Article Type : Research Article
Authors : Roshan Vinayak CS, Bino A, Chandraja CV, Sisir PR, Mohan CK, Sugathan NV and Chandra Sekhara Nair K
Keywords : Dental calculus; Fragaria vesca
Dental calculus or tartar is a form of hardened dental
plate. Dental calculus develops when non mineralized biofilms, extremely rich
in oral bacteria, become mineralized with calcium phosphate mineral salts.
These mineralized biofilms form both supragingivally and subgingivally.
Fragaria vesca, commonly called wild strawberry, has the property of removing
tartar from teeth. When compared using size scales, dental calculus before and
after treatment was considerably reduced between two treatments. Similarly
stain has also showed significant reduction. Comparative study with control
group increased the transparency of effect of Fragaria vesca. Homoeopathic
therapeutics is a concealed goldmine in field of Dentistry which should be
fetched out.
In dentistry, calculus
or tartar is a form of hardened dental plaque. It is caused by precipitation of
minerals from saliva and gingival reticular fluid (GCF) in plaque on the teeth.
This process of precipitation kills the bacterial cells within dental plaque,
but the rough and hardened surface that is formed provides an ideal surface for
further plaque formation. This leads to calculus build up, which compromises
the health of the gingiva (gums). Calculus can form both along the gum line,
where it is referred to as supra gingival ("above the gum"), and
within the narrow sulcus that exists between the teeth and the gingiva, where
it is referred to as sub gingival ("below the gum"). Calculus
formation is associated with a number of clinical manifestations, including bad
breath, receding gums and chronically inflamed gingiva. Brushing and flossing
can remove plaque from which calculus forms; however, once formed, calculus is
too hard (firmly attached) to be removed with a toothbrush. Calculus build-up
can be removed with ultrasonic tools or dental hand instruments (such as a
periodontal scalar). Dental calculus develops when non mineralized biofilms,
extremely rich in oral bacteria, become mineralized with calcium phosphate
mineral salts (23). These mineralized biofilms form both supragingivally and
subgingivally (20). No mineralized dental biofilm entraps particles from the
oral cavity, including large amounts of oral bacteria, human proteins, viruses
and food remnants, and preserves their DNA. Fragariavesca, commonly called wild
strawberry, is a perennial herbaceous plant in the Rose family that grows
naturally throughout much of the Northern Hemisphere and that produces edible
fruits. F. vesca contains the ellagitannin agrimoniin which is an isomer of
sanguiin H-6. Acts on digestion and mesenteric glands. Prevents formation of
calculi. Removes tartar from teeth and prevents attacks of gout. The fruit has
refrigerant properties, strawberries produce symptoms of poisoning in certain
susceptible individuals such as urticarial rashes here give Fragaria high
potency. Part used: Ripped fruits and roots.
Source
of data
Cases visiting our
collegiate OPDs. POPULATION: 30 cases of dental calculus treated in OPDs of our
collegiate hospital has been taken for detailed study.
Sampling
Judgemental sampling
Method
of data collection
Data concerning the
variation of dental calculus is assessed through a tool, visual analogue scale
(VAS) for staining and calculating the calculus grading scale. Calculus grading
scale is 5 points (0-4) numerical rating scales performs best to analyse the
calculus intensity than descriptive method therefore VAS was preferred and
staining scale is 14 point (1-14) numerical rating scale. The cases were
recorded on our collegiate case record format. Patients were examined to
qualify the calculus intensity in visual analogue scale and it was noted down
and compared on second visit. Improvement criterions were mainly done on the
basis of comparison of photographs. Follow-ups were done for a month. The
inferences were drawn by analysing outcome. The method used in the study was
clinical method and results obtained were scientifically analysed and
evaluated.
Preparation
of mouth wash
Mouth wash was prepared thoroughly mixing 2 parts of Fragaria Vesca Q with 8 parts of water (Figure 1).
Figure 1: 7 Medicated mouth wash.
Preparation
of tooth powder
Tooth powder was prepared by thoroughly mixing 2 parts of FragariaVesca Q with 8 parts of charcoal powder (Figure 2).
Figure 2: 8 Medicated tooth powder.
Group
1
Step 1: Mouth is rinsed with water.
Step 2:
Then rinsing is done with FragariaVesca mouth wash for 2minutes.
Step 3:
Usual cleaning is done. The above steps will be repeated twice a day.
Group
2
Step 1:
Mouth is rinsed with water.
Step 2:
Then cleaning is done with FragariaVesca tooth powder for 2minutes.
Step 3: Usual cleaning is done. The above steps will be
repeated twice a day. Patients are advised to visit the collegiate dental OP
for cleaning purpose once in a week where cleaning will be done by the Dental
Surgeon with FragariaVesca Q.
It was based on
following criterion:
•
Clinical
assessment: disappearance or improvement of tartar
•
Scoring
chart based on the improvement criterion was formulated to access the efficacy
of treatment. The pre and post treatment intensity scores were then
statistically evaluated.
Selection
of tools
•
SKHMC
case record format
Inclusion
criteria
•
Age
between 19-59
•
Both
sexes.
Exclusion
criteria
•
Patients
with other dental problems like dental carries
I selected 28 participants by judgemental
sampling and respectively divided them into 2 groups. In first group, medicine
was administered with mouth wash where water is used as vehicle while the
second group was administered with tooth powder with charcoal powder as
vehicle, with 14 participants in each group. Here 7 participants from each
group is control group with single blinding.
Case
Name: Mr. X; Age: 26 yrs; Sex: Male; Address: Trivandrum (Figure 3,4).
Figure 3: Evaluation using
calculus grading scale.
The outcome of the study conducted in 28 cases of dental calculus is recorded here. These cases were followed for a minimum period of 1 month and results are mentioned below. Statistical analyses were done in order to test the significance of the pre-test and post-test scores (Table 1).
Table 1: Data showing difference in the grade of calculus and stain, before and after in participants administered with medicine.
GROUP IN MEDICINE IS
ADMINISTERED
| ||||
Sl.No |
Calculus
before |
Calculus
after |
Stain
before |
Stain
after |
1. |
4 |
3 |
9 |
5 |
2. |
3 |
2 |
6 |
4 |
3. |
3 |
2 |
7 |
3 |
4. |
4 |
3 |
8 |
4 |
5. |
3 |
2 |
10 |
6 |
6. |
2 |
2 |
8 |
4 |
7. |
3 |
2 |
7 |
5 |
8. |
4 |
2 |
10 |
4 |
9. |
4 |
2 |
11 |
5 |
10. |
3 |
2 |
9 |
4 |
11. |
4 |
3 |
10 |
5 |
12. |
3 |
2 |
8 |
4 |
13. |
3 |
2 |
9 |
4 |
14. |
2 |
2 |
7 |
3 |
Table 2: Aetiology and
comparison of calculus before and after and the results.
SL NUMBER |
T Test Of Unusual Variable |
T TEST |
PVALUE |
1 |
Case Calculus |
4.570037845 |
8.32E-05 |
2 |
Case Stain |
9.428981782 |
2.68E-09 |
3 |
Control Calculus |
0 |
0.5* |
4 |
Control Stain |
0 |
0.5* |
Medicine was
administered, and there was marked improvement in the patients administered
with medicine as compared to the control group. The data were interrupted
according to vehicle used, from aetiology and comparison of calculus before and
after and the results are presented in tables and figures. The values of the
test are given below (Table 2).
For testing of hypothesis
t-test for unequal variables is done. Here the P value for the group
administered with medicine is <0.0001 for both calculus and stain, which
implies the test is highly significant. While the P value of control group is
0.5, thus the null hypothesis is rejected and alternative hypothesis is
accepted here.
Among the 28 cases taken most of the participants were from the age group 18- 30. Generally it is found that the use of tobacco has been a major factor in the incident of dental calculus. The rate of calculus formation and the amount of calculus formed depends on multiple factors, including diet, especially alkaline foods and sugars, genetic variations in the salivary content and other factors, such as age, race, gender, and presence of disease and the bacterial load of the subject. 18 participants were confirmed smokers and the remaining 10 had an affinity towards caffeinated beverages, however the incidents of dental calculus was even worse in smokers than in tea coffee drinkers. It’s a known fact that people who smoke are more prone to dental problems as compared to others, but how severe and long lasting is it? Which is exactly the point of the research.
Figure 4: Showing difference in the grade of calculus and stain, before and after in participants administered with medicine.
Mineralised biofilms
penetrated by crystals of various calcium phosphates, develop above or below
the free gingival margin as moderately hard deposits that are white or yellow
in colour. Most of the patients who took treatment never opted for homoeopathy
in initial stage of disease as revealed by the deposition of calculus, so there
is need to spread awareness about the potential of homoeopathy in treating such
cases. Fragariavesca, commonly called wild strawberry, woodland strawberry,
Alpine strawberry, etc. is a perennial herbaceous plant in the Rose family that
grows naturally throughout much of the Northern Hemisphere and that produces edible
fruits. F vesca contains the ellagitannin agrimoniin which is an isomer of
sanguiin H-6. Acts on digestion and mesenteric glands. Prevents formation of
calculi. Removes tartar from teeth and prevents attacks of gout. The fruit has
refrigerant properties, strawberries produce symptoms of poisoning in certain
susceptible individuals such as urticarial rashes here give Fragaria high
potency. While our research point out the efficacy of FragariaVesca in removing
dental calculus. Studies have also made the superiority of charcoal powder over
the other vehicle used in the study. Participants who used tooth powder showed
faster improvement based on calculus grading scale and scale of staining.
Among the 28
participants with dental calculus, sub gingival calculus deposits were found to
be common. Out of which 18 were tobacco users and rest 10 were affected by over
use of caffeinated beverages. Most of the cases were challenging due to the old
dated deposition. Comparative study with control group increased the
transparency of effect of FragariaVesca. Homoeopathic therapeutics is a
concealed goldmine in field of Dentistry which should be fetched out.