PHARMACOLOGICAL STUDY OF GUAVA (PSIDIUM GUAJAVA LINN.) IN PERIODONTITIS THERAPY

• Main Author: Sulastri, Afianti
• Format: Dissertations
• Language: Indonesia
• Online Access: https://digilib.itb.ac.id/gdl/view/57155
• Institution: Institut Teknologi Bandung

Over the past two decades, the oral disease has become one of the major burdens of public health worldwide. One of them is inflammation of the periodontal tissue, namely periodontitis. Periodontitis is a multifactorial disease caused by infection with periodontal pathogenic bacteria, resulting from poor oral hygiene and nutritional imbalance, thereby increasing the colonization of pathogenic bacteria. The unkontrolled condition of periodontitis causes loss of adhesions between the teeth and gums. The phenomenon of tooth loss can harm the chewing process, aesthetics, self-confidence, and quality of life. Therefore, pharmacological therapy is needed to treat and prevent the worsening of periodontitis. Two approaches can be carried out as pharmacological therapy for the treatment of periodontitis. They are eliminating the causes of disease and overcoming the symptoms that arise due to periodontitis. Based on the aetiology, antibiotics are needed to inhibit the development of bacteria that cause periodontitis. Meanwhile, to overcome inflammatory manifestations in tissue damage, a compound with antiinflammatory activity and adequate nutrition, especially antioxidants, are needed. Anti-inflammatory agents are necessary to suppress the inflammatory process that occurs, while antioxidant agents are necessary to trigger the regeneration of tissue damaged by periodontitis. Guava (P. guajava), belonging to the Myrtaceae family, is a tropical plant with a height of approximately 35 feet. Its leaves are often used to treat various systemic pathophysiologic conditions, including diarrhoea, diabetes, and hypercholesterolemia. In addition, this plant is known to improve oral hygiene. It has been known that guava leaves and fruit are known to contain high quercetin and vitamin C. Quercetin is a class of flavonoids known to have anti-inflammatory and antioxidant activity in several chronic inflammatory therapies, including periodontitis. Meanwhile, vitamin C is a strong antioxidant and is proven to increase the body's immunity against bacteria or viruses. With these two compounds in the guava plant, it is hypothesized that this plant can support the healing of periodontitis conditions. Various studies have proven the benefits of the guava plant in supporting human health. However, no research has been done on the effect of guava supplementation on periodontitis conditions. Therefore, this study focuses on investigating which parts of the guava plant can be used to treat periodontitis and assess its therapeutic potency compared to existing treatments through pre-clinical studies using Sprague Dawley rats as models of periodontitis. This research was initiated by screening the ethanol extract from the parts of the guava plant to get the best parts used in periodontitis therapy. Qualitative and quantitative examinations on guava plants were carried out on the leaves and fruit. The guava fruit examined was taken from three different stages of maturity, namely unripe fruit, half-ripe fruit, and full-ripe fruit. Each fruit was separated into three parts, namely the exocarp (skin), the mesocarp (fruit flesh), and the fruit placenta. We examined their phytochemical properties, involving qualitative and quantitative analyses of quercetin and vitamin C. The HPLC analysis results showed that the highest quercetin level was found in the guava leaves, while the highest vitamin C level was in ripe guava fruit. The in vitro antioxidant activity test using the DPPH assay method showed that the half ripe fruit of guava (BS) had a sufficient IC-50 value as an antioxidant. Based on the regression analysis, BS was chosen for further tests. It had the optimum compostion of quercetin and vitamin C composition based on data on the yield, activity, and correlation analysis to obtain the best synergistic effect. An in vivo test on Sprague Dawley rats model of periodontitis was made using the induction method of ligature/thread binding, which had immersed in a suspension of Porphyromonas gingivalis bacteria and then attached to the lower incisors of the rats for a week. The successful induction was indicated by the formation of a periodontal pocket (PPD) with a depth of >1 mm. In its pure compound form, quercetin has been shown to provide a protective effect on rat periodontal tissue through in vivo antioxidant and anti-inflammatory mechanisms. The in vivo tests were carried out in seven groups consisting of the kontrol group (C); normal kontrol (N); the metronidazol (M), given at a dose of 45 mg/kg bw/day; the quercetin group, given at 45 mg/kg bw/day with preventive (Qp) and curative (Qc) approach; and the group given guava ethanol extract 1,35 g/kg BW/day with preventive (Gp) and curative (Gc) approach. Preventive administration of quercetin 45 mg/kg BW per day and guava ethanol extract at a dose of 1,35 g/kg BW per day orally in a group of periodontitis rats was proven to improve pocket depth, which was confirmed by histological data in the form of a decrease in the level of inflammation in periodontal tissues. The results showed that metronidazol produced improvement of periodontitis by 47% as compared to untreated group. Pure quercetin decreased PPD values by 58.7% when given preventively and 47% when administered curatively. Meanwhile, the ethanol extract of the half ripe guava fruit contains quercetin and vitamin C with a dose of 1.35 g/kg bw/day provided protective effect which was comparable to pure quercetin against periodontitis in the rat model. The combination was synergistic, through anti-inflammatory and antioxidant mechanisms, preventing tissue damage and promoting cell regenation, both preventively curatively.