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ENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGYENDODONTOLOGY

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Role of herbs in endodontics: An update

* 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

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

ABSTRACTOver the past decade, interest in drugs derived from medicinal plants has markedly increased. In dentistryphytomedicine 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 andpossible drug interactions when used as phytomedicine in endodontics.

INTRODUCTIONHerbal 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.

CLASSIFICATIONA) Phytotherapeutic substances are generally

classified in to three groups(2).

1. Plant products

2. Animal products

3. Mineral origin

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 SUBSTANCESMORINDA 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).

TRIPHALA:This is an ayurvedic rasayana consisting of

Amulaki (emblica officinalis), Bibhitaki (terminalia

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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).

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(11), root canal

irrigant (12) and storage media for avulsed teeth to

maintain viability of periodontal ligament(13).

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).

ORANGE OIL:It is oil produced by glands inside the rind of

an orange fruit. This is composed mostly of d-

limonene. 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.

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

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).

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).

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).

TEA TREE OIL:This is a native Australian plant with terpenin-

4-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).

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

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and prolongs the regenerative phase. It is shown

as an alternative intra canal medicament(12).

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).

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 E-

faecalis(27).

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).

JIEERYIN SOLUTION:This is a pure Chinese herbal compound and

has heat clearing, detoxifying, antibacterial and anti-

inflammatory 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).

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 E-

faecalis because of anthra quinine(28). Its bactericidal

activity is found to be less than Ca (OH)2(29).

PSORALEA CORYLIFOLIA:This is found to be effective against

E-faecalis(30). It acts by causing injury to cell

membrane and inhibiting DNA polymerase.

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).

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)

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).

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Aloe Vera Abdominal cramps, diarrhoea

Garlic Bowel irritation, mouth ulceration,halitosis & prevention of blood clotting

Orange oil G I irritation

Chamomile tea Allergic conjunctivitis

Green tea Irritability, anxiety

Tea tree oil Allergic contact dermatitis

DRUG (PHYTOTHERAPEUTIC)INTERACTION(3)

There is little available information regarding

drug interactions between herbal products and the

conventional drugs.

m.chamomile potentiates anticoagulationeffects of warfarin

garlic interacts with anti platelets andhypo glycemic drugs

green tea reduces bioavailability of anticancer drugs

PERSPECTIVES AND CONCLUSIONLiterature 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.

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16. Bauer K, Garbe D, Surburg H. “Common Fragrence andFlavor Materials”, 4th Ed, Wiley VCH, 2001:189.

17. De Vincenzi M, Stammati A, De Vincenzi A, Silano M.“Constituents of aromatic plants: carvacrol”. Fitoterapia2004:75, 801–4.

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19. Gradišar et al. Green Tea Catechins Inhibit Bacterial DNAGyrase by Interaction with Its ATP Binding Site.2007: http://pubs.acs.org/doi/abs/10.1021/jm060817o

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23. Sader Lahijini MSS, Raoof kateb HR,heady R,Yazdini D.The effect of German chamomile (Marticaria recutita L.) extractand tea tree (Melaleuca alternifolia L.) oil used as irrigants: ascanning electron microscope study. Int Endod J 2006: 39:190-195.

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ROLE OF HERBS IN ENDODONTICS: AN UPDATE

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