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com

Universal Journal of Pharmacy, 02(05), Sep-Oct 2013 18
*Corresponding author:
Fazeela Ayub
Postgraduate Student, Department of Conservative
Dentistry and Endodontics, Rajas Dental College,
Tirunelveli, Tamil Nadu, India Phone: 07598729610
E-mail: fazeelaayub1987@gmail.com
Universal Journal of Pharmacy
Take Research to New Heights


HERBS AND DENTAL CARIES A REVIEW
Fazeela Ayub
*
, Bejoy Thomas, Benin Paulaian, Jonathan Emil

Department of Conservative Dentistry and Endodontics, Rajas Dental College, Tirunelveli, Tamil Nadu, India
Received 26-07-2013; Revised 20-08-2013; Accepted 24-09-2013

ABSTRACT
Oral diseases are major health problems with dental caries among the most important preventable global infectious
disease. Oral health influences the general quality of life and poor oral health is linked to chronic conditions and
systemic diseases. The association between oral diseases and the oral microbiota is well established. The development
of dental caries involves acidogenic and aciduric Gram-positive bacteria (Mutans streptococci, Lactobacilli and
Actinomycetes). The present day treatment was not found to prevent or eradicate dental caries. The increase in
incidence of oral diseases, increased resistance by bacteria to antibiotics, adverse affects of some antibacterial agents
currently used in dentistry and financial considerations in developing countries, there is a need for alternative
prevention and treatment options that are safe, effective and economical. While several chemical agents are available
commercially, these chemicals can alter oral microbiota and have undesirable side- effects such as vomitting,
diarrhoea and tooth staining. Hence, the search for alternative yet safe products continues and natural phytochemicals
isolated from plants used as traditional medicines come as good alternatives. In this review, plant extracts or
phytochemicals like that inhibit the growth of oral pathogens, reduce the development of biofilms and dental plaque
thus preventing and managing dental caries are reviewed.
Keywords: Dental diseases, Herbs, Medicinal plants, Caries prevention, Caries management

INTRODUCTION
Oral diseases continue to be a major health problem
worldwide. Oral health is integral to general well-being
and relates to the quality of life that extends beyond
the functions of the craniofacial complex
1
. Dental
caries is an infectious microbiologic disease of the
teeth that results in localized dissolution and
destruction of the calcified tissues
2
. Dental caries
occurs when there is an interaction of four principle
factors: the host, the microflora, the substrate and the
time. For caries to occur all the four factors should be
favourable: a succeptible host, cariogenic oral flora
and a suitable substrate for a sufficient length of time
3
.
The global need for alternative prevention and
treatment options and products for prevention and
management of dental caries that are safe, effective
and economical to battle within the upsurge of the
disease. Increased resistance by pathogenic bacteria to
currently used antibiotics and chemotherapeutics,
opportunistic infections in immune-compromised
individuals and financial considerations in developing
countries pose the basic requirements for alternative
treatments. Despite several chemical agents being
commercially available, these can alter oral micro
biota and have undesirable side-effects such as
vomiting, diarrhea and tooth staining
4,5,6,7
.The natural
phytochemicals isolated from plants used in traditional
medicine are considered as good alternatives to
synthetic chemicals.
8
The natural products derived
from medicinal plants such as neem, babool, miswak
etc. have proven to be abundant source of biologically
active compounds, many of which have become the
basis for the development of new lead chemicals for
pharmaceuticals. With respect to diseases caused by
microorganisms, the increasing resistance in many
common pathogens to currently used therapeutic
agents has led to renewed interest in the discovery of
novel anti- infective compounds derived from herbs.
HERBS IN CARIES PREVENTION
Dental caries is a fearsome major oral health problem
worldwide. Streptococcus mutans is the primary cause,
having the ability to adhere to tooth surfaces while
producing acid and surviving in acidic conditions.
Various compounds in plants that are produced for self-
protection could support each other in inhibiting
bacterial growth, while also reducing the chances of
the development of resistant bacterial strains. Crude
Review Article
ISSN 2320-303X

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Universal Journal of Pharmacy, 02(05), Sep-Oct 2013 19
ethanol extracts of Terminalia bellirica, Glycyrrhiza
glabra and Syzygium aromaticum, clove oil, Terminalia
chebula, Phyllanthus embillica exhibit antimicrobial
activity against dental caries pathogens
9
.
HERBS IN CARIES MANAGEMENT
Caries continues to affect a significant portion of the
world population and treatment of the decay is
associated with pain by many patients. Conventional
caries removal and cavity preparation entail the use of
burs. Disadvantages of this system include the
perception by patients that drilling is unpleasant, local
anesthesia is frequently required, drilling can cause
deleterious thermal effects, drilling can also cause
pressure effects on the pulp, and the use of a hand
piece may result in removal of softened, but
uninfected dentin, resulting in an excessive loss of
sound tooth tissue. As a result, there is a growing
demand for procedures or materials that facilitate
caries management.
In 2003, a research project in Brazil led to the
development of a new formula to universalize the use
of chemo-mechanical method for caries removal and
promote its use in public health. The new formula was
commercially known as Papacarie. Papacarie is
basically comprised of papain, chloramines, toluidine
blue, salts, thickening vehicle, which together are
responsible for the Papacaries bactericidal,
bacteriostatic and anti inflammatory characteristics
10
.
Therefore, the purpose of this review is to present
some recent examples of traditional medicinal plant
extracts or phytochemicals that have been shown to
inhibit the growth of oral pathogens, reduce the
development of dental plaque, and reduce the
symptoms of oral diseases
8
.
Salvadora persica (miswak):
It is a widely available medicinal shrub belongs to
salvadoraceae family. The branches of the plant is
found to be rich in chemicals that fight with the
common oral diseases.It affects the C3T3 fibroblast and
viability of cariogenic bacteria including Streptococcus
mutans. Calcium salts helps to remineralize early
carious lesion and fluoride along with calcium prevents
caries and strengthen the tooth. Triethylamine reduces
the surface tension and reduces the formation of
microbial plaque around the tooth structure. Vitamin C
and sit-sterol present helps to strengthen the blood
capillaries and improve the gingival health. Although
this shrub is universally available, certain community
people use it as a tool for cleaning their teeth.
Products based on this plant is recently marketed and
they serve as inexpensive although harmless, effective
alternative to expensive chemically based dentrifices
11
.
Newbouldia laevis (Blood root plant):
Newbouldia laevis or Boundary Tree is a medium sized
angiosperm in the Bignoniaceae family that grow in
Cental and South America and Canada. Sanguinarine
which is a benzophenanthridine alkaloid derivative is
responsible for its chemical activity. In addition
sanguinarine contains iminium ions which will retain in
the plaque for several hours and cause anti plaque
activity. Sanguinarine acts synergistically along with
zinc in suppressing the growth of various oral stains of
streptococci. The pattern of venation in the fully
matured leaves Newbouldia laevis gives the impression
of a rough tooth-like grinding surface which will
attribute their use in cleaning the tooth. In the folk
medicine community these leaves are used for the
treatment of toothache .Products based on this plant
are commercially available as toothpaste and mouth
rinse
12
.
Licorice root:
It is the name applied to the bark and stolon of
Glycrrhiza species. Licorice root contains Glycrrhizol A
which has strong antimicrobial effect against
Streptococcus mutans. GU, commonly referred to as
licorice root, contains active antimicrobial compounds.
With minimum inhibitory concentrations of 1 and 2
g/mL Glycyrrhizol A and B, extracted from the roots
of GU, exhibited potent antibacterial activity against
SM . Licorice root has been used worldwide as a
sweetener in food and medicine production for many
years and is listed in the USA by the Food and Drug
Admin- istration (FDA) as Generally Recognized as Safe
(GRAS). On long term use it cause decrease in blood
pressure and sodium and water retention
13
.

Cratoxylum formosum gum:
Cratoxylum is a small group belonging to the
Guttiferae family, distributed in several Southeast
Asian countries. It has been reported that xanthones
and anthraquinones are the main components of C.
formosum. Xanthones have antimicrobial activity
against both gram-positive and gramnegative bacteria
such as Bacillus subtilis, Staphylococcus aureus,
Pseudomonas aeruginosa, Streptococcus faecalis and
Samonella typhi while anthraquinones have little
activity. Not much is known about the antimicrobial
activity of C. formosum against oral microorganisms. It
has little inhibitory effect of on the growth of salivary
Mutans streptococci (MS). Species of this genus have
been used for their diuretic, gastric and tonic effects,
as well as for diarrhea, flatulence, food poisoning and
internal bleeding. Cratoxylum formosum or Tew is a
Thai medicinal plant used in folk-medicine as an agent
to prevent oral diseases, especially dental caries. The
gum has been used extensively by hill tribe people of
Thailand Vietnam, Myanmar, Cambodia and China for
painting on tooth surfaces as varnish. Hill tribe people
use black gum from the burned stem bark to stain their
teeth by smearing it on the buccal and occlusal
surfaces. It is believed to have dental preservative
effect against decay and pain
14
.
Syzgium aromaticum (clove oil):
Syzygium aromaticum commonly known as Clove which
belongs to the family Myrtaceae. Clove is an evergreen
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Universal Journal of Pharmacy, 02(05), Sep-Oct 2013 20
tree, which produces a flower bud that has numerous
medicinal properties. It is often referred as clove bud.
Cloves are used in Indian Ayurvedic medicine, Chinese
medicine, and western herbalism and dentistry, where
the essential oil is used as an anodyne for dental
emergencies. Cloves are used as a carminative, to
increase hydrochloric acid in the stomach and to
improve peristalsis. Cloves are also said to be a natural
anthelmintic. Clove oil is commonly used for the relief
of toothache 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 .Clove oil
contains eugenol and methanolic extract which is
effective against gram positive , gram negative , acid
fast bacilli fungus and gram negative anaerobic
periodontal pathogens like Streptococcus mutans,
Staphylococcus aureus, Lactobacillus acidophilus
(bacteria), Candida albicans and Saccharomyces
cerevisiae (yeast). Clove oil is also effective in treating
painful teeth and bleeding gums. Products based on
this plant is marketed as toothpaste
15
.
Azadirichta indica ( neem ):
Azadirachta Indica commonly known as Neem is an
evergreen tree, cultivated in several parts of the Indian
subcontinent. Neem has been extensively used in
ayurveda, unani and homoeopathic medicine and has
become a cynosure of modern medicine. Nimbidin, a
major crude bitter principle extracted from the oil of
seed kernels of A. indica along with the alkaloid
margosine, resins, gum, chloride, fluoride, silica,
sulfur, tannins, oils, saponins, sterols, and calcium
demonstrated several biological activities. Neem
extract reduces bacterial adhesion and has an
inhibitory effect on Streptococcus mutans. Even at 5%
concentration this extract shows antimicrobial activity.
Neem 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. Increases antioxidant level in the body.
Neem is commonly available in the market as
toothpaste and mouthrinse
16
.
Quercus infectoria gall (oak)
Quercus infectoria Olivier (Fagaceae) is a small tree
native of Greece, Asia Minor and Iran. The galls arise
on young branches of this tree as a result of attack by
the gall-wasp Adleria gallae-tinctoria. Majuphal, as it is
widely known in Indian traditional medicine have been
used as dental powder and in the treatment of
toothache and gingivitis.
The main constituents found in the galls of Q.
infectoria are tannin (50-70%) and small amount of free
gallic acid and epigallicic acid. The extracts from the
galls inhibited the Gram-positive bacteria better than
Gram-negative bacteria. The crude powder of the galls
of Q. infectoria was found to be active against
Streptococcus aureus and Bacillus subtilis while both
the methanol and aqueous extracts were active against
Streptococcus epidermidis
17
.
Acacia Catechu
Acacia catechu Willd. (Family: Fabaceae and subfamily:
Mimosoideae.) is widely used in Ayurveda for many
diseases and mainly for skin diseases. Most of the
people in Kerala use boiled Khadira water (karingali
water) for drinking purpose. The chief
phytoconstituents of the heartwood are catechin and
epicatechin. Catechins have siginificant antioxidant
and antimicrobial effects. It is considered to be the
best antioxidant. Acacia catechu is useful as a topical
agent for sore gums and mouth ulcers. Acacia catechu
heartwood extract is found to be an effective
antibacterial agent. Ethanolic and aqueous heartwood
extract of acacia catechu, proved its efficacy as a
potent anti bacterial agent. Taxifolin is the
antimicrobial agent which has an inhibitory effect
against Streptococcus mutans and Lactobacillus
acidophilus
15
.
Allum sativum (garlic):
Allium sativum, commonly known as garlic, is a species
in the onion genus, Allium. It has been used throughout
its history for both culinary and medicinal purposes.
The garlic plant's bulb is the most commonly used part.
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 bacteria47. This is used as irrigant alternative to
NaOCl Garlic extract inhibits the growth of oral
pathogens like streptococcus mutans and
porphyromonas gingivalis hence used for management
of dental periodontitis. Despite of its antibacterial
function, garlic extract also increases biofilm formation
by S.mutans to orthodontic wire, likely through
upregulation of glucosyltransferase expression. Garlic
extract also plays an important role in increased
bacterial attachment to orthodontic wires. The
beneficial antimicrobial effects of garlic are attributed
to the sulphur based compounds, (the significant ones
being allicin and the products of its breakdown namely
diallyl sulphide (DAS) and diallyl disulfides (DADS) The
sulphur compounds are known to have an inhibitory
effect on Streptococcus mutans (S. mutans) harboured
in the dental plaque, whose acidogenicity leads to
demineralization of the teeth and dental caries .This
antimicrobial action could be applied in the prevention
of dental caries. In vitro studies have shown that garlic
extract has an inhibitory effect on periodontopathic
and cariogenic bacteria
18
.
Nidus Vespae(honey comb):
Nidus Vespae [the honeycomb of Polistes Olivaceous
(De Geer), P.Japonicus Saussure, and Parapolybiavaria
Fabricius] stands out because of its multiple
pharmacological activities, including antimicrobial,
anti-inflammatory, antivirus, antitumour and
anaesthetic properties. A famous pharmacopoeia of
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Universal Journal of Pharmacy, 02(05), Sep-Oct 2013 21
Chinese traditional medicine states: Nidus Vespae for
toothache through tooth brushing.. Nidusvespae
showed a remarkable capacity for inhibiting the acid
production of Streptococcus mutans and glucosyl
transferases (GTFs) activity. The extract and chemical
fractions of Nidus Vespae showed remarkable inhibitory
activities against biofilm accumulation by Strep
mutans. The Chl MeOH fraction demonstrated similar
potency to 0.5% chlorhexidine
19
.

CONCLUSION
As demonstrated by the examples included in this
review, there is considerable evidence that plant
extracts, essential oils and purified phytochemicals
have the potential to be developed into agents that can
be used as preventive or curative agents for dental
caries
ACKNOWLEDGEMENTS
The authors are grateful to the authors / editors of the
all those journals, articles and books from where the
literature of this article has been reviewed and
discussed
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Source of support: Nil, Conflict of interest: None Declared