You are on page 1of 5

ENDODONTOLOGY Role of herbs in endodontics: An update

SHARAD KAMAT * # RAJEEV K ** ## PRAHLAD SARAF *** ###

Review Article

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.

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).

CLASSIFICATION
A) Phytotherapeutic substances are generally classified in to three groups(2). 1. Plant products 2. Animal products 3. Mineral origin

TRIPHALA:
This is an ayurvedic rasayana consisting of Amulaki (emblica officinalis), Bibhitaki (terminalia

* 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

98

ENDODONTOLOGY
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).

SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF

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).

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 irrigant
(12) (11)

, root canal

and storage media for avulsed teeth to

maintain viability of periodontal ligament(13).

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).

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).

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).

ORANGE OIL:
It is oil produced by glands inside the rind of an orange fruit. This is composed mostly of dlimonene. 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.

TEA TREE OIL:


This is a native Australian plant with terpenin4-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).

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
99

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

ENDODONTOLOGY
and prolongs the regenerative phase. It is shown as an alternative intra canal medicament .
(12)

ROLE OF HERBS IN ENDODONTICS: AN UPDATE

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 Efaecalis because of anthra quinine(28). Its bactericidal activity is found to be less than Ca (OH)2(29).

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).

PSORALEA CORYLIFOLIA:
This is found to be effective against E-faecalis (30). It acts by causing injury to cell membrane and inhibiting DNA polymerase.

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 Efaecalis(27).

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).

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).

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)

JIEERYIN SOLUTION:
This is a pure Chinese herbal compound and has heat clearing, detoxifying, antibacterial and antiinflammatory 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)

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).

100

ENDODONTOLOGY
Aloe Vera Garlic Orange oil Chamomile tea Green tea Tea tree oil Abdominal cramps, diarrhoea Bowel irritation, mouth ulceration, halitosis & prevention of blood clotting G I irritation Allergic conjunctivitis Irritability, anxiety Allergic contact dermatitis

SHARAD KAMAT, RAJEEV K, PRAHLAD SARAF

(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: 1867. 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, Pea RC, Gmez 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 antiinflammatory 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. 101

DRUG (PHYTOTHERAPEUTIC) INTERACTION(3)


There is little available information regarding drug interactions between herbal products and the conventional drugs.
m.chamomile garlic green tea potentiates anticoagulation effects of warfarin interacts with anti platelets and hypo glycemic drugs 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.

ENDODONTOLOGY
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, 8014. 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. Gradiar 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: 2735. 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.

ROLE OF HERBS IN ENDODONTICS: AN UPDATE

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: 18486 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.

102