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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 4  |  Page : 277-290

Alternative medicinal interventions for oral diseases: Scoping review


Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India

Date of Submission28-Mar-2018
Date of Acceptance03-Oct-2018
Date of Web Publication29-Nov-2018

Correspondence Address:
Dr. Ananthalekshmy Rajeev
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_78_18

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  Abstract 

Oral diseases hamper the overall systems of our body. People of all age groups and races of different geographic locations are affected by oral diseases which range from dental caries to oral cancer. Therefore, timely dental treatment is needed. Apart from conventional therapies, complementary alternative medicines are becoming popular nowadays. The aim of this scoping review is to compare the efficacy of alternative medicinal interventions with conventional therapies among the living subjects for treating oral diseases. A literature search was performed in PubMed Central and Cochrane Library, Embase, Google Scholar up to 2017 to identify appropriate studies. Full text of original research articles, observational studies, in vivo studies, and randomized control trials were only included in the study. Our target finding was complementary alternative medicines for oral diseases. In the various articles available through the electronic database, 43 articles fulfilled the inclusion criteria and were selected for the review. Even though different studies explain different alternative treatment options, however, these studies show better efficiency for various oral diseases. Alternative medications with many beneficial properties are a good choice for the prevention or treatment of oral diseases without any side effects. In a developing country like India, where there are people who still cannot afford even their daily expenditure, alternative medicinal interventions will be a boon.

Keywords: Complementary alternative medicine, complementary medicine, complementary therapies, stomatognathic diseases, tooth disease


How to cite this article:
Rajeev A, Patthi B, Singla A, Gupta R, Malhi R, Rai M. Alternative medicinal interventions for oral diseases: Scoping review. J Indian Assoc Public Health Dent 2018;16:277-90

How to cite this URL:
Rajeev A, Patthi B, Singla A, Gupta R, Malhi R, Rai M. Alternative medicinal interventions for oral diseases: Scoping review. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2018 Dec 13];16:277-90. Available from: http://www.jiaphd.org/text.asp?2018/16/4/277/246363


  Introduction Top


Oral health is a reflection of the physiological, social, and psychological factors that are essential to our quality of life.[1] People of all age groups and races of different geographic locations are affected by oral diseases which range from dental caries to oral cancer.[2] According to the WHO (2017), the 2015 Global Burden of Disease Study counts dental caries as the most prevalent condition, ranking first for the decay of permanent teeth (2.3 billion people) and 12th for deciduous teeth (560 million children).

Apart from conventional allopathic therapies, complementary and alternative medicines (CAMs) are also used for the treatment of various diseases as well as for maintaining good oral health.[3] CAM was defined by the National Center for CAM, United States, in 2002 as “a group of diverse medical and healthcare systems, therapies, and products that are not presently considered to be conventional medicine.” The most common CAM therapies include Acupuncture, Ayurveda medicine, Homeopathy, Naturopathy, megavitamin therapy, chiropractic therapy, Herbal medicines, massage therapy, biofeedback, Hypnosis, Meditation, Deep breathing exercises, Yoga, Tai Chi, Prayer for healing, and Reiki.[4]

Herbs, with medicinal properties which are used to treat diseases or for maintaining health or even used as ingredients in allopathic medicines, are called herbal medicines. Turmeric (commonly known as haldi, curcumin, or curcuma longa) and propolis make themselves a good stand in the field of dentistry because of its antimicrobial, antioxidant, and astringent properties.[5],[6],[7] For the treatment of wounds, the best choice among herbal medicine is chamomile.[8] Triphala, a key ingredient in ayurvedic medicine, is a botanical preparation consisting of equal parts of three herbal fruits such as harada (Terminalia chebula), amla (Emblica officinalis), and bihara (Terminalia bellerica).[9] Hypericum perforatum popularly known as St. John's wort is an herbaceous perennial plant which is used in popular medicine and phytotherapy.[10] For maintaining orodental hygiene as well as for treating oral diseases, traditional Persian medicine Golnar and even the root extracts of some medicinal plants, such as Salvadora persica, are found to be effective.[11],[12] Antineoplastic properties are present in a mixture of herbal-marine substances named HESA-A which is an Iranian patented new immunomodulating medication.[13] Another herbal medicine for cancer therapy is Solanum nigrum which is commonly known as black nightshade.[14],[15] For decades because of their antimicrobial property, Melaleuca alternifolia and a typical shrub Lippia sidoides are used as antiseptic.[16],[17] Traditional Korean medicine, Yukmijihwang-tang is a commonly used herbal remedy for many diseases.[18] Aloe vera (Babosa), which is commonly found in Northeast of Brazil, is a currently available herbal agent.[19] Another alternative medicine therapy for preventing most of the common oral diseases is oil pulling or oil swishing, a traditional Indian folk remedy using edible oils such as sunflower oil or sesame oil which gives both oral and systemic benefits.[20]

Traditional Chinese medicine (TCM), which is based on a holistic, natural approach, has its own importance in CAM. It includes acupuncture, herbal therapy, massaging and breathing, and relaxation exercises.

Acupuncture, which means “to puncture with a needle,” is one of the important TCMs. With a history of 2500 years, it still successfully remains as an alternative or complementary therapy in the field of dentistry mainly because it is nontoxic and produces very negligible adverse reactions. Acupuncture is defined by TCM as “the stimulation of certain points on or near the surface of the human body through any technique of point stimulation with or without the insertion of needles, these include the use of electrical, magnetic, light and sound energy, cupping, and moxibustion (the burning on or over the skin of selected herbs), and to normalize physiologic functions or to treat various conditions of the human body.”[21] Nowadays, laser acupuncture became more advantageous over needle acupuncture due to its noninvasive property and the ability to stimulate even difficult points.[22] Melzack et al., through his study, observed that even a simple ice massaging can relieve dental pain due to its analgesic effect.[23] All these suggest that there are various alternative therapeutical options for curing diseases. There is a paucity of the reports regarding the alternative medicinal interventions available for various oral diseases. A review by Turagam N is the only previous study with the same topic, and this study itself did not explain individually about the medicinal interventions for various oral diseases. Hence, this study focuses to find the alternative medicinal interventions for various oral diseases.

Aim

The aim of this scoping review is to compare the efficacy of alternative medicinal interventions with conventional therapies among the living subjects for treating oral diseases.

Focused question

Instead of conventional therapies, what all are the alternative medicinal interventions available for treating various oral diseases among living subjects?


  Materials and Methods Top


Eligibility criteria

The articles, which were published in English, dated from the year 1980 to 2017, were included in this review. The search terms for articles were either in the title or abstract. Full-text original research articles were taken. Unpublished articles in press and personal communications were excluded from the study [Figure 1].
Figure 1: Flow chart of selection of studies included in the study

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Inclusion criteria

  • Original research articles
  • Observational studies
  • In vivo studies
  • Randomized control trials.


Exclusion criteria

  • In vitro studies as it does not assure the safety of the medicines in human beings
  • Case Series, Cases Reports, and Letters to the Editors due to the lack of available information and lack of credibility of the medicine
  • Articles whose abstract are only readable.


Search strategy for identification of studies

For the identification of the studies included in this review, we devised the search strategy for each database. The search strategy used a combination of controlled vocabulary and free-text terms. The main database was PubMed, PubMed Central, Cochrane Review, Embase, and Google Scholar.

Electronic searches

  1. PubMed (1980–2017)
  2. PubMed Central (1980–2017)
  3. Cochrane Review (1980–2017)
  4. Embase (1980–2017)
  5. Google Scholar (1980–2017).


Other sources

The search also included the hand search of the journals fulfilling the inclusion criteria for the review [Figure 1].


  Results Top


All the 43 articles, which are included in this review, show better efficiency of different alternative medicinal interventions for various oral diseases [Table 1].
Table 1: Alternative medicine for different oral diseases

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In 1980, Melzack et al. conducted a study through which he demonstrated that intense cold of ice relieves dental pain when applied to the Hoku point.[23] A study by Soukoulis and Hirsch found out that tea tree oil is effective in reducing gingivitis but not in reducing plaque.[24] It was explained in the studies of both Duailibe et al. and Hegde et al. that propolis has in vivo antimicrobial activity against Streptococcus mutans.[25],[39] Different studies of the year 2008 observed a significant reduction of plaque and gingivitis by the usage of aloe vera as well as coconut oil or sesame oil.[19],[20] In the same year, a study conducted by Ritenbaugh et al. found out that TCM and naturopathic medicine (NM) provide greater improvement in some patients with temporomandibular disorders than state-of-the-art specialty care (SC).[15] A study by Rodrigues et al. in 2009 found out that Lippia Sidoides gel is an effective gingivitis controlling agent but not a good antiplaque agent.[17] Baeshen et al. (2017) concluded that miswak is as effective as toothbrushing for plaque removal.[27] Various studies conducted in different years show the effectiveness of acupuncture in the treatment of pain originating from the temporomandibular joint disorder. Myofascial pain of the jaw muscles, trigeminal neuralgia, chemotherapy, and chemoradiotherapy induced oral mucositis, Bell's palsy, and acute dental pain can also be cured with acupuncture.[22],[24],[26],[28],[29],[30],[33],[42],[45] Paterniti et al. and Barrella et al. explained that H. perforatum extract and Ipomoea alba L extract can reduce periodontitis.[10],[35] In the study of Longo and São Dimas, it is found that chamomile can be used to treat tongue ulcer.[8] Green tea was found to be effective in reducing oral bacterial count as well as for preventing plaque formation and halitosis in the study of Moghbel et al.[31] Patel et al. in his study observed that miswak can be an effective adjunct to toothbrushing in reducing plaque and gingivitis.[32] In the studies of Bhattacharjee et al. (2015) and Srinagesh (2012) et al., they observed that Triphala mouthwash is effective against plaque and gingivitis as well as oral streptococcal count.[1],[9] In 2012, Gonzalez-Perez et al. conducted a study to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain and found it to be effective.[36] Rassameemasmaung et al. (2013) also found out that green tea can reduce oral malodor, plaque, and gingivitis.[37] Study of Han et al. (2013) shows that Yukmijihwang-tang can be an effective alternative treatment for xerostomia in the elderly.[18] In the same year, Nayak et al. observed that manuka honey is as effective as chlorhexidine in reducing plaque formation.[38] In 2014, Atwa et al. found out that honey can be an effective alternative for the prevention of dental caries, plaque, and gingivitis in orthodontic patients.[40] In the same year, Hosamane et al. conducted a study in which tulsi or basil is found to be an effective antioxidant, anti-inflammatory, antipyretic, anticancer, and analgesic.[41] De Campos Rasteiro et al. in 2014 found out that M. alternifolia is effective in eradicating Candida albicans.[16] In the study of Patel et al., it was found out that aqueous extract of S. nigrum leaves has protective effect on chemoradiotherapy induced oral mucositis.[14] Aloe vera was again proved to be an effective mouthwash for reducing plaque and gingivitis in the study of Karim et al. (2011).[43]

Hafez et al. in 2015 conducted a study which found out that miswak is as effective as the combination of chlorhexidine and toothbrush, in improving oral care and in reducing dental plaque and oral bacterial count.[38] Hesa-A extract shows potent antitumor activity in the study of Abbasi et al. in 2015.[13] Study of Abdulbaqi et al. in 2016 concludes that the combination of green tea and S. persica L aqueous extracts can act as a natural alternative mouthwash for controlling plaque.[12] In the same year, the study of Shetti et al. revealed that S. persica (miswak) can also act as a good chemical plaque control agent.[46] In 2016, the study of Sedigh-Rahimabadi et al. concludes that Golnar mouthwash is safe and effective in the treatment of gingivitis in diabetic patients.[11] A study by Ahmed et al. in 2017 says that in areas where chlorhexidine is unavailable, mouth rinses with tulsi and honey can be used as an effective alternative.[47] Salvatori et al. found out in his study that tree oil can reduce gingivitis.[48] Mango leaf mouthwash was proved to be a promising alternative for patients with plaque and gingivitis in the study of Bhat et al.[49] Jalaluddin et al. discovered that neem mouthwash can be used as an alternative to chlorhexidine mouthwash for reducing plaque and gingivitis.[50]


  Discussion Top


Oral cavity is the mirror image of the whole body; hence, appropriate treatment of oral diseases is needed on time. In a developing country like India, dentistry is unaffordable for many people especially of low socioeconomic status, and in such conditions, complementary medicine can help a lot [Table 2]. Treatment with no side effects is an attractive advantage of these complementary alternative medicines. Many studies are there showing the effectiveness of various complementary alternative medicines. The present study aims to find all the available alternative medicinal interventions for oral diseases.
Table 2: Alternative medicines and its uses in dentistry

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Herbal extracts have been used for centuries to improve and maintain dental health. Neem, miswak, lemongrass, and triphala herbal extracts are famous for their effectiveness in reducing plaque, gingivitis, and bacterial counts. Triphala is a well-known ancient ayurvedic Indian powdered preparation which can be used as an effective, economic alternative in reducing plaque and gingivitis as well as reducing oral streptococcal count.[1],[9] Other effective antiplaque agents include S. persica L.(miswak) with green tea mouthwash, aloe vera, and oil pulling with sesame oil.[12],[19],[20],[43] Some studies even show that miswak alone has a potential to reduce plaque, oral bacterial count, and gingivitis.[27],[32],[40],[44],[46] It is discovered that plaque and gingivitis can also be reduced with the help of mango leaves or neem in simultaneous studies by Bhat et al. and Jalaluddin et al.[49],[50] A study by Rodrigues et al. discovered that Lippia Sidoides gel is not a good antiplaque agent, however, it is effective in the control of gingivitis.[17] In diabetic patients, Golnar mouthwash is found to be effective alternative for reducing gingivitis.[11] Periodontal diseases are inflammatory disorders that give rise to damage the surrounding cells and connective tissue structures including alveolar bone causing tooth loss. H. perforatum extract and I. alba L have a potential to reduce the inflammation and tissue injury associated with periodontitis by removing the periodontal pathogens.[10],[35] Toothache is an emergency condition in which most of the people seek the assistance of a dentist. Melzack et al. suggested that a simple ice massaging can be a better alternative treatment for dental pain.[23]

Another major oral problem, especially for teenagers, is mouth ulcers. Study by Longo and São Dimas found that chamomile extract ointment, which stimulates reepithelialization and the formation of collagen fibers after 10 days of treatment, can be used to reduce mouth ulcers.[8] In the study of de Campos Rasteiro et al., essential oil of M. alternifolia (tea tree oil) is found effective in reducing yeasts of C. albicans.[16] Some studies prove that it can also reduce gingivitis but not the plaque.[24],[28] There are studies which state that even for oral cancer there is an alternative medicinal intervention. One of such was the study done by Abbasi et al. in 2015 to evaluate the effect of two doses of Hesa-A on mRNA expression of p53 as a main prognosticator of oral cancer, and it concludes this can be an alternative because of its potent antitumor activity.[13] Study on rats showed that aqueous extract of S. nigrum leaves has protective effect on chemotherapy and chemoradiotherapy-induced oral mucositis.[14] Xerostomia, a subjective sense of dry mouth, is not generally regarded a disease despite its high prevalence among the elderly and the study by Han et al. found that Yukmijihwang-tang can be an effective alternative treatment for this xerostomia in elders.[18]

Holy basil (tulsi) is discovered as an effective adjunctive plaque controlling agent in the study of Hosamane et al.[41] It was also found to be an effective antimicrobial agent in the study of Ahmed et al. which states that both tulsi and honey mouthwashes are effective against S. mutans.[47] Honey is proved to be effective in preventing gingivitis and dental caries in the study of Atwa et al.[40] Honey collected from the species Leptospermum scoparium is called manuka honey, which can be used as an effective plaque controlling agent.[38] Studies by Duailibe et al. and Hegde et al. simultaneously discovered that S. mutans count could be reduced by using propolis.[25],[39] Halitosis is a major oral problem which correlates with periodontal disease and studies by Moghbel et al. and Rassameemasmaung et al. prove that it can be overcome by using green tea, which is effective against bacterial infection, halitosis, and plaque formation.[31],[37] A study by Ritenbaugh et al. shows TCM and NM may provide pain relief for some patients with temporomandibular disorders.[15] At the same time, many studies state that for treating temporomandibular disorders, Bell's palsy, trigeminal neuralgia, myofascial pain, and even for acute dental pain, acupuncture is the best alternative treatment.[22],[24],[26],[28],[29],[30],[33],[42],[45]

Despite advanced medical treatments, going natural is the new trend reflecting in the field of medicine. This is because of low expense with fewer side effects of the natural treatment methods. Improper awareness about the available alternative medicines and their applications is acting as a roadblock in this field. Hence, proper studies and researches should be anticipated for further development of natural alternative treatments [Table 3]a and [Table 3]b.


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  Conclusion Top


The present review identified a wide range of researches revealing the various alternative medicinal interventions for oral diseases. There are even some alternative medicines, such as tulsi, aloe vera, miswak, honey, and acupuncture, which alone can cure or prevent many oral diseases. Hence, these alternative medications, which are having many beneficial properties, are a good choice for the prevention or treatment of oral diseases without any side effects. In a developing country such as India, there are several people who cannot even afford their daily basic expenses, and for them, these alternative medicines will be a boon. Henceforth, researchers should be encouraged to quench the demand in preventive measures and to find the hidden alternative medicines and ensure their effectiveness, which can help a wide range of people. This implicates a wide scope for further researches in the same topic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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