Role of herbs in endodontics: An update

Review Article ENDODONTOLOGY Role of herbs in endodontics: An update SHARAD KAMAT * # RAJEEV K ** ## PRAHLAD SARAF *** ### ABSTRACT Over the past de...
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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

98

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.

REFERENCES:

15. Bohora A,Hegde V,KokateS . Comparison of antibacterial efficacy of neem leaf extract and 2% sodium hypochlorite against E.faecalis,C.albicans and mixed culture- an in vitro study. Endodontology 2010: 22: 8-12.

1. Palombo EA. Traditional medicinal plant extracts and natural products with activity against oral bacteria; potential application in prevention and treatment of oral diseases.

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ENDODONTOLOGY

ROLE OF HERBS IN ENDODONTICS: AN UPDATE

25. Gentil M, Pereira JV, Pietro R, Sousa Neto MD, Vansan LP,Franca Sd . In vitro evaluation of the antibacterial activity of Arctium lappa as a phytotherapeutic agent used in intracanal dressings Phytothera. Res. 2006: 20: 184–86

16. Bauer K, Garbe D, Surburg H. “Common Fragrence and Flavor Materials”, 4th Ed, Wiley VCH, 2001:189. 17. De Vincenzi M, Stammati A, De Vincenzi A, Silano M. “Constituents of aromatic plants: carvacrol”. Fitoterapia 2004:75, 801–4.

26. Pereira J, Bergamo D, Franca S, Pietro R, Silva-Sousa Y. Antimicrobial activity of articum lappa against microorganisms commonly found in endodontic infections, Braz Dent J 2005:16 :192-196

18. Seghatoleslami S, Samadi N, Salehnia A, Azmi S. Antibacterial activity of endemic satureja khuzistanica Jamzad essential oil against oral pathogens . Int Endo J 2009:4: 5-9. 19. Gradišar et al. Green Tea Catechins Inhibit Bacterial DNA Gyrase by Interaction with Its ATP Binding Site.2007: http:// pubs.acs.org/doi/abs/10.1021/jm060817o

27. Abuzied ST, Eissa SAL. Comparative study on antibacterial activities of two natural plants versus three different intracanal medicaments. ( Online article) http://www.kau.edu.sa/Files/ 165/Researches/19240_Comparative%20Study%20On.pdf

20. Almas K. The antimicrobial effects of extracts oof Azadirachta indica (neem) and Salvadora Persica (Arak) chewing sticks. Indian J Dent Res 1999: 10: 23-26.

28. Wynn RL . Aloe Vera gel: update for dentistry ,general dentistry 2005: 53(1): 6-9. 29. Maguire H,Torbinejad M, Kettering JD. Use of aloe vera gel as an intracanal medicament. J Endod 1996: 22(4): 193.

21. Al- subawi NAK, Abdull- khalik K,Mahmud Y ,Taha MY, Abdul A. The Antimicrobial actitvity ion of Salvadora persica solution (Miswak –siwak) as root canal irrigant. University of sharjah journal of pure & applied science 2007:4: 69-91.

30. Kastura H, Tsukiyama R, Suzuki A,Kobayashi M. Invitro antimicrobial activity activities of Bukachiol against oral microorganisms. Antimicrob. Agents Chemother. 2001:45: 3009-3013.

22. Almas K. “The Effect of Salvadora Persica Extract (Miswak) and Chlorahexidine Gluconate on Human Dentin: A SEM Study”. J Contemp Dent Pract 2002: 3: 27–35.

31. Sanches NR, Cortez DAG, Schiavini MS, Nakamura CV, Filho BPD. An evaluation of antibacterial activities of Psidium guajava. Braz Arch Biol Technol 2005:48: 429-430.

23. Sader Lahijini MSS, Raoof kateb HR,heady R,Yazdini D. The effect of German chamomile (Marticaria recutita L.) extract and tea tree (Melaleuca alternifolia L.) oil used as irrigants: a scanning electron microscope study. Int Endod J 2006: 39: 190-195.

32. Khan R,Islam B, Akram M et al. Antimicrobial activity of five herbal etracts against multidrug resistant strains of bacteria and fungus of clinical origin. Molecules 2009:14: 586-597. 32. Chaturvedi TP. Uses of turmeric in dentistry in dentistry – an update. Indian J Dent Res 2009: 20(1): 107-109.

24. Traditional Chinese medicine used in root canal disinfection research. Pharmacy papers (Online article). http:/ /eng.hi138.com/?b106.

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