Medicinal Plants, against Dental associated Problems

 

Ms. Neha T. Nistane*, Mr. C. B. Chauriya, Mr. Rahul Bangade

Ravi Institute of Diploma in Pharmacy, Devi Road, Koradi, Nagpur, Maharashtra, India.

 

ABSTRACT:

Oral hygiene is an integral part of general health of a person. Scientific investigation of medicinal plants is essential because of their contribution to healthcare. It is also necessary to document the information about the knowledge of traditional medicines before it is lost permanently. In such a way the aim of the present review is to document the ethno medicinal plants and practices followed for oral health and diseases and to suggest that the traditional knowledge should be integrated with modern dental care practices to formulate their sustainable utilization. The review indicated that, there are plenty of medicinal plants to treat a wide spectrum of oral ailments and create an interest among people regarding the potential of natural plants in treating the infections and disorders of oral cavity.

 

 

 

INTRODUCTION:

Oral disease can significantly affect the general well-being of a person by causing considerable pain and discomfort, thus affecting quality of life. The World Health Organization (WHO), 1978 has estimated that 80% of the populations of developing countries rely on traditional medicines, mostly plant drugs, for their primary health care needs. The use of traditional medicines and medicinal plants in most developing countries as therapeutic agents for the maintenance of good health has been widely observed. In India 65 % of the population relies on ethno medicine which is the only source of their primary health care need¹. Dental diseases are among the major public health problems in the global level affect mankind.

 

 

 

The oral cavity is inhabited by microbial species and many intrinsic and extrinsic factors affect the composition, pathogenicity and metabolic activity and of the highly diversified oral microbial flora responsible². Several agents are commercially available, these chemicals can alter oral micro biota and have undesirable side effect, such as vomiting, diarrhea, and tooth staining. Hence the search for unconventional product continues and natural phytochemicals isolated from plants used as traditional medicines are considered as good alternatives³. The association between oral diseases and the oral micro biota is well established. The development of dental caries involves acidogenic and aciduric Gram-positive bacteria (Mutans Streptococci, Lactobacilli and Actinomycetes)⁴. Streptococcus mutans is considered the main culprit among cariogenic microorganisms¹³. Periodontal diseases have been linked to anaerobic Gram-negative bacteria (Porphyromonasgingivalis, Actinobacillus, Prevotella and Fusobacterium⁴.The plant extract or phytochemicals that hinder the growth of oral pathogens, diminish the progress of dental plaque, manipulate the adhesions of bacteria to surface and reduce the symptoms of the oral diseases ⁵.

 

OBJECTIVE:

Therefore keeping above view into consideration the present view is an attempt to explore medicinal plant that have been proven. To have significant potential in treatment of dental associated problems.

 

ROLE OF PLANTS IN ORAL CARE:

Due to adverse effects of chemical based remedies the use of plants and plant based products emerged out as a best alternative. A number of plants are used as chewing sticks in various parts of world which help in cleaning the buccal cavity (Lewis, 1990). These days a number of plants are used to prepare plant based tooth pastes and gels, since plant contains chemical constituents which are active against microbes, example Propolis which is a resin rich in flavonoids, it is manufactured by bees from plants. There are many essential oils that form an important constituent of toothpastes, example oils of Eucalyptus, tea tree, clove, cinnamon etc. Equally promising were tests done on a couple of plant substances widely used for dental hygiene in the Middle East and Indian subcontinent. A 1999 study published in the Indian Journal of Dental Research focuses on the antimicrobial effects of two plant species: Salvadorapersica, known locally as miswak or arak, and Azadirachtaindica, usually called neem. Both proved extremely effective against common oral bacteria⁶.

 

ANTIMICROBIAL ASSAYS:

1    Assays that have been used to test the antimicrobial properties of medicinal plant extracts and natural products used to treat or prevent oral diseases involve assessing.

(Represented from Enzo A. Palombo)

 

Figure 1: The development of tooth decay. (a) Initial adhesin-mediated attachment of mutans streptococci; (b) aggregation mediated by synthesis of extracellular polysaccharide; (c) metabolism of carbohydrates results in acid production, leading to demineralization and cavitation of the tooth. Plant extracts and phytochemicals have been demonstrated to inhibit any or all of these stages. That is, cidal activity against cariogenic bacteria, inhibition of adherence/aggregation/biofilm formation and inhibition of glycolytic acid production. capacity of the test material to inhibit the growth of typical oral pathogens, such as Streptococcus sp. (as an example of bacteria implicated in dental caries) and P. gingivalis (as an example of bacteria implicated in periodontal diseases).

These tests are usually rapid and can be carried out with minimal cost. Agar diffusion methods (disc diffusion or well diffusion) are popular and have been used in a number of studies. Alternative methods involve adsorbing the test compounds in solution to a solid matrix (e.g., silica gel plates) and then overlaying with agar containing indicator organisms.

 

2    The viable count method can be used as an alternative to agar plate diffusion methods.

 

3    Quantifying the antimicrobial activity involves methods analogous to those used to determine the minimum inhibitory concentration of antimicrobial chemical agents such as antibiotics or disinfectants. This involves exposing the test organism to serially diluted extract/compound (either in liquid or solid media) and determining the minimum concentration that inhibits growth. These methods are described in ISO 20776 (Clinical laboratory testing and in vitro diagnostic test systems), which states that “Dilution procedures are used to determine the minimum inhibitory concentrations (MICs) of antimicrobial agents and are the reference method for antimicrobial susceptibility testing.

 

4    Time-kill assays are used to determine the time required for a compound or extract under investigation to eliminate the growth of the test bacteria. Bio-autography has been used to carry out preliminary determinations of the number of active constituents in plant extracts. This method involves separation of the extract using thin layer chromatography (TLC) and other chromategraphys¹⁴.

 

Medicinal plant used in dental associated problems:

That have been there are several medicinal plant which have been transnational used have also been scientifically explored to have potential therapeutic effect in dental associated problems. Some of the medicinal plant listed below with their therapeutic significant.

 

Azadirachtaindica (Meliaceae):

English name- Margosa tree, Hindi- Neem.Bark, leaves are astringent, antiseptic & antibacterial. Seeds are astringet and emollient they are useful in odontalgia. Nimbidine gargle and dentifrices are effective in the treatment of bleeding gums and pyorrhea⁷. Azadirachtaindica (neem) has been an integral part of health and oral care since times immemorial. It has shown to be an effective antimicrobial, antinflammatory and anticancer agent. In India it has been an indespensible part of oral care and is still a popular dental care agent in rural India. Almas Khalid in his study showed inhibition of Streptococcusmutans and Streptococcusfaecalis at 50% concentration of neem bark extract. Neem extract has demonstrated inhibition of Streptococcus mutans, Streptococcus salivarius, Streptococcus mitisand Streptococcus sanguisat various concentrations, antibacterial properties were seen at even 5% of concentration. N. C. J. PackiaLekshmi et al evaluated the antibacterial activity of neem extracts againt oral pathogenic bacteria using disc diffusion method⁵.

 

Terminaliachebula (Combretaceae):

English name-Tamarind tree, Hindi-Imli. Root bark is astringent and is useful in gingivitis⁷.This study is attempt to strengthen the previous studies to show the therapeutic effect on caries causing bacteria since the extract of T. Chebula was used as an anticariogenic mouth rinse against three dental caries causing bacteria S. mutans, Lactobacilus sp. and Candida sp. The result of this study indicated that, the methanol and ethyl acetate extract of T. Chebula fruit is found to be very effective. Since the antimicrobial activity of methanol fruit extract of T. Chebula was evaluated by the standard disc diffusion and broth dilution method. Aneja and Joshi reported the highest activity of acetonic fruit extracts of Terminaliachebula with a mean diameter of inhibition zone being 25.32mm and a minimum inhibitory concentration (MIC) of 25mg/ml against S. mutans and a mean diameter of 32.97mm and MIC of 12.5mg/ml against S. aureus. In the present study, methanol extract of T. Chebula showed maximum activity with zone of inhibition 29.5mm and MIC of ≤0.17mg/ml against S. mutans MTCC 497 and mean diameter of 20.1mm and MIC of 1.25mg/ml against S. aureus MTCC 740. Prabhatet al. reported that the maximum zone of inhibition against S. aureus was 27mm in methanolic extract of T. chebula. His study also revealed that the methanolic extracts of T. Chebula showed maximum antimicrobial activity against S. mutans(23mm), L. acidophilus(24mm) S. salivarius and C. albicans (26mm). In the present study, the zone of inhibition of methanol extract of T. chebula against S. mutans MTCC 497 and C. albicans MTCC 227 was 29.5mm and 22.6mm at 400μg/disc concentration. ⁶.

 

Mimusopselengi Linn (Sapotaceae):

English name-Bullet wood tree, Hindi-Bakul. Bark is astringent, it is used as gargle for odontopathy, inflammation and bleeding gums. Unripe fruit is used as a masticatory and will help to fix loose teeth⁷.The bark is used as a gargle for odontopathy, ulitis and ulemorrhagia. Tender stems are used as toothbrushes. Rinsing mouth with bark decoction is believed to strengthen the gums, reduce inflammation, and prevent bleeding of gums and stop bad breath caused by pyorrhea and dental caries. Fruit: Unripe fruit is used as a masticatory. It is therefore recommended to be chewed for fixing loose teeth and Seeds are used to fix loose teeth⁸. Acetone extract of Mimusopselengi was found to be effective as anti-microbial against the oral micro flora. The scientific approach has confirmed the antimicrobial potential of the plant extract thus adding weight to its use as a preventive remedy for various microbial diseases of hard tissues in the oral cavity in traditional medicine⁹.

 

Aloe barbadensisMill. (Liliaceae):

English name-Indian Aloe, Hindi- Ghikunwar. The chemical in gradients in aloe veragel include aloin, vitamins, enzymes, minerals, sugars, fatty acids, amino and salicylic acid ⁷. The antibacterial activity of Aloe vera gel was initially evaluated by the disk diffusion method using 20 isolates of S. mutans as the main causative agent of dental caries and 20 isolates of each of the periodontopathic bacteria, i.e. A. actinomycetemcomitans and P. gingivalis, and the opportunistic periodontopathogen, B. fragilis. Undiluted Aloe vera gel produced significant growth inhibition zones against all of the oral bacteria tested. The diameter of the growth inhibition zone was directly proportional to the concentration of Aloe vera gel. The zone of inhibition produced by undiluted Aloe vera gel was widest for S. mutans (54 mm) and narrowest for P. gingivalis (32 mm). At a dilution of 1:8 (12.5%), Aloe vera gel inhibited only S. mutans, with an inhibition zone of 10 mm, while all isolates of A. actinomycetemcomitans, P. gingivalis and B. fragilis were resistant to this dilution. None of the above bacteria were sensitive to dilutions of Aloe vera gel of 1:16 or higher. The 10% DMSO used as a diluent showed no inhibitory activity on any of these bacteria. The mean MIC values for Aloe vera gel measured by the microdilution method against clinical isolates of S. mutans, A. actinomycetemcomitans, B. fragilisand P. gingivalis were 12.5, 25, 50, and 25 µg/ml, respectively¹⁰.

 

Ocimum sanctumLinn. (Lamiaceae):

English name: Holy basil, Hindi: Tulsi, Sanskrit: Tulsi, Gujarati: Tulsi.The cup and plate method was used to determine the zone of inhibition. In this method, five circular wells that could incorporate five different volumes (10 μl, 20 μl, 30 μl, 50 μl, 75 μl) of the test agent (Tulsi extract) were cut in the agar plates using a template. the data obtained were appraised observationally. At the 0.5% concentration, a minimum zone of inhibition of 12 mm was achieved at a high volume of 75 μl. At lower volumes, Streptococcus mutans was resistant to the action of Tulsi extract. Increasing the concentration further produced a zone of inhibition at a much lower volume of 30 μl and 50 μl. An interesting result was obtained at the 4% concentration. At this particular concentration, even with the slightest volume of 10 μl, a zone of inhibition of 12 mm was achieved, and only at the 4% concentration was an inhibition zone seen with all the five volumes that were used. A maximum zone of inhibition of 22 mm was also achieved at the 4% concentration at a volume of 75 μl. However, a 22 mm inhibition zone was also seen at the 3% concentration at 75 μl. Increasing the concentration further above 4% did not produce any increase in the zone of inhibition. However, for 0.2% chlorhexidine (positive control), a much wider zone of inhibition of 24 mm was achieved at the lowest volume of 10 μl and a maximum inhibition zone of 34 mm was achieved at 75 μl. Streptococcus mutans was resistant to the action of dimethyl formamaide (negative control)¹². Antibacterial activity of Ocimum Sanctum on S. Mutans determined by using Agar Well Diffusion Method. In this study, methanol OS extract showed MBC value at 6.4 mg/ml and MIC value at 3.2mg/ml against S. mutans. Methanol extract of Ocimum sanctum demonstrated good antimicrobial activity and inhibitory effect on key virulence factors of streptococcus mutans¹³.

 

Engeniacaryophyllus (Myrtaceae):

English name: Holy basil Hindi: Tulsi Sanskrit: Tulsi Gujarati: Tulsi. The antibacterial activity of the extracts at different concentrations was screened by disc diffusion technique and the zone of inhibition was measured in mm diameter. The results was of clove extract more effective against S. mutans with a zone of inhibition of 22 mm diameter (at concentrate 1000 µl)¹⁵. The characteristic smell of clove oil helps removing bad breath. As a result, clove oil is added to numerous dental products and medications, including, mouth washes, and tooth pastes. Dentists also mix clove oil with zinc oxide and prepare a white filling material as temporary alternative to root canal¹⁹.

 

Piper nigram(piperaceae):

Kali Mirch: Urdu and Hindi, Pippali: Sanskrit, Milagu: Tamil and Peppercorn, White pepper, Green pepper, Black pepper, Madagascar pepper: English. It is one of the most commonly used spices and considered as’’ The King of spices’’ among various spices¹⁸.Black pepper has been named the “black gold” for its wide therapeutic uses. The Black pepper extract was more effective against S. mutans with a zone of 17 mm diameter (at concentrate 1000 µl)¹⁵.

 

Cinnamomumverum (Lauraceae):

Truly called cinnamon tree belonging to family –Lauraceae. The essential oil from C. verum exhibited the greatest antibacterial activity. Gas chromatography mass spectrometry analysis revealed that the major components of C. verum essential oil were cinnamaldehyde (56.3%), cinnamyl acetate (7.1%) and bphellandrene (6.3%). The MIC of cinnamaldehyde was measured using broth dilution assays. The MIC of cinnamaldehyde was 0.02% (v/v) against both bacterial strains tested. The minimum bactericidal concentration of cinnamaldehyde against S. mutansand S. sobrinus were 0.2% and 0.1% (v/v), respectively¹⁶.

 

CarumcarviLinn. (Apiaceae):

English name-Black caraway, Hindi- Kala Jeera. The plant is commonly called caraway. Two main components present in the plant are carvone (50-60%) and limonents (40%). Volatile oil from the plant is beneficial in gingivitis and periodontal diseases (as mouth wash). Caraway has been used as a flavouring agent in tooth paste, mouth wash and cosmetic products⁷.

 

Accacianilotica (Fabaceae):

Babool (Accacianilotica) extract at 50% concentration and at volumes of 75µl showed the maximum zone of inhibition against Streptococcus Mutans²⁰. Babool have strong antimicrobial activity against oral micro organisms like Streptococcus mutans²¹.

 

Antimicrobial activity of some medicinal plants against oral flora:

The antimicrobial activity of ethanolic extract of medicinal plants were evaluated using well diffusion method against Streptococcus mutans, Enterococcus faecalis, Lactobacillus acidophilus, Candida albicans and Candida tropicalis. Ethanolic extracts of Aloe barbadensis, Cinnamumzeylanicum and Tinosporacoridfolia, were not effective against Streptococcus mutansand Enterococcus faecalis respectively. However, Azadirachtaindica, Centellaasiatica, Zingiberofficinale were showing week and the extract of Allium sativum, Curcuma longa, Glycyrrhizaglabra, Ocimum sanctum, Piper nigrum, displaying strong antimicrobial activity against most of the test species. The ethanol extract of Syzygiumaromaticum showing strong antimicrobial activity against all test species¹¹.

 

CONCLUSION:

The present review will act as a valuable source of information for reader to have sufficient knowledge regarding various medicinal plant that can be used in treatment of dental associated problems. The use of herbal extracts in various forms is entirely consistent with the primary health-care principles. These aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis. Studies for assessment of safety and efficacy of herbal remedies are in its infancy. Herbal remedies are expected to be widely used in future. Researchers should be encouraged to conduct controlled studies to prove the effectiveness and safety of natural dental products. Future studies should be focused on chemical nature and mode of action of active constituents of these plants.

 

ACKNOWLEDGEMENTS:

The authors is highly thankful to the all authors and researchers who shared their valuable information which was of immense use to prepare this brief review. I cannot express enough thanks to Mr. C. B. Chauriya (Principal of Ravi institute of Diploma in Pharmacy) for their continued support and encouragement.

 

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Received on 25.09.2018         Modified on 05.10.2018

Accepted on 25.10.2018       ©A&V Publications All right reserved