|Year : 2014 | Volume
| Issue : 3 | Page : 148-156
Dentistry meets nature-role of herbs in periodontal care: A systematic review
Venisha Pandita, Basavaraj Patthi, Ashish Singla, Shipli Singh, Ravneet Malhi, Vaibhav Vashishtha
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||15-Nov-2014|
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Ajit Mahal, Niwari Road, Modinagar, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Natural products have been used for several years in folk medicine. Over the last decade herbal medications turned out to be a popular form of therapy throughout the world when used in prophylaxis and treatment of various diseases. Many side-effects associated with modern medicines have been averted by using herbal medicines, and thus they are safer to use. Objective: The aim was to evaluate the effect of herbs on the periodontal diseases. Data Source: A literature review was performed in PubMed Central and Cochrane library using MeSH Terms - herbal medicine, periodontitis, and dentistry. Materials and Methods: Of a total 368 titles appeared 39 were related to the research question. Further search criteria were applied to the articles, of which 13 articles fulfilled the criteria and were selected for the review. Five articles that were hand searched were also included. Results and Conclusion: In the available literature, it was found that the low toxicity of herbs encourage further investigation that leads to a better understanding of alternative medicine for prevention of plaque formation and strengthening of the gums, as well as in reducing the incidence of periodontal infections.
Keywords: Aoe vera , Ayurveda, herb oral dentifrice, herbs, neem, periodontal disease
|How to cite this article:|
Pandita V, Patthi B, Singla A, Singh S, Malhi R, Vashishtha V. Dentistry meets nature-role of herbs in periodontal care: A systematic review. J Indian Assoc Public Health Dent 2014;12:148-56
|How to cite this URL:|
Pandita V, Patthi B, Singla A, Singh S, Malhi R, Vashishtha V. Dentistry meets nature-role of herbs in periodontal care: A systematic review. J Indian Assoc Public Health Dent [serial online] 2014 [cited 2020 Jan 19];12:148-56. Available from: http://www.jiaphd.org/text.asp?2014/12/3/148/144784
| Introduction|| |
Plants have played an important role in the treatment of many diseases, especially in the East region countries.  Drugs, which are of plant origin and used to treat diseases to attain or maintain the condition of improved health are known as Herbal drugs. , Traditional medicine has its roots, grounded deep in India and is being used here since times immemorial. Ayurvedic medicine (Ayurveda = the science of life) is a system of Hindu traditional medicine native to the Indian subcontinent and a form of alternative medicine. It has also attracted much attention in developed countries such as Europe, United States and Japan. , Ayurveda stresses the use of plant-based medicines and treatments. These medicines are not only used for the treatment of systemic diseases, but the natural phytochemicals in them offer an effective alternative to antibiotics and represent a promising approach in the prevention and therapeutic strategies for oral infections too.  Ayurveda has mentioned various procedures for maintaining oral hygiene and gingival health. The stem, bark, root and young fruits of Melia azadirachtaare used as bitter, tonic, antiseptic, astringent, and antibacterial. Neem twigs as tooth brush, Azadirachta indica as mouth wash. These herbal medicines help in maintaining good oral health and thus can be used for the treatment of periodontal diseases which are recognized as a major public health problem throughout the world and are the most common cause of tooth loss in adults. , Thus, a systematic review was conducted to evaluate the effect of various medicinal herbs on the periodontal health.
- To evaluate various medicinal herbs used in dentistry
- To assess the effect of various medicinal herbs on the periodontal health.
| Materials and Methods|| |
- Original research articles
- In vivo and in vitro studies
- The articles are emphasizing on the efficacy of herbs on periodontal diseases.
- Review articles
- Articles whose abstract are only readable
- Studies done on younger children
- Studies on diseases other than periodontal disease.
Published literature on recent developments in research on effect of herbs on periodontal disease, including original articles and papers in PubMed Central Databases were taken into study for the review on 4 th of December 2013 up to 15 th December 2013. A literature review was performed using MeSH terms herbal medicine, periodontitis and dentistry. With this combination total of 368 abstracts appeared. Of these 39 abstracts were related to the research question that is "In patients with periodontal disease does herbal products, compared with commercially available nonherbal, reduce the effect of periodontitis?." Further inclusion and exclusion criteria were applied to these articles. Thirteen articles that fulfilled the criteria's were selected for the review. Five articles that were hand searched were also included in the review. Thus, a total of 18 full-text articles were retrieved for the review [Table 1]. Reported data were analyzed and represented in the form of figures and tables for the current review.
- Manual Search (total articles) = 3 (dated: 6 th December 2013)
- Contact with Experts (total articles) = 2 (dated 9 th December 2013)
- Electronic Search (total articles) =13 (dated 4-15 th December 2013).
- Google scholar
- World Health Organization website
- Cochrane library
- Literatures and reports
| Results|| |
Uses of various medicinal herbs described in the 18 articles selected for review
Herb oral dentifrice and herboral mouthrinses
The effect of the Paradontax dentifrice (herb oral dentifrice) was found to be effective in reducing plaque and gingivitis.  Various studies have compared herb oral dentifrices with conventional fluoride dentifrice in which herbal-based toothpaste provided statistically significant plaque inhibitory action over control toothpaste. ,,
Studies were also conducted to evaluate and compare the efficacy of a commercially available herbal mouthrinse (Herboral) with that of chlorhexidine (CLX) gluconate that is considered to be a gold standard as an antiplaque agent. Although CLX inhibited plaque growth significantly; herbal mouth rinse was also found to be a potent plaque inhibitor and was preferred by patients for its taste, its convenience of use and taste duration (aftertaste). 
The clinical efficacy of an alcohol-free mouthwash containing 5.0% (W/V) Brazilian green propolis (MGP 5%) was also evaluated for the control of plaque and gingivitis that showed significant reduction in the plaque and gingival scores with no side effects in soft and hard tissues of the mouth. 
The low plaque index (PI) observed in these subjects could be explained by the fact that Aloe vera is a good antibacterial and showed its antibacterial properties against Candida albicans, Streptococcus pyogenes, Streptococcus faecalis. The antimicrobial effects of A. vera have been attributed to the plant's natural anthraquinones: Aloe emodin, aloetic acid, aloin, anthracine, anthranol, barbaloin, chrysophanic acid, ethereal oil, ester of cinnamonic acid, isobarbaloin, and resistannol. In relatively small concentrations, together with the gel fraction, these anthraquinones provide analgesic, antibacterial, antifungal, and antiviral activities; in high concentrations, they could be toxic. A. vera can be used to treat early stages of periodontitis and gave good results. A. vera when used as a medicament in the periodontal pocket site comprised scaling and root planning (SRP) followed by intra-pocket placement of A. vera gel, which was compared with the control site in which only SRP was done, and clinical parameter. Results exhibited encouraging findings in clinical parameters of the role of A. vera gel as a drug for local delivery and concluded that subgingival administration of A. vera gel results in improvement of periodontal condition and can be used as a local drug delivery system in periodontal pockets. ,
Frankincense , a resin-like extract of Bowsellia species from Burseraceae family, possessing Boswellic acid is a pentacyclic terpeniod that has been used in the Indian Ayurvedic traditional medicine for the treatment of both systemic and dental diseases. The effect of Frankincense powder or extract in the treatment of gingivitis was studied by various authors and was found that administration of 0.1 g of Frankincense extract or 0.2 g of its powder led to a significant decrease in various gingival and plaque scores due to its antiinflammatory and antibacterial effects. It was also preferred by patients due to its low-cost and easy availability. 
Neem leaves have been used in the treatment of gingivitis and periodontitis since a long time. Its antiinflammatory action can be attributed to its ability to inhibit prostaglandin E and 5 HT and its antibacterial action can be explained by "Azadiachtin" that is known to destroy bacterial cell wall and thus inevitably inhibit the growth of bacteria. In a study that was conducted to assess the efficacy of neem based mouth rinse; significant reduction of gingival, bleeding, and plaque indices was found in 21 days. 
Meswak (Salvadora persica)
The most common type of chewing stick, Meswak, is derived from Arak tree (Salvadora persica) that grows mainly in Saudi Arabia and also in other parts of the Middle East. Meswak is a chewing stick used by many people of different cultures and in many developing countries as a traditional toothbrush for oral hygiene. The religious and spiritual impact of Meswak probably is the principal reason for using it in Islamic countries and mostly by Muslim population. The Meswak extract has also found its way into the dentifrices in the recent years as antiplaque and antigingivitis agents. A study was carried out to evaluate the antiplaque efficacy of a commercially available Meswak containing dentifrice compared to the conventional dentifrice using a randomized, triple-blind, parallel design method. The results showed comparable effects of meswak with that of the conventional dentifrice. 
Septilin-herbal immune modulators
Host modulation is a fast gaining popularity as a preferred therapeutic modality for periodontal disease. Recent research in herbal immune modulators such as Septilin ® has spurred an interest in evaluating its efficacy in periodontitis. A study was done to evaluate the effect of septilin in chronic periodontal disease. The gingival index and gingival bleeding index showed a significant reduction. Salivary tumor necrosis factor level reduction was also observed. 
Berberine is an alkaloid agent which has shown high antimicrobial effects. This alkaloid is the most active alkaloid (isoquinolines group) extracted from the root and stem of the plant barberry. A study was done to evaluate the clinical effects of dental gel containing barberry extracts (from Berberis vulgaris) on gingivitis and microbial plaque control. The results showed that barberry gel has reduced the PI for about 56%. Thus, the study indicated that the barberry dental gel effectively controls microbial plaque and gingivitis in the school-aged children. 
Turmeric, more commonly known as "HALDI" possesses antiinflammatory, antioxidant, and antimicrobial properties, along with its hepatoprotective, immunostimulant, antiseptic, antimutagenic, and many more properties. It is for this reason that the promotion of turmeric in dental terrain would prove beneficial. Thus, the efficacy of 0.1% turmeric mouthwash as an antiplaque agent and its effect on gingival inflammation was done and it was found that it can be effectively used as an adjunct to mechanical plaque control in prevention of plaque and gingivitis. 
Tea tree oil
The local delivery of tea tree oil (TTO) gel in case of chronic periodontitis may have some beneficial effects to augment the results of the conventional periodontal therapy. Moreover, it places a focus on the value of monitoring gingival crevicular fluid levels of pentraxin-3 (PTX3) as a marker of periodontal tissue healing. There is effectiveness of adjunctive treatment of TTO on the clinical parameters and the level of PTX3 in chronic periodontitis. 
Studies have indicated that the major components of Lippia sidoides essential oil exhibit potent antimicrobial activity against oral pathogens and reduce the severity of gingivitis, dental plaque and histological inflammatory infiltrate. A significant reduction on plaque and gingivitis has also been found. Thus, the gel preparation containing 10% L. sidoides essential oil has been found to be an efficient herbal antiplaque and antigingivitis agent. 
The free radical scavenging property and the antimicrobial activity of Triphalβ, an herbal product, which was made from equal proportions of Terminalia chebula, Terminalia bellirica and Emblica officinalis, have been evaluated. This herbal extract effectively inhibited bio-film formation and the better antioxidant activity which is exhibited by this extract could protect the gum cells effectively from free radicals than the commercial toothpastes. Thus, Triphalβ could be used as an effective antiplaque agent. 
Tulsi (Ocimum sanctum)
Tulsi has an antimicrobial property against a variety of microbes like C. albicans, Staphylococcus aureus, Escherichia coli by its phytoconstituents isolated from various parts of plant include eugenol, palmitric acid, vallinin, galic acid, Vitamin A, Vitamin C which are responsible for preventing dental cavities, plaque, tartar, bad breath, etc., and thus protects the teeth. Its astringent properties helps the gums to make hold of the teeth tighter thereby protecting them from falling, but one should always avoid chewing of these leaves as certain compounds mercury (having rich germicidal properties), which is harmful for the teeth in direct contact for a long. Tulsi is also an excellent mouth freshener (this freshness lasts very long) and oral disinfectant. It destroys most of the germs and bacteria in the mouth, and this effect lasts long. It can also cure ulcer in the mouth and can help inhibit the growth of oral cancer. Hence, it is termed as the "Queen of Herbs." 
The germicidal properties of the oil make it very effective for relieving toothache, sore gums and mouth ulcers. Clove oil contains the compound eugenol, which has been used in dentistry for many years. Gargling with diluted clove oil helps in easing throat pain and irritation. The characteristic smell of clove oil also helps to eliminate bad breath. 
Ginger, the rhizome of Zingiber officinale
Ginger contains constituents with pharmacological properties similar to the novel class of dual-acting nonsteroidal antiinflammatory drugs (NSAIDs). Compounds in this class inhibit arachidonic acid metabolism via the cyclooxygenase and lipoxygenase pathways. These compounds have notably fewer side effects than conventional NSAIDs and now are being investigated as a novel class of antiinflammatory compounds. 
Cinnamon oil shows stronger inhibitory activity as measured by minimum inhibitory concentration determination. Streptococcus mutans, the etiological agents of dental caries, are highly sensitive to Cinnamon oil and hence it may be used as an antiseptic in toothpaste, mouthwash or chewing gum for prevention of dental caries and other oral infections. 
Garlic (Allium sativum)
Garlic is one of the most extensively researched medicinal plants and its typical odor and antibacterial activity depends on allicin produced by enzymatic activity of allinase (a cysteine sulfoxide lyase) on allicin after crushing or cutting garlic clove. Allicin and other thiosulfinates have reported to inhibit the growth of various Gram-positive and Gram-negative bacteria in the oral cavity. Garlic extract signiﬁcantly inhibits the growth of S. mutans and therefore can be used as an effective remedy in the prevention of dental caries. It is thought that toothpaste or mouthwash containing optimum concentration of garlic extract might be useful for prevention of dental caries. 
Curry leaf tree (Murraya koenigii spreng)
This is a green leafy vegetable grown all over India and other countries for its aromatic leaves, used daily as an ingredient in Indian cuisine. The fresh curry leaves contain 2.65 volatile essential oils such as sesquiterpenes and monoterpenes, which have broad antimicrobial effects on S. mutans, Streptococcus sanguinis. It also contains chlorophyll that is proposed as an anticariogenic agent and also helps to reduce halitosis. 
Eucalyptus (Globulus labill)
Eucalyptus essence has antimicrobial activity against some microorganisms such as Vibrio cholerae, Aspergillus flavus and S. aureus. The results of studies indicated that eucalyptus extract could prevent tooth decay through inhibition of biofilm formation of plaques. It has also been reported that chewing gum containing eucalyptus extract improves gingival health, decreases bleeding during probing, and reduces periodontal diseases. 
| Discussion|| |
The present review revealed a growing interest in the use of herbs in dentistry, particularly in periodontal diseases. Herbal medicines have been used for many years, and their history can be rooted from the ancient civilization, where their role as a primary source of medication have been evident [Table 2].
Sanguinaria extract, a derivative of Sanguinaria canadensis (bloodroot) has been incorporated in oral rinse and toothpaste products to control bad breath and have proved to be effective. The ability of the herbal extract, German chamomile, in mouthwashes to reduce gingival inflammation and plaque formation and for use as an irrigant to disinfect the root canal with less toxicity, has been well-documented medicament in clinical practice. Although several herbal products have been tested, yet conclusive results are still lacking. 
There are a number of herbs that can help eliminate inflammation and infection associated with periodontal diseases. Coenzyme Q-10, a natural supplement helps to increase tissue oxygenation in the body that helps to provide healthy blood flow to the gums. A reported clinical trial demonstrated improvement in plaque and calculus levels by twice a day intake of 25 mg of Coenzyme Q-10 in patients suffering from periodontal disease.
Evidences have been reported for the relation between Vitamin C and periodontal disease. Significant gum bleeding can occur in Vitamin C deficiency. Vitamin C along with bioflavonoids helps to speed up the healing process. Clinical studies have also been reported to lower plaque, gingival and bleeding indices by use of formulations containing extracts of bloodroot. A. vera gel has been reported to sooth gum tissue and relieved pain and discomfort when applied on gums. Clove oil reduces infection and relieves pain. Echinacea and Goldenseal have also been reported to relieve infection and inflammation. 
Researchers should be encouraged to conduct controlled studies to prove the effectiveness and safety of natural dental products. Those studies will provide dentists with sufficient clinical evidence before prescribing promoted natural products for their patients. The low toxicity and low cost of these herbs should encourage further investigation leading to a better understanding of traditional herbal medicine for prevention of plaque formation and strengthening of the gums, as well as in reducing the incidence of dental or periodontal infections. Thus, doing further researches in this field, will provide more data and will prove to be helpful in studying the effects of various herbal medicinal plants on periodontal diseases.
| Conclusion|| |
The use of herbal medicine continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing the release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis and thereby improving immunity.
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[Table 1], [Table 2]