Efficacy of papain-arginine gel on gingivitis treatment caused by orthodontic appliances

Orthodontic appliances can be linked to a lack of proper oral hygiene which is commonly associated with gingivitis incidence. Gingivitis treatment is required to prevent further periodontal diseases such as periodontitis, pocket formation, tooth luxation, and tooth loss. Papain is known for its anti-inflammatory, antibacterial and antioxidant effects, while arginine is known for its capability to inhibit biofilm formation and interfering plaque stability. This study aimed to demonstrate the effect of papain-arginine gel on gingivitis caused by orthodontic appliances. The gel was prepared from CMC-Na as the polymer. The papain and arginine powder was successfully dissolved homogenously into the CMC-Na in distilled water 50 mL at 25oC. Papain-arginine gel showed good stability in room temperature with pH 7. Therefore, the gel is suitable for oral application. Twenty-seven adult Sprague Dawley rats weighing ± 250–300 g were included in this study. A closing loop was placed in the margin gingiva of animal’s upper incisor to generate orthodontic force and develop reproducible gingivitis. After 7 days of orthodontic tooth movement, animals were randomly divided into three groups; the papain-arginine gel group, the chlorhexidine gel group, and the untreated group. Three rats in every group were conducted clinical observation on its gingival index (GI) and periodontal pocket depths (PPD) before and at 1, 3 and 7 days after treatment. The number of newly-formed capillaries, neutrophils and macrophages proliferation were evaluated using hematoxylin-eosin staining. The clinical response such as increasing GI and decreasing PPD on the treatment did not appear significant difference (P >.05); while the histopathological analysis showed neutrophil and macrophage proliferation were significantly higher and reached its peak on day 3 after papain-arginine and chlorhexidine gel application (P <.05). A considerably larger number of newly-formed capillary formed, and the smaller number of neutrophils and macrophages were noticed significantly at 7 days after papain-arginine and chlorhexidine gel treatment (P >.05). In early gingivitis lesion, gingiva may appear clinically healthy. However, previous studies suggested that inflammatory cells decrease indicates the process of gingivitis healing. Treatment with papain-arginine gel compared to the untreated group significantly diminished the process of inflammation. Hence, it can be concluded that papain-arginine gel was efficient in treating gingivitis caused by orthodontic appliances. © 2020 Trans Tech Publications Ltd, Switzerland.