A clinical trial evaluates the effect of pomegranate extract as a mouth wash for gingivitis in type 2 diabetic patients


  • Shayma Ghazi Oral and Maxillofacial Surgery Department, College of Dentistry, Hawler Medical University
  • Dilyar Ahmed Baban Periodontics Department, College of Dentistry, Hawler Medical University
  • Saif Monem Aziz Oral and Maxillofacial surgery Department, College of Dentistry, Hawler Medical University




gingivitis, pomegranate peel, chlorhexidine.


Background and Objectives: Type-2 diabetes mellitus (T2DM) is a systemic disease which have higher incidence of gingivitis and periodontitis. Pomegranate peel has higher content of phenolic compounds with potent anti-inflammatory, antioxidant and antibacterial activity. The aim is to evaluate the efficacy of pomegranate peel extract on the clinical and biochemical measures of (IL-1β) and the enzyme (AST) in saliva of (T2DM) patients suffering from gingivitis in comparison with chlorhexidine.

Patients and Methods: A randomized controlled clinical trial on 45 (T2DM) patients, both sexes with moderate gingivitis, age 40-55 years, (Hb1Ac) < 7%. They were randomly assigned to 3 groups undergo scaling and polishing, (15) for each group, group 1 used chlorhexidine mouthwash (0.12%), group 2 used pomegranate peel extract (6.25%) and group 3 pomegranate peel extract (12.5%). Before and after 14 days, PI, GI, BOP, salivary IL-1β and AST were evaluated.

Results: All the results for both biochemical and clinical parameters in the three groups showed significant reduction after 14 days of treatment except for the salivary IL-1β in group 1. No significant difference between group1 and group 2 except for PLI and group1 and group 3 except for IL-1β, while significant differences between group 2 and 3 after 14days of treatment except for the salivary AST, with no side effects associated with the use of pomegranate peel extract as a mouthwash at both concentrations.

Conclusion: pomegranate peel extract could be considered more effective in treating gingivitis especially at the high concentration with no considerable side effects comparing to chlorhexidine.


1. Moritz A, Mealey B. Periodontal disease, insulin resistance, and diabetes mellitus: a review and clinical implications. Grand Rounds Oral-Sys Med 2006; 2:13-20.

2. Radhika T, Kannan R. Diabetes mellitus and oral health. J Orofac Sci 2012; 4(1): 7-10.

3. Naemiratch B, Manderson L. Lay Explanations of type2 diabetes in Bangkok, Thailand. Anthropology and Medicine 2007; 14(1):83-94.

4. Katagiri S, Nitta H, Nagasawa T, Izumi Y, Kanazawa M. Effect of glycemic control on periodontitis in type 2 diabetic patients with periodontal disease. J Diabetes Investig 2013; 4(3):320–5.

5. Salgado AD, Maia JL, Pereira SL, Lemos TL, Mota OM. Antiplaque and antigingivitis effects of a gel containing punica granatum linn extract: a double - blind clinical study in humans. J Appl Oral Sci 2006; 14:162-66.

6. Orzoco A, Gemmell E, Bickel M, Seymour GJ. Interleukin-1beta, interleukin-12 and interleukin-18 levels in gingival fluid and serum of patients with gingivitis and periodontitis. Oral Microbial Immunol 2006; 21 (4):256-60.

7. Michael W. Salivary biomarker of periodontal disease in response to treatment. J Clin Periodontol 2011; 38(5):434-41.

8. Totan A, Greabu M, Totan C, Spinu T. Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases. Clin Chem Lab Med 2006; 44(5):612-5.

9. Dabra S, China K, Kaushik A. Salivary enzymes as diagnostic markers for detection of gingival/ periodontal disease and their correlation with the severity of the disease. J Indian Soc PeriodontoL 2012; 16(3):358-64. doi.org/10.4103/0972-124X.100911.

10. Zhang L, Henson BS, Camargo PM, Wong DT. The clinical value of salivary biomarkers for periodontal disease. J Periodontol 2009; 51:25- 37.

11. Lee CJ, Liang WL, Chen LG, Wang CC. Anti inflammatory effects of punica granatum linne in vitro and vivo. J Food Chem 2010; 118:315-22.

12. Saad S, Ali MN, Dahamm SS. Studies on antibacterial and antifungal activity of pomegranate. American-Euroasian J Agric and Environ Sci 2010; 9(3):273-81.

13. Prakash CVS, Prakash I. Bioactive chemical constituents from pomegranate (Punica granatum) juice, seed and peel- A Review. Int J Res Chem Environ 2011; 1:1-18.

14. Li y, Guo C, Yang J, Wei J, XU J, Cheng S. Evaluation of antioxidant properties of pomegranate peel extract in comparison with pomegranate pulp extract. Food chemistry 2006; 96(2):254-60.

15. Park S, Seok JK, Kwak JY, Suh H, Kim YM, Boo CY. Anti-inflammatory effects of pomegranate peel extract in THP-1 cells exposed to particulate matter PM10. Evidence-Based Complementary and Alternative Medicine 2016; e6836080. doi.org/10.1155/2016/6836080.

16. Sherwanin SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomark Insights 2016; 11: 95–104. doi.org/10.4137/BMI.S38440.

17. Silness J, Loe H. Periodontal disease in pregnancy ІІ. Correlation with oral hygiene and periodontal condition. Acta Odont Scand 1964; 22:121-35.

18. Ainamo D, Bay I. Problems and protocols for recording gingivitis and plaque. Int Dent D 1975; 25(4):229-35.

19. Loe H and Silness J. Periodontal disease in pregnancy 1. Prevalence and severity. Acta Odont Scand 1963; 21:533-37.

20. Nobrega MDR, Santos RL, Soares RSC, Alves PM, Medeiros ACD, Pereira JV. A randomized controlled clinical trial on the clinical and microbiological efficacy of Punica granatum Linn mouthwash. Braz Res Pediat Dent and Integrated Clinic 2015; 15(1):301-8.

21. Badawi ME, Gomaa AM. Influence of diets supplemented with pomegranate peel extract on performance in Oreochromus niloticus. Japanese Journal of Veterinary Research 2016; 64(Suppl2): S87-S94.

22. Rasheed Z, Akhtar N, Anbazhagan AN, Ramamurthy S, Shukla M, Haqqi TM. Polyphenol-rich pomegranate fruit extract (POMx) suppresses PMACI-induced expression of proinflammatory cytokines by inhibiting the activation of MAP Kinases and NF-κB in human KU812 cells. J Inflamm (Lond) 2009; 6: 1. doi.org/10.1186/1476-9255-6-1.

23. Noda Y, Kaneyuki T, Mori A, Packer L. Antioxidant activities of pomegranate fruit extract and its anthocyanidins: delphinidin, cyanidin, and pelargonidin. J Agric Food Chem 2002; 50(1):166-71.

24. Bhavna, JK, Vidhya D. Herbal mouthwash - A gift of nature. Int J Pharma and Bio Sci 2012; 3(2):47-52.

25. Kote S, Kote S, Nagesh L. Effect of pomegranate juice on dental plaque microorganisms. Anc Sci Life 2011; 31(2):49-51.

26. Menezes SM, Cordeiro LN, Viana GS. Punica granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother 2006; 6(2):79-92.

27. Leo H, Schiott C. The effect of mouthrinse and topical application of chlorhexidine on the development of dental plaque and gingivitis. J Periodontol Res 1970; 5:79-83.

28. Cascaes AM, Clark VL, Barros AJ. Effectiveness of motivational interviewing at improving oral health: a systematic review. Rev Saude Publica 2014; 48(1):142-53.

29. Zannatta FB, Antoniazzi RP, Rosing CK. Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: a randomized trial. J Appl Oral Sci 2010; 18(5):515–21.

30. Prakash J, Bhatnagar V, Nath S, Pulikkotil S, Prajapati VK. Effect of punica granatum extract gel on gingival crevicular fluid levels of interleukin1β, interleukin-8 and CCL28 levels: Randomized controlled clinical trial. Journal of Clinical and Diagnostic Research 2017; 11(11): ZC12-ZC1712.

31. Rahimabadi MS, Fani M, Rostami M, Zarshenas MM, Shams M. A traditional mouthwash (Punica granatum var pleniflora) for controlling gingivitis of diabetic patients. J Evid Based Complementary Altern Med 2017; 22(1):59–67.

32. Vechis BS. 0.1% chlorhexidine mouthwash for gingival inflammation in diabetic adults: double blind study. J Periodontol 1989; 8(3):299-310.

33. Ahuja S, Dodwad V, Kukreja BJ, Mehra P, Kukreja P. A comparative evaluation of efficacy of Punica granatum and chlorhexidine on plaque and gingivitis. J Int Clin Dent Res Organ 2011; 3(1):29-32.

34. Houri HY, Halabi A, Soskolne WA. Inflammatory response to chlorhexidine, minocycline HCl and doxycycline HCl in an in vivo mouse model. J Clin Periodontol 2008; 35(9):783-8. doi.org/10.1111/ j.1600-051X.2008.01290.x.

35. Vaughan ME, Garnick JJ. The effect of a 0.125% chlorhexidine rinse on inflammation after periodontal surgery. J Periodontol 1989.; (12):704-08.

36. Sastravaha G, Gassmann G, Sangtherapitikul P, Grimm WD. Adjunctive periodontal treatment with centella asiatica and punica granatum extracts in supportive periodontal therapy. J Int Acad Periodontol 2005; 7(3):70-9.

37. Türkoğlu O, Becerik S, Emingil G, Kütükçüler N, Baylas H, Atilla G. The effect of adjunctive chlorhexidine mouthrinse on clinical parameters and gingival crevicular fluid cytokine levels in untreated plaque-associated gingivitis. Inflamm Res 2009; 58(5):277-83.

38. Andriankaja OM, Barros SP, Moss K, Panagakos FS, DeVizio W, Beck J, Offenbacher S. Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E (2) among non-smoking subjects with gingivitis and type 2 diabetes. J Periodontol 2009; 80(2):307-16. doi.org/10.1902/jop.2009.080385.

39. Shukla M, Gupta K, Rasheed Z, Khan AK, Haqqi TM. Bioavailable constituents/metabolites of pomegranate (Punica granatum L) preferentially inhibit COX2 activity ex vivo and IL-1betainduced PGE2 production in human chondrocytes in vitro. J Inflamm (Lond) 2008; 5:9

40. Deepali C Mahajan, Usha SS, Pratima AT, Vikram AN. Evaluation of punica granatum fruit peels extract for its free radical scavenging and antiinflammatory activity. International Journal of Pharmacy and Pharmaceutical Sciences 2015; 7.




How to Cite

Ghazi S, Baban DA, Aziz SM. A clinical trial evaluates the effect of pomegranate extract as a mouth wash for gingivitis in type 2 diabetic patients. EDJ [Internet]. 2020 Jun. 6 [cited 2022 Jun. 26];3(1):24-32. Available from: https://pha.hmu.edu.krd/index.php/journal/article/view/76



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