Eugenia uniflora Dentifrice for Treating Gingivitis in Children: Antibacterial Assay and Randomized Clinical Trial

The Current Antimicrobial and Antibiofilm Activities of Synthetic/Herbal/Biomaterials in Dental Application

Herbal and chemical products are used for oral care and biofilm treatment and also have been reported to be controversial in the massive trials conducted in this regard. The present review is aimed at evaluating the potential of relevant herbal and chemical products and comparing their outcomes to conventional oral care products and summarizing the current state of evidence of the antibiofilm properties of different products by evaluating studies from the past eleven years. Chlorhexidine gluconate (CHX), essential oils (EOs), and acetylpyridinium chloride were, respectively, the most commonly studied agents in the included studies. As confirmed by all systematic reviews, CHX and EO significantly control the plaque formation and gingival indices. Fluoride is another interesting reagent in oral care products that has shown promising results of oral health improvement, but the evidence quality needs to be refined. The synergy between natural plants and chemical products should be targeted in the future to accede to the formation of new, efficient, and healthy anticaries strategies. Moreover, to discover their biofilm-interfering or biofilm-inhibiting activities, effective clinical trials are needed. In this review article, therapeutic applications of herbal/chemical materials in oral biofilm infections are discussed in recent years (2010-2022).

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.

Effects of Kangfuxin solution on IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid in patients with fixed orthodontic gingivitis

Changes of interleukin (IL)-1β, IL-6, IL-17 and tumor necrosis factor-α (TNF-α) in gingival crevicular fluid in patients with fixed orthodontic gingivitis after treatment with Kangfuxin solution were analyzed to explore the clinical effect of Kangfuxin solution in patients with orthodontic gingivitis. A total of 78 patients diagnosed with fixed orthodontic gingivitis in Weifang People's Hospital from January 2015 to March 2017 were selected. Thirty-nine patients were treated with gingival cleansing as control group, and the other 39 patients were treated with gingival cleansing plus spraying and sublingual administration with Kangfuxin solution as treatment group. The general data of patients were collected, and the changes of IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid were measured, the bleeding index (BI), probing depth (PD), swelling and pain grades were recorded, and the clinical curative effects were compared between the two groups. The curative effect in treatment group was better than that in control group (p<0.05). After treatment, gingival BI and PD in both groups were lower than those before treatment. The curative effect in treatment group was better than that in control group (p<0.05). The levels of gingival pain and swelling after treatment in treatment group were mainly in grade I. The levels of gingival pain and swelling after treatment in control group were mainly in grade II and III (p<0.05). After treatment, the effective rate of control group was 76.92% and that of treatment group was 97.44% (p<0.05). It was found that the levels of IL-6 and TNF-α in gingival crevicular fluid were positively correlated with PD. The use of Kangfuxin solution in the treatment of patients with orthodontic gingivitis can effectively reduce the levels of IL-1β, IL-6, IL-17 and TNF-α in gingival crevicular fluid, and improve the periodontal conditions and the effective rate of treatment.