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Role of herbs in endodontics: An update
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bellirica) and Halituki (terminalia chebula)(7)
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and prolongs the regenerative phase. It is shown...
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Aloe Vera Abdominal cramps, diarrhoea
Garlic Bow...
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16. Bauer K, Garbe D, Surburg H. “Common Fragren...
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Role of herbs in endodontics an update

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Role of herbs in endodontics: An update

Sharad Kamat Rajeev K. Prahlad Saraf

A PUBLICATION OF INDIAN ENDODONTIC SOCIETY
VOL 23 ISSUE 1 JUNE 2011

Published in: Health & Medicine
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Role of herbs in endodontics an update

  1. 1. 98 ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY 98 Role of herbs in endodontics: An update * 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 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 Herbal products have been used since ancient times in folk medicine, involving both eastern and western medicinal traditions. Many plants with biological and antimicrbiological properties have been studied since there has been a relevant increase in the incidence of antibiotic overuse and misuse. In dentistry Phytomedicines has been used as anti-inflammatory, antibiotic, analgesic and sedative agents. In endodontics because of the cytotoxic reactions of the most of the commercial intracanal medicaments used and their inability to eliminate bacteria from dentinal tubules, trend of recent medicine attends to use biologic medication extracted from natural plants(1) . This paper reviews the role of various herbal products in endodontics. CLASSIFICATION A) Phytotherapeutic substances are generally classified in to three groups(2) . 1. Plant products 2. Animal products 3. Mineral origin B) In dentistry they are used as(3) 1. Antimicrobial - Matricaria chamomile, Salvadora percica, Azadirachta indica. 2. Anti-inflammatory - Plumeria acuminate, Kalanchoe Brasiliensis, Guaco, Propolis. 3. Sedative and Anxiolytics- Melissa officinalis, Passiflora incarnale, Piper meythsticum 4. Miscellaneous - endodontic irrigants, medicaments and endodontic retreatment. PHYTOTHERAPEUTIC SUBSTANCES MORINDA CITRIFOLIA: A native from south East Asia or Australia grows in shady forests as well as on open rock. Its antibacterial property is attributed to the presence of L- asperuloside and alizarin. It also has a number of pytochemicals including lignans, oligopolysaccharides, flavinoids and catechins(4) . It is used as a root canal irrigant(5, 6) . TRIPHALA: This is an ayurvedic rasayana consisting of Amulaki (emblica officinalis), Bibhitaki (terminalia Review Article
  2. 2. 99 ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY 99 bellirica) and Halituki (terminalia chebula)(7) . Its fruit is rich in citric acid, which may aid in removal of smear layer thereby acting as chelating agent and also found to be alternative to sodium hypochlorite for root canal irrigation(8) . PROPOLIS: This is prepared from resins collected by bees from trees of poplars and conifers or from flowers of genera clusia. It also contains viscidone(10) . It is used as intracanal medicaments(11) , root canal irrigant (12) and storage media for avulsed teeth to maintain viability of periodontal ligament(13) . AZADIRACHTA INDICA: It is known as Indian neem/margosa tree(14) . This product has been proved to be effective against E-faecalis and candida albicans. Its antioxidant and antimicrobial properties makes it a potential agent for root canal irrigation as an alternative to sodium hypochlorite(15) . ORANGE OIL: It is oil produced by glands inside the rind of an orange fruit. This is composed mostly of d- limonene. It also has long chain aliphatic hydrocarbon alcohols, aldehydes like octanal and octanal(16) . It is suggested as an alternative to chloroform or xylene for gutta-percha softening and also in dissolving endodontic sealers. CARVACROL: Carvacrol is present in the essential oils of origanum vulgare, oil of thyme, pepperwort, bergamot and satureja khuzistanica jamsizad oil (SKJ oil) Carvacrol has inhibitory action on e-coli and p-aeroginosa. The cause of antimicrobial property is attributed to action on several targets in bacterial cell and disruption of bacterial cell membrane. It also helps in repair of periapical tissues. This property is due to the presence of phenolic component which stimulates pulpal fibres, phenomena known as hormesis (17, 18) . GREEN TEA: It is a tea made solely from the leaves of camellia sinensis. The antimicrobial activity is due to inhibition of bacterial enzyme gyrase by binding to ATP B sub unit(19) . Green tea exhibits antibacterial activity on E-faecalis plaknotic cells. It is also found to be a good chelating agent(8) . SALVADORA PERSICA SOLUTION (MISWAK-SIWAK) : Its chewing sticks contain trimethyl amine, salvadorime chloride and fluoride in large amounts(20) . Fifteen percent alcoholic extracts of it has maximum antimicrobial action. It can be used as a substitute for sodium hypochlorite and chlorexidine as root canal irrigant(21, 22) . GERMAN CHAMOMILE: It is used as a table tea and flower of chamomile plant contain a wide variety of active chemical components (chamazolene, capric acid and caprylic acidchlorgenic acid). It is used for removal of smear layer and found to be more effective than NaOCl (23) . TEA TREE OIL: This is a native Australian plant with terpenin- 4-ol as a major component, responsible for antibacterial and anti fungal properties. It is used as root canal irrigant, but less effective compared to EDTA and NaOCl (23) . CASEARIA SYLVESTRIS: It is more common in tropical America and Brazil. Alcoholic extract of c.sylvestris constitutes a rich source of phospholipase A2 inhibitors which reduce the acute phase of inflammatory process SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF
  3. 3. 100 ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY 100 and prolongs the regenerative phase. It is shown as an alternative intra canal medicament(12) . GARLIC (ALLIUM SATIVUM): The main active component of garlic is allicin. It is antibacterial and has immune regulatory functions. Allicin destroys cell wall and cell membrane of root canal bacteria(24) . This is used as irrigant alternative to NaOCl. ARTICUM LAPPA: This is prepared from ethyl acetate and is used as intra canal dressing with limited activity(25, 26) . LEMON SOLUTION: Lemon solution (pH2.21) is a natural source of citric acid (pH1.68) with lower acidity. Citric acid, a chemical product has some irritating effect compared to natural lemon solution. Fresh lemon solution is used as root canal medicament because of its wide antibacterial efficiency including E- faecalis(27) . RHUS PLANTS: It contains gallic tannins and gallic acid. Tannins exhibit antibacterial and antifungal properties. Gallic acid is antioxidant and bactericidal. Gallic acid has been found to reduce periapical inflammation. Water extract of RHUS plants help in opening of blocked dentinal tubules(24) . JIEERYIN SOLUTION: This is a pure Chinese herbal compound and has heat clearing, detoxifying, antibacterial and anti- inflammatory effects. It is used for root canal irrigation with ultrasonics and is found to be effective against anaerobic bacteria. 30% concentration of this has similar effect to that of NaOCl(24) . ALOE VERA GEL: Aloe leaves contain clear gel and green part of the leaf that surrounds the gel is used to produce juice or dried substance. It contains alloins and barbadoins as main chemical constituents. Aloe Vera gel has inhibitory effects on S-pyogens and E- faecalis because of anthra quinine(28) . Its bactericidal activity is found to be less than Ca (OH)2 (29) . PSORALEA CORYLIFOLIA: This is found to be effective against E-faecalis(30) . It acts by causing injury to cell membrane and inhibiting DNA polymerase. PSIDIUM GUAJAVA: The fruits and leaves of this shrub contain essential oil rich in cineol, tannins, tripentnes and flavinoids. Ethanol extracts of it has higher antimicrobial activity, especially against E-faecalis(31) ACACIA NILOTICA: It is species of Indian and Africans sub continent. Antimicrobial function is believed to be due to tannins, phenolics compounds, essential oil and flavinoids and is effective against E-faecalis(32) . SYZIGIUM AROMATICUM/CLOVE TREE: Essential oil shows antioxidant, antibacterial and anodyne effects(32) TURMERIC: Massing the aching teeth with ground turmeric eliminates pain and swelling(33) SAFETY: Herbal products are normally considered safe. The literature has revealed few reports concerning the adverse effects of these natural products commonly used in endodontics(3) . ROLE OF HERBS IN ENDODONTICS: AN UPDATE
  4. 4. 101 ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY 101 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 DRUG (PHYTOTHERAPEUTIC) INTERACTION(3) There is little available information regarding 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 PERSPECTIVES AND CONCLUSION Literature has addressed many plants with potential source for new therapies in endodontics. The studies listed have shown important medicinal activities of plants, with great demand to inhibit or suppress bacteria and their biofilm. However there is scarce information on the quality, Safety and greater efficiency of these products for use in endodontics. As most of the studies are carried out ex vivo, more of these compounds should be subjected to animal and human studies to determine their effectiveness, side effects, toxicity and drug interactions. REFERENCES: 1. Palombo EA. Traditional medicinal plant extracts and natural products with activity against oral bacteria; potential application in prevention and treatment of oral diseases. (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. 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. 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. 9. Ayurvedic pharmacopoeia committee. The Ayurvedic Formulary of India, Part I, 2nd English Ed. New Delhi: Controller of Publications. 2003: 167. 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 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. 12. da silva FB, de Almeida JM, de souse SMG. Natural medicaments in endodontics- A comparative study of the anti- inflammatory action. Braz Oral Res 2004:18: 174-179. 13. Martin MP, Pileggi R . A quantitative analysis of Propolis: a promising new storage media following avulsion. Dent Traumatol. 2004: 20: 85-9. 14. Ganguli S. “Neem: A therapeutic for all seasons” Current Science.2002: 82: 1304. 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. SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF
  5. 5. 102 ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY 102 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. 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 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. 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. 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. 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. 24. Traditional Chinese medicine used in root canal disinfection research. Pharmacy papers (Online article). http:/ /eng.hi138.com/?b106. 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 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 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 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. 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. 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. 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. ROLE OF HERBS IN ENDODONTICS: AN UPDATE

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