Avaliação in vivo do óleo essencial de Lippia sidoides nas apresentações farmacêuticas : bochecho, gel e dentifrício, frente aos Streptococcus mutans em crianças com cárie

Abstract

During a long period of time, plants have been evaluated as a source of natural products for prevention of oral diseases, especially caries and periodontal disease. The antimicrobial activity of these plants has been studied to combat pathogenic microorganisms of the mouth, among them the Lippia sidoides Cham. Considering that caries are the main oral disease affecting children at school age, it is necessary to find a safe and effective prevention of this disease. This study aimed to conduct a randomized clinical trial, from a pilot study to evaluate the effectiveness of three different dosage forms, rinses, gels and toothpaste, essential oil of Lippia sidoides Cham, facing one of the major bacteria-related disease caries: Streptococcus mutans. The survey was conducted in three phases: the first consisted of a pilot study in which 20 patients were randomly assigned to four different groups, with 5 patients in each group. Group I was treated with topical Lippia sidoides mouthrinse with 0.6%, group II Lippia sidoides mouthrinse to 0.8%, group III at 1% and group IV used mouthwash concentration of 1.2%. From the best dosage (0.8%) proceeded in the same way with the gel Lippia sidoides, also to study the best concentration (1.4%), this concentration was also used for toothpaste. The second phase of the study consisted of 100 children who were divided into five different groups at random. Group I was treated with topical Lippia sidoides mouthrinse, group II Lippia sidoides gel, chlorhexidine mouthwash group III, group IV received chlorhexidine gel and group V received toothpaste Lippia sidoides. In the case of mouthwash and gel formulations, the identification of each substance was made with letters so as not to know which antimicrobials were being applied. The patient was also unaware of which substance was being applied to it, ensuring the double-blind study. In each of the treatments were used with mouthwash 5ml, 1 minute, 1 time a day for 5 consecutive days. In each treatment gel, were used 5ml, applied in individual trays for 4 minutes, 1 time a day for 5 consecutive days. In the treatment with toothpaste was used an amount corresponding to a lump of sweet, 1 minute, 1 time a day for 5 consecutive days. The saliva of each patient was collected before starting treatment (D1), the last day of treatment (D5), 30 days after day 1 (D30), 60 days after day 1 (D60), 6 months after initiation of treatment (D180) and 1 year after initiation of treatment (D360), to verify the effectiveness of dosage forms of Lippia sidoides in the reduction of Streptococcus mutans. Before the start of treatment was a survey done by a single examiner using the visual method / tactic to calculate the number of surfaces decayed, missing and filled (DMF) to assess the emergence of new carious lesions during the course of one year after treatment. The best formulation was found the toothpaste, although when all the formulations were compared to chlorhexidine, it has shown greater efficacy in the reduction of Streptococcus mutans. This led us to conclude that the problem could be related to insufficient number of applications (only 1 time a day). So has begun the third phase of the study, which consisted of the same principles described above, but were selected only 20 children with caries, which were sprayed with Lippia sidoides dentifrice for 1 month, brushing 3 times a day. Another 20 children, also with caries, were selected to make brushing with fluoridated common folder for the same period, with the same number of daily brushings. All children received hygiene instruction in a standardized manner, so that the brushing done at home to approach the maximum of the way it has been established. The best efficacy in reducing the levels of Streptococcus mutans was observed in the dentifrice of Lippia sidoides in the group that used the common folder. There were no reported side effects; however, it was reported some improvement in the breath of children who used toothpaste rosemary. These data indicate that the plant studied can serve as an low cost alternative and culturally acceptable to the prevention of dental caries in children aged 6 to 12 years if used 3 times a day as toothpaste.