Exploring the Potential of Phytodentistry: A Comprehensive Review

INTRODUCTION

There are about 700 different kinds of microbes in the mouth, and all of them contribute to a variety of dental and oral health issues. Infectious illnesses of the mouth, including dental caries, are a global health concern.¹ According to Kuang et al², dental caries is not just a one-way process of demineralization but rather a multi-step process that includes remineralization as well.

Ayurveda is an ancient Indian medical system that aims to treat the whole person by incorporating principles of nutrition, physical activity, meditation, breathing exercises, herbal remedies, and physical treatment into a patient's daily routine.³ An ancient Sanskrit term for "life" or "longevity" (ayuh) and "science" or "sacred knowledge" (veda) form the basis of the modern English word "Ayurveda". Commonly referred to as herbal medicine or therapy, the technical term for the use of plant extracts for therapeutic purposes is phytotherapy or complementary and alternative medicine (CAM).^4,5

The field known as phytotherapy investigates the potential medicinal and curative effects of plant-based extracts. Many people consider traditional phytotherapy, which is commonly referred to as herbalism, to be an alternative kind of treatment.⁶ Phytomedicine has several applications in dentistry, such as endodontic irrigants, analgesics, antibiotics, sedatives, and anti-inflammatory drugs. Sorting according to phytocompounds' dental medicinal uses.

An increasing trend in dentistry therapy recently has been the use of natural therapies, which can be referred to as phytotherapeutics or ethnopharmacology.⁷

Historical use of plant-based compounds in traditional medicine and dentistry.

Polynesians have relied on Morinda citrifolia (MC) (noni) and other traditional medicinal plants for more than two millennia8. Numerous reports have pointed to its nutritional and medicinal benefits. The popular name for MC is noni, although it goes by many other names in different cultures around the world, including Indian mulberry, ba ji tian, nono, nonu, cheese fruit, and nhau.

A wide variety of medical conditions, including cancer, infections, arthritis, diabetes, asthma, high blood pressure, and pain, have reportedly responded positively to it. Herbal treatments can be made from a wide variety of noni plant parts, including roots, stems, bark, leaves, flowers, and fruits.¹⁰ Specopletin, octoanoic acid, potassium, vitamin C, terpenoids, alkaloids, anthraquinones (including rubiadin, morindone, rubiadin-1-methyl ether, and anthraquinone glycoside), G-sitosterol, beta-carotene, vitamin A, flavone glycosides, linoleic acid, alizarin, amino acids, aucubin, L-asperuloside, caproic acid, caprylic acid, ursolic acid, and rutin are some of the components identified in the MC plant.¹¹ The infectious bacterial strains Pseudomonas aeruginosa, Proteus morganii, Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Salmonella, and Shigella have been demonstrated to be susceptible to these chemicals' effects.¹²

These two sources results showed that MC was just as effective as NaOCl and EDTA as an intracanal irrigant in removing the smear layer from the root canal walls of instrumented teeth, as compared to chlorhexidine (CHX) and NaOCl.in Propolis and MC were found to be more effective than 2% CHX gel, propolis, and calcium hydroxide as an intracanal medicament against Enterococcus faecalis (E. faecalis) in dentin on removed teeth in another investigation.¹³ When looking for juices to utilise intracanally instead of NaOCl, MC seems to have been the first to be considered.

PHYTOCHEMICALS AND ORAL HEALTH

Antimicrobial properties of phytochemicals:

Scientific name for "Indian gum Arabic tree" is Acacia nilotica. Its use in the treatment of skin, genital, digestive, and dental issues dating back many centuries. Evidence suggests it can alleviate symptoms of malaria, sore throat (airborne component), and toothache (bark).

Streptococcus mutans and E. faecalis are two of the microorganisms that babool has been found to inhibit.¹⁴ The antimicrobial properties are thought to be attributed to flavonoids, essential oil, tannins, and phenolic chemicals.¹⁵ Arctium lappa is a plant brought from Japan and acclimated in Brazil, which is widely used in popular medicine all over the world for its well-known therapeutic applications. It has anti-bacterial and antifungal activity, diuretic, anti-oxidant and anxiolytic action, platelet anti-aggregating effect and HIV-inhibitory action. In Dentistry, Arctium lappa has been investigated due to its antimicrobial potential against oral microorganisms, specifically those associated with endodontic infections, as demonstrated by Perin et al. and Gentil et al. Because of its antibacterial properties, A. lappa has been studied in dentistry as a possible treatment for endodontic infections and other oral pathogens. In vitro testing of A. lappa's antibacterial activity against endodontic infection-causing microbes revealed that the plant effectively inhibited the growth of all of the tested pathogens. This work provides new evidence that A. lappa may have antimicrobial properties, which could lead to its possible usage as an intracanal medicine.¹⁶

Neem has been used in India and south Asia for thousands of years as the preferred tool for maintaining healthy teeth and gums. Brushing with neem twigs and chewing neem leaves and seeds after a meal has been the traditional dental care practice in this area. With available modern preparations many people are now using commercial products that contain the same basic neem components. The antibacterial activity of neem has been evaluated and known from ancient times (Chaurasia and Jain, 1978, Chawla et al., 1994). Neem has been considered to have various activities such as astringent, antiseptic, insecticidal, anti ulcer and for cleaning the teeth in pyorrhoea and other dental diseases. Other than this leaf extract of the neem showed superior antiviral and antihyperglycemic activity in vitro and in vivo on animals (Chattopadhyay, 1999, Parida et al., 2002). Leaves of the neem have been used in the treatment of gingivitis and periodontitis (Husain et al., 1992). Neem has also showed better efficacy in the treatment of oral infections and plaque growth inhibition in treating periodontal disorders (Patel and Venkatakrishna, 1988). Neem had showed good in vitro broad range antibacterial activity (Rao et al., 1986).¹⁷

ANTI-INFLAMMATORY AND ANTIOXIDANT PROPERTIES

Propolis, also known as bee glue and bee propolis, is a potent antimicrobial, antioxidant, and anti-inflammatory agent. The main chemical elements present in propolis are flavonoids, phenolics, and various aromatic compounds. Flavonoids are well- known plant compounds that have antioxidant, anti- bacterial, antifungal, antiviral, and anti-inflammatory properties (Gopikrishna et al. 2008).¹⁸ Morinda citrifolia (Rubiaceae) (MCJ), commercially known as noni is considered as an important folk medicine. Its juice has a broad range of therapeutic effects including antibac-terial, antifungal, antiviral, antitumor, antihelminthic, analgesic, hypotensive, anti-inflammatory, and immune enhancing effects (Murray et al. 2008). Murray et al. (2008) compared the effectiveness of MCJ with sodium hypochlorite and chlorhexidine gluconate to remove the smear layer from the walls of instrumented root canals. They concluded that 6% MCJ could be used as an endodontic irrigant in combination with EDTA followed by a final flush with 6% MCJ.¹⁸ Amulaki/Nelli (Phyllanthus Emblica), Bibhitaki/Bulu (Terminalia belerica), and Halituki/Aralu (Terminalia chebula) make up the ayurveda Rasayana known as Triphala. Triphala is used in Ayurvedic medicine in treating a variety of conditions and also forms part of many other Ayurvedic formulations. Conditions for which Triphala is employed include headache, dyspepsia, constipation, liver conditions, ascites and leucorrhoea. It is also used as a blood purifier that can improve the mental faculties and is posseses anti-inflammatory, analgesic anti-arthritic, hypoglycaemic and anti-aging properties.¹⁹ Some have proposed using it in endodontics. Aside from being a mouth rinse, it is also utilised as an anti-parasitic. Neem is a rich source of antioxidants. It has got antimicrobial property against S. mutans and E. faecalis. Neem has antimicrobial properties due to the presence of alkaloids, glycosides, flavonoids, steroids, anthraquinone and tannic acid. These active ingredients uncouple mitochondrial oxidative-phosphorylation; thus, inhibiting the respiratory chain. This leads to the anti-adherence activity which interrupts with bacterial adhesion. Aloe vera gel or mucilage has got many therapeutic purposes. It reduces the adhesion in dentistry. It has got significant action against E. faecalis.It has anti-inflammatory activities. It is a potent antioxidant.²⁰ A member of the coffee family, Morinda Citrifolia is a fruit-bearing tree that yields Morinda Citrifolia Juice (MCJ). It can bind to chelates. It works wonders on the smear layer. Anaerobic bacteria, such as E. faecalis and Candida albicans, are also susceptible to its antimicrobial effects.²¹ According to Gomes et al²² and Salame et al.²³, triphala has anti-inflammatory, antioxidant, and antibacterial properties against a wide range of microorganisms. And Triphala is also 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.²³ RHUS plants has gallic acid and gallic tannins. It has been found that tannins have antifungal and antibacterial effects. Gallic acid kills bacteria and acts as an antioxidant. The inflammation around the nail bed can be lessened by using gallic acid. When dentinal tubules get clogged, an extract from RHUS plants can be used to open them.²⁴ Jieeryin solution is a pure Chinese herbal compound and has heat clearing, detoxifying, antibacterial and anti inflammatory effects and is used for root canal irrigation with ultrasonics and has similar effects to that of NaOCl.²⁴ 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 NaO Cl. To make the active ingredient "allicin," crushing the garlic bulb releases the sulfur-containing molecule allin. Enzymes like 3-hydroxy-3-methylglutaryl CoA reductase, which are crucial in cholesterol production, are inhibited by this chemical.²⁵ Garlic reportedly lowers triacylglycerol by inhibiting fatty acid synthesis via malic enzymes, fatty acid synthatase , and glucose 6 phosphate dehydrogenase, whereas its hypocholesterolemic impact is exerted by a reduction in hepatic cholesterogenesis. Lipid implantation on the artery wall can be prevented with the use of garlic. Root canal bacteria have their cell walls and membranes destroyed by allicin. As a substitute for NaOCl as an irrigant, this is utilised.²⁶

The broad antibacterial efficacy of fresh lemon solution, which includes E. faecalis, makes it an effective root canal medicament. When applied topically, lemon oil can alleviate symptoms of stomatitis and oral thrush.²⁷

IMPACT OF PLANT EXTRACTS ON PERIODONTAL HEALTH

Due to their widespread availability, low cost, high efficacy, and relative safety, plant extracts have a long history of medicinal usage. The Salvadoraceae family counts the little Salvadora persica (S. persica) among its members. Many people in the Asian, African, and Middle Eastern subcontinents have long relied on plant stems, roots, and twigs to keep their teeth clean. It is highly recommended by the World Health Organisation (WHO) as an excellent tool for oral health care.²⁸ Randomised controlled trials conducted by Al-Otaibi et al²⁹ found that S. persica significantly reduced plaque score, inflammation of the gums, and bleeding from the gums.

NATURAL AGENTS FOR TOOTH DECAY PREVENTION

Most of the time, researchers have only wanted to ensure that the plant's long-standing therapeutic use is true. As an illustration, a study demonstrated that chloroform extracts of the aerial plant parts of Drosera peltata (Droseraceae) leaves had broad spectrum activity against multiple oral cavity bacteria, including S. mutans and S. sobrinus, with minimum inhibitory concentrations (MICs) of 31.25 and 15.625 μg mL−1, respectively, validating the traditional use of these leaves as a treatment for dental caries.³⁰ It was determined that plumbabin was the active ingredient in this extract. Numerous extracts from medicinal and non-medicinal plants were found by Tichy and Novak³¹ to suppress the growth of oral streptococci. The most potent phytochemicals were isolated from the following plants: Abies canadensis (Pinaceae), Albizia julibrissin (Fabaceae), Chelidonium majus (Papaveraceae), Ginkgo biloba (Ginkgoaceae), Juniperus virginiana (Cupressaceae), Pinus virginiana (Pinaceae), Rosmarinus officinalis (Lamiaceae), Sassafras albidum (Lauraceae), Sassafras albidum (Lauraceae), Tanacetum vulgare (Asteraceae), and Thuja plicata (Cupressaceae). According to bioautography, some of the extracts had chemically distinct components, while others had common antimicrobial components. A traditional Chinese medicinal herb called Coptidis rhizoma (Ranunculacea) shown bactericidal efficacy against oral bacteria, especially periodontopathogenic bacteria, in a boiling water extract (MIC = 31-250 μg mL−1).³² The capacity of several medicinal plant methanol extracts and 10% decoctions to inhibit bacterial isolates isolated from crevicular fluid of periodontal pockets of periodontic patients was investigated by Iauk et al.³³ As a rule, the decoctions were less active than the methanol extracts. Overall, all bacteria tested showed the strongest activity against the extract from the leaves of Hamamelis virginiana (Hamamelidaceae), with MIC values typically. Pulp capping using natural herbs is another viable alternative. Researchers found that baicalin, a flavonoid derived from the plant's roots, promoted angiogenic factors, mineralization of alkaline phosphate activity, and morphogentic protein expression, all of which improved the angiogenesis and odontoblastic differentiation of human dental pulp cells.³⁴

HERBAL REMEDIES FOR ORAL PAIN MANAGEMENT

Roundworms, toothaches, fever, rheumatism, ulcers, pain relief, antifungal activity, and disinfection of Escherichia coli can be achieved through the proper combination of several other herbs, such as Cissampelos pariera, Acorus calamus, Zanthoxylum alatum, Honey, impure carbonates of potash, and impure carbonates of soda.^35,36 For recurrent apthous ulcer pain management and faster wound healing, Moghadamnia et al³⁷ tested licorice bioadhesive hydrogel patches. Inflammatory halo and necrotic centre diameters were significantly reduced in the licorice patch group as compared to the placebo group. Findings suggest that licorice bioadhesive hydrogel patches may alleviate pain, inflammation, and the necrotic core of apthous ulcers.

A paste made using Myrtus communis (Myrtle) was tested for its effectiveness in treating recurrent apthousstomatitis. According to the results, using the paste significantly reduced ulcer size, pain intensity, erythema, and exudation level. Applying myrtle paste also enhanced patients' overall evaluation of treatment. Reports of adverse effects were nonexistent.³⁸

CHALLENGES AND CONSIDERATIONS

A number of issues and factors come to light as we work towards incorporating phytodentistry into conventional oral treatment. The doubts and oppositions within traditional dental practices towards utilizing plant-based methods is a major concern. One potential obstacle to the seamless integration of phytodentistry into ordinary oral healthcare practices is the lack of awareness and acceptance among dental practitioners and patients alike. Furthermore, there is a significant hurdle in the form of standardization issues. There is cause for concern regarding the consistency and dependability of plant-derived products due to the inherent heterogeneity in phytochemical composition across various plant sources and extraction processes. In order to prove that phytodentistry works, there needs to be a standardised method for measuring quality, potency, and purity.

Another important factor that needs careful consideration is dosage. It is not an easy undertaking to determine the ideal dosage of chemicals produced from plants for use in oral health applications. The difficulty in developing suitable dosage recommendations is exacerbated by factors such as individual differences in response, the particular oral ailment being treated, and the method of administering the phytochemicals. To guarantee the dependability and safety of phytodentistry in varied patient populations, it is essential to find a middle ground between the therapeutic efficacy and possible adverse effects.

In addition, it is worth noting that there is a concern over the possible interactions between substances derived from plants and current dental treatments. It is possible for unexpected or unforeseen effects to occur when phytochemicals are administered with conventional dental procedures. To avoid negative impacts on treatment outcomes, interactions at the molecular or pharmacological level must be thoroughly investigated. Synergies and conflicts between phytodentistry and traditional dental therapies can be better understood with thorough research and clear recommendations. This will allow for a more harmonic integration of the two approaches, which will maximise the advantages to oral health as a whole. The successful acceptance and integration of phytodentistry into standard oral healthcare procedures will depend on addressing these issues.

FUTURE DIRECTIONS

According to what was discussed before, endodontics makes use of herbs and other natural therapies in order to reduce inflammation and calm tissues that have been affected. The antibacterial properties of herbal ingredients have been proved to be effective against a wide variety of oral bacterial infections, such as Streptococcus mutans, Candida albicans, E. faecalis, and others. It has been demonstrated through research that these herbal medicines require a substantial amount of clinical and pre-clinical research, which should also include a large number of interactions with other substances. Due to the fact that they are a more cost-effective alternative to more expensive treatments, these herbal cures are of tremendous help to patients all over the world.

CONCLUSION

In phytodentistry, herbal products are utilized for a variety of reasons, including the fact that they are safe, simple to use, more readily kept, affordable, and do not have any microbial tolerance. Recently, there has been a significant increase in the number of people interested in phytomedicine. According to the findings of this study, a wide variety of herbal medicines might have some medicinal properties. On the other hand, there is a dearth of published research about the efficacy, safety, and quality of herbal plants for use in dental applications. It is necessary to conduct additional study in order to ascertain the potential adverse effects, toxicity, and drug interactions that may be associated with the utilization of these plants in the dental field.

REFERENCES