Gingivitis is an inflammatory condition that is prompted by the accumulation of dental biofilm, which causes gingival (gum around the base of the tooth) swelling and redness. The more progressive form of inflammation that stems from a variety of factors, including oral bacteria and host immunity, is called periodontitis.
Mangosteen is a tropical fruit which is a rich source of xanthones, including α-mangostin, β-mangostin, and γ-mangostin. Xanthones have been shown to exhibit various pharmacological properties, including antioxidant, antimicrobial, anti-carcinogenic, anti-allergic and anti-inflammatory activity by inhibiting the production of nitrous oxide, TNF-α, and interleukin-8.
A randomised clinical trial using local delivery of 4% mangostana gel into the periodontal pockets of chronic periodontitis patients showed significant improvement in periodontal parameters.
Propolis is a viscous substance produced by bees that comprises flavonoids, cinnamic acids, caffeic acids, and caffeic acid phenethyl ester and exhibits antimicrobial, anti-inflammatory, and antioxidant properties.Propolis has been locally delivered in various forms, such as mouthwash, toothpaste, irrigation, and subgingival gel, and has been reported to reduce plaque formation and exhibit antimicrobial effects against some key periodontal pathogens.
Furthermore, propolis has been studied extensively for its anti-oxidative property, which could be beneficial for treatment of periodontitis, as reduction in oxidative stress may decrease secretion of pro-inflammatory cytokines and prevent alveolar bone loss.However, there are no clinical studies up to date to verify the efficacy and safety of both mangosteen and propolis in combination.
The current multi-centered, double-blinded, parallel-armed, placebo-controlled randomized clinical trial therefore set out to evaluate the clinical and immunological efficacy of MAEC as well as safety and patient-reported outcomes (PROMs) on gingivitis and incipient periodontitis.
The trial involved a total of 104 patients (aged 20-75) diagnosed with gingivitis or incipient periodontitis enrolled from Yonsei University Dental Hospital, Kyung Hee University Dental Hospital, and Veterans Health Service Medical Center, in Korea. Participants were randomly allocated to either the test group, with daily intake of a single capsule containing 194 mg of MAEC for eight weeks, or control group, where they were given a placebo.
Researchers assessed saliva and gingival sulcular fluid by undertaking clinical periodontal evaluation and immunological parameters at baseline, four, and eight weeks.
A total of 80 participants completed the trial and were included in the final data analysis.
From the results, the researchers found daily ingestion of MAEC resulted in a considerable variation of modified gingival index (GI) at four and eight weeks between the test and placebo groups. Also, a daily intake of the 194 mg dose was safe and without any considerable adverse events. In addition, MAEC intake led to a considerable improvement in PROMs compared to placebo.
The researchers concluded that the oral administration of MAEC has a potential to reduce the resulting impact of gingival inflammation, both clinically and immunologically, in patients with gingivitis and incipient periodontitis.
They say the MAEC in this study has been studied previously to determine its anti-inflammatory effect. In addition, the anti-inflammatory effect of MAEC was greater than when mangosteen and propolis extracts were used alone and in combinations with varying concentrations, which suggests that there might be a synergistic effect between the two substances in that specific combination.
They point out the immunological parameters were inconclusive to determine the complex interactions between the MAEC, innate immune system, and the cascade of MMP/cytokine reactions therefore this data should be interpreted with caution and remain open for discussion in future research. However the enhanced parameters from blood tests along with PROM can place MAEC in the positive light as a dietary supplement.
Park JY, Ko KA, Lee JY et
“Clinical and Immunological Efficacy of Mangosteen and Propolis Extracted Complex in Patients with Gingivitis: A Multi-Centered Randomized Controlled Clinical Trial”