringents and this was compared to a control group of 10
patients who underwent only oral prophylaxis. The results after the 6 day
study showed that gum astringents can serve as useful adjuncts to routine
scaling and root planing.
Introduction
It has been well documented that local factors especially dental
plaque is one of the main factors for the initiation of gingival and
periodontal disease2
. Supragingival plaque control is undoubtedly an
effective method of controlling gingivitis (Loe et al 1965)1
and is an
important component of periodontal therapy. However, there are also
several chemotherapeutic astringents available in the market which are
routinely promoted as effective adjuncts to oral prophylaxis and
mechanical plaque control3
. Zinc sulphate is available as 2% solution
while. Gum gel is a herbal formulation, both of which are recommended as
anti-inflammatory drugs for gingivitis.
1
* Postgraduate students
**Reader
S.D.M. College of Dental Sciences, Dharwad

2. The aim of the study was therefore to evaluate and compare the
efficacy of a 2% zinc sulfate lotion and Gum gel as adjuncts to therapy
over a one week period.
Materials and Methods
Each tube of Gum gel (Himalaya Drug Co.) contained a formulation
with potent herbs, comprising mainly of Xanthoxylym alatum, Triphala,
Punica granatum, Vitex negunda, Embelia ribes and Alpenia galanga.
The 2% zinc sulphate lotion used was marketed under the name of
Zingisol (20ml, ICPA health products Ltd.).
Experimental design
3 groups of 30 subjects were entered into a randomized double
blind, parallel design type of study. The sextant under study was the (L)
anteriors (33 to 43).
Subject selection criteria: The following subjects were entered into the
study; subjects with:
- No history of systemic disease.
- No history of any drug intake in the last 3 months.
- No history of any local drug application in last 3 months.
- Moderate gingivitis with a gingival index score of 1.1-2.1. (Loe and
Silness)
After selection, subjects received oral prophylaxis and were
randomly allotted to one of the following groups:
Group I – Control : Oral prophylaxis + gum massage with water.
Group II – Test A : Oral prophylaxis + ZnSO4 application.
Group III – Test B : Oral prophylaxis + Gum gel application.
2

3. The patients were then instructed in the Bass method of brushing, to
be practiced twice daily along with the appropriate instructions according
to the group allotted.
Method and duration of application of astringents:
The appropriate subjects were instructed to use either the zinc
sulfate / gum gel thrice daily by massaging the same on the gums for 1
minute daily. They were instructed not to eat, drink or rinse for 30 minutes
after application.
Compliance was maintained by asking the patient to return with the
allotted samples, during recall visits.
Clinical indices
Clinical index scoring was carried out by one investigator. The area
assessed was the lower anterior region from 33 to 43. All patients were
assessed at baseline 1 / 2 / 3 / 6 days for the gingival index (Loe and
Silness, 1963).
Gingival index (Loe and Silness, 1963)
0 - Normal gingiva.
1 - Mild inflammation, slight change in colour, slight edema; no
bleeding on palpation.
2 - Moderate inflammation, redness, edema and glazing; bleeding on
palpation.
3 - Severe inflammation, marked redness and edema, ulcerations;
tendency to spontaneous bleeding.
3

4. Results
Comparing the results on day 1 after application we found that there
was a significant difference between the gum paint group (GP) and control
group. There was highly significant difference between Gum gel (GG) and
control groups. However there was no significant difference between the
two astringents namely GG and GP groups.
Table showing comparison of mean difference between groups from
baseline to day 1
Period Group Mean S.D. p-value Significance
0-1
I
II
0.26
0.36
0.084
0.096
<0.05 S
I
III
0.26
0.49
0.084
0.207
<0.001 HS
II
III
0.36
0.49
0.096
0.207
>0.05 NS
4
0.26
0.36
0.49
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Mean
Group I Group II Group III
Groups
Graph I : Showing comparison of mean difference between
groups from baseline to day 1
0.26
0.36
0.49
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
Mean
Group I Group II Group III
Groups
Graph I : Showing comparison of mean difference between
groups from baseline to day 1

5. Similarly on day 2 after application, there was significant difference
between gum astringents and control group while again there was no
significant difference between either gum astringents.
Table showing comparison of mean difference between groups from
baseline to day 2
Period Group Mean S.D. p-value Significance
0-2
I
II
0.61
0.84
0.213
0.227
<0.05 S
I
III
0.61
0.80
0.213
0.133
<0.05 S
II
III
0.84
0.80
0.227
0.133
>0.05 NS
5
0.61
0.84
0.8
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Mean
Group I Group II Group III
Groups
Graph II : Showing comparison of mean difference between
groups from baseline to day 2
0.61
0.84
0.8
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Mean
Group I Group II Group III
Groups
Graph II : Showing comparison of mean difference between
groups from baseline to day 2

6. On day 3, once again similar results were observed, with gum
astringents proving to be better than the control group.
Table showing comparison of mean difference between groups from
baseline to day 2
Period Group Mean S.D. p-value Significance
0-3
I
II
0.82
0.99
0.198
0.196
<0.05 S
I
III
0.82
1.03
0.198
0.094
<0.10 S
II
III
0.99
1.03
0.196
0.094
>0.05 NS
6
0.82
0.99
1.03
0
0.2
0.4
0.6
0.8
1
1.2
Mean
Group I Group II Group III
Groups
Graph III : Showing comparison of mean difference
between groups from baseline to day 3
0.82
0.99
1.03
0
0.2
0.4
0.6
0.8
1
1.2
Mean
Group I Group II Group III
Groups
0.82
0.99
1.03
0
0.2
0.4
0.6
0.8
1
1.2
Mean
Group I Group II Group III
Groups
Graph III : Showing comparison of mean difference
between groups from baseline to day 3

7. After 1 week of application yet again, gum astringents consistently
offered significantly better results than the control group but again, no
difference in efficacy was seen between either gum gel or ZnSo4.
Table showing comparison of mean difference between groups from
baseline to day 2
Period Group Mean S.D. p-value Significance
0-6
I
II
1.08
1.35
0.209
0.150
<0.001 S
I
III
1.08
1.29
0.209
0.185
<0.05 S
II
III
1.35
1.29
0.150
0.185
>0.05 NS
7
1.08
1.35
1.29
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mean
Group I Group II Group III
Groups
Graph IV : Showing comparison of mean difference between
groups from baseline to day 6
1.08
1.35
1.29
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mean
Group I Group II Group III
Groups
Graph IV : Showing comparison of mean difference between
groups from baseline to day 6

8. Discussion
Astringents are agents which act by precipitating blood proteins,
causing a mechanical obstruction to hemorrhage from injured blood
vessels. Various astringents like tannic acid, zinc sulphate and herbal
formulations are promoted in the market to aid as adjuncts to routine oral
prophylaxis.
Zinc salts possess astringent, corrosive and weak antiseptic
properties. Externally zinc sulphate is used as an astringent lotion to assist
granulation formation. Gum gel is a herbal formulation also promoted to
have an astringent effect and meant for treatment for gingivitis. Being a
herbal derivative, it is believed to be safer with lesser adverse effects.
Removal of local irritants by scaling and root planing is
undoubtedly the mainstay of initial periodontal therapy. The aim of this
study was to evaluate whether these astringents could be used as adjuncts
to therapy. Interestingly results showed that astringents did show a
significant reduction in inflammation as compared to only oral prophylaxis.
However there was no significant difference between the 2 astringents at
any point in time during the 6 day study period.
Conclusion
Astringents showed significant reduction inflammation as compared
to plain oral prophylaxis but no significant difference was seen between the
two astringents tested. These findings from the above study go to prove
that gum astringents can serve as effective adjuncts to therapy. They may
therefore not be a plain myth but possibly a reality.
8

9. References
1. Loe H., Theilade E., James S.B. : Experimental gingivitis in man.
Journal of Periodontology, 1965; 36 : 177-187.
2. Listgarten M.A. : The role of dental plaque in gingivitis and
periodontitis. Journal of Clinical Periodontology, 1988; 15 : 485-
487.
3. Mandel I.D. (1988) : Chemotherapeutic agents for controlling
plaque and gingivitis. Journal of Clinical Periodontology, 15 : 488-
498.
4. Satoskar R.S., Bhandarkar S.D., Ainapure S.S. : Pharmacology
and Pharmacotherapeutics. 16th
Edition, 1999.
9

10. References
1. Loe H., Theilade E., James S.B. : Experimental gingivitis in man.
Journal of Periodontology, 1965; 36 : 177-187.
2. Listgarten M.A. : The role of dental plaque in gingivitis and
periodontitis. Journal of Clinical Periodontology, 1988; 15 : 485-
487.
3. Mandel I.D. (1988) : Chemotherapeutic agents for controlling
plaque and gingivitis. Journal of Clinical Periodontology, 15 : 488-
498.
4. Satoskar R.S., Bhandarkar S.D., Ainapure S.S. : Pharmacology
and Pharmacotherapeutics. 16th
Edition, 1999.
9