Recent Patents on Drug Delivery & Formulation 2009, 3, 221-228 221

1872-2113/09 $100.00+.00 2009 Bentham Science Publishers Ltd.

Herbal Remedies for the Treatment of Periodontal Disease - A Patent
Review
Pramod Kumar
1
, Shahid H. Ansari
2
and Javed Ali*
1
1
Department of Pharmaceutics, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi 110 062, India,
2
Department of Pharmacognosy & Phytochemistry, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi
- 110 062, India
Received: April 5, 2009; Accepted: June 17, 2009; Revised: June 19, 2009
Abstract: Periodontal diseases, if left unchecked, can lead to major health problems. There are a number of traditional
herbal remedies for the treatment and management of diseases related to teeth, gum and oral hygiene. Use of clove oil is
an age old remedy still practiced for periodontal problems. Our aim is to present an overall view of the current strategies
adopted for the formulation and application of traditional herbal remedies. The article provides a review of the patents
obtained on herbal remedies for the treatment of periodontal diseases. In addition, it also provides an overall view of
potent herbal remedies widely used for periodontal diseases.
Keywords: Herbal remedies, periodontal, gingivitis.
INTRODUCTION
Periodontal diseases affect the tissues surrounding the
teeth. Gums and bone supporting the teeth come under the
term periodontal. Gingivitis, the mildest form of periodontal
disease, is generally caused by insufficient oral hygiene.
Inadequate oral hygiene can lead to plaque buildup. A
variety of triggering factors like bacterial causes, dyscrasias,
avitaminosis etc. cause inflamed gums leading to gingivitis.
Salivary tartar has an additive effect to these causative
factors in causing gingivitis. Aggressive periodontitis,
chronic periodontitis and those resulting from conditions like
HIV, diabetes, malnutrition and immunosuppression are the
other types of periodontitis [1].
Periodontal disease is recognized as a major public health
problem throughout the world and is the most common cause
of tooth loss in adults. Periodontal disease is a general term
used to describe several pathological conditions that affect
the supporting structures /tissues of teeth [2]. Pain, discom-
fort and cosmetic considerations are some of the factors that
demonstrate severity of the problems associated with dental
diseases and hence, it is of utmost importance to minimize
and control dental diseases [3]. Periodontal treatment aims to
cure inflamed tissue, reduce the number of pathogenic
bacteria and eliminate the diseased pockets. Mechanical
therapy, chemotherapy and systemic administration of
antibiotics are some of the clinical methods being utilized
currently. Conventional therapy includes scaling - removal
of the calculus and the plaque, curettage clearing the
inflamed soft tissue, and root planning - removal of necrotic
tissues on the root surface. Periodontal diseases are
associated with bacterial infections; therefore antibacterial
treatment seems to be an appropriate method of improving
the condition of the inflamed tissues. One of the major
*Address correspondence to this author at the Department of Pharmaceutics,
Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi - 110
062, India; Tel: + 00- 91- 9811312247; Fax: + 00- 91- 11- 2605 9663;
E.mail: javedaali@yahoo.com, jali@jamiahamdard.ac.in
problems associated with conventional treatment of systemic
administration of antibiotics is the distribution of drug
throughout the body, which is not required and it can also
give rise to toxicity problems. One method of minimizing the
distribution of therapeutic agents in the body is through the
use of local drug delivery system. Many antibacterial are
applied directly to the mouth for the treatment of periodontal
diseases. Mouth rinses, irrigating solutions and sustained
release devices are some of the local delivery systems [4].
Periodontal local delivery devices that have been used for the
targeted delivery of antimicrobial agents include: fibers
(hollow and monolithic), strips and compacts, films,
microparticles, gels and nanoparticles.
COMMONLY USED HERBAL REMEDIES
There are many natural ways to treat periodontal disease
some of which even help in preventing it from occurring.
There are a number of herbs that can help eliminate
inflammation and infection associated with periodontal
diseases. Proper oral hygiene, of course, goes a long way in
treating and preventing periodontal disease. Coenzyme Q-10,
a natural supplement helps to increase tissue oxygenation in
the body that helps to provide healthy blood flow to the
gums. A reported clinical trial demonstrated improvement in
plaque and calculus levels by twice daily intake of 25mg of
Coenzyme Q-10 in patients suffering from periodontal
disease [5]. A number of neutraceuticals are currently being
used in the prevention and treatment of periodontal disease.
Evidences have been reported for the relation between
Vitamin C and periodontal disease. Significant gum bleeding
can occur in vitamin C deficiency [6, 7]. Vitamin C along
with bioflavonoids helps to speed up the healing process.
Clinical studies have also been reported to lower plague,
gingival and bleeding indices by use of formulations
containing extracts of bloodroot [8]. Aloe vera gel has been
reported to sooth gum tissue and relieve pain and discomfort
when applied on gums. Clove oil reduces infection and
222 Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 Ali et al.
relieves pain. Echinacea and goldenseal have also been
reported to relieve infection and inflammation [9].
Clove oil will reduce infection and relieves pain. Clove
oil is commonly used for the relief of toothache [8]. In
dentistry, clove oil is applied in an undiluted form using a
plug of cottonwool soaked in the oil and applied to the cavity
of the tooth [8]. A study by Cai et al. (1996) reported
preferential activity of crude methanolic extract of clove
against Gram-negative anaerobic oral pathogens which cause
periodontal diseases [10]. This study included isolation of
eight active constituents and the antibacterial effect of these
isolated compounds were studied. The authors reported
kaempferol and myricetin to have significant growth-
inhibitory effect against periodontal pathogens.
Chan et al. (2003) evaluated the effects of herbal medi-
cines in treating periodontal diseases. Three Chinese herbal
compositions widely used for periodontal diseases were
tested for their ability to retard progression of experimental
periodontitis in hamsters, inhibit bacterial growth, and
induce mutations. The study also included evaluation of
major components of these compositions. The results
showed that between the animal groups there were no signi-
ficant differences in terms of the degree of inflammation,
alveolar bone resorption, and rate of repair with or without
the use of Chinese herbal medicine but hamsters treated with
one composition (Conth Su) showed early regeneration of
epithelium. Among the evaluated herbs, Chi Tong Ning
demonstrated superior bacterial inhibition ability of MIC
0.025gmL
-1
. While both of the above mentioned compo-
sitions were capable of inhibiting bacterial growth, none of
the individual herb components showed comparable bacterial
inhibition abilities. Also no signs of induction of cell
mutations were observed for the tested herbal composites or
their components using the Ames test. The results of the
study demonstrated that traditional Chinese herbal medi-
cines, which have been used for hundreds of years by
Chinese people to treat periodontal diseases, could effec-
tively inhibit bacterial growth without causing cell mutation
[11].
Cao et al. (1998) reviewed articles published on the
effects and mechanisms of herbal medicine on periodontal
disease. Particularly, two modifications of an ancient
compound prescription, Guchiwan (Tooth-firming pills) and
Guchigao (Tooth-firming extract), were serially studied. It
was pointed out in the review that various herbal extracts had
shown suppressive effects on bone resorption by isolated
osteoclasts during in vitro studies. The author emphasized an
indepth study on traditional Chinese medicine for their
possible use in periodontal diseases [12].
Cai et al. (2000) demonstrated the growth inhibitory
effect of methanolic extract of Diospyros lycioides on oral
pathogens that could cause periodontal diseases. The twigs
of this plant were used to clean teeth by people in Namibia
as chewing sticks. The active compounds were isolated and
structures were elucidated. The compounds showed growth
inhibitory effect on oral cariogenic baceria and periodontal
pathogens [13].
Table 1 [14-18] displays more possible herbals remedies
for periodontal diseases which have been used traditionally
for the care of teeth and gums. These plants/herbs represent
potential candidates for being patented as constituents of
herbal remedies for periodontal diseases.
A phase II clinical trial (NCT00731432) is under
progress for the evaluation of efficacy of a transmucosal
herbal periodontal patch in reducing gingival inflammation
in diabetic patients. The study is being sponsored by Izun
Pharma Ltd., New York, USA [19].
PATENTS FOR HERBAL REMEDIES
Piramal et al. (2008) described a composition for
treatment and prevention of periodontal diseases using a
bioadhesive formulation comprising curcuminoids as an
active agent. The composition included curcumin, tetrahy-
drocurcumin, bishydrocurcumin, crude drug and solvent
extracts of Curcuma longa, one or more bioadhesive
polymers such as hydroxypropyl cellulose, hydroxypropyl
methylcellulose, sodium carboxymethylcellulose, hydroxy-
ethyl cellulose and carbomers and sodium chloride, sodium
bicarbonate or mixtures and one or more excipients. This
orally applicable composition can be used for the treatment
of gingivitis and other periodontal diseases [1].
Greve et al. (2005) described the use of vervain
(ironweed, Verbena officinalis, Verbenaceae) and/or ribwort
(Plantago lanceolata / P. angustifolia, Plantaginaceae) either
alone or as a mixture of these two herbs or of their
constituents or extracts. Aerial parts of the plants were
preferred for the composition though all parts could be used.
A combination of these two herbs or of the constituents or
extracts of the two herbs were claimed to be very effective.
Pharmaceutical additives and/or adjuvants such as fillers,
extenders, binders, wetting agents, stabilizers, colorants,
buffers, aroma chemicals, flavouring agents and/or preser-
vatives could be included in addition to active ingredients.
Use in the form of extracts or constituents of the two plants
was preferred The extracts had herb/extract ratio from 50:1
to 1:1. The extracts could be prepared in such a way that 0.2
to 100 parts of liquid extract, or 0.1 part of dry extract was
obtained from dried or fresh plant material with the aid of
suitable liquid extractants such as water, alcohols, in parti-
cular ethanol or ethanol-water mixtures. The composition
could be liquid, gel-like or pasty and could contain diluents
compatible with vervain and/or ribwort. Twenty drops of
2.5% of an extract which contained nearly 60% v/v ethanol
preparation per half a glass of water (50ml) was sufficient
for achieving adequate inhibition of microorganisms. The
semi-solid forms such as toothpaste or oral gels contained
approximately 2.5% of an extract which contained almost
80%v/v ethanol. In the case of lozenges, chewable tablets
and (chewable) pastilles, it was preferred that such
preparations contain approximately 250mg of dry extract per
unit. A dry extract prepared by concentrating the liquid
extract which originally had an herb/extract ratio of
approximately 1:1 and an alcohol component of appro-
ximately 80% v/v was claimed to be advantageous [20].
Kim et al. (2006) provided a herbal mixture extract of
Pleurotus eryngii, Acanthopanacis Cortex and Notoginseng
Radix and a composition for prevention and treatment of
periodontal disease. The herbal mixture extract had potential
of inhibiting the generation and activation of osteoclasts and
Herbal Remedies for Periodontal Disease Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 223
Table 1. List of Plants/Herbs Used Traditionally for Care of Teeth and Gums
Plant/Herb Part Used Dosage Form Ref.
Foeniculum vulgare (Fennel) Seed - [14]
Potentilla arbuscula Rootstock Tooth powders [14]
Sibbaldia parviflora Tooth powders [14]
Wahlenbergia marginata Herb Topical [14]
Zanthoxylum armatum (Toothache tree, Indian Prickly Ash)
Bark
Essential oil of fruit
Tooth powder [14]
Zanthoxylum americanum (toothache tree) Bark, berries - [8, 14]
Zanthoxylum acanthopodium Seeds Tooth powder [14]
Zanthoxylum budrunga Fruits - [14]
Zanthoxylum nitidum Roots - [14]
Zanthoxylum oxyphyllum / Xanthoxylon violaceum Fruits - [14]
Acacia farnesiana Bark, Extract - [14]
Acacia chundra Bark, Leaves - [14]
Anacardium occidentale Bark, Leaves - [14]
Anacyclus pyrethrum Root - [14]
Dicoma tomentosa - - [14]
Quercus infectoria Galls Tooth powder, toothpaste [14]
Salvadora persica (Tooth Brush tree, Miswaak) Root As tooth brush [14]
Salvia officinalis Herb Tooth powder, Mouth rinse [14]
Salvia plebeia Leaves [14]
Spermacoce hispida (Madana Ghanti) Root Mouthwash [14]
Spilanthes oleracea Flowers - [14]
Tabernaemontana coronaria Root - [14]
Trachyspermum ammi (Thyme) Essential oil Toothpaste [8,14, 15]
Barleria prionitis Herb - [14]
Barleria cristata (Ottamulli) Leaves - [14]
Begonia laciniata var.
nepalensis
Fresh shoots - [14]
Borreria articularis Root Mouthwash [14]
Cinnamomum zeylanicum (Daarchini) Bark, Essential oil Toothpaste [14]
Dracaena cinnabari (DragonsBlood) Root Toothpaste [14]
Ervataemia coronaria (East Indian Rosebay) Herb - [14]
Gymnosporia spinosa Leafy twigs Mouthwash [14]
Hovenia dulcis Fruit and seed extracts Toothpaste [14]
Humulus lupulus Extract Toothpaste [14]
Juniperus communis var. saxatillis Plant extract Toothpaste, mouth-rinses [14]
Lannea coromandelica Bark Decoction [14]
224 Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 Ali et al.
(Table 1) Contd.
Plant/Herb Part Used Dosage Form Ref.
Peltophorum pterocarpum Bark Tooth powders [14]
Azadiracta indica (Neem) Leaves, Extract Gel, Toothpastes [14]
Sanguinaria canadensis (Blood root) Rhizomes, Extracts
Tincture, Capsules, Toothpaste,
Oral rinses
[8]
Tanacetum parthenium Leaf, Aerial parts - [8]
Anemopsis californica (Yerba mansa), Echinacea angustifolia, Gentiana
lutea (Gentian), Rumex crispus (Yellow duck), Taraxacum officinale
(Dandelion), Mahonia aquiffolium (Orange Grape), Piper methysticum
(Kava), Panax quinqefolium
Root - [16]
Zingiber officinale (Ginger) Rhizome -
[16]
Avena sativa (Oat) Seed -
[16]
Calendula officinalis Flower -
[16]
Scutellaria laterifolia (Skull Cap), Centella asiatica (Gotu kola),
Matricaria reticulate, Spilanthus sp.
Herb -
[16]
Symphytum officinale (Comfrey) Root, Leaf Gargle
[16]
Stachys betonica (Bishopswort) Herb Powder, Syrup
[16]
Mentha Piperita (Peppermint) Essential oil, Leaves Aromatic water, Toothpaste, Gel [17]
Spearmint Essential oil Toothpaste [17]
Anise Essential oil Toothpaste [17]
Commiphora molmol (Myrrh) Gum resin Tincture [18]
Plantago lanceolata (Plantain) Leaf, Seed Tea, Capsules [18]
Krameria triandra (Rhatany) Root Tincture [18]
inhibiting the proliferation of osteoclasts and maintaining the
growth of cells of periodontal ligament and gingival fibro-
blasts. Inhibition of generation and activation of osteoclasts
was by enhancing the expression of osteoprotegerin (OPG)
in osteoblasts, preventing alveolar bone from destruction by
inhibiting the proliferation of osteoclasts [21].
Thame (1989) described an oral hygiene method for
treatment of periodontal diseases of bacterial etiology and
for reducing plaque by use of a dried methanolic extract of
Vinca rosea in the oral cavity. The composition contained
0.03 - 50% w/w of methanolic extract. The oral rinse and
toothpaste formulations of the compositions contained
suitable excipients [22].
Zhu (2006) described a Chinese herbal preparation for
treating periodontitis, consisting of fleece-flower (18-25%),
dried rehmanria (11-18%), liquorice (3-7%), fresh-water
turtle shell (11-17%), dogwood fruit (7-15%), dodder seed
(4-11%), Derla andrographis (4-12%) and Tokyo violet herb
(8-15%). The formulation could be administered in dosage
forms such as hard capsule, soft capsule, tablet, pill, granule,
oral liquid etc. The active ingredients of the above herbs
prepared by supercritical carbon dioxide fluid extraction
could also be used [23].
Pawar (2005) explained a dentifrice herbal tooth powder
which removed plaque, stain or patches and cleaned and
polished tooth surfaces without any abrasive action. The
composition comprised the powder of Acacia catechu,
Menthol and camphor in the proportion of 91%, 2.7% and
6.3% respectively. The powder of Acacia catechu was used
to remove tarter, plaque and stain and in cleansing and
polishing tooth surface without any abrasion action. The
powders of menthol and camphor were used as a flavouring
agent. A clinical study on this dentifrice herbal tooth powder
reported 87-95%, 70-72% and 80-95% reductions in plaque,
gingivitis and dental calculus respectively, in merely 15 days
[24].
Behl et al. (2004) developed a synergistic herbal
formulation comprising of active fractions from Azadirachta
indica, Citrullus colocynthis and Cucumis sativus extract and
a carrier or additive. They also explained a process for
preparation of formulation comprising of extraction of neem
bark and leaves in aqueous solution or polar solvents,
Citrullus colocynthis, preferably underground parts using a
homogenizer in an aqueous polar solvent and the anti-
oxidant portion from Cucumis sativus by cold extraction
using aqueous polar solvents at temperature. They claimed
Herbal Remedies for Periodontal Disease Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 225
the composition to be useful for teeth and gums as mouth-
wash or mouth rinse. This herbal formulation was described
to be useful for preventing dental plaque and gingivitis in
humans and also as an antimicrobial agent for preventing
periodontal diseases. A clinical study conducted on 60
volunteer subjects to evaluate the efficacy of fraction from
neem, fraction from Citrullus colocynthis and a mixture of
them on the reduction of dental plaque led to significant
reductions of dental plaque [25].
Dulin (2006) explained the use of a natural plant herb,
herbal extract or essential oils like eucalyptus oil and clove
oil either alone or in combination with an anti-microbial
compound, a fluoride ion-providing compound, analgesic,
enzyme etc. The composition was formulated in the form of
a liquid or a gel which moistened a single-use disposable
sterile cotton roll to be received in a buccal vestibule. The
system was therapeutically effective in treatment of
periodontal diseases on topical administration [26].
Shi et al. (2003) developed compositions of herbs and
methods of using these compositions for the treatment and
prevention of microbial infection, in particular for dental
caries or periodontal disease. The composition consisted of
mixture of any two or more herbs such as Phellodendron
amurense, Paris polyphylla , Prunus mume, Glycyrrhiza
uralensis, Aframomum villosum, Sanguisorba officinalis,
Elsholtzia splendens, Eugenia caryophyllata, Rhus chinensis,
Atractylodes chinensis Koidz, Perilla frutescens , Coptis
chinensis, Sophora flavescens, Bletilla striata , Aframomum
cardamomum, Sophora tonkinensis, Melia toosendan, and
Medicinal rhubarb root. The authors conducted evaluation of
the herbal formula using human cell lines and Ames DNA
mutagenesis tests and found the formulation to be safe [27].
Musick (2006) detailed the use of the herb, mastic gum
(Isle of Chios) in alone or combination with antimicrobials
like metronidazole, Keflex, amoxicillin, tetracycline,
clarithromycin, bismuth in a method for treating the cause of
a diagnosed non-gastric disease such as periodontal disease
and gingivitis. Mastic gum might be helpful in maintenance
therapy. The therapy could extend up to 120 days. Optimal
success was claimed by a 90-day therapy for preventing
recurrence and was found to be effective in treating
Helicobacter sp. infections outside or involving the upper GI
tract [28].
Levine et al. (2002) described compositions containing
extracts of Echinacea purpurea and Sambucus nigra and the
extract(s) of one or more plants such as Hypericum
perforatum, Commiphora molmol and Centella asiatica. In
the management of inflammatory mucosal diseases of both
viral and non-viral origin these compositions were described
to have significant application. The composition was found
to be useful in many mucosal diseases including gingivitis
and periodontal diseases. Tissue samples taken during a
double-blind matched-sample clinical trial of a transmucosal
adhesive patch of this herbal composition in sixteen patients
for the treatment of gingival inflammation showed no
protease activity. The result suggested significant inhibitory
effect of the herbal composition [29].
Romanowski (2005) described compositions that were
safe and effective for preventing and treating oral disease
and for maintaining good oral health for both humans as well
as animals. They could be used regularly. They claimed
compositions which contained xylitol, a preservative and an
antimicrobial agent in a carrier. The composition might
further contain a herbal ingredient such as olive leaf extract,
black walnut green hulls, clove leaf, thyme herb, grapefruit
seed extract, Aloe vera, Calendula flower, Echinacea
pupurea, gota kola extract, chamomile flower, green tea leaf,
Oregano leaf, Peppermint oil, Cinnamon bark, Eucalyptus
leaf, Lavender oil etc. This invention provided long-term
improvement in oral care and provided permanent solution to
oral disorders. The composition might be formulated as a
solution which could be diluted before use, as powders that
may be added to beverages, candies, dental chew, oral gels
toothpaste, lozenges, whitening molds etc. Use of pleasant
flavors was said to make the formulation more appealing,
especially for children and elderly. The composition was
particularly useful for treating and preventing oral problems
such as gingivitis, periodontal disease, stomatitis and
halitosis. It also prevented build-up of tartar on teeth and
also suppressed oral and throat cancer. The composition may
optionally contain antimicrobials, immunomodulators and/or
anticancer agents. The composition could exert both local
and systemic effects. For animals, food and water could be
used for incorporating these compositions [30].
Chen (2005) described the use of an extract of a herb
from the family Scutellaria which served as a phytoestrogen
and a method of treating estrogen-related disorder such as
periodontal disease, tooth loss etc. The extract could be of
Glycyrrhiza uralensis, Glycyrrhiza glabra, Taraxacum
mongolicum, Medicago sativa, Brassica oleracea or Eclipta
prostrata [31].
Reddy et al. (2000) explained that the effect of herbal
remedies for periodontal diseases can be enhanced by the use
of probiotics using genera such as Lactobacillus and
Propionibacterium. They conducted clinical trials on herbal
tooth powder and tooth paste formulations intended for bad
breath, bleeding gums and periodontal disorders. Khadira,
shilajit, guggulu, arka, cinchona, eucalyptus, vidonga
karkata, shringi beejarasa, ardhraka, amlaki and scariva were
the herbal ingredients whereas Lactobacillus acidophilus and
Propionibacterium shermanii were the probiotics used. The
formulations containing probiotics were found to enhance
the activity of the herbal remedy than those without
probiotics. Similar results were observed when probiotics
were added to a marketed herbal toothpaste [32].
Domb (2003) described the usefulness of a solid, self-
bioadhesive composition for reducing the depth of
periodontal pockets in a patient by topical application that
adheres to the oral mucosal tissue. The composition
consisted of atleast one herbal or homeopathic active agent.
The herbal active may be herbal extracts, tinctures, essential
oils either alone or in mixtures. Essential oils such as Lemon
oil, Citronella oil, Citron oil, Cedarwood oil, Juniper Berries
oil, Pomela Peel oil, Lemon basil oil, Cinnamon oil, Cajeput
oil, Eucalyptus oil, Fennel oil, Girofle oil, Lavender oil,
Geranium oil, Clove oil, Myrte oil, Oregano oil, Pine oil,
Rosemary oil, Sarriette oil, Thyme oil, Spearmint oil and
Tea-tree oil could be used. Gotu Kola, Salvia offincinalis,
Echinacea, Hypericum, Myrrah, Elder, Plantago, Baptisia,
226 Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 Ali et al.
Camphoria, Uncaria, Calendula, Phytolaca, Catechu black,
Krameria, Tsuga, Coneflower, grape fruit seed extract,
Rosmarinus, Crataegus, Glycerrhiza, Angelica, Styrax,
Krameria, Matricaria, Mallow, Propolis, Sage, Barberine
from Hydrastis canadensis L. and other plant from the
family Berberidaccae, gentian from the Gentianaceae family
of plants for the treatment of fungal infections, Lonicera
flower extract, Taraxacum extract, Scutellaria root extract,
Gardenia fruit extract, Pueraria root extract, Radix gentianae,
Pulsatilla root extract, Longdancao antifungal agent and
combinations thereof can be used for herbal tincture actives.
A solid bioadhesive carrier in 40-99% w/w was used in the
formulation for bioadhesivity [33].
Basu (2002) described a composition useful for the
treatment of disorders such as periodontal disease and any
periodontal disorder caused as a result of smoking. The
composition consisted of either or both extract of Citrus
reticulata and Prunus mume with one or more of the extracts
Table 2. Summary of Patents
Plant/Herb Dosage Form Ref.
Curcuma longa Bioadhesive [1]
Verbena officinalis, Plantago lanceolata, P.angustifolia
Toothpaste, Oral gel, Lozenges,
Chewable tablets and (chewable)
pastilles
[20]
Pleurotus eryngii, Acanthopanacis, Notoginseng - [21]
Vinca rosea Oral rinse, Toothpaste [22, 37]
Fleece-flower, Rehmanria, Liquorice, Dogwood fruit, Dodder seed, Derla andrographis and Tokyo
violet herb
Hard capsule, Soft capsule, Tablet,
Pill, Granule, Oral liquid
[23]
Acacia catechu Wild, Menthol and camphor Dentifrice [24]
Azadirachta indica, Citrullus colocynthis, Cucumis sativus Mouthwash or Mouth rinse [25]
Eucalyptus oil, clove oil Gel [26]
Phellodendron amurense, Paris polyphylla , Prunus mume, Glycyrrhiza uralensis, Aframomum
villosum, Sanguisorba officinalis, Elsholtzia splendens, Eugenia caryophyllata, Rhus chinensis,
Atractylodes chinensis Koidz, Perilla frutescens , Coptis chinensis, Sophora flavescens, Bletilla
striata, Aframomum cardamomum, Sophora tonkinensis, Melia toosendan, Rhubarb
- [27]
Isle of Chios - [28]
Echinacea purpurea, Sambucus nigra, Hypericum perforatum, Commiphora molmol, Centella asiatica - [29]
Olive leaf extract, Black walnut, Clove leaf, Thyme herb, Grapefruit seed extract, Aloe vera,
Calendula flower, Echinacea pupurea, Gota kola extract, Chamomile flower, Green tea leaf, Oregano
leaf, Peppermint oil, Cinnamon bark, Eucalyptus leaf, Lavender oil
Beverages, candies, Dental chew,
Oral gels toothpaste, Lozenges,
Whitening molds
[30]
Glycyrrhiza uralensis, Glycyrrhiza glabra, Taraxacum mongolicum, Medicago sativa, Brassica
oleracea, Eclipta prostrata
- [31]
Lemon oil, Citronella oil, Citron oil, Cedarwood oil, Juniper berries oil, Pomela peel oil, Lemon basil
oil, Cinnamon oil, Cajeput oil, Eucalyptus oil, Fennel oil, Girofle oil, Lavender oil, Geranium oil,
Clove oil, Myrte oil, Oregano oil, Pine oil, Rosemary oil, Sarriette oil, Thyme oil, Spearmint oil, Tea-
tree oil, Gotu kola, Salvia officinalis, Echinacea, Hypericum, Myrrah, Elder, Plantago, Baptisia,
Camphoria, Uncaria, Calendula, Phytolaca, Catechu black, Krameria, Tsuga, Coneflower, grape fruit
seed extract, Rosmarinus, Crataegus, Glycerrhiza, Angelica, Styrax, Krameria, Matricaria, Mallow,
Propolis, Sage, Hydrastis canadensis, Taraxacum extract, Scutellaria root extract, Gardenia fruit
extract, Pueraria root extract, Radix gentianae, Pulsatilla root extract
Topical Bioadhesive [33]
Citrus reticulate, Prunus mume, Magnoliae officinalis, Coptis chinensis, Agastaches rugosa,
Phellodendron chinense, Zingiberis officinalis, Fraxinus rynchophylla and Glycyrhizae inflate. Citrus
reticulate, Prunus mume
- [34]
Pine, Liquorice, Cassia seed, Cinnamon, Nothosmyrnium root, Sophora, lonicera flower, Platycodon,
green tea, dayflower, Korean Angelica root, liriope rhizome, moutan, Arabian myrrh, seseleos radix,
Angelicae Dahuricae Radix, Lagerstroemia indica, morus bark, ginger, Sanguinaria, asarum,
cimicifuga, Chinese galls, Grapefruit seed, lycium root, cnidium, Alpinia katsumadai Hayata,
Gardenia, Lythrum salicaria L., dandelion, propolis, flavonoid, nepta herb, Reynoutria japonica Houtt,
Scutellaria, machilia, black adzuki bean, Camomile, ratanhia, Sage oil
Powder, Toothpaste, Oral cleaner,
Oral purifier
[36]
Herbal Remedies for Periodontal Disease Recent Patents on Drug Delivery & Formulation, 2009, Vol. 3, No. 3 227
of Magnoliae officinalis, Coptis chinensis, Agastaches
rugosa, Phellodendron chinense, Zingiberis officinalis,
Fraxinus rynchophylla and Glycyrhizae inflate. Citrus
reticulata and Prunus mume were reported to show
significant inhibition of LPS-induced TNF-alpha secretion in
human peripheral blood mononuclear leukocyte cells. The
extracts of other seven herbs mentioned earlier exhibited
significant inhibition of TNF-alpha induced release of PGE
sub 2 [34].
Compositions of a mixture of two or more ingredients
from a list of myrrh extract or oil, mulberry bark extract,
Cimicifuga heraleifolia extract and green tea extract have
been patented by Suh et al. (1993). Each of the above
ingredients was in quantities of 0.001-10 %w/w of the
mixture. The extraction was done with water, alcohol or
acetone. Toothpastes, breath fresheners, mouthwashes,
chewing gums or sweets were the claimed formulations of
these compositions. Antibacterial activity was claimed
against cariogenic and plaque-forming bacteria. They also
claimed their use in inhibiting bacterial glycosyltransferase.
Use of these compositions was proposed for prophylaxis of
caries and periodontal disease and also for treating bad
breath [35].
Moon et al. (2003) described method for preparation of
plant extract powder and use of this extract in oral
formulations for prevention and treatment of periodontal
diseases and tooth decay. The plant extract was loaded into a
porous powder carrier, which was further coated by a water
insoluble coating material. The extracts was used in
quantities of 0.05 - 5.0%w/w. Pine, Liquorice, Cassia seed,
Cinnamon, Nothosmyrnium root, Sophora, Lonicera flower,
platycodon, green tea, dayflower, Korean angelica root,
liriope rhizome, moutan, Arabian myrrh, seseleos radix,
Angelicae Dahuricae Radix, Lagerstroemia indica, morusk,
ginger, Sanguinaria, Asarum, Cimicifuga, Chinese galls,
Grapefruit seed, Lycium root, Cnidium, Alpinia katsumadai
Hayata, Gardenia, Lythrum salicaria L., dandelion, propolis,
flavonoid, nepta herb, Reynoutria japonica Houtt,
scutellaria, machilia, black adzuki bean, camomile, ratanhia
or Sage oil as single or in combination. The carriers may be
inorganic abrasives, high molecular weight substances,
colloidal humed silica etc. Colloidal humed silica having
submicron particle size was advantageous in liquid
formulations. The water insoluble coating agent was claimed
to be easily disintegrated in the mouth and the active is
released when applied in the mouth. The composition may
be formulated as toothpaste, oral cleaner, oral purifier etc.
[36].
Use of dried ethanolic extract of periwinkle (Vinca
rosea) in the oral cavity as a method for treatment of
periodontal diseases has been described by Thame (1990).
The formulation contained 0.03 - 50% w/w of the extract. A
carrier such as water, glycerin and lower alcohols could be
used for the extracts. The composition could be oral rinse or
toothpaste and may include anionic surface active agents
such as sodium lauryl sulfate. The ethanolic extract was
shown to possess enhanced antimicrobial action with sodium
lauryl sulphate [37].
Table 2 summarizes the patents granted on herbal
remedies for periodontal infections.
CURRENT & FUTURE DEVELOPMENTS
Pharmacologically active phytochemicals useful for the
prevention, treatment and maintenance of periodontal
diseases have been widely identified. They may be tannins,
terpenoids, flavanoids, alkaloids etc. Antimicrobial activities
of these have been found to be particularly useful for
periodontal diseases. Clinical trials for assessment of safety
and efficacy of these herbal remdies are in its infant stage.
These herbal remedies are expected to be a widely used in
future. The herbal remedies have an edge over conventional
antibiotic treatment which suffer the limitation of low benefit
to high risk as compared to herbal treatment which possess
high benefit to low risk ratio. Standardization and quality
assurance of these herbal remedies is also a key area to be
focused in future and efforts have been initialized towards
this target. There are much more opportunities for further
research in the utility of herbal remedies for periodontal
diseases. More organized and long-term research is to be
carried out to support the use of established remedies.
Development of novel drug delivery systems for these herbal
ingredients is likely to be one of the thrust areas of research
in future. Research on colloidal drug delivery systems such
as nanoparticles, nanoemulsion etc seems to be promising.
CONFLICT OF INTEREST
There is no conflict of interest in the present manuscript.
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