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Lima Bezerra JJ, Domingos da Silva JM. Dental applications of Punica granatum L. in the treatment of gingivitis: A review of ethnomedicinal uses, randomized clinical trials, and antibacterial potential against Porphyromonas gingivalis. JOURNAL OF ETHNOPHARMACOLOGY 2024; 336:118701. [PMID: 39153519 DOI: 10.1016/j.jep.2024.118701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 08/06/2024] [Accepted: 08/15/2024] [Indexed: 08/19/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mouthwashes based on medicinal plants have demonstrated benefits in controlling plaque and inflammation, acting positively on the oral hygiene of patients with gingivitis. In traditional medicine, Punica granatum L. has been used to treat oral diseases in countries in Europe, Asia, North America, and Africa. AIM OF THE STUDY The present study aimed to conduct a comprehensive review on the dental applications of Punica granatum L. for the treatment of gingivitis, including ethnomedicinal uses, analysis of randomized clinical trials, antibacterial activity against Porphyromonas gingivalis, mechanisms of action of phytochemicals isolated from this plant, and preclinical toxicity. MATERIALS AND METHODS The literature was retrieved from Google Scholar, PubMed®, SciELO, and ScienceDirect®, since the first report published on the topic in 2001 until March 2024. RESULTS Several clinical trials have demonstrated that mouthwashes containing P. granatum have equal or better efficacy than chlorhexidine in treating patients with gingivitis, confirming the indications for use of this plant by traditional communities. However, reports on the in vitro antibacterial activity of extracts from the fruits of this plant have not shown clinical relevance against the pathogen P. gingivalis. The ellagitannin punicalagin isolated from P. granatum has shown potential against several strains of Gram-positive and Gram-negative bacteria, but, to date, this compound has not yet been tested against P. gingivalis. It is likely that the mechanisms of action of flavonoids, such as quercetin, are involved in the inhibition of the activities of the RgpA, RgpB, and Kgp proteases of P. gingivalis. CONCLUSIONS In summary, natural products obtained from P. granatum do not present toxic side effects and can be considered as possible substitutes of commercial products recommended for the treatment of gingivitis and other oral diseases.
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Affiliation(s)
- José Jailson Lima Bezerra
- Universidade Federal de Pernambuco, Departamento de Botânica, Av. da Engenharia, s/n, Cidade Universitária, 50670-420, Recife, PE, Brazil.
| | - Jadson Mathyas Domingos da Silva
- Departamento de Materiais dentários e Prótese, Instituto de Ciência e Tecnologia da Universidade Estadual Paulista Júlio de Mesquita Filho - ICT/UNESP, 12245-000, São José dos Campos, São Paulo, Brazil
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Lavaee F, Parhizkar E, Tavakoli F, Zarshenas MM, Asmarian N. Evaluation of the Effects of Punica granatum Flower Tablets on Pain and Healing of Minor Recurrent Aphthous Stomatitis: A Randomized Clinical Trial. Clin Exp Dent Res 2024; 10:e920. [PMID: 39016077 PMCID: PMC11252825 DOI: 10.1002/cre2.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/18/2024] Open
Abstract
OBJECTIVES The purpose of this study was to determine the therapeutic effect of the Punica granatum (PG) flower on recurrent aphthous stomatitis in comparison with corticosteroid therapy. MATERIALS AND METHODS This cross-over randomized clinical trial was conducted on the patients who had been referred to Shiraz Dental School for their RAS in 2021. All the participants used both P. granatum flower tablets and Triadent a month apart for wash-out time and all compared themselves. In the experimental group, 30 patients received pomegranate flower tablets, three tablets daily, for 6 days. In the control group, oral paste Triadent has been prescribed three times a day for 6 days. The visual analog scale (VAS) and the size of RAS were evaluated on Days 0-6. Data were analyzed by SPSS version 21. The Wilcoxon test was used. RESULTS The mean age of participants was 27.8 ± 14.77 years old. In this study, 15 patients (50%) were men and 15 patients (50%) were women. The mean value of VAS after using prescribed treatment in both evaluated groups on all days was significantly different such that the VAS values were lower for PG flower tablets than Triadent (p value < 0.05). The size of oral lesions in participants who used PG flower tablets was significantly less than those who used Triadent on all evaluation days (p value < 0.05) except on Day 1 (p value = 0.29). The descending slope of VAS from Days 1 to 6 for both Triadent and PG flower tablet users was significant and noticeable. (p value < 0.05). CONCLUSION According to the result of this study, both P. granatum flower tablet and Triadent are useful in reducing the size, period of healing, and VAS of patients with RAS, but the PG flower tablet is more effective.
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Affiliation(s)
- Fatemeh Lavaee
- Oral and Maxillofacial Disease Department, School of DentistryShiraz University of Medical SciencesShirazIran
| | - Elahehnaz Parhizkar
- Department of Pharmaceutics, School of PharmacyShiraz University of Medical SciencesShirazIran
| | - Fatemeh Tavakoli
- Oral and Maxillofacial Medicine Department, School of DentistryShiraz University of Medical SciencesShirazIran
| | - Mohammad M. Zarshenas
- Department of Phytopharmaceuticals (Traditional Pharmacy), School of PharmacyShiraz University of Medical SciencesShirazIran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research CenterShiraz University of Medical SciencesShirazIran
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Vitamia C, Iftinan GN, Latarissa IR, Wilar G, Cahyanto A, Elamin KM, Wathoni N. Natural and Synthetic Drugs Approached for the Treatment of Recurrent Aphthous Stomatitis Over the Last Decade. Drug Des Devel Ther 2024; 18:1297-1312. [PMID: 38681204 PMCID: PMC11048360 DOI: 10.2147/dddt.s449370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/10/2024] [Indexed: 05/01/2024] Open
Abstract
Recurrent aphthous stomatitis (RAS) refers to a sore and frequently recurring inflammation of the oral tissues, distinguished by the presence of small ulcers that cause significant discomfort and cannot be attributed to any underlying disease. Different treatments have been used for RAS. This review aims to provide a comprehensive overview of the treatment options over the past decade for recurrent aphthous stomatitis (RAS), encompassing both natural and synthetic treatments. It will utilize clinical efficacy studies conducted in vivo and in vitro, along with a focus on the pharmaceutical approach through advancements in drug delivery development. We conducted a thorough literature search from 2013 to 2023 in prominent databases such as PubMed, Scopus, and Cochrane, utilizing appropriate keywords of recurrent aphthous stomatitis, and treatment. A total of 53 clinical trials with 3022 patients were included, with 35 using natural materials in their research and a total of 16 articles discussing RAS treatment using synthetic materials. All the clinical trials showed that natural and synthetic medicines seemed to benefit RAS patients by reducing pain score, ulcer size, and number of ulcers and shortening the healing duration.
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Affiliation(s)
- Cszahreyloren Vitamia
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
- Departement of Pharmacy, Akademi Farmasi Bumi Siliwangi, Bandung, Indonesia
| | - Ghina Nadhifah Iftinan
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Irma Rahayu Latarissa
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Gofarana Wilar
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Arief Cahyanto
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khaled M Elamin
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nasrul Wathoni
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
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Mahapatra S, Hebbale M, Mhapuskar A, Halli R, Jadhav S. The efficacy of Punica granatum extract gel in the treatment of symptomatic oral lichen planus in an Indian population: A clinical study. Indian J Pharmacol 2024; 56:84-90. [PMID: 38687311 PMCID: PMC11160999 DOI: 10.4103/ijp.ijp_107_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 10/31/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. MATERIALS AND METHODS The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. RESULTS In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. CONCLUSION P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment.
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Affiliation(s)
- Subharina Mahapatra
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India
| | - Manjula Hebbale
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India
| | - Amit Mhapuskar
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India
| | - Rajshekhar Halli
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India
| | - Santosh Jadhav
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Pune, Maharashtra, India
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Čolić M, Miljuš N, Đokić J, Bekić M, Krivokuća A, Tomić S, Radojević D, Radanović M, Eraković M, Ismaili B, Škrbić R. Pomegranate Peel Extract Differently Modulates Gene Expression in Gingiva-Derived Mesenchymal Stromal Cells under Physiological and Inflammatory Conditions. Int J Mol Sci 2023; 24:15407. [PMID: 37895087 PMCID: PMC10607867 DOI: 10.3390/ijms242015407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Pomegranate has shown a favorable effect on gingivitis/periodontitis, but the mechanisms involved are poorly understood. The aim of this study was to test the effect of pomegranate peel extract (PoPEx) on gingiva-derived mesenchymal stromal cells (GMSCs) under physiological and inflammatory conditions. GMSC lines from healthy (H) and periodontitis (P) gingiva (n = 3 of each) were established. The lines were treated with two non-toxic concentrations of PoPEX (low-10; high-40 µg/mL), with or without additional lipopolysaccharide (LPS) stimulation. Twenty-four genes in GMSCs involved in different functions were examined using real-time polymerase chain reaction (RT-PCR). PoPEx (mostly at higher concentrations) inhibited the basal expression of IL-6, MCP-1, GRO-α, RANTES, IP-10, HIF-1α, SDF-1, and HGF but increased the expression of IL-8, TLR3, TGF-β, TGF-β/LAP ratio, IDO-1, and IGFB4 genes in H-GMSCs. PoPEx increased IL-6, RANTES, MMP3, and BMP2 but inhibited TLR2 and GRO-α gene expression in P-GMSCs. LPS upregulated genes for proinflammatory cytokines and chemokines, tissue regeneration/repair (MMP3, IGFBP4, HGF), and immunomodulation (IP-10, RANTES, IDO-1, TLR3, COX-2), more strongly in P-GMSCs. PoPEx also potentiated most genes' expression in LPS-stimulated P-GMSCs, including upregulation of osteoblastic genes (RUNX2, BMP2, COL1A1, and OPG), simultaneously inhibiting cell proliferation. In conclusion, the modulatory effects of PoPEx on gene expression in GMSCs are complex and dependent on applied concentrations, GMSC type, and LPS stimulation. Generally, the effect is more pronounced in inflammation-simulating conditions.
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Grants
- 451-03-68/2020-14/200019 Ministry of Education, Science and Technological Development, Republic of Serbia
- MFVMA/03/20-22 University of Defense in Belgrade, Medical Faculty of the Military Medical Academy, Belgrade, Serbia
- UIS/MFF: I.1.20-22 University of East Sarajevo, Medical Faculty Foča, Foča, Bosnia and Herzegovina
- N/A Medical Faculty Banja Luka, University of Banja Luka, Bosnia and Herzegovina
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Affiliation(s)
- Miodrag Čolić
- Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
- Medical Faculty Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina;
| | - Nataša Miljuš
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (N.M.); (A.K.); (R.Š.)
| | - Jelena Đokić
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (J.Đ.); (D.R.)
| | - Marina Bekić
- Institute for the Application of Nuclear Energy, University of Belgrade, 11080 Belgrade, Serbia; (M.B.); (S.T.)
| | - Aleksandra Krivokuća
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (N.M.); (A.K.); (R.Š.)
| | - Sergej Tomić
- Institute for the Application of Nuclear Energy, University of Belgrade, 11080 Belgrade, Serbia; (M.B.); (S.T.)
| | - Dušan Radojević
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (J.Đ.); (D.R.)
| | - Marina Radanović
- Medical Faculty Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina;
| | - Mile Eraković
- Clinic for Stomatology, Medical Faculty of the Military Medical Academy, University of Defense, 11154 Belgrade, Serbia;
| | - Bashkim Ismaili
- Faculty of Dental Medicine, International Balkan University, 1000 Skopje, North Macedonia;
| | - Ranko Škrbić
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (N.M.); (A.K.); (R.Š.)
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Amanpour S, Akbari Javar M, Sarhadinejad Z, Doustmohammadi M, Moghadari M, Sarhadynejad Z. A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:306. [PMID: 38023092 PMCID: PMC10670971 DOI: 10.4103/jehp.jehp_1297_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/27/2022] [Indexed: 12/01/2023]
Abstract
Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.
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Affiliation(s)
- Sara Amanpour
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahsa Akbari Javar
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohreh Sarhadinejad
- Noncommunicable Disease Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Mohammadmahdi Doustmohammadi
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Moghadari
- Department of Persian Medicine, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zarrin Sarhadynejad
- Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Department of Traditional Pharmacy, Faculty of Persian Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Kshirsagar KR, Pathak SS, Patil SM. Pomegranate (Punica granatum L): A Fruitful Fountain of Remedial Potential. Cureus 2023; 15:e45677. [PMID: 37868528 PMCID: PMC10590020 DOI: 10.7759/cureus.45677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Pomegranate (Punica granatum L.) has long been used for medical purposes. Punica protopunicas and Punica granatum L. are two prominent species of pomegranate, generally known as "Anar" and farmed worldwide. Its medicinal value is documented in several ancient texts. This review article aims to provide a comprehensive overview of the remedial uses of pomegranate in traditional and modern medicine. The methodology employed for this review involves a systematic literature search, collection of relevant articles, and critical analysis of their content. The review covers the botanical properties, phytochemical composition, and diverse remedial applications of pomegranate, including its antioxidant, anti-inflammatory, anticancer, cardiovascular, antimicrobial, and dermatological properties. The gathered data emphasizes the potential benefits of pomegranate-derived compounds in managing a range of health issues. This review sheds light on the importance of pomegranate as a valuable natural resource for various therapeutic interventions and encourages further research to unlock its full remedial potential. Traditional medicine is gaining popularity to restore health to individuals with few negative effects. Due to the existence of key phytochemical elements such as flavonoids, punic acid, ellagic acid, anthocyanins, ellagitannins, flavones, and estrogenic flavonoids, it has a wide range of clinical applications.
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Affiliation(s)
- Kalyani R Kshirsagar
- Clinical Research, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swanand S Pathak
- Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sejal M Patil
- Clinical Research, School of Allied Health sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Tirupathi S, Gopalakrishnan D, Deshkar S. Herbal topical anesthetics in dentistry: an exploratory review. J Dent Anesth Pain Med 2022; 22:419-426. [PMID: 36601130 PMCID: PMC9763823 DOI: 10.17245/jdapm.2022.22.6.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/23/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
Topical anesthetics are routinely used in dental practice for various purposes. They are usually available at higher dosages and have serious potential adverse reactions, such as seizures, anaphylaxis, and acquired methemoglobinemia. To date, the scope of application of herbal plants and their extracts, which have medicinal properties, has been elaborated in the field of dentistry. The growing interest in herbal medication can be attributed to the increased safety profile of herbal agents, in contrast to synthetic preparations that have a higher risk of systemic complications. Herbal preparations can induce topical anesthesia with minimal side effects. Recently, many studies have reported the use of topical herbal preparations. The current review aimed to evaluate data from various articles comparing the capacity of herbal topical anesthetic formulations and conventional synthetic anesthetics in reducing pain perception when used as local anesthesia before dental procedures.
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Affiliation(s)
- Sunnypriyatham Tirupathi
- Department of Pediatric and Preventive Dentistry, Dr.D.Y. Patil Dental College and Hospital, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr.D.Y. Patil Dental College and Hospital, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Sanjeevani Deshkar
- Department of Pharmaceutics, Dr.D.Y. Patil Institute of Pharmaceutical Sciences & Research, Dr.D.Y. Patil Unitech Society, Pimpri, Pune, Maharashtra, India
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Fernandes GL, Vieira APM, Danelon M, Emerenciano NG, Berretta AA, Buszinski AFM, Hori JI, de Lima MHF, dos Reis TF, de Lima JA, Delbem ACB, da Silva SCM, Barbosa DB. Pomegranate Extract Potentiates the Anti-Demineralizing, Anti-Biofilm, and Anti-Inflammatory Actions of Non-Alcoholic Mouthwash When Associated with Sodium-Fluoride Trimetaphosphate. Antibiotics (Basel) 2022; 11:1477. [PMID: 36358132 PMCID: PMC9686636 DOI: 10.3390/antibiotics11111477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/27/2022] [Accepted: 10/19/2022] [Indexed: 12/01/2023] Open
Abstract
This study investigated the anti-caries and anti-inflammatory effects of mouthwash formulations containing Punica granatum (pomegranate) peel extract (PPE), sodium-trimetaphosphate, and low concentrations of fluoride. PPE was characterized using high-performance liquid chromatography (ellagic acid and punicalagin). Total phenolics were quantified among formulations, and their stability was analyzed for 28 days. The formulation effects were evaluated as follows: (1) inorganic component concentration and reduced demineralization on bovine enamel blocks subjected to pH cycling; (2) anti-biofilm effect on dual-biofilms of Streptococcus mutans ATCC 25175 and Candida albicans ATCC 10231 treated for 1 and 10 min, respectively; and (3) cytotoxicity and production of inflammatory mediators (interleukin-6 and tumor necrosis factor-alpha). The formulation containing 3% PPE, 0.3% sodium-trimetaphosphate, and 225 ppm of fluoride resulted in a 34.5% surface hardness loss; a 13% (treated for 1 min) and 36% (treated for 10 min) biofilm reduction in S. mutans; a 26% (1 min) and 36% (10 min) biofilm reduction in C. albicans; absence of cytotoxicity; and anti-inflammatory activity confirmed by decreased interleukin-6 production in mouse macrophages. Thus, our results provide a promising prospect for the development of an alcohol-free commercial dental product with the health benefits of P. granatum that have been recognized for a millennium.
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Affiliation(s)
- Gabriela Lopes Fernandes
- Graduate Program of Dental Science, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | - Ana Paula Miranda Vieira
- Graduate Program of Dental Science, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | - Marcelle Danelon
- School of Dentistry, University of Ribeirão Preto—UNAERP, Ribeirão Preto 14096-039, São Paulo, Brazil
- Department of Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | - Nayara Gonçalves Emerenciano
- Graduate Program of Dental Science, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | | | | | - Juliana Issa Hori
- Apis Flora Industrial and Comercial Ltd. Ribeirão Preto 14020-670, São Paulo, Brazil
| | - Mikhael Haruo Fernandes de Lima
- Department of Biochemistry and Immunology, University of São Paulo Ribeirão Preto, Ribeirão Preto 14049-900, São Paulo, Brazil
| | - Thaila Fernanda dos Reis
- Department of Dental Materials and Prosthodontics, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | | | - Alberto Carlos Botazzo Delbem
- Department of Restorative Dentistry, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
| | | | - Debora Barros Barbosa
- Department of Dental Materials and Prosthodontics, School of Dentistry, Araçatuba, São Paulo State University (UNESP), Araçatuba 16015-050, São Paulo, Brazil
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10
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Vuletic M, Jakovljevic V, Zivanovic S, Papic M, Papic M, Mladenovic R, Zivkovic V, Srejovic I, Jeremic J, Andjic M, Kocovic A, Sretenovic J, Mitrovic S, Božin B, Kladar N, Bolevich S, Bradic J. The Evaluation of Healing Properties of Galium verum-Based Oral Gel in Aphthous Stomatitis in Rats. Molecules 2022; 27:molecules27154680. [PMID: 35897855 PMCID: PMC9332434 DOI: 10.3390/molecules27154680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/25/2023] Open
Abstract
Although oral ulcers represent one of the most frequent oral mucosal diseases, the available treatment is not sufficient to provide complete ulcer recovery without side-effects. Therefore, the aim of our study was to prepare a mucoadhesive oral gel based on Galium verum ethanol extract (GVL gel) and reveal its healing effects in the model of aphthous stomatitis in rats. Rats with oral ulcers were divided into the following groups: control (untreated), gel base (ulcer was treated with the gel base, three times per day for 10 days), and GVL gel group (the ulcer was treated with GVL gel in the same way as the gel base). Animals from each group were sacrificed on days 0, 3, 6, and 10 for collecting blood and ulcer tissue samples. Healing properties of oral gel were determined by clinical evaluation, as well as biochemical and histopathological examinations. Our findings suggest a significant decrease in the ulcer size in GVL gel group, with healing effects achieved through the alleviation of oxidative stress, reduction in COX-2 immunopositivity, and increase in collagen content in buccal tissue. Significant ulcer repairing potential of GVL gel highlights this oral mucoadhesive gel as a promising tool for prevention and treatment of RAS.
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Affiliation(s)
- Miona Vuletic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Vladimir Jakovljevic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
- Department of Human Pathology, 1st Moscow State Medical University I.M. Sechenov, 119991 Moscow, Russia;
| | - Suzana Zivanovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Milos Papic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Mirjana Papic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Rasa Mladenovic
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujeva, Serbia; (M.V.); (S.Z.); (M.P.); (M.P.); (R.M.)
| | - Vladimir Zivkovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Ivan Srejovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Jovana Jeremic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Marijana Andjic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Aleksandar Kocovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
| | - Jasmina Sretenovic
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (V.J.); (V.Z.); (I.S.); (J.S.)
| | - Slobodanka Mitrovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
| | - Biljana Božin
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (B.B.); (N.K.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nebojša Kladar
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (B.B.); (N.K.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Sergey Bolevich
- Department of Human Pathology, 1st Moscow State Medical University I.M. Sechenov, 119991 Moscow, Russia;
| | - Jovana Bradic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.J.); (M.A.); (A.K.)
- Correspondence: ; Tel.: +381-34306800
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Shavakhi M, Sahebkar A, Shirban F, Bagherniya M. The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials. Phytother Res 2021; 36:672-685. [PMID: 34816511 DOI: 10.1002/ptr.7332] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/09/2021] [Accepted: 10/23/2021] [Indexed: 01/08/2023]
Abstract
This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.
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Affiliation(s)
- Mojgan Shavakhi
- Department of Orthodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Medicine, The University of Western Australia, Perth, Australia.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farinaz Shirban
- Department of Orthodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagherniya
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Anesthesia and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Therapeutic Effects of Punica granatum (Pomegranate): An Updated Review of Clinical Trials. J Nutr Metab 2021; 2021:5297162. [PMID: 34796029 PMCID: PMC8595036 DOI: 10.1155/2021/5297162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Punica granatum L. belongs to the Punicaceae family which is distributed around the world. Different parts of pomegranate like seed, peel, juice, and leaves are rich in potential bioactive compounds. These plants have found application in traditional medicine such as in treatment of gastrointestinal, cardiovascular, and endocrine diseases, among others. The present review aimed to summarize the current research on the traditional and scientific applications of P. granatum with regard to the phytochemical content and clinical applications that may be useful for future drug development. Information about P. granatum was obtained from local classic herbal literature and electronic databases, such as PubMed, Scopus, and ScienceDirect. Several phytochemical constituents including polyphenolics, flavonoids, anthocyanosides, alkaloids, lignans, and triterpenes have been reported from the plant. Randomized clinical trials have provided evidence as to the pharmacological activities of pomegranate in several diseases including diabetes, cardiovascular disease, oral cavity disorders, endocrine disorders, and cancer. The present review has provided an insight into the traditional applications of the plants, and some of them have been validated by scientific evidence, particularly their applications as treatment of cardiovascular and endocrine diseases.
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13
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Wen SD, Sans-Serramitjana E, Santander JF, Sánchez MR, Salazar-Aguilar P, Zepeda AB, Alvarado SI, Miranda IB. Effects of natural extracts in the treatment of oral ulcers: A systematic review of evidence from experimental studies in animals. J Clin Exp Dent 2021; 13:e1038-e1048. [PMID: 34667500 PMCID: PMC8501866 DOI: 10.4317/jced.58567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background To evaluate the clinical and histopathological effects of natural extracts in the treatment of oral ulcers induced in animal experimental models.
Material and Methods We carried out a search in the Medline, Scopus, WoS and Embase databases from the start of the databases to December 2020, and also made a manual search of the references. The search and selection were carried out by two researchers independently. The inclusion criteria were: experimental studies in animal models, in english, which complied with the study object.
Results A total of 705 articles were identified. After selection by title, abstract and full text, 19 articles were finally included. Natural extracts of Jasminum grandiflorum, Ficus deltoidea, curcumin and Bixina orellana provoked a significantly greater reduction in the size of the ulcer. Extracts of Salvatora persica, Musa acuminate, Ganoderma lucidum mycelia and Bixina Orellana, as well as preparations of Kouyanqing Granule and curcumin, were able to reduce levels of pro-inflammatory cytokines and increase the expression and serum levels of growth factors and anti-inflammatory cytokines. Extracts of Piper sarmentosus, Cannabis sativa and Bletilla striata provoked a reduction in the severity of the histological inflammation. No significant differences were observed compared to controls in the treatments with extracts of Cannabis sativa, Aloe barbadensus Miller and Malva sylvestris in reducing the area of the oral ulcers.
Conclusions Most of the natural extracts described in this review presented a positive clinical and histological effect on the cicatrisation of oral ulcers induced in animal models. Key words:Recurrent aphthous stomatitis, oral ulcer, plants, herbs, extracts, medicine, treatment.
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Affiliation(s)
- Schilin D Wen
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile.,Doctoral Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile
| | - Eulàlia Sans-Serramitjana
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile.,Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco, Chile
| | - Javiera F Santander
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile
| | - Mariela R Sánchez
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile
| | - Paulina Salazar-Aguilar
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile
| | - Andrea B Zepeda
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile.,Non-Governmental Organization for Technology and Science Development for Humanity, Chile
| | - Susana I Alvarado
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile.,Non-Governmental Organization for Technology and Science Development for Humanity, Chile
| | - Ignacia B Miranda
- Grupo de investigación en Ciencias Aplicadas a la Odontología, Facultad Ciencias de la Salud, Universidad Autónoma de Chile, Chile.,Non-Governmental Organization for Technology and Science Development for Humanity, Chile
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How to transfer traditional knowledge about medicinal herbs? or TCM plants: a black box for modern oncologists. J Cancer Res Clin Oncol 2020; 147:351-359. [PMID: 33037900 DOI: 10.1007/s00432-020-03415-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE How could we transfer knowledge about healing plants from other cultures? We analyzed the results of literature search in two exemplary fields-oral mucositis and polyneuropathy. MATERIALS AND METHODS In both systematic searches of existing literature, we found 57 studies investigating 68 plants from different traditional cultures (16 Western Medicine, 14 Persian Medicine, 9 Japanese, 10 Chinese, and 8 other sources). We analyzed studies regarding their ingredient plants and reproducibility in relation to the system of origin. RESULTS Western and Persian Medicine trials investigate single plants, whereas Japanese and Chinese trials focus on mixtures and decoctions. European folk medicine knows of only 50% of plants used in both Asian cultures. The used ingredients and dosages were reproducible in all analyzed trials except TCM studies. CONCLUSIONS Herbal knowledge has been transferred from all folk medicines worldwide. However, Western oncologists should be aware that Traditional Chinese Medicine herbs are still a black box of knowledge for us until today.
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15
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Buentzel J, Bauer C, Buentzel J. How to bridge the gap? European medical plants used for treating oral mucositis: on the search for evidence. J Cancer Res Clin Oncol 2020; 146:985-1001. [PMID: 31955287 PMCID: PMC7085484 DOI: 10.1007/s00432-020-03124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Judith Buentzel
- Department of Haematology and Medical Oncology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
| | - Christoph Bauer
- Department of Nephrology and Hypertension, Center for Internal Medicine and Medical Clinic III, Klinikum Fulda, Fulda, Germany
| | - Jens Buentzel
- Department of Otolaryngology, Head Neck Surgery, Südharz Hospital, Nordhausen, Germany
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16
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Tavangar A, Aslani A, Nikbakht N. Comparative Study of Punica granatum Gel and Triadent Oral Paste Effect on Recurrent Aphthous Stomatitis, a Double Blind Clinical Trial. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2019; 20:184-189. [PMID: 31579693 PMCID: PMC6732176 DOI: 10.30476/dentjods.2019.44913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statement of the Problem Recurrent aphthous stomatitis is a common oral lesion, and the use of herbal remedies containing tannin and flavonoid has been reported to be effective in treating aphthous stomatitis. Purpose This study was aimed to evaluate the effect of Punica granatum muco-adhesive gel on controlling the oral recurrent aphthous stomatitis and its comparison with Triadent oral paste. Materials and Method In this double-blind clinical trial, 60 patients with minor aphthous stomatitis were enrolled. These patients had no systemic diseases and were not on any medications. The patients were randomly treated with Punica granatum formulated gel, Triadent oral paste and placebo. The time of pain elimination and the time of complete healing were recorded and the pain degree was assessed and recorded by each patient. The data were analyzed using survival analysis and ANOVA test. Results The Kaplan-Meier survival analysis demonstrated that pain relief time in Punica granatum group was lower than placebo group (p= 0.002), even so, it caused no significant difference with the Triadent group in comparison with the placebo group (p= 0.08). The survival analysis also indicated that the wound healing time in Punica granatum group was significantly lower than the other two groups (p< 0.05). Conclusion Punica granatum gel has a successful effect in controlling and treating recurrent aphthous stomatitis. It can be considered as an affordable and inexpensive treatment.
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Affiliation(s)
- Atefeh Tavangar
- Dental Material Research Center, Dept. of Oral and Maxillofacial Medicine, Dental Research Institute,Isfahan University of Medical Sciences, Isfahan,Iran
| | - Abolfazl Aslani
- Dept. of Pharmaceutics, School of Pharmacy and Novel Drug Delivery Systems Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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The effects of pomegranate peel extract on recurrent aphthous stomatitis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2019. [DOI: 10.2478/cipms-2019-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
As high as 20% of the population is thought to have recurrent aphthous stomatitis (RAS), hence, finding new therapeutic agents may be needed. Pomegranate (Punica granatum), has been extensively used in the folk medicine of many cultures, as it possesses antioxidant, anti-inflammatory and anti-bacterial properties. In this study, it is hypothesized that a topical form of pomegranate peel extract (PPE) may shorten the duration, accelerate the healing and reduce the pain of RAS patients. The presented randomized, double-blind study was conducted on 56 patients. Herein, 28 patients were advised to apply PPE gel, and the other 28 patients were given placebo gel, twice daily for one week. Efficacy evaluations were made at days 0 (before using the gel), 3, 5 and 7. The mean values of ulcer size, pain and healing duration of ulcers were compared in both groups. PPE gel was significantly effective in reducing the pain (p<0.001), ulcer size (p<0.001), and healing duration of ulcers (p<0.001) over a period of one week. PPE in the form of oral gel can be used in the management of aphthous ulcers.
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Nasry SA, El Shenawy HM, Mostafa D, Ammar NM. Different modalities for treatment of recurrent aphthous stomatitis. A Randomized clinical trial. J Clin Exp Dent 2016; 8:e517-e522. [PMID: 27957263 PMCID: PMC5149084 DOI: 10.4317/jced.52877] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/28/2016] [Indexed: 01/05/2023] Open
Abstract
Background The underlying etiology of recurrent aphthous stomatitis (RAS) is unclear and treatment aims to provide symptomatic and faster relief. This study compared the efficacy of diode laser, a herbal combination of Acacia nilotica and Licorice (A and L) and Amlexanox in the management of RAS. Material and Methods Sixty patients with minor aphthae were selected and randomly divided into four groups of 15 each. Group I and II received adhesive preparations of a herbal mixture of A and L and a 2 mg Amlexanox paste respectively, group III received diode laser and the fourth group (control) used a placebo. Ulcer size, pain score were recorded on days 1, 2 and 5. Results Laser group showed the statistically highest mean percentage (%) of reduction in pain scores and ulcer size than the other groups. The mean % of reduction in pain scores was 43.3+20.0 at day 2 and 67.8+21.5 % at day 5 in the laser group while Amlexanox group demonstrated a 29.8 +11.3 and 61.9+24.5 mean % of reduction in pain scores at day 2 and 5 respectively. A and L group showed a lower mean % of reduction in pain scores than laser and Amlexanox groups with a 22.2+10.5 and 43.4+15.8 mean % reduction in pain scores at day 2 and day 5 respectively. Similarly the highest mean % of reduction in ulcer size was seen in the laser group being 52.7+19.8 at day 2 and 85.1+22.0 at day 5, while it was 48.1+16.5 at day 2 and 77.8+28.7 at day 5 in the Amlexanox group and 42.0+11.5 at day 2 and 63.0+20.5 at day 5 in the A and L group. Conclusions All treatment modalities reduced pain and ulcer size than placebo group. Laser therapy demonstrated the highest percentage of reduction of pain score and ulcer size. Key words:Aphthous stomatitis, laser, herbal plants, Acacia nilotica, Licorice.
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Affiliation(s)
- Sherine A Nasry
- Professor. Department of Oral Surgery and Medicine, National Research Centre, Giza, Egypt
| | - Hanaa M El Shenawy
- Professor. Department of Oral Surgery and Medicine, National Research Centre, Giza, Egypt
| | - Dina Mostafa
- Associate Professor. Department of Pharmaceutical Technology, National Research Centre, Giza, Egypt
| | - Nagwa M Ammar
- Professor. Department of Pharmacognosy, National Research Centre, Giza, Egypt
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Aslani A, Zolfaghari B, Davoodvandi F. Design, Formulation and Evaluation of an Oral Gel from Punica Granatum Flower Extract for the Treatment of Recurrent Aphthous Stomatitis. Adv Pharm Bull 2016; 6:391-398. [PMID: 27766223 DOI: 10.15171/apb.2016.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/09/2016] [Accepted: 08/14/2016] [Indexed: 11/09/2022] Open
Abstract
Purpose: Recurrent aphthous stomatitis is a disease with unknown etiology that's mostly treated symptomatically and has no definite cure. Pomegranate (Punica granatum) flowers have been used as medicinal herb that due to its antimicrobial, antioxidant, anti-inflammatory, analgesic and healing effects, has been useful in treatment of oral aphthous. Therefore, we decided to formulate a mucoadhesive gel with pomegranate flower extract to reduce the need for corticosteroid therapy in patients. Methods: Pomegranate flowers are extracted by percolation method. Several formulations with different amounts of carbomer 934, sodium carboxymethylcellulose (SCMC) and hydroxypropyl methylcellulose K4M were prepared and the condensed extract was dispersed in polyethyleneglycol (PEG) 400 and added to gel bases. Then the formulations underwent macroscopic and microscopic studies. The formulations that passed these tests successfully were studied through assay tests using spectrophotometry in 765 nm, drug release from mucoadhesive gel using cell diffusion method, viscosity test, mucoadhesion test and accelerated stability test. Results: The phenolic content of pomegranate flower dried extract was found to be 212.3±1.4 mg/g in dried extract. The F4-F6 formulations contains carbomer 934, SCMC, pomegranate flower extract, PEG 400, potassium sorbate and purified water passed all above tests. Conclusion: The F4 formulation had higher viscosity and mucoadhesion values due to its higher carbomer 934 and SCMC content. Since F4, F5 and F6 had no significant variation in drug release, the F4 formulation was chosen as the superior formulation because of proper appearance and uniformity, acceptable viscosity, mucoadhesion and stability in different temperatures.
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Affiliation(s)
- Abolfazl Aslani
- Department of Pharmaceutics, School of Pharmacy and Novel Drug Delivery Systems Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Zolfaghari
- Department of Pharmacognosy, School of Pharmacy and Isfahan Pharmaceutical Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Davoodvandi
- Novel Drug Delivery Systems Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Gavanji S, Larki B, Bakhtari A. WITHDRAWN: The effect of extract of Punica granatum var. pleniflora for treatment of minor recurrent aphthous stomatitis. Integr Med Res 2016. [DOI: 10.1016/j.imr.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Li CL, Huang HL, Wang WC, Hua H. Efficacy and safety of topical herbal medicine treatment on recurrent aphthous stomatitis: a systemic review. Drug Des Devel Ther 2015; 10:107-15. [PMID: 26770058 PMCID: PMC4706126 DOI: 10.2147/dddt.s96589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
This study aimed to evaluate the efficacy and safety of topical treatment with natural herbal medicines on recurrent aphthous stomatitis (RAS). Nine electronic databases were searched to identify the randomized controlled trials and clinical controlled trials that reported the potential effect of natural herbal medicines on RAS published in Chinese or English. Ulcer size and duration, and remission of pain were assessed as main outcome measures. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systemic Review of Interventions and Rev Man software. Thirteen trials with a total of 1,515 patients were included in the present analysis, which showed that topical treatment with natural herbal medicines seemed to benefit RAS patients by reducing ulcer size, shortening ulcer duration, and relieving pain without severe side effects. In conclusion, there is some evidence of the efficacy of topically applied natural herbal medicines with regards to improved RAS outcome measures and fewer side effects. However, given the limitations of this study, the evidence remains insufficient. Well-designed and high-quality randomized controlled trials are required for further exploration.
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Affiliation(s)
- Chun-Lei Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
| | - He-Long Huang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
| | - Wan-Chun Wang
- Department of Oral Medicine, Qingdao Stomatological Hospital, Qingdao, People’s Republic of China
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
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Prasad D, Kunnaiah R. Punica granatum: A review on its potential role in treating periodontal disease. J Indian Soc Periodontol 2014; 18:428-32. [PMID: 25210254 PMCID: PMC4158581 DOI: 10.4103/0972-124x.138678] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 11/05/2013] [Indexed: 01/01/2023] Open
Abstract
A wide variety of plants possess enormous treasure of medicinal value. Majority of these medicinal plants have been used to treat various systemic conditions successfully. Over the recent years, use of these medicinal plants has resurfaced to treat oral conditions. Among the oral conditions, periodontal disease remains one of the most common. Alternative and preventive options has become the need of the hour in order to overcome the adverse effects of the antimicrobial agents used in large as an adjunct to mainstream periodontal treatment. Punica granatum (Pomegranate) is one of the oldest edible fruit which has a long history as a medicinal fruit. This review is an attempt to highlight the potential of Punica granatum as a preventive and therapeutic aid to periodontal disease.
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Affiliation(s)
- Divyashree Prasad
- Department of Periodontics, MES Dental College and Hospital, Perintalmanna, Mallapuram, Kerala, India
| | - Ravi Kunnaiah
- Department of Periodontics, MES Dental College and Hospital, Perintalmanna, Mallapuram, Kerala, India
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Gavanji S, Larki B, Bakhtari A. The effect of extract of Punica granatum var. pleniflora for treatment of minor recurrent aphthous stomatitis. Integr Med Res 2014; 3:83-90. [PMID: 28664082 PMCID: PMC5481717 DOI: 10.1016/j.imr.2014.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/14/2014] [Accepted: 03/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background Herbal drugs are considered alternative agents and have been used for several years around the world. Recurrent aphthous stomatitis (RAS) is one of the most common problems recognized by dentists and skin specialists. This problem is characterized by recurring, painful, small oral mucosal ulcers with a round or oval aspect that mostly appear in keratinized mucosa, cheeks, and on the surface of the mouth under the tongue. Methods In our experiment, the alcoholic and water extracts of Punica granatum var. pleniflora, P. granatum var. Sweet Alak, and P. granatum var. Saveh Black were tested on minor RAS. The study was carried out using the double-blind method. The study population consisted of 210 participants, of whom 69 were females (32%) and 141 were males (68%). In addition to checking several factors, the pain and the degree of the participant's satisfaction had been determined based on visual analog scale. Data analysis was done in the form of a nonparametric method using Kruskal–Wallis test and SPSS version 20 software. Results The results show that the alcoholic and water extracts of P. granatum var. pleniflora have a meaningful therapeutic effect on minor RAS. Results from the antioxidant activity and its relation to total phenolics show that P. granatum var. pleniflora and P. granatum var. Sweet Alak are rich in phenols. Conclusion The water and alcoholic extracts of P. granatum varpleniflora decreased the entire time of complete treatment, and the treatment was meaningfully satisfactory for patients who participated in this experiment.
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Affiliation(s)
- Shahin Gavanji
- Young Researchers and Elite Club, Khorasgan Branch, Islamic Azad University, Khorasgan, Isfahan, Iran
| | - Behrouz Larki
- Department of Plant protection, Khorasgan (Isfahan) Branch, Islamic Azad University, Isfahan, Iran
| | - Azizollah Bakhtari
- Department of Animal Science, Isfahan University of Technology, Isfahan, Iran
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Evaluation of the Effectiveness of the Iralvex Gel on the Recurrent Aphthous Stomatitis Management. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:175378. [PMID: 27350983 PMCID: PMC4897505 DOI: 10.1155/2014/175378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/23/2014] [Indexed: 12/31/2022]
Abstract
Introduction. As there is no definitive treatment for the recurrent aphthous stomatitis (RAS), most of the available therapies aim at decreasing pain and discomfort. The aim of this study was to investigate the effectiveness of the Iralvex gel on the RAS management. Material and Methods. In this double-blind and placebo-controlled clinical trial study, twenty patients were treated with the Iralvex gel and the other twenty patients were treated with placebo. In every participant complete healing of lesions, pain duration, and intensity were evaluated. Data were analyzed by independent t-test and analysis of variance. Results. Pain was relieved after 6.10 ± 0.29 days in the Iralvex group in comparison to 8.00 ± 0.33 days in the placebo group (P value ≤0.001). Complete remission in the Iralvex group was after 6.80 ± 0.27 days and 10.20 ± 0.42 days in the placebo group (P value ≤ 0.001). Furthermore, significant differences in the pain intensity between Iralvex and placebo group measured on days 1, 3, and 5 were obtained (P value ≤ 0.01). Conclusion. The results of this study show that Iralvex gel is effective and cheap remedy for treatment of RAS without side effects. This trial is registered with IRCT201207253251N3.
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