Brazilian Journal of Oral Sciences, Vol. 6, No. 21, April - June 2007, pp. 1308 - 1312
Ethnomedicine: use in dental caries
Singh J1, Kumar A2, Budhiraja S1, Hooda A2
1Department of Pharmacology , Pt.B.D.Sharma PGIMS,Rohtak-124001, Haryana,India.
Correspondence to: Salil Budhiraja Shiksha kunj public school, Chinnot colony, Rohtak, 124001, Haryana, India. E-mail: firstname.lastname@example.org
Received for publication: March 03, 2006
Code Number: os07012
Ubiquitousness and increasing prevalence of dental caries makes it one of the most important problems in public health. Due to high cost and lack of resources at primary levels prevention is better in dental caries. Since the origin is related to bacteria, antibacterial is mainstay of treatment. Lack of high efficacy with antibacterial agents, unwanted effects and resistance to these agents are drawing attention of scientists to search for new and better drugs. Plants products are currently gaining attention for treatment of various ailments. Although, these has been exploited for various oral ailments this article describes use of plants products for prevention and cure of dental caries.
Key Words: dental caries, herbal, plants, ethnomedicineIntroduction
Dental caries is one of the most important problems in public health because of its ubiquitousness in civilized populations. The prevalence of dental caries in industrialized countries like India is on the rise. As the treatment is very costly and requires a lot of manpower, the prevention at the primary level is the solution of choice. Dental plaque is formed by the colonization and accumulation of oral microorganisms in the insoluble glucan layer that are synthesized by glucosyltransferase (GTase) from Streptococcus mutans1. De novo synthesis of water insoluble glucan is essential for the adherence of S. mutans and other oral microorganisms to the tooth surface, forming a barrier that prevents the diffusion of acids produced by the bacteria. The acids accumulate in situ and decalcify minerals in the enamel2. Actinomyces naeslundii and Actinomyces visosus are usually associated with dental caries particularly human root surface caries3.
To avoid dental caries due to cariogenic bacteria, inhibition of glucosyltransferase activity by specific enzyme inhibitor4, inhibition of initial cell adhesion of S. mutans by polyclonal and monoclonal antibodies5 and inhibition of cell growth of S. mutans by antibacterial agents have been investigated. This third line of research in particular has attracted a great deal of attention. Effective antimicrobial agents against these oral pathogens could play an important part in the prevention of dental caries. However, many attempts for prevention of dental caries were of no practical use up to the present. Antibiotics such as penicillin and erythromycin have been reported to effectively prevent dental caries in animal and humans6 but they are never used clinically because of many adverse effects such as hypersensitivity reaction, suprainfections and teeth staining. Furthermore, viridans group streptococci including S. mitis, S. sanguis and S. mutans, the most representative human cariogenic bacteria are moderately resistant to antibiotics7. These drawbacks justify further research and development of natural antibacterials that are safe for the host or specific for oral pathogens. The natural phytochemicals could offer an effective alternative to antibiotics and represent a promising approach in prevention and therapeutic strategies for dental caries and other oral infections. Although, plant products are greatly exploited for therapeutic potential to cure various oral ailments, this article describes natural medicines/ products beneficial only in dental caries.
Natural products have been used for thousands of years in folk medicine for several purposes. As most of the oral diseases are due to bacterial infections and it has been well documented that medicinal plants confer considerable antibacterial activity against various microorganisms including bacterias responsible for dental caries8. The spice extracts, Cinnamon bark oil, Papua mace extract and Clove bud oil were reported to inhibit the growth of many oral bacteria9. Green tea extracts which is customarily drunk after every meal in Japan is known to contain several polyphenols that inhibit the growth of S. mutans10. Sanguinaria is an alkaloid extract from the rhizome of the Sanguinaria canadensis. It has been reported to possess a broad spectrum antibacterial activity against a variety of oral bacteria11. Antibacterial activity of some plant species like Melia azadirachta, Calotropis gigantean, Leucas aspera, Vitex negundo and others have been tested12.
In India plant wealth is greatly exploited for its therapeutic potential and medicinal efficacy to cure dental caries. RN Chopra has described many plants being used in prevention of dental caries. These include Melia azadirachta, Moringa pterygosperma and Balsamodendron mukul. The stem, bark, root and young fruits of Melia azadirachta are used as bitter, tonic, antiseptic, astringent and antibacterials. In several indigenous tooth powders, toothpastes, toilet soaps, the extract from various parts of this tree is used. The use of Neem twigs as tooth brush has been endorsed by the dentists to prevent caries13. Azadirachta indica mouth wash is reported to inhibit growth of S. mutans and carious lesions14. The medicinal virtues of Moringa pterygosperma (Moringaceae) have long been known and appreciated in India. Almost all parts of the plant (root, leaves, seeds, flowers) have been used in indigenous system. Seed oil is used externally for relieving pain of joints in gout and rheumatism. The root has been recommended by Hakims (Ayurvedic practitioner) in the treatment of soreness of the mouth and throat and pain in the gum due to dental caries. It has also been used as an abortifacient, rubefacient and counter irritant13. Balsamodendron mukul (Burseraceae) grows in the arid zones of Rajputana, Khandesh, Sind, Kathiawar, East Bengal and Assam. The oleogum resin from the plant known as guggul is used as a demulcent, carminative and alternative. It is stated to be useful in leprosy, rheumatism, syphilis, nervous system and skin diseases. The drug has a wide range of usefulness in the indigenous medicine. It is used in the form of lotion for ulcers and as a gargle in caries of teeth, weak and spongy gums, pyorrhoea alveolaris, chronic tonsillitis, pharyngitis and ulcerated throat13.
Hebber et al.15 reported the results of a survey carried out in western ghat region of Dharwad district of Karnataka (India). These workers suggested the use of some plants in the treatment of dental caries for example dried whole plant of Calotropis gigantea (Asclepiadaceae) is burnt to get ash which is used to massage the tooth and gum after brushing in the morning and evening for curing of plaque, caries and pyorrhea. Powdered seeds of Cassia hirsute (Caesalpiniaceae) are used to massage the teeth and gums to protect from plaque and caries. Dried seeds of Cassia tora are fried and powdered. It is also used to massage the teeth and gums to protect from plaque and caries. Leucas aspera (Lamiaceae) whole plant is powdered and used to massage on the teeth and gums for plaque and caries.
Namba et al.16 isolated two compounds magnold and honokiol from the ether and methanol extract of bark of Magnoliae cortex. These workers reported potent antibacterial activity of these compounds against cariogenic bacterium, S. mutans (MIC 6.3 mg/ml). Kohda et al.17 isolated and identified oleonolic acid and ursolic acid as active principles from chloroform extract of Zizyphi fructus. These workers demonstrated inhibitory activity of these compounds against insoluble glucan formation by glucosyltransferase from cariogenic bacterium S. mutans. Toukairin et al.18 isolated polyphenolic 5’-nucleotidase inhibitors from the seed and skin of the wine grape “Koshu” designated as NPF-88 BU-IA, NPF-88 BU IB, NPF-88 BU IIA and NPF-88 BU IIB. These compounds displayed inhibitory effects on the growth of S. mutans, a primary cariogenic bacterium. Furthermore, they inhibited the glucan formation from sucrose. Therefore, 5-nucleotidase inhibitors can prevent cause of caries of tooth. Chewing sticks (Miswak) which are roots of Salvadora persica plant have been used for centuries as oral hygiene tool in many parts of the world particularly in south Arabia. Many studies have demonstrated antiplaque, anticaries, antiperiopathic and antibacterial effects of these sticks19. Phytoalexins purified from Sophora exigua (Leguminosae) has been shown to possess significant anticaries and antibacterial activity20. A new cariostatic compound named eucalyptone has been isolated from the leaves of Eucalyptus globules by Osawa et al.21 Sato et al.22 reported that methanolic extract from Artocarpus heterophyllus showed most intensive antibacterial activity against cariogenic bacteria. These workers suggested that isoprenyl flavones from this plant would be potent compounds for prevention of dental caries. Antibacterial activity of onion (Allium cepa) extract against S. mutans and S. sobrinus has also been reported23. Plumbagin isolated from the chloroform extract of aerial parts of Drosera peltata is reported to possess significant antibacterial activity against cariogenic bacteria24. Jagtap and karkera25 reported that aqueous and alcoholic extracts from Juglandaceae regia, used as chewing sticks inhibited the growth and physiological functions of S. mutans. Bakuchiol was isolated from the seeds of Psoralea corylifolia a tree native to China with various uses in traditional oriental medicine26. Further, antibacterial activity of Bakuchiol observed against S. mutans suggested great potential of this compound in preventing and treating dental caries26. Wongkhan et al.27 demonstrated antibacterial activity in ethanolic extract of Streblus asper. These workers suggested use of Asper leaf extract in controlling dental caries. A few recent studies have demonstrated antibacterial activity against selected oral pathogens from the native American plant Ceanothus americans, Ceanothic acid and Ceanothetric acid. These plants demonstrated growth inhibitory effects against S. mutans, Actinomyces viscosus and P. gingivalis26. Perilla seed extract (Perilla Frutescaris Britton Var Japonica Hara) has been shown to possess antimicrobial activity against oral cariogenic Streptococci and periodontopathic Porphyromonas gingivalis28. Therefore, Perilla seed extract could prevent dental caries and periodontal diseases. Addai et al.29 reported that Garcinia manii (stick chewing) confers a caries preventing/ control benefit by reversing acidogenic challenge to teeth. Antibacterial agent Kuwanon-G has been isolated from the ethylacetate fraction of methanol extract of Morus alba by Park and coworkers30. MIC of Kuwana-G against S. mutans was determined to be 8 µg/ml. The bactericidal test showed that Kuwanon-G completely inactivated S. mutans at the concentration of 20 µg/ml. It also significantly inhibited the growth of other cariogenic bacteria such as S. sobrins, S. sanguis and Porpyromonas gingivalis causing periodontitis. Gymnema sylvestre extracts are widely used in Australia, Japanese, Vietnamese and Indian folk literature. The plant is used in the treatment of diabetes mellitus and food additives against obesity and caries31. Sato et al.32 reported antibacterial activity of isoflavonoids isolated from Erythrina variegata (Leguminosae). These workers suggested the potential use of erycristagallin for prevention of dental caries.
In several animal experiments and human trials, green tea and black tea have been shown to reduce plaque score and caries index. Catechins and theaflavins, polyphenolic compounds derived from tea (Camellia sinensis, family Theaceae) have been reported to prevent tooth decay and oral cancer33. These workers suggested possible use of tea in prevention of dental caries. Xiao et al.34 reported the anticaries effects of five natural chinese medicine such as Radix et Rhizoma rhei, Semen areca, Rhizoma ligustici chuanxiong and Catechu. These products prevented the adherence of S. mutans and suggested to be beneficial in preventing dental caries. Oil of Syzygium aromaticum (clove) and Zanthoxylum limonella (makaen) were widely used essential oils for dental caries or flavoring of food in Thailand and other countries35. Isopanduratin A, isolated from Kaempferia pandurata has shown to possess marked antibacterial activity against cariogenic S. mutans. Therefore, Isopanduratin A could be employed as a potential antibacterial agent for preventing dental caries36.
Propolis, a resinous hive product is reported to prevent dental caries since it demonstrated significant antimicrobial activity against microorganisms such as S. mutans, S. sobrinus and C. albicans which involves in oral diseases37. Propolis is a natural product that may prevent dental caries. Baccharis dracunculifolia D.C. (Asteraceae), a native plant from Brazil, is the most important botanical origin for the production of green propolis (Brazilian propolis) by honey bees. Leitao et al.38 made a comparative evaluation of the effects of extracts from green propolis and B. dracunculifolia (BD) on the glucan synthesis and acidogenic potential of S. mutans. These workers demonstrated that BD leaf rinse and green propolis extracts have similar inhibitory effects on the S. mutans cariogenic factors. They suggested that BD leaves may be a potential product for use against dental caries. Yatsuda et al.39 demonstrated cariostatic potential of Cupressenic, Kurenoic and diterpenic acids isolated from Mikania laevigataI and M. glomerata plants. Further, these workers showed antibacterial activity of these acids against S. mutans, S. sobrinus and Actinomyces naeslundii.
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