Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24.

www.ijprsonline.com

ISSN: 2348 –0882

====================================...
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Aloe-Vera: A Boon In Management Of Dental Disease

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Aloe Vera has been used medicinally for a few
thousand years. It was sufficiently in demand that
Hannibal was known to have gone to war over it in
order to obtain control over its growing area

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  1. 1. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ Aloe-Vera: A Boon In Management Of Dental Disease Sambhav Jain1, Rohit Rai*1 1. Department of Periodontology and Oral Implantology,Teerthanker Mahaveer Dental College and Research Centre,Delhi Road,Moradabad,India Correspondence Author: Dr Rohit Rai, Department of Periodontology and Oral Implantology,Teerthanker Mahaveer Dental College and Research Centre,Delhi Road,Moradabad,India Email:periodontics07@gmail.com -----------------------------------------------------------------------------------------------------------------------------------------Abstract: Aloe Vera has been used medicinally for a few thousand years. It was sufficiently in demand that Hannibal was known to have gone to war over it in order to obtain control over its growing area (N. Africa). It is still very much in use today for a wide range of ailments. Orthodoxy it is used in burns units to great effect and is increasingly being used in the treatment of dermatological lesions. Several studies on burns have been conducted in comparison trials between Aloe products and non-Aloe. The Aloe seems to promote more rapid healing and pain relief.Aloe vera has showen multiple uses in dentistry. Some of its extreme uses have been observed in the treatment of gum diseases by reducing bleeding of the gums, acting as antiseptic in gum pockets, and its antifungal properties help greatly in the problem of denture stomatitis. Keywords: Aloe vera, dentistry, gingivitis, medicine, periodontitis. used both as a moisturizing agent and for the treatment of minor burns, skin abrasions, and irritations. It has been suggested that external application of aloe vera gel promotes wound healing. The Aloe barbadensis plant consists of two different parts, each of which produces substances with completely different compositions and therapeutic properties. The parenchymal tissue makes up the inner portion of the aloe leaves and produces the aloe vera gel (or mucilage), a clear, thin, tasteless, jelly- like material. This tissue is recovered from the leaf by separating the gel from the inner cellular debris. The other part of the plant is a group of specialized cells known as the pericyclic tubules, which occur just beneath the outer green rind of the leaf. These cells produce exudates that consist of bitter yellow latex with powerful laxative-like actions. This exudate which is not to be confused with the gel/mucilage from the parenchymal leaf tissue is available commercially for systemic ingestion to produce catharsis.1 Fig. 1 Introduction: The fresh gel or mucilage from Aloe barbadensis Mill (family Liliaceae)—otherwise known as aloe vera—is a handy home-grown remedy that can be 18
  2. 2. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ Botanical classification Aloe Vera: Kingdom: Plantae clade: Angiosperms Order: Asparagales Family: Xanthorrhoeaceae Subfamily: Asphodeloideae Genus: Aloe Species: A. vera History Its history of health benefits was first recorded in Egyptian medical writings in 1500BC. Even Cleopatra was said to have pampered her skin with Aloe gel. History reports that Alexander the Great captured the island of Socotra in the Red Sea, which had abundant Aloe fields, to help heal the battle wounds of his troops. Aloe was applied to cuts, infections, blisters, insect bites and used for internal maladies. In America, Aloe Vera has been growing in Florida and the Rio Grande Valley of Texas for some 4000 years. The initial credible research on Aloe Vera was done by Dr. C.E. Collins in 1934, where several cases of Roentgen Dermatitis, the ulcerated skin lesions were treated with Aloe Vera leaves split and wrapped around the wounds. A markedly improved rate of healing was observed. Some dermatologists began a series of comparable reports. In 1937, Dr J.E. Crewe presented a wider use for the application of Aloe Vera in treating chronic ulcers, eczema, burns, sunburn, poison ivy, and minor injuries. His findings recorded complete healings and tissue regeneration without scarring. Many investigations were pursuing further Aloe Vera studies and in 1959, the FDA admitted that Aloe ointment actually did regenerate skin tissue. Since those studies, topical success with Aloe Vera is common place, as doctors use it to treat decubitous (bed sores), alopecia (hair loss) and acne.2 Fig. 2 Composition The chemical composition of the aloe vera gel is complex constituting vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids; numerous monosaccharides and polysaccharides; vitamins B1, B2, B6, and C; niacinamide and choline; several inorganic ingredients; enzymes such as acid phosphatase, alkaline phosphatase, amylase, lactic dehydrogenase, and lipase; and numerous organic compounds such as aloin, barbaloin, and emodin.3 Aloe Vera also consist aluminum, boron, barium, calcium, iron, magnesium, sodium, phosphorous, silicon, and strontium.4 Polysaccharide components in aloe vera consisted of glucomannans some of which were acetylated; polymers of galactose and galacturonic acid.5 It also contains 75 potentially active constituents: vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids.6 Fig. 3 Processing Of Aloe Vera The Aloe barbaden is plant consists of two different parts, each of which produce substances with completely different compositions and therapeutic properties. The parenchymal tissue makes up the inner portion of the aloe leaves and produces the aloe vera gel (or mucilage), a clear, thin, tasteless, gelly like material. This tissue is recovered from the leaf by separating the gel from the inner cellular debris. 19
  3. 3. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ The other part of the plant is a group of specialized cells known as the pericyclic tubules, which occur just beneath the outer green rind of the leaf. These cells produce exudates that consist of bitter yellow latex with powerful laxative-like actions. This exudate which is not to be confused with the gel/mucilage from the parenchymal leaf tissue is available commercially for systemic ingestion to produce catharsis.1 5. Properties Of Aloe Vera 1. 2. 3. 4. The constituents of aloe vera are related to biological effects, which are as follows: Healing properties: - Glucomannan, amannoserich polysaccharide, and gibberellin, a growth hormone, interacts with growth factor receptors on the fibroblast, there by stimulating its activity and proliferation, which in turn significantly increases collagen synthesis after topical and oral Aloe vera. Protective effects: - On skin exposed to UV and gamma radiation: Following the administration of aloe vera gel, an antioxidant protein, metallothionein, is generated in the skin, which scavenges hydroxyl radicals and prevents suppression of superoxide dismutase and glutathione peroxidase in the skin. Aloe vera gel has been reported to have a protective effect against radiation damage to the skin. Anti-inflammatory action: - Aloe Vera inhibits the cyclooxygenase pathway and reduces prostaglandin E2 production from arachidonic acid. Recently, the novel anti-inflammatory compound called C-glucosyl chromone was isolated from gel extracts. Effects on the immune system: - Alprogen inhibit calcium influx into mast cells, thereby inhibiting the antigen-antibody-mediated release of histamine and leukotriene from mast cells. Acemannan 6. 7. 8. a. stimulates the synthesis and release of interleukin1 (IL-1) and tumour necrosis factor from macrophages which in turn initiates an immune attack that result in necrosis and regression of the cancerous cells. Antiviral and antitumor activity: - These actions may be due to indirect or direct effects. Indirect effect is due to stimulation of the immune system and direct effect is due to anthraquinones. The anthraquinone alone inactivates various enveloped viruses such as herpes simplex, varicella zoster and influenza. In recent studies, a polysaccharide fraction has shown to inhibit the binding of benzopyrene to primary rat hepatocytes, thereby preventing the formation of potentially cancerinitiating benzopyrene-DNA adducts. An induction of glutathione S-transferase and an inhibition of the tumour-promoting effects of phorbol myristic acetate has also been reported which suggest a possible benefit of using aloe gel in cancer chemoprevention. Moisturizing and anti-aging effect: Mucopolysaccharides in aloe vera help in binding moisture into the skin. Aloe stimulates fibroblast which produces the collagen and elastin fibers making the skin more elastic and less wrinkled. Antiseptic effect:- Aloe Vera contains 6 antiseptic agents as Lupeol, salicylic acid, urea nitrogen, cinnamonic acid, phenols and sulfur and have inhibitory action on fungi, bacteria and viruses.7 Use of aloe vera in dentistry: - Uses of aloe vera in dental conditions based on its biologic effects are as follows: Extraction sites heal properly and dry socket formation is prevented when Aloe vera is applied on extraction site. Lesions are improved by direct application in gel form on herpetic viral lesions or 20
  4. 4. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ aphthous ulcers. It has been reported that acemannan hydrogel accelerates the healing of aphthous ulcers and reduces the pain associated with them.8 b. Studies using aloe vera in toothpastes have shown that aloe vera tooth gel and the toothpastes were equally effective against Candida albicans, Streptococcus mutans, Lactobacillus acidophilus, Enterococcus faecalis, Prevotella intermedia, and Peptostreptococcus anaerobius. Aloe Vera tooth gel demonstrated enhanced antibacterial effect against S. mitis. 9 The dental uses of Aloe Vera are multiple. It is extremely helpful in the treatment of gum disease; it reduces the bleeding of the gums; it is powerfully antiseptic in gum pockets and its antifungal properties help greatly in the problem of denture stomatitis, i.e. red and sore mucous membranes which are permanently covered by a denture – this is a form of thrush. Cracked and split corners of the mouth are also subject to fungal infection and this can be cured by Aloe. Its antiviral properties help in the treatment of cold sores (Herpes Simplex) and shingles (Herpes Zoster). It is a powerful healing promoter and when inserted into extraction sockets is very beneficial. It can be used in any surgical wound. It has a use in root canal treatment as a sedative dressing, healing promoter and file lubricant. 10 9. Aloe Vera in periodontal disease: - Periodontitis is an infectious inflammatory disease. Bacteria modulate the inflammatory response and alter the diversity of periodontal disease. In recent years, various host-response modulation therapies and local drug therapies have been developed to block the pathways responsible for periodontal tissue breakdown. 11 Treatment of periodontal disease by different type of local drug delivery system has been investigated. Subgingival administration of aloe vera gel results in improvement of periodontal condition. Aloe Vera can be used as a local drug delivery system because of its various benefits such as: 1. It is easily available. 2. It is cheap 3. Easily applicable with minimal equipments Aloe latex contains anthraquinones, which are chemical compounds that are used in healing and arresting pain because they are anti-inflammatory in nature. But, because aloe vera tooth gel tends to be less harsh on teeth, as it does not contain the abrasive elements typically found in commercial toothpaste, it is a great alternative for people with sensitive teeth or gums. Application directly to the sites of periodontal surgery along with periodontal dressing or to gum tissues when they have been traumatized by toothbrush-dentifrice abrasion, sharp foods, dental floss, and toothpick injuries. Existing evidence indicates that aloe vera used in variety of concentrations might be effective in shortening the duration of wound healing.10 The various forms of Aloe used in dentistry are: –  The toothpaste is a gelly like substance for healing promotion, which can also be used for burns, stings, insect bites and many skin lesions:such as “Aloe Dent”, aloe tooth gel”, “forever bright”, “Kingfisher aloe vera tooth paste”.12  Mouthwash, floss. Fig. 4 21
  5. 5. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================  The jelly for healing promotion, which can also be used for burns, stings, insect bites and many skin lesions.  The Aloe & Propolis hand cream which helps to counteract frequent hand washing and the wearing of latex gloves. Fig. 5  The Aloe activator spray which is excellent for throat infections, painful erupting wisdom teeth and joint pains.  The Aloe juice which is taken as a drink. This is used in conjunction with any topical treatment for skin lesions, joint lesions and, in itself, as an amelioration in irritable bowel syndrome. The juice is also a strong detoxifying agent and if used in conjunction with the planned removal of mercury amalgams act as a scavenging agent for mercury, a neuro-sedative and immune enhancer. As a routine general tonic it generally makes people feel better who are otherwise not well enough but not frankly ill. Fig. 6 Contraindications: - Aloe Vera should be used cautiously in pregnancy, lactating mothers and allergy to lilliacea family.13 Side Effects: - Side effects may be categorized into due to topical or systemic routes as follows: A. Topical: - It may cause redness, burning and stinging sensation. Allergic reactions are mostly due to anthraquinones, such as aloin and barbaloin. It is best to apply it to a small area first to test for possible allergic reaction. B. Systemic: - Abdominal cramps, diarrhea, red urine, hepatitis, dependency or worsening of constipation. Prolonged use has been reported to increase the risk of colorectal cancer. Laxative effect may cause electrolyte imbalances (low potassium levels).7 Conclusion Aloe Vera is a natural product having various uses in the field of cosmetology, dermatology, and gastroenterology. In dentistry, aloe vera is useful in many ways due to its antibacterial, antifungal, antiviral, immunostimulatory and healing properties. Future research may be directed at the further investigations of gel ability to stimulate cell growth in tissue culture and its anti microbial, anti fungal, antibacterial and anti-inflammatory properties in randomized controlled clinical trials along with its beneficiary effect in periodontal disease. Aloe Vera certainly gives scope to the phrase, “the whole is more than the sum of its parts”. Fig. 1 Different Parts of Aloe Vera Fig. 2 Aloe Vera Plant 22
  6. 6. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ Fig. 3 Constitutes Of Aloe Vera Fig. 4 Aloe Vera Paste, Mouth Wash, Floss Fig. 5 Aloe Vera Cream Fig. 6 Aloe Vera Juice 23
  7. 7. Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882 ============================================================================ References 1. Richard L.et al. Aloe vera gel: Update for dentistry. General Dentistry 2005:6-9. 2. Moore et al. Aloe Vera has been used for thousands of years. Why is it so important for our health? www.flpirelandshop.com 2006. 3. Hayes SM. Lichen planus—Report of successful treatment with aloe vera. Gen Dent 1999; 47:268-272. 4. Yamaguchi I et al. Components of the gel Aloe vera(L.) burm. f. Biosci Biotechnol Biochem 1993;57:1350-1352. 5. Reynolds T et al. Aloe vera leaf gel: A review update. J Ethnopharmacol 1999; 68:3-37. 6. Vogler BK et al. Aloe vera: A systematic review of its clinical effectiveness. Br J Gen Pract 1999; 49:823-828. 7. Renu et al. Aloe Vera and its uses in Dentistry. Indian J Dent Adv 2011; 3(4): 656-658. 8. Poor MR et al. Reduction in the incidence of alveolar osteitis in patients treated with the SaliCept Patch, containing aceman-nan hydrogel. J Oral Maxillofac Surg 2002; 60:374-379. 9. George Det al. Comparative evaluation of the antimicrobial efficacy of aloe vera tooth gel and two popular commercial toothpastes: An in vitro study. General Dentistry. 2009; 238241. 10. Bhat et al. Aloe vera nature’s soothing healer to periodontal disease. J Indian Soc Periodontol 2011; 15:205-209. 11. Kiloy.W.J et al . Controlled local delivery of antimicrobials in the treatment of periodontitis. Dent Clinical North Am 1998;43:263-283. 12. Mohan.R. et al. Aloe vera in dentistry- The Herbal Penecca.Ind. J Dent. Spec. Res. 2011;29: 13. Moore T.E.The M and M’s of aloe vera-is it for dentistry? J Okla Dent Assoc. 2001; 9:3036. 24

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