Review of Indications and Adverse Side Effects of Herbs Useful in Dentistry.
Taheri JB, Azimi S, Rafieian N, Zanjani HA. Herbs in dentistry. Int Dent J. 2011;61(6):287-296.
Herbal medicine is no longer on the periphery of treatment options, including in the field of dentistry. As such, there is an urgency for generating and understanding evidence-based data, especially with respect to efficacy and safety. This article reviews the indications, adverse side effects, and recommended intake levels of herbs that can be used in oral health care.
Bloodroot
Bloodroot (Sanguinaria canadensis) contains alkaloids, principally sanguinarine, that can be useful for gingivitis or periodontal disease because they inhibit the growth of oral bacteria. However, the safety profile of bloodroot is suspect. A report in 2000 associated its use in dental preparations with leukoplakia, a precancerous condition. Amounts as small as 1 ml of tincture (or 1 g of plant material), if taken internally, can cause nausea and vomiting, and long-term use can cause stomach pain, diarrhea, visual changes, paralysis, fainting, and collapse. The plant is not considered safe for use in children.
Caraway
Caraway (Carum carvi) volatile oil contains carvone (50-60%) and limonene (40%) and may help gingivitis or periodontal disease when used as a mouthwash. It is also used as a flavoring component in toothpaste and mouthwash. It is generally safe for use, but the oil should not be given to children under the age of 2 years.
Chamomile
Chamomile (Matricaria recutita) flowers contain volatile oils as well as the flavonoids apigenin, luteolin, and quercetin. It is known for its anti-inflammatory and muscle-relaxing actions. For oral applications, it has been used in mouthwash to prevent periodontal disease. Adverse side effects are primarily seen in those with allergies to the Asteraceae family (i.e., ragweed). It is considered safe for pregnant and nursing women. The recommended use in dentistry is the tea as a mouthwash between meals 3-4 times daily, or 4-6 ml of tincture 3 times per day between meals.
Echinacea
Echinacea (Echinacea spp.) alkamides or polyacetylenes, caffeic acid derivatives, and polysaccharides have been shown to boost the activity or proliferation of white blood cells. It is effective as a mouthwash for gingivitis or periodontal disease in combination with sage (Salvia officinalis), peppermint (Mentha x piperita) oil, menthol from Chinese mint (Mentha canadensis syn. M. arvensis), and chamomile. Echinacea has no reported acute or chronic toxicity.
Myrrh
Myrrh (Commiphora molmol) consists of the resin, gum, and essential oil, and has been used for inflammations of the gums and mouth mucosa, such as gingivitis and stomatitis. To make a gargle or mouthwash, 30-60 drops of tincture are added to warm water as a mouthwash or brushed undiluted onto the mucous membranes 2-3 times daily. It has no known adverse side effects.
Peppermint
Peppermint oil, which is mostly comprised of menthol and menthone, acts as a topical analgesic. It can be used for a toothache or gum inflammation by soaking a cotton ball in the essential oil and applying it to the site of pain in the mouth. Reactions to the oil when used topically have been rare, though it may cause stomach upset in some people if swallowed, especially those with heartburn, who should avoid its use. The oil should not be applied to the face near the nose or in it, especially of children.
Rosemary
Rosemary (Rosmarinus officinalis) contains the volatile oil eucalyptol, which has antibacterial and antifungal properties; this is useful locally, but the oil should not be taken systemically. Rosemary's carnosol also inhibits bacteria, and its rosmarinic acid is antioxidant. A tea can be prepared by adding 10 g of herb to one cup (250 ml) of boiling water and allowing it to steep in a covered container for 10-15 minutes. Rosemary tincture can be taken at 2-5 ml 3 times daily.
Sage
Sage contains alpha- and beta-thujone, camphor, cineole, rosmarinic acid, tannins, and flavonoids. A gargle of sage tea is used to treat sore throat, or as a mouthwash for inflammations in the mouth and gingivitis. To make a tea, 3 g of the leaf is infused in boiling water, and it should be used several times daily. Chronic use of sage may cause increased heart rate and mental confusion, but this is only with ingestion and not use as a gargle. Consumption of sage should be avoided if fever is present.
Thyme
Thyme (Thymus vulgaris) constituents include the phenols thymol and carvacol. Thyme is used to treat chronic candidiasis and halitosis. In addition, a salve made of thyme, myrrh, and goldenseal (Hydrastis canadensis) can be used to treat oral herpes. As a fluid extract, 1-4 ml can be used 3 times daily. Thyme is considered to be safe, even for children and pregnant or breastfeeding women. The oil should only be used topically, and still some people may be sensitive to it on the skin or in the mouth.
Aloe
Aloe (Aloe vera) gel is an antibacterial, antifungal, and antiviral agent. It is used for many conditions in oral health, including application to affected tissues after surgery, extractions, or trauma; to lesions, ulcers, and canker sores; to chronic conditions such as lichen planus and benign pemphigus; to irritations from dentures; and to inflammation from dental implants. Many additional applications may come to light in the near future.
Propolis
Propolis has antifungal, antiviral, antioxidant, anticarcinogenic, antithrombotic, and immunomodulatory activity, and is available in lozenges, mouthwash, and toothpaste.
Numerous other herbs and uses are briefly listed. One aspect the authors did not address that is pertinent with oral exposure to herbal extracts is the concern about palatability. The taste of liquid preparations is often determinant as to whether the patient will be compliant with instructions for use. For example, for jaw pain, a tea is recommended that is made with lobelia (Lobelia inflata) combined with black cohosh (Actaea racemosa syn. Cimicifuga racemosa), skullcap (Scutellaria lateriflora), cayenne (Capsicum annuum), and myrrh. One hopes for a quick cure.
Gingivitis / Tandvleesontsteking
Gum disease is a common condition that, in severe cases, calls for antibiotics. Now, researchers are developing a treatment based on wild blueberry extract that could prevent the formation of dental plaque that leads to gum disease.
Researchers are developing a treatment to fight gum disease that is based on wild blueberry extract.
A report on the work, by a team from Université Laval in Canada, can be found in the Journal of Agricultural and Food Chemistry.
Many people have some degree of gum inflammation, or gingivitis, that results from the build-up of dental plaque containing bacteria. However, if the inflammation persists, it eventually leads to gum or periodontal disease.
If the bacterial plaque is not removed - for example, by regular brushing and gum care - it leads to a much harder deposit called tartar that only a dental health professional can remove to stop the periodontal disease process.
According to the Centers for Disease Control and Prevention (CDC), nearly half of American adults aged 30 and over have some form of periodontal disease.In severe cases of periodontal disease, the dentist may also prescribe antibiotics to fight the infection.
Blueberry extract shows antibacterial and anti-inflammatory action
Fast facts about gum disease
Gum disease and tooth decay are the two biggest threats to dental health
Smoking, diabetes and poor oral hygiene increase the risk of developing gum disease
Red, swollen, tender or bleeding gums and persistent bad breath or bad taste are some of the signs of gum disease.
The team behind the new study has been investigating a range of natural antibacterial compounds to fight gum disease. More recently they began to look at blueberry polyphenols, which are known to protect plants against some diseases.
They wondered if the compounds - which they found in extracts from the wild lowbush blueberry, Vaccinium angustifolium Ait. - might have an effect on Fusobacterium nucleatum, a bacterium that plays a key role in gum disease.
Lab tests showed the compounds successfully stopped the bacterium growing and forming biofilms. Tests on macrophages - immune system cells that play a key role in inflammation - also showed that the polyphenol-rich extract blocked a molecular pathway that is involved in inflammation.
Biofilms are precursors to plaques. They consist of a matrix of substances the bacteria cells produce and in which they embed themselves.
J Am Dent Assoc. 2008 May;139(5):606-11. Antimicrobial effectiveness of an herbal mouthrinse compared with an essential oil and a chlorhexidine mouthrinse. Haffajee AD1, Yaskell T, Socransky SS.
The authors investigated mouthrinses' antimicrobial effectiveness against predominant oral bacteria, as determined by the minimum inhibitory concentration (MIC). Specifically, they evaluated an herbal mouthrinse, an essential oil rinse and a 0.12 percent chlorhexidine gluconate rinse.
METHODS:
The authors assessed the inhibitory effects of the three test agents against 40 oral bacteria at concentrations of 1, 2, 4, 8, 16, 32, 64, 128, 256 and 512 micrograms per millliter. They inoculated plates containing basal medium and the test agents with suspensions of the test species and incubated them anaerobically at 35 degrees C. The authors interpreted the MIC as the lowest concentration of the agent that completely inhibited the growth of the test species.
RESULTS:
The herbal mouthrinse inhibited the growth of most of the 40 test species. Compared with the essential oil mouthrinse, the herbal mouthrinse exhibited significantly lower MICs for Actinomyces species, periodontal pathogens Eubacterium nodatum, Tannerella forsythia and Prevotella species, as well as the cariogenic pathogen Streptococcus mutans. The chlorhexidine gluconate rinse had the lowest MICs compared with the essential oil rinse and the herbal rinse for all test species examined.
CONCLUSIONS:
Although less potent than the chlorhexidine gluconate rinse, the herbal rinse was more effective than the essential oil rinse in inhibiting the growth of oral bacteria in vitro.
CLINICAL IMPLICATIONS:
The data suggest that the herbal mouthrinse may provide oral health benefits by inhibiting the growth of periodontal and cariogenic pathogens. In vivo clinical testing is essential to confirm in vitro results.
ISRN Dent. 2011;2011:541421. doi: 10.5402/2011/541421. Epub 2011 Jun 8.
Antimicrobial Activity of Few Medicinal Plants against Clinically Isolated Human Cariogenic Pathogens-An In Vitro Study.
Jebashree HS1, Kingsley SJ, Sathish ES, Devapriya D.
Hexane, ethyl acetate, ethanol and methanol extracts of Psidium guajava, Terminalia chebula, Mimusops elengi and Achyranthes aspera were tested against the dental caries causing bacteria Streptococcus mutans and fungus Candida albicans isolated from caries infected patients. All the four extracts of P. guajava showed activity against both S. mutans and C. albicans. Maximum zone of inhibition was observed in ethyl acetate of P. guajava. The four extracts of T. chebula and M. elengi showed antibacterial activity against S. mutans. M. elengi extracts and ethanol extract of T. chebula did not show any antifungal activity against C. albicans. Except for the hexane extract of A. aspera, the other three extracts showed activity against the tested microbes. The ethyl acetate P. guajava leaf extract showed the minimum inhibitory concentration (MIC) against S. mutans to be <0.076 mg/mL in both MHB and BHI. The P. guajava ethyl acetate extract was subjected to GC-MS.
Ceylon Med J. 2011 Mar;56(1):5-9. A randomised double-blind placebo-controlled study on the effects of a herbal toothpaste on gingival bleeding, oral hygiene and microbial variables.
Jayashankar S1, Panagoda GJ, Amaratunga EA, Perera K, Rajapakse PS.
Different systems of traditional medicine of the Indian subcontinent, have used Acacia chundra Willd, Adhatoda vasica Nees., Mimusops elengi L., Piper nigrum L., Pongamia pinnata L. Pirerre, Quercus infectoria Olivier., Syzygium aromaticum L., Terminalia chebula Retz., Zingiber officinale Roscoe., individually or in combinations, to cure oral diseases.
OBJECTIVE:
To investigate the oral hygiene and gingival health benefits of toothpaste formulated with a mixture of the above herbs (15% w/w).
METHODS:
Sixty participants (test n = 30, control n = 30, mean age 23.6 +/- 2.25 vs 23.9 +/- 3.2 years) who fulfilled the selection criteria and had similar plaque (1.734 +/- 0.29 vs 1.771 +/- 0.33) and percentage of sites with gingival bleeding (19.6 +/- 7 vs 20.7 +/- 8) were studied in a double blind randomised clinical trial. Brushing instructions to all and a scaling for those with calculus were provided two weeks before baseline examination. One ml of resting saliva was collected to ascertain anaerobic (SAnB) and aerobic (SAB) bacterial counts, plaque index (PI), percentage sites with bleeding on probing (BOP) and pocket depth (PD) (at 6 sites/tooth) were recorded at baseline, followed by home use of the allocated toothpaste (test or placebo) twice a day for 12 weeks. Measurements were repeated at 4, 8, and 12 weeks.
RESULTS:
PI, BOP and SAnB decreased significantly in the test group at 4, 8, and 12 weeks compared to baseline measurements (Wilcoxon-Signed Rank Test, p < 0.01). There was no statistically significant improvement in PI, BOP, and SAnB in the placebo group.
CONCLUSIONS:
Our study indicates the beneficial effects of this herbal toothpaste (Sudantha) on oral hygiene and gingival health variables when compared with the placebo. Further clinical trials using patients with gingivitis are necessary to confirm the therapeutic benefits of this herbal toothpaste.