INTRODUCTION:

Oral health is very important in our lives and maintaining oral hygiene is important to prevent oral diseases. Oral cavity consists of large number of bacteria. These bacteria when accumulates on the oral surface they give rise to various oral diseases. World Health Organization (WHO) defines oral health as “A state of being free from chronic mouth pain, oral infection and sores, periodontal (gum) disease, tooth loss, oral ulcer, oral cancer¹.

The most common oral diseases are the dental caries, Gingivitis, Periodontitis, Mouth ulcer, Oral candidiasis. Dental plaque can be defined as accumulation of bacteria and their products which accumulate on the tooth surface². The cause of Dental caries is cariogenic bacteria. In caries the tooth surface gets damaged by acid by-products made by bacteria which give rise to cavities³.

Gingivitis is inflammation of the gingivae. Gingivitis causes are plaque-related, several times non–plaque-related forms also are recognized. Gingivitis is the first sign of periodontitis. Periodontitis is also affecting the gums which spreads and affects the supporting tooth structures possibly leading to the tooth loss⁴.

In most of cases the cause of oral diseases is poor oral hygiene. Poor oral hygiene leads to plaque formation. Oral microorganisms are the main cause of oral diseases such as dental plaques, dental caries, and oral candidiasis as well as gingival and periodontal diseases. Streptococcus mutans is one of the main precursor which is responsible for the formation of dental plaque and caries. Other microorganisms which also give rise to oral diseases include Escherichia coli, S. aureus, P.gingivalis and Candida species.

GLOBAL ESTIMATION

Ø According to WHO, the Global Burden of Disease Study 2017 observed that oral diseases affect closely to 3.5 billion people worldwide

Ø According to the Global Burden of Disease 2017 untreated dental caries (tooth decay) in permanent teeth is most common

Ø It was found that 530 million children suffer from dental caries

Ø Generally, 2% to 70% percentage of overall population get affected by oral candidiasis.

PROBLEMS CAUSED BY ORAL DISEASES

Ø Chewing problems or eating disorders

Ø Insomnia

Ø Irritability, and low self-esteem.

Ø Dental trauma⁵

Fig.1.Types of oral diseases

According to WHO 80% of world population depends on the traditional medicine. Many herbs can be used to treat the oral diseases. Herbal drugs are used because of their antimicrobial, antifungal activity. Nowadays, there is high demand of oral care products that are incorporated with herbal ingredients and their extracts and are used by the consumers. As herbal drugs possess low toxicity as compared to oral care products which contain synthetic antimicrobial agents⁶.

Marketed Formulations Containing Synthetic agents and their disadvantages

Ø Toothpastes, mouthwash containing fluorides in repeated exposure and high concentration is reported to exhibit toxicity.

Ø Synthetic oral formulation toothpastes contain bleaching agents which may cause staining of teeth

Ø Chlorhexidine mouthwash containing chlorhexidine cause taste alteration, staining of teeth

Some oral care cosmetics such as toothpaste, lozenges, chewing gum contain sugars as sweetening agents which may induce plaque formation

Advantages of Herbal drugs

Ø Easy availability and cheaper in cost

Ø Less toxic and less side effects

Ø Can be used in various forms

Disadvantages of herbal drugs

Ø Herbal drugs may cause drug interactions

Ø Some herbs may cause adverse drug reactions or reported to be toxic

Tulsi (Ocimum sanctum)

Fig.2. Ocimum sanctum

Tulsi belongs to the Family Labiatae. It is found on large scale in India, Malaysia, Australia, Different parts of tulsi have medicinal properties such as leaves, flowers, stem, root seeds etc. Most of therapeutic properties are present in the leaves⁷. It is reported that tulsi leaves contain 0.7% volatile oil which consists of about 71% eugenol and 20% methyl eugenol. Tulsi leaves are effective in treating common oral infections Tulsi leaves can be chewed raw which can treat ulcers and infections of mouth⁷.Tulsi oil contains eugenol and linalool which help in maintaining halitosis and has antifungal activity which can treat oral candidiasis. It has anti-inflammatory property which will help in treatment of gingivitis and periodontitis. Tulsi contains phytoconstituents which acts as anti-bacterial especially against E. coli, S. Mutans and S.aureus,Candida albicans⁸.It also has anti-fungal, anti-viral, anti-ulcerogenic properties. Tulsi oil can be used in dental gels, Mouthwashes. Tulsi extract can be used in Toothpastes, mouthwash.Tulsi extract contains antimicrobial agents such as Carracrol, tetpene and sesquiterepene b-caryophyllene which can prevent microbial infection of mouth.⁹

Guava (Psidium guajava)

Fig.3.Psidium guajava

Common names of P. guajava are guava, guayaba, goiaba, perala, pichi, p Magnoliophyta, Class: Magnoliopsida, Subclass: Rosidae, Order: Myrtales, Family: Myrtace

It belongs to Family Myrtaceace. It is cultivated throughout the world and used as traditional system of medicine. The main chemical constituents of guava include guavajerin, phenolic compounds, flavonoids, carotenoids, essential oils vitamins, tannins, sesquiterpene alcohols and triterpenoid acids. The Leaves of Psidium guajava contain phenolic compounds, isoflavonoids, gallic acid, catechin, epicatechin. Guava leaves can be used as antiplaque agent due to presence of active flavonoids compounds. Quercitin in guava which is a flavonoid has strong antibacterial action¹⁰. Aqueous, chloroform and methanol extract of leaves can reduce the growth of different bacteria. Guava leaves aqueous extract is highly active against S.aureus, S mutans,E coli. Guava leaves can be chewed raw to treat the gingival inflammation. Guava leaves decoction can be used as mouthwash,to treat inflamed gums and reduce the pain associated with ulcers and can heal the oral ulcers¹¹.

Pomegranate (Punica granatum)

Fig.4.Punica granatum

It belongs to Family Punicaceae generally known as “pomegranate,” It is found in Asia and cultivated throughout the Mediterrian region Each part of Pomegranate plant (peel, seed, arils, juice, pericarp, leaves, flowers, bark and roots) have therapeutic properties. Pomegranate fruit extract contains anthocyanins, glucose, ascorbic acid, ellagic acid, gallic acid, caffeic acid, catechin, epigallocatechin, quercetin, rutin, iron and amino acids which has got excellent anti-inflammatory activity. Pomegranate leaves, fruit extract gel can be active against S. sanguis, S. mutans and S.aureus by inhibiting various microorganisms in the oral cavity. It can act as the anticariogenic agent.The pomegranate active components include polyphenolic flavonoids (e.g., punicalagins and ellagic acid. It has antiinflammatory effect, antibacterial activity and it removes plaque from the teeth. Peel contains bioactive compounds that include phenolics, flavonoids, proanthocyanidin compounds and complex polysaccharides. Pomegranate peel extract reduces plaque index and can be used in mouthwash or topical oral formulations and can be used in gingivitis patients¹².

Turmeric (Curcuma longa)

Fig.5.Curcuma longa

Magnoliophyta, Class: Magnoliopsida, Subclass: Rosidae, Order: Myrtales, Family: Myrtaceae

Turmeric a rhizome of Curcuma longa belongs to Family Zingaberaceae. Turmeric is widely use as spice and medicinal herb. Turmeric is an important component of Indian Ayurvedic medicine. The main Components of tumeric are curcuminoids, which include mainly curcumin, demethoxycurcumin, and bisdemethoxycurcumin. Curcumin (diferuloylmethane) is a polyphenol which is derived from Curcuma longa known as turmeric. The flavonoid curcumin (diferuloylmethane) is the active constituent of turmeric. Other constituents are volatile oils including tumerone, atlantone, and zingiberone. Other constituents include sugars, proteins, and resins. The active constituent is curcumin, which comprises 0.3-5.4% of raw turmeric. It has many therapeutic properties including antioxidant, analgesic, anti-inflammatory, antiseptic activity, and anticarcinogenic activity. The anticariogenic activity is due to essential oil from C. longa inhibits Streptococcus mutans. The aqueous and methanolic extract of turmeric inhibits S aureus,S mutans,E coli. The anti-inflammatory of turmeric can be beneficial in the treatment of gingivitis, both as a local application in the form of a gel or as a mouthwash. It can relive pain associated with gingivitis and periodontitis.¹³

Clove (Syzygium aromaticum)

Fig.6.Clove buds

Clove (Syzygium aromaticum) belongs to Family Myrtaceae is used as a natural medicine for dental diseases. It has been used traditionally for the treatment of tooth pain; oral ulceration Clove contains eugenol is a volatile oil main component of clove.¹³It is present in 72-90% of essential oil. The other constituents are beta cryophyllene, vanillin, crategolic acid, galatonic acid, methyl salicylate. In dentistry clove is used for pain relief or toothache. Eugenol due to its anaesthetic property relieves toothache. It has anti-bacterial, anti-fungal, anti-inflammatory properties.¹⁸ Clove oil has a specific anti- inflammatory property due to flavonoid content. Clove if kept in mouth and chewed strengthens the gums and reduce halitosis. The clove oil exhibited antibacterial activity against Staphylococi, Streptococci, Pneumomocci. So, it shows antiplaque effect and can treat plaque induced gingival and periodontal conditions. Studies have showed that mouthwash containing clove shows antigingivitis effect. It can treat oral candidiasis due to its antifungal property.¹⁴

Cinnamon (Cinnamomum zeylanicum)

Fig.7.Cinnamomum zeylanicum

Cinnamon (Cinnamomum zeylanicum) belong to Family lauraceae is one of the most important spice used in various food products. Cinnamon contains essential oils and other derivatives, such as cinnamaldehyde, eugenol, cinnamic acid, and cinnamate. The main constituent of cinnamon essential oil is cinnamaldehyde. Cinnamon contains essential oils and other constituents which also have important activities, such as antimicrobial, antifungal. The eugenol which is present in essential oil has been proven to be effective against fungi and bacteria such as C.albicans, S.mutans, S.salivarius, S.aureus, and P.gingivalis which are cause of periodontal diseases.¹⁵Aqueous extract of cinnamon shows activity against oral microflora .It can treat toothaches, plaque induced gingivitis and bad breath. Cinnamon can be used in powderform or extract in mouthwash, chewing gums, and toothpastes¹⁹

Mango (Mangifera indica)

Fig.8.Mangifera indica

It belongs to Family Anacardiaceae.It is native tropical Asia and has been cultivated in the Indian subcontinent. Various parts of plant are used as a dentrifrice, antiseptic, astringent to treat toothache, wounds. It is observed from phytochemical studies that different parts of M. indica contains chemical constituents such as phenol constituents, triterpenes, flavonoids, phytosterols, and polyphenols. Mango leaf is a rich source of various biologically active compounds. Leaves contain constituent’s glucoside and mangiferin which are antimicrobial. Mangiferin which is important constituent has shown to exhibit antibacterial activity against bacterial species, Staphylococcus aureus, and Escherichia coli. It has been reported that aqueous and ethanol extract of leaves of mango has activity against Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Pseudomonas aeruginosa, Candida albicans, Enterococcus faecalis .Antibacterial activity of mango extracts upon gram-positive, gram-negative bacteria and yeast Candida albicans was also found and it is found that the antibacterial activity of mango extract is due to the presence of gallotannin and mangiferin¹⁶.The decoction of the leaves is used in the prevention of halitosis or bad breath. Mango leaf powder, extract can be used in mouthwash, Toothpastes, chewing gums.

Fig (Ficus carica)

Fig. 9. Ficus carica

It belongs to Family Moraceae. It is native to Sub-Himalayan region, Bengal, and central India, it has been extensively cultivated worldwide. Ficus carica belongs to traditional systems of medicine such as Ayurveda, Unani, and Siddha. Ficus carica leaf consists of flavonoids such as Quercetin, luteolin, biochanin-A, luteolin-6C-hexose-8Cpentose, apigenin rutinoside, Kaempferol rutinoside, Quercetin rutinoside, Quercetin glucoside, Quercetin which can show antibacterial activity against oral bacteria. It has been reported that methanol extract of Ficus carica leaves exhibits strong antibacterial activity against Streptococcus gordonii, Streptococcus anginosus, Porphyromonas gingivalis, Escherichia coli, Staphylococcus aureus, Streptococcus sanguinis.¹⁷some phenolic compounds isolated from plants exhibit anticaries activity due to growth inhibition against Streptococci mutans. Ficus leaf powder or extract can be used in dental caries, plaque reduction and also in management of gingival, periodontal conditions.

Liquorice (Glycyrrhiza glabra)

Fig.10.Glycyrrhiza glabra

It belongs to Family Fabaceae. Liquorice is native to Mediterranean countries and Asia. Liquorice root is integral part of Chinese medicine and Ayurveda for centuries. Liquorice contains chemical constituent’s glycyrrhizin which gives sweet taste and 10-25% of liquorice. It also contains secondary metabolites like saponins, flavonoids, isoflavonoids, chalcones, coumarins, aurones, benzofurans, phenols, pterocarpans, aqueous extracts of G. glabra have shown antibacterial activity against P. gingivalis. So liquorice can be used in oral hygiene products to maintain gingival and oral health. Liquorice is also reported to have potent antibacterial action against a cariogenic bacterium S. mutans .So it can be used for caries prevention. The aqueous extract of G. glabra shown activity against C.Albicans. Liquorice thus can be used treating oral candidiasis, gingivitis, Periodontitis¹⁸

Amla (Emblica officinalis)

Fig.11. Emblica officinalis

It belongs to the Family Euphorbiaceae. It is commonly known as Indian gooseberry. It is native to India and also grows in subtropical, tropical region. Gallic acid is the primary phytoconstituent of amla. Other constituents of are tannins, phenolic compounds and alkaloid. Amla fruit contains Vitamin C in abundance which act as antioxidant can be used in treatment of gingivitis²¹. Phytoconstituents present in amla can prevent and cure the periodontal diseases by inhibiting the plaque causing microorganism. Amla can be used in dental gels, mouthwash, dentifrices for treatment of periodontal diseases.²²

Stevia (Stevia Rebaudina)

Fig.12. Stevia Rebaudina

Stevia Rebaudina is an herb which belongs to Family Asteraceae commonly known as sweetgrass. It is native to Brazil and Paraguay. It is cultivated in Southeast Asia, Japan The sweet constituents of stevia include eight diterpene glycosides: stevioside, steviolbioside, rebaudiosides A, B, C, D, and E, and dulcoside A. Stevioside is 300 times sweeter than sucrose. As stevia is a non-caloric sweetener there has been high demand to use in oral hygiene products. It is potent antimicrobial with less local side effects²³. It has been observed that stevia is non-cariogenic. Stevia can be used as sweetener as well as oral microbe suppressor. Rebaudiana leaf extracts have antibacterial activity against dental caries causing microorganisms. In an experiment conducted by Ghosh et al., it was reported that petroleum ether extracts were found to have highest antimicrobial activity against S. aureus, Enterococcus faecalis and Pseudomonas aeruginosa.²⁴ The flavonoids in Stevia have antiplaque activity.

CONCLUSION:

Hence in conclusion herbal medicines must be used to prevent oral diseases and to maintain oral hygiene. Herbal medicines can be an alternative to allopathic medicines to minimize the adverse effects of synthetic medicines on oral health. As many of herbs are reported to exhibit medicinal properties from traditional systems of medicines.²⁰ Herbs can be used alone or in combination to treat various oral diseases.

ACKNOWLEDGEMENT:

The authors wish to express their gratitude to MET’S Institute of Pharmacy, Adgaon, Nashik, Maharashtra, India for providing necessary facilities to carry out this review work

CONFLICT OF INTEREST:

We declare that we have no conflict of interest.

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Received on 12.06.2020 Revised on on 30.09.2020

Asian J. Pharm. Res. 2020; 10(4):321-326.

DOI: 10.5958/2231-5691.2020.00055.6