Research - Teeth + Gum Disease
Clinical efficacy of an herbal mouth wash composed of Salix alba, Malva sylvestrais and Althaea officinalis in chronic periodontitis patients
- Mehrdad Radvara, 1, ,
- Amir Moeintaghavia, 1,
- Mohsen Tafaghodib,
- Habibollah Ghanbaria,
- Kazem Fatemic,
- Majid Reza Mokhtaric, ,
- Fahime Najafid,
- Zahra Hoseinipourd,
- Parisa Dastmalchid,
- Fateme Farazie
The aim of this pilot study was to evaluate the adjunctive use of a herbal mouthwash consisting of Salix alba, Malva sylvestris and Althaea officinalis with scaling and root planing, compared with chlorhexidine (CHX) as a standard chemical mouthwash in the treatment of chronic periodontitis and gingivitis.
Materials and methods
In the first part of this trial (study No 1) the clinical efficacy of a prepared herbal mouthwash was assessed in chronic periodontitis patients; in study No 2, the same mouthwash was assessed in gingivitis patients. In study No 1, 30 periodontitis patients were randomly selected and divided into three groups. Along with their scaling and root planing, group A received CHX as their mouthwash, group B received a herbal mouthwash and group C received a placebo mouthwash. Each of the groups were assessed for bleeding on probing, probing depth and clinical attachment level at baseline and 6 weeks after scaling and root planing plus 4 weeks usage of their bottle of mouthwash. In study No 2, 34 gingivitis patients were divided into the same three groups. For 2 weeks patients rinsed with their mouthwash twice daily. Each of the groups were assessed for bleeding on probing, gingival index and plaque index at baseline and 2 weeks after using mouthwashes.
In study No 1 the results showed greater reduction in indices in the CHX group than the herbal mouthwash group and the herbal mouthwash compared to the placebo group. However, the differences in indices between the three groups were not statistically significant. No adverse reaction was seen in the herbal mouthwash group. In study No 2, the CHX and herbal mouthwash groups produced greater reduction in bleeding on probing and gingival indices than the placebo group, but the difference between groups A and B was not statistically significant. Furthermore, the reduction in plaque index in all three groups was statistically significant, but differences between the groups were not significant.
Within the limitation of this small pilot investigation, an herbal mouthwash consisting ofSalix alba, Malva sylvestris and Althaea officinalis, provided a clinical benefit comparable to that of CHX if used as an adjunct to scaling and root planing, especially in gingivitis patients, however, further large-scale studies are warranted.
Source : Journal of Herbal Medicine
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Review of the Efficacy of Aloe Vera in Dentistry
Mangaiyarkarasi SP, Manigandan T, Elumalai M, Cholan PK, Kaur RP. Benefits of Aloe vera in dentistry. J Pharm Bioallied Sci. 2015;7(Suppl 1):S255-S259.
The succulent leaves of the aloe vera (Aloe vera syn. A. barbadensis, Xanthorrhoeaceae) plant have been used medicinally for hundreds of years. The yellow leaf sap or latex is rich in 12 different anthraquinones, which are strong laxatives. The clear gel, or mucilage, found inside the leaves, is a well-known treatment for burns and has wound-healing, anti-inflammatory, and analgesic properties. The gel is composed primarily of polysaccharides and contains 75 nutrients including vitamins A, C, E, B1, B2, B3 (niacin), B6, choline, folic acid, alpha-tocopherol, and beta-carotene, and 19 of the 20 required amino acids. Aloe vera also contains enzymes that aid in digestion and are anti-inflammatory (e.g., bradykinase). Other components that are anti-inflammatory are acemannan, fatty acids, hormones (auxins and gibberellins), salicylic acid (also an analgesic), and sterols. The sterol lupeol also has antiseptic and analgesic properties. The polysaccharide acemannan is an antiviral and has immunomodulating properties; it has been shown to reduce secondary infections and increase the activity of T-lymphocytes and macrophages. This review article provides very brief summaries of the experimental and clinical evidence supporting the use of aloe vera in dentistry.
Patients with oral submucous fibrosis (n = 20) receiving 5 mg of topical aloe vera gel three times per day for three months had reduced burning and enhanced mouth opening compared to patients treated with antioxidant capsules two times per day for three months. Oral aloe gel was also clinically more effective than placebo in the treatment of oral lichen planus and minor aphthous stomatitis. In the latter study, 2% gel decreased patient pain scores, reduced wound size, and increased the rate of healing.
Patients undergoing head and neck radiotherapy who used an oral aloe vera mouthwash had reduced oral candidiasis and radiation-induced mucositis.
Patients (n = 15) with plaque-induced gingivitis treated with 10 mL aloe vera mouthwash two times per day for three months plus scaling had reduced gingival inflammation compared to patients treated with the mouthwash alone (n = 15) or scaling alone (n = 15).
Adults (n = 15) with periodontitis and mechanical debridement (scaling plus root planing) treated with intra-pocket placement of aloe vera in one site of the mouth or no aloe vera in another site had improved periodontal condition in the aloe vera site.
Several studies demonstrate the antimicrobial activity of aloe vera. In an in vitro study, aloe vera toothpaste was more effective than two popular commercial toothpastes (The Colgate-Palmolive Company; New York, New York) in destroying seven microbes commonly found in the mouth despite the absence of additional fluoride in the aloe vera toothpaste. It is noted that aloe vera does not contain the abrasives found in commercial toothpastes and hence is less harsh on teeth and a good alternative for patients with sensitive teeth. Aloe vera also controlled bacteria-induced inflammation around dental implants. Aloe vera was an effective antimicrobial for disinfecting gutta percha cones (used for root canals). Also, aloe vera plus sterile water had superior antimicrobial activity against 18 strains of microorganisms isolated from infected root canals. A patch containing acemannan hydrogel derived from aloe vera was found to significantly reduce the incidence of alveolar osteitis following molar extraction compared to clindamycin (n = 607). Acemannan has also been formulated as a denture adhesive with minimal cytotoxicity.
Aloe vera is not recommended during pregnancy or lactation because theoretically it can stimulate the uterus of pregnant women, and it could cause gastrointestinal distress in nursing infants. Other side effects include transient redness, burning, or stinging after topical use and have been reported in a few cases. Oral aloe vera containing high levels of latex-derived anthraquinones can cause cramps, diarrhea, red urine, hepatitis, and dependency or worsening of constipation. Prolonged use of anthraquinone-rich latex as a purgative may increase the risk of colorectal cancer. The laxative effect may cause electrolyte imbalances (low potassium levels).
The authors conclude that for the purposes of dentistry, aloe vera has the advantage of being easily available, inexpensive, easy to apply orally, and has no adverse effects. The authors caution that it should not be used in people allergic to plants in the Liliaceae family, or by pregnant or lactating women. [Note: Formerly classified as a member of the Liliaceae family, aloe vera is now placed in the Xanthorrhoeaceae family.] The authors acknowledge that long-term studies with larger populations are needed.
—Heather S. Oliff, PhD
Source : American Botanical Council - Herbclip
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Comparative evaluation of terminalia chebula extract mouthwash and chlorhexidine mouthwash on plaque and gingival inflammation - 4-week randomised control trial.
Gupta D, Gupta RK, Bhaskar DJ, Gupta V.
PURPOSE:The present study was conducted to assess the effectiveness of Terminalia chebula on plaque and gingival inflammation and compare it with the gold standard chlorhexidine (CHX 0.2%) and distilled water as control (placebo).
MATERIALS AND METHODS:A double-blind randomised control trial was conducted among undergraduate students who volunteered. They were randomly allocated into three study groups: 1) Terminalia chebula mouthwash (n = 30); 2) chlorhexidine (active control) (n = 30); 3) distilled water (placebo) (n = 30). Assessment was carried out according to plaque score and gingival score. Statistical analysis was carried out to compare the effect of both mouthwashes. ANOVA and post-hoc LSD tests were performed using SPSS version 17 with p ≤ 0.05 considered statistically significant.
RESULTS:Our result showed that Terminalia chebula mouthrinse is as effective as chlorhexidine in reducing dental plaque and gingival inflammation. The results demonstrated a significant reduction of gingival bleeding and plaque indices in both groups over a period of 15 and 30 days as compared to the placebo.
CONCLUSION:The results of the present study indicate that Terminalia chebula may prove to be an effective mouthwash. Terminalia chebula extract mouthrinse can be used as an alternative to chlorhexidine mouthrinse as it has similar properties without the side-effects of the latter.
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Effects of green tea (Camellia sinensis) mouthwash containing 1% tannin on dental plaque and chronic gingivitis: a double-blinded, randomized, controlled trial.
Radafshar G1,2, Ghotbizadeh M1, Saadat F3,4, Mirfarhadi N1.
AIM:The aim of the present study was to explore the effects of Iranian green tea mouthwash containing 1% tannin on dental plaque and chronic gingivitis.
METHODS:In this randomized, double-blinded, parallel, controlled clinical trial, 40 volunteer dental students with a gingival index ≥1 were enrolled. At baseline, gingival, plaque, and bleeding indices were recorded and all the participants received dental polishing. Based on random allocation, 20 participants used the test and 20 used chlorhexidine mouthwash with no change in regular toothbrushing methods. The participants were asked to use 15 mL of the respective mouthwash for 1 min, twice a day for 28 days. All indices, as well as stain index, were recorded after 1 and 4 weeks post-rinsing. Data were analyzed using repeated-measures ANOVA and Bonferroni tests.
RESULTS:Significant in-group differences, but not between-group differences, were observed in all indices after 1 and 4 weeks compared to baseline. The test mouthwash resulted in significantly less tooth staining than the control.
CONCLUSION:The 1% tannin green tea mouthwash could be a safe and feasible adjunct to mechanical plaque control. The tested green tea mouthwash could be considered a good alternative for chlorhexidine in contraindicating situations.
Source : J Investig Clin Dent.
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In vitro Antibacterial Activity of Propolis, Alum, Miswak, Green and Black Tea, Cloves Extracts Against Porphyromonas Gingivalis Isolated from Periodontitis Patients in Hilla City, Iraq
Huda Hadi Mohammad
Microbiology Department, College of Medicine, Babylon University, Babylon province, Iraq
Human periodontal disease has been associated with a complex microbiota, the development of destructive periodontitis seems to be the result of a specific infection. Gram positive coccoid bacteria have been related to periodontal health, while periodontal disease was associated with Gram negative rods. The clinical use of antibiotics and other antimicrobial agents, as adjuvants for the treatment of periodontitis, has been extensively investigated in the past decade. Recently, special attention has been paid to natural medication including propolis, alum and various plant extracts.
Swabs were taken from periodontal pockets of 30 patients (periodontic Department, teaching clinics of oral and dental surgery in Hilla city), porphyromonas gingivalis was identified according to the cultural properties, microscopic examination and biochemical tests. Antibacterial action was evaluated on this isolate by using six different aqueous extracts of Salvadora persica (Miswak), aluminum potassium sulphate (alum), propolis, green and black tea, cloves (Syzygium aromaticum ) .
Antimicrobial activity of propolis, alum and plant aqueous extracts at 50% concentration by well-diffusion method was characterized by inhibition zones. At this concentration, the maximum inhibition zone diameters 35mm, 40 mm were found in Salvadora persica and alum, respectively, for propolis the inhibition zone was 30 mm, while green tea and clove give the same inhibition zone 20 mm, the minimum inhibition zone 10 mm was found in black tea.
In summary, they showed a wide spectrum antibacterial activity. These results suggest that, propolis, alum, Salvadora persica (Miswak), clove, green and black tea have antibacterial actions against black pigmented P.gingivalis (from periodontal pockets) and may be used for the treatment and prophylaxis against periodontal diseases.
Source : American Journal of Phytomedicine and Therapeutics
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Coconut Oil May Prevent Tooth Decay
Coconut oil, a natural antibiotic when digested, destroys the bacteria that cause tooth decay, researchers at the Athlone Institute of Technology, Ireland, reported at the Society for General Microbiology's autumn conference at the University of Warwick, England, today. They added that the antibiotic component in digested coconut oil could be added to dental care products.
Dr Damien Brady and team set out to determine whether coconut oil might have antibacterial qualities at combating some strains of Streptococcus bacteria which commonly inhabit the human mouth and cause tooth decay. They tested the coconut oil in its natural and semi-digested state. They added enzymes so that the oil could be tested in a digested state.
Although natural, undigested coconut oil appeared to have no impact, the scientists found that the digested oil stopped most Streptococcus bacteria from multiplying. Of particular interest was Streptococcus mutans, a type of bacterium which produces teeth-decaying acids.
Dr. Brady explained that previous studies had demonstrated that certain foodstuffs, when semi-digested, had the capacity to destroy micro-organisms. The binding of S. mutans to tooth enamel was significantly reduced when teeth were exposed to enzyme-modified milk, one study had shown. That study encouraged this team to test out other foods.
The researchers plan to see how coconut oil interacts with Streptococcus bacteria at molecular level. They also want to find out whether digested coconut oil might combat other pathogens, including some types of bacteria and yeasts.
The team inform that preliminary studies have found that semi-digested coconut oil destroys Candida albicans, a yeast that causes thrush.
The scientists believe that enzyme-modified coconut oil, meaning in its semi-digested state, may have commercially viable antimicrobial qualities for the oral healthcare industry.
Dr Brady said:
"Dental caries is a commonly overlooked health problem affecting 60-90% of children and the majority of adults in industrialized countries. Incorporating enzyme-modified coconut oil into dental hygiene products would be an attractive alternative to chemical additives, particularly as it works at relatively low concentrations.
Also, with increasing antibiotic resistance, it is important that we turn our attention to new ways to combat microbial infection.
Our data suggests that products of human digestion show antimicrobial activity. This could have implications for how bacteria colonize the cells lining the digestive tract and for overall gut health.
Our research has shown that digested milk protein not only reduced the adherence of harmful bacteria to human intestinal cells but also prevented some of them from gaining entrance into the cell. We are currently researching coconut oil and other enzyme-modified foodstuffs to identify how they interfere with the way bacteria cause illness and disease." Streptococcus mutans (S. mutans) Streptococcus mutans (S. mutans) is an anaerobic, Gram-positive, coccus shaped bacterium. Coccus shaped means the bacterium has a spherical or spheroidal shape. S. mutans commonly inhabits the human oral cavity and is the leading cause of tooth decay globally.
S. mutans, according to experts, is the most cariogenic of all the oral streptococci. Cariogenic means producing or promoting the development of tooth decay. The bacterium sticks to the surface of the tooth and exists on certain types of carbohydrates. As it metabolizes sugars and other sources of energy, it produces an acid that damages teeth.
Virtually all humans carry S. mutans in their oral cavity.
Source : Medical News Today
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Comparative Study of Chlorhexidine Gluconate and Turmeric Extract Mouthwashes for Dental and Gingival Health
Waghmare PF, Chaudhari AU, Karhadkar VM, Jamkhande AS. Comparative evaluation of turmeric and chlorhexidine gluconate mouthwash in prevention of plaque formation and gingivitis: A clinical and microbiological study. J Contemp Dent Pract. 2011;12(4):221-224.
Periodontal disease and gingivitis affect a majority of the population and are thought to be caused by bacterial plaque. Toothpastes and mouthwashes are the best adjunct to mechanical cleaning for plaque build-up, and the dentistry gold standard compound for plaque is chlorhexidine gluconate (CHX). It does have adverse side effects, such as discoloration of the teeth, bitter taste, and mucosal erosion, and alternative remedies are desirable. Turmeric (Curcuma longa) has a number of properties such as anti-inflammatory, antioxidant, and antimicrobial activity that could make it a useful dental preventative treatment. This randomized, double-blind, comparative study examined the efficacy of CHX and turmeric mouthwashes in healthy, young adults.
The study was conducted in the Department of Periodontology, Bharati Vidyapeeth Dental College and Hospital, Pune, India. Subjects (aged 25-35 years) having fair to poor Loe and Silness gingival index scores and Turesky-Gilmore-Glickman modified Quigley-Hein plaque index scores >1 were included in the study. Exclusion criteria included those with systemic diseases, those wearing oral appliances or whose habit it was to breathe out of their mouth, pregnant or lactating females, and smokers. The study included 100 subjects who were randomly given either CHX mouthwash (ICPA Health Products Limited; Maharashtra, India) or turmeric mouthwash (10 mg curcumin extract dissolved in 100 ml of water with a peppermint flavoring agent added; no information on the source of the curcumin extract given). Subjects (n=50 in each group) were asked to gargle with 10 ml of mouthwash in a 1:1 dilution with water twice a day after brushing. Subjects recorded their use of the mouthwash as a check of compliance, and oral hygiene instructions were given at the beginning and again to those whose compliance faltered during the course of the study. Both the gingival index and plaque index scores were recorded on days 0, 14, and 21. Plaque was collected from the tooth surface of 5 subjects in each group and analyzed for bacteria on days 0 and 21.
Both groups had a significant decrease in the plaque index from baseline after 14 days, and an even greater decrease after 21 days (CHX 1.59 ± 0.33 and 2.48 ± 0.48 below baseline, respectively, P < 0.01 for both; and turmeric 1.27 ± 1.86 and 2.05 ± 0.48 below baseline, respectively, P < 0.01 for both). There was a statistically significant difference in the plaque index between the 2 groups in favor of the CHX mouthwash (74.36% decrease for CHX and 61.76% decrease for turmeric, from day 0 to day 21, P < 0.05). Both groups also had a significant decrease in the gingival index from baseline after 14 days, and an even greater decrease after 21 days (CHX 0.90 ± 0.15 and 1.04 ± 0.67 below baseline, respectively, P < 0.01 for both; and turmeric 0.90 ± 0.12 and 1.1 ± 0.11 below baseline, respectively, P < 0.01 for both). A reduction in the gingival index shows a reduction in inflammation. There was no statistically significant difference in the gingival index between the 2 groups. There was a significant reduction in the total bacterial count of both groups after 21 days, down 126.87 ± 51.6 for CHX and down 178.68 ± 28.92 for turmeric (volume units not given; P < 0.05 for both), but there was no difference between the groups.
Both mouthwashes showed efficacy and reduction of inflammation and plaque count, with the CHX mouthwash scoring better on the plaque index. The authors suggest that a possible mechanism of action of the turmeric mouthwash could be "its inhibitory action on prostaglandin synthesis and a strong stabilizing action on the lysosomal membranes." They conclude that turmeric mouthwash could be a good adjunct to mechanical plaque control. Further study is suggested to determine optimal concentration for antiplaque activity and individual periodontopathogen sensitivity.
Source : ABC
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Fish Oil Could Be Therapy for Periodontal Disease
Periodontitis, inflammation of the tissue surrounding the teeth, affects more than half of adults and is linked to an increased risk of stroke and other heart problems. To evaluate whether fish oil supplementation could be an adjunct therapy for periodontitis, Dr. Alison Coates from the University of South Australia and colleagues from the School of Dentistry at University of Adelaide in Australia reviewed evidence from eight unique studies that involved humans. Their review of these studies showed that improvements in clinical measures were common in all studies, but were scientifically significant in two that used a combination of fish oil and aspirin. Although this is not conclusive evidence, intake of fish oil is recommended for health benefits beyond the teeth.
“I would recommend that people ensure they have a sufficient intake of long chain omega-3 fatty acids in their diet for general health,” said Coates. “In Australia, these types of fatty acids are considered to be essential with ~500 mg recommended as the suggested dietary target. This equates to approximately 2 fatty fish meals per week.”
There are no serious dangers to consuming fish oil. At high levels of fish oil above the GRAS limit, people may experience a delayed clotting time and at very high doses potential gastric upset. If people are taking blood thinning medication, then they should consult with a doctor.
The group reports that the evidence for fish oil being effective in reducing periodontal symptoms is building but there is a need for more well designed studies that evaluate the supplement both alone and in combination with aspirin to be able to tease out whether fish oil by itself is effective. It is important that compliance to treatment is considered and that the dose and length of supplementation is appropriate. A clinical trial is underway in Australia that is investigating the effects of fish oil as adjunct therapy for periodontitis.
Results from this study will be presented April 24, 2012 at the Experimental Biology 2012 meeting in San Diego, CA.
Source : Newswise
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Dried Licorice Root Fights the Bacteria That Cause Tooth Decay and Gum Disease
Scientists are reporting identification of two substances in licorice -- used extensively in Chinese traditional medicine -- that kill the major bacteria responsible for tooth decay and gum disease, the leading causes of tooth loss in children and adults. In a study in ACS' Journal of Natural Products, they say that these substances could have a role in treating and preventing tooth decay and gum disease.
Stefan Gafner and colleagues explain that the dried root of the licorice plant is a common treatment in Chinese traditional medicine, especially as a way to enhance the activity of other herbal ingredients or as a flavoring. Despite the popularity of licorice candy in the U.S., licorice root has been replaced in domestic candy with anise oil, which has a similar flavor. Traditional medical practitioners use dried licorice root to treat various ailments, such as respiratory and digestive problems, but few modern scientific studies address whether licorice really works. (Consumers should check with their health care provider before taking licorice root because it can have undesirable effects and interactions with prescription drugs.) To test whether the sweet root could combat the bacteria that cause gum disease and cavities, the researchers took a closer look at various substances in licorice.
They found that two of the licorice compounds, licoricidin and licorisoflavan A, were the most effective antibacterial substances. These substances killed two of the major bacteria responsible for dental cavities and two of the bacteria that promote gum disease. One of the compounds -- licoricidin -- also killed a third gum disease bacterium. The researchers say that these substances could treat or even prevent oral infections.
Source : Science Daily
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