A clinical study: Melaleuca, Manuka, Calendula and green tea mouth rinse

Efficient removal of allicin from the stalk of Allium fistulosum for dietary fiber production

The stalk of Allium fistulosum contains dietary fibers with complicated monosaccharide composition and glycosidic bond linkages, which renders it a better dietary fiber supplement. However, the unfavorable odor, majorly contributed by allicin, limits its applications. Although many physical and chemical methods have been developed to remove allicin, there is currently no comparison between their efficiencies. Here, we comprehensively compare all these methods of eliminating allicin in the Allium stalk by starting with optimization of the allicin extraction method. Results indicate that incubation of the chopped Allium stalk with water for 20 min and extraction with 75% ethanol reached a maximal extraction yield. Different methods of allicin elimination are examined, and physical removal of allicin by blanching at 100 °C reaches a maximal clearance rate of 73.3%, rendering it the most efficient and effective method eliminating allicin from the stalk of Allium fistulosum for the preparation of a totally green dietary fiber.

Chemical vs. natural toothpaste: which formulas for which properties? A scoping review

Introduction

The proliferation of the oral care industry has made it more challenging for shoppers to zero in on the best possible toothpaste for their preventative requirements. It also makes the toothpaste’s various components safer.

Objective

The researchers set out to evaluate the state of information about the biological properties and cytotoxicity of adult toothpaste so that they might make some informed recommendations.

Methods

A scoping review of research published between 2015 and 2020 according to PRISMA guidelines was performed.

Results

In vitro clinical trials account for 44% of the papers, in vivo clinical trials for 25%, systematic reviews for 19%, and metaanalyses for 12%. They have active chemical components that have been shown to be antimicrobial, anti-inflammatory, or desensitizing. Herbal toothpaste has these characteristics and is very secure to use. Toothpaste with sodium lauryl sulfate has been found to be harmful.

Conclusions

Scientists have investigated the biological effects of a wide range of chemically active compounds and plant extracts. Herbal toothpaste, it has been discovered, is both efficient and secure. Companies making toothpaste should be required to clearly label the product’s qualities, active ingredients, and potentially harmful ingredients on the packaging.

Antiparasitic Activity of Tea Tree Oil (TTO) and Its Components against Medically Important Ectoparasites: A Systematic Review

Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to 4 April 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.

Efficacy of medicinal plant extracts as dental and periodontal antibiofilm agents: A systematic review of randomized clinical trials

ETHNOPHARMACOLOGICAL RELEVANCE

The presence of biofilm in oral cavity is associated with dental plaque and related diseases, including gingivitis, periodontitis and inflammatory responses. Some medicinal plants traditionally used for biofilm-associated pathologies such as Camellia sinensis (L.) Kuntze, Punica granatum L. and Lippia sidoides Cham. are currently incorporated into dosage forms as antiplaque agents.

AIMS OF THE STUDY

To present the current application of medicinal plant extracts associated in drug dosages to control microbial biofilms, with emphasis on those present in the oral cavity, especially to treat dental plaque.

MATERIALS AND METHODS

A PRISMA-compliant systematic search was conducted using the PubMed, Web of Science and Scopus databases. After the abstract and full-text analysis, the Cochrane Collaboration's tools for clinical studies was applied to assess the methodological quality of randomized clinical trials.

RESULTS

Of 964 potentially eligible studies, 47 studies met the inclusion criteria and were included in the systematic review. Camellia sinensis was the most commonly used species (8 studies), with positive results in reducing both the PI and GI in the form of mouthwash, toothpaste and gel. The Melaleuca alternifolia oil (5 studies) demonstrated low reduction in PI but important effects on GI scores. Azadirachta indica (4 studies) extracts presented efficacy similar to CHX to improve the periodontal parameters, including PI and GI. Ricinus communis oil (3 studies), despite reducing microbiological counts and GI, did not prove to be better than the hypochlorite solution, used as an alternative treatment for dentures. The main bioactive compounds described for the plant species are polyphenols, essential oils and alkaloids, most of them with identified antibiofilm activities.

CONCLUSIONS

These active species could lead to future development of safer and newer treatments for oral biofilm-associated infections. However, more studies are needed to further understand the clinical relevance of their application.

Therapeutic Potential of Tea Tree Oil for Tungiasis

Tungiasis (sand flea disease) is a neglected tropical disease caused by penetration of female sand fleas, Tunga penetrans, into a person's skin usually in their feet. The disease inflicts immense pain and suffering on millions of people, particularly children. The condition is most prevalent in Latin America, the Caribbean, and sub-Saharan Africa. Currently, there is no standard drug treatment for tungiasis. The available treatment options are fairly limited and unrealistic to use in endemic areas; as a result, in desperation, the affected people do more harm to themselves by extracting the fleas with non-sterile instruments, further exposing themselves to secondary bacterial infections and/or transmission of diseases such as hepatitis B virus, hepatitis C virus, or HIV. This highlights the urgent need for simpler, safer, and effective treatment options for tungiasis. Tea tree oil (TTO) has long been used as an antiseptic with extensive safety and efficacy data. The evidence on parasiticidal properties of TTO against ectoparasites such as head lice, mites, and fleas is also compelling. The purpose of this review is to discuss the current tungiasis treatment challenges in endemic settings and highlight the potential role of TTO in the treatment of tungiasis.

Treatment of tungiasis using a tea tree oil-based gel formulation: protocol for a randomised controlled proof-of-principle trial

INTRODUCTION

Tungiasis (sand flea disease or jigger infestation) is a neglected tropical disease caused by penetration of female sand fleas, Tunga penetrans, in the skin. The disease inflicts immense pain and suffering on millions of people, particularly children, in Latin America, the Caribbean and sub-Saharan Africa. Currently, there is no standard treatment for tungiasis, and a simple, safe and effective tungiasis treatment option is required. Tea tree oil (TTO) has long been used as a parasiticidal agent against ectoparasites such as headlice, mites and fleas with proven safety and efficacy data. However, current data are insufficient to warrant a recommendation for its use in tungiasis. This trial aims to generate these data by comparing the safety and efficacy of a 5% (v/w) TTO proprietary gel formulation with 0.05% (w/v) potassium permanganate (KMnO₄) solution for tungiasis treatment.

METHODS AND ANALYSIS

This trial is a randomised controlled trial (RCT) in primary schools (n=8) in South-Western Kenya. The study will include school children (n=88) aged 6-15 years with a confirmed diagnosis of tungiasis. The participants will be randomised in a 1:1 ratio to receive a 3-day two times a day treatment of either 5% TTO gel or 0.05% KMnO₄ solution. Two viable embedded sandflea lesions per participant will be targeted and the viability of these lesions will be followed throughout the study using a digital handheld microscope. The primary outcome is the proportion of observed viable embedded sand fleas that have lost viability (non-viable lesions) by day 10 (9 days after first treatment). Secondary outcomes include improvement in acute tungiasis morbidities assessed using a validated severity score for tungiasis, safety assessed through adverse events and product acceptability assessed by interviewing the participants to rate the treatment in terms of effectiveness, side effects, convenience, suitability and overall satisfaction.

ETHICS AND DISSEMINATION

The trial protocol has been reviewed and approved by the University of Canberra Human Research Ethics Committee (HREC-2019-2114). The findings of the study will be presented at scientific conferences and published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBERS

Australian New Zealand Clinical Trials Registry (ACTRN12619001610123); PACTR202003651095100 and U1111-1243-2294.

Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments

Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.

Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis

Background

Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive.

Objective

To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults.

Methods

We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals.

Results

A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)).

Conclusion

For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.

Comparative Evaluation of Efficacy of Green Tea Mouth Rinse and Green Tea Gel on the Salivary Streptococcus mutans and Lactobacillus Colony Count in 12-18-year-old Teenagers: A Randomized Clinical Trial

Aims:

Green tea is an antibacterial agent with no significant side effect. This feature makes green tea safe for children to use. The purpose of this study was to compare the effectiveness of green tea gel and mouth rinse on salivary level of Streptococcus mutans and Lactobacillus of teenagers aged 12–18 years.

Subjects and Methods:

In this randomized controlled clinical trial study, 30 children aged 12–18 years were included in the study according to the inclusion criteria and were randomly divided into two groups. Participants in mouth rinse group were asked to rinse their mouth with 0.5% green tea mouthwash twice a day for 2 weeks. In the gel group, participants were requested to brush their teeth with 0.5% green tea gel twice a day for 2 weeks. After 4 weeks of washout period, mouthwash group applied the gel and the gel group rinsed the mouthwash for 2 weeks and with the same instruction as mentioned. Colony count of S. mutans and Lactobacillus was determined before and after intervention and data were analyzed using t-test.

Results:

According to the independent t-test, there was no significant difference in the salivary levels of S. mutans before and after intervention regarding age and gender (P = 0.33). Results from paired t-test showed significant decrease in the mean count of S. mutans and Lactobacillus colonies in both groups before and after intervention (P < 0.001).

Conclusions:

Green tea gel and mouthwash contribute to a significant reduction of salivary levels of S. mutans and Lactobacillus colonies, with a greater effect of mouthwash than the green tea gel, which was not statistically significant.

Effects of Herbal Mouthwashes on Plaque and Inflammation Control for Patients with Gingivitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Objective

The aim of this study was to evaluate the overall effects of herbal mouthwashes as supplements to daily oral hygiene on plaque and inflammation control compared with placebos and chlorhexidine (CHX) mouthwashes in the treatment of gingivitis.

Methods

PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and grey literature databases were searched. Only randomised controlled trials (RCTs) comparing herbal mouthwashes with placebos or CHX in the daily oral hygiene of patient with gingivitis were included to compare the effect of different mouthwashes on plaque and inflammation control.

Results

A total of 13 studies satisfied the eligibility criteria, and 11 studies were included in meta-analyses. Significant differences were observed in favour of herbal mouthwashes compared with placebos in both plaque- and inflammation-related indices (Quigley-Hein Plaque Index, QHPI: WMD = −0.61, 95% CI (−0.80, −0.42), P < 0.001; Gingival Index, GI: −0.28 (−0.51, −0.06), P=0.01; Modified Gingival Index, MGI: −0.59 (−1.08, −0.11), P=0.02; Gingival Bleeding Index, GBI: −0.06 (−0.09, −0.04), P < 0.001). No significant difference was found between herbal and CHX mouthwashes.

Conclusions

Herbal mouthwashes have potential benefits in plaque and inflammation control as supplements to the daily oral hygiene of patients with gingivitis. Although no difference was observed between herbal and CHX mouthwashes in the selected studies, further high-quality RCTs are needed for more firm support before advising patients with gingivitis about whether they can use herbal mouthwashes to substitute for CHX mouthwashes or not (PROSPERO registration number: CRD42019122841).

Herbal Dentifrices: Emerging Trends and Patterns

Background:

Herbal extracts have been employed since ages in dentistry as tooth cleansing and antimicrobial agents. The use of herbal medicines continues to expand and trend rapidly across the world. Herbal extracts have been used in dentistry for multiple uses as reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials and analgesics. They also aid in healing process and are very effective in controlling microbial plaque and other disorders related to gums.

Objective:

The present review aims towards the combined review as well as compilation of available herbs under the category of various dental associated problems.

Materials and Methods:

The herbs were studied by sectioning them as for looking after different works or findings done against dental caries, tooth ache, scouring teeth, gum troubles and herbs as mouth fresheners.

Results:

Herbal extracts have been used on a large scale in dentistry as tooth cleansing and antimicrobial plaque agents. Many people take herbal derived medicines or herbal based products for the purpose of reducing inflammation, as antimicrobial agents, for preventing release of histamine and as antiseptics, antioxidants, antifungals, antibacterials, antivirals and analgesics. Herbal extracts are used in dentistry for treatment of various dental disorders.

Conclusion:

The use of herbal medicines are blooming rapidly across the world. Herbal extracts and the various herbs on the whole or their specific parts have been used in dentistry. They relieve the problems of gums and act as excellent mouth fresheners. The natural herbal remedies act as an effective substitute to antibiotics and represent a promising approach for prevention and as therapeutic strategies for various oral infections as they are natural, eradicate the problem from its root and provide long lasting relief. The herbal remedies are advantageous over conventional treatment.

Effect of herbal mouthrinses on dental plaque formation and gingival inflammation: A systematic review

To evaluate the effect of herbal mouthrinses as an adjuvant to oral hygiene on dental plaque and gingival inflammation in subjects with gingivitis. Searches were conducted in the PubMed/MEDLINE, Cochrane-CENTRAL, EMBASE, Web of Science, LILACS/BIREME, Clinical Trials Registry and grey literature for Randomised Clinical Trials (RCTs) published up to April 2018 without language restrictions. From 4,013 paper found, 20 studies met the eligibility criteria and were included. The herbal mouthrinses achieved significant reductions in dental plaque and gingival inflammation compared to placebo rinses. Five herbal products (Camelia sinensis, Azadirachta indica, Anacardium occidentale Linn, Schinus terebinthifolius and Curcuma longa) showed better results than chlorhexidine in dental plaque and gingival inflammation reductions. However, the unclear risk of bias of most included RCTs precludes definitive conclusions. Therefore, it is necessary to improve the design of future RCT in other reduced potential bias that may affect the degree of precision of treatment outcomes in order to evaluate the effect size and clinical relevance of herbal mouthrinses.

Adverse events associated with home use of mouthrinses: a systematic review

Background

Poor oral hygiene is strongly associated with oral and systemic diseases. Alongside mechanical tooth cleaning, the adjunctive use of mouthrinses has been widely advocated. Although research on the efficacy of various mouthrinse formulations is very active, there are a lack of conclusive data regarding their adverse effects.

Methods

We undertook a systematic review in accordance wih PRISMA guidelines of electronic databases of clinical trials of any duration with daily home use of mouthwashes, presenting clinical and subjective side effects (PROSPERO registration: CRD42016054037).

Results

After evaluating 614 titles and abstracts, 154 studies were selected for full-text analysis; 85 final papers were included. Based on the active ingredient in the test product, nine categories were created: cetyl pyridinium chloride, essential oils, chlorhexidine, triclosan, natural products, diclofenac, fluorides, delmopinol, and miscellaneous active substances. Most of the studies were of short duration (less than 6 months) with a defective 'methods' description; the reporting of adverse events often being overlooked. Both local morphological (oral mucosa and dental-crown staining, mucosal lesions) and functional (taste modifications, abnormal oral sensation) alterations were reported. Tooth staining was the most commonly listed adverse event, but it was quantitatively assessed only in a very small number of papers; most studies relied on patient reports. Staining was time associated; the longer the study, the higher its reported incidence and severity.

Conclusions

The reduced report of side effects may partly be due to a lack of an objective measure and lack of general guidelines that demand studies report their adverse events. The most frequently reported adverse effect was teeth staining. As in most studies, the effect was associated with trial duration; clinical trials should be of sufficient duration. New investigations meeting the suggested criteria of a minimal duration of 6 months should be planned.

Effects of Caesalpinia sappan on pathogenic bacteria causing dental caries and gingivitis

The present study explores antimicrobial activities of Caesalpinia sappan extracts against three strains of oral pathogenic bacteria; Streptococcus mutans DMST9567 (Smu9), Streptococcus mutans DMST41283 (Smu4), and Streptococcus intermedius DMST42700 (Si). Ethanol crude extract of C. sappan (Cs-EtOH) was firstly compared to that of other medicinal plants using disc diffusion method. Cs-EtOH showed significantly higher effective inhibition against all tested strains than other extracts and 0.12% chlorhexidine with the inhibition zone of 17.5 ± 0.5, 18.5 ± 0.0, and 17.0 ± 0.0 mm against Smu9, Smu4, and Si, respectively. Three fractionated extracts of C. sappan using hexane, ethyl acetate, and ethanol, respectively, were further investigated. The fractionated extract from ethanol (F-EtOH) presented the strongest activities with the minimum bactericidal concentration (MBC) of 125-250 µg/mL. Killing kinetics of F-EtOH was depended on the bacterial species and the concentration of F-EtOH. Two-fold MBC of F-EtOH could kill all tested strains within 12 h whereas its 4-fold MBC showed killing effect against Si within 6 h. Separation of F-EtOH by column chromatography using chloroform/methanol mixture as an eluent yielded 11 fractions (F1-F11). The fingerprints of these fractions by high-performance liquid chromatography at 280 nm revealed that F-EtOH consisted of at least 5 compounds. F6 possessed the significantly highest antimicrobial activity among 11 fractions, however less than F-EtOH. It is considered that F-EtOH is the promising extract of C. sappan for inhibiting oral pathogenic bacteria and appropriate as natural antiseptic for further develop of oral hygiene products.

Mechanical and Morphological Effect of Plant Based Antimicrobial Solutions on Maxillofacial Silicone Elastomer

The objective of this study was to determine the effect of plant based antimicrobial solutions specifically tea tree and Manuka oil on facial silicone elastomers. The purpose of this in vitro study was to evaluate the effect of disinfection with plant extract solution on mechanical properties and morphology on the silicone elastomer. Test specimens were subjected to disinfection using tea tree oil, Manuka oil and the staphylococcus epidermidis bacteria. Furthermore, a procedure duration was used in the disinfection process to simulate up to one year of usage. Over 500 test specimens were fabricated for all tests performed namely hardness, elongation, tensile, tear strength tests, visual inspection and lastly surface characterization using SEM. A repeated measures ANOVA revealed that hardness and elongation at break varied significantly over the time period, whereas this was not observed in the tear and tensile strength parameters of the test samples.

Composition and Antibacterial Activity of the Essential Oils of Orthosiphon stamineus Benth and Ficus deltoidea Jack against Pathogenic Oral Bacteria

In this study, the essential oils of Orthosiphon stamineus Benth and Ficus deltoidea Jack were evaluated for their antibacterial activity against invasive oral pathogens, namely Enterococcus faecalis, Streptococcus mutans, Streptococcus mitis, Streptococcus salivarius, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Fusobacterium nucleatum. Chemical composition of the oils was analyzed using gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). The antibacterial activity of the oils and their major constituents were investigated using the broth microdilution method (minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC)). Susceptibility test, anti-adhesion, anti-biofilm, checkerboard and time-kill assays were also carried out. Physiological changes of the bacterial cells after exposure to the oils were observed under the field emission scanning electron microscope (FESEM). O. stamineus and F. deltoidea oils mainly consisted of sesquiterpenoids (44.6% and 60.9%, respectively), and β-caryophyllene was the most abundant compound in both oils (26.3% and 36.3%, respectively). Other compounds present in O. stamineus were α-humulene (5.1%) and eugenol (8.1%), while α-humulene (5.5%) and germacrene D (7.7%) were dominant in F. deltoidea. The oils of both plants showed moderate to strong inhibition against all tested bacteria with MIC and MBC values ranging 0.63-2.5 mg/mL. However, none showed any inhibition on monospecies biofilms. The time-kill assay showed that combination of both oils with amoxicillin at concentrations of 1× and 2× MIC values demonstrated additive antibacterial effect. The FESEM study showed that both oils produced significant alterations on the cells of Gram-negative bacteria as they became pleomorphic and lysed. In conclusion, the study indicated that the oils of O. stamineus and F. deltoidea possessed moderate to strong antibacterial properties against the seven strains pathogenic oral bacteria and may have caused disturbances of membrane structure or cell wall of the bacteria.

The Effect of Calendula officinalis on Oxidative Stress and Bone Loss in Experimental Periodontitis

Periodontitis is associated with reduced antioxidant capacity and increased oxidative damage. Oxidative stress induces inflammation and bone loss contributing to the pathological progression of periodontal disease. Calendula officinalis (CLO) has demonstrated anti-inflammatory and anti-oxidant activities. Therefore, the aim of this study was to evaluate the effect of CLO on oxidative stress and bone loss in rats subjected to experimental periodontitis (EP). For this, 72 male Wistar rats were divided into groups: Naïve, Saline (SAL) and CLO. Rats received SAL or CLO (90 mg/kg) 30 min before ligature and daily until the 11th day. Naïve group experienced no manipulation. After 11 days, the animals were euthanized and left maxillae collected for macroscopic analysis of alveolar bone loss (ABL). Periodontium was analyzed by macroscopy, scanning electron microscopy; confocal and light polarized microscopy. Immunohistochemical examination of DKK1, WNT 10b and β-catenin was performed. The gingival tissue was collected to reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and malondialdehyde (MDA) analyses. The 11 days of ligature induced bone loss, breakdown of collagen fibers, increased the immunostaining DKK-1 while reduced WNT 10b and β-catenin expressions. Periodontitis reduced GSH, SOD, CAT and increase MDA. All findings were reversed by 90 mg/kg of CLO. In summary our findings demonstrated that CLO reduced oxidative stress and bone loss and preserved collagen fibers in rats with EP, with participation of WNT signaling pathway.

Effects of chlorhexidine, essential oils and herbal medicines (Salvia, Chamomile, Calendula) on human fibroblast in vitro

Antiseptic rinses have been successfully used in inflammatory states of the gums and oral cavity mucosa. Antibacterial effects of chlorhexidine, essential oils and some herbs are well documented. Reaction of host tissue to these substances has much poorer documentation. The aim of the study was to analyse the influence of chlorhexidine (CHX), essential oil (EO: thymol, 0.064%; eucalyptol, 0.092%; methyl salicylate, 0.060%; menthol, 0.042%) mouth rinses and salvia, chamomile and calendula brews on fibroblast biology in vitro. The human fibroblast CCD16 line cells were cultured in incubation media which contained the examined substances. After 24 and 48 hours, the cell morphology, relative growth and apoptosis were evaluated. Exposure of fibroblasts to CHX, EO or salvia caused various changes in cell morphology. Cells cultured for 48 hours with CHX revealed a noticeably elongated shape of while cells cultured in high EO concentration or with salvia were considerably smaller and contracted with fewer projections. Chlorhexidine, EO and salvia reduced the fibroblast proliferation rate and stimulated cell death. Both reactions to EO were dose dependent. Cells exposure to chamomile or calendula brews did not change morphology or proliferation of fibroblasts. The results of this in vitro study showed that in contrast to chamomile and calendula, the brews of EO, CHX or salvia had a negative influence on fibroblast biology.

Essential oils and metal ions as alternative antimicrobial agents: a focus on tea tree oil and silver

The increasing occurrence of hospital-acquired infections and the emerging problems posed by antibiotic-resistant microbial strains have both contributed to the escalating cost of treatment. The presence of infection at the wound site can potentially stall the healing process at the inflammatory stage, leading to the development of a chronic wound. Traditional wound treatment regimes can no longer cope with the complications posed by antibiotic-resistant strains; hence, there is a need to explore the use of alternative antimicrobial agents. Pre-antibiotic compounds, including heavy metal ions and essential oils, have been re-investigated for their potential use as effective antimicrobial agents. Essential oils have potent antimicrobial, antifungal, antiviral, anti-inflammatory, antioxidant and other beneficial therapeutic properties. Similarly, heavy metal ions have also been used as disinfecting agents because of their broad spectrum activities. Both of these alternative antimicrobials interact with many different intracellular components, thereby resulting in the disruption of vital cell functions and eventually cell death. This review will discuss the application of essential oils and heavy metal ions, particularly tea tree oil and silver ions, as alternative antimicrobial agents for the treatment of chronic, infected wounds.

Evaluation of the efficacy of a polyherbal mouthwash containing Zingiber officinale, Rosmarinus officinalis and Calendula officinalis extracts in patients with gingivitis: A randomized double-blind placebo-controlled trial

BACKGROUND

Gingivitis is a highly prevalent periodontal disease resulting from microbial infection and subsequent inflammation. The efficacy of herbal preparations in subjects with gingivitis has been reported in some previous studies.

OBJECTIVE

To investigate the efficacy of a polyherbal mouthwash containing hydroalcoholic extracts of Zingiber officinale, Rosmarinus officinalis and Calendula officinalis (5% v/w) compared with chlorhexidine and placebo mouthwashes in subjects with gingivitis.

METHODS

Sixty patients participated in this randomized double-blind placebo-controlled trial and were randomly assigned to the polyherbal mouthwash (n = 20), chlorhexidine mouthwash (n = 20) or placebo mouthwash (n = 20). Participants were instructed to use the mouthwash twice a day (after breakfast and dinner) for 30 s for a period of two weeks. Gingival and plaque indices were assessed using MGI, GBI and MQH scales at baseline, day 7 and day 14 of the trial.

RESULTS

There were significant improvements in all assessed efficacy measures i.e. MGI, GBI and MQH scores from baseline to the end of trial in both polyherbal and chlorhexidine mouthwash groups; however, the scores remained statistically unchanged in the placebo group. MGI, BGI and MQH scores in the treatment groups were significantly lower compared with those of the control group at both day 7 and day 14 of the trial. However, there was no significant difference between the polyherbal and chlorhexidine groups, neither at day 7 nor day 14 of the trial. Polyherbal mouthwash was safe and there was neither report of adverse reactions, nor any drop-out during the course of study.

CONCLUSION

Polyherbal mouthwash containing hydroalcoholic extracts of Z. officinale, R. officinalis and C. officinalis (5%) was effective in the treatment of gingivitis and its efficacy was comparable to that of chlorhexidine mouthwash.

Comparing the antiplaque efficacy of 0.5% Camellia sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children

BACKGROUND

Dental caries is a multifactorial disease which requires a susceptible host, a cariogenic microflora, and a suitable substrate that must be present for a sufficient length of time. Tea is prepared by the infusion of dried leaves of the tea plant, Camellia sinensis, which contains bioactive compounds like polyphenols, flavonoids, and catechins that are thought to be responsible for the health benefits that have traditionally been attributed to tea. These compounds have multidimensional effects such as antibacterial action, inhibitory action on the bacterial and salivary amylase, and inhibition of acid production.

AIMS

The aim of this study is to compare the antiplaque efficacy of 0.5% C. sinensis extract, 0.05% sodium fluoride, and 0.2% chlorhexidine gluconate mouthwash in children.

MATERIALS AND METHODS

A randomized blinded controlled trial with 60 healthy children of age group 9-14 years was carried out. The subjects were randomly assigned to three groups, i.e. group A - 0.2% chlorhexidine gluconate, group B - 0.05% sodium fluoride, and group C - 0.5% C. sinensis extract, with 20 subjects per group. Plaque accumulation and gingival condition were recorded using plaque index and gingival index. Oral hygiene was assessed by simplified oral hygiene index (OHIS). Salivary pH was assessed using indikrom pH strips. Plaque, gingival, and simplified OHI scores as well as salivary pH were recorded at baseline, immediately after first rinse, after 1 week, and in the 2(nd) week.

STATISTICAL ANALYSIS USED

The data were analyzed using a computer software program (SPSS version 17). Analysis of variance (ANOVA) tests were used to identify significant differences between the means of the study groups. Finally, paired t-tests were used to assess the significance of changes within each group between time periods. Critical P values of significance were set at 0.05 and the confidence level set at 95%.

RESULTS

Mean plaque and gingival scores were reduced over the 2-week trial period in the experimental groups. Antiplaque effectiveness was observed in all groups, the highest being in group C (P < 0.05). Chlorhexidine gluconate and tea showed comparative effectiveness on gingiva better than sodium fluoride (P < 0.05). The salivary pH increase was sustained and significant in groups B and C compared to group A. Oral hygiene improvement was better appreciated in groups A and C.

CONCLUSIONS

The effectiveness of 0.5% C. sinensis extract was more compared to 0.05% sodium fluoride and 0.2% chlorhexidine gluconate mouth rinses. It should be explored as a cost-effective and safe long-term adjunct to oral self-care of patients as it has prophylactic benefits with minimum side effects.

Antibacterial Activity of Essential Oils and Their Isolated Constituents against Cariogenic Bacteria: A Systematic Review

Dental caries remains the most prevalent and costly oral infectious disease worldwide. Several methods have been employed to prevent this biofilm-dependent disease, including the use of essential oils (EOs). In this systematic review, we discuss the antibacterial activity of EOs and their isolated constituents in view of a potential applicability in novel dental formulations. Seven databases were systematically searched for clinical trials, in situ, in vivo and in vitro studies addressing the topic published up to date. Most of the knowledge in the literature is based on in vitro studies assessing the effects of EOs on caries-related streptococci (mainly Streptococcus mutans) and lactobacilli, and on a limited number of clinical trials. The most promising species with antibacterial potential against cariogenic bacteria are: Achillea ligustica, Baccharis dracunculifolia, Croton cajucara, Cryptomeria japonica, Coriandrum sativum, Eugenia caryophyllata, Lippia sidoides, Ocimum americanum, and Rosmarinus officinalis. In some cases, the major phytochemical compounds determine the biological properties of EOs. Menthol and eugenol were considered outstanding compounds demonstrating an antibacterial potential. Only L. sidoides mouthwash (1%) has shown clinical antimicrobial effects against oral pathogens thus far. This review suggests avenues for further non-clinical and clinical studies with the most promising EOs and their isolated constituents bioprospected worldwide.

Effects of the medicinal plants Curcuma zedoaria and Camellia sinensis on halitosis control

Volatile sulphur compounds (VSC) are the gases mainly responsible for halitosis (bad breath). The aim of this research was to evaluate the effects of medicinal plants on halitosis control. Two commonly used plants were tested: Curcuma zedoaria and Camellia sinensis (green tea). These plants were prepared as an aqueous solution and used as mouthwashes, compared with a standard mouthwash of 0.12% chlorhexidine gluconate and a placebo (water). The experiment was conducted with 30 volunteers from the School of Dentistry of São Jose dos Campos, Univ. Estadual Paulista - UNESP, SP, Brazil. Each volunteer tested the four mouthwashes. The Cysteine Challenge Method, modified for this study, was used for initial breath standardization. Four breath assessments were conducted after volunteers rinsed orally with acetylcysteine: one before the test mouthwash was used; the second, one minute after its use; a third 90 minutes later; and the last 180 minutes later. The results showed that chlorhexidine gluconate lowered VSC production immediately, and that this effect lasted up to 3 hours, while the tested plants had immediate inhibitory effects but no residual inhibitory effects on VSC. We concluded that Curcuma zedoaria and Camellia sinensis, prepared as infusions and used as mouthwashes, did not have a residual neutralizing effect on VSC.

Antimicrobial activity of Calendula officinalis, Camellia sinensis and chlorhexidine against the adherence of microorganisms to sutures after extraction of unerupted third molars

Objective

The objective of this study was to compare the antimicrobial effect of mouthwashes containing Calendula officinalis L., Camellia sinensis (L.) Kuntze and 0.12% chlorhexidine digluconate on the adherence of microorganisms to suture materials after extraction of unerupted third molars.

Material and Methods

Eighteen patients with unerupted maxillary third molars indicated for extraction were selected (n=6 per mouthwash). First, the patients were subjected to extraction of the left tooth and instructed not to use any type of antiseptic solution at the site of surgery (control group). After 15 days, the right tooth was extracted and the patients were instructed to use the Calendula officinalis, Camellia sinensis or chlorhexidine mouthwash during 1 week (experimental group). For each surgery, the sutures were removed on postoperative day 7 and placed in sterile phosphate-buffered saline. Next, serial dilutions were prepared and seeded onto different culture media for the growth of the following microorganisms: blood agar for total microorganism growth; Mitis Salivarius bacitracin sucrose agar for mutans group streptococci; mannitol agar for Staphylococcus spp.; MacConkey agar for enterobacteria and Pseudomonas spp., and Sabouraud dextrose agar containing chloramphenicol for Candida spp. The plates were incubated during 24-48 h at 37ºC for microorganism count (CFU/mL).

Results

The three mouthwashes tested reduced the number of microorganisms adhered to the sutures compared to the control group. However, significant differences between the control and experimental groups were only observed for the mouthwash containing 0.12% chlorhexidine digluconate.

Conclusions

Calendula officinalis L. and Camellia sinensis (L.) Kuntze presented antimicrobial activity against the adherence of microorganisms to sutures but were not as efficient as chlorhexidine digluconate.

Traditional Medicinal Plant Extracts and Natural Products with Activity against Oral Bacteria: Potential Application in the Prevention and Treatment of Oral Diseases

Oral diseases are major health problems with dental caries and periodontal diseases among the most important preventable global infectious diseases. Oral health influences the general quality of life and poor oral health is linked to chronic conditions and systemic diseases. The association between oral diseases and the oral microbiota is well established. Of the more than 750 species of bacteria that inhabit the oral cavity, a number are implicated in oral diseases. The development of dental caries involves acidogenic and aciduric Gram-positive bacteria (mutans streptococci, lactobacilli and actinomycetes). Periodontal diseases have been linked to anaerobic Gram-negative bacteria (Porphyromonas gingivalis, Actinobacillus, Prevotella and Fusobacterium). Given the incidence of oral disease, increased resistance by bacteria to antibiotics, adverse affects of some antibacterial agents currently used in dentistry and financial considerations in developing countries, there is a need for alternative prevention and treatment options that are safe, effective and economical. While several agents are commercially available, these chemicals can alter oral microbiota and have undesirable side-effects such as vomiting, diarrhea and tooth staining. Hence, the search for alternative products continues and natural phytochemicals isolated from plants used as traditional medicines are considered as good alternatives. In this review, plant extracts or phytochemicals that inhibit the growth of oral pathogens, reduce the development of biofilms and dental plaque, influence the adhesion of bacteria to surfaces and reduce the symptoms of oral diseases will be discussed further. Clinical studies that have investigated the safety and efficacy of such plant-derived medicines will also be described.

The effects of different oral care protocols on mucosal change in orally intubated patients from an intensive care unit

AIM

To compare the effectiveness of three different oral care protocols in intubated patients.

BACKGROUND

Although oral care is important to improve the oral mucosa integrity in intubated patients, there are few evidence-based nursing protocols to deal with this problem in critical care units.

DESIGN

A quasi-experimental design was employed for this study.

METHODS

Eighty-one orally intubated patients recruited from the intensive care unit of a medical centre in northern Taiwan were employed in this study. Patients were divided into three treatment groups: a control group (n = 27), green tea group (n = 29) and boiled water group (n = 25). Oral mucosal status was monitored using a rating scale for 14 days. All data were analysed by the sas software (version 8.2; SAS Institute, Cary, NC, USA) using descriptive statistics, the Kruskal-Wallis H test and generalised estimating equation regression models.

RESULTS

Severity of mucosal change was significantly less on six subscales (labial mucosa, tongue mucosa, gingival colour, gingivitis, salivary status and amount of dental plaque) in the boiled water group than the control group (p < 0·05). In addition, severity was significantly less on two subscales (salivary status and amount of dental plaque) in the green tea group than the control group (p < 0·05).

CONCLUSIONS

Both boiled water and green tea oral care protocols may improve mucosal status of orally intubated patients. Mucosal status was significantly more improved by oral care with boiled water than by oral care with green tea.

RELEVANCE TO CLINICAL PRACTICE

Because oral care plays an important role in improving mucosal status, nurses are urged to find new effective oral care methods to further reduce the occurrence of oropharyngeal colonisation and ventilator-associated pneumonia in intubated patients.

Acaricidal activity of triketone analogues derived from Leptospermum scoparium oil against house-dust and stored-food mites

BACKGROUND

Various attempts to control the populations of house-dust and stored-food mites have been implemented using synthetic chemicals. Although effective, the repeated use of these chemicals has led to resistance owing to the mite's high reproductive potential and short life cycle. Therefore, this study aimed to develop natural acaricides using oils derived from Leptospermum scoparium JR & G Forst., which may affect the overall biological activity of a mite without adverse effects. Results were compared with those from using benzyl benzoate and N,N-diethyl-3-methylbenzamide (DEET).

RESULTS

The LD(50) values of L. scoparium oil were 0.54, 0.67 and 1.12 microg cm(-2) against Dermatophagoides farinae (Hughes), D. pteronyssinus (Troussart) and Tyrophagus putrescentiae (Schrank) respectively. The active constituent isolated from L. scoparium was identified as leptospermone (6-isovaleryl-2,2,4,4-tetramethyl-1,3,5-cyclohexanetrione) by spectroscopic analysis. Based on the LD(50) values of leptospermone and its derivatives, the most toxic compound against D. farinae was leptospermone (0.07 microg cm(-2)), followed by 2,2,4,4,6,6-hexamethyl-1,3,5-cyclohexanetrione (1.21 microg cm(-2)), benzyl benzoate (10.03 microg cm(-2)) and DEET (37.12 microg cm(-2)). Furthermore, similar results were observed when the leptospermone and its derivatives were tested against D. pteronyssinus and T. putrescentiae.

CONCLUSIONS

These results indicate that L. scoparium oil-derived materials, particularly leptospermone and 2,2,4,4,6,6-hexamethyl-1,3,5-cyclohexanetrione, have potential for development as new agents for the control of three species of mite.