|Year : 2016 | Volume
| Issue : 2 | Page : 34-41
Biomedical applications of phytomedicines: Dental perspective
Meenakshi Iyer1, Anil Kumar Gujjari1, Raghunath Nagasundara Rao1, Devegowda Vishakante Gowda2, Atul Srivastava2
1 Department of Prosthodontics, JSS Dental College and Hospital, JSS University, Mysuru, Karnataka, India
2 Department of Pharmaceutics, JSS College of Pharmacy, JSS University, Mysuru, Karnataka, India
|Date of Web Publication||9-Jun-2016|
Department of Prosthodontics, JSS Dental College and Hospital, JSS University, SS Nagara, Mysore - 570 015, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Ayurveda is the ancient Indian system of health care and longevity. Ayurvedic treatment is aimed at the patient as an organic whole, and treatment consists of salubrious use of drugs, diets, and certain practices. Currently, Ayurveda is widely practiced in the Hindustan peninsula (India and the neighboring countries) and in recent years, there has been a resurgence of herbs in economically developed countries such as those in Europe, United States, and Japan. Methods: A comprehensive literature search was made in PubMed, MEDLINE, LILACS/BBO, Cochrane Database of Systematic Reviews, sciencedirect, and Google Scholar databases. Results: Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamics sense, drugs themselves. Taking into consideration the ineffectiveness, potential side effects, and safety concerns of synthetic drugs, the herbal alternatives for dental usage might prove to be advantageous. Conclusion: Phytomedicine has been used in dentistry as an anti-inflammatory, antibiotic, analgesic, sedative and also as endodontic irrigant. Herbal preparations can be derived from the root, leaves, seeds, stem, and flowers.
Keywords: Dentistry, phytomedicines, toxicity
|How to cite this article:|
Iyer M, Gujjari AK, Rao RN, Gowda DV, Srivastava A. Biomedical applications of phytomedicines: Dental perspective. Dent Hypotheses 2016;7:34-41
| Introduction|| |
Ayurveda is the ancient Indian system of health care and longevity. Ayurvedic treatment is aimed at the patient as an organic whole, and treatment consists of the salubrious use of drugs, diets, and certain practices.  Currently, Ayurveda is widely practiced in the Hindustan peninsula (India and the neighboring countries) and in recent years, there has been a resurgence of herbs in economically developed countries such as those in Europe and in the United States and Japan.  There are approximately 1,250 Indian medicinal plants  that are used in formulating beneficial measures according to Ayurveda or other ethnicities. This 5,000-year-old system of phytotherapy involves a combination of lifestyle management (which includes diet, exercise, and meditation), and treatment with specific herbs and minerals to cure various diseases.
Herbs have been used for centuries to prevent and control disease. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamics sense, drugs themselves. By using herbal medicines, patients have averted many side effects that generally come with traditional medicines. There is a lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. Several popular conventional drugs in the market are derived from herbs. These include aspirin (from white willow bark), Digitalis (from foxglove), and Sudafed (modeled after a component in the plant ephedra). Herbal products can vary in their potency. Therefore, care must be taken in selecting herbs; even then, herbal medicines have dramatically fewer side effects and are safer to use than conventional medications. Herbs may be good alternatives to current treatments for oral health problems but it is clear that it requires more research.  The botanicals in the Ayurvedic Materia Medica have been proven to be safe and effective, through several hundred to thousand years of use. The exploration of botanicals used in traditional medicine, particularly traditional Asian medicine, may lead to the development of novel preventive or therapeutic strategies for oral health.  Oral health is integral to the general well-being and relates to the quality of life that extends beyond the functions of the craniofacial complex.  Despite several chemical agents being commercially available, these can alter oral microbiota and have undesirable side effects such as vomiting, diarrhea, and tooth staining. , As a result, natural phytochemicals isolated from plants used in traditional medicine are considered as good alternatives to synthetic chemicals.
In this review, an attempt has been made to understand the mechanism of action of various phytogens by considering studies that include individual plants or mixtures of plants consistent with the philosophy of Ayurveda.
| Methods|| |
To summarize the current evidence on the antimicrobial and antifungal efficacies of commonly used herbs in Indian medicine, they were screened.
A written research protocol was prepared before retrieving the literature. The protocol emphasized the methods for literature search, screening, and data extraction to minimize bias before starting the literature search.
A comprehensive literature search was done from July 20, 2015 to September 19, 2015 from PubMed, MEDLINE, LILACS/BBO, Cochrane Database of Systematic Reviews, Sciencedirect, and Google Scholar databases [Table 1]. The following search terms were employed in a sequential order for electronic retrieval of the required literature from the databases:
- Antimicrobial efficacy.
- Oral microflora.
- Streptococcus mutans and/or Lactobacillus acidophilus.
- Antifungal activity/Candida albicans.
The journal articles with any of the above cited search terms either in the title, abstract, or keywords were considered for the initial screening. The titles and abstracts of these articles were checked for relevance in the present review. This initial screening was performed by two investigators. The type of study, herbal extracts, comparative groups, the microorganisms investigated, methods employed for antimicrobial efficacy testing, and outcome measures were noted in a standardized electronic data extraction sheet.
A preliminary list of studies on the antimicrobial efficacy of herbal extracts on dental caries (S. mutans and L. acidophilus) and plaque microorganisms (primary, secondary, and tertiary plaque colonizers) was prepared following the initial screening. Then, a list of 20 herbs/herbal extracts commonly available were selected based on the relevant terms mentioned and the articles investigating the antimicrobial and antifungal efficacies of these 20 herbal extracts were considered in the next phase.
Second-stage screening and selection of articles
The abstracts of these articles were scrutinized by the investigators. The outcome parameters antimicrobial and antifungal activities were listed out.
Toxicity of phytomedicines
There has been acceptance and public interest in natural therapies both in developing and developed countries with these herbal remedies being available not only in drug stores but at present also in food stores and supermarkets. The fact that something is natural does not necessarily make it safe or effective. Traditionally, herbs and herbal products have been considered to be nontoxic and have been used by the general public and traditional medicinal doctors worldwide to treat a range of ailments. The active ingredients of plant extracts are chemicals that are similar to those in purified medications, and they have the same potential to cause serious adverse effects. On many occasions, the potential toxicity of herbs and herbal products has not been recognized. 
In the context of toxicity, herbs can be broadly classified into three major categories:
High-risk patients such as the elderly, expectant mothers, children, those taking several medications for chronic conditions, those with hypertension, depression, high cholesterol, or congestive heart failure should be more cautious in taking herbal medicine. Based on published reports, the side effects or toxic reactions associated with herbal medicines in any form are rare [Table 2]. This could be due to the fact that adverse reactions following their use are in process, or because the natures of the side effects or minor allergic reactions are such that they are not reported. Perhaps the major problem with regard to the safety of herbal medicines is related to the manufacturing practice including contamination, substitution, incorrect preparation and dosage, intentional addition of unnatural toxic substances, interactions involving synthetic prescriptions, drugs, and herbal medicines, either intentional or unintentional mislabeling, and the presence of natural toxic contaminants. Modifications may involve stopping herbal supplements prior to dental procedures/treatment or adjusting the dental procedures/treatment plans. Realizing the medical problems associated with the use of some herbs, the American Society of Anesthesiologists and the American Academy of Orthopedic Surgeons recommend the discontinuation of herbal medications at least 2 weeks prior to surgery. Similar procedures in dental clinics demand discontinuity of herbal medications. This could be achieved by a combined effort of both dental practitioners and hygienists to obtain information from patients on the use of herbal supplements and educate themselves about the products reported using available reliable sources of scientific information. 
- The food herbs: Medicines such as peppermint, ginger, garlic, hawthorn, nettles, lemon, and balm are gentle in action, have low toxicity, and are unlikely to cause any adverse response. They can be consumed in substantial quantities over long periods of time without any acute or chronic toxicity. However, they may bring about allergic reactions in certain individuals.
- The medicinal herbs: These are not daily "tonics" and need to be used with greater knowledge (dosage and rationale for use) for specific conditions (with a medical diagnosis) and usually only for a limited period. They have a greater potential for adverse reactions and in some cases drug interactions. They include Aloe vera, black cohosh, comfrey, Echinacea, ephedra, Ginkgo biloba, Ginseng, kava-kava, milk thistle, and Senna.
- The poisonous herbs have a strong potential for either acute or chronic toxicity and should only be prescribed by trained clinicians who understand their toxicology and appropriate use. Fortunately, the vast majority of these herbs is not available to the public and is not sold in health food or herbal stores. Aconite, Arnica spp., Atropa belladonna, Digitalis, Datura, male fern, Gelsemium, and Veratrum are some examples.  The general public and many practitioners also believe that the herbs are nontoxic. Herbs and herbal preparations can cause toxic adverse effects, serious allergic reactions, adverse drug interactions, and can interfere with laboratory tests. ,,,,,,,
|Table 2: Herbal medications and dietary supplements associated with adverse oral effects |
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Phytogens against candidal infections
Candida spp. are considered opportunistic pathogens as they are both colonizers and have the ability to cause infections in response to alterations in the host's physiology.  The presence of these yeasts in the oral cavity of healthy individuals varies from 35% to 60%. C. albicans is the most prevalent species, totaling 60-70% of the isolates followed by C. tropicalis and C. glabrata. ,, An imbalance between the host factors (local/systemic) and virulence factors could trigger candidal infection [Table 3]. ,
Conventional therapeutic options for oral candidiasis range from topical polyene antifungals to azole agents. The increase in the occurrence of resistance of Candida spp. to conventional antifungals has been reported in the last few decades. Apart from this, antifungal drugs show relevant limitations such as low spectrum, interaction with other drugs, high cost, and toxic effects; the toxic effects are a result of the similarities between yeast and host cells (both eukaryotic), relevant in the clinical context. In particular for erythematous candidosis, the recurrence of the lesion after treatment with conventional antifungals has been reported, especially when associated to poor denture hygiene.  Investigations on the dental applications of propolis for Candida infections have been done. The use of propolis ethanolic extract inhibited in vitro growth of C. albicans isolates from oral candidiasis. Moreover, this extract showed a similar clinical effectiveness for the treatment of patients with denture-associated candidiasis when compared to miconazole. 
Plant extracts, essential oils, and compounds have been an important source of research for new antifungal options against Candida spp. The effectiveness of Coriandrum sativum L. essential oil on the biofilm formation by C. albicans isolates from patients with periodontal disease was reported.  Cybopogon citratus and triphala dry extract, Syzygium aromaticum essential oils inhibited C. albicans biofilm formation and were more active against preformed biofilms when compared to amphotericin B and fluconazole in vitro.  Methanol extract of Mentha piperita, Rosmarinus officinalis, Arrabidaea chica, Tabebuia avellanedae, Punica granatum, and Syzygium cumini showed antifungal activity on Candida species.  Methanol extract of Ficus deltoidea showed in vitro activity on C. albicans.  Some studies already evaluate isolated substances or secondary metabolites from plants. The effects of licorice and its isolated compounds (licochalcone A, glabridin, and glycyrrhizic acid) on C. albicans also show promising results. Glabridin and licochalcone A showed potent antifungal activity and prevented yeast-hyphal transition. Apart from this, licochalcone Z showed a significant effect on C. albicans biofilm formation. ,
Triphala, which is an important therapeutic and antimicrobial aid in various ailments, is a combination of three tropical fruits' preparation, which has been established as potent antimicrobial and antifungal agents. The anticandidal activity may be attributed to the gallic acid components present in triphala.  According to the results of some studies, it was concluded that S. aromaticum bud extracts and clove oil when tested against the bacterial and fungal strains emerged as the potent agent exhibiting even much higher antibacterial and antifungal activities than the standard antibacterial and antifungal drugs ciprofloxacin and amphotericin B, respectively. The need of the hour is to perform more and more screening of the natural products or plant parts as such screening experiments form a primary platform for further phytochemical and pharmacological studies that may open the possibilities of finding new clinically effective antifungal and antibacterial compounds against the dental caries pathogens and the resistant bacterial and fungal pathogens. 
In a study conducted by Ngari et al.,  various plant parts used for the management of oral health are roots were highly utilized (34.28%) followed by leaves (31.4%), bark (14.3%), fruits (8.6%), and seeds (8.6%) while plant sap was least utilized (2.8%). The herbs were used in different forms such as chewing sticks, herbal pastes, herbal powders, capsules, suspensions, saps, mixtures, or just unprocessed materials [Table 4]. Most of herbal materials were used in the management of toothache (30.5%) followed by mouth ulcers (27%).
| Conclusion|| |
In the age of intensive investigations aiming to discover new compounds, which can be used in treatment, we shall not forget about natural substances of herbal origin. Plants are a precious source of natural compounds, which can be used both in prophylaxis and treatment of oral cavity and teeth diseases. Phytotherapy is useful in the treatment of chronic pathological conditions in which medicines are not well-tolerated. Herbal drugs can be used for a long time, and do not cause addiction and allergic reactions. The research assessing the antimicrobial efficacy of a combination of plant extracts is the need of the hour, and such research will aid the development of a novel, innovative method that can simultaneously inhibit the two most common dental diseases of mankind, apart from lowering the development of drug resistance.
The authors express their gratitude to Jagadguru Sri Shivarathreeswara (JSS) University and JSS Dental College and Hospital for providing the necessary support in the due course of the work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]