Review Article

ISSN 2228-5032

Use of herbs and medicinal plants in dentistry: a review

Bahareh Nazemi Salman,a Surena Vahabi,b* and Mahshid Mohebbi Radc

a
Department of Pediatrics, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran.
b
Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
c
Dental student, Zanjan University of Medical Sciences, Zanjan, Iran.
Correspondence to: Dr S. Vahabi (email: [email protected])
(Submitted: 29 October 2016 – Revised version received: 29 December 2016 – Accepted: 07 January 2017 – Published online: Spring 2017 )

Objectives This study reviews herbs and medicinal plants in dentistry and discusses their biological activities, benefits and side effec ts.
Review of Literature In this review, the PubMed, Medline and Google Scholar databases were electronically searched for relevant articles and
books in English using the keywords “medicinal plant”, “herb”, “phytotherapy”, “dentistry” and “pediatric”.
Conclusion Medicinal herbs have long been an inseparable part of treatment of various diseases. Today, the range of applications of these plants
is not limited to medical treatment and various types of medicinal plants are used in various fields including dentistry. Increased interest in
medicinal plants is mainly due to less side effects compared to those of synthetic drugs and they are often favored for use in children.
Keywords plants, medicinal, phytotherapy, pediatric dentistry

Introduction Overview of the Use of Plants in Dentistry

The use of medicinal plants has a long history in medical and Before the main discussion, we provide an overview of the
dental practice and they have long been used worldwide. 1 use of plants in various fields of dentistry. For example, in per-
Anti-inflammatory, antibacterial and antioxidant properties iodontics, aloe vera (medicinal aloe) is used for reducing gin-
of plants as well as their biocompatibility explain the people’s gival bleeding and gingival inflammation, 11,12 Azadirachta
growing interest in the use of herbal medications.2 indica (neem) is used for reducing plaque index,13 Pistacia
Today, more than 90% of school children and a large atlantica (mastic tree) is used for its activity against gingival
proportion of adults have dental caries in many parts of the microorganisms14 and Salvadora persica (mustard tree) is used
world.3 This indicates the need for improved diagnostic and for improving gingival health.15
therapeutic procedures in dentistry, especially in children. In endodontics, Camellia sinensis (green tea),6 Morinda
On the other hand, misuse and overuse of antibiotics are citrifolia (Indian mulberry)16 and propolis17 can be used as irri-
increasing.1 Use of synthetic drugs, especially in children, gating solutions. For pulp capping, propolis can be named.18
can have adverse effects such as liver complications.4 Plants that have been studied as intracanal medicaments
A study conducted on irrigating solutions showed that include Arctium lappa (greater burdock).19 Curcuma longa
chlorhexidine (CHX) causes tooth discoloration, creates a (turmeric) can be used for endodontic retreatment for dis-
burning sensation in the mouth and results in loss of taste.5 solving and softening of gutta-percha.20
Sodium hypochlorite can cause allergy and tissue toxicity In oral and maxillofacial surgery, Ankaferd Blood Stopper®
and calcium hydroxide cannot efficiently remove bacteria made of Glycyrrhiza glabra (licorice), Vitis vinifera (grape vine),
from the dentinal tubules. 2,6,7 Moreover, not all people have Alpinia officinarum (lesser galangal), Thymus vulgaris
access to synthetic drugs and thus, they may use herbal (common) and Urtica dioica (common nettle) can be used to
medicines as alternatives. Evidence shows that 65–80% of decrease bleeding and SaliCept patch made of aloe vera can be
people in developing countries use medicinal plants for used to decrease the incidence of alveolar osteitis.21
their treatment.8 In 2007, a study conducted in the United Various types of lesions can occur in the mouth. In order
States showed that 12% of children in the US used alterna- to find a cure for them, various medicinal plants have been
tive medicine, and 5% used plant-based treatments.9 Many studied. For example, for the treatment of aphthous ulcers,
people also prefer herbal remedies, and ask for guidance aloe vera can accelerate healing of ulcers and reduce pain.22
and advice in this regard from their physicians.10 For the treatment of viral lesions such as herpetic lesions,
Since different plants have different compositions and Melissa officinalis (lemon balm) can be used to decrease cyto-
effects, we aimed to review a number of medicinal plants used pathic effect of herpes simplex virus (HSV) type II23 and
in dentistry, especially pediatric dentistry, and discuss their Mentha piperita (peppermint) can be used for its high viru-
benefits and side-effects to promote proper use of medicinal cidal activity against HSV-1 and HSV-2.24 For treatment of
herbs in treatment of oral conditions in children. Candida albicans, Coriandrum sativum (coriander) can be
used.25 For the treatment of lichen planus, aloe vera26 and Por-
tulaca oleracea (little hogweed) can be named.27
Materials and Methods Plants are the basis of many dental materials. For example,
The PubMed, Medline and Google Scholar databases were Cinnamomum camphora (camphor tree) is used in camphorated
electronically searched for relevant articles and books pub- monochlorophenol, an intracanal medicament; Gelidium amansii
lished in English using the keywords “medicinal plant”, “herb”, (agar agar) is used in agar impression material, Laminariadigitata
“phytotherapy”, “dentistry” and “pediatric”. (Oarweed) is used in alginate impression material, Syzygium

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Surena Vahabi et al. Use of herbs and medicinal plants in dentistry

aromaticum (clove) is used in zinc oxide eugenol cement endo- treatment of asthma, arthritis, atherosclerosis and cir-
dontic sealer, Citrus limon (lemon) is used in citric acid perio- culatory and digestive problems. Its fresh oil, raw cloves
dontal root conditioning and Palaquium gutta is used in and odorless extract are used.20,30 Research shows that
gutta-percha endodontic filling material.21 allicin is responsible for its antibacterial properties. The
Table1 presents an overview of a number of plants used in plant inhibits the growth of Streptococcus mutans and
dentistry and their biological properties. reduces its acid production. It also increases the secre-
tion of saliva and can be effective for prevention and
Phytotherapy in Pediatric Dentistry treatment of dental caries.32,65
Since many people believe that medicinal plants are safer than 2. Azadirachta indica: Neem reduces the frequency of
invasive methods and chemical drugs and have fewer side early caries and reverses its process to the same extent
effects, the tendency to use medicinal plants for children has as chlorhexidine by decreasing the count of Strepto-
increased. Some of the properties of plants used for this pur- coccus mutans.21 It has antibacterial properties and is a
pose are reviewed. biocompatible antioxidant. It is effective against Ente-
rococcus faecalis and Candida albicans.37 It has been
Prevention of Dental Caries shown that this plant can inhibit the growth of Strepto-
High rates of decay besides the high costs of treatment highlight coccus mutans, Streptococcus mitis, Streptococcus san-
the need for caries prevention. For this reason, the use of anti-bac- guinis and Streptococcus salivarius.66 In another study,
terial materials and fluoride-containing substances is important. it was shown that the gel containing neem significantly
Studies have shown that some plants can increase the sensitivity decreased the plaque index and bacterial count.13
of microorganisms by using secondary metabolites. Moreover, 3. Camelliasinensis: Green tea is anti-cancer,67 anti-oxidant,
some of them can inhibit bacterial growth and their acid produc- anti-inflammatory and free radical inhibitor. It is consid-
tion, inhibit the adhesion of bacteria to the teeth and inhibit the ered to be safe.43 Due to its disinfectant and deodorant
synthesis of exopolysaccharide for prevention of dental decay.62–64 activities, green tea can also be effective in reducing oral
For example, some of these plants are mentioned below: malodor.68 It has antimicrobial properties via inhibition
of gyrase enzyme.69 Flavonoids found in it cause antibac-
1. Allium sativum (garlic): Garlic reinforces the immune terial activity against cariogenic bacteria. It contains flu-
system, reduces blood pressure and decreases choles- oride that is effective in preventing cavities.6 Miller et al.
terol synthesis in the liver. This plant can be used for showed that compounds of these plants, especially

Table 1. Biological activities of medicinal plants

Herbs Biological activities Herbs Biological activities
Allium sativum 20,30–
Antibiotic, antibacterial, antifungal, hypotensive, Melaleuca alternifolia Antibacterial, antifungal, anti-
32 antithrombotic, immune regulatory function, (tea-tree)28,29 inflammatory
hypocholesterolemic, anti-caries
Aloe vera26,34,35 Antibacterial, antioxidant, antifungal, antiviral, Melissa officinalis23,33 Sedative, anxiolytic, hypnotic,
anti-inflammatory antiviral
Arctium lappa19 Antibacterial, antifungal, diuretic, antioxidant, anxiolytic, Morinda citrifolia16 Antimicrobial
platelet anti-aggregating, HIV-inhibitory action
Azadirachta Antioxidant, antifungal, antibacterial, antimicrobial Passiflora incarnate36 Sedative, anxiolytic
indica37 38,39
Camellia Antimicrobial, antibacterial, anti-cariogenic, antioxidant, Propolis Antimicrobial, cytostatic, antiox-
sinensis40–43 anti-inflammatory idants, anesthetic, anti-inflam-
matory, antifungal, Antibacte-
rial, antiviral, anti-carcinogenic,
antithrombotic, immunomod-
ulatory
Carum carvi45 Antihistaminic, antiseptic, antimicrobial, expectorant, Punica granatam Antibacterial
spasmolytic, diuretic (pomegranate)44
Citrus aurantium Antimicrobial Ricinnus communis Antimicrobial
(orange)47,48 (castor bean)46
Commipho Antiseptic Rosmarinus officinalis Antibacterial, antifungal
ra (Rosemary)49
myrrha50
Coriandru Antifungal Sanguinaria Antibacterial, antiplaque
m canadensis51,52
sativum25 54
Echinacea Stimulates immune response Salvadora persica53 Antimicrobial
55 45
Equisetum anti-inflammatory, antipyretic, anti-bleeding Salvia officinalis Anti-inflammatory, antibacterial,
antifungal, antiviral
Matricaria Anti-inflammatory Syzygium Antioxidants, antibacterial, ano-
chamomilla36 aromaticum56,57 dyne effect, anti-cariogenic
Mentha Carminative, analgesic, antimicrobial, muscle-relaxing Valeriana officinalis36,58 Tranquilizing and sedative
piperita45,59– action
61

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Use of herbs and medicinal plants in dentistry Surena Vahabi et al.

simple catechins in it, are responsible for anti-cariogenic oral, pulmonary, gastrointestinal and blood circulation
properties of this plant. For example, it has anti-bacterial problems. Chewing clove reduces bad breath. Rubbing
effects against S. mutans, S. salivarius and E. coli,70 it the oil on the gums and teeth can reduce pain.55,56 Its
inhibits adhesion of bacteria to tooth by inhibition of extract can reduce water-insoluble glucan synthesis and
glucosyl transferase and inhibits sticky glucan biosyn- thus can have anti-caries property.57
thesis and also bacterial and human amylase enzyme.
Some studies have shown that regular consumption of
Storage Media for Avulsed Teeth
tea can effectively decrease the incidence and severity of In case of occurrence of avulsion, it is important to use a suit-
dental caries.42 able storage medium for the avulsed tooth until its replanta-
4. Curcuma longa: Turmeric is antioxidant, anti-inflamma- tion in dental office. Some of these media include milk, saliva,
tory and antimutagenic. Its mouthwash causes a rapid and Hank’s balanced salt solution (HBSS).78,79 Some plants can
reduction of pain. When rubbed on the aching tooth, it be used for preparation of such media as follows:
relieves pain. The paste contains turmeric, mustard and
salt and is useful for reducing gingivitis and periodon- 1. Camellia sinensis: Green tea extract can be used as a
titis.55 Turmeric has strong antibacterial properties storage medium for avulsed teeth. It has been as effi-
against S. mutans biofilm and is as effective as CHX. So it cient as the HBSS for keeping PDL cells alive.67
can be effective in preventing dental caries.21 2. Cocos nucifera (coconut): one study showed that
5. Mentha piperita: In the past, peppermint used to treat skimmed and whole milk, followed by natural coconut
stomach, intestinal and muscle conditions and improve water and HBSS were effective for keeping PDL fibro-
blood circulation. Today, it is also used to treat condi- blasts viable.80
tions such as colic, fever, nausea and diarrhea. Menthol 3. Morus rubra (red mulberry): Studies have shown that
and methyl acetate are among its other constituents. In the juice of red mulberry with concentration of 2.5%
dentistry, it can be applied topically to relieve dental and 4% had superior efficacy compared to HBSS at 3,
pain, and as mouthwash for reducing inflammation of 6, and 12 hours. Its 4% extract had equal efficacy to
the gums.55In one study, the antimicrobial activity of M. HBSS at 24 hours. Thus, it is suitable as a medium.81
piperita and Rosmarinus officinalis essential oils and 4. Salvia officinalis (garden sage): Its constituents include
CHX against S. mutans and Streptococcus pyogenes was alpha and beta-thujone, camphor, cineole, rosmarinic
investigated; the results showed that the antimicrobial acid, tannins and flavonoids. In modern herbal medicine
activity of peppermint was good.60 Another study in Europe, this plant is recommended for treatment of
showed that its oil locally had virucidal properties sore throat, inflammation of the gums and mouth. Its oil
against herpes simplex viruses (HSV-1 and HSV-2).24 has antibacterial, antifungal, and antiviral properties.45
6. Pistacia atlantica: This plant is from Pistacia species. The extract can be used as storage medium. This medium
Different parts of the plant including resin, leaves, can maintain the viability of the periodontal ligament of
fruit, and aerial part can be used for therapeutic pur- the avulsed tooth and its 2.5% concentration is the most
poses. For example, its resin, which is also known in effective.82 Sage and chamomile tea can be used before
Iran as Saqqez, can be used as mouth freshener, anti- dental treatment to reduce stress.55
septic and gum tissue strengthener and is available in 5. Propolis: In vitro studies on dogs have shown that the sur-
the form of chewing gum for gastrointestinal disor- vival rate of PDL cells in propolis is similar to milk.
ders, and motion sickness treatment.71,72 Its constitu- Another study showed that it was appropriate to keep the
ents include α-pinene and terpenoids. In one study, it avulsed tooth in propolis, as a medium, for up to 6 hours.83
was shown that mouthwash containing this plant can
act effectively against gingival microorganisms. 14 Endodontic Treatment in Primary Teeth
Another study showed that this plant extract can have In many cases, the primary teeth should be maintained during
antibacterial effects on S. mutans and S. mitis.73 the primary and mixed dentition period for the purpose of
7. Propolis: This resin mixture is collected by honeybees space maintenance. Also, preserving the integrity of primary
from plant sources.31 It has antimicrobial, anti-inflam- teeth is important for development of permanent teeth.84,85
matory, healing, anesthetic, cytostatic and cariostatic Endodontic treatment is the last option to maintain the
properties and can also improve the immune system.74 primary teeth. Zinc oxide eugenol, iodoform-based pastes and
A study showed that Propolis can effectively decrease calcium hydroxide can be used for endodontic treatment of pri-
plaque accumulation.75 Other studies have shown that mary teeth.86 Vital pulpotomy is another modality, which
Propolis can interfere in growth and adhesion of involves applying a medicament over the residual radicular pulp
S. mutans and its glucosyl transferase activity. Thus, it tissue to promote healing.87 Formocresol, calcium hydroxide,
has anti-caries properties. It is worth mentioning that glutaraldehyde, enriched collagen solution, ferric sulfate and
more studies are needed to assess the quality and safety mineral trioxide aggregate can be used for pulpotomy.88
of the substance.76 Due to its antimicrobial properties A study showed that using a mixture of zinc oxide powder
against E. faecalis, studies evaluated its efficacy in endo- and aloe vera gel for endodontic treatment of primary teeth
dontic treatment as irrigant and intracanal medica- yielded good clinical and radiographic success. 86 Another
ment.2,16 It also has potential for use as pulp-capping study showed that propolis and mineral trioxide aggregate are
agent.18It is available in various forms such as tablet, gel more biocompatible than formocresol and ferric sulfate.89 In
and mouthwash.77 vital pulpotomy of primary molar, it was seen that formocresol
8. Syzygium aromaticum: Clove has antiseptic, antioxidant and Ankaferd Blood Stopper® were successful as pulp dressing
and antiemetic properties. It can be used for treatment of in primary molars at 12-month follow-up.90 It has been shown

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Surena Vahabi et al. Use of herbs and medicinal plants in dentistry

that A. sativum oil has stronger effects than formocresol on the effects as well as side effects of its own: Aloe vera,12,35 A. indica,21
infected pulp of primary non-vital molars.91 Of course, more C. longa,55 Echinacea,54 M. chamomilla,93 M. piperita,94 Pistacia
research is needed in this area. atlantica,14 propolis,77 Sanguinaria canadensis,95,96 S. officinalis,97
S. persica,15 C. carvi, C. myrrha, Stellaria media (chickweed),
Oral Mouth Rinse Sambucus (elderberry), Hydrastis canadensis (goldenseal), Equi-
Mouthwashes are efficient and convenient for use to improve setum (horsetail), Calendula officinalis (common marigold),
oral hygiene. Salvia officinalis, M. piperita, menthol, Matri- violet, Achillea millefolium (yarrow).45
caria chamomilla (chamomile), Commiphora myrrha (myrrh),
Carum carvi (caraway seed), S. aromaticum and Echinacea
Sedative and Anti-anxiety Activity
purpurea (purple coneflowers)94 are plant compounds that can Control and reduction of fear and anxiety in patients is one of
be used as mouth rinse to reduce gingival index.92 the most important points that dentists should consider in their
The following plants are also used in mouth rinses. It practice. This is especially important in children. Chemical
should be noted that each of these oral rinses has therapeutic
Table 2. Constituents of medicinal plants
Constituents Properties Example
Alkaloids Analgesic Indian mulberry
Allicin Antibacterial Garlic
Anthraquinine Antibacterial Aloe vera
Carotenoids Antimicrobial, antioxidant Orange
Catechins Antimicrobial Indian mulberry
Flavonoids Antioxidant, anticancer, anti-inflammatory, antiviral Green tea, Indian mulberry
Fluoride Cavity prevention Green tea
Phenols Analgesic, antimicrobial, anti-inflammatory Thyme
Tannins Anti-inflammatory, antimicrobial Sage
Terpenoids and Essential oils Antimicrobial Indian mulberry

Table 3. Adverse effects of medicinal plants

Herbs Adverse effects
1. Allium sativum104 Contact dermatitis
45
2. Carum carvi Avoid using it in children under 2 years old; skin and mucosal membrane irritation if
accompanied by Umbelliferae family
3. Echinacea104,105 Allergic reactions, gastrointestinal discomfort
4. Melaleuca alternifolia104 Contact dermatitis
5. Matricaria Allergic conjunctivitis, interaction with warfarin
chamomilla106,107
6. Mentha piperita45,94,108 Burning sensation and gastrointestinal upset, interferes with iron absorption; avoid
applying its oil on face in children and infants.
7. Melissa officinalis33,104 Contact dermatitis, diarrhea, nausea, elevated intraocular pressure, sleep disorders,
headache, fatigue, synergistic effect with alcohol and barbiturates
8. Passiflora incarnate36,109 Vasculitis in insomnia patients; use with caution with CNS depressants, phenelzine
and stimulants
9. Pistacia atlantica110 Cytotoxic/genotoxic effects
10. Sanguinaria Leukoplakia, diarrhea, stomach pain, distorted vision, paralysis, fainting, edema,
Canadensis45,111 glaucoma, heart disease, miscarriage, unsafe in children and pregnant or lactating
women
11. Ricinnus communis112–114 Asthma, contact dermatitis, laxative effect, nausea, vomiting, colic
12. Rosmarinus officinalis45 Avoid during pregnancy, iron deficiency
45
13. Thymus vulgaris Skin and mucous membrane sensitivity, dizziness, vomiting, spasmodic cough
especially in young children
14. V. officinalis36,115 Gastrointestinal discomfort, dizziness, headache, extra-sedation, interaction with
sedatives

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Surena Vahabi et al. Use of herbs and medicinal plants in dentistry

agents such as oral benzodiazepines and nitrous oxide-oxygen is more important in children because of their small body size
inhalation are used for this purpose.98 and lower capacity of detoxification. It is important to note that
Plants with sedative and anti-anxiety properties include children are different from adults in absorption, digestion,
Melissa officinalis,33 Passiflora incarnata (purple passion- metabolism and excretion of substances. On the other hand,
flower)36and V. officinalis (valerian).58More studies are needed since their liver is still developing, they have different detoxifica-
on their use in dentistry. tion capacity compared to adults. Thus, it is important to assess
the side effects and toxicity of plants for use in children.103
Constituents of Plants used in Dentistry Table 3 summarizes some of the side effects of herbs and their
Several studies have been done on the molecular structure of interactions with synthetic drugs.
plants. However, due to their complex structure, it is difficult
to explain the precise molecular mechanisms behind their
properties. Table 2 shows some of the constituents of medic-
Conclusion
inal plants and some of their properties.6,20,21,45,99,100 Due to the side effects and disadvantages of synthetic drugs,
the use of medicinal plants is increasing considering their low
Adverse Effects cost, availability and biocompatibility. Further studies on types
Side effects and toxicity of medicinal plants can be discussed in of suitable medicinal plants, their use and dosage are required
general, and specifically for each plant and depend on factors especially in children to know more about their toxicity and
such as their chemical composition, contaminants and adulter- possible side effects.
ants. Also, some plants can have synergistic effects on each other.
One of the important points is how plants are named in different
geographic areas; this means that a plant can have different names
Acknowledgment
in different regions, which can cause a lot of problems.101,102 None.
Another point is the concentration of active components in
a plant, which can vary based on part of the plant used, the har-
vesting time of plant, weather and soil conditions. That makes
Conflict of Interest
the dose of active components variable and unpredictable. This None. n

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How to cite:
Nazemi Salman B, Vahabi S, Mohebbi Rad M, and Bayat N. Use of Herbs and Medicinal Plants in Dentistry: A Review. J Dent Sch. 2017;35(2):58–64.

64 Journal Dental School | Vol. 35, No. 2, Spring 2017: 58–64