Role of Medicinal Plant Species in Oral Health Sector
Medicinal plants have played a dominant and extensive role in the discovery of less expensive, more potent and reliable source of drugs against oral diseases. The continuous use of synthetic chemical substances in dentistry has shown off-target toxicities; this has necessitated the discovery of some alternative medicine with least side effects and high efficiency. Emergence of resistance towards the present antibiotics and the immunodeficiency has prompted researchers to discover novel drug leads against numerous diseases. Broad biological effects such as anti-inflammatory, antimicrobial, analgesic, antifungal and antioxidant activity has been demonstrated by herbal medicines used in the treatment of oral diseases. Plants are used in the maintenance of oral hygiene by various means, which includes nourishing oral health, combating and prevention of oral diseases. Hence, the use of medicinal herbs for improvement of oral health and dental hygiene is a marked advantage of these herbal formulations.
KeywordsMedicinal plants Antimicrobial Anti-inflammatory Analgesic Medicinal herbs Gingivitis Infection
The current global need for some alternative treatment and prevention options for oral diseases that are effective, safe, and economical is due to increase in incidence of diseases, emergence of antimicrobial resistance bacteria, opportunistic infections in immune compromised persons, and financial burden (Khan et al. 2017). Although many agents are being commercially used for treatment of oral microbiota, their undesirable side effects make them less successful in safety aspects (Fair and Tor 2014). Some of the chemical antibacterial agents such as cetylpyridinium chloride, chlorhexidine, and amine fluorides have shown to exhibit some kind of toxicity with staining of teeth, leading to oral cancer. Therefore, the search for alternative substances is in great demand and bioactive compounds from plants are being used in traditional medicines as complementary medicine (Chandra shekar et al. 2016; Palombo 2011).
Medicinal herbs are gaining importance and herbal renaissance is observed all over the world. The herbs and their products are symbolizing safety in contrast to the synthetic medicine, which are considered as unsafe to both environment and humans (Karunamoorthi et al. 2013; Karimi et al. 2015).
Herbs comprising medicinal properties are a valuable and effective source for treatment of various diseases (Petrovska 2012). These herbal extracts have been consistently used in maintaining oral health by tooth cleaning and as antimicrobial plaque agents (Balto et al. 2017).
5.1 Combating Oral Diseases with Herbal Medicine
The herbal medicine usage is successfully increasing around the globe. The herbal medicine has gained a marked momentum in various national health care settings (Yuan et al. 2016). The use of herbal extracts in dentistry is due to various advantages such as antimicrobial plaque agents, reducing inflammation, antiseptics, antioxidants, antifungals, antivirals, and analgesic. Furthermore, the herbal medicine is effective in controlling microbial plaque in gingivitis, wound healing, and periodontitis (Cruz Martínez et al. 2017).
The application of herbal remedies presumed an international interest, which has culminated in their being used in combating various diseases and ailments in both developing and well-developed countries (Sinha and Sinha 2014). Furthermore, currently only a few herb-based drugs are approved for their admirable medicinal properties, a vast majority of naturally occurring medicinal herbs are considered only as food supplements due to lack of studies about clinical trials (Parveen et al. 2015). However, in recent few years much importance was given in exploring different herbs in dentistry.
Various medicinal herbs are having applications in maintenance of oral hygiene by suppressing various oral microbes and by other curative ways (Sravani et al. 2015).
5.2 Medicinal Plants Used in Dentistry
5.2.1 Aloe vera (Fig. 5.1a)
5.2.2 Blood Root (Sanguinaria canadensis) (Fig. 5.1b)
The major constituent of Sanguinaria canadensis is sanguinarine, which have the medicinal properties such as anti-inflammatory, antibacterial, and antifungal properties. This plant is mainly used for remineralization of enamel lesions, acute sore throat, gingivitis, and periodontal disease. However, in case of children and pregnant or lactating women it is considered as unsafe. It has some side effects when used for long term such as glaucoma, stomach pain, diarrhea, edema, heart disease, nausea and vomiting, miscarriage, visual changes, and paralysis (Taheri et al. 2011).
5.2.3 Cranberry (Vaccinium macrocarpon) (Fig. 5.1c)
Cranberry has many medicinal properties and the major constituents include polyphenols and flavonoids, which have been reported to have anticarcinogenic, antibacterial, antiviral, antifungal, and antioxidant properties. Because of its antiadhesive property, it is used against periodontal disease, dental caries, and oral squamous cell carcinoma. Furthermore, there are no reports of adverse effects (Oswal and Charantimath 2011; Kukreja and Dodwad 2012; Yoo et al. 2011).
5.2.4 Chamomile (Matricaria recutita) (Fig. 5.1d)
The chemical composition of chamomile consists of essential oils, volatile oils, and chamazulene. Other constituents include α-bisabolol, flavonoids, luteolin, and related sesquiterpenes, quercetin, and apigenin. Presence of above active ingredients is responsible for its antibacterial and antiviral activity, antispasmodic, anti-inflammatory, and smooth muscle-relaxing action. Major uses include in gingivitis, periodontal disease also in ulcers as a mouthwash. Generally, chamomile is considered safe during pregnancy or breast-feeding. However, it is not recommended for the people with allergies to plants of the Asteraceae family (aster, ragweed, and chrysanthemums), and mugwort pollen (Sudarshan and Vijayabala 2012; Kamat et al. 2011; Taheri et al. 2011).
5.2.5 Black Cohosh (Rhizoma Cimicifugae racemosae) (Fig. 5.1e)
The principle constituents of black cohosh are acetylacetone, cycloartenol-based triterpenes action, 26 deoxy acetol, 26-deoxyactein, cimidenol, and cimicifugaside. It has been reported to be an anti-inflammatory property. This feature is used for treatment of periodontitis although there is not much evidence and studies about it. It is contraindicated during pregnancy and lactation and in children under the age of 12 years. Minor adverse effects of black cohosh include headache and gastrointestinal upset (Taheri et al. 2011).
5.2.6 Caraway (Carum carvi) (Fig. 5.1f)
The major components of caraway are carvone (50–60%) and limonene (40%). It also contains 3–7% volatile oil; the medicinal properties of caraway are antihistaminic, expectorant, antiseptic, antimicrobial, anti-inflammatory, spasmolytic, and flavoring agent (Mardani et al. 2015).
5.3 Medicinal Plants Used to Maintain Oral Health
5.3.1 Evening Primrose (Oleum oenothera biennis) (Fig. 5.2a)
5.3.2 Garlic (Allium sativum) (Fig. 5.2b)
The presence of components such as diallyl sulfide, alliin, S-acetylcysteine, ajoene, dithiin, vitamins B, enzymes, proteins, and minerals. It has antiviral, antibacterial, bacteriostatic, antifungal, antiseptic, and antihelminthic effects. Garlic was tested for treatment of periodontitis and dental caries, and few reports have demonstrated adverse effects such as asthmatic attacks, increased bacterial attachment to orthodontic wires, and contact dermatitis (Mohammad et al. 2014; Oswal and Charantimath 2011; Kamat et al. 2011).
5.3.3 Ginger (Zingiber officinalis) (Fig. 5.2c)
The multiple components of ginger include oleoresin, 1–4% essential oils, zingiberene, curcumin, bisabolene, and sesquiphellandrene along with alcohol and monoterpene aldehydes. The medicinal properties include antibacterial, anti-inflammatory, and analgesic property. The use of ginger is also reported for relieving toothache and for the treatment of oral thrush. Furthermore, ginger may reduce the toxic effects of the cyclophosphamide, a chemotherapeutic agent. Use of ginger is not preferred during pregnancy and patients with the biliary disease. Due to interference of ginger with blood clotting, a special care should be taken in patients undergoing treatment on anticoagulant therapies such as coumadin or heparin (Sudarshan and Vijayabala 2012; Azizi et al. 2015).
5.3.4 Myrrh (Commiphora myrrha) (Fig. 5.2d)
There are three major constituents of myrrh, which include the volatile oil, the resin, and the gum. The gum consists of 65% carbohydrates, 20% proteins, and is composed of 4-O-methylglucuronic acid, arabinose, and galactose. Myrrh has various applications, both in general health and oral health maintenance such as in gingivitis, pharyngitis, ulcers, tonsillitis, and stomatitis. Topical application is used for the treatment of infections of the oral region. Nevertheless, it should be avoided during pregnancy. Some side effects include contact dermatitis (Oswal and Charantimath 2011; Al-Mobeeriek 2011).
5.3.5 Green Tea (Camellia sinensis) (Fig. 5.2e)
The polyphenol contents in green tea comprises catechin (C), gallocatechin (GC), epicatechin gallate (ECG) epicatechin (EC), epigallocatechin (EGC), and epigallocatechin gallate. It is antibacterial, anti-inflammatory, and antiviral. Camellia sinensis is reported to be used in the treatment of periodontal disease (Florêncio Passos et al. 2018; Kukreja and Dodwad 2012; Wolfram 2007; Corwin 2009; Sultan et al. 2016; Naauman et al. 2017).
5.3.6 Neem (Azadirachta indica) (Fig. 5.2f)
Neem is rich with many useful constituents such as sodium nimbinate, azadirachtin, salannin, nimbin, nimbidin, genin, nimbidiol, and quercetin. Leaves of neem consist of carbohydrates, fiber, and about ten amino acid proteins, carotenoids, calcium, and fluoride. Neem has a wide range of activities such as antimicrobial, antitumor, analgesic, antibacterial, antiviral, antifungal, anti-inflammatory, antihelminthic, anticariogenic, antipyretic, and antioxidant activity. There are some reports about the neem and its components, which are used in the treatment of gingivitis, dental caries, and periodontitis. External applications: 70% ethanol extract of the leaves is diluted to 40%. This diluted extract must be applied (Kukreja and Dodwad 2012; Dhingra and Vandana 2016; Bodiba et al. 2018).
5.4 Medicinal Plants Used in the Treatment of Oral Diseases
5.4.1 Thyme (Thymus vulgaris) (Fig. 5.3a)
5.4.2 Turmeric (Curcuma longa) (Fig. 5.3b)
Curcuma longa contains a variety of bioactive components, which include a number of monoterpenes and sesquiterpenes such as zingiberene, β-turmerone, and curcumin Alpha. The coloring is due to curcuminoids, around 60% among them are a mixture of monodesmethoxy, curcumin and bis-desmethoxy curcumin. Various pharmacological properties of turmeric include anticarcinogenic, antibacterial, antimutagenic, and antioxidant used in treatment of dental caries, gingivitis, halitosis, pit and fissure sealant, and oral lichen planus. There is a great relief observed when the aching teeth was massaged with finely grinded and roasted turmeric powder which reduces the swelling also (Chaturvedi 2009; Nagpal and Sood 2013).
5.4.3 Tulsi (Ocimum sanctum) (Fig. 5.3c)
Tulsi is a traditional medicinal plant, which consists of eugenol, tannins, and few essential oils. It has also got few bioactive components such as methyl chavicol, linalool, and 1,8-cineole. It is antiulcer, antimicrobial, antihelminthic, analgesic, and antipyretic, and is used in the treatment for periodontal diseases (Kukreja and Dodwad 2012).
5.4.4 Meswak (Salvadora persica) (Fig. 5.3d, e)
Chewing sticks have been widely used in Africa, Indian subcontinent, and the Middle East since ancient times. Meswak is a derivative obtained from Arak tree and is used by people of different cultures and in many developing nations as a traditional toothbrush to maintain oral hygiene (Al lafi et al. 1995). This is a cheap and easily affordable natural toothbrush suitable for cleansing teeth, possesses various medicinal properties, and is easily available in developing countries. The Meswak extract has also found to be effective in the dentifrices as antiplaque and antigingivitis agents (Gupta et al. 2012). Chewing sticks should be obtained from fresh stems of medicinal plants. It is believed that chewing on these stems facilitate salivary secretions which possibly help in oral cleaning and control of plaque.
5.4.5 Peppermint (Mentha piperita) (Fig. 5.3f)
Peppermint leaves are having some chemical constituents, which include 0.1–1.0% volatile oil, which comprises of menthone (20–31%) and menthol (29–48%). The oil is having muscle-relaxing action and is analgesic. One traditional use of peppermint oil is its application for toothache just by soaking a cotton ball in the oil and rubbing it on the tooth or placing it in the cavity. Peppermint oil is to be avoided by people with inflammation of the gallbladder, severe liver damage, or obstruction of bile ducts. Some marked side effects include headache, perianal burning, bradycardia, burning and gastrointestinal upset, skin rashes, muscle tremors, heartburn, and ataxia. Some in vivo studies are also being performed (Tardugno et al. 2017; Taheri et al. 2011; Gupta et al. 2017).
5.5 Medicinal Plants in Nourishing Oral Health
5.5.1 Sesame (Sesamum indicum) (Fig. 5.4a)
5.5.2 Lavender Oil (Lavandula angustifolia) (Fig. 5.4b)
The oil is extracted from the Lavandula angustifolia flowers. There are reports of stress reduction, decrease in anxiety, and improvement in the mood when inhaled or orally administered but at high anxiety levels does not favor the positive effects of the oil. It is used to reduce patients’ anxiety in dental clinics. It is reported to be an anxiolytic agent, particularly when it is used in waiting area. Furthermore, it is also used during surgical procedures, as it has been demonstrated to decrease the pain due to needle insertion (Lehrner et al. 2005; Kim et al. 2011).
5.5.3 Tea Tree Oil (Melaleuca alternifolia) (Fig. 5.4c)
Melaleuca alternifolia is a native of Australia with antifungal and antiseptic properties with a mild solvent (Arweiler et al. 2000). The products of this plant are used in the treatment of throat irritation, wounds, burns, stings, and skin infections of all kinds. The method of using it is rubbing tree tea oil directly on inflamed gum and sore for temporary relief. The tree tea mouthwash is used for soothing oral inflammation. There is a little solvent action observed and hence has wide and potential applications in root canal treatment for necrotic pulp tissue dissolution. Mouthwashes with tea tree oil have proved to be effective for oral candidiasis patients (Filoche et al. 2005).
5.5.4 Sage (Salvia officinalis) (Fig. 5.4d)
Sage volatile oil consists of major constituents as alpha and beta-thujone, cineole, and camphor. Apart from it, there are other bioactive components such as tannins, rosmarinic acid, and flavonoids. Other than this, the use of sage is prevalent in treatment of sore throat, inflammations, and gingivitis. Sage oil is reported to have various medicinal properties including antifungal, antibacterial, and antiviral, to be avoided by children, when there is high fever and in pregnant women. However, fewer side effects such as increased heart beat and mental disturbance is observed in some cases. High dose may cause convulsions (Taheri et al. 2011; Beheshti-Rouy et al. 2015).
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