2008

NPC Natural Product Communications Vol. 3

No. 11
1813 - 1824
Botanical Medicines for Oral Health
Robert A. Halberstein

Department of Anthropology and School of Nursing and Health Studies, University of Miami,
Coral Gables, FL 33124-2005, USA

R.Halberstein@Miami.edu

Received: November 15th, 2007; Accepted: March 5th, 2008

Dedicated to Prof. Wilfred R. Chan for his inspiration and dedication to natural products chemistry.

The use of natural medicines for dental care is an ancient cross-cultural practice that persists in the majority of cultures today.
Medicinal plants have been employed in dentistry since prehistoric times in different societies for both therapeutic and
preventive oral health care. The various applications of phytomedicines for dental health and healing were explored through a
survey of 91 medicinal plant shops in Miami, Florida, original research results from the Caribbean, and a review of published
cross-cultural evidence. Anecdotal informant reports, case-study field data, clinical research trials, and biochemical laboratory
tests all indicate that botanical medicines represent an historically effective and promising complementary approach to dental
health maintenance, therapy, and support. Botanical remedies have proven effective in the treatment and management of a
variety of oral disorders, partly due to the action of beneficial phytochemicals they contain. Contraindications and potentially
negative side effects have also been recorded in the safety profiles for several of the medicinal plants.

Keywords: medicinal plants, dentistry, phytochemistry, traditional healing, oral health.

Oral health problems date back to some of the earliest
known people. Ample fossil evidence indicates that
ancestral humans suffered from a full range of dental
disorders, including broken and missing teeth, severe
decay and abscesses (both interproximal and “pit-
and-fissure” varieties), genetic anomalies such as
supernumerary teeth, developmental defects such as
enamel hypoplasia and hyperplasia, extreme attrition,
periodontal diseases including pyorrhea alveolaris,
fusion of adjacent teeth, jaw infections and injuries,
malocclusion, dental crowding, transposition or
rotation of teeth, oral tumors, and a variety of other
painful and/or debilitating conditions [1-7; 8, p.44-
64].
Case studies of specific prehistoric and historical
populations have elucidated some of the causes of the
observed dental pathologies as well as ancient
treatment methods. Extensive archaeological research
has been conducted on the effects of past dietary
habits, diseases, and various physical stresses upon
the dentition. For example, an analysis of 669
Neanderthal teeth dating back to 200,000 years ago
revealed that 42% exhibited enamel hypoplasia
attributed to severe nutritional stress during growth
and development [9]. Dental pathologies in four
ancient Peruvian populations, including extreme root
exposure and cervical root caries, have been
attributed to the effects of coca leaf chewing over
4,000 years ago [10]. The evolution of therapeutic
and cosmetic management of oral disorders through
dentistry has also been traced and reconstructed with
fossil and artifact evidence [11-18].
Bioarchaeological evidence in the form of diagnostic
dental grooves suggests that nearly two million years
ago early people---members of the fossil genus
Australopithecus---used selected plant parts for teeth
cleaning [19]. Intentional extractions likewise date
back to early human prehistory. The oldest known
examples of restorative dentistry, consisting of tooth
enamel drilling, have been reported for the Neolithic
period in Pakistan and are 8,000-9,000 years old [20].
Harris et al [21] describe a 4,500-year-old dental
bridge from Egypt featuring artificially prepared
natural teeth with delicately drilled holes and gold
wire.
1814 Natural Product Communications Vol. 3 (11) 2008
Before the recent advent of synthetic analgesics,
antibiotic drugs, toothpaste, antiseptic mouthwash,
mercury fillings, bondings, ceramic composites,
amalgams, resins, plastic sealants, and other material
elements of modern dental care, people relied mainly
upon medicinal plants and animal products to
maintain dental health and enhance the healing
process of pathologies [22; 23, p. 71-72; 24, p. 246-
249]. For example, antibacterial chewing sticks and
sponges preceded the invention of the toothbrush for
daily cleaning [25-27]. Early healers also
administered psychoactive herbal products to reduce
stress and pain in their patients [28, 29].
The increasing expense and well-documented side
effects of synthetic drugs have recently prompted
many medical and dental patients to seek relief with
either complementary or alternative medications,
including time-tested botanical products that are used
cross-culturally. With the ever-increasing demand for
safer and more effective medications with dental
applications, research on medicinal plants has
multiplied accordingly in recent years [22, 30-31].
The purpose of the present paper is to review the
evidence regarding the widespread applications of
medicinal herbs in dentistry practiced in different
societies. Original and previously published data are
evaluated with respect to usage patterns,
effectiveness, and safety of botanical medications in
the treatment, management, and prevention of dental
disorders.
METHODS
Information on herbal medicines employed for
preventive and therapeutic dental care was collected
from original field data, along with previously
published anecdotal and historical reports, case-study
evidence, and results of clinical research trials.
Anthropological health surveys regarding traditional
and modern medication usage patterns were
conducted in two Caribbean countries—The
Bahamas and Turks and Caicos Islands.
Three indigenous healers/herbalists were interviewed
in these populations, and their curing practices were
monitored, including medicinal plant selection and
preparation. Botanical medicine “prescriptions” and
sales records were examined. A demographic
questionnaire administered in Bimini, Bahamas
indicated that 84% of a sample of 717 residents aged
between 15-84 reported the regular use of medicinal
plant products [32-34].
Halberstein
Demographic and health history information was also
collected from a sample of 290 Caribbean-American
migrants aged between 21-85 residing permanently in
Miami, FL. These subjects, averaging 16 years of
residence in the USA, represent 17 Caribbean
countries of origin. Two-thirds (65.2%) of the sample
reported the regular use of traditional herbal remedies
in addition to any synthetic pharmaceuticals [35,36].
A survey was conducted of 91 medicinal plant shops
(“botanicas”) in Miami. Ten of the proprietors of
these establishments were consulted regarding herbal
remedies, their preparation procedures, therapeutic
applications and potential contraindications.
Medicinal plants recommended for the following
chronic conditions were documented: high and low
blood pressure, fertility-related problems, diabetes,
insomnia, and dental disorders. The botanical
products in the Miami shops are stored in dehydrated
form and displayed in clear plastic bags and air-tight
metal containers. Each is labeled in Latin taxonomic
terms along with English and/or Spanish common
names. Botanica personnel also provided information
on historical and cultural aspects of the specimens
(e.g. religious or ritual uses). Health-related
paraphernalia was also observed and noted in the
botanicas, including oils, amulets, potions and
equipment to process and store the plants in stock
[22].
FINDINGS
In the Miami botanicas 33 plant species were
recorded that are specifically indicated for dental
disorders, and these are listed in Table 1, along with
preparation instructions and suggested applications.
For purposes of standardization, Latin taxonomic
terms are used rather than the common names of the
plants discussed in the present paper. Binomial
taxonomic categories (genus and species) are
universally recognized in scientific studies, while
common (“vernacular”) names for the same plant
vary by region and language. For example, species in
the genera Eugenia and Aloe are called “Stopper
Bush” and “Aloe” respectively in the Bahamas, but
they are called “Berry Bush” and “Alvis” on Middle
Caicos Island [32]. In other countries Eugenia
caryophyllus/Syzygium aromaticum* is variously
known as “Clove Bush”, “Clavus”, “Clavos”,
“Clovos”, “Caryophyllus”, “Carophyllus”, “Ding
Xiang”, and “Lavanga” (www.viable-herbal.com). In
*The taxonomic binomial for the clove plant was changed several years
ago from Eugenia caryophyllus to Syzygium aromaticum. Both labels are
used in the Miami botanicas and in the literature.
Natural medicines for dental care Natural Product Communications Vol. 3 (11) 2008 1815

Table 1: Medicinal Plants Used for Dental Health—Miami Botanicas.

Species Preparation/Uses

Aloe vera Leaf consumption; leaf/stem extracts application

Azadirachta indica chewing stick
Calendula officinalis flower head/oil infusion applications
Capsicum frutescens fruit consumption; fruit juice application
Chamomila recutita Leaf/dried flower infusions
Chondrus crispus Gum, mucilage application
Cinnamomum zeylanicum bark application; powdered bark infusion
Citrus paradise seed extract application; seed decoction
Commiphora myrrha bark resin tincture application/gargle
Echinacea angustifolia flower infusion; flower application
Eugenia caryophyllus * powdered clove decoction; dried flower bud oil application
Foeniculum vulgare oil application; fruit ingestion
Haemamelis virginiana bark decoction
Helianthus annus oil application
Hydrastis Canadensis rhizome & root infusion
Krameria triandra root decoction or tincture application
Melaleuca alternifolia root/bark decoctions; oil application
Mentha piperita oil application
Mentha spicata Leaf /oil applications; leaf ingestion
Mentha viridis oil application
Myrica cerifera bark decoction; berry juice/oil applications
Myrica pensylvanica bark decoction; berry juice/oil applications
Olea europaea Leaf decoction; leaf infusion; oil application
Origanum vulgare oil application; leaf decoction
Pastinaca sativa root decoction
Petroselinum crispum seed oil application
Pimenta acris fruit decoction application
Plantago major Leaf decoction; powdered plant ointment
Quercus alba bark decoction
Salvadora persica antiseptic chewing gum; oil extract and tooth powder application
Simmondsia chinensis flower and seed oil application
Syzygium aromaticum powdered clove ingestion; dried flower bud oil application
Zanthoxylum americanum bark decoction

the Miami botanicas species labeled Syzygium
aromaticum, Eugenia caryophyllus* and Eugenia
aromatica are also known by the Spanish terms
“Clavo” (translated as either “clove” or “nail”) and
“Diente” (“tooth”), both of which refer to the shape
of the flower buds that are used medicinally. These
terms also apply to Syzygium aromaticum products
(e.g. oils) sold in the botanicas for dental care (Table
1). Clove oil is listed as an active ingredient in
several over-the-counter mouthwash products and
toothache pain relievers available in pharmacies.
Zanthoxylum americanum is labeled the “toothache
tree” (Spanish term = “arbol dentista”, literally
translated as “dentist tree”) in the botanicas and its
derivatives are sold almost exclusively for oral
treatments.
Several of the tabulated species are recommended
primarily for dental pain and/or inflammation, but are
also dispensed for a variety of other purposes (e.g.
Calendula officinalis, Camomila recutita, and
Mentha piperita). In the surveyed botanicas cloves
(Eugenia caryophyllus/Syzygium aromaticum*) are
sold mainly for dental pain and halitosis but are also
recommended as a remedy for colds, coughs,
bronchitis, fever, throat irritations, stomach ailments,
and skin diseases. Extracts of the aloe plant (Aloe
vera and A. barbadensis) have been used topically
and internally for thousands of years for a wide range
of health conditions [37, p. 9; 38, p. 340]. Absent
from Table 1 are those botanica specimens classified
by the proprietors as general anti-inflammatories or
analgesics, but not specifically prescribed for dental
conditions (e.g. Gaultheria procumbens, Quercus
phellos, Salix humilis, and Hypericum perforatum).
Plants indicated primarily for “sore throat” are
likewise excluded.
A number of preparation methods are included in
Table 1 which help to enhance the therapeutic
qualities of the beneficial chemical components of
the designated plant parts. “Decoction”, the
prolonged boiling of harder structures like bark and
seeds, serves to extract and concentrate
phytochemicals while at the same time reducing their
potential toxicity. “Infusion” refers to the more rapid
boiling and straining of softer parts such as leaves
and flowers [22]. The decoctions and infusions are
swabbed in the mouth and/or ingested to enhance oral
health and healing. In some cases portions of plants
are consumed without modification (Mentha spicata
leaves; Syzygium aromaticum cloves) or directly
1816 Natural Product Communications Vol. 3 (11) 2008
applied to teeth and gums (Cinnamomum zeylanicum
bark; Capsicum frutescens fruit juice). The single
example of an antiseptic chewing stick (Azadirachta
indica) discovered to be available in the Miami
botanicas is also used in other cultures [25, 27].
Other plant components that are processed into
medicines include stems, roots, rhizomes, and resins.
The majority of the medicinal plants in Table 1 are
modified by the herbalists or clients in order to
produce topical or ingestible oils which are claimed
to deliver anesthetic and bactericidal effects in the
oral environment. The volatile oils, sometimes called
“medicinal spirits”, are prepared by pulverizing or
finely chopping specified parts of the herbs,
combining them with grain alcohol, and heating the
mixture to the point of evaporation. The oil released
by special glands in the plant is captured in a
distillation vessel and preserved in ethanol [37].
Undiluted clove oil (Eugenia caryophyllus/Syzygium
aromaticum*) is applied directly to irritated areas in
the mouth, and a 5% solution in distilled water is
used as a mouthwash for preventive care. A
surprising discovery was the availability in a number
of the botanicas of a “dental chewing gum”
commercially produced and packaged by the Peelu,
USA® Company of Fargo, ND. The fibrous gum’s
main ingredient is derived from the peelu tree
(Salvadora persica)--also known as “siwak”, “arak”
and “miswak”--and it contains smaller amounts of
peppermint oil, soy lecithin, titanium dioxide and
carnauga wax. It is recommended for use after meals
to prevent plaque formation. The same company
produces a toothpaste with these ingredients plus tea
tree oil (Melaleuca alternifolia).
The species listed in Table 1 are frequently combined
and/or mixed together to produce a single
formulation for ethnomedical dental treatments.
Clients in the botanicas can receive either hand-
written or pre-printed “prescriptions” upon request
which delineate preparation instructions and dosage
schedules. Extracts of several of the species have
been identified in the literature as bioactively
effective for oral/dental disorders: Aloe vera—
analgesic, anti-inflammatory, promotes wound
healing; Capsicum frutescens—analgesic for chronic
dental pain; Echinacea angustifolia—immune
stimulant/support, anti-bacterial, anti-viral, anti-
fungal; Hydrastis canadensis—reduces inflammation
in mucous membranes and soft tissue; Mentha
piperita—analgesic, cold sore cure, halitosis
treatment; and Sanguinaria canadensis—analgesic,
Halberstein
anti-inflammatory, anti-bacterial, anti-microbial, anti-
plaque [39].
Botanical species reported in the literature with
dental applications in other populations (N = 178) are
compiled in Table 2, along with suggested
preparation methods and application techniques. All
continents except Antarctica are represented in this
sample. Duke [40] lists 90 plant species reported as
sources of dentifrices in different societies and 440
species that have been applied in different forms in
toothache treatments. Lewis and Elvin-Lewis [41, pp.
418-429] describe 188 plant species that are used in
various cultures to relieve toothaches. The authors
also identify numerous species traditionally
prescribed for halitosis, oral infections, cosmetic
tooth coloring, temporary restorations/fillings, and
teething pain preparations [41 pp. 432-445]. Morton
[42, p.1277] cites 32 botanical species exploited in
indigenous Central American populations in the
treatment of gum ailments such as gingivitis and
pyorrhea, as well as 93 species prescribed for
“toothache, caries, and tooth strengthening” [42,
pp.1291-1292].
Eleven of the plants sold in the Miami botanicas for
dental health (Table 1) are also exploited in other
cultures (Table 2): Azadirachta indica, Calendula
officinalis, Cinnamomum zeylanicum, Citrus
paradisi, Commiphora myrrha, Echinacea
angustifolia, Eugenia caryophyllus/Syzygium
aromaticum*, Mentha piperita, Myrica cerifera, Olea
europaea, and Zanthoxylum americanum. The
parallel development of different formulations and
applications for the same species across cultures
provides an instructive example of medical behavior
evolution through independent experimentation
(Cinnamomum zeylanicum, Commiphora myrrha,
Echinacea angustifolia, and Olea europaea).
Conversely, the cross-culturally similar topical
employment of peppermint oil (Mentha piperita) and
clove oil (Syzygium aromaticum) probably represents
the global diffusion of a thoroughly tested and
successful therapy through culture contact and
communication. Like Zanthoxylum (Table 1), the
genus Spilanthes (Table 2) is also popularly known
as the “toothache plant” in a number of cultures [43].
The species outlined in Table 2 are prepared and
applied in a variety of different forms ranging from
seed and root tonics (Avena sativa) to tooth powders
(Gouania polygama; Myrica cerifera), teething rings
(Hyoscyamus niger; Verbena sp.), and toothpicks/
Natural medicines for dental care
Species
Acacia adonsonii
Acacia arabica
Acacia pennata
Acacia senegal
Acacia seyal
Achillea millefolium
Achyranthes aspera
Aerva tomentosa
Alamanda violacea
Alchornia cordifolia
Allium cepa split bulb is roasted & bound while hot on the wrist over the pulse, on the opposite
Allium sativum
Alnus glutinosa
Aloe barbadensis
Alpinia galangal
Althaea officinalis
Amaranthus retroflexus
Anacardium occidentale
Anacylus pyrethrum
Anemopsis californica
Anogeissus leiocarpus
Arbutus unedo
Artemisia dracunculus
Avena sativa
Azadirachta indica
Betula davurica
Betula lenta
Betula paprifera
Betula populifolia
Boswellia sacra
Bumelia laetevirens
Bytyrospermum paradoxum
Caesalpina pulcherrima
Calendula officinalis flower decoction; oral anti-inflammatory; oral antimicrobial; oral wound healing
Cameria latifolia
Candida albicans
Capparis aphylla
Carica papaya
Carpolobia sp.
Cassia reticulate
Cassia sieberianba
Cassia vinnea
Centella asiatica
Chlorophora excelsa
Chrysanthemum parthenium
Cinnamomum zeylanicum
Citrus aurantafolia
Citrus lemoni
Citrus paradise
Citrus sinensis
Clausena anisata
Cnestis ferruginea
Cnidoscolus texanus
Cnidoscolus urens
Cocus nucifera
Coix lacryma-jobi
Commiphora myrrha Granules soaked in water & strained liquid used as mouthwash & to treat oral sores,
Coriandrum sativum
Cornus florida
Croton sellowii
Curcuma longa plant sliced, grated, chopped, or ground to a paste & used to treat mouth pustules & as
Curcuma sp.
Cyperus articulatus
Daemonorops draco
Dalbergia nigra
Dentaria diphylla
Natural Product Communications Vol. 3 (11) 2008 1817
Table 2: Medicinal Plants Used for Dental Health.
Preparation/Uses Reference
oral antibiotic Elvin-Lewis [26]
chewing stick; oral antibacterial; oral antimicrobial Almas [25]
chewing sponge; oral antibiotic Elvin-Lewis [26]
oral antibiotic Elvin-Lewis [26]
oral antibiotic Elvin-Lewis [26]
fresh leaves chewed for toothache Meyer [24]
twig and root infusions used for teeth cleaning Elvin-Lewis [26]
root used for teeth cleaning Elvin-Lewis [26]
teeth cleaning; oral antimicrobial, antifungal, anti-protozoal Elvin-Lewis [26]
teeth cleaning; treats buccal ulcerations Elvin-Lewis [26]
Meyer [24]
side of the body from the toothache
oral antimicrobial & antifungal Elvin-Lewis [26]
bark powder or decoction used as dentifrice for cleaning & decay prevention Meyer [24]
leaf/stem application to dental abscess; oral antibacterial Halberstein [32]
stem shavings applied around tooth for toothache Meyer [24]
root chewed to treat teething in infants Meyer [24]
teeth cleaning; oral antimicrobial Elvin-Lewis [26]
oral antimicrobial Elvin-Lewis [26]
root decoction for toothache Lev & Amar [58]
root infusion for toothache Yarnell et al. [45, p.215]
root & stem used as chewing stick; oral antibacterial; oral antimicrobial Rotimi et al. [27]
oral antibiotic Elvin-Lewis [26]
branch decoction for toothache Lev & Amar [58]
seed tonic for toothache and dental cleansing Yarnell et al. [45, p.218]
toothbrush/chewing stick; oral anti-inflammatory; oral antibacterial Almas [25]
Lebling & Pepperdine[59,p.114]
twigs used for teeth cleaning; oral antimicrobial Elvin-Lewis [26]
twigs used for teeth cleaning Elvin-Lewis [26]
twigs used for teeth cleaning; oral antimicrobial Elvin-Lewis [26]
twigs used for teeth cleaning; oral antimicrobial Elvin-Lewis [26]
plant chewed to freshen breath Lebling & Pepperdine [59, p.68]
drops or cataplasm of leaf decoction for toothache Hirschhorn [60]
root & stem used as chewing stick; oral antibacterial; oral antimicrobial Rotimi et al. [27]
astringent bark infusion to clean teeth & gums; leaf decoction for mouth Hirschhorn [60]
& throat ulcers
Yarnell et al. [45, p.219]
milky sap application for toothache Laguerre [61, p.98], Hirschhorn [60]
oral antimicrobial Elvin-Lewis [26]
chewing stick Almas [25]
sliced fruit applied for oral pain & toothache Halberstein [32]
Halberstein & Saunders [62]
teeth cleaning; oral antimicrobial Elvin-Lewis [26]
teeth cleaning; oral antibiotic Elvin-Lewis [26]
chewing stick (root) Almas [25]
chewing stick (root) Almas [25]
plant infusion for oral wound healing Yarnell et al. [45, p.215]
oral antifungal Elvin-Lewis [26]
leaf ingestion, leaf & stem decoction for toothache Floyd [63]
oil soaked lint placed in cavity to ease toothache pain Meyer [24, p.247]
chewing stick; antiseptic for oral infections Almas [25], Halberstein & Saunders [62]
oral antimicrobial; teeth cleaning Elvin-Lewis [26]
oral antimicrobial; oral analgesic Elvin-Lewis [26]
chewing stick Almas [25]
heals oral wounds/reduces pain Elvin-Lewis [26]
teeth cleaning Elvin-Lewis [26]
root chewed for toothache Meyer [24]
oral antibiotic Elvin-Lewis [26]
peduncle used for teeth cleaning Elvin-Lewis [26]
necklace made from beans and placed around child’s neck to treat teething Meyer [24, p.248]
Lebling & Pepperdine [59, p.110]
blisters, caries, & inflamed gums
toothache treatment Kowalak et al. [64, p.325]
teeth cleaning/toothbrush; oral antimicrobial Meyer [24, p.246], Laguerre [61, p.31]
oral antibiotic Elvin-Lewis [26]
Lebling & Pepperdine [59, p.145]
a dentifrice to strengthen gums
teeth cleaning; oral antibiotic & oral antimicrobial Elvin-Lewis [26]
toothache treatment Hirschhorn [60]
sap, fruit resin, bark used to clean/disinfect teeth Swerdlow [38, p.282]
oral antibiotic Elvin-Lewis [26]
leaf ingestion/leaf infusion; reduces dental pain & speeds oral healing Halberstein [22]
1818 Natural Product Communications Vol. 3 (11) 2008 Halberstein

Table 2 (Continued)
Species Preparation/Uses Reference

Diospyros tricolor chewing stick/teeth cleaning Elvin-Lewis [26]

Distemonanthus
benthamianus
Drypetes sp.
Dydymopanax morototoni
Echinacea angustifolia root ingestion/plant decoction; toothache treatment; oral anti-inflammatory
Equisetum arvense
Equisetum bogotense
Eschscholzia californica
Eugenia caryophyllus *
Fagara (Xanthoxylum)
zanthoxyloides
Ferula asafetida
Ficus sp.
Garcinia afzelii
Garcinia epunctata
Garcinia kola
Garcinia morella
Garcinia sp.
Gaultheria procumbens
Gentiana lutea
root & stem used as chewing stick; oral antibacterial; oral antimicrobial Rotimi et al. [27]
toothache treatment Elvin-Lewis [26]
stems used as toothpicks Hirschhorn [60]
Swerdlow [38, p.99], Yarnell et al.
[45, p.216]
decoction held in mouth as long as possible to stop bleeding from tooth extraction Meyer [24, p.248]
tea used as mouthwash for pyorrhea Hirschhorn [60]
raw root placed into cavity for toothache Emboden [65, p.162]
clove oil application/decoction for toothache Meyer [24, p.247], Lev & Amar [58]
root & stem used as chewing sticks; oral antibacterial; oral antimicrobial; oral Almas [25], Rotimi et al.[27]
analgesic/counterirritant; treatment for toothache & oral canker sores
resin is ground, crushed or melted in liquid & placed in cavity to treat dental pain Lebling & Pepperdine [59, p.23]
teeth cleaning; oral antiseptic; antibiotic chewing gum Elvin-Lewis [26]
teeth cleaning; oral antibiotic Elvin-Lewis [26]
teeth cleaning; oral antibiotic Elvin-Lewis [26]
teeth cleaning; oral antibiotic Elvin-Lewis [26]
teeth cleaning; oral antibiotic Elvin-Lewis [26]
chewing stick; oral antimicrobial Elvin-Lewis [26]
root chewed for toothache/teeth cleaning; oral antibiotic Meyer [24, p.246]
root tonic to strengthen dentition; increases salivation Yarnell et al. [45, p.218]

Gliricidia sepium fruit juice application for toothache Laguerre [61, p.98]

Glycosmic pentaphylla chewing stick Almas [25]

Glycyrrhiza glabra plant chewed to treat teething in infants Meyer [24, p.248]
Gouania lupuloides powder dentifrice; tincture gargled for gum disease & throat ulceration; toothbrush Elvin-Lewis [26]
Hirschhorn [60]
Gouania polygama teeth cleaning Elvin-Lewis [26]
Haematoxylum campecianum oral antibiotic Elvin-Lewis [26]
Hibiscus rosa-sinensis chewing stick; oral antibiotic Elvin-Lewis [26]
Humulus lupulus oral antibiotic Elvin-Lewis [26]
Hyoscyamus niger cut into beads to make teething ring (soaked in wine with powdered coral) Kennett [23, p.72]
Jatropha sp. treatment for bleeding gums Elvin-Lewis [26]
Juglans regia teeth cleaning Elvin-Lewis [26]
Juglans sp. bark used as toothbrush, to strengthen gums, & treat gum inflammation Lebling & Pepperdine [59, p.147]
Lactobacillus acidophilus capsules, granules, powders, & tablets treat pain of a sore mouth caused by oral Kowalak et al. [64, p.319]
candidiasis & canker sores
Ligistrum medium teeth cleaning; oral antimicrobial Elvin-Lewis [26]
Liquidambar styraciflua chewing stick; teeth cleaning; treatment for canker sores, trench mouth, & oral Elvin-Lewis [26]
herpes simplex
Maclura pomifera oral antifungal Elvin-Lewis [26]
Magnifera indica teeth cleaning; resin used to treat canker sores; bark & leaves used to treat toothache, Elvin-Lewis [26]
sore gums & sore throat
Mahonia aquifolium root tonic; increases salivation Yarnell et al. [45, p.218]
Mallotis sp. teeth cleaning Elvin-Lewis [26]
Massularia accuminata teeth cleaning; root & stem used as chewing stick; oral antibacterial; oral Rotimi et al. [27]
antimicrobial
Massularia acuminate teeth cleaning; oral antimicrobial Elvin-Lewis [26]
Matricaria recutita flower decoction used to heal dental wounds; oral antimicrobial; oral Yarnell et al. [45, p.219]
anti-inflammatory
Melaleuca cajaputi oil-soaked lint placed in cavity to ease toothache pain Meyer [24, p.247]
Melampodium divaricatum toothache treatment Hirschhorn [60]
Meletia zachiana teeth cleaning; oral antibiotic Elvin-Lewis [26]
Melilotus sp. oral antibiotic Elvin-Lewis [26]
Mentha piperita oil application/leaf decoction for toothache treatments Lev & Amar [58]
Yarnell et al [45, p. 220]
Musa balbisiana fibrous strings in leaf stems placed in the ear on the affected side for toothache Meyer [24, p.248]
Musa sapientum pounded peduncle & inflorescence used with charcoal for teeth cleaning; skin and Elvin-Lewis [26]
fruit used as oral anticariogenic/ oral antibiotic
Mussaenda sp. teeth cleaning Elvin-Lewis [26]
Myrica cerifera bark powder/bark decoction used as dentifrice for cleaning and decay prevention Meyer [24, p.246]
Myristica fragrans oil placed in cavity to Meyer [24, p.247]
ease toothache
Nauclea latifolia root & stem used as chewing stick; oral antibacterial; oral antimicrobial; oral cleanser Rotimi et al. [27]
Nigella sativa boiled seeds chewed & seed oil gargled for toothache & gum pain Lebling & Pepperdine [59, p.30]
Olea europaea chewing stick/toothbrush; oral cleanser & disinfectant Almas [25]
Origanum majorana oil-soaked lint placed in cavity to ease toothache pain Meyer [24, p.247]
Osimum sp. teeth cleaning; oral antibiotic Elvin-Lewis [26]
Natural medicines for dental care
Species
Oxyanthus speciosus
Panax quinquefolium
Pandanus sp.
Paullinia jamaicensis
Petiveria alliacea
Phaseolus vulgaris
Phoenix dactylifera
Phyllanthus epiphyllanthus
Pimpinella anisum
Piper methysticum
Plumeria multiflora
Polygala lutea
Populus deltoids
Populus tremuloides
Prunella vulgaris
Pseudowintera colorata
Psychotria sp.
Pyrethrum parthenium
Quercus alnifolia
Rheum officinale
Rhus glabra
Rumex crispus
Saccharum officinarum
Salmea scandens
Salvadora persica
Salvia officinalis
Sanguinaria canadensis
Sassafras albidum
Scutellaria baicalensis
Scutellaria lateriflora
Sedum album
Serindei wernickei
Sissyrhinchium schafferi
Spilanthes sp.
Stachys betonica
Symphytum officinale
Syzgium aromaticum clove oil used as oral anesthetic, analgesic & antiseptic; treatment for toothache,
Tabebuia bahamensis
Tabebuia heterophylla
Tanacetum parthenium
Taraxacum officinale
Teclea verdoorniana
Terminalia glaucesens
Terminalia ivorensis
Tibouchina bourgaena
Turnera ulmifolia
Ulmus fulva
Vellozia equisteloides
Verbena sp.
Vernonia amygdalina
Vicia faba
Zanthoxylum americanum
Zanthoxylum clava-herculis
Zanthoxylum elephantiasis
Zingiber officinale grated plant on coarse brown paper steeped in cold vinegar & applied to affected side
of face overnight for toothache; root tonic is anti-inflammatory
Zizania aquatica
Natural Product Communications Vol. 3 (11) 2008 1819
Table 2 (Continued)
Preparation/Uses Reference
teeth cleaning; oral antimicrobial Elvin-Lewis [26]
root tonic to strengthen dentition Yarnell et al. [45, p.218]
pedicel used for teeth cleaning Elvin-Lewis [26]
stem & leaves used for teeth cleaning Laguerre [61, p.31]
leaf decoction used as toothache cure Laguerre [61, p.31]
oral antifungal Elvin-Lewis [26]
peduncle used for teeth cleaning Elvin-Lewis [26]
leaf decoction used for teeth cleaning Laguerre [61, p.98]
seeds chewed to freshen the mouth; seed tea reduces tooth & mouth pain Lebling & Pepperdine [59, p.15]
root tonic for dental pain Yarnell et al. [45, p.218]
teeth cleaning; oral antimicrobial & oral antifungal Elvin-Lewis [26]
oral antimicrobial Elvin-Lewis [26]
teeth cleaning; dental pain reliever Elvin-Lewis [26]
extract or decoction of bark mixed with rum & applied to tooth for toothache Meyer [24, p.247]
root decoction/tonic Abascal & Yarnell [43]
leaves chewed to cure toothache Kennett [23, p.71]
teeth cleaning Elvin-Lewis [26]
leaf ingestion/leaf & stem decoction for toothache Floyd [63]
bark powder or decoction as dentifrice for cleaning & decay prevention Meyer [24, p.246]
teeth cleaning and oral antibiotic Elvin-Lewis [26]
teeth cleaning; treat canker sores, toothache, sore gums & throat Elvin-Lewis [26]
root tonic; increases salivation Yarnell et al. [45, p.218]
teeth cleaning Elvin-Lewis [26]
toothache treatment Hirschhorn [60]
root used as chewing stick; teeth cleaning & decay prevention; oral antibacterial & Almas [25]
oral antimicrobial; breath freshener; extract used as toothpaste Lebling & Pepperdine [59, p.17]
& mouthwash van Wyk & Wink [54, p.282]
leaf decoction for dental pain; hot leaf infusion used as mouth rinse Kennett [23, p.72]
Yarnell et al. [45, p.220]
toothpaste/mouthwash/oral rinse/chewing stick; oral antimicrobial; toothache Halberstein [22], Meyer [24, p.247]
treatment Rotimi et al. [27]
chewing stick; toothpaste flavoring Elvin-Lewis [26]
Kowalak et al. [64, p.339]
root decoction Yarnell et al. [45, p.217]
plant infusion for dental pain Yarnell et al. [45, p.215]
cut into beads to make teething ring (soaked in wine with powdered coral) Kennett [23, p.72]
root & stem used as chewing stick; oral antibacterial & oral antimicrobial Almas [25]
Rotimi et al. [27]
toothache treatment Hirschhorn [60]
plant decoction for toothache Abascal & Yarnell [43]
plant decoction for toothache Yarnell et al. [45, p.220]
leaf decoction for toothache Yarnell et al. [45, p.220]
Elvin-Lewis [26]
postextraction alveolitis, & teething pain; applied in root canal therapy Kowalak et al. [64, p.324]
Lebling & Pepperdine [59, p.43]
leaf decoction used for dental pain Halberstein & Saunders [62]
leaf infusion used for toothaches; leaves chewed for dental pain Halberstein [32]
leaf ingestion/leaf & stem decoction for toothache Floyd [63]
root tonic increases salivation Yarnell et al. [45, p.218]
toothache treatment; oral antibiotic Elvin-Lewis [26]
chewing sponge/chewing stick; teeth cleaning; treatment for caries, pulpitis, & Elvin-Lewis [26]
periodontal disease; oral antibacterial & oral antimicrobial Rotimi et al. [27]
chewing sponge for teeth, cleaning; treatment for caries, pulpitis, & Elvin-Lewis [26]
periodontal disease
warm mouthwash from leaf infusion for toothache Hirschhorn [60]
leaf infusion to treat toothache Halberstein [32]
poultice of bark infusion & cold water applied to face inflamed by toothache Meyer [24, p.247]
teeth cleaning Elvin-Lewis [26]
cut into beads to make teething ring (soaked in wine with powdered coral) Kennett [23, p.72]
root & stem used as chewing stick & toothbrush; oral antibacterial/antimicrobial; Rotimi et al. [27]
mouth & tongue cleanser
oral antifungal Elvin-Lewis [26]
bark chewed or mashed bark applied around aching tooth Meyer [24, p.247]
toothache treatment; oral antibiotic Elvin-Lewis [26]
toothache treatment; oral antibiotic Elvin-Lewis [26]
Meyer [24, p.247]
Yarnell et al. [45, p.218]
teeth cleaning Elvin-Lewis [26]
1820 Natural Product Communications Vol. 3 (11) 2008
Table 3: Clinical Studies of Medicinal Plant Products in Dentistry.
Subjects Species
40 patients with fixed orthodontic Salvadora persica
appliances (mean age = 17.2)
15 periodontal patients Centella asiatica and
Punica granatum
28 healthy subjects age 18-42 Salvadora persica
60 healthy patients age 9-25 with Punica granatum
fixed orthodontic appliances
15 healthy subjects age 21-36 Salvadora persica
40 healthy subjects age 20-45 Salvadora persica
toothbrushes (Cornus florida; Dydymopanax
morototoni). Specially selected branches and stems of
22 of the species in Table 2 are modified to create
antiseptic chewing sticks. Lewis and Elvin-Lewis
[41, p. 387-402] document 181 plant species
employed in different cultures as chewing sticks for
teeth cleaning. The porous roots of several species
are chopped and matted to produce a “chewing
sponge”—e.g. Acacia pennata, Althaea officinale,
and Terminalia ivorensis. The following plant parts
are utilized to create the dental phytomedicines in
Table 2: roots, stems, seeds, pods, leaves, bulbs,
barks, branches, twigs, flowers, saps, fruits, oils,
peduncles, resins, juices, gums and pedicels.
Several of the species in Table 2 have previously
been identified as potentially curative for dental
conditions due to their positive biochemical effects.
Matricaria recutita has been prescribed as an oral
anti-inflammatory, canker sore treatment, and
wound-healing aid. Allium sativum has reported anti-
microbial and immune system stimulant properties.
Extracts of Chrysanthemum parthenium are
traditionally formulated into mouthwashes and
applied to sockets after extractions. Zingiber
officinale is reported to increase the absorption of
medicines for oral conditions.
Glycyrrhiza glabra and Piper methysticum are
prescribed by herbalists in many cultures as
analgesics and stress reducers. Salvia officinalis is
sometimes recommended to help heal wounds and
oral sores [39]. Abascal and Yarnell [43] suggest a
“sample internal formula” for naturally treating
periodontal disease. It consists of a liquid “tea”
produced by boiling the following constituents: 20%
Mahonia aquifolium, 20% Scutellaria lateriflora,
20% Centella asiatica, 15% Prunella vulgaris, 15%
Panax quinquefolium, and 10% distilled water.
Dosage is 6 mL twice daily, 15 minutes before lunch
and dinner. By contrast, a commercially-produced
Halberstein
Results Reference
plaque reduced and gingival condition better in sub-samples treated Al-Teen, et al. [49]
with S. persica compared to control subjects.
significant improvement in pocket depth, attachment level, and Sastravaha, et al. [66]
gingival condition; reduced bleeding.
improved gingival condition and lower rate of cariogenic bacteria Khalessi, et al. [50]
compared to placebo.
sharp decrease in plaque and associated bacteria and other Menezes, et al. [52]
microorganisms with herbal mouthwash treatment.
“miswak” chewing stick significantly more effective than toothbrush Al-Otaibi, et al. [67]
in reducing plaque and gingivitis.
significant reduction in oral bacteria with “miswak” chewing stick Almas & Al-Zeid [68]
extract compared to toothbrush.
“natural” toothpaste has been developed for
preventive periodontal care which includes co-
enzyme Q10, lactoferrin, squalene, xylitol, folic acid,
hydrogen peroxide and tea tree (Melaleuca
alternifolia) oil [44].
Recent case study evidence regarding the use of
medicinal plant products in dentistry is presented in
Table 3. The subjects in these investigations were
randomized into experimental (treatment with
phytomedicines and traditional botanical chewing
sticks) and placebo (e.g. distilled water and/or
commercial toothpastes) groups. The findings are
generally positive, with few reports of any side
effects. Probably because of its lengthy history of
successful outcomes, Salvadora persica is the most
frequently applied medicinal plant in dentistry.
Several investigators have recorded significant
reductions in plaque and bacteria counts, as well as
improvements in gingival condition with Salvadora
persica extracts. Clinical tests of Centella asiatica
and Punica granatum also indicate significant
reductions in oral bleeding, bacterial counts and
plaque, as well as gingival and socket strengthening
(Table 3).
Discussion
Medicinal plants represent a promising approach for
the future of dental care, especially considering their
widespread and successful usage for this purpose
since ancient times. Summarizing previous
investigations, Yarnell et al. [45] state that “Herbs
can reduce gum bleeding and the depth of tissue
pockets substantially and reduce the mobility (or
looseness) of teeth significantly. Botanicals can also
help to avert the development of abscesses, allowing
patients to avoid root canal procedures and
extractions as well as helping to reduce caries, a
common cause of tooth loss”. The research cited in
the present review indicates that phytomedicines
have produced positive results in traditional dentistry
Natural medicines for dental care
practice with minimal side effects. Wang [46] points
out that 10-15% of the estimated 300,000 total
species of higher plants have been documented as
efficacious in cross-cultural studies of medical
systems. A single plant can contain several thousand
potentially useful phytochemicals, and Daniel [47]
estimates there are some two million chemical
components present in the plant kingdom. Further
research is thus warranted on this practically
unlimited healing resource.
Observations in the Miami botanicas (Table 1) and
previously published data (Table 2) indicate that
virtually every plant part has been exploited in
dentistry. Among the 33 plants cited in Table 1, over
a quarter (27%) are prescribed mainly as oil
applications and 24.2% involve bark preparations,
while leaves (18%) and roots (12%) are used less
often. By way of comparison, Ramawat et al. [48]
estimate that roots account for 29% of the different
plant parts that constitute herbal medicine
pharmacopoeias of India, compared to barks (14%),
fruits (10%), stems/wood (9%), seeds (7%), leaves
(6%), flowers (5%) and rhizomes (4%). According to
the latter authors, whole-plant preparations comprise
the remaining 16% of all East Indian botanical
medicines.
One of the reasons for the positive outcomes of
medicinal plant applications in dentistry is the
beneficial activity of the phytochemicals they
contain. The Salvadora persica chewing stick (Tables
1 and 2) has been described as possessing hemostatic,
analgesic, anti-inflammatory and anti-microbial
properties due to several of its components including
fluoride, chlorides, alkaloids, sulfur compounds,
volatile oils and glucosinolates [49, 50].
Archaeological evidence indicates that antiseptic
chewing sticks have been used for dental health/oral
hygiene for at least 9,000 years [25, 51]. Punica
granatum (Table 2) ingestion delivers a number of
anti-oxidant pyridine alkaloids and therapeutic anti-
bacterial polyphenols to the oral environment [52].
Essential oils derived from the dried flower buds of
cloves (Syzygium aromaticum), applied directly to
toothaches (Table 1 and Table 2), contain eugenol,
caryophyllene and tannins and have been used in
dentistry for over 2,000 years [26]. Eugenol
(C10H12O2), a colorless aromatic oil, is a major active
ingredient in some commercial preparations used to
treat alveolalgia (“dry socket”) and other painful
dental anomalies [53]. Chlorophyll (C55H70MgN4O6),
the green pigment in plants which converts carbon
Natural Product Communications Vol. 3 (11) 2008 1821
dioxide and water into carbohydrates, has been added
to commercial toothpastes and mouthwashes for
many years for its cleansing, deodorizing and
disinfectant effects. A current (2008) commercial
website states “Chlorophyll has anti-inflammatory,
antioxidant, and wound-healing properties.”
(http://www.vitamins-supplements.org).
According to van Wyk and Wink [54] a number of
other species co-listed in both Table 1 and Table 2
possess therapeutic biochemicals that would be
useful in dentistry: 1) Azadirachta indica—
triterpenoids (limonoids), tannins and flavonoids that
help heal wounds and infections; 2) Calendula
officinalis—saponins, triterpenes and flavonoids that
reduce inflammation, aid wound healing and
stimulate the development of granulation tissue
during scar formation; 3) Commiphora myrrha—
polysaccharides, triterpene acids and essential oils
that are effective in the treatment of gingivitis and
oral infections; 4) Echinacea angustifolia—
polysaccharides and polyacetylenes which are anti-
inflammatory and anti-bacterial; 5) Mentha
piperita—menthol, menthone and methyl acetate in
essential oil that have anti-bacterial and anesthetic
effects; 6) Myrica cerifera—the flavonoid myricitrin,
tannins and triterpenoids that exert anti-bacterial and
choleretic effects; 7) Olea europaea—oleuropein,
flavonoids and phenolic acids which act as
emollients, anti-pyretics and anti-spasmodics; and 8)
Syzygium aromaticum—eugenol, flavonoids and
caryophyllene which have antiseptic, anesthetic and
anti-inflammatory qualities.
Contraindications and potentially negative side
effects have been reported in the safety profiles for
the phytomedicines produced from several of the
species in Tables 1 and 2, and additional clinical
evidence is required for more definitive evaluations.
Mills and Bone [55] note that Aloe vera, Foeniculum
vulgare, Piper methysticum, and Hydrastis
canadensis are not recommended for use by pregnant
women or individuals with hypertension. Gastro-
intestinal disturbances and liver toxicity have been
associated with the extended usage of Tanacetum
parthenium, Piper methysticum, Glycyrrhiza glabra,
Scutellaria lateriflora, and Zingiber officinale. The
same authors also point out that Echinacea
angustifolia, Mentha piperita, Matricaria recutita,
and Taraxcum officinale can produce allergic
reactions, including dermatitis. Caution is
recommended in the use of Sanguinaria canadensis
because of its reported carcinogenic potential.
1822 Natural Product Communications Vol. 3 (11) 2008 Halberstein

Commenting on medicinal plant safety in general,
Magee and Loiacono [39, p. 113] state: “Several
herbal supplements have been found to cause not
only adverse systemic reactions but also adverse oral
consequences, however the dosage of the herb that
causes the adverse reaction can vary greatly from
individual to individual. These oral reactions include
tongue numbness, increased gingival bleeding, oral
irritation and inflammation of the tongue and lips,
aphthous ulcers, excessive salivation, xerostomia and
oral cancer.” Murray [56] discusses several potential
problems in quality control in “natural” and
commercial herbal health products. Biochemical
assays of phytomedicines have disclosed wide
variations in their purity, concentration, and
bioactivity due to different preparation procedures.
The latter author points out that “Currently, no
organization or government body certifies the
labeling of herbal preparations. Without quality
control, one cannot be sure that the herb contained in
the bottle is the same as that stated on the label” [56,
p. 408]. Another cautionary factor in medicinal plant
usage is the possible lack of coverage of
consultations and/or herbal product costs by health
insurance policies and managed care programs.
The present review provides several lines of evidence
supporting the prescription of herbal medicines as a
relatively safe and effective complementary approach
to supplement regular dental care. Laboratory tests of
plant chemical products, double-blind experiments,
case studies of individuals or sample populations
followed through specified time periods, clinical
trials and retrospective anecdotal reports have all
yielded positive results in the search for
phytomedicines for dentistry. Further clinical
research, such as double-blind in-vivo and in-vitro
assessments, are required for definitive evaluations,
however.
The ancient practice of medicinal plant usage is
gaining renewed attention from a variety of scientists
in several different fields. Chen and Volding [57, p.
51] note: “Today the medicinal use of plants, which
is based in part from the knowledge of trial and error
use over thousands of years in various cultures, has
become incorporated in virtually all human cultures.
Some notable herbs, in fact, have shown
contemporary medicinal promise and value for their
potential health promoting and protective effects.” It
is thus apparent that while botanical medicines show
great promise for the future of dentistry and dental
health, a tremendous amount of additional validating
research work remains to be undertaken.

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