Current herbal medicine as an alternative treatment in dentistry: In vitro, in vivo and clinical studies

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Abstract

Since the time that human population comprehended the importance of general health maintenance and the burden of disease, there has been a search for healing properties in the natural environment. Herbal medicine is the use of plants with medical properties for prevention and treatment of conditions that can affect general health. Recently, a growing interest has been observed toward the use of traditional herbal medicine alongside synthetic modern drugs. Around 80% of the population, especially in developing countries relies on it for healthcare. Oral healthcare is considered a major part of general health. According to the world health organization (WHO), oral health is considered an important part of general health and quality of life. The utilization of natural medications for the management of pathologic oro-dental conditions can be a logical alternative to pharmaceutical methods due to their availability, low costs, and lower side effects. The current literature review aimed at exploration of the variety and extent of herbal products application in oral health maintenance including different fields of oral healthcare such as dental caries, periodontal maintenance, microbial infections, oral cancers, and inflammatory conditions.

Introduction

Oro-dental health has always been considered an inseparable part of general health. The dimensions of oral health have been expanded, in accordance with broadening of the definition of health by WHO, with inclusion of individual and social wellbeing. Because the oral health closely contributed to general wellbeing, it has gained more importance in recent years (Baiju et al., 2017). Every threatening factor to oral health, will affect the quality of life, well-being, food selection, and psychosocial aspects of life, directly or indirectly. Considering their worldwide prevalence, oro-dental pathologies and abnormalities are regarded as a significant public health challenges due to their impact on individuals and society. The direct and indirect global costs of oro-dental problems were estimated around $298 and $144 billion respectively (Listl et al., 2015). According to WHO, tooth decay is the most prevalent nontransmissible disease and considered a significant global public health issue (Organization W.H., 2017).

Besides conventional treatment methods, herbal agents have been extensively entered oral care products in recent years. These compounds have interesting medical and physicochemical characteristics. Nowadays, lots of manufacturers use herbal ingredients in their products to provide additional therapeutic characteristics. The earliest reports of herbal drug application in oral health are related to Indian and Chinese traditional medicine. It has been mentioned that Hippocrates suggested a combination of alum, salt, and vinegar as a mouth rinse. Religious manuscript, Talmud, dating back about 1800 years, recommended using “dough water" and olive oil for oral health. Greek physician Pedanius Dioscorides, proposed a combination of wine, milk and herbal extract of olive tree leaves and pomegranate (Manipal et al., 2016). “Miswak” which is obtained from the Arak tree is one of the oldest known oral hygiene tools, but it is still being used in many Asian and African cultures since ancient times (Haque and Alsareii, 2015). At some instances, herbal medications are preferred over conventional drugs because of their immense natural bio-characteristics, lower costs, availability, and wide safety margin. In addition, many of the modern medications used in dentistry are responsible for known side effects (Tartaglia et al., 2019). It is important to know that herbal medications are currently used by about 80% of the world’s population for health-related purposes, mostly by a majority of citizens at rural communities of developing countries (Siddeeqh et al., 2016).

Regarding oral health maintenance a huge number of studies have focused on antimicrobial and anti-inflammatory properties of different natural agents. Antimicrobial topical medications have been recommended as adjuncts for mechanical dental plaque control methods. Among them, chlorhexidine gluconate (CHX) is considered the most common medication prescribed to fight harmful oral microorganisms but it has some potential side effects including tooth staining, taste alteration, increased mineral uptake into biofilm and calculus formation, and irritation of oral mucosa (Gurgan et al., 2006; Sakaue et al., 2018). Hence, the development of some new treatment protocols is required to safely manage these oral health problems. A logical approach is exploring among the abundantly available medicinal plants in nature. The “naturally occurring” bio-active components in herbal products can be beneficial with minimal side effects and maximum efficiency. Either as single ingredient products or in combinations, herbs are proven to be safe and effective in the management of various oral diseases (Sakagami et al., 2018).

In this review article, we aimed to review the indications of herbal medicine for different aspects of oro-dental maladies. Pre-clinical studies have provided a basis for the determination of potential indications of natural products in oral care. Therefore, they have a fundamental role in the development of research fields for herbal dentistry. Some of these laboratory workups are mentioned in this review, to build a database of relevant literature for each topic. Regarding clinical implications, these treatment options are usually used as alternative therapies in dentistry. However, numerous clinical trials evaluated their efficiency and reached promising results. This fact has encouraged a large number of practitioners to employ herbal agents in their routine clinical practice. Several outstanding studies in this field are discussed in the following section, separately for the specified headings.

Section snippets

In-vitro and animal studies

Microorganisms are etiologic factors in the occurrence of carious lesions (Bradshaw and Lynch, 2013). Streptococcus mutans and Lactobacillus acidophilus are known to be the principal microorganisms involved in dental caries (van Houte, 1993) and a significant correlation has been identified between the salivary numbers of these microorganisms and dental caries prevalence (Damle et al., 2016). Other culprit phylotypes for such pathologies include Fusobacterium, Dialister, Prevotella, Atopobium,

In-vitro and animal studies

Periodontal pathologies are common multifactorial oral conditions with an incidence rate of over 46% among American citizens (Eke et al., 2015). Gingivitis and periodontitis induced by plaque are categorized among the most prevalent periodontal problems which can have a negative correlation with the oral-health related quality of life (Jansson et al., 2014). It is essential to know that plaque accounts for 20% of the direct risk of developing periodontitis (Lang and Bartold, 2018). The main

In-vitro studies

The prevalence of oral fungal infections has changed dramatically in recent years (Gleiznys et al., 2015). These changes are mainly related to the increase in predisposing factors like immune-compromising situations such as HIV infection, endocrine disorders, using immunosuppressive drugs and prolonged antibiotic therapies, malnourishment, using dentures, etc. (Gleiznys et al., 2015). Candida is considered a natural flora in the human oral cavity but it can cause pathogenic conditions due to

In vitro studies

Bacterial pathogenesis is the primary factor responsible for endodontic infections. Enterococcus faecalis is one of the most common bacteria found in infected root canals and cases of failed root canal therapies with the need for retreatment (with the prevalence from 24% to 77%) (Choudhary et al., 2018). It is a gram-positive bacterium with the ability to survive in most unfavorable environments (Evans et al., 2002). E. faecalis can alter host responses, control pH homeostasis, and contains

Anti-inflammatory and wound healing properties

Herbal remedies are well-known for their traditional use for their soothing effects. Dentistry practice has benefited a lot from such potentials. A large number of plant products have been introduced to have tangible anti-inflammatory effects. Some researchers have used single-ingredient products and others have utilized complex formulations. Chisandra chinensis and its major lignan Schisandrin C possess anti-inflammatory properties by suppressing Interleukin-1β and Tumor necrosis factor-α

Antineoplastic properties in herbal medications

Head and neck cancers are ranked among the top 10 most common malignancies in the world with an incidence rate of 4.84 per 100,000 persons in 2017 (Ren et al., 2020). Delayed clinical diagnosis, poor prognosis, limited and expensive therapeutic alternatives are among the problems we face against oral cancers (Rivera, 2015). Patients suffering from oral squamous cell carcinoma (OSCC) are currently treated with conventional treatment techniques such as radiotherapy, chemotherapy, and surgery.

Analgesic properties in herbal medicine

Oral pain is a very common manifestation of numerous clinical presentations and pathologies in dental patients. Oral lesions and surgical wounds are on the top rank etiologies (Hargitai, 2018). Bromelain is an enzyme extract mainly found in Ananas comosus which possesses anti-inflammatory effects. The Bromelain mechanism of action is exerted via inhibition of pain mediators such as prostaglandin E2 and substance P (Onken et al., 2008). Baicalin is another natural molecule found in Scutellaria

Halitosis and herbal medicine

Halitosis is defined as a disagreeable and unpleasant odor emanating from the mouth air and breath. More than 31% of the population suffer from halitosis (Silva et al., 2018). This condition results from volatile molecules (like sulfur compounds, aromatic compounds, and nitrogen-containing compounds) which can be produced by pathological or nonpathological factors (Aylikci and Colak, 2013). Solobacterium moorei is an anaerobic bacterium that is closely related to halitosis (Haraszthy et al.,

Vital pulp therapy and herbal medicine

Nowadays non-invasive vital pulp therapy has gained popularity due to giving dentists the possibility to preserve tooth structure and avoid more aggressive treatment techniques like pulpectomy, especially in pediatric dentistry. Among vital pulp therapies, direct pulp capping involves using a topical medication or a dressing on the exposed dental pulp to induce reparative dentin production without compromising its vitality. Ca (OH)2 compounds are the gold standard materials for pulp capping in

Bone regeneration and herbal medicine

Bone regeneration therapy is an obligation for many dentistry procedures. Herbal medicine has entered this field as well, in recent years. Acemannan is the major polysaccharide found in Aloe vera gel. Acemannan significantly stimulates bone marrow stromal cells, expression of vascular endothelial growth factor, and bone mineralization. An animal experiment showed that the application of acemannan sponge on rat tooth socket after extraction increases the rate of new bone formation and presence of

Conclusion

Herbal medicine has gained considerable popularity during the past decade. Many researchers in the field of dentistry and pharmacology have dedicated their time and resources to evaluation of natural products, discovering their bioactive compounds and finding applications for them in various aspects of oral health maintenance. In this article, we tried to make a comprehensive review of recent scientific studies about medicinal plants and their current status in the field of dentistry.

Limitations of the study

The outcomes mentioned in this review should be approached with caution based on some facts. Diversity in methodological approaches in both in vitro and in vivo studies prevents reaching a specified recommendation or guideline for use of herbal formulations in the above-mentioned oro-dental disorders. This heterogeneity exists in different aspects such as herbal extract preparation methods (alcoholic extraction, aqueous extraction, essential oil preparation and etc.), extract concentrations,

Future direction

Herbal medicine shows promising results in almost every aspect of oro-dental treatment plans. Although many of the studies with reference to the beneficial properties of herbal medicine in dentistry claim that herbal products can be used as alternatives for conventional drugs, without bearing common side effects, the majority of them lack proper evidence about their safety and biocompatibility. Most of these researches are conducted at in-vitro and pre-clinical settings. Therefore, there is an

Author contribution

The authors declare that this work was done by the authors named in this article. Ehsan Tafazoli Moghadam, Elahe Tahmasebi, Mohsen Yazdanian, Hamid Tebyanian, Reza Ranjbar, Ali Tafazoli, and Alireza Yazdanian were involved in study design and data collections. Mohsen Yazdanian, Hamid Tebyanian, Elahe Tahmasebi, and Alexander Seifalian were involved in critically reviewing the data and help in writing the review article.

Funding

There was no financial support.

Ethical approval

This article is a review and does not contain any studies with human or animal interventions performed by any of the authors.

Declaration of competing interest

The authors declare that they have no competing interests.

Acknowledgment

The authors would like to acknowledge the useful comments given by colleagues at the Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.

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