Role of Phytotherapy in Gingivitis: A Review
N. Jagan Rao,
K. Sandeep Kumar
There is a long and venerable history of the use of plants to improve dental health and promote oral hygiene. Plants contain phytochemicals such as alkaloids, tannins, essential oils and flavonoids which have pronounced antimicrobial activity. Plants have also been incorporated into dentifrices and have been used to provide natural chewing gums for oral hygiene, to treat toothache, gingivitis and periodontal disease. There is a potentially valuable role for Phytotherapy in assisting with the management of gingival and periodontal diseases. The evidence and research which supports such a role for a few plants and plant products has been reviewed in this study.
Received: September 03, 2011;
Accepted: December 16, 2011;
Published: February 15, 2012
Chronic gingival inflammatory conditions primary etiology is often investigated
to be bacterial plaque and its byproducts (Botelho et
al., 2007). The association between poor oral hygiene, dental plaque
and the severity of periodontal diseases is also well established (Botelho
et al., 2007). Numerous antimicrobial agents have been and are being
tested throughout the world in order to determine which agents are efficacious
and safe in preventing plaque formation and/or inhibiting the colonization of
periodontopathogens within the plaque (Tsao et al.,
Plants (herbs) and naturally derived products from plants (herbal supplements)
have been used to enhance health and for medicinal purposes for thousands of
years (Cohan and Jacobsen, 2000). Most herbal supplements
have been utilized for centuries based on empirical and testimonial support
for their efficacy (Cohan and Jacobsen, 2000). Development
in alternative medicine research has led to many mouth rinses and toothpastes
based on plant extracts (Ozaki et al., 2006).
The scientific evidence-based literature also supports the efficacy and safety
of numerous herbs today (Cohan and Jacobsen, 2000).
Hence scientific evaluation for safety and efficacy is needed for the drugs
of alternative medicine (Subash et al., 2011).
Therapy comes from the Latin word therapia, originally from Greek therapeia,
from therapeuein which means to treat medically. The Latin prefix phyto stands
for plant and is called photon in Greek. In other words "Phytotherapy" can be
called herbal medicine (http://www.scienceinafrica.co.za/2004/june/phytotherapy.htm)
It is the study of the use of extracts from natural origin as medicines or health-promoting
agents (Zhao, 2007). The term phytonutrients refer to
plant nutrients with particular biological activities in supporting human health.
Phytonutrients emphasize more specifically natural bioactive compounds from
plants with general benefits to human health.
RATIONALE FOR PHYTOTHERAPY
Phytotherapy has a long history and has been used worldwide. For plant after
plant, isolates demonstrate effects that are immune-enhancing, anti-inflammatory
and anti-cancer (Lee, 2005). Some phytotherapy strategies
have been well recognized since they have been extensively studied in chemistry
and pharmacology and are partly proven by clinical trials (Jiang
et al., 2005). There are also noted advantages of advocating phytotherapy
which include (1) unique mechanisms of action, (2) typically low side-effect
profiles, (3) low cost and (4) a high level of acceptance (Shoskes,
USEFUL PARTS AND ACTIVE CONSTITUENTS
Many plants are being studied for their potential as phytonutrients or phytotherapy
materials (Jiang et al., 2005). The literature
suggests several plants and plant parts which have anti-inflammatory, antioxidant,
antibacterial, astringent and other useful properties.
|| List of useful plant parts and their active constituents
These properties can be made use of in the treatment of gingival and periodontal
diseases. Compared to plant-derived drugs that often consist of one single natural
compound in combination with other minor chemicals, herbs or phytotherapy materials
often contain multiple bioactive components with multiple targets during intake
and therapy (Jiang et al., 2005). Various plants
along with their useful parts and active constituents have been listed in Table
Alkaloids are naturally occurring chemical compounds containing basic nitrogen
atoms. They often have pharmacological effects and are used as medications (http://en.wikipedia.org/wiki/Alkaloids).
Volatile oils are concentrated, hydrophobic liquids containing volatile aroma
compounds from plants. Various essential oils have been used medicinally at
different periods in history. Medical applications range from skin treatments
to remedies for cancer (http://en.wikipedia.org/wiki/Volatile_oils).
Polyphenols are a group of chemical substances found in plants, characterized
by the presence of more than one phenol unit. Polyphenols can be mainly divided
into tannins, lignins and flavonoids (http:
//en.wikipedia.org/wiki/Polyphenols). Tannins are astringent, bitter plant
polyphenols that either bind and precipitate or shrink proteins. The anti-inflammatory
effect of tannins helps control all indications of inflammation. The ability
of tannins to form a protective layer over the exposed tissue keeps wounds from
being infected further. Tannins are also beneficial when applied to the mucosal
lining of the mouth (http://en.wikipedia.org/wiki/Tannins).
Flavonoids are water soluble polyphenolic molecules containing 15 carbon atoms.
They have antioxidant activityActivities attributed to flavonoids include: anti-allergic,
anti-cancer, antioxidant, anti-inflammatory and anti-viral (http://www.phytochemicals.info/phytochemicals/flavonoids.php).
Vitamin C is essential to prevent disease associated with connective tissue
and to improve immune cell functions. It is also used to regenerate vitamin
E (Jiang et al., 2005). Carotenoids are organic
pigments that are naturally occurring in the chloroplasts and chromoplasts of
plants and some other photosynthetic organisms like algae, some types of fungus
and some bacteria. Most carotenoids have antioxidant activity and they are efficient
free-radical scavengers (http://en.wikipedia.org/wiki/Carotenoids).
PREPARATIONS AND MARKERS
Phytonutrients have been traditionally used as tinctures, oils or as components of toothpastes and mouthrinses. They are predominantly for topical usage only and not for systemic consumption. Some phytonutrients may also be taken in the form of tea or boiled syrup.
Fine et al. (2007) stated that rinsing with
an essential oil mouthrinse can have an impact on the subgingival plaque flora.
Yamanaka et al. (2007) conducted a study in which
it was concluded that cranberry polyphenol fraction inhibits biofilm formation
and the Arg-gingipain and Lys-gingipain activities of P. gingivalis.
Al-Bayati and Sulaiman (2008) investigated the aqueous
extracts of Salvadora persica for its antimicrobial activity against
7 isolated oral pathogens (Staphylococcus aureus, Streptococcus mutans,
Streptococcus faecalis, Streptococcus pyogenis, Lactobacillus
acidophilus, Pseudomonas aeruginosa and Candida albicans)
and found that the extracts inhibited all the isolated microorganisms.
Hirasawa et al. (2002) determined the usefulness
of green tea catechin for the improvement of periodontal disease using a slow-release
local drug delivery system. Green tea catechin showed a bactericidal effect
against black-pigmented, Gram-negative anaerobic rods and the combined use of
mechanical treatment and the application of green tea catechin using a slow
release local delivery system was effective in improving periodontal status.
Habiboallah et al. (2008) formulated a novel
cost-benefit material by mixing ghee from sheep butterfat with the powdered
rhizomes of Curcuma longa and evaluated its potential therapeutic effect
on acceleration of surgical wound healing. They suggested a positive potential
therapeutic effect on surgical wound healing particularly improvement of periodontal
treatment consequences after surgery.
For comparison chlorhexidine gluconate 0.2% is considered to be the gold standard
to treat human gingival disease (Rahmani and Radvar, 2005).
A spartate aminotransferase appears to have the potential to serve as a biological
marker to monitor orthodontic tooth movement (Rohaya et
al., 2009). Human gingival fibroblast (GHF1) cell lines were used to
assess plant phytonutrients cytotoxicity using clonogenic assay and the total
cellular GSH level was analyzed using a photometrical assay (Shokrzadeh
and Ebadi, 2006). The bony turnover specifically the bone formation can
be monitored through the expression of alkaline phosphatase activity in the
gingival crevicular fluid during orthodontic treatment (Asma
et al., 2008). Spectrum of pathogenicity of the periodontal disease
and effective management of diagnosis by use of multiplex PCR using the subgingival
plaque samples (Faghri et al., 2007). Subgingival
plaque samples were used for presence of Epstein-Barr virus type 1 (EBV-1) in
patients with chronic periodontitis with nested-PCR (Moghim
et al., 2007). The analysis of plaque index, gingival index and bleeding
on probing can give vital data on gingival inflammation and plaque formation
(Amoian et al., 2010).
Most phytotherapy strategies are ahead of the scientific basis and without
strict controls in quality, safety and efficiency (Zhao,
2007). Certain herbals may cause direct effects on oral tissues, including
tongue numbness, burning of the tongue and mouth/throat irritation (Cohan
and Jacobsen, 2000). Toxicity is usually seen only when excessive amounts
of phytochemicals are ingested. This is rarely encountered because phytotherapy
for gingival inflammation usually involves only topical application and systemic
administration is not required.
Another risk with herbal supplements, as with exposure to nearly all substances,
is that of an allergic reaction that can manifest in the oral mucous membranes,
gingiva, tongue, or elsewhere. Indirect oral effects may also be seen which
include halitosis, excess saliva and blood pressure increase and irritability
(Cohan and Jacobsen, 2000).
PHYTOTHERAPY RESEARCH IN INDIA
Use of plants as a source of medicine has been inherited and is an important
component of the health care system in India. India is the largest producer
of medicinal herbs and is appropriately called the botanical garden of the world.
The officially documented plants with medicinal potential in India are 3000
but traditional practitioners use more than 6000 (Seth and
Sharma, 2004). Several institutes in the country are working extensively
in this area in order produce newer and more effective phytochemicals which
can be manufactured on a mass scale and made available to the common man at
low and affordable costs. These include The Central Institute of Medicinal and
Aromatic Plants (CIMAP) at Lucknow, The Indian Council of Medical Research (ICMR)
at New Delhi, The French Institute of Pondicherry (FIP) at Pondicherry, The
Central Drug Research Institute (CDRI) at Lucknow, The National Botanical Research
Institute (NBRI) at Lucknow, The Tropical Botanic Garden Research Institute
(TBGRI) at Thiruvananthapurnam and The Medicinal Plant Conservation Park at
Phytotherapy, the most ancient medication, is still useful today. It can be
believed that many unstudied plants might have some secrets for the medical
However, concerns from scientists, professionals and customers continuously
arise, due to increases in the use of phytochemicals. Quality, safety, long-term
adverse effects and toxicity are the primary concerns (Zhao,
2007). A systematic approach through experimental and clinical validation
of efficacy is required for a plant identified for phytotherapy, as is done
in modern medicine; animal toxicity studies are also required to establish the
potential adverse effects.
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