ISSN 0975-8437
REVIEW ARTICLE
Plant products in Dentistry-A review
Siddana Goud Reddy, Shoba Fernandes, Shrudha Potdar, Kailash Attur
Abstract
Renewed research into various plant products is currently in progress. This short review endeavors to
bring about an understanding regarding the various applications of plant products in oral health care.
Key Words: Oral health;Onion;Ginger;Garlic; Aloevera;Turmeric;Plant products
India is the land of Naturopathy where
Ayurveda forms the foundation for majority of the
traditional and natural healing systems. It is a well-
documented fact that natural remedies through
Ayurveda owe their origin to India. The populace
at various stages relies on differing methods of
natural treatment modalities, whether in the form
of home remedies or prescription medications from
ayurvedic practitioners. There has been a rise in
the awareness and interest in seeking alternative
natural remedies among western populations,
especially in combating the rising dilemma of side
effects caused by synthetic allopathic medications.
About 25% of modern pharmaceuticals are derived
from plants.(1) Patients are often unaware of the
similarities between medicinal herbs and
prescription drugs, and they may mistakenly
believe that these "natural" substances do not
contain powerful bioactive ingredients. In addition,
because herbs may be sold and marketed without
FDA approval, there are concerns about the limited
evidence on herbal side-effects, drug interactions,
and product consistency.(2,3) Interest in the
potential health benefits of various natural plant
products like Onion (Allium cepa), Garlic (Allium
sativum), Ginger (Zingiber officinaleradix Roscoe),
Aloevera (Alebarbadensis) and Turmeric
(Curcumin), this paper review the systemic as well
as the oral health benefits which could be derived
from these natural products.
Articles for this review were obtained
through MEDLINE, using a keyword search of the
common and Latin botanical names for each of the
5 herbs. The search was limited to English-
language articles and human and in-vitro studies.
The authors reviewed the articles identified by the
search, summarizing the evidence through a
process of discussion and consensus. Evidence on
five most commonly used plant products were as
follows.
Onion (Allium cepa): Onion has the
distinction of being the king of vegetables. Its
extensive use in various forms due to the
antibacterial and antifungal properties is well
documented. It promotes good heart health because
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it facilitates the thinning of the blood which helps
to prevent clot formation.
Studies which researched the activities of
onion extracts on Streptococcus mutans and
Streptococcus sobrinus, the main causal bacteria
for dental caries, and Porphyromonas gingivalis
and Prevotella intermedia, considered to be the
main causal bacteria of adult periodontitis. The
results showed that the onion extracts possess an
effect on all test bacterial strains (S.mutans JC-2,
S.sobrinus OMZ176, P.gingivalis ATCC 33277
and P.intermedia ATCC 25611), and the effects
were bactericidal against cultured and resting
bacterial cells.(4)
Several epidemiologic investigations have
suggested an inverse relation between intake of
allium vegetables and stomach, colorectal, and
prostate cancers,(5,6) but the results for other
cancer sites are scanty, especially for cancers in the
head and neck region where further investigations
are indicated. Studies of experimental
carcinogenesis in animal models and in cell culture
systems indicate that several allium-derived
compounds exhibit inhibitory effects and that the
underlying mechanisms may involve both the
initiation and the promotion phases of
carcinogenesis.(7) However, the specific
components of allium vegetables involved in the
specific cellular and molecular events that govern
these anticancer properties are not known.(8)
The potential anticarcinogenic action of
onions may also be related to their high content of
organosulfur compounds or to their high
antioxidant activity, which is principally due to
their wide content of flavonoids. However, there
are important varietal differences in the
composition, concentration, and beneficial
activities of these bioactive compounds, which also
result by modalities of cooking.(9)
Garlic: Historically, garlic was used in
China to lower blood pressure, in Egypt to increase
physical strength, in Europe to prevent the plague
and in India as a home remedy for various minor
ailments like flu and cough. Garlic has been used
not only to flavor food but also because it contains
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a sulfur-rich derivative of cysteine felt to have
medicinal benefits.
Garlic contains several different organo-
sulfur compounds in addition to amino acids,
vitamins, and micronutrients. Its anticarcinogenic
actions may be explained by particular organo-
sulfur compounds. Diallyl sulfide, for example,
which is responsible in part for its strong taste and
odor, has been shown to selectively inhibit as well
as induce certain P-450 enzymes.(10)
Garlic extract is effective against
S.mutans when tested both in vitro and in vivo. As
S.mutans is one of the primary etiological
organisms in dental caries development, and in this
study garlic extract has been shown to be effective
against S.mutans, garlic extract mouth rinse might
be used as an effective remedy in the prevention of
dental caries.(11)
Allicin is considered the most therapeutic
constituent of garlic. Research performed using
broth dilution method revealed that planktonic
growth of the cariogenic, gram-positive species
S.mutans, S.sobrinus, and Actinomyces oris was
inhibited by various allicin concentrations.
Planktonic growth of the tested gram-negative
perio-pathogenic species a.a.a.comitans and
Fusobacterium nucleatum was also inhibited by
allicn. The Porphyromonas gingivalis, an
anaerobic, gram-negative pathogen and the bacteria
most associated with chronic periodontitis
demonstrated lower levels of sensitivity to allicin
in comparison to the other oral pathogens.(12)
In a study it was found that the garlic has
antimicrobial properties in vitro against
streptococci and anticariogenic properties against
oral microorganism.(13) Experimental studies
have shown that the chemo-preventive activity
of Allium vegetables is related to their content of
organo-sulphur compounds (OSCs). Although how
these compounds achieve chemoprevention is not
fully understood, several modes of action have
been proposed.(14-17) These include: (i) effect on
drug metabolizing enzymes (i.e. induction of phase
II detoxification enzymes, including glutathione
transferases, quinine reductase, epoxide hydrolase
and glucuronosyl transferase, that inactivate toxic
substances and facilitate their excretion); (ii)
antioxidant activity (garlic preparations exhibit
radical scavenging activity and decrease lipid
peroxidation, which is relevant in the light of the
observation that tumour promotion may involve
oxygen radicals); (iii) tumour growth inhibition
that has been documented in several carcinoma cell
lines, including prostate carcinoma cells; (iv)
induction of apoptosis, which coincides with an
increase in the percentage of cells blocked in the
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G2/M phase of the cell cycle (possibly through a
depression in p34cdc2 kinase) and (v) effective
stimulation of the immune response (OSCs
stimulates proliferation of lymphocytes and
macrophage phagocytosis, induce the infiltration of
macrophages and lymphocytes in transplanted
tumours, induce splenic hypertrophy, stimulate
release of interleukin-2, tumour necrosis factor-
α and interferon-γ, enhance natural killer cell, killer
cell and lymphokine-activated killer cell
activity.(18)
Aloe Vera (Alebarbadensis) is indigenous
to the Sudan and the Arabian Peninsula but is now
grown in many parts of the world, including Indian
subcontinent. Aloe may be dried into capsules or
formulated into gels for topical application. The
Aloe Vera plant has been known and used for
centuries for its health, beauty, medicinal and skin
care properties. The name Aloe Vera derives from
the Arabic word “Alloeh” meaning “shining bitter
substance,” while “Vera” in Latin means “true.”
2000 years ago, the Greek scientists regarded Aloe
Vera as the universal panacea. The Egyptians
called Aloe “the plant of immortality.” Aloe has
been found to be effective against many
dermatological conditions like herpes, and
psoriasis. Although effectiveness with other
conditions like radiation dermatitis are found to be
questionable.(19)
Aloe Vera contains 6 antiseptic agents:
Lupeol, salicylic acid, urea nitrogen, cinnamonic
acid, phenols and sulfur. They all have inhibitory
action on fungi, bacteria and viruses. Aloever has
been found to be useful in cancer prevention,(20,
21) aphthous stomatitis,(22) mucositis,(23) and
radiation dermatitis.(24) In addition studies have
revealed the effectiveness of aloe in combination
with other medicaments like allantoin for treatment
of apthous stomatitis.(25)
Topical application of aloe vera is not an
effective prevention for radiation-induced injuries.
However it can be effective for genital herpes,
psoriasis, human papilloma virus, seborrheic
dermatitis, aphthous stomatitis, xerosis, lichen
planus, frostbite, burn, wound healing and
inflammation. It can also be used as a biological
vehicle and an anti-microbial and antifungal agent
and also as a candidate for photodynamic therapy
of some kinds of cancers.(26)
The antimicrobial effect of a dentifrice
containing Aloevera has been demonstrated in an in
vitro study, in which this phytotherapic agent
inhibited the growth of diverse oral
microorganisms, such as S.mutans, S.sanguis,
A.viscosus and C.albicans.(27) The only study
available evaluating the clinical effects of Aloe
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vera showed a significant reduction of gingivitis
and plaque accumulation after use of a mouth rinse
containing this natural product.(28)
Ginger: Ginger, the rhizome of “Zingiber
officinalis”, one of the most widely used species of
the ginger family, is a common condiment for
various foods and beverages. Ginger has a long
history of medicinal use dating back 2500 years.
Ginger has been traditionally used from time
immemorial for varied human ailments in different
parts of the globe, to aid digestion and treat
stomach upset, diarrhoea, and nausea. Some
pungent constituents present in ginger and other
zingiberaceous plants have potent antioxidant and
anti-inflammatory activities, and some of them
exhibit cancer preventive activity in experimental
carcinogenesis.(29)
Several plant-derived extracts have been
evaluated as possible inhibitors of the NF-κB
pathway. Ginger root (Zingiber officinaleradix
Roscoe) and its main poly-phenolic constituents
(gingerols and zerumbone) have anti-oxidant,(30-
35) anti-inflammatory(36-39) and anti-
carcinogenic activity.(40-44) In particular, ginger
root and its constituents can inhibit NF-κB
activation induced by a variety of agents(45-48)
and has been shown to down regulate NF-κB
regulated gene products involved in cellular
proliferation and angiogenesis, including IL-8,(49)
and VEGF.(50) These factors have also been
shown to promote tumor cell proliferation,
angiogenesis, and affect apoptotic response in
ovarian cancer.
A study revealed that the ethanol and n-
hexane extracts of ginger exhibited antibacterial
activities against three anaerobic Gram-negative
bacteria, Porphyromonas gingivalis ATCC 53978,
Porphyromonas endodontalis ATCC 35406 and
Prevotella intermedia ATCC 25611, causing
periodontal diseases. Authors concluded that two
highly alkylated gingerols, [10]-gingerol and [12]-
gingerol effectively inhibited the growth of these
oral pathogens at a minimum inhibitory
concentration (MIC) range of 6-30 microg/mL.
These ginger compounds also killed the oral
pathogens at a minimum bactericidal
concentration.(51)
Turmeric (Curcumin): India has been
recognized all over the world for spices and
medicinal plants. Both exhibit a wide range of
physiological and pharmacological properties.
Current biomedical efforts are focused on their
scientific merits, to provide science-based evidence
for the traditional uses and to develop either
functional foods or nutraceuticals. The Indian
traditional medical systems use turmeric for wound
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healing, rheumatic disorders, gastrointestinal
symptoms, deworming, rhinitis and as a cosmetic.
Studies in India have explored its anti-
inflammatory, cholekinetic and anti-oxidant
potentials with the recent investigations focusing
on its preventive effect on precarcinogenic, anti-
inflammatory and anti-atherosclerotic effects in
biological systems both under in vitro and in vivo
conditions in animals and humans. Both turmeric
and curcumin were found to increase detoxifying
enzymes, prevent DNA damage, improve DNA
repair, decrease mutations and tumour formation
and exhibit antioxidative potential in animals.(52)
Curcumin (diferuloylmethane) is the chief
component of the spice turmeric and is derived
from the rhizome of the East Indian plant Curcuma
longa. Curcuma longa is a member of the
Zingiberacae (ginger) family of botanicals and is a
perennial plant that is native to Southeast Asia.(53)
Turmeric has also been widely used in Ayurvedic
medicine for its anti-oxidant, antiseptic, analgesic,
antimalarial and anti-inflammatory properties.(54)
Curcumin has been consumed as a dietary
supplement for centuries and is considered
pharmacologically safe.(55) Curcumin is a
lipophilic polyphenol and thus is insoluble in
water, but is readily soluble in organic solvents
such as dimethylsulfoxide, acetone and
ethanol.(54, 56)
The antioxidant activity of the
curcuminoids comes by virtue of their chemical
structure. The curcuminoids consist of two
methoxylated phenols connected by two a, B
unsaturated carbonyl groups that exist in a
stableenol form.(57) Curcumin’s inhibitory effect
on the NF-_B pathway is central to providing the
compound with its anti-inflammatory
properties.(58-60) Epidemiological studies
attribute the low incidence of colon cancer in India
to the chemopreventive and antioxidant properties
of diets rich in curcumin.(61) Curcumin’s
inhibitory effect on carcinogenesis has been
demonstrated in several animal models of various
tumor types including oral cancer, mammary
carcinoma and intestinal tumors.(62-64) In addition
to the potential synergistic effect of curcumin with
platinum based chemotherapy, the spice may also
have potential utility as an enhancer of radiation
therapy. A recent study by Khafif et al the
combination of both therapies resulted in an
additive growth suppressive effect.(65)
Low incidence of colon cancer among
Indians has been attributed to the use of turmeric in
Indian cooking.(66) Curcumin appears to suppress
oxidative damage, inflammation, cognitive deficits,
and amyloid accumulation in Alzheimer’s disease.
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In addition, curcumin appears to show protective
effects in cystic fibrosis, human immunodeficiency
virus, and experimental alcoholic liver disease.(67)
Porphyromonas gingivalis, a major
periodontopathic bacterium, is necessary for
periodontitis to take place. The lipopolysaccharide
(LPS) of P.gingivalis stimulates cytokine secretion
in immune cells, and thereby initiates the
inflammation related to periodontitis. Macrophages
are the important immune cells that are prominent
at inflammatory periodontal sites. Curcumin, a
major curcumanoid found in the spice turmeric,
exhibits anti-inflammatory properties against these
microorganisms.(68)
Natural Xan natural Curcuma
xanthorrhiza extract (Xan) has strong bactericidal
activity, inhibitory effects on acidogenesis, and
alters the microstructure of S.mutans biofilm. In
conclusion, Xan has potential in anti-S.mutans
therapy for the prevention of dental caries.(69)
The renaissance into the study and use of
plant products is an eye opener to increased
awareness of the myriad of side effects associated
with allopathic medications. Though extensive
research has brought to light several benefits of
plant based medications on oral pathogens further
human studies are essential relating to oral
disorders in particular. Judicious use of these
remedies under the guidance of Ayurvedic health
care providers with extensive knowledge would
certainly aid patients in their pursuit of safer health
care.
Authors Affiliations: 1. Dr. Siddana Goud Reddy,
MDS, Sr. Lecturer, Department of Community Dentistry,
2.Dr. Shoba Fernandes, MDS, Professor & Head,
Department of Pedodontics, RKDF Dental College &
Research Centre, Bhopal, M.P, 3. Dr. Shrudha Potdar,
MDS, Post Graduate student, Department of Community
Dentistry, Bapuji Dental College & Hospital, Davangere,
Karnataka, 4.Dr. Kailash M Attur, Reader, Department
of Conservative and Endodontics, RKDF Dental College
& Research Centre, Bhopal, M.P., India.
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