coenzyme q10 ( co - q10 ; ubiquinone ) is a compound which is naturally found in every cell of the human body . it derives its name from the ubiquitous presence in nature and quinone structure , which is similar to that of vitamin k. it is a fat - soluble compound which forms an important link in the electron transport system of mitochondria . it is known to play a crucial role in the generation of adenosine triphosphate ( atp ) and cellular respiration . it exists in two molecular forms , ubiquinone , the oxidized form , and ubiquinole , the reduced form , which are the basis for its antioxidant properties . numerous disease processes which are linked to low levels of co - q10 can benefit from co - q10 supplementation including cardiovascular disease , parkinson 's disease , muscular dystrophy , breast and other cancers , diabetes mellitus , male infertility , acquired immunodeficiency syndrome ( aids ) , asthma , thyroid disorders , and periodontal disease . co - q10 has been the topic of research interest since 1970s , which experienced a series of trails depicting its anti - inflammatory , anti - oxidant , and immune modulatory activities . but there is scarcity of literature regarding the anti gingivitis effects of co - q10 . hence , the present study was designed with the aim to evaluate anti - gingivitis effect of coenzyme q-10 on plaque induced gingivitis . thirty patients ( 16 female and 14 male ) were recruited from the outpatient department of periodontics and implantology ; institute of dental sciences , bareilly , after obtaining ethical clearance from the ethical committee . systemically , healthy individuals with a minimum of 20 teeth present were enrolled in the study . the enrolled subjects had bleeding index ( mullerman and son ) , plaque index ( silness and loe ) , and gingival index ( loe and silness ) scores of more than 2.0 . pregnant or lactating women , subjects with any systemic disease , and those who were using anti inflammatory drugs or antibiotics for the past six months were excluded from the clinical trial . coenzyme q  10 preparation * [ figure 1f ] which was utilized had an active ingredient of 20% co - q10 cyclodextrin complex ( hydro  q  sorb ) . option a : scaling only ; option b : co  q10 along with scaling ; option c : co  q10 application only ; option d : no treatment . subjects were given a demonstration for the topical application of co  q10 , and were then instructed for night application with a cotton roll stick . eating , spitting , and drinking plaque , gingival and bleeding index was recorded at 0 , 7 , 14 , 21 , and 28 day . any oral itching , dryness , diarrhea , and taste alteration was enquired and recorded . ( a ) marked inflammation seen in all quadrants at baseline after employing treatment options ; ( b ) 7 day recall ; ( c ) 14 day recall ; ( d ) 21 day recall ; ( e ) 28 day recall ; ( f ) co - q10 material and application kit the clinical trial was statistically analyzed by two way analysis of variation , followed by post hoc tukey test for inter group comparisons at 5% level of significance and 95% confidence limit . two way anova table was employed for plaque , gingival and bleeding index depicting a significant difference due to treatment options a , b , and c at all recall visits [ figure 24 ] . the results obtained for a particular case is depicted in figure 1a through figure 1e . means.d ( plaque index ) , a : scaling ; b : coq 10 + scaling ; c : coq 10 ; d : no treatment means.d ( gingival index ) , a : scaling ; b : coq 10 + scaling ; c : coq 10 ; d : no treatment means.d ( bleeding index ) , a : scaling ; b : coq 10 + scaling ; c : coq 10 ; d : no treatment when mean  s.d for plaque index was considered significantly improved from baseline visit to 28th day recall was seen . such as 2.050.02 reduced to 1.260.03 ( option a ) ; 2.050.02 to 0.540.02 ( option b ) 2.060.02 to 1.340.04 ( option c ) , while no significant difference was seen in option d [ table 1 ] . means.d ( plaque index ) also , gingival index scores significantly improved from baseline to 28 day recall ; 2.060.02 reduced to 1.080.03 ( option a ) ; 2.080.02 reduced to 0.440.03 ( option b ) ; and 2.060.02 reduced to . 1.230.05 ( option c ) , while no significant difference was seen in option d [ table 2 ] . similarly , bleeding index scores significantly improved from baseline to 28th day recall ; 2.040.02 reduced to 1.110.04 ( option a ) ; 2.080.02 reduced to 0.390.05 ( option b ) ; and 2.070.02 reduced to 1.190.02 ( option c ) , while no significant difference was seen in option d [ table 3 ] . later post hoc tukey test was used for inter group comparison and following inferences were made . [ table 4 ] . when scaling alone was compared with co - q10 alone , application i.e ( a versus c ) ; there was no significant difference between the two treatment options depicting equal efficacy of two treatments at all recall visits . also , when scaling alone ( a ) and co q10 alone ( c ) were compared with no treatment group ( d ) . q10 ( b ) was compared with only scaling ( a ) and only co q10 ( c ) , a more significant difference was observed at all recall visits . means.d ( gingival index ) means.d ( bleeding index ) finally , when scaling along with co  q10 ( b ) was compared with no treatment group ( d ) . after randomization , the patient depicted in the picture [ figure 1a  e ] received following treatment options . first quadrant received scaling along with co - q10 application ; second quadrant received no treatment ; third quadrant was treated only with co - q10 application ; and fourth quadrant received only scaling . the clinical features improved significantly at 7 , 14 , 21 , and 28th day recalls , which were depicted by improved scores of aforementioned indices . the mechanism of co - q10 had not been known until littaru and kamamura reported its deficiency in patients with periodontal disease . co - q10 reductase enzyme , which is found in mitochondrial complex ii of the cell . this was latter supported by the works nakamura and matsumura the effect of co - q10 on the nfkb1-dependent pro - inflammatory cytokine tnf- was studied and was suggested that co - q10 exerts anti - inflammatory properties via nfb1-dependent gene expression . aforementioned is a common pathway for periodontal inflammation , suggesting that this could be the possible mechanism for gingival inflammation . patients with decreased level of serum co - q10 were at increased risk of rapid progression of gingivitis and periodontitis as compared to controls . our study has shown significant decrease in plaque , bleeding , and gingival scores , which is consistent with the earlier studies done by wilkinson et al and mcree et al , similarly , a split mouth trail conducted by hanioka demonstrated improved periodontal scores along with gingival scores when co - q10 was applied alone or as an adjunct to scaling and root planing . clinical trials on human have revealed a relation between oral administration of co - q10 and improved gingival health and immune response . our study showed similar results when co - q10 was solitary used or when used as an adjunct to scaling and root planing , although the present study was restricted only to plaque induced gingivitis and bleeding . the slight reduction or persistence of gingival inflammation of the teeth adjacent to the various treatment options could be credited to the carry cross effect of split mouth design . a study was conducted by figuero ( 2006 ) to evaluate potential oxidant / antioxidant interactions of nicotine with antioxidant coenzyme q10 in subjects with periodontitis suggesting that the catabolic effects of nicotine could be reversed by the addition of antioxidants such as coq10 . in a clinical trial of co - q10 , systemic administration on patients of aids related complex , t4/t8 ratio was increased , and they were symptom free for duration of four years . also when co- q10 was given to healthy individuals , a significant increase in t4/t8 ratio was observed . the improved clinical parameters in our study could also possibly be credited by improvement in immunity in combating periodontal insult . the present study shows promising results with the application of coenzyme - q10 solitary used and also as an adjunct to scaling and root planing for the treatment of plaque induced gingivitis ; thus , opening new treatment options by strengthening the host side of the disease interaction . further , long term trials are desired to comment on the application of co - q10 in periodontal diseases , in routine supportive periodontal therapy .
background : deficiency of co - q10 has been found to be responsible for periodontal destruction ; therefore , this study was undertaken to evaluate the anti - gingivitis effect of co - q10 on plaque induced gingivitis.materials and methods : thirty subjects with plaque induced gingivitis were enrolled in a split mouth randomized controlled trial . for each subject , scaling was randomly performed for any two quadrants , followed by the topical application of co - q10 randomly in a previously scaled and as an unscaled quadrant for a period of 28 days . 
 four treatment options were planned : option a : scaling only ; option b : co - q10 along with scaling ; option c : co-q10.results:marked reduction in gingival , bleeding , and plaque scores were recorded at the sites where c0-q10 was applied . 
 means.d of aforementioned periodontal parameters at 28th day showed significant reduction for option a , b , and c when compared with baseline.conclusion:promising results were obtained after the solitary application of co - q10 as well as when it was used as an adjunct to scaling and root planing for treatment of plaque induced gingivitis .