Review Article
ENDODONTOLOGY Role of herbs in endodontics: An update SHARAD KAMAT * # RAJEEV K ** ## PRAHLAD SARAF *** ###
ABSTRACT Over the past decade, interest in drugs derived from medicinal plants has markedly increased. In dentistry phytomedicine has been used as anti-inflammatory, antibiotic, analgesic, sedative and also as endodontic irrigant. This update focuses on various herbal drugs and products as well as their therapeutic application, side effects and possible drug interactions when used as phytomedicine in endodontics.
INTRODUCTION
B) In dentistry they are used as(3)
Herbal products have been used since ancient
1. Antimicrobial - Matricaria chamomile,
times in folk medicine, involving both eastern and
Salvadora percica, Azadirachta indica.
western medicinal traditions. Many plants with
2. Anti-inflammatory - Plumeria acuminate,
biological and antimicrbiological properties have
Kalanchoe Brasiliensis, Guaco, Propolis.
been studied since there has been a relevant increase in the incidence of antibiotic overuse and
3. Sedative and Anxiolytics- Melissa officinalis,
misuse. In dentistry Phytomedicines has been used
Passiflora incarnale, Piper meythsticum
as anti-inflammatory, antibiotic, analgesic and
4. Miscellaneous - endodontic irrigants,
sedative agents. In endodontics because of the
medicaments and endodontic retreatment.
cytotoxic reactions of the most of the commercial intracanal medicaments used and their inability to
PHYTOTHERAPEUTIC SUBSTANCES
eliminate bacteria from dentinal tubules, trend of
MORINDA CITRIFOLIA:
recent medicine attends to use biologic medication
A native from south East Asia or Australia
extracted from natural plants(1). This paper reviews
grows in shady forests as well as on open rock. Its
the role of various herbal products in endodontics.
antibacterial property is attributed to the presence
CLASSIFICATION
of L- asperuloside and alizarin. It also has a number of
A) Phytotherapeutic substances are generally
pytochemicals
including
lignans,
oligopolysaccharides, flavinoids and catechins(4). It
classified in to three groups(2).
is used as a root canal irrigant(5, 6).
1. Plant products
TRIPHALA:
2. Animal products
This is an ayurvedic rasayana consisting of
3. Mineral origin
Amulaki (emblica officinalis), Bibhitaki (terminalia
* Professor, ** Post Graduate Student, *** Sr. Lecturer, Dept of Conservative Dentistry and Endodontics, # Modern Dental College and Research Centre, Airport Road, Gandhinagar, Indore, ## P.M.N.M Dental College and Hospital Bagalkot, ### B V P Dental College and Hospital, Walneswadi, Sangli
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ENDODONTOLOGY
SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF
bellirica) and Halituki (terminalia chebula)(7). Its fruit
tissues. This property is due to the presence of
is rich in citric acid, which may aid in removal of
phenolic component which stimulates pulpal fibres,
smear layer thereby acting as chelating agent and
phenomena known as hormesis (17, 18).
also found to be alternative to sodium hypochlorite
GREEN TEA:
for root canal irrigation(8).
It is a tea made solely from the leaves of
PROPOLIS:
camellia sinensis. The antimicrobial activity is due
This is prepared from resins collected by bees
to inhibition of bacterial enzyme gyrase by binding
from trees of poplars and conifers or from flowers
to ATP B sub unit(19). Green tea exhibits antibacterial
of genera clusia. It also contains viscidone(10). It is
activity on E-faecalis plaknotic cells. It is also found
used as intracanal medicaments irrigant
(12)
(11)
, root canal
to be a good chelating agent(8).
and storage media for avulsed teeth to
SALVADORA PERSICA SOLUTION (MISWAK-SIWAK) :
maintain viability of periodontal ligament(13).
Its chewing sticks contain trimethyl amine,
AZADIRACHTA INDICA: It is known as Indian neem/margosa tree(14).
salvadorime chloride and fluoride in large
This product has been proved to be effective against
amounts(20). Fifteen percent alcoholic extracts of it
E-faecalis and candida albicans. Its antioxidant and
has maximum antimicrobial action. It can be used
antimicrobial properties makes it a potential agent
as a substitute for sodium hypochlorite and
for root canal irrigation as an alternative to sodium
chlorexidine as root canal irrigant(21, 22).
hypochlorite(15).
GERMAN CHAMOMILE: It is used as a table tea and flower of
ORANGE OIL: It is oil produced by glands inside the rind of
chamomile plant contain a wide variety of active
an orange fruit. This is composed mostly of d-
chemical components (chamazolene, capric acid
limonene. It also has long chain aliphatic
and caprylic acidchlorgenic acid). It is used for
hydrocarbon alcohols, aldehydes like octanal and
removal of smear layer and found to be more
octanal (16). It is suggested as an alternative to
effective than NaOCl (23).
chloroform or xylene for gutta-percha softening and
TEA TREE OIL:
also in dissolving endodontic sealers.
This is a native Australian plant with terpenin4-ol as a major component, responsible for
CARVACROL: Carvacrol is present in the essential oils of
antibacterial and anti fungal properties. It is used
origanum vulgare, oil of thyme, pepperwort,
as root canal irrigant, but less effective compared
bergamot and satureja khuzistanica jamsizad oil
to EDTA and NaOCl (23).
(SKJ oil) Carvacrol has inhibitory action on e-coli
CASEARIA SYLVESTRIS:
and p-aeroginosa. The cause of antimicrobial
It is more common in tropical America and
property is attributed to action on several targets in
Brazil. Alcoholic extract of c.sylvestris constitutes
bacterial cell and disruption of bacterial cell
a rich source of phospholipase A2 inhibitors which
membrane. It also helps in repair of periapical
reduce the acute phase of inflammatory process 99
ENDODONTOLOGY
ROLE OF HERBS IN ENDODONTICS: AN UPDATE
ALOE VERA GEL:
and prolongs the regenerative phase. It is shown
Aloe leaves contain clear gel and green part
as an alternative intra canal medicament . (12)
of the leaf that surrounds the gel is used to produce
GARLIC (ALLIUM SATIVUM):
juice or dried substance. It contains alloins and
The main active component of garlic is allicin.
barbadoins as main chemical constituents. Aloe
It is antibacterial and has immune regulatory
Vera gel has inhibitory effects on S-pyogens and E-
functions. Allicin destroys cell wall and cell
faecalis because of anthra quinine(28). Its bactericidal
membrane of root canal bacteria(24). This is used as
activity is found to be less than Ca (OH)2(29).
irrigant alternative to NaOCl.
PSORALEA CORYLIFOLIA:
ARTICUM LAPPA:
This is found to be effective against
This is prepared from ethyl acetate and is used
E-faecalis (30). It acts by causing injury to cell
as intra canal dressing with limited activity(25, 26).
membrane and inhibiting DNA polymerase.
LEMON SOLUTION:
PSIDIUM GUAJAVA:
Lemon solution (pH2.21) is a natural source
The fruits and leaves of this shrub contain
of citric acid (pH1.68) with lower acidity. Citric
essential oil rich in cineol, tannins, tripentnes and
acid, a chemical product has some irritating effect
flavinoids. Ethanol extracts of it has higher
compared to natural lemon solution. Fresh lemon
antimicrobial activity, especially against
solution is used as root canal medicament because
E-faecalis(31)
of its wide antibacterial efficiency including E-
ACACIA NILOTICA:
faecalis(27).
It is species of Indian and Africans sub
RHUS PLANTS:
continent. Antimicrobial function is believed to be
It contains gallic tannins and gallic acid.
due to tannins, phenolics compounds, essential oil
Tannins exhibit antibacterial and antifungal
and flavinoids and is effective against E-faecalis(32).
properties. Gallic acid is antioxidant and
SYZIGIUM AROMATICUM/CLOVE TREE:
bactericidal. Gallic acid has been found to reduce
Essential oil shows antioxidant, antibacterial
periapical inflammation. Water extract of RHUS plants help in opening of blocked dentinal
and anodyne effects(32)
tubules(24).
TURMERIC: Massing the aching teeth with ground turmeric
JIEERYIN SOLUTION:
eliminates pain and swelling(33)
This is a pure Chinese herbal compound and has heat clearing, detoxifying, antibacterial and anti-
SAFETY:
inflammatory effects. It is used for root canal
Herbal products are normally considered safe.
irrigation with ultrasonics and is found to be
The literature has revealed few reports concerning
effective against anaerobic bacteria. 30%
the adverse effects of these natural products
concentration of this has similar effect to that of
commonly used in endodontics(3).
NaOCl . (24)
100
ENDODONTOLOGY Aloe Vera
Abdominal cramps, diarrhoea
Garlic
Bowel irritation, mouth ulceration, halitosis & prevention of blood clotting
Orange oil
G I irritation
Chamomile tea
Allergic conjunctivitis
Green tea
Irritability, anxiety
Tea tree oil
Allergic contact dermatitis
SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF
(Online article) http://ecam.oxfordjournals.org/cgi/content/full/ nep067. 2. Patil DR. “Cultural history from the vayupurana” 1st ed. Motilal Banarasidas Publishers, New Delhi.1973: 230. 3. Groppo FC, Bergamaschi CC, Cogo K, France –Montan M, Motta RHL, de Andrade ED. Use of Phytotherapy in Dentistry. Phytother. Res.2008: 22: 993-998. 4. Levand O, Larson HO. “Some chemical constituents of Morinda citrifolia”. Planta Medica. 1979: 36: 186–7. 5. Kandaswamy D, Venkatesh babu N, Gogulnath D, Kindo AJ. Dentinal tubule disinfection with 2% chlorexidine gel, propolis, Morinda citrifolia juice, 2% povidine iodine and calcium hydroxide. Int Endod J. 2010: 43: 419-423.
DRUG (PHYTOTHERAPEUTIC) INTERACTION(3) There is little available information regarding
6. Murray PE, Farber RM, Namerow KN, Kutler S et al. Evaluation of Morinda citrifolia as an endodontic irrigant. J Endod 2008: 34: 66-70.
drug interactions between herbal products and the conventional drugs. m.chamomile
potentiates anticoagulation effects of warfarin
garlic
interacts with anti platelets and hypo glycemic drugs
green tea
reduces bioavailability of anti cancer drugs
7. Anne McIntyre. Herbal treatment of children: Western and Ayurvedic perspectives. Elsevier Health Sciences. 2005: 278– 280. 8. Prabhakar J, Senthil kumar M, Priya M S, Mahalakshmi K, Sehgal PK, Sukumaran VG. Evaluation of antimicrobial efficacy of herbal alternatives (Triphala and Green tea polyphenols),MTAD and 5% sodium hypochloride against Enterococcus faecalis biofilm formed on tooth substrate: An invitro study. J Endod 2010: 36: 83-86.
PERSPECTIVES AND CONCLUSION
9. Ayurvedic pharmacopoeia committee. The Ayurvedic Formulary of India, Part I, 2nd English Ed. New Delhi: Controller of Publications. 2003: 167.
Literature has addressed many plants with potential source for new therapies in endodontics.
10. Montenegro G, Mujica AM, Peña RC, Gómez M, Serey I & B N Timmermann. Similitude pattern and botanical origin of the Chilean propolis. Phyton 2004:73 :145-54
The studies listed have shown important medicinal activities of plants, with great demand to inhibit or suppress bacteria and their biofilm.
11. Oncag A, Cogulu D, Uzel A, Sorkun K. Efficacy of propolis as an intracanal medicament against Enerococcus faecalis . Gen. dent. 2006: 54: 319-22.
However there is scarce information on the quality, Safety and greater efficiency of these
12. da silva FB, de Almeida JM, de souse SMG. Natural medicaments in endodontics- A comparative study of the antiinflammatory action. Braz Oral Res 2004:18: 174-179.
products for use in endodontics. As most of the studies are carried out ex vivo, more of these
13. Martin MP, Pileggi R . A quantitative analysis of Propolis: a promising new storage media following avulsion. Dent Traumatol. 2004: 20: 85-9.
compounds should be subjected to animal and human studies to determine their effectiveness, side effects, toxicity and drug interactions.
14. Ganguli S. “Neem: A therapeutic for all seasons” Current Science.2002: 82: 1304.
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