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J Bagh College Dentistry Vol.

25(4), December 2013 Effect of small cardamom

Effect of small cardamom extracts on Mutans streptococci


and Candida Albicans in comparison to chlorhexidine
gluconate and de-ionized water (In vivo study)
Ghada A. Ibrahim, B.D.S. (1)
Wesal A. Al – Obaidi, B.D.S., [Link]. (2)

ABSTRACT
Background: Small cardamom or green cardamom is the dried fruit of the tall perennial herbaceous plant, Elettaria
cardamomum Maton belonging to the family Zingiberaceae. The major use of small cardamom on world wide is for
domestic culinary purpose and in medicine. This study was conducted to test the effect of small cardamom extracts
on Mutans streptococci and Candida Albicans in comparison to 0.2% chlorhexidine gluconate and de-ionized water
in vivo.
Materials and Methods: Mutans streptococci and Candid Albicans were isolated, purified and diagnosed according
to morphological characteristic and biochemical test. In this experiments, the effect of control agents and small
cardamom extracts as a mouth rinses was tested on the saliva of group of volunteers to determine the level of
Mutans streptococci and Candida Albicans in vivo. Also the salivary flow rate and pH were measured in vivo.
Result: 10 % aqueous cardamom extracts had a highly significant antimicrobial activity against mutans streptococci
after 15 min after rinsing and following times. 30 % aqueous cardamom extracts had a significant antifungal activity
in vivo against Candida albican after 30 min after rinsing and following times. But still CHX is more effective than the
other agents in reduction the counts of mutans streptococci and Candida Albicans. CHX 0.2% mouth rinse had the
highest stimulation of salivary flow rates and pH followed by hot water cardamom mouth rinse 30% followed by cold
cardamom mouth rinse 10% then de-ionized water mouth rinse.
Conclusion: Cardamom extracts were effective against Mutans streptococci and Candida Albicans, but still less
than CHX.
Keywords: Mutans Streptococci, Candida Albicans, Small Cardamom, Chlorhexidine, De-ionized water. (J Bagh Coll
Dentistry 2013; 25(4):104-108).
‫اﻟﺨﻼﺻﺔ‬
‫ إن اﻻﺳﺘﺨﺪام اﻟﺮﺋﯿﺴﻲ ﻟﻠﮭﯿﻞ ﻋﻠﻰ اﻟﻨﻄﺎق اﻟﻌﺎﻟﻤﻲ ھﻮ‬.‫ اﻟﮭﺎل ﻣﺎﺗﻮن ﯾﻌﻮد إﻟﻰ اﻟﻌﺎﺋﻠﺔ اﻟﺰﻧﺠﺒﯿﻠﯿﺔ‬,‫ اﻟﮭﯿﻞ اﻟﺼﻐﯿﺮ او اﻻﺧﻀﺮ ھﻮ ﺛﻤﺮة ﻣﺠﻔﻔﺔ ﻟﻨﺒﺎت ﻋﺸﺒﻲ ﻣﻌﻤﺮ ﻃﻮﯾﻞ اﻟﻘﺎﻣﺔ‬:‫اﻟﻤﻘﺪﻣﺔ‬
‫ ﻛﻠﻮروھﻜﺴﯿﺪﯾﻦ‬%0.2 ‫ أﺟﺮﯾﺖ ھﺬه اﻟﺪراﺳﺔ ﻻﺧﺘﺒﺎر ﺗﺄﺛﯿﺮ ﻣﺴﺘﺨﻠﺺ اﻟﮭﯿﻞ اﻷﺧﻀﺮ ﻋﻠﻰ ﻧﻤﻮ ﺑﻜﺘﺮﯾﺎ اﻟﻤﯿﻮﺗﺎﻧﺰ وﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت ﺑﺎﻟﻤﻘﺎرﻧﺔ ﻣﻊ‬.‫ﻟﻺﻏﺮاض اﻟﻄﮭﻲ اﻟﻤﺤﻠﯿﺔ وﻓﻲ اﻟﻄﺐ‬
.‫ﻛﻠﻮﻛﻮﻧﯿﺖ واﻟﻤﺎء اﻟﻐﯿﺮ اﯾﻮﻧﻲ‬
‫ ﻓﻲ ھﺬة اﻟﺘﺠﺮﺑﺔ ﺗﻢ اﺧﺘﺒﺎر ﺗﺄﺛﯿﺮ اﻟﻤﻮاد‬.‫ ﺗﻢ ﺗﻨﻘﯿﺔ و ﺗﺸﺨﯿﺺ ﺑﻜﺘﺮﯾﺎ اﻟﻤﻜﻮرات اﻟﻤﺴﺒﺤﯿﺔ اﻟﻤﯿﻮﺗﺎﻧﺰ و ﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت ﺣﺴﺐ اﻟﺼﻔﺎت اﻟﺸﻜﻠﯿﺔ و اﺧﺘﺒﺎرات اﻟﻜﯿﻤﯿﺎء اﻟﺤﯿﺎﺗﯿﺔ‬:‫اﻟﻤﻮاد واﻟﻌﻤﻞ‬
‫ ﻛﺬﻟﻚ ﺗﻢ ﻗﯿﺎس إﻓﺮاز وﻗﺎﻋﺪﯾﺔ اﻟﻠﻌﺎب‬,‫اﻟﻀﺎﺑﻄﺔ و ﻣﺴﺘﺨﻠﺺ اﻟﮭﯿﻞ اﻷﺧﻀﺮ ﻛﻐﺴﻮل ﻓﻢ ﻋﻠﻰ ﻣﺠﻤﻮﻋﺔ ﻣﻦ اﻟﻤﺘﺒﺮﻋﯿﻦ ﻟﺘﺤﺪﯾﺪ ﻣﺴﺘﻮﯾﺎت ﺑﻜﺘﺮﯾﺎ اﻟﻤﻜﻮرات اﻟﻌﻘﺪﯾﺔ اﻟﻤﯿﻮﺗﺎﻧﺰ وﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت‬
.‫ﺳﺮﯾﺮﯾﺎ‬
‫ دﻗﯿﻘﺔ ﻣﻦ اﻟﻤﻀﻤﻀﺔ ﺑﮫ واﻷوﻗﺎت‬15 ‫ ﺳﺮﯾﺮﯾﺎ ﻟﮫ ﻓﺮق إﺣﺼﺎﺋﻲ ﻋﺎﻟﻲ ﻓﻲ ﺗﻘﻠﯿﻞ اﻟﻨﻤﻮ اﻟﺤﯿﻮي ﻟﻠﺒﻜﺘﺮﯾﺎ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻤﺎء اﻟﻐﯿﺮ اﻻﯾﻮﻧﻲ ﺑﻌﺪ‬%10 ‫ ﻣﺴﺘﺨﻠﺺ اﻟﮭﯿﻞ اﻟﻤﺎﺋﻲ ﺑﺘﺮﻛﯿﺰ‬:.‫اﻟﻨﺘﺎﺋﺞ‬
‫ دﻗﯿﻘﺔ ﻣﻦ اﻟﻤﻀﻤﻀﺔ ﺑﮫ واﻷوﻗﺎت‬30 ‫ ﺳﺮﯾﺮﯾﺎ ﻟﮫ ﻓﺮق إﺣﺼﺎﺋﻲ ﻓﻲ ﺗﻘﻠﯿﻞ اﻟﻨﻤﻮ اﻟﺤﯿﻮي ﻟﻔﻄﺮ اﻟﻤﺒﯿﻀﺎت ﻣﻘﺎرﻧﺔ ﺑﺎﻟﻤﺎء اﻟﻐﯿﺮ اﻻﯾﻮﻧﻲ ﺑﻌﺪ‬%30 ‫ ﻣﺴﺘﺨﻠﺺ اﻟﮭﯿﻞ اﻟﻤﺎﺋﻲ ﺑﺘﺮﻛﯿﺰ‬.‫اﻟﺘﺎﻟﯿﺔ‬
.‫ ﻛﻠﻮرھﻜﺴﺪﯾﻦ ﻛﻠﻮﻛﻮﻧﯿﺖ اﻛﺘﺮ ﻓﻌﺎﻟﯿﺔ ﻓﻲ ﺗﻘﻠﯿﻞ اﻟﻨﻤﻮ اﻟﺤﯿﻮي ﻟﺒﻜﺘﺮﯾﺎ اﻟﻤﻜﻮرات اﻟﻤﺴﺒﺤﯿﺔ وﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت‬%. 0.2. ‫اﻟﺘﺎﻟﯿﺔ‬
.‫ ﻛﻠﻮرھﻜﺴﺪﯾﻦ ﻛﻠﻮﻛﻮﻧﯿﺖ‬%0.2‫ ان ﻣﺴﺘﺨﻠﺺ اﻟﮭﯿﻞ ﻛﺎن ﻓﻌﺎﻻ ﺿﺪ ﺑﻜﺘﺮﯾﺎ اﻟﻤﯿﻮﺗﺎﻧﺰ وﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت وﻟﻜﻦ اﻗﻞ ﺗﺄﺛﯿﺮا ﻣﻦ‬:‫اﻻﺳﺘﻨﺘﺎج‬
‫ اﻟﻤﺎء اﻟﻐﯿﺮ اﯾﻮﻧﻲ‬,‫ اﻟﻜﻠﻮرھﻜﺴﺪﯾﻦ ﻛﻠﻮﻛﻨﯿﺖ‬,‫ اﻟﮭﯿﻞ اﻻﺧﻀﺮ‬,‫ ﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت‬,‫ اﻟﻤﻜﻮرات اﻟﻤﺴﺒﺤﯿﺔ اﻟﻤﯿﻮﺗﺎﻧﺰ‬:‫ﻛﻠﻤﺎت ﻣﻔﺘﺎﺣﯿﮫ‬

INTRODUCTION Treatment of dental caries and periodontal


Dental caries is a dynamic process of diseases need a lot of as cost as well manpower.
demineralization of the dental hard tissues by Prevention, including use of chemical therapies, is
products of bacterial metabolisms, alternating more cost effective as patient shifts from high -
with periods of remineralization (1). Mutans risk to low-risk level (11). Chlorhexidine is very
streptococci were found to be the predominant potent chemo-prophylatic agent (12). It has abroad
bacteria in caries process (2-4). Different spectrum action especially against Mutans
epidemiological and experimental studies showed streptococci group and Candida Albicans (12,13).
a positive association between Mutans But it has many side effects (12). Small cardamom
streptococci with initiation of carious lesion (2,4-6). or green cardamom, popularly known as ‘Queen
C. Albicans is the most common fungal pathogen of Spices’, is the dried fruit of the tall perennial
in humans. C. Albicans can also act as an herbaceous plant, Elettaria cardamomum Maton
opportunistic pathogen with the ability to cause a belonging to the family Zingiberaceae. The major
variety of infections (7). Some studies even have use of small cardamom on world wide is for
shown a significant association between C. domestic culinary purpose and in medicine. The
Albicans and dental caries in children and young aroma and medicinal properties of cardamom are
(8,9)
. Colonization of the oral cavity by C. Albicans due to the volatile oil present in it (14).There are
involves adherence of yeast cells to oral surfaces very little exclusive studies about small
(10)
. cardamom antibacterial effect on Mutans
(1) MSc student, Department of Pedodontics and Preventive streptococci and Candida Albicans. For all of the
dentistry, College of Dentistry, Baghdad University above this study was conducted.
(2) Professor, Department of Pedodontics and Preventive
dentistry, College of Dentistry, Baghdad University

Pedodontics, Orthodontics and Preventive Dentistry104


J Bagh College Dentistry Vol. 25(4), December 2013 Effect of small cardamom

MATERIALS AND METHODS 0.1 ml was taken and spread in duplicate on the
Small cardamom fruits were obtained from surface of MSB and SDA agar plates, then
AL-Shoorga market. For Mutans streptococci we incubated anaerobically for 48 hr at 37 oC, and
used cold water extract by disolve100 grams of aerobically for 24 hr at room temperature.
fruit powder of cardamom in 1000ml cold sterile
distilled water and left undisturbed for 24 then RESULTS
filtered (15).The filtered extract was concentrated Mean counts of bacteria was estimated before
under vacuum below 40oC using a rotaevaporator. and after rinsing with water extract 10%, CHX
The weight of the solid residue was recorded and gluconate, de-ionized water. CHX had the
taken as the yield of crude extract (16). For maximum reduction in the bacterial viable counts
Candida Albicans, we use hot water extract by followed by water cardamom extracts 10% while
dissolve 100grams of fruit powder of cardamom de-ionized water had the least reduction of
in 1000ml of sterile hot distilled water. The bacterial counts among the agents as in Table (1).
extract left for 48hr at room temperature then ANOVA test was used to examine the difference
centrifuged at 2000 rpm for 10 min, then filtered. among the Mutans streptococci viable counts for
The extract was incubated at 37C until it became the three mouth rinses at 5 time intervals. There
dry and stored in sterile screw capped vials in the no significant difference was found before
refrigerator until needed (17). Stimulated saliva was rinsing while a significant difference after one
collected from ten healthy looking students from minute of rinsing and a highly significant
University of AL-Mustansiriya aged (18-22) from differences was found for the rest time point
which Mutans streptococci and Candida (Table1).Mean counts of C. Albicans was
Albicans were isolated, purified, and diagnosis estimated before and after rinsing with water
according to morphological, microscopical, extract 30%, CHX gluconate, and de-ionized
biochemical test and by VITEK2 test. The total water. CHX had the maximum reduction in the
number of volunteers were 24 and they were Candida counts followed by water cardamom
divided into 4 groups (each group was made up of extracts 30% while de-ionized water had the least
6 volunteers), the first group is the experimental reduction of Candida counts among the agents as
group they used the water cardamom extract in Table (2). ANOVA test was applied to examine
mouth rinse 10%, the second group is the the difference among the Candida Albicans for the
experimental group they used the water three mouth rinses at 5 time intervals. There were
cardamom extract mouth rinse 30 %, The third no significant differences before rinsing and after
group used CHX 0.2% mouth rinse as control one minute and 15 minutes of rinsing while highly
positive and the fourth group used de-ionized significant differences were found for the rest
water mouth rinses as control negative. time point (Table 2). Salivary flow rate was
increased immediately after rinsing for the four
Procedure:- mouth rinses, rinsing with CHX and both
1.10 ml of 10%, 30% water cardamom extract, de- cardamom extracts results in marked increased in
ionized water, and chlorhexidine gluconate 0.2% the mean values of flow rates immediately after
mouth wash were prepared. rinsing which continue for half an hour then
[Link] saliva was collected by chewing a started reduction (Table 3).
piece of Arabic gum (0.5 gm) for 1 minute and Salivary pH was increased immediately after
then expectorate to remove all saliva then rinsing for the four mouth rinses, rinsing with
chewing a piece of gum (0.5 gm) for 1 minute and both cardamom extracts result in marked
collecting the saliva in screw capped bottles(18). increased in the mean values of salivary pH
Each participant was asked to rinse with immediately after rinsing which continue for half
aqueous solution for 1 minute, and then an hour then started reduction (Table 4). CHX
expectorate, stimulated salivary samples were 0.2% mouth rinse had the highest stimulation of
recollected after 1 minute, 15minutes, 30 minutes, salivary flow rates and pH followed by hot water
and 1 hour, during this time volunteers were cardamom mouth rinse 30% followed by cold
asked not to eat or drink anything except water. cardamom mouth rinse 10% then de-ionized water
Within less than 15 minutes, the pH of saliva was mouth rinse. Alcoholic extract cause burning and
measured by the digital pH meter; also the volume discomfort of the mouth and the volunteers
of saliva was measured also. Sample of saliva couldn't tolerate it. Therefore only water extract
were processed immediately, they were dispersed were used in vivo study.
for 1 minute by vortex mixer, then 0.1 ml of
saliva transferred to 0.9 ml of PBS, tenfold
dilutions were performed. From the dilution 10-3,

Pedodontics, Orthodontics and Preventive Dentistry105


J Bagh College Dentistry Vol. 25(4), December 2013 Effect of small cardamom

4. Sulaiman A. Quantitative Measurement of urea


DISCUSSION content in saliva, acquired pellicle and dental plaque in
Aqueous extract of cardamom 10% was tested relation to dental caries susceptibility in human adults.
for its effects on mutans streptococci colony Ph.D. Thesis, College of Dentistry, University of
forming unit counts among group of volunteers in Baghdad, 2000.
comparison to de-ionized water and CHX. 5. Al-Ubaidia A. The prevalence of streptococcus
Cardamom extract had highly significant Mutans biotypes among preschool children. Master
Thesis, College of Dentistry, Baghdad University,
antimicrobial activity against Mutans streptococci 1993.
as it can reduce the viable count of the bacteria 6. El-Samarrai S. Major and trace elements contents of
profoundly in comparison to de-ionized water permanent teeth and saliva, among a group of
after 15 min after rinsing and following times. adolescents, in relation to dental caries, gingivitis and
The reduction in the counts of the bacteria after 15 Mutans streptococci (in vitro and in vivo study). Ph.D.
minutes after rinsing may be explained by the thesis, College of Dentistry, Baghdad University,
2001.
assumption that Mutans streptococci were 7. Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes
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bacteriostatic action and ability to adsorb into 9. de Carvalho FG, Silva DS, Hebling J, Spolidorio LC,
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confirmed antifungal efficacy of small cardamom German Chamonile mouthwash on dental plaque and
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. But still CHX is significantly more effective Carranza's clinical periodontology. 2nd ed.
Philadelphia, W. Saunders, 2002.
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cardamom mouth rinses which continue to Agric Food Chem 2004; 52(20): 6278-82.
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to approximate the baseline after one hour. CHX activities of some Nigerian chewing sticks.
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0.2% mouth rinse had the highest stimulation of 16. Bag A, Bhattacharya S, Bharati P, Pal N,
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2. Al-Mizrakchi A. Adherence of Mutans streptococci on features of dental caries. In: Thylstrup A, Fejerskov O
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21. Al-Hussaini J, Al-Mohana M. An evaluation of the
antifungal activity of some local medicinal plants

Table 1: Mean and standard deviation of MSX104 of three mouth washes in vivo.
Time Agents No. Mean ± SD F P Description
CHX 6 268.5 19.68
base D.W. 6 268.0 24.65
3.059 0.077 NS
W.E. 10% 6 234.0 36.13
CHX 6 204.83 29.56
1 min D.W. 6 254.17 21.48 4.778 0.025 S
W.E. 10% 6 213.66 35.65
CHX 6 154.83 26.69
15 min D.W. 6 245.0 15.42 18.902 0.000 HS
W.E. 10% 6 196.33 31.44
CHX 6 116.33 22.09
49.363 0.000 HS
30 min D.W. 6 253.83 25.65
W.E. 10% 6 179.0 24.11
CHX 6 95.67 11.29
1 hr D.W. 6 259.17 27.49
89.017 0.000 HS
W.E. 10% 6 192.83 21.99
d.f=2

Table 2: Mean and standard deviation of C. albicansX102 of three mouth washes in vivo.
Time Agents No. Mean ± SD F P Description
CHX 6 14.33 5.12
base D.W. 6 11.16 3.71 0.658 0.532 NS
W.E.30% 6 13.16 5.49
CHX 6 8.16 4.16
1 min D.W. 6 9.66 3.50 0.299 0.746 NS
W.E.30% 6 9.66 3.93
CHX 6 4.66 2.73
15 min D.W. 6 8.16 3.12 2.344 0.130 NS
W.E.30% 6 6.50 2.50
CHX 6 2.83 2.31
30 min D.W. 6 9.00 3.16 9.121 0.003 HS
W.E.30% 6 4.83 2.04
CHX 6 1.83 2.04
1 hr D.W. 6 9.83 3.18 12.980 0.001 HS
W.E.30% 6 5.66 2.80
d.f=2

Pedodontics, Orthodontics and Preventive Dentistry107


Table 3: Mean and standard deviation of salivary flow rate before and after small cardamom,
CHX and D.W mouthwashes.
Time Agents No. Mean ± SD F P Description
CHX 6 3.43 0.34
D.W. 6 3.30 0.33
base 0.504 0.684 NS
W.E. 10% 6 3.45 0.50
W.E 30% 6 3.21 0.33
CHX 6 3.71 0.27
D.W. 6 3.38 0.31
1 min 1.552 0.232 NS
W.E. 10% 6 3.60 0.43
W.E. 30% 6 3.38 0.24
CHX 6 3.90 0.23
D.W. 6 3.43 0.28
15 min 3.147 0.048 S
W.E. 10% 6 3.71 0.38
W.E. 30% 6 3.51 0.21
CHX 6 4.16 0.28
D.W. 6 3.40 0.21
30 min 9.301 0.000 HS
W.E. 10% 6 3.83 0.27
W.E. 30% 6 3.68 0.24
CHX 6 4.11 0.27
D.W. 6 3.36 0.23
1 hr 9.051 0.001 HS
W.E. 10% 6 3.73 0.21
W.E. 30% 6 3.58 0.29
d.f=3

Table 4: Mean and standard deviation of salivary pH before and after cardamom extracts,
CHX and D.W mouth washes.
pH Agents No. Mean ± SD F P Description
CHX 6 7.14 0.10
D.W. 6 7.12 0.10
base 1.114 0.367 NS
W.E. 10% 6 7.05 0.07
W.E. 30% 6 7.13 0.09
CHX 6 7.30 0. 09
D.W. 6 7.17 0.08
1 min 4.599 0.013 S
W.E. 10% 6 7.13 0.05
W.E. 30% 6 7.25 0.10
CHX 6 7.42 0.09
D.W. 6 7.22 0.08 9.252 0.000 HS
15 min
W.E. 10% 6 7.20 0.06
W.E. 30% 6 7.35 0.09
CHX 6 7.60 0.07
D.W. 6 7.20 0.09
30 min 34.633 0.000 HS
W.E. 10% 6 7.25 0.04
W.E. 30% 6 7.44 0.08
CHX 6 7.66 0.07
D.W. 6 7.16 0.09
1 hr
W.E. 10% 6 7.21 0.05 47.053 0.000 HS
W.E. 30% 6 7.39 0.09
d.f=3

Pedodontics, Orthodontics and Preventive Dentistry 108

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