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 Table of Contents  
REVIEW ARTICLE
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 38-44

Application of herbal products in management of periodontal diseases: A mini review


Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Rucha Shah
Department of Periodontics, Bapuji Dental College and Hospital, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-6027.171166

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  Abstract 

Periodontal disease is a chronic inflammatory disease affecting the supporting structures of teeth and may lead to bleeding gums, tooth mobility, and eventually tooth loss. With the limited effectiveness of current forms of mechanical therapy in the management of periodontal diseases, there has been a shift in focus on to alternative therapies. One such area where maximum research has been going on is phytotherapy. Several studies now focus on the efficacies of herbal extracts on various important periodontal pathogens such as Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Treponema denticola and Tannerella forsythia. Furthermore, recent studies have explored the benefits of using plant-based products on various periodontal clinical parameters such as gingival inflammation, gingival bleeding, etc. The aim of this review to focus on potential, of pros and cons of the several plants/extracts that have been used in vitro or in vivo for management of periodontal diseases and also to highlight the direction of future research to improve their efficacy.

Keywords: Chronic periodontitis, herbals, therapeutics


How to cite this article:
Shah R, Gayathri G V, Mehta DS. Application of herbal products in management of periodontal diseases: A mini review. Int J Oral Health Sci 2015;5:38-44

How to cite this URL:
Shah R, Gayathri G V, Mehta DS. Application of herbal products in management of periodontal diseases: A mini review. Int J Oral Health Sci [serial online] 2015 [cited 2017 Apr 29];5:38-44. Available from: http://www.ijohsjournal.org/text.asp?2015/5/1/38/171166


  Introduction Top


Periodontal diseases are inflammatory disease of the supporting tissues of the teeth caused by complex interaction between specific microorganisms or groups of specific microorganisms and host immune response. This condition may result in exfoliation of teeth and even deterioration of systemic health if sufficient attention is not paid for its treatment.

As our understanding of the etiology and pathogenesis of periodontal disease is continually changing with increased scientific knowledge, the paradigm of treatment concept is also varying. Though initially mechanical therapy alone was considered as the remedy due to tissue invasive nature of periodontopathogens, antimicrobial therapy as an adjunct to mechanical therapy has grabbed the attention in the treatment of periodontal disease.

These synthetic antimicrobials irrespective of their delivery system are found to be associated with specific or nonspecific challenges such as the emergence of drug resistance, development of hypersensitivity reactions, and suppression or imbalance of normal oral flora. Hence, to overcome these problems, age-old solution but currently receiving the focus of wide interest of both medical and dental fraternity due to their natural and nonchemical property is herbal therapy/phytotherapy.

Phytotherapy is the use of extracts from the natural origin as medicines or health-promoting agents. These herbal drugs are the secondary metabolites of plants. They are required only indirectly to enable plants to survive and reproduce in a given competitive ecosystem in contrast to primary metabolites, which are crucially needed for growth and maintenance of plants. It has been hypothesized that until date only 1% of available plant species have been phytochemically investigated. Thus there is great potential for discovering novel bioactive compounds.[1],[2]

For the purpose of writing this review, a thorough literature search was carried out using manual and electrical means. A manual search was performed for journal articles, textbooks, and magazines giving references to in vivo or in vitro herbal formulations used for the nonsurgical and surgical management of periodontal diseases. For electronic search, the keywords "herbal" and periodontitis were searched with the operator AND. All the articles were then segregated and relevant references were then included in the review.

Though the use of herbals for the medicinal purpose is traced back to several centuries, it is only in the recent evidence-based era that, methodical and systematic approaches to study their properties have reinstated. This has sparked a wide interest for their application in all healthcare specialties including periodontics. In this article, a few important plant or herb extracts that have shown a beneficial effect on periodontal health have been reviewed. [Table 1] summarizes few common herbs that have found applications in the medical field, which also have therapeutic applications in dentistry.
Table 1: Common medicinal herbs

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  Uses in Periodontics Top


Eucalyptus extracts (Eucalyptus globulus) have demonstrated anticariogenic and antiplaque activity. A recent study has demonstrated inhibitory activity on virulence factors of Porphyromonas gingivalis, including Arg-and Lys-specific cysteine proteinases. Sixty percent ethanol extracts from the E. globulus leaf displayed antibacterial activity against several periodontopathic bacteria, including P. gingivalis and Prevotella intermedia. In particular, among periodontopathic bacteria, the growth of P. gingivalis was strongly inhibited even with a low concentration (10 mg/ml) of eucalyptus extracts.[5] The results of a double-masked study revealed that subjects who chewed eucalyptus containing gum found reduced gum bleeding, reduction in pocket depth, and plaque accumulation.[3]

Neem extracts (Azadirachta indica) have been used as an anticariogenic agent as well as root canal irrigant.[7] They have shown to cause a significant reduction in gingival bleeding and plaque index scores over a period of 21 days and were considered as equally efficacious as chlorhexidine.[8],[9] Neem leaf extract helped to reduce bacteria and plaque levels that cause the progression of periodontitis. It has been observed that subjects using neem gel experienced improvement in periodontal health when compared to a control group.[10]

Black cutch (Acacia catechu Willd.) extracts have demonstrated anticaries activity and have also been tried for the management of halitosis.[11] A clinical study on black cutch extracts reported 87–95%, 70–72%, and 80–95% reduction in plaque, gingivitis, and dental calculus scores, respectively, during the 15 days of the study period.[9]

Aloe vera (Aloe barbadensis Miller.) has been used as a natural remedy for throat infections and painful teeth eruptions. A clinical study demonstrated improvement in clinical parameters such as plaque index, probing pocket depth, and gain in clinical attachment following an intra-pocket placement of aloe vera gel in type 2 diabetes mellitus

patients with chronic periodontitis.[13]

Chamomile flower (Chamomilla recutita/Chamaemelum nobile) extracts have been used as a remedy for mucositis, oral ulceration, and sore throat. A study evaluated the antimicrobial effects of the extract and essential oil of chamomile (Anthemis nobilis, Compositae) flower head against P. gingivalis, which provided effective evidence for the potential use of chamomile as mouthwash for the treatment of periodontitis.[15] A significant reduction in plaque and gingival scores was observed after usage of a German chamomile mouth rinse.[16]

Liquorice extracts (Glycyrrhiza glabra) have been used as anticaries agents and also for the management of herpetic lesions. These extracts have demonstrated their potential for the development of novel host-modulating strategies to treat cytokine and/or matrix metalloproteinase-mediated disorders such as periodontitis. In another study, liquorice extract exhibited potent anti-inflammatory properties and inhibited the periodontopathogen lipopolysaccharide-induced interleukin

1 beta (IL-1β), IL-6, and IL-8 and tumor necrosis factor alpha (TNF-α) responses by macrophages.[18] Liquorice extract was also seen to minimize bone loss in IL-10 deficient mice.[19]

Pomegranate extracts (Punica granatum) have found application as anticaries agents and also in the management of denture stomatitis. A study evaluating the effect of P. granatum demonstrated a trend toward decreasing plaque formation and significant pocket depth reduction and attachment level gain at 3 months study period as compared to placebo. Improvement in clinical parameters was noted, and the effect was further confirmed by a significant decrease in IL-1β and IL-6 levels at 3 and 6 months postoperatively in contrast to the baseline values.[22],[23]

Mandukparni or Indian pennywort or jalbrahmi (Centella asiatica) has been used to enhance wound healing. A study evaluating the effect of C. asiatica demonstrated a trend toward decreasing plaque occurrence. It also showed a significant reduction in pocket depth with a gain in attachment level at 3 months compared to placebo. In another study, all the re-measured parameters showed better results, which was confirmed by detection of a significant reduction in IL-1β and IL-6 levels at 3 and 6 months follow-up compared to baseline.[22],[23]

Turmeric (Curcuma Longa) has been used as a pit and fissure sealant and also as an ingredient in a plaque detection system.[25] An animal study was conducted to evaluate the effect of systemically administered curcumin on periodontal disease. Curcumin did not prevent alveolar bone resorption, but it effectively inhibited cytokine gene expression at both the messenger RNA and the protein level. It produced a dose-dependent inhibition of the activation of nuclear factor-kappa beta in the gingival tissues. However, activation of the cellular pathway p38 mitogen-activated protein kinase was not inhibited by curcumin. Curcumin treated animals also presented a marked reduction of the inflammatory cell infiltrate and increased collagen content and fibroblastic cell numbers.[27]

Tulsi (Ocimum sanctum) has long been considered as a medicinal plant. A study conducted to evaluate the efficacy of an herbal mouth rinse containing tulsi showed that the rinse was a potent plaque inhibitor, though it was less effective than chlorhexidine gluconate. However, it can serve as a good alternative for the patients with special needs as in the case of diabetics, xerostomics.[29]

Garlic extracts (Allium sativum) have demonstrated anticaries activity.[32] A study assessed the antimicrobial activity of garlic allicin on periodontal pathogens. It inhibited the growth of Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum at a minimum allicin concentration of 300 μg/ml, but

P. gingivalis showed low sensitivity to allicin. However, this study emphasized the use of allicin for alleviating dental diseases and stressed the need for further studies.[33]

Though sanguinarine (Sanguinaria canadensis) based toothpaste and mouthwashes were used commonly before the 21st century, later reports suggested a possible link between the use of sanguinarine-containing products and leukoplakia. Hence, the use of these products has been largely discontinued.[35]

Cranberry extracts (Vaccinium macrocarpon) have established anticaries activity. They prevent adherence and biofilm formation by P. gingivalis and

F. nucleatum.[37],[38] They have shown to hinder the production of pro-inflammatory cytokines by host macrophages following lipopolysaccharides stimulation by A. actinomycetemcomitans, F. nucleatum, P. gingivalis, Treponema denticola and Tannerella forsythia.[39]

Guava extracts (Psidium guajava) have also been evaluated for their anticaries activity. A study performed to evaluate the efficiency of guava extract demonstrated that it efficiently neutralizes A. actinomycetemcomitans leukotoxicity and thus may aid in the development of novel therapeutic agents and strategies for prevention and treatment of aggressive forms of periodontitis.[42]

Mango extracts (Garcinia mangostana L.) have been recently tried in dentistry. The pericarp gel when applied topically as an adjunct to periodontal treatment was found to enhance the clinical effects of periodontal treatment.[44]

Muthala extracts (used as chewing sticks to clean teeth) have revealed antimicrobial activity against periodontal pathogens including P. gingivalis and P. intermedia.[45] Many other herbs and their extracts such as Diospyros lycioides, Morinda citrifolia, triphala orange oil, carvacrol, sasearia, sylvestris, Psoralea corylifolia, rhus plants, jieeryin solution, Coriandrum sativum, Syzygium aromaticum, lemon solution, Salvadora persica, Ampelopsis brevipedunculata, Quercus brantii, C. sativum, A. brevipedunculata are currently being evaluated for their medicinal properties and potential use in the field of dentistry.[46],[47],[48],[49],[50],[51]

Though the benefits of herbal products are highlighted, they are not devoid of adverse effects. Studies have demonstrated the occurrence of lesions such as plasma cell gingivitis, hypersensitivity, and stomatitis venenata.[52],[53],[54] Therefore, it is necessary to check the effect of these agents on viable oral tissues.

With the rise of multiple drug resistant organisms in the oral cavity the need for alternative therapeutic and palliative treatment modalities gains limelight. Herbal products have proven their potential in the management of various dental problems as an adjunct to mechanical therapy. Hence, there is a plethora of research in the field of herbal dentistry. In a recent review article on herbals in dentistry, 142 relevant articles were found in the year 2013. Of these 75 were literature review, 31 were clinical studies, 20 were conducted in animals, and 16 were retrospective studies.[55] When we focus on the field of periodontology, a recent review exhibited that there is increasing evidence on the role of herbal extracts in periodontal therapy.[56] The preponderance of such literature elaborates the renewed of researchers and clinicians interest in these age old remedies.


  Conclusion Top


Herbal products present an attractive potential as an adjunct to mechanical periodontal therapy. The research in the field of herbals is still in its infancy. However, most of the studies are in vitro studies and use single herbal extracts. Such findings cannot be strictly extrapolated to their in vivo efficacy.

Amalgamation of the maximum desired beneficial biological properties of multiple herbs and formulating a working combination to maximize their combined efficacy as a product are required. Such agents must also be compared to the conventional antibiotics to evaluate their in vivo and in vitro efficacy. Hence, focused methodological researches are mandatory to throw light not only on therapeutic but also the preventive applications of these herbals in periodontal therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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