Evaluation of Sodium Bicarbonate as an Adjunct to Non-Surgical Periodontal Therapy and its Effect on Oxidative Stress: A Clinico-Biochemical Study

Abstract

Objectives: The purpose of the interventional study was to determine the effects of sodium bicarbonate as an adjunct to non surgical periodontal therapy in chronic periodontitis by measuring salivary malondiadehyde (MDA) levels. Methods: The study included 30 chronic periodontitis patients who were randomly assigned to test and control group. Patients were subjected to scaling and root planing. In test group, subjects were instructed to massage their teeth and gingiva with sodium bicarbonate slurry twice daily after regular brushing. Clinical parameters of Gingival Index, Plaque Index, Probing Pocket Depth and Clinical attachment level and whole saliva samples were obtained from both groups at baseline and 3 months. The salivary MDA levels were measured using colorimetric assay procedure. The Student t-test was used to analyze all parameters. Results: At 3 months follow up all the clinical parameters in both the group were significantly reduced (p<0.001). The gingival index score showed statistically significant reduction in test group (1.2 ± 4.8) and control group (0.28 ± 0.18) at 3 month interval. The difference in MDA levels at baseline and 3 months was (4.8 ± 1.94) in test group and (1.8 ±0.81) in control group. The magnitude of difference in gingival index and MDA levels in the test group was greater on intergroup comparison. Conclusions: The present study showed positive outcome in all the clinical parameters and significant reduction in salivary MDA levels with the adjunct use of sodium bicarbonate to non-surgical periodontal therapy. studied product of polyunsaturated fatty acid peroxidation. As whole saliva constitute a first line of defence against free radical mediated oxidative stress.MDA that is realeased during oxidative stress becomes one constituent of saliva and can be used as a biomarker to asses the inflamatory condition as sampling of saliva is easy, non invasive and it represents pooled sample with contribution from all periodontal sites .Thus salivary MDA levels were used to detect the inflammatory state in the study. Bacterial plaque is generally considered to be the main etiological agent. When stimulated by bacterial pathogens, host cells (eg., PMNs) release reactive oxygen species (ROS) as part of the immune response. The interactions between pathogen and host defensive capacity result in periodontal tissue breakdown. Oxidative stress lies at the heart of this periodontal tissue damage as a result of host–microbial interactions [1] . Hence, periodontal therapy has been directed at altering the periodontal environment to one which is less conducive to the retention of bacterial plaque in the vicinity of gingival tissue. It comprises of non-surgical therapy and surgical therapy. Current therapeutic guidelines for chronic periodontitis emphasize the need for control of bacterial population by scaling and root planning and maintenance of plaque control by means of patient home care. In this form of disease, the inability to control the clinical signs of disease results from either inadequate homecare or inadequate access for subgingival cleaning. Therefore, non-surgical periodontal therapy remains the core component and mainstay of successful periodontal therapy [2] . The use of a chemical agent as an adjunct to the non surgical therapy will greatly enhance patient's oral hygiene and motivation. Sodium biocarbonate (NaHCO 2 , baking soda) is one such agent which has been widely used. [3]