Role of herbs in endodontics: An update Sharad Kamat Rajeev K. Prahlad Saraf A PUBLICATION OF INDIAN ENDODONTIC SOCIETY VOL 23 ISSUE 1 JUNE 2011

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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 *** ###
ABSTRACT
Over the past decade, interest in drugs derived from medicinal plants has markedly increased. In dentistry
phytomedicine 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 and
possible drug interactions when used as phytomedicine in endodontics.
INTRODUCTION
Herbal 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.
CLASSIFICATION
A) 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 SUBSTANCES
MORINDA 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 anticoagulation
effects of warfarin
garlic interacts with anti platelets and
hypo glycemic drugs
green tea reduces bioavailability of anti
cancer drugs
PERSPECTIVES AND CONCLUSION
Literature 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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ROLE OF HERBS IN ENDODONTICS: AN UPDATE