Efektifitas Bahan Kumur Berbasis Minyak Atsiri Buah Kapulaga (Amomum Cardamommum L) Terhadap Penurunan Gas Volatile Sulfur Compound (VSC) Pada Subjek Halitosis

Abstract

Background: Halitosis or bad breath requires serious attention from health professional because it can disturb private life of patient or surrounding people. Management of halitosis usually uses antiseptic mouthwash containing alcohol. Indonesia is a country that potential to produce herbal mouthwash which capable to reduce halitosis-causing bacteria. Cardamom (Amomumcardamomum L) is a type of herbal containing essentials oils and has antibacterial effect. Aim: This study was conducted to produce standardized cardamom essential oil in mouthwash and demonstrated the effectiveness of the mouthwash in reducing the level of metil mercaptan (CH3SH), hidrogen sulfide (H2S), dimetil sulfida (CH3)2S and volatile sulfur compounds (VSC) in halitosis subjects. Research methods: The present study was conducted in three stages, 1st stage to produce standardized cardamom essential oil according to Materia Medika Indonesia which is based on determination of water content, solubility in water and ethanol, total ash and acid insoluble ash. The 2nd stage included preclinical tests to establish the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) with concentration 0,125%, 0,25%, 0,5%, 1%, 1,5%, and 2% using dilution and diffusion methods against Porphyromonas gingivalis ATTC 33277. In addition, the stability testing using pH meter and viscometer, and hedonic testing for human sense (color, smell, and taste) among 15 panels. In the clinical trial of 3rd stage, a randomized, double blind pre and post test cross over experimental design was performed among 20 healthy male and female subjects at Religion based School of Raudhatul Hasanah to compare cardamom essential oil 0,5% in mouthwash with Listerine® as positive control and placebo. Subjects were instructed to rinse with the 10cc experimental mouthwash, twice per day (on morning and afternoon) for 5 days. At baseline and after 5 days, the concentration of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide [(CH3)2S] were assessed by using oral chroma and organoleptic assessment. Statistical analysis were performed using Anova Repeated Measure. Results:The standardized cardamom essential oil in mouthwash was produced. In preclinical trial, 0.25% cardamom essential oil in mouthwash was obtained as MIC and 0.5% as MBC. Hedonic test showed 0.5% cardamom essential oil in mouthwash the highest preferred score from the panels in terms of color, taste and aroma. Stability test showed the pH value of cardamom essential oil in mouthwash was 6.5 – 6.7 with viscosity 3. It was demonstrated from clinical trial that level of CH3SH, H2S, (CH3)2S was reduced in 0.5% cardamom essential oil and Listerine® treatment group, on the other hand, there were no reduction in placebo group. It also appeared that 0.5% cardamom mouthwash could more effectively reduce VSC level when compared to placebo. ANOVA repeated measures analysis showed significant differences of cardamom essential oil in mouthwash and Listerine® groups (p=0,001 and p=0,007, respectively; p<0,05), however, there was no significant difference in placebo group (p=0,172; p>0,05). Both cardamom and Listerine® mouthwash are effective to reduce the level of VSC moreover cardamom essential oil mouthwash does not contain alcohol which can cause dry mouth and therefore it is safe. Conclusion: It can be concluded that cardamom essential oil in concentration 0,5% mouthwash can be used to overcome halitosis, therefore these cardamom mouthwash possible to become phytopharmaca drug that is useful for the community.

Latar belakang: Masalah halitosis atau bau mulut yang tidak sedap, perlu mendapat perhatian dari kalangan profesi kesehatan, karena dapat mengganggu kehidupan pribadi penderita maupun orang di sekitarnya. Penanganan halitosis biasanya menggunakan obat kumur antiseptik yang mengandung alkohol. Indonesia merupakan negara berpotensial menghasilkan obat kumur herbal non-alkohol yang mampu membunuh bakteri penyebab halitosis. Kapulaga (Amomum cardamomum L) merupakan salah satu jenis tanaman herbal yang mengandung minyak atsiri dan bersifat antibakteri. Tujuan: Penelitian ini dilakukan untuk menghasilkan obat kumur minyak atsiri buah kapulaga terstandar dan membuktikan keefektifannya dalam menurunkan kadar gas metil mercaptan (CH3SH), hidrogen sulfide (H2S), dimetil sulfida (CH3)2S dan Volatile Sulfur Compound (VSC) pada subjek halitosis. Metode Penelitian: Penelitian ini dilakukan dalam tiga tahap, tahap I untuk mendapatkan minyak atsiri kapulaga terstandar sesuai dengan persyaratan Materia Medika Indonesia yaitu dengan memeriksa kadar air, kadar sari yang larut dalam air, kadar sari yang larut dalam etanol, kadar abu total, kadar abu yang tidak larut dalam asam. Tahap II meliputi uji pre-klinis untuk menentukan Kadar Hambat Minimal (KHM) dan Kadar Bunuh Minimal (KBM) minyak atsiri kapulaga dengan konsentrasi 0,125%, 0,25%, 0,5%, 1%, 1,5% dan 2% terhadap bakteri Porphyromonas gingivalis ATTC 33277 dengan metode dilusi dan difusi. Uji stabilitas sediaan menggunakan pH meter dan viscometer, sedangkan uji hedonik/uji kesukaan dilakukan oleh 15 orang panelis terhadap warna, rasa dan aroma. Tahap III merupakan uji klinis untuk membandingkan keefektifan obat kumur minyak atsiri kapulaga 0,5% dengan Listerine® dan plasebo. Rancangan penelitian adalah randomized clinical trial dengan cross over design dan double blinded. Sampel adalah subjek halitosis pada pesantren Raudhatul Hasanah berjumlah 20 orang, yang terdiri atas laki-laki dan perempuan. Masing-masing subjek berkumur 2 kali sehari sebanyak 10 cc selama 5 hari. Pengukuran kadar gas CH3SH, H2S, (CH3)2S dan Volatile Sulfur Compound (VSC) dilakukan setiap hari (pagi dan siang hari) menggunakan alat Oral Chroma dan secara organoleptik. Analisis statistik dilakukan menggunakan uji Anova Repeated Measure. Hasil: Penelitian ini menghasilkan sediaan obat kumur minyak atsiri buah kapulaga terstandar. Hasil uji pre-klinis menunjukkan sediaan obat kumur pada konsentrasi 0,25% sebagai KHM dan 0,5% sebagai KBM. Uji stabilitas sediaan menunjukkan nilai pH obat kumur minyak atsiri kapulaga berkisar 6,5 – 6,7 dengan nilai viskositas 3. Uji hedonik menunjukkan sediaan 0,5% mendapat skor tertinggi disukai panelis dari segi rasa, warna, dan aroma. Dari uji klinis terbukti adanya penurunan kadar gas H2S, CH3SH, dan (CH3)2S pada kelompok perlakuan berkumur minyak atsiri kapulaga dan Listerine®, sebaliknya tidak dijumpai penurunan pada kelompok perlakuan plasebo. Hasil analisis statistik dengan Anova Repeated Measure menunjukkan perbedaan yang signifikan antara kelompok perlakuan berkumur dengan obat kumur minyak atsiri buah kapulaga dan Listerine®, yaitu masing-masing p=0,001 dan p=0,007 (p<0,05) sedangkan pada kelompok perlakuan plasebo tidak menunjukkan adanya perbedaan yang signifikan (p>0,05). Obat kumur minyak atsiri buah kapulaga maupun Listerine® terbukti efektif dalam menurunkan kadar gas VSC, namun kelebihan obat kumur minyak atsiri buah kapulaga tidak mengandung alkohol yang dapat menyebabkan mulut kering sehingga aman digunakan. Kesimpulan:. Sediaan obat kumur minyak atsiri buah kapulaga 0,5% efektif digunakan untuk mengatasi keluhan halitosis, oleh karena itu diharapkan dapat menjadi sediaan fitofarmaka yang bermanfaat bagi masyarakat.