J Bagh College Dentistry

Vol. 23(1), 2011

Effect of water extracts of cinnamon

Effect of water extracts of cinnamon on the microhardness

of initial carious lesion of permanent teeth, compared to
stannous fluoride (An in vitro study)
Maha J. Al Anni M. Sc. (1)

ABSTRACT
Background: The attention of this study was to assess the effect of water extracts of cinnamon on the microhardness
of artificially initiated carious lesion of the outer enamel surfaces, and compared with that stannous fluoride, while
de-ionized water was used as control negative.
Materials and methods: Teeth were subjected to Vicker's microhardness test before and after PHcycle and
following the treatment with different concentration of selected solution.
Results: stannous fluoride in addition to water extract of cinnamon at 1%, 5 and 10% succeeded in the
remineralization of artificially initiated carious lesion. This was indicated by the increase in the values of the
microhardness.
Conclusion :maximum changes in he microhardness values of enamel was recorded for stannous fluoride 8%,10%
while water cinnamon extract at 10% the less changes in the microhardness for all study groups.
Key wards: microhardness, Cinnamon, SnF2, remineralization, demineralization. (J Bagh Coll Dentistry 2011;23(1):120124).

INTRODUCTION
Teeth play an important role in determining
the resistance or susceptibility to caries process.
Mineralization of teeth is determined by major
inorganic elements as calcium, phosphorous in
addition to other elements that occur in traces
within tooth structure (1-3). Fluoride now a day is
widely used systemically or topically to increase
resistance of teeth surface, it has been well
documented as a major contributing factor in the
decline of the incidence and severity of dental
caries (2, 4,). So far, fluoride has been considered to
play an almost unique role in the prevention of
dental caries; however, there is no reason to
dismiss the role of other materials to increase the
resistance to dental caries. Cinnamon is the dried
inner bark of various evergreen trees belonging to
the genus Cinnamoum. At harvest the bark is
stripped off and put in the sun, where it curls into
the familiar form called "quills"(5).The various
species of Cinnamon differ but little chemically,
the principal constituent of Cinnamon oil is
cinnamic aldehyde(C6H8CH:CHCHO) together
with cinnamyl acetic ester and little cinnamic
acid(6). Cinnamon in medicine it had a reputation
as a cure for colds. It has been used to treat
diarrhea and other problem of the digestive
system (7). Cinnamon has been reported to have
remarkable pharmacological effects in the
treatment of type II diabetes. Several studies
suggest that cinnamon may have a regulatory
effect on blood sugar (8).

(1) Assistant lecturer, Department of Orthodontics, Pedodontic

and Preventive dentistry, Collage of dentistry, Mustansiriyah
University.

Orthodontics, Pedodontics and Preventive Dentistry120

Cinnamon help people with type 2 diabetes

improve their ability to respond to insulin, thus
normalizing their blood sugar levels (9). The
essential oil of cinnamon has anti microbial
properties, which can aid in the preservation of
certain foods and also has shown an amazing
ability to stop medication- resistant yeast
infections (10). Cinnamon is a powerful an
antioxidant, it is more effectively than all other
spices(11). Cinnamon reduced the proliferation of
leukemia and lymphoma cancer cells, and it has
an anti-clotting effect on the blood (12). Cinnamon
has been used to treat toothache and used as
flavor in toothpastes and mouthwashes (13). The
multiple uses of cinnamon in folk medicine
encouraged many investigators to understand its
pharmacological actions, in order to increase the
knowledge in regards to the use of cinnamon in
the
prevention
of
dental
caries
and
remineralization of initial caries, this laboratory
study was conducted.

MATERIALS AND METHODS

Teeth selected for this experiment were first
permanent premolars extracted from 12-14 year
old patients referred from orthodontics in the
College of Dentistry/ University of Mustansria.
Buccal and lingual surfaces of each tooth were
coated with an acid resistant nail varnish leaving
a circular window six mm in diameter. The
position of each window on tooth surface was
standardized using orthodontic ruler, an
imaginary line was drowning from the tip of the
buccal cusps to the cervical line and another one
between the most prominent curvature of mesial

J Bagh College Dentistry

Vol. 23(1), 2011

and distal surfaces. Therefore, the middle area of

each surface was identified.
Caries-Like Lesion Induction in Enamel
Specimens:
The pH-cycling procedure was followed for the
induction of caries lesion on enamel surface (14).
The preparation of de mineralized and re
mineralized solution was conducted by mixing
the following and adjusting the pH:De mineralizing solution: This solution consisted
of 0.075 M/L acetic acid, 1.0 M/L calcium
chloride, and 2.0 mM/L phosphate chloride. The
pH was adjusted to 4.3 at 37oC,
Re mineralizing solution: This solution consisted
of I50 m M/L potassium chloride, 0.9 m M/L
potassium phosphate and 1.5 m M/L calcium
nitrate. The pH was adjusted to seven at 37oC.
The Cycling Steps:
Each tooth was immersed in 20 ml of the
demineralization solution and kept for 6 hours at
37C in the incubator. Teeth were then with
drawn and rinsed with running de-ionized water
for one minute. There after each tooth was
immersed in a re mineralizing solution for 17
hours and kept in an incubator at 37C. This
procedure was repeated daily for a period of ten
days.
Cinnamon was purchased from the market,
ground into fine powder in an electrical mixer.
One hundred gram of finely powdered cinnamon
mixed with one litter of de-ionized water and kept
in a water bath at 60oC for five hours, then
filtered through filter paper. The extract then left
to dry at 40oC in hot air oven for evaporation of
water. The extract was preserved in refrigerator
until use (8).
Different solutions were prepared by
dissolving proper amount of selected agents in deionized water as following:
1. Aqueous Cinnamon extracts solutions: three
concentrations were used:
1% aqueous Cinnamon extracts solution by
dissolving one gm of Cinnamon extract in 100 ml
of de-ionized water.
5% aqueous Cinnamon extracts solution by
dissolving five gm of Cinnamon extract in 100 ml
of de-ionized water.
10% aqueous Cinnamon extracts solution by
dissolving ten gm of Cinnamon extract in 100 ml
of de-ionized water.
2. Stannous Fluoride (Snf2): 8 gm of Snf2 in
100ml de- ionized water, 10 gm of Snf2 in 1ooml
de-ionized water (15).
Teeth samples consisted of 32 maxillary first
premolars, two teeth were used for ground section
preparation for enamel and demineralized enamel,
the rest were randomly divided to five study

Orthodontics, Pedodontics and Preventive Dentistry121

Effect of water extracts of cinnamon

groups and one control group and each group

consisted of five teeth for microhardness test.
Then they subjected to PH-Cycling procedures
(14)
. PH Cycling procedure, measured initially
for normal enamel and after induction of caries
lesion enamel microhardness. This test was
achieved by Vicker's microhardness device at a
load of 500 gm. Three indentations were made
and the mean of records was determined for each
specimens.
Teeth were treated by the solutions of the
selected agents by emerging each tooth separately
in 20ml of selected agent solution for four
minutes, which prepared daily. Then each tooth
was rinsed with de-ionized water for two minutes.
Teeth were restored in de-ionized water for the
next day at temperature of 37oC in incubator, this
procedure was repeated daily for one week,
samples were re-examined for the microhardness.
Vicker's microhardness test was carried out
using optical microscope. The instrument uses a
square- based diamond indenter with an included
angle of 136 between the opposite faces, the
magnification used was 50 X and the load was
500 gm, the average of three indentations length
was taken and the applied load stayed 30 seconds
for each reading.
The change in the hardness (D) or the
difference between initial (HVi) and final (HVf)
microhardnes, was calculated for each specimen
and the mean of this difference was calculated for
each the experimental groups. The ratio of the
difference in (HVi), to the (HVf) was also
calculated for each experimental group, which
represents the rate of change in hardness of the
specimens.
The detection of changes of outer enamel
surface was calculated by dividing the difference
between the rate of change in hardness in the
experimental groups and the control group, by the
rate of change of hardness in control group (17).
(D) = (HVi) - (HVf) -------------- (1)
(D) = (D) / n ------------- (2)
(HVi) = (HVi) n -------------- (3)
% change in the hardness
(CH) = (D) / (HVi) x 100 ----------- (4)
% change of caries lesion = {(CH) control - (CH)
exp} / CH control

RESULTS
The mean values of the microhardness of the
sound enamel surfaces, after demineralization and
following the treatment with aqueous Cinnamon
extract at concentrations 1%, 5%, 10% are seen in
table 1. Statistically highl significant reduction in

J Bagh College Dentistry

Vol. 23(1), 2011

the enamel microhardness was observed after

dimeneralization. A noticed increase the
microhardness values were seen after treatment
with 1%, 5%, 10% concentration of aqueous
Cinnamon extracts. This increase was statistically
highly significant. The values t-test is shown in
table 2.
Microhardness values of the sound enamel
surfaces and following the PH- Cycling procedure
(demineralization) and after the treatment with
8% and 10% stannous fluoride Snf2 are seen in
table 3. A marked reduction was seen following
PH-Cycling technique. The reduction was
statistically
highly difference
for
both
concentrations. An increase in the microhardness
following the treatment with 8%, 10% of Snf2
was seen. This increase was statistically highly
significant for both concentrations. A value of
student test is shown in table 4.
Teeth were selected as a control group
subjected to microhardness test before and after
PH-Cycling procedures and following the
treatment with de-ionized water. The mean values
are shown in table 5. After demineralization, a
statistically highly significant reduction in values
of enamel surfaces microhardness was seen, while
after treatment with de-ionized water there was a
minor changes in enamel microhardness, which
was statistically not significant, as shown in table
6.
Table 7 shown changes in the microhardness
values after treatment with the selected agents
estimated by special equation. Values reflect
Stannous fluoride in both concentrations caused
the highest change, while Cinnamon water extract
at 10%concentration resulted in the lowest
changes in the microhardness for all study groups.

DISCUSSION
The primary prevention of dental caries
involves the increase in the resistance of the outer
enamel surface to acid dissolution and
enhancement of remineralization (1). Fluoride has
been widely used since the thirties of last century
for the prevention of dental caries (3, 7). However,
the effect of other elements in relation to dental
caries is not well substantiated.
In this study water extract of Cinnamon was
chosen to investigate its ability to remineralize the
initial carious lesion of enamel in comparison to
stannous fluoride. This fluoridated agent was used
as control positive because of their documented
remineralizing potential against caries attack (18).
While de-ionized water was used as a control
negative. Another type of Cinnamon extract is
present, but aqueous one is considered the best

Orthodontics, Pedodontics and Preventive Dentistry122

Effect of water extracts of cinnamon

way for the extract activity and it can be prepared

at home easily (9).
The PH-Cycling method was success fully
applied in the present experiment (14), which was
also used by other Iraqi studies (21, 22). Enamel
microhardness measurement was applied in this
study reflect accurately the degree of
demineralization of the lesion (15). This as
achieved by Vicker's method which gave
successful result by other studies (21, 22). Enamel
microhardness was measured for sound enamel,
after demineralization and following treatment
with chosen solution.
A statistically highly significant reduction was
found in the microhardness of enamel surfaces
after PH-Cycling as an indication of enamel
demineralization and initiation of carious lesion,
which was also confirmed by microscopic
examination.
Following application of 8%and 10% stannous
fluoride an increase in the microhardness was
detected. this may indicate mineralization of
initial carious lesion,it is assumed that fluoride
ion in addition to tin ions react with
hydroxyapetite crystals and new crystalline
product was formed which is differ from
fluoroapetite and this new compound is stannous
trifluorophosphate(3,23).
The result recorded in this study was the higher
microhardness values for 1% and less for 5%and
lesser for 10%concentrationsof cinnamon. This
can be explained by the ion calcium ion of
hydroxyapetite crystals lead to decrease in the ca/
p ratio and forming other crystals that may
decrease the microhardness of tooth structure.
When the changes in the microhardness were
measured by certain equations, stannous fluoride
10%, 8% was found to produce maximum
remineralization as the highest number was
recorded for it. Cinnamon water extract at 1%
came the next then extract at 5%. This was
followed by Cinnamon extract at 10%. This
results need to be confirmed by further studies
involving in vivo, before the recommendations of
using Cinnamon extract in dental practice.

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H. Inhibitory effects of species on growth and toxin
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Several Culinary and Medicinal Herbs are Important
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PA. Handbook of Medicinal Spices. Boca Raton:
CRC. New Delhi. 2003.
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Regulation of PTP-1 and insulin receptor kinase by
fractions from cinnamon:implications for cinnamon
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14. Featherstone J, Oreilly MM, Shariati M, Bruder S.
Enhancement of remineralization in vitro and vivo.
In: Leach S.A. Ed. Factor relatingto demineralization
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Effect of water extracts of cinnamon

remineralization of the teeth. Oxford: IRL.

Press1986; 23-34.
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Table 1: Microhardness (Mean values &

standard deviation) of Enamel Surfaces
Treated by water Cinnamon Extract at (1%,
5%, 10%) concentrations.
Conc. Mean S.D
235.4 3.21
242.8 3.27
Normal enamel
224.4 4.56
28.58 0.39
31.74 1.861
Demineralization
22.42 0.531
1% 84.06 1.918
Remineralization 5% 61.20 1.304
10% 41.28 1.593
Variables

Table 2: Students t-test between variables of Microhardness of enamel surface treated by water
Cinnamon Extract at (1%, 5%, 10%) concentrations.
1% Cinamon 5% Cinamon 10% Cinamon
t -value P - value t-value P -value t -value P - value
Normal enamel &
143.05
Demineralization
Normal enamel &
90.51
Remineralization
Demineralization &
63.39
Remineralization

0.000

125.4

0.000

98.36

0.000*

0.000

115.32

0.000

84.76

0.000*

0.000

28.99

0.000

25.12

0.000*

* Highly significant at level P < 0.01.

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Effect of water extracts of cinnamon

Table 3: Microhardness (Mean values) of Enamel Surfaces Treated by Stannous fluoride at 8%,
10% concentrations.
Mean S.D
273.2 2.86
Normal enamel
275.6 2.79
71.24 0.856
Demineralization
50.996 1.308
8 % 142.7 0.84
Remineralization
10% 111.2 1.30
Variables

Table 4: Students t-test between variables of Microhardness of enamel surface treated by

stannous fluoride at 8% and 10% Concentrations
8%
Snf2
10% Snf2
t - value P - value t - value P - value
Normal enamel &
151.10
Demineralization
Normal enamel &
97.81
Remineralization
Demineralization &
133.48
Remineralization

0.000

162.84

0.000*

0.000

119.27

0.000*

0.000

72.88

0.000*

* Highly significant at level P < 0.01.

Table 5: Microhardness (Mean values & standard deviation) of Enamel for faces Treated by
De-ionized water
Variables
Mean S.D
Normal enamel 291.4 7.13
Demineralization 67.36 1.228
Remineralization 68.3 0.636

Table 6: Students t-test between variables of Microhardness of enamel treated by

De-ionized water
t -value P - value
Normal enamel &
Demineralization

69.27

0.000

Normal enamel &

69.72 0.000*
Remineralization
Demineralization &
1.52 0.180**
Remineralization
* Highly significant at level P < 0.01.
** Non significant at level p> 0.05

Table 7: Changes in the Microhardness Values after Treatment with the Selected Agent.
Normal enamel
Snf2 8%
Snf2 10%
Cinnamon 1%
Cinnamon 5%
Cinnamon 10%

Demineralization Remineralization

93.75%
94.58 %
80.78%
83.32%
77.01%

Orthodontics, Pedodontics and Preventive Dentistry124

75.76%
74.71%
42.43%
47.12%
33.28%

108.93%
162,81%
123.08%
89.60%
60.44%