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

Development of Tooth Brushing Recommendations Through Professional Consensus

INTRODUCTION

Despite being a largely preventable disease, untreated caries of permanent teeth is estimated to affect almost 2 billion people worldwide, which is followed by severe periodontal disease. The aim of this work was to provide a professional consensus on tooth brushing methods and associated oral hygiene behaviours and develop evidence-informed recommendations.

METHODS

An initial scoping search was undertaken to identify systematic reviews of relevance and key questions. This was followed by comprehensive evidence mapping of the literature focussing on systematic reviews and clinical guidelines. Electronic searches of several databases including MEDLINE (via Ovid), Embase (via Ovid), Epistemonikos, and The Cochrane Library were undertaken from 2000 to May 2022, alongside a guideline repository search. Considered Judgement Forms were developed detailing the underpinning evidence, balance between benefits and harms, potential impact on the population, and feasibility of implementation. An online survey comprising 22 draft recommendations was distributed to international members of all FDI committees, including the FDI Council. Participants were asked to indicate to what level they agreed or disagreed with for each recommendation and to provide feedback. The Considered Judgement Forms were provided for reference.

RESULTS

Three hundred ten records were identified and mapped to different aspects of tooth brushing methods and associated behaviours. Research literature informed 7 Considered Judgement Forms comprising 12 questions with draft recommendations. Twenty-five participants from Asia, Europe, North and South America, Africa, and Australia provided feedback on the recommendations. More than 70% of respondents showed agreement with 21 of the 22 draft recommendations. Final recommendations were drafted with associated strength of recommendation.

CONCLUSION

Using a robust methodology and an international professional consensus, a set of evidence-informed recommendations was developed. These recommendations provide clinicians with practical guidance to facilitate communications with patients that may help to reinforce individual-level preventive strategies.

Effectiveness of herbal oral care products in reducing dental plaque and gingivitis: an overview of systematic reviews

Introduction

Numerous clinical trials and systematic reviews have investigated the effectiveness of both herbal and conventional oral care approaches to reducing plaque and gingivitis. However, their findings vary and are inconsistent. Thus, the objective of this umbrella review is to compile data from systematic reviews and provide an overview of the effects of herbal oral care products on tooth plaque and gingivitis.

Methods

A comprehensive search of the literature was performed in 6 databases for systematic reviews with or without meta-analyses, published up to 30 May 2023, without any language restrictions. Only clinical trials comparing herbal oral care products (in the form of mouthrinse or toothpaste) against standard oral care products or placebo were considered.

Results

Some herbal oral care products, particularly in the form of mouthrinses, have a similar level of positive effect on plaque and gingivitis reduction and, thus, can be used as an adjunct to traditional dentifrices. However, the shorter duration of trials (<4 weeks) and reported publication bias in the clinical trials mean that these findings must be interpreted with caution.

Conclusion

To accurately determine the impact of various herbal extracts on periodontal health, well-designed, long-term, and controlled trials that adhere to standardized protocols must be carried out.

Anticaries and Antigingivitis Properties of Cannabinoid-Containing Oral Health Products: A Review

To evaluate the anticaries and antigingivitis properties of cannabinoid-containing oral health products. A systematic research strategy was employed. Specific search terms were used, including "Cannabinoids AND dental caries," "Cannabinoids AND oral health," "Cannabinoids AND dental plaque," "Cannabinoids AND gingivitis AND periodontitis," "Cannabinoids AND S. mutans," "Cannabidiol AND oral health," and "Cannabidiol AND oral biofilm." The search was conducted in PubMed, Cochrane, and EBSCO Host databases. The search yielded a total of 73 articles, out of which 15 articles (20.5%) were relevant to the scope of this systematic review. Among the relevant articles, only eight (10.9%) directly addressed the research question. The findings from these articles suggest that cannabinoids have the potential to reduce the metabolism of cariogenic bacteria, specifically Streptococcus mutans, and decrease the number of bacterial colonies in dental plaque. In vitro studies also demonstrated a significant inhibitory effect of cannabinoids on oral biofilms and create a considerable inhibitory zone of growth when investigated on oral biofilms in vitro. Furthermore, CBD exhibited antibacterial properties against Porphyromonas gingivalis, a primary pathogen associated with periodontal disease. The current review shows insufficient data to conclude on the anticaries and antigingivitis effects of cannabinoids. Despite extensive research on their systemic therapeutic benefits, their oral health impact remains underexplored, lacking clinical trials and primary research.

Investigating the efficacy of a varnish containing gallic acid on remineralization of enamel lesions: an in vitro study

This study evaluated the efficacy of a formulated remineralizing gallic acid (GA) varnish in treating artificial enamel caries lesions. Fifty-five intact bovine incisors were collected. Enamel blocks (5 × 9 mm) were prepared. A third of each block's surface remained intact. Primary carious lesions were induced on the middle and bottom thirds of the blocks by immersing the samples in a demineralization solution for 6 h. The bottom third of the blocks were further remineralized by randomly applying 0.5%, 2%, or 8% GA varnishes and 2.26% fluoride varnish (V varnish, Vericom, Seoul, Korea), or the varnish base without active ingredients (n = 11 each). The specimens were immersed in a remineralizing solution for 4 h and then subjected to a 2-hour immersion in the demineralizing solution. After six days of pH cycling, the surface microhardness was measured at depths of 30, 75, and 120 μm. The percentage of surface microhardness recovery (SMHR%) was compared among the groups using the Shapiro-Wilk, ANOVA, and Tukey HSD post-hoc tests (α = 0.05). The SMHR% of all experimental groups was higher than the control group at 30 μm (p < 0.05). The 0.5% GA varnish showed the highest SMHR% at all depths; however, the difference with the other experimental groups was significant at a depth of 30 μm (p < 0.05). The SMHR% of the fluoride and the 2% and 8% GA varnishes was comparable at all depths. All treatments potentially remineralize enamel lesions, with 0.5% GA varnish having the greatest effect, particularly on the top surface layer. As such, this newly developed varnish may emerge as a promising alternative to fluoride varnish.

Comparison of the Clinical Efficacy of Herbal, Chlorhexidine, and Normal Saline Mouthwash in the Management of Chronic Gingivitis

BACKGROUND

The incidence of chronic gingivitis, a widespread inflammatory condition of the gums, is considerable across the demographic spectrum, with potential progression to advanced periodontal pathology in the absence of intervention. The objective of this investigation was to conduct a comparative analysis of the clinical effectiveness of various oral rinses in mitigating the symptoms of chronic gingivitis.

METHODS

This empirical study was conducted within the confines of the Department of Oral Medicine and Radiology. A cohort of 60 individuals diagnosed with chronic gingivitis, ranging from 18 to 45 years of age and inclusive of all sexes, was systematically selected for participation.

RESULTS

Quantitative analysis yielded data indicating that the mean score on the gingival index was minimally recorded for participants utilizing herbal mouthwash (HO), in contrast to those administered with normal saline (NS), which displayed the highest mean score. A corresponding trend was observed with the plaque index, where the HO users exhibited the lowest mean values, as opposed to the NS cohort, which demonstrated the highest.

CONCLUSION

Employing post-hoc statistical evaluations, a pronounced disparity in the mean gingival index was discerned favoring the chlorhexidine (CHX) and HO groups over the NS group. No statistical significance was detected in the comparative mean gingival index between the CHX and HO cohorts. This pattern of findings was paralleled in the plaque index assessments, where the NS group's values were significantly elevated relative to those of both the CHX and HO groups.

Dentinomimetics and cementomimetics of Moringa oleifera leaves extract

To evaluate the biomimetic remineralization capabilities of Moringa oleifera leaves (MOL) extract on coronal dentin and acellular cementum, two different concentrations (50 and 200 mg/ml) of MOL extract loaded in plain varnish (M1 and M2 groups respectively) were compared to fluoride varnish (FL group) and native surface (C group). Eighty sound premolar teeth were collected. Forty teeth (10 teeth in each group) were used for coronal dentin testing while the other forty (10 teeth in each group) were used for acellular cementum testing. Teeth in M1, M2, and FL groups were etched for 30 s and then received the specific varnish treatment. All samples were immersed in artificial saliva for 14 days and then collected, dried, and examined by scanning electron microscopy and energy dispersive X-ray spectroscopy (EDX). Histologically, FL group showed mineral deposition as discrete vesicular granules of various sizes on the surface of both coronal dentin and acellular cementum. Mineral deposition only occurred on some DTs openings while opened tubules remained. The surface of the acellular cementum revealed regular grooves, micro-fissures, and cracks. In the M1 and M2 groups, mineral deposition appeared as a homogenous continuous layer on coronal dentin and acellular cementum. Only a few DTs and cementum fissures were not filled completely. In L.S. sections of the coronal one-third, the DTs appeared almost sealed with varying lengths of mineral deposition. EDX results statistical analysis showed that the M2 group had the highest phosphate ions (P-) and calcium ions (Ca+2) at%. MOL has an extraordinary effect on the remineralization of coronal dentin and acellular cementum. It would have a promising ability to control dentinal hypersensitivity and formation of biomimetic cementum tissue.

Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis - A consolidated report of two randomized controlled clinical trials

BACKGROUND

Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use.

OBJECTIVES

Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis.

METHODS

The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test.

RESULTS

Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups.

CONCLUSION

The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis.

CLINICAL TRIAL REGISTRATION NUMBER

For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Ayurvedic and herbal plaque control agents in gingivitis: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Since the effectiveness of ayurvedic and herbal plaque control agents in reducing plaque in gingivitis is inconsistent across multiple trials, we conducted a study to evaluate their overall effect on dental plaque index (PI), gingival index, and bacterial colony counts (CC) of debris in gingivitis patients.

MATERIALS AND METHODS

We searched major electronic biomedical databases (PubMed/Medline, CAM-QUEST®, EBSCOhost, Google Scholar, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials) from August 2004 to August 2021 for randomized control trials on gingivitis using ayurvedic, herbal plaque control agents, and oil pulling therapy as interventions. We grouped comparable outcome parameters of similar products and estimated the standard mean difference (SMD) for pooled effect size with 95% confidence intervals (CI) using RevMan 5.4.1 software. Risk-of-bias (ROB) assessment followed the Cochrane Collaboration's recommended approach.

RESULTS

We found 554 articles of 2,806 patients after searching of which 41 randomized clinical trials were considered for meta-analysis. Ayurvedic plaque control agents (Plaque index (PI): SMD = -0.52, 95% CI (-0.94, -0.11); CC: SMD = -1.70, 95% CI (-5.06, 1.67)), (Oil pulling therapy: PI: SMD = -0.38, 95% CI (-1.45, 0.68); CC: SMD = -1.04, 95% CI (-2.20, 0.11)), (Herbal plaque control agents: PI: SMD = -0.58, 95% CI (-1.55, 0.39)), (Triphala: PI: SMD = -0.65, 95% CI (-1.32, 0.03)) were found as good as control. Significant reduction in the gingival index and bacterial colony count was also seen.

CONCLUSIONS

In addition to conventional dental care, ayurvedic and herbal plaque control agents may help in plaque reduction, gingival inflammation, and bacterial growth. They are safe and may be recommended in community dentistry practices.(PROSPERO registration number: CRD42021274656).

Knowledge and attitude toward oral health behavior of overseas students during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has impacted overseas students, including their oral health. Due to movement restrictions, limited living allowances, dental treatment costs, and health insurance fees, overseas students might be more concerned about their oral health. The objective of the present study was to determine the association of knowledge and attitude toward oral healthcare behavior of overseas university students staying in Thailand between January 2020 to July 2022 and explore the experiences of their oral health problems.

METHODS

A cross-sectional study was conducted using an online survey in English operated through the Google platform by convenience sampling among overseas Chulalongkorn University students. A newly developed self-administered questionnaire on knowledge and attitude toward oral health-related behavior and experiences in oral health problems was completed voluntarily. Descriptive statistics, Chi-square test, t-test, ANOVA, and Pearson correlations were employed using IBM SPSS version 29.

RESULTS

Of 311 overseas students, 55.6% were male. The average age of students was 27.5 ± 4.5 years. 68.81% of students were from ASEAN countries, and 73.31% studied in non-health science programs. The study fields, health and non-health sciences, were associated with knowledge score (p < 0.001) and attitude score (p = 0.004), whereas the type of health insurance had an association with behavior score (p = 0.014) and the student's perspective about dental visits (p = 0.014). Three hundred fifty-nine cases of oral health problems were experienced by 47.3% of overseas students. These problems consisted primarily of tooth hypersensitivity (21.2%), gingivitis (15.3%), caries (14%), cracked or broken tooth (10%), severe toothache (9%), fallen out filling (8%), and wisdom tooth pain (7.8%). There was an association between oral healthcare behavior and oral health problems (p < 0.001), and a negative correlation was found between behavior score and the number of oral health problems (p < 0.001, r=-0.204).

CONCLUSION

The oral healthcare habits of overseas university students correlated positively with knowledge and attitude. A negative correlation was observed between behavior and the number of oral health problems. Furthermore, studying in health science programs impacted students' knowledge and attitude toward oral health, while dental treatment coverage insurance affected decisions for dental visits.

Current and Potential Applications of Monoterpenes and Their Derivatives in Oral Health Care

Plant products have been employed in medicine for centuries. As the world becomes more health-conscious, there is a growing interest in natural and minimally processed products for oral health care. This has led to an increase in research into the bioactive compounds found in plant products, particularly monoterpenes. Monoterpenes are known to have beneficial biological properties, but the specific mechanisms by which they exert their effects are not yet fully understood. Despite this, some monoterpenes are already being used in oral health care. For example, thymol, which has antibacterial properties, is an ingredient in varnish used for caries prevention. In addition to this, monoterpenes have also demonstrated antifungal, antiviral, and anti-inflammatory properties, making them versatile for various applications. As research continues, there is potential for even more discoveries regarding the benefits of monoterpenes in oral health care. This narrative literature review gives an overview of the biological properties and current and potential applications of selected monoterpenes and their derivatives in oral health care. These compounds demonstrate promising potential for future medical development, and their applications in future research are expected to expand.

Assessment of potential antimicrobial activity of Ocimum basilicum extract and chlorhexidine against Socransky's complex pathogens of oral cavity: An in vitro study

Background and Objective

Periodontitis is a multifactorial disease initiated by periodontal pathogens and progresses further in destruction of periodontium. Hence, the objective of this study was to test the efficacy of Ocimum basilicum seeds extract on periodontal pathogens.

Materials and Methods

O. basilicum seeds were authenticated from a recognized taxonomist. They were coarsely powdered; ethanol-based extract preparation was done by the Soxhlet method and aqueous-based extract by hot infusion procedure. Extracts so obtained were assessed for minimum inhibitory concentration, minimum bactericidal concentration, zone of inhibition, and time-kill assay of O. basilicum seeds extract on periodontal pathogens, and comparatively evaluated the effectiveness against 0.12% chlorhexidine (CHX) gluconate in triplicates. Kruskal-Wallis Test was employed wherein the statistical significance was set at P ≤ 0.05.

Results

The concentration of O. basilicum ethanolic extract against periodontal pathogens was determined to be 10 mg/ml, whereas 4.7 mg/ml of aqueous extract was proven effective against periodontal pathogens. Similarly, aqueous extract of O. basilicum developed a wider zone against periodontal pathogens compared to ethanol-based O. basilicum extract. Statistically significant difference found in the effectiveness between both extract and CHX.

Conclusion

The antibacterial activity was evident in both the extracts of O. basilicum against anaerobic periodontal pathogens. However, it was more pronounced in aqueous extract, but lower compared to CHX.

Revisiting Oral Antiseptics, Microorganism Targets and Effectiveness

A good oral health status is mostly dependent on good oral hygiene habits, which knowingly impacts systemic health. Although controversial, chemical oral antiseptics can be useful in adjunct use to mechanical dental plaque control techniques in the prevention and management of local and overall health and well-being. This review aims to revisit, gather and update evidence-based clinical indications for the use of the most popular oral antiseptics, considering different types, microorganism targets and effectiveness in order to establish updated clinical recommendations.

Antioxidant, anti-inflammatory and antimicrobial activity of natural products in periodontal disease: a comprehensive review

Periodontal diseases (PD) are common chronic inflammatory oral pathologies that are strongly linked to others not found in the mouth cavity. The immune system mediates the host response, which includes the upregulation of proinflammatory cytokines, metalloproteinases, and reactive oxygen species (ROS); the latter may play an important role in the establishment and progression of inflammatory diseases, particularly periodontal disease, via the development of oxidative stress (OS). Natural antioxidants have powerful anti-inflammatory properties, and some can reduce serum levels of key PD indicators such tumor necrosis factor (TNF) and interleukin IL-1. This review compiles, through a thorough literature analysis, the antioxidant, anti-inflammatory, and antibacterial effects of a variety of natural products, as well as their therapeutic potential in the treatment of PD.

The Effect of Nonnutritive Sweeteners on the Antimicrobial Activity of Eucalyptus Extracts against Salivary Mutans Streptococci (in-vitro Study)

The eucalyptus tree is an excellent source of antimicrobial agents; it is used in many oral cure products. The bitter taste of these agents could compromise their usage. Therefore, fortifying the extracts with non-nutritive sweeteners could be a promising procedure for masking their unpleasant taste. This study was an in vitro evaluation of the antimicrobial activity of eucalyptus (alcoholic and aqueous) extracts against salivary Streptococci mutans. It aimed to investigate the effect of non-nutritive sweeteners on the antimicrobial activity of these extracts against salivary S. mutans. The test microbes were sensitive to different concentrations of eucalyptus alcoholic and aqueous extract, and the inhibition zone increased as the concentration of the extracts increased. All the Mutans isolates were killed at a concentration of 75 mg/ml for the alcoholic extract and 175 mg/ml for the aqueous extracts. In this experiment, the concentration of up to 15% stevia and up to 5% sucralose did not affect the antimicrobial activity of eucalyptus alcoholic extract. While the concentration of up to 1% of stevia and sucralose did not interfere with the antimicrobial activity of aqueous eucalyptus extract against salivary S. mutans. An increase in the concentration of non-nutritive sweeteners in this experiment appeared to interfere with the antimicrobial activity of eucalyptus extract against salivary S. mutans.

Inhibition of biofilm formation and virulence factors of cariogenic oral pathogen Streptococcus mutans by natural flavonoid phloretin

Objectives

To evaluate the effect and mechanism of action of the flavonoid phloretin on the growth and sucrose-dependent biofilm formation of Streptococcus mutans.

Methods

Minimum inhibitory concentration, viability, and biofilm susceptibility assays were conducted to assess antimicrobial and antibiofilm effect of phloretin. Biofilm composition and structure were analysed with scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). Water-soluble (WSG) and water-insoluble glucan (WIG) were determined using anthrone method. Lactic acid measurements and acid tolerance assay were performed to assess acidogenicity and aciduricity. Reverse transcription quantitative PCR (RT-qPCR) was used to measure the expression of virulence genes essential for surface attachment, biofilm formation, and quorum sensing.

Results

Phloretin inhibited S. mutans growth and viability in a dose-dependent manner. Furthermore, it reduced gtfB and gtfC gene expression, correlating with the reduction of extracellular polysaccharides (EPS)/bacteria and WIG/WSG ratio. Inhibition of comED and luxS gene expression, involved in stress tolerance, was associated with compromised acidogenicity and aciduricity of S. mutans.

Conclusions

Phloretin exhibits antibacterial properties against S. mutans, modulates acid production and tolerance, and reduces biofilm formation.

Clinical significance

Phloretin is a promising natural compound with pronounced inhibitory effect on key virulence factors of the cariogenic pathogen, S. mutans.

Development of a novel, entirely herbal-based mouthwash effective against common oral bacteria and SARS-CoV-2

BACKGROUND

Parallel to the growth of the oral healthcare market, there is a constantly increasing demand for natural products as well. Many customers prefer products that contain fewer toxic agents, therefore providing an environmentally friendly solution with the benefit of smaller risk to the user. Medieval and early modern medicinal knowledge might be useful when looking for natural, herbal-based components to develop modern products. Along with these considerations we created, tested, and compared an entirely natural mouthwash, named Herba Dei.

METHODS

The manufacturing procedure was standardized, and the created tincture was evaluated by GC/MS analysis for active compounds, experimentally tested in cell-based cytotoxicity, salivary protein integrity, cell-free antioxidant activity, anti-bacterial and anti-viral assays, and compared with three market-leading mouthwashes.

RESULTS

Our tincture did not show significant damage in the cytotoxicity assays to keratinocyte and Vero E6 cells and did not disrupt the low molecular weight salivary proteins. Its radical scavenging capacity surpassed that of two tested, partly natural, and synthetic mouthwashes, while its antibacterial activity was comparable to the tested products, or higher in the bacterial aerobic respiratory assay. The active compounds responsible for the effects include naturally occurring phenylpropanoids, terpenes, and terpenoids. Our mouthwash proved to be effective in vitro in lowering the copy number of SARS-CoV-2 in circumstances mimicking the salivary environment.

CONCLUSIONS

The developed product might be a useful tool to impede the transmission and spread of SARS-CoV-2 in interpersonal contact and aerosol-generating conditions. Our mouthwash can help reduce the oral bacterial flora and has an antioxidant activity that facilitates wound healing and prevents adverse effects of smoke in the oral cavity.

The potency of herbal extracts and its green synthesized nanoparticle formulation as antibacterial agents against Streptococcus mutans associated biofilms

This study aims to determine the effects of the extracts of Streblus asper, Cymbopogon citratus, Syzygium aromaticum and its formulation of green synthesized silver nanoparticle (AgNPs) on Streptococcus mutans growth and biofilm formation. The ethanolic extracts of S. asper, C. citratus, S. aromaticum, and a mix of the three herbs demonstrated antibacterial activity against S. mutans isolates by reducing bacterial biofilm formation and decreasing bacterial cell surface hydrophobicity. The formulated AgNPs from the ethanolic extracts could enhance the antibacterial activities of the plant extracts. Molecular docking found the best interaction between luteolin isolated from C. citratus and glucosyltransferase protein (GtfB), assuming the promising anti-biofilm activity. The scanning electron microscopy revealed morphological changes in the biofilm structure and a significant decrease in the biofilm area of the AgNPs treated. The study suggested that the extracts and its application could be used as natural alternative agents with multi-action against S. mutans infections.

Assessing knowledge of herbal medicine course for dental students

BACKGROUND

The aims of this article are to assess dental students' knowledge about herbal medicine usage and the potential benefits and side effects, and to conduct a short course about herbal medicine.

METHODS

All fourth-year pre-doctoral students were invited to participate in a herbal medicine course as a test while the sixth-year students were the control group. A survey was tested for validity and reliability. It comprised of 16 multiple choice questions was given before the course and one month after the course. The sum score of knowledge for each participant was calcuated based on the ability to identify the use of herbs in dentistry with high-quality evidence (correct answer) or total answer for periodontal disease and caries.

RESULTS

The response rate for completing the study was 112 fourth-year students (73.7%) and 64 sixth-year students (39.0%). More than half of the participants (52.5%) were unsure about the importance of herbal medicine in dentistry. However, the majority also stated that the most common herbs used in dentistry were clove (62.9%), followed by curcuma turmeric (54.7%) and meswak (43.0%). The fourth-year students displayed evidence of a higher overall knowledge score after the course in herbal medicine related to periodontal disease in total and correct answers (mean 4.48 ± 4.13, 3.73 ± 3.31, respectively) compared to before the course (mean 0.84 ± 1.23, 0.74 ± 1.16, respectively) (p-value < 0.001). The post-course periodontal disease total and correct answers were statistically significant between fourth- and sixth-year students.

CONCLUSION

Herbal medicine has a potential positive impact on dentistry. However, these effects are not fully investigated and received full attention in academic institute. This short educational program related to medicinal herbs can improve the knowledge of dental students. This will help increase the awareness about the use and potential side effects of herbal medicine in the dental field.

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.

Clinical Effectiveness of Herbal Oral Care Products in Periodontitis Patients: A Systematic Review

BACKGROUND

The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use.

OBJECTIVE

To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients.

MATERIAL AND METHODS

A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened.

RESULTS

Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies).

CONCLUSIONS

Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.

Evidence on the Use of Mouthwash for the Control of Supragingival Biofilm and Its Potential Adverse Effects

Antimicrobial mouthwash improves supragingival biofilm control when used in conjunction with mechanical removal as part of an oral hygiene routine. Mouthwash is intended to suppress bacterial adhesion during biofilm formation processes and is not aimed at mature biofilms. The most common evidence-based effects of mouthwash on the subgingival biofilm include the inhibition of biofilm accumulation and its anti-gingivitis property, followed by its cariostatic activities. There has been no significant change in the strength of the evidence over the last decade. A strategy for biofilm control that relies on the elimination of bacteria may cause a variety of side effects. The exposure of mature oral biofilms to mouthwash is associated with several possible adverse reactions, such as the emergence of resistant strains, the effects of the residual structure, enhanced pathogenicity following retarded penetration, and ecological changes to the microbiota. These concerns require further elucidation. This review aims to reconfirm the intended effects of mouthwash on oral biofilm control by summarizing systematic reviews from the last decade and to discuss the limitations of mouthwash and potential adverse reactions to its use. In the future, the strategy for oral biofilm control may shift to reducing the biofilm by detaching it or modulating its quality, rather than eliminating it, to preserve the benefits of the normal resident oral microflora.

Anti-biofilm studies of synthetic imidazolium salts on dental biofilm in vitro

Objective

Biofilm formation under cariogenic conditions contributes to dental caries development, in which Streptococcus mutans (S. mutans) is regarded as the major cariogenic bacteria. Here, we synthesized a series of imidazolium salts. Their properties of antimicrobial and anti-biofilm were investigated.

Methods

The microdilution method crystal violet staining, and cell counting Kit-8 assay were used to screen imidazolium salts. Then, the bacterial composition in multi-species biofilm composed of S. mutans, Actinomyces naeslundii, and Streptococcus gordonii was quantified by quantitative PCR. The exopolysaccharide and morphology of the structure of multi-species biofilm were further observed by confocal laser scanning microscopy and scanning electron microscope, respectively.

Results

Imidazolium salts exhibited highly antimicrobial activity against oral pathogens, especially for S. mutans . Compounds with ortho-diisopropyl and para-methoxyl on N-moieties as well as bearing ancenaphthyl skeleton (C5) showed the lowest cytotoxicity and most efficient anti-biofilm activity. C5 inhibited approximately 50% of multi-species biofilm at 0.98 μg/mL. Notably, C5 resulted in 98.97% live S. mutans and 77.65% A. naeslundii decreased. Furthermore, the exopolysaccharide was reduced by 88%, along with a sparse and scattered microstructure.

Conclusion

The imidazolium salts present low cytotoxicity and remarkable antimicrobial activity against S. mutans in multi-species biofilm, suggesting that they may have a great potential in anti-biofilm clinical applications.

The Effect of Dental Paste from Coconut Butter as a Replacement to Toothpaste on Reducing Debris Index and Plaque Index in Class 3 to 5 Students in Elementary School

The coconut tree is a multipurpose plant because all parts of it, from the roots to the coconut fruit, can be used for clothing, food and shelter. Coconut fruit contains calories, water, protein, carbohydrates, fat, calcium, iron, vitamins A, B and C as well as edible parts. Besides being processed into coconut oil (coconutoil) it also contains many benefits for human health, coconut can also be processed into Coconut Butter which can be made as toothpaste. Many elementary school age children still have dirty teeth in their oral cavity up to 67.3%. Therefore, researchers want to know the effect of toothpaste from coconut butter as a substitute for toothpaste on the reduction of index debris and index plaque in students in grades 3 to 5 in elementary schools.This type of research uses Quasi Experiment (Pseudo Experiment). The research design used a pre-test and post-pest approach. Pre-test. The samples in this study were 32 grade 3 students, 34 grade 4 students and 34 grade 5 students, so the total number of students was 100 students. Sampling using purposive sampling technique, and statistical tests using the Wilcoxom test. The results showed that the debris index before brushing teeth using coconut batter as a substitute for toothpaste obtained an average value of 1.8, while for the debris index after brushing teeth using coconut batter as a substitute for toothpaste, the average value was 0.4. Judging from the p Value = 0.000, the probability is smaller than 0.05 (p <0.05), so H0 is rejected and H1 is accepted, thus these results indicate that there is a significant difference between the debris index before brushing teeth using coconut batter as a substitute for toothpaste. and index debris after brushing teeth using coconut batter as a substitute for toothpaste. Plaque index before brushing teeth using coconut batter as a substitute for toothpaste obtained an average value of 4.4, while for the index plaque after brushing your teeth using coconut batter as a substitute for toothpaste, the average value is 2.4. Judging from the p value = 0.000, the probability is smaller than 0.05 (p <0.05), so H0 is rejected and H1 is accepted, thus these results indicate that there is a significant difference between the plaque index before brushing your teeth using coconut batter as a substitute for toothpaste. and index plaque after brushing your teeth using coconut batter as a substitute for toothpaste

Exploring the Potential of Natural Product-Based Nanomedicine for Maintaining Oral Health

Oral diseases pose a major threat to public health across the globe. Diseases such as dental caries, periodontitis, gingivitis, halitosis, and oral cancer affect people of all age groups. Moreover, unhealthy diet practices and the presence of comorbidities aggravate the problem even further. Traditional practices such as the use of miswak for oral hygiene and cloves for toothache have been used for a long time. The present review exhaustively explains the potential of natural products obtained from different sources for the prevention and treatment of dental diseases. Additionally, natural medicine has shown activity in preventing bacterial biofilm resistance and can be one of the major forerunners in the treatment of oral infections. However, in spite of the enormous potential, it is a less explored area due to many setbacks, such as unfavorable physicochemical and pharmacokinetic properties. Nanotechnology has led to many advances in the dental industry, with various applications ranging from maintenance to restoration. However, can nanotechnology help in enhancing the safety and efficacy of natural products? The present review discusses these issues in detail.

Formulation and Antibacterial Potential of Sarang Semut (Myrmecodia pendans) against Oral Pathogenic Bacteria: An In Vitro Study

Background:

Dental diseases are generally caused by oral bacteria such as Enterococcus faecalis, Streptococcus mutans, and Streptococcus sanguinis. These bacteria have resistance to synthetic drugs; thus, it is required to discover new antibacterial agents. Sarang Semut (Myrmecodia pendans) has been empirically used as a medicinal plant to treat various conditions, including those caused by pathogenic bacteria.

Objective:

The present study was aimed to investigate the antibacterial activity of Sarang Semut extracts against E. faecalis, S. mutans, and S. sanguinis.

Materials and Methods:

Sarang Semut was extracted with several solvents to yield n-hexane, ethyl acetate, methanol, and water extracts. Each extract and combination were adjusted for assay with chlorhexidine, fosfomycin, and quercetin and used as positive controls.

Results:

The n-hexane extract showed activity with inhibition zone values of 7.15 and 10.45 ppm against E. faecalis and S. mutans at 1%, respectively. All combination extracts could inhibit the growth of E. faecalis and S. sanguinis. The synergistic effects resulting from the combination of extract-fosfomycin were also presented in this evaluation, with the strongest shown by water-fosfomycin against S. mutans, with inhibition zones of 28.5 mm at 1%.

Conclusion:

Sarang Semut extracts demonstrated antibacterial activity against oral pathogenic bacteria. These results offer alternative natural sources for the new antibacterial drug candidate.

Classic vs. Novel Antibacterial Approaches for Eradicating Dental Biofilm as Adjunct to Periodontal Debridement: An Evidence-Based Overview

Periodontitis is a multifactorial chronic inflammatory disease that affects tooth-supporting soft/hard tissues of the dentition. The dental plaque biofilm is considered as a primary etiological factor in susceptible patients; however, other factors contribute to progression, such as diabetes and smoking. Current management utilizes mechanical biofilm removal as the gold standard of treatment. Antibacterial agents might be indicated in certain conditions as an adjunct to this mechanical approach. However, in view of the growing concern about bacterial resistance, alternative approaches have been investigated. Currently, a range of antimicrobial agents and protocols have been used in clinical management, but these remain largely non-validated. This review aimed to evaluate the efficacy of adjunctive antibiotic use in periodontal management and to compare them to recently suggested alternatives. Evidence from in vitro, observational and clinical trial studies suggests efficacy in the use of adjunctive antimicrobials in patients with grade C periodontitis of young age or where the associated risk factors are inconsistent with the amount of bone loss present. Meanwhile, alternative approaches such as photodynamic therapy, bacteriophage therapy and probiotics showed limited supportive evidence, and more studies are warranted to validate their efficiency.

Analysis of an Herbal Ayurdantham Medicated Tooth liquid on Dentinal Tubule Occlusion using Scanning Electron Microscopy

BACKGROUND

Dentin hypersensitivity is described as "short sharp pain arising from exposed dentin in response to various stimuli typically thermal, evaporative, tactile, osmotic or chemical and cannot be ascribed to any other form of dental defect or disease." Dentine hypersensitivity can be treated with various desensitizing agents ,where oral rinse has a promising effect in delivering the therapeutic effect all over the tooth surface including interproximal areas, as they can flow and reach areas where toothpastes are not much effective, hence the occlusion of dentinal tubules using Ayurdhantam medicated an herbal mouthwash was evaluated.

METHODOLOGY

Twenty such dentinal blocks were obtained; the surfaces of each dentin block were polished using a silicon carbide disc for 30 s to create a basic smear layer. The smear layer is finally detached by applying 17% EDTA solution onto the dentin blocks for 5 min to ensure the patency of the dentinal tubules, following which they were rinsed with distilled water. The specimens were placed into the Ayurdhantam solution (medicated) for 2 min every day for 7 days. The specimens were stored in artificial saliva during the study. The specimens were analyzed under scanning electron microscope (SEM) for the occlusion of dentinal tubules.

RESULTS

SEM images showed the partial occlusion of the tubules and a large amount of smear layer.

CONCLUSIONS

Based on this in vitro experiment carried out, it is shown that Ayurdhantam-medicated mouthwash can be used for treating dentine hypersensitivity effectively.

Enamel remineralization and surface roughness after treatment with herbal-containing toothpastes

Background

Oral care products containing bioactive agents obtained from extracts of plant drugs were launched. This in vitro study investigated the effects of herbal-containing toothpastes associated or not with fluoride to remineralize the enamel after cariogenic challenge with pH cycling. The chemical and physical factors of toothpastes and the enamel surface roughness after brushing were also analyzed.

Material and Methods

Sixty bovine enamel blocks were obtained and divided into 3 thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling, and brushing with toothpastes). Toothpastes containing herbal compounds contained no fluoride [Galla chinensis (GCH)], low-F concentration [D’Or (DOR); Herbal Bliss (HBL)], or a different fluoride type [Elmex Anticaries (EAC)]. The results were compared to NaF-containing toothpastes: 1450 and 5000 ppm. Enamel blocks were brushed with the toothpastes using a pH-cycling model (7 days). The Knoop hardness (25g/10s) of the surface and the longitudinal sections were then evaluated. The percentage of surface hardness recovery (%SHR) was calculated. The enamel surface roughness, pH, particle size, zeta potential, and polydispersity index of toothpaste slurries were also evaluated. Data were statistically analyzed (α=5%).

Results

No significance was observed when %SHR was compared (p>0.05). DOR, GCH, and HBL were more effective in remineralizing the enamel subsurface. Significantly higher surface roughness was observed when treated with EAC and GCH (p<0.05).

Conclusions

All toothpastes were able to remineralize the enamel, especially the subsurface, with results equal or better than that of standard toothpastes.

Key words:Enamel, hardness, roughness, toothpaste, tooth remineralization.

An assessment of the current status of children's toothpaste in Australia

BACKGROUND

Despite recommendations that pre-school children use toothpaste containing 500-550 ppm of fluoride, there has been an increase in non-fluoridated toothpastes marketed for children. This study investigated children's toothpaste in Australia.

METHODS

A comprehensive audit of all toothpastes marketed for pre-school children and available in store in the Macarthur region of NSW, Australia, was carried out. All toothpastes available for purchase were obtained and examined; size and price were catalogued, along with ingredient lists and fluoride levels.

RESULTS

One hundred and seven individual toothpastes were identified in the audit, with 67 (62.6%) containing no fluoride. Of the 40 fluoridated toothpastes, only 11 (10.3%) contained the recommended level of fluoride of 500-550 ppm. Twenty-two (20.6%) of all toothpastes were made in Australia, all of which were non-fluoridated. Six (5.6%) of the toothpastes studied contained excessive levels of fluoride (1350-1500 ppm). Seventeen of the 20 least expensive toothpastes contained fluoride, while 18 of the 20 most expensive toothpastes were non-fluoridated.

CONCLUSIONS

Despite expert recommendations, the majority of children's toothpaste available in Australia contains either no fluoride or the wrong levels of fluoride. Further study is needed to determine why this change is occurring and what is influencing the increase in non-fluoride toothpastes on the market.

Do natural ingredients in a dentifrice contribute to prevention of plaque and gingivitis?

OBJECTIVE

To test the effectiveness of a dentifrice containing the turmeric and licorice extract compared to a control for preventing plaque and gingivitis over a four-month period.

MATERIAL AND METHODS

Ninety (non-dental) participants with moderate gingival inflammation(≥40%) were selected. The triple blind study consisted of two phases, namely at first a 3-week pre-experimental phase of using an oxygenating and chlorhexidine (CHX) mouthrinse. Secondly, a 4-months experimental period in which participants were randomly assigned to a test or control group. All were instructed to brush their teeth twice daily for 2 minutes with their assigned dentifrice. Gingival bleeding(BI), plaque(PI) and gingivitis(GI) were assessed.

RESULTS

Eighty participants completed the protocol. At the first assessment in the pre-experimental phase, the mean scores of all indices showed no differences for the two groups. At the second session, the values of all three parameters had decreased significantly (p<0.001). At the last session the BI values were 0.52(0.25) for the test group and 0.56(0.25) for the control, the mean GI was 0.27(0.17) for the test group and 0.31 0.16) for the control, and for PI the scores were 1.89(0.46) for the test group and 1.98(0.43) for the control group. Statistical comparison of the scores for the two groups at each stage of the study showed no significant difference for any of the parameters.

CONCLUSION

Within the limits of the current study design, dentifrice formulation and concentration of turmeric/licorice extracts the results show that the adjuvant effect of the natural ingredients in the test dentifrice was not evident on clinical parameters of gingivitis and plaque.

Current uses of chlorhexidine for management of oral disease: a narrative review

Objectives

Chlorhexidine (CHX) is a commonly used antiseptic mouthwash, used by dental practitioners and the public, due to its antimicrobial effects. The aim of this article was to provide a narrative review of current antimicrobial uses of CHX relevant to dentistry in the context of oral diseases, highlighting need for further studies to support its safe and appropriate use.

Study selection, data and sources

Randomised controlled trials, systematic reviews and national (UK and US) guidelines were consulted where available, with search terms for each subject category entered into MEDLINE, PubMed, Google Scholar and the Cochrane database.

Results

Some evidence existed to support adjunctive short-term use of CHX to manage dental plaque, and reduce clinical symptoms of gingivitis, dry socket, as well as reduce aerosolisation of bacteria. However, use must be weighed alongside the less desirable effects of CHX, including extrinsic staining of teeth, antimicrobial resistance to antiseptic agents and the rare, but fatal, allergic reactions to CHX. Conversely, evidence for the effectiveness of chlorhexidine to manage or prevent periodontitis, dental caries, necrotising periodontal diseases, peri-implantitis, and infections associated with extraction and aerosolised viruses remains less certain.

Conclusions

The use of CHX in dentistry and oral healthcare continues to be widespread and thus it is important that dental practitioners understand that, based on its differential mechanisms of action on different microbes, appropriate clinical and dental use of CHX should be oral disease specific. However, further scientific and clinical research is required before full recommendations can be made.

Antibacterial activity of essential oils from Ethiopian thyme (Thymus serrulatus and Thymus schimperi) against tooth decay bacteria

In this study, we evaluated the antibacterial activities of the essential oils (EOs) of Thymus serrulatus and Thymus schimperi collected from Ofla (Ofl), Alamata (Ala), Yilmana Densa (Yil), Tarmaer (Tar), Butajira (Buta), and Bale (Bal) in Ethiopia against cariogenic bacteria (Streptococcus mutans and Lactobacillus) isolated from human teeth. Inhibition zones (IZs), minimum inhibitory concentrations (MICs), and minimum bactericidal concentrations (MBCs) were measures of the antibacterial activity. Significant bacterial inhibitions resulted in a dose-and EO-dependent manner. At 128 μl/mL, IZs against S. mutans were 37.33 mm (Tar), 36.00 mm (Bal), 33.67 mm (Yil), 33.33 mm (Ofl), 30.00 (Ala), and 29.67 mm (Buta) and IZs against Lactobacillus were 31.00 mm (Tar), 30.67 mm (Yil), 27.67 (Bal), 27.00 (Buta), 26.67 (Ofl), and 21.33 (Ala). The respective inhibition zones due to 3% DMSO (negative control) and 3% H2O2 (positive control) were 0.00 mm/30.00 mm against S. mutans and 0.00 mm/29.00 mm against Lactobacillus. At 128 μl/mL dose, all the EOs resulted in significantly higher inhibition zones than that of 3% H2O2 against S. mutans and Lactobacillus.

Microbial Etiology and Prevention of Dental Caries: Exploiting Natural Products to Inhibit Cariogenic Biofilms

Dental caries is one of the most common microbe-mediated oral diseases in human beings. At present, the accepted etiology of caries is based on a four-factor theory that includes oral microorganisms, oral environment, host, and time. Excessive exposure to dietary carbohydrates leads to the accumulation of acid-producing and acid-resistant microorganisms in the mouth. Dental caries is driven by dysbiosis of the dental biofilm adherent to the enamel surface. Effective preventive methods include inhibiting the cariogenic microorganisms, treatment with an anti-biofilm agent, and sugar intake control. The goal is to reduce the total amount of biofilm or the levels of specific pathogens. Natural products could be recommended for preventing dental caries, since they may possess fewer side effects in comparison with synthetic antimicrobials. Herein, the mechanisms of oral microbial community development and functional specialization are discussed. We highlight the application of widely explored natural products in the last five years for their ability to inhibit cariogenic microorganisms.