Adjunctive use of essential oils following scaling and root planing -a randomized clinical trial

Unleashing nature's defense: potent antimicrobial power of plant extracts against oral pathogens and Streptococcus mutans biofilms

Objectives

The increasing demand for alternatives to antibiotics against resistant bacteria has led to research on natural products. The aim of this study was to analyze the antimicrobial and antibiofilm activity of 16 Mediterranean herb extracts.

Materials and methods

The extracts were analyzed using High Performance Thin Layer Chromatography. The minimum inhibitory concentration and minimum bactericidal concentration of the extracts from Achillea taygetea, Cistus creticus ssp. creticus, Cistus monspeliensis, Lavandula stoechas, Mentha aquatica, Mentha longifolia, Origanum vulgare, Phlomis cretica, Rosmarinus officinalis, Salvia sclarea, Satureja parnassica, Satureja thymbra, Sideritis euboea, Sideritis syriaca, Stachys spinosa, and Thymus longicaulis were determined against eight oral bacteria and fungus Candida albicans. Microtiter plate test was conducted to evaluate the antibiofilm activity against Streptococcus mutans.

Results

Overall, all tested extracts efficiently suppressed the growth of obligate anaerobic bacteria. When applied at concentrations ≥0.15 mg/ml, the extracts exhibited moderate to high antibiofilm activity comparable to that of chlorhexidine (CHX) against S. mutans. Interestingly, R. officinalis (MIC: 0.01-0.06 mg/ml) and O. vulgare (MIC: 0.04-1.25 mg/ml) demonstrated the highest antibacterial activity against oral bacteria. Additionally, R. officinalis and L. stoechas significantly inhibited S. mutans biofilm formation at 0.15 mg/ml.

Conclusions

The tested plant extracts can be considered as alternative natural antimicrobial and antibiofilm agents.

Clinical relevance

Mediterranean herb extracts show promise as natural alternatives to combat oral bacteria and biofilm formation, offering potential new therapies for infectious oral diseases in the context of antibiotic resistance.

A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

Periodontitis is a common chronic inflammatory disease of the supporting tissues of the tooth that involves a complex interaction of microorganisms and various cell lines around the infected site. To prevent and treat this disease, several options are available, such as scaling, root planning, antibiotic treatment, and dental surgeries, depending on the stage of the disease. However, these treatments can have various side effects, including additional inflammatory responses, chronic wounds, and the need for secondary surgery. Consequently, numerous studies have focused on developing new therapeutic agents for more effective periodontitis treatment. This review explores the latest trends in bioactive substances with therapeutic effects for periodontitis using various search engines. Therefore, this study aimed to suggest effective directions for therapeutic approaches. Additionally, we provide a summary of the current applications and underlying mechanisms of bioactive substances, which can serve as a reference for the development of periodontitis treatments.

Exploring the Clinical Applications of Lemongrass Essential Oil: A Scoping Review

Lemongrass is a medicinal plant that produces essential oil with a variety of therapeutic properties. Although lemongrass essential oil (LGEO) is promising in clinical applications, the existing knowledge on the efficacy and safety of LGEO remains limited. This scoping review aimed to identify, summarize, and synthesize existing literature related to the clinical applications of LGEO to provide an overview of its potential therapeutic benefits for patients. Three databases (PubMed, Web of Science, Scopus) were used following the PRISMA-ScR guidelines to find articles published between 1 January 2013, and 1 November 2022. A total of 671 records were identified and 8 articles were included in this scoping review. The majority of patients received oromucosal and topical treatment. The results of the studies suggest that LGEO might be a useful tool in the treatment of periodontitis, gingivitis and oral malodour, with similar efficacy to chlorhexidine (anti-gingivitis effect) and doxycycline (periodontitis). Additionally, LGEO has the potential for treating pityriasis versicolor and preventing skin aging and may have anti-dandruff effects. These findings not only underscore the diverse clinical potential of LGEO but also emphasize its comparable efficacy to established treatments. Further research is imperative to comprehensively evaluate LGEO's effectiveness, safety, mechanisms of action, potential interactions with other medications, and its long-term tolerability across diverse populations.

Aesthetic Radiofrequency Associated with Rosmarinus officinalis Supplementation is Safe and Reduces Oxidative Stress in Women: Randomized, and Double-Blind Clinical Trial

The objective were to evaluate the effects of supplementation of standardized dry extract of Rosmarinus officinalis (RO) and the application of aesthetic radiofrequency on the oxidative stress markers catalase (CAT), superoxide dismutase (SOD), non-protein thiols (NP-SH), and thiobarbituric acid reactive species (TBARS) and the biochemical markers triglycerides, total cholesterol, high density lipoprotein (HDL) cholesterol, glutamic-oxaloacetic transaminase (TGO/AST), pyruvic-glutamic transaminase (TGP/ALT), gamma glutamyl transpeptidase (gamma-GT), and creatinine. This study included 32 women received the aesthetic therapy to reduce localized fat. They were divided into the control group (n = 8) receiving placebo capsules and the intervention group (n = 24) subdivided into Group A, B, and C, each with eight members receiving supplementation with 100, 500, and 1000 mg/day of standardized dry extract of RO, respectively. The Universal Trial Number (UTN) - U1111-1274-6255. Supplementation with RO (500 mg/day) demonstrated a reduction in oxidative stress (quantified with through a significant increase in NP-SH and a reduction in SOD and CAT enzymes). The radiofrequency aesthetic treatment did not promote an increase in oxidative stress; however, it caused significant changes in total cholesterol, HDL cholesterol, and creatinine. RO is a plant with antioxidant effects and its oral consumption is safe in selected women subjects in hepatic and renal markers.

Supra and subgingival application of antiseptics or antibiotics during periodontal therapy

Periodontal diseases (gingivitis and periodontitis) are characterized by inflammatory processes which arise as a result of disruption of the balance in the oral ecosystem. According to the current S3 level clinical practice guidelines, therapy of patients with periodontitis involves a stepwise approach that includes the control of the patient's risk factors and the debridement of supra and subgingival biofilm. This debridement can be performed with or without the use of some adjuvant therapies, including physical or chemical agents, host modulating agents, subgingivally locally delivered antimicrobials, or systemic antimicrobials. Therefore, the main aim of this article is to review in a narrative manner the existing literature regarding the adjuvant application of local agents, either subgingivally delivered antibiotics and antiseptics or supragingivally applied rinses and dentifrices, during the different steps in periodontal therapy performed in Europe.

Green Alternatives as Antimicrobial Agents in Mitigating Periodontal Diseases: A Narrative Review

Periodontal diseases and dental caries are the most common infectious oral diseases impacting oral health globally. Oral cavity health is crucial for enhancing life quality since it serves as the entranceway to general health. The oral microbiome and oral infectious diseases are strongly correlated. Gram-negative anaerobic bacteria have been associated with periodontal diseases. Due to the shortcomings of several antimicrobial medications frequently applied in dentistry, the lack of resources in developing countries, the prevalence of oral inflammatory conditions, and the rise in bacterial antibiotic resistance, there is a need for reliable, efficient, and affordable alternative solutions for the prevention and treatment of periodontal diseases. Several accessible chemical agents can alter the oral microbiota, although these substances also have unfavorable symptoms such as vomiting, diarrhea, and tooth discoloration. Natural phytochemicals generated from plants that have historically been used as medicines are categorized as prospective alternatives due to the ongoing quest for substitute products. This review concentrated on phytochemicals or herbal extracts that impact periodontal diseases by decreasing the formation of dental biofilms and plaques, preventing the proliferation of oral pathogens, and inhibiting bacterial adhesion to surfaces. Investigations examining the effectiveness and safety of plant-based medicines have also been presented, including those conducted over the past decade.

Antimicrobial and Cytotoxic Activity of Ocimum tenuiflorum and Stevia rebaudiana-Mediated Silver Nanoparticles - An In vitro Study

Background

Silver nanoparticles (AgNPs) are the nanoparticles of silver between 1 nm and 100 nm in size. In this study, AgNPs were extracted from Ocimum tenuiflorum and Stevia rebaudiana which is a medicinal plant of Indian origin, worshipped by the Hindus and used in Ayurvedic medicine since ancient times.

Aim

The aim of the study was to assess the antimicrobial and cytotoxic effect of AgNPs reinforced with the herb O. tenuiflorum and S. rebaudiana against oral pathogens.

Materials and Methods

In this in vitro study, the organisms used were Streptococcus mutans, Staphylococcus aureus, Lactobacillus sp., and Candida albicans. Agar well-diffusion method was used to assess the antimicrobial efficacy of the nanoparticles at 25 mL, 50 mL, and 100 mL. To assess the cytotoxic effect, brine shrimp lethality assay was used.

Results

Zone of inhibition was found to be highest at 100 mL against S. mutans, S. aureus, Lactobacillus sp., and C. albicans. The cytotoxic activity at 5 mL and 10 mL was 0%. The maximum cytotoxicity was seen at 80 mL where 30% of the Nauplii's died.

Conclusion

The findings from this study suggest that AgNPs reinforced with O. tenuiflorum and S. rebaudiana extracts has the potential as an antimicrobial agent and has less cytotoxic effect on brime shrimp and can be used as an alternative to commercially available antimicrobial agents.

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.

The effect of Brazilian propolis type-3 against oral microbiota and volatile sulfur compounds in subjects with morning breath malodor

OBJECTIVES

To evaluate propolis type-3 mouthrinse effects on the concentration of volatile sulfur compounds (VSCs) and on tongue dorsum microbial profile.

MATERIALS AND METHODS

A three-step double-blind, crossover, randomized study with 10 individuals divided into three groups: I-placebo (P); II-ethanolic extract of propolis type-3 3% (EEP); and III-chlorhexidine 0.12% (CHX) and instructed to rinse twice daily for 5 days. Each experimental period was followed by a 21-day washout interval. Morning mouth breath was assessed by VSC concentrations and microbiological samples were obtained from tongue dorsum at baseline and the end of period of rinses and analyzed using checkerboard DNA-DNA hybridization technique for 39 bacterial species.

RESULTS

CHX and EEP presented the lowest VSC concentration when compared with placebo (p < 0.05). Even in the absence of mechanical plaque control, CHX and EEP treatments reduced VSC levels and there were no statistical differences for VSC measurement between CHX and EEP. There was a significant reduction in mean counts of 10 species including some VSC producers (Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) by EEP. Total counts of organisms, gram-negative and gram-positive bacterial species showed a decrease for EEP and CHX (p < 0.05). In addition, no statistical difference was observed between EEP and CHX (p > 0.05). A positive correlation was observed between decrease of bacterial counts and decrease of VCSs concentration for the EEP and CHX.

CONCLUSIONS

The use of a 3% propolis type-3 mouthrinse is an effective way to prevent morning bad breath. Thus, propolis may be a promising agent for the treatment of halitosis.

CLINICAL RELEVANCE

Propolis type-3 may be used as adjuvant treatment for morning breath malodor.

Screening strategies for quorum sensing inhibitors in combating bacterial infections

Interference with quorum sensing (QS) represents an antivirulence strategy with a significant promise for the treatment of bacterial infections and a new approach to restoring antibiotic tolerance. Over the past two decades, a novel series of studies have reported that quorum quenching approaches and the discovery of quorum sensing inhibitors (QSIs) have a strong impact on the discovery of anti-infective drugs against various types of bacteria. The discovery of QSI was demonstrated to be an appropriate strategy to expand the anti-infective therapeutic approaches to complement classical antibiotics and antimicrobial agents. For the discovery of QSIs, diverse approaches exist and develop in-step with the scale of screening as well as specific QS systems. This review highlights the latest findings in strategies and methodologies for QSI screening, involving activity-based screening with bioassays, chemical methods to seek bacterial QS pathways for QSI discovery, virtual screening for QSI screening, and other potential tools for interpreting QS signaling, which are innovative routes for future efforts to discover additional QSIs to combat bacterial infections.

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Interference with QSrepresents a promising antivirulence strategy for the treatment of bacterial infections. The discovery ofQSIs was demonstrated as an appropriate strategy to expand the anti-infective therapeutic arsenal to complement classical antibiotics and antimicrobial agents.

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For the discovery of QSIs, diverse approaches exist and develop in-step with the scale of screening and targeted QS systems.

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Few previous reviews have summarized the strategies and approaches of QSI screening, whereas this review highlights the recent findings in QSI screening strategies and methodologies.

The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies

BACKGROUND

Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified.

OBJECTIVES

This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients.

MATERIALS AND METHODS

Placebo-controlled RCTs with ≥6 months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified.

RESULTS

Fifty eight studies met the inclusion criteria. After 6 months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83 mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed.

CONCLUSIONS

Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safety need to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of other host modulators.

Effect of essential oils on oral halitosis treatment: a review

Halitosis is a very common condition which may affect up to 30% of the population. In about 90% of the cases, halitosis originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth. Oral malodor is mainly caused by a microbial degradation of amino acids into volatile, bad-smelling gases (volatile sulfur compounds - VSCs). Management of oral malodor is directed primarily at managing and reducing the VSC-producing bacteria count as well as masking the odor. Essential oils have been used for this purpose in traditional medicine for centuries. In the present review, data on the antimicrobial activity of essential oils against relevant oral VSC-producing bacteria are compiled and compared. Additionally, other positive aspects of essential oils with regard to oral odor are considered.

How to bridge the gap? European medical plants used for treating oral mucositis: on the search for evidence

PURPOSE

Oral mucositis is a common, painful side effect of cancer treatment-be it locoregional (e.g. irradiation) or systemic (e. g. chemotherapy). Phytotherapy is often used by patients to alleviate symptoms. However, knowledge on which medical plants are recommended by literature about Traditional European Medicine (TEM), their effect(s) on symptoms and their efficacy is severely lacking. Therefore, we developed a novel approach to assess traditional knowledge of herbals used in TEM and searched the online databases for studies reporting effects of these plants.

METHODS

At first, online research did not yield a satisfying number of studies (MESH terms: "mucositis" OR "stomatitis" AND "herbal" OR "herbal medicine"). Trials were labelled by the country conducting the study. In parallel, we compiled a list of 78 plants recommended for treating oral mucositis by screening 14 books on TEM. Then, a "hit list" of the plants most often mentioned was composed and used further for a second online investigation using the Latin plant designations as MESH term. Studies of both online searches were pooled for analysis.

RESULTS

There is a gap between traditional knowledge and trials investigating medical plants used by TEM. Overall, herbal remedies alleviate oral mucositis and especially, gingivitis well. There is good evidence for using Matricaria recutita L., Salvia officinalis L., Calendula officinalis L. and Thymus spp. L. for treating oral mucositis.

CONCLUSION

Clinical trials investigating medical plants known in TEM are rare. However, following our research strategy, we could extrapolate four plants with good evidence for alleviating symptoms of oral mucositis and gingivitis.

Efficacy of an All-Natural Polyherbal Mouthwash in Patients With Periodontitis: A Single-Blind Randomized Controlled Trial

Aim: This study aimed to evaluate the anti-inflammatory effect and the incidence of adverse effects of an all-natural polyherbal mouthwash in patients with periodontitis, after 3 months of use. These aims were accomplished by using full mouth bleeding score (FMBS), full mouth plaque score (FMPS), probing depth (PD) clinical attachment level (CAL) and a questionnaire recording any adverse events.

Methods: The present randomized controlled clinical study considered 40 patients with moderate or severe periodontitis, randomized in two groups: a test group (TG) and a control group (CG). TG was instructed to use a polyherbal mouthwash composed of Propolis resin extract, Plantago lanceolata, Salvia officinalis leaves extract, and 1.75% of essential oils and the CG was given a placebo mouthwash. Both groups were instructed to rinse for 2 min, twice daily after their routine oral home care with the different mouthwashes. Clinical measurements of FMBS, FMPS, PD and CAL were recorded at baseline (T0) and after 3 months (T1). The incidence of adverse outcomes was recorded at every follow-up. Mann–Whitney U test and Wilcoxon signed-rank test were used for the statistical analysis (p < 0.05).

Results: The final study sample consisted of 34 healthy individuals, 17 individuals in each of the two groups. TG and CG showed a statistically significant reduction in FMBS (p = 0.001 TG; p = 0.002 CG), FMPS (p = 0.001 TG; p = 0.003 CG), PD (p = 0.001 TG; p = 0.011 CG) and CAL (p < 0.001 TG; p = 0.020 CG) values from baseline to 3 months. The TG showed a statistically significant decrease in FMBS and FMPS compared with the CG. No adverse events or side effects were reported or observed in both groups.

Conclusion: The use of polyherbal mouthwash in patients with moderate or severe periodontitis has proved safe and effective in reducing bleeding score and plaque accumulation, after 3 months, compared with placebo, although no difference between the two groups were reported on PD and CAL (both improving at T1).

Clinical Assessment of Rosemary-based Toothpaste (Rosmarinus officinalis Linn.): A Randomized Controlled Double-blind Study

The present study was to investigate the action of a toothpaste made from the extract of Rosmarinus officinalis Linn. (rosemary) in a clinical randomized, controlled, open and double-blind trial. One hundred and ten volunteers fulfilled the inclusion criteria and were randomly separated into two groups according to the toothpastes used: Group A (experimental) and Group B (control). They were assessed at baseline and 30 days after the study using the gingival bleeding index (GBI) and the plaque index (PI). Data analysis was conducted to calculate the effects of the two toothpastes on gingival bleeding and plaque, using measurements such as the excess relative risk (ERR), the Relative Risk Reduction (RRR), the Absolute Risk Reduction (ARR) and the Number Needed for Treatment (NNT). The two toothpastes provided similar results in terms of the reduction in the risk of gingival bleeding (relative and absolute): a reduction of 38% in Group A, ERR=0.38; a reduction of 29.3% in Group B, ERR=0.293; A and B reduced by 18% ARR=0.18). The reductions in bacterial plaque were also similar (22.7% reduction in Group A, RRR=0.227; 28% reduction in Group B, RRR= 0.28). The number needed for treatment values for bleeding and plaque were A and B NNT=5 and A and B NNT=7, respectively. The rosemary-based toothpaste effectively treated gingival bleeding and reduced bacterial plaque, when compared with conventional toothpaste.

Developing natural products as potential anti-biofilm agents

Biofilm is a natural form of bacterial growth ubiquitously in environmental niches. The biofilm formation results in increased resistance to negative environmental influences including resistance to antibiotics and antimicrobial agents. Quorum sensing (QS) is cell-to-cell communication mechanism, which plays an important role in biofilm development and balances the environment when the bacteria density becomes high. Due to the prominent points of biofilms implicated in infectious disease and the spread of multi-drug resistance, it is urgent to discover new antibacterial agents that can regulate biofilm formation and development. Accumulated evidences demonstrated that natural products from plants had antimicrobial and chemo-preventive properties in modulation of biofilm formation in the last two decades. This review will summarize recent studies on the discovery of natural anti-biofilm agents from plants with clear-cut mechanisms or identified molecular addresses, as well as some herbs with unknown mechanisms or unidentified bioactive ingredients. We also focus on the progression of techniques on the extraction and identification of natural anti-biofilm substances. Besides, anti-biofilm therapeutics undergoing clinical trials are discussed. These newly discovered natural anti-biofilm agents are promising candidates which could provide novel strategies for biofilm-associated infections.