Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 Available online at www.ordoneardentistrylibrary.org

ISSN 2249-488X

Review - Article

INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY

Aloe Vera – A Miracle Herb Dr. Madhuri Alankar Sawai Dept. of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi-110025 Received: 10 Feb 2014; Revised: 13 Mar. 2014; Accepted: 16 Apr. 2014; Print date: 5 May. 2014 ABSTRACT

Aloe vera is one of the plant species which has multiple uses to mankind. It has been widely used for ages as an alternative medicine and also as a cosmetic product. Because of its rejuvenating, soothing and healing properties, it has been used for various medical ailments like peptic ulcers, digestive problems, skin irritation and various skin lesions. Also, it has been found to be beneficial in oral problems like apthous ulcers, gingivitis and periodontitis and various fungal and viral diseases. Though, the uses of this plant are well known to humans since a long time now, still its uses in dentistry are not widespread. The review here emphasizes the great importance of this commonly found plant. Key words: aloe vera, gingivitis, periodontitis, oral lesions, inflammation, wound healing Introduction: Aloe vera is a stem less, succulent plant which looks like a cactus, but is actually a member of the lily family (liliaceae). The botanical name is Aloe barbadensis Mill. The species has a number of synonyms: Aloe indica Royle, Aloe perfoliata L var. Vera and A. Vulgaris Lam(1,2). Commonly, it is known as Chinese Aloe, Indian Aloe, True Aloe, Barbados Aloe, Burn Aloe, First aid plant (3). A spotted variety of aloe vera is termed as Aloe vera var.chinensis. This plant probably originated in the northern Africa, but now grows in the Asia and warmer parts of America and Europe too. The plant is widely naturalised, occurring in temperate and tropical regions of Australia, Belize, Nigeria, Paraguay and Barbados. The plant grows to around 60-100 cm (24-39 inches) tall and spreads by offsets. The leaves are thick and fleshy, of green and grey-green colour with small white teeth on the margins. Some varieties show white spots or flecks on the stems. It is a summer flowering plant, producing yellow tubular flowers about 2-3 cm long on a long spike.(4) The leaves of the plant consists of two different parts. The parenchymal tissue which makes up the inner portion of the leaves produces the mucilage/ gel which is clear and tasteless. The other part is a group of specialised cells known as pericyclic tubules, which are present just beneath the outer green rind of the leaf. These cells produce an exudates that consists of a bitter yellow latex.(5) Aloe vera has been used for its medicinal properties since ages. The Egyptians used it to heal battle wounds and treat infections. The Greeks used it for relieving blisters, burns and leg ulcers as well as healing bowel and 1

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar.-Apr 2014

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 stomach disorders. Early records of aloe vera use appears in the Ebers Papyrus from 16th century BC in both Discorides De Materia Medica and Pliny the Elder’s Natural History written in the mid-first century along with Juliana Anicia Codex produced in 512 AD.(6) Composition of Aloe vera gel: The composition of aloe vera gel is complex including 75 known ingredients: (7,8) The ingredients are: 1) Vitamins - All vitamins except Vitamin D. 2) Enzymes - acid phosphatise, alkaline phosphatase, amylase, lactic dehydrogenase and lipase which aids in digestion and reducing inflammation. 3) Long chain sugars - that help to re-balance the digestive system. 4) Saponins- that have an antimicrobial effect against bacteria, viruses and fungi and yeasts. 5) Amino acids – 20 out of 22 amino acids (including 7 out of 8 essential amino acids that can’t be produced by the body). 6) Minerals - needed for the enzymes to function. Yamaguchi et al.(9) reported the presence of aluminium, boron, barium, calcium, iron, magnesium, sodium, phosphorus, silicon and strontium. Biologic effects of aloe vera: Aloe vera has multiple biologic effects: (5) 1. Moisturizing properties 2. Anti- inflammatory property 3. Antibacterial 4. Antifungal 5. Antiviral 6. Wound healing 7. Pain relief 8. Treatment of minor burns, skin abrasions and irritations 9. Treatment of psoriasis and frost bite 10. Antioxidant effect Moisturizing effect - The aloe gel is a mix of water and polysaccharide component making into a jelly- like consistency. Hence, it can minimize evaporation and prevent drying of tissues. It is thus, used for general itching, psoriasis, acne, eczema. Many cosmetic products also use aloe vera to provide moisturizing effect and to improve the elasticity of skin. Anti- inflammatory effects - Hanley et al. reported that aloe vera extract decreased inflammation by 48% in a rat adjuvant- induced arthritic inflammatory model.(10) Ito et al. has reported that peptidase bradykinase was

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Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar.-Apr 2014

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 isolated from aloe and shown to breakdown the bradykinin, an inflammatory substance that induces pain.(11) Thus, aloe vera can be used for skin infections, minor burns, grazes, insect stings etc. Antibacterial/ antifungal/ antiviral effects - Two microorganisms have been found to be inhibited by the use of aloe vera. Heggers et al.(12) in their study in a rat model has suggested that aloe vera has antibacterial properties against streptococcus pyogenes and streptococcus fecalis. Also, it enhances the wound healing process by eliminating the bacteria which contributed to inflammation.(13) Aloe vera gel has bactericidal effects against Pseudomonas aeruginosa(14) and has found to inhibit the growth of Candida albicans (12). Aloe has antiviral effects against herpes simplex infection. A study done by Sydiskis et al. reported the activity of aloe vera gel against herpes simplex virus type 1 and type 2 and also against varicella- zoster, influenza virus and pseudorabies virus.(15) A study done in 1990 noted that fractions of aloe gel containing lectins directly inhibits the cytomegalovirus proliferation in cell culture by interfering with protein synthesis.(16) Wound healing – Aloe vera extracts might have antibacterial and antifungal activities, which possibly could help treat minor skin infection such as boils and benign skin cysts. (17) Skin protection and cancer - The polysachharides present in the aloe vera, may offer skin protection by specifically targeting pathways activated by UV radiation that can lead to non-melanoma skin cancers.(18) The UV radiation causes local depletion of antigen- presenting langerhans cells, as well as, systemic immunosuppresion. Strickland et al. in an experiment done in laboratory mice, noted that polysaccharides preserved the number and morphology of immunosuppressive langerhan cells and dentritic cells in the skin that was damaged by UV. These sachharides have also been seen to preserve delayed type hypersensitivity and cutaneous contact hypersensitivity suppressed by acute UV radiation. Delayed-type hypersensitivity – protective sachharides extracted from aloe vera also prevented the systemic suppression of T-cell mediated immune responses and the production of keratinocyte - derived interleukin 10 by UV-radiated epidermal cells in mice.(18) In an animal study on cats and dogs, compounds extracted from aloe vera have been used as an immunostimulant that aids in fighting cancer.(19) Antioxidant effect - Three aloesin derivatives from aloe (isorabaichromone, feruoylaloesin and pcoumaroylalosin) showed potent free radical and superoxide anion-scavenging activities in an assay using the lipid peroxidation rat liver microsomal system as the free radical generator. (20) General uses of Aloe vera gel and juice: Aloe vera has multiple uses to mankind. It used in1. Skin burns 2. Itch relief 3. Juice is used to reduce cholesterol and weight management 4. Used in ulcerative colitis, digestive disorderslike ulcers, heartburn and constipation

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Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar.-Apr 2014

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 5. Used for eliminating dandruff and acts as a scalp conditioner. Also can be used as styling products to fight frizzy hairs. 6. Skin moisturizer and hand sanitizer 7. Yeast infection Uses in dentistry: There are multiple uses of aloe vera in dentistry. It can be safely used in denture stomatitis cases and in thrush as aloe vera has antifungal properties as well. Other oral infections like apthous ulcers, herpes simplex, herpes zoster etc can also be effectively treated using aloe veral gel.(21) It has been reported that acemannan hydrogel accelerates the healing of apthous ulcers and reduces the pain associated with them. This study carried out in 90 patients with the history of recurrent apthous ulcers were randomly treated with acemannan hydrogel, acemannan freeze dried hydrogel and OTC remedy, reported that ulcers healed faster with acemannan hydrogel than OTC product. Also the hydrogel did not have any disaggreable taste and texture. Garnick et al. evaluated a gel that used a combination of allantion, aloe vera and silicon dioxide on apthous ulcers of the oral cavity. The subjects in the study reported a reduction in ulcer size and pain with a mean of 6 days for those using aloe gel and 9 day in controls.(22) Hayes S M reported a successful case of treatment of lichen planus using aloe vera in 1999. The case reported the use of aloe vera juice intake along with topical application of aloe vera lip balm and cream. It was noted that the oral lesion subsided within four weeks, however, systemic lesions took longer to heal.(23) Aloe vera is a powerful healing promoter and hence when inserted into an extraction socket, it is very beneficial. It can be used in the extraction socket to redice the occurrence of dry socket. A retrospective study of 587 patients ( total 1031 sockets) whose extraction sites had been treated with clincamycin-soaked gelfoam; in addition, a prospective study was performed in which freeze-dried pledglets containing acemannan hydrogel immediately after extraction, reported that aloe vera pledglet reduced the incidence of alveolar osteitis significantly compared to clindamycin-soaked gelfoam.(24) It is useful in the treatment of gingivitis and periodontitis. Due to its anti-inflammatory property, aloe vera reduces swelling of the soft tissues and thereby reduces bleeding of gums. Aloe gel can also be applied to the periodontal surgical wounds. Also it can be used effectively for treating tooth brush trauma, tooth pick injuries and injuries due to hard /sharp foods. In a clinical study, aloe vera mouthwash was reported to reduce gingival inflammation and was found to be a good adjunct to mechanical therapy for treating plaque-induced gingivitis.(25) However, in a double blind study, using aloe vera dentrifice and fluoridated dentifrice, no statistical significant difference was found in the reduction of gingivitis and plaque.(26) In 2003, a study by Barrantes and Guinea, a collagenase from Clostridium histolyticum was dose-dependently inhibited by aloe vera gel and an active aloe vera gel fraction containing phenolics and aloins; aloe vera gel and aloins were effective inhibitors of stimulated granulocyte matrix mettaloproteinases( MMPs).(27) 4

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar.-Apr 2014

Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 Aloe has its uses in root canal treatment as a sedative dressing, healing promoter and file lubricant.(23) Improvements in the oral symptoms has been reported in cases of geopgraphic tongue, burning mouth syndrome, migratory glossitis, pemphigus and in certain leukemic patients. Aloe vera is available and used by: Toothpaste – can be used by all patients, safe during pregnancy Jelly – used for skin infections/ lesions- like acne, eczema, psoriasis, generalized itching Hand cream – used for counteracting frequent handwash and itching due to wearing of latex gloves Oral spray – for throat infections, painful eruption of wisdom teeth Juice – for correcting irritable bowel syndrome, joint and skin lesion like arthritis, rheumatism (along with topical application of gel),

as a routine general tonic, powerful nutritional supplement and antioxidant,

used for peptic ulcers, acid reflux, Crohn’s disease, Candida, etc. Toxicity: Ingestion of aloe vera is sometimes associated with diarrhoea, electrolyte imbalance, kidney dysfunction and conventional drug interactions; episodes of contact dermatitis, erythema, and photo toxicity have been reported from topical application.(28) The diarrhoea caused by the laxative effect of aloe vera, can decrease the absorption of other systemically used drugs. However, these side effects are not seen in all patients. It is hence, important to choose an aloe product which is pure, stabilized, concentrated and grown organically. Also, it is desirable to check for the label of accreditation’ Seal of Approval of The International Aloe Science Council’ as this seal guarantees the desired necessities. Conclusion: The herb aloe vera has multiple benefits. It has systemic uses along with topical and local uses to humans. However, safety issues have to be taken into consideration during long term use. References: 1. "Aloe vera, African flowering plants database". Conservatoire et Jardin botaniques de la Ville de Genève. Retrieved 2008-06-20. 2.

"Taxon: Aloe vera (L.) Burm. f.". Germplasm Resources Information Network, United States Department of Agriculture.. Retrieved 2008-07-16.

3. Liao Z, Chen M, Tan F, Sun1 X and Tang K . Microprogagation of endangered

Chinese aloe Plant Cell,

Tissue and Organ Culture. 2004; 76(1):83–86. 4. Yates A. (2002) Yates Garden Guide. Harper Collins Australia 5. Richard L. Wynn. Aloe vera gel: Update for dentistry- General Dentistry 2005;Jan-Feb: 6-9 6. Barcroft and Myskja BAAM. Aloe vera: Nature’s silent healer. 2003 ISBN-0-9545071-0-X 7. Volger and Ernst. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999;49:823828 5

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Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 8. Shelton R.M. Aloe vera. Its chemical and therapeutic properties. Int J Dermatol 1991;30:679-683 9. Yamaguchi I, Mega N, Sanada H. components of the gel Aloe vera (L.) burm.f. Biosci Biochem 1993; 57: 1350-1352 10. Hanley DC, Solomon WA, Saffran B, Davis RH. The evaluation of natural substances in the treatment of adjuvant arthritis. J. Am Podiatry Assoc 1982; 72: 275-284 11. Ito S, Terdaira R, Beppu H, Obata M, Nagatsu T, Fujita K. Properties and pharmacological activity of carboxypeptidase in Aloe arborescence Mill var. natalensis Berges. Phytotherapy Res 1993; 7: 526 – 529 12. Heggers JP, Pineless GR, Robson MC. Dermaide aloe/ aloe vera gel: comparison of the antimicrobial effects. J Am Med Technol 1979; 41 : 293-294 13. Heggers JP, Kucukcelibi A, Stabenou CJ Ko F, Broemeling LD, Robson MC, Winters WD. Wound healing effects of the aloe gel and other topical antibacterial agents in rat skin. Phytotherapy Res 1995; 9: 455-457 14. Azghani AO, Williams I, Holiday DB, Johnson AR. A beta-linked mannan inhibits adherence of Pseudomonas aeruginosa to human lung epithelial cells. Glycobiology 1995;5:39-44 15. Sysdiskis RJ, Owen DG, Lohr JL, Rosler KH, Blomster RN. Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicob Agents Chemother 1991; 35:2463-2466 16. Saoo K, Miki H, Ohmori M, Winters WD. Antiviral activity of aloe extracts against cytomegalovirus. Phytotherapy Res 1990;10: 348-350 17. Shamin Sumbul, Ahmed S, Wassemuddin, Azhar Iqbal. Antifungal activity of Allium Aloe and Solanum species. Pharmaceutical Biology 2004; 42(7): 491-498 18. Strickland FM. Immuneregulation by polysaccharides: implications for skin cancer. J Photochem Photobiol B 2001;63( 1-3), 132- 140 19. King GK, Yates KM, Greenlee PG et al. The effect of acemannan immunostimulant in combination with surgery and radiation therapy on spontaneous canine and feline fibrosarcomas. Journal of the American Animal Hospital Association 1995; 31(5): 439-447 20. Yagi A, Kabash A, Okamura N, Haraguchi H, Moustafa SM, Khalifa TI. Antioxidant, free radical scavenging and anti-inflammatory effects of aloesin derivatives in aloe vera. Planta Med 2002; 68: 957-960 21. Richard Sudworth. The uses of aloe vera in dentistry. Cited in positive health online. Originally published in Issue 20, May 1997 22. Oral ulcers remedy gets FDA clearance. J Am Dent Assoc 1994; 125: 1308- 1310 23. Hayes SM. Lichen planus- report of successful treatment with aloe vera. Gen Dent 1999; 47: 268-272 24. Poor MR, Hall JE, Poor AS. Reduction in the incidence of alveolar osteitis in patients treated with the Salicept patch containing acemannan hydrogel. J Oral Maxillofac Surg 2002; 60: 374- 379 25. Ajmera N, Chatterjee A, Goyal V. Aloe vera: It’s effect on gingivitis. J Ind Soc of Periodontology 2013;17; issue 4, Jul-Aug : 435-438 6

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Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar-Apr 2014 26. De oiveira SM, Torres TC, Pereira SL te al. Effect of a dentifrice containing Aloe vera on the plaque and gingivitis control; A double blind clinical study in humans. J Appl oral Sci 2008; 16(4): 293-296 27. Barrantes E, Guinea M. Inhibition of collenase and metalloproteinase by aloins and aloe gel. Life Sci 2003; 72: 843- 850 28. Boudreau MD, Beland FA. An evaluation of the biological and toxicological properties of Aloe Barbedensis (Miller), Aloe vera. Journal of environmental science and health 2006 part C; 24: 103-15431. Aloe veraside effects and cautions. National Center for Complementary and Alternative medicine – retrived 2011-1007

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Dr. Madhuri Alankar Sawai et al. / IJRID Volume 4 Issue 2 Mar.-Apr 2014