Herbal medicine … Irani S Journal of International Oral Health 2016; 8(10):989-994
th th Received: 13 May 2016 Accepted: 10 August 2016 Conflicts of Interest: None Review Article Source of Support: This research was supported only by Hamadan University of Medical Sciences Doi: 10.2047/jioh-08-10-09
Herbal Medicine and Oral Health: A Review Soussan Irani1,2
Contributors: therapy to treat different types of cancer such as metastatic 1Associate Professor, Department of Oral Pathology, Dental bladder cancer in both lungs without chemotherapy or Research Center, Dental Faculty, Dental Research Center, radiotherapy.7 The metastatic and angiogenic potential of Hamadan University of Medical Sciences, Hamadan, Iran; Anisi stellate fructus extract were examined in in vitro and 2 Lecturer, Department of Pathology, School of Medicine, Griffith in vivo studies. The results showed that it remarkably reduced University, Gold Coast, Australia. the number of pulmonary metastatic colonies in mice and Correspondence: also suppressed in vivo tumor-induced angiogenesis through Dr. Irani S. Dental Faculty, Shahid Fahmideh Street, Hamadan 8 65178-38741, Iran. Tel.: +98813-8354250, Fax: +98813-8354220. a reduction of pro-angiogenic factors in tumors. One of the Email: [email protected] traditional herbal medicines is Guibitang, which induces How to cite the article: apoptotic death in colon cancer cells by regulating the Irani S. Herbal medicine and oral health: A review. J Int Oral Health activities of mitogen-activated protein kinases. Furthermore, 2016;8(10):989-994. Guibitang stimulates MAPKs and p53 signaling pathways that Abstract: are required for cell growth and tumorigenesis.9 Interestingly, Medicinal plants have been used since ancient times for the stem cells from human exfoliated deciduous teeth differentiate treatment of different diseases. Natural sources are one of the into functional hepatocyte-like cells by herbal medicine such important fields of research for preventing immunological as liquorice or angelica extracts.10 complications. Using herbal medicine has decreased as the result of the development of chemical drugs. This review aimed to study Oral health has a great impact on the general quality of life, herbal medicine regarding the oral cavity. English literature was and poor oral health has a great impact on chronic conditions searched with the terms “herbal medicine and oral cavity” in two and systemic diseases. In the oral cavity, herbal medicine has data bases of PubMed, and Google scholar among published studies been used for the treatment of several diseases.11 More than from 2000 to 2015. All review articles, original articles, case reports, 700 bacterial species have been detected in the oral cavity.12 and case series were evaluated. This study found that many herbs are Some of these bacteria have been implicated in oral diseases used in the treatment of diseases, among which many do not have 13 any side effects. Herbal medicine is a complementary/alternative such as caries and periodontitis. Biofilm bacteria have effective therapy for several diseases. Despite the development of increased antimicrobial resistance and, for this reason, new 14 many chemical drugs, using herbal medicine is highly demanded. antimicrobials are highly demanded. Herbal medicine can be used in the treatment of several oral diseases. In addition, herbal Key Words: Disease, herbal medicine, mouth, neoplasm remedies are used as homeopathic drugs, alternative therapy, in oral diseases such as ulcer, lichen planus, and xerostomia.15 Introduction Medicinal plants have been used since ancient times for the Materials and Methods 1 treatment of different diseases. Natural sources are one of English literature searched with the terms “herbal medicine the important fields of research for preventing immunological and oral cavity” in two data bases of PubMed, and Google complications.2 The use of herbal medicine had decreased as scholar among published studies since 2000 to 2015. All related the result of the development of chemical drugs. However, review articles, original articles, case reports, and case series many scientists are still using herbal medicines in different were evaluated. fields.3 For example, the bark of Prunus yedoensis which belongs to Rosaceae family is used for the treatment of skin Results inflammatory lesions. It can decrease the serum levels of tumor Oral epithelium necrosis factor-α and interleukin-6 (IL-6) in macrophages Oral epithelium is a barrier against microbial infection by in mice.4 In addition, rhizoma Acori tatarinowii has been producing antimicrobial peptides which function against applied to patients with cognitive deficits caused either by bacteria, fungi, and viruses.16 Hangeshashinto (HST), a aging or by neurodegenerative diseases including Alzheimer’s traditional Japanese herbal medicine, has anti-inflammatory disease.5 Herbal products have also been proposed as adjuvant effects. In the oral cavity, HST may increase immunity by therapy of diseases such as cardiovascular diseases, cancer, up-regulation of calprotectin, a heterodimer of S100A8 and diabetes mellitus in which free radicals play a key role in their S100A9 with antimicrobial properties, which is expressed in pathogenesis.6 There are some reports on Korean medicine gingival keratinocytes.17,18
989 Herbal medicine … Irani S Journal of International Oral Health 2016; 8(10):989-994
Oral microbiome Chamomile has analgesic, antioxidant, antiparasitic, anticancer In the human oral cavity, micro-organisms have been referred and immunoregulatory properties, and therefore, can be used to as the oral microflora, oral microbiota, or more recently as to treat some inflammatory diseases such as gastrointestinal the oral microbiome. The term microbiome was created by and skin diseases.27 Punica granatum (pomegranate) also Joshua Lederberg. In the mouth, there are several microbial has a potential to prevent and fight several inflammatory and habitats including teeth, gingival sulcus, attached gingiva, microbial diseases.28 Rokumigan, a Kampo Japanese traditional tongue, lip, hard palate, and soft palate.12 Some Plantago medicine made of six different plants, prevents biofilm species have considerable antiviral, anti-inflammatory, and formation by Fusobacterium nucleatum, inhibits IL-6 and antioxidant activities. Plantago lanceolata infusion has anti- IL-8 secreted by mucosal cells, and promotes wound healing microbial activity, particularly against salivary streptococci. in a fibroblast model. These properties make it attractive Thus, it is a natural anti-cariogenic agent.19 Herbal products candidate for prevention and treatment of periodontitis.29 A of Persica inhibit the growth of Porphyromonas gingivalis and previous study showed that sword bean extract containing Aggregatibacter actinomycetemcomitans in in vitro study.20 Clove 6.4% canavanine inhibits the growth of P. gingivalis and and gallnut extracts have antibacterial activity on Streptococcus Fusobacterium nucleatum in rats. Therefore, alveolar bone mutans and Streptococcus salivarius.21 Propolis is the generic resorption can be inhibited using sword bean extract.30 The name for the resinous substance produced by honeybees hydrophobic gingiva-adhering gel has the same effect of (Apis mellifera)22 and has been used for medicinal purposes chlorhexidine after scaling and root planning. Thus, it is a as it has antimicrobial, antitumoral, and immunomodulatory suitable alternative treatment for moderate periodontitis in properties.23 Baccharis dracunculifolia is the most important the patients which are allergic to chlorhexidine.31 botanical source of Southeastern Brazilian propolis24 which reduces the rate of plaque (biofilm) in the same level as chloride Oral diseases triclosan.25 Hand, foot, and mouth disease (HFMD) is a common infectious disease in children usually caused by enterovirus Dental caries 71 or coxsackievirus type A 16.32 The combination of Dental caries is a very common infectious oral disease which conventional therapy with Jinlianqingre Effervescent tablets is associated with various pathogenic micro-organisms significantly reduces the fever clearance time and healing most probably S. mutans.19 It has this ability to produce time of skin or oral mucosal lesions without any adverse glucosyltransferases, insoluble glucans, and acids.20 Bacterial event and complications.33 Reduning injection, composed plaque is a general term and refers to the accumulation of three herbs (Herba Artemisia annua, Lonicera japonica of microorganisms (mainly bacteria) and plays a primary Thunb, and Gardenia jasminoides Ellis) reduces the fever and role in the development of dental caries and periodontal inflammation associated with HFMD. However, it is not useful disease.21 It is suggested that Streptococcus sanguinis to be the in the treatment of severe HFMD cases.34 Jinzhen oral liquid first responsible for formation and maturation of bacterial is a kind of Chinese patent medicine extracted from the herbs plaque,22 and S. salivarius is a common micro-organism in the including Baikal skullcap root, rhubarb, and gypsum. It has saliva and on oral mucosal surfaces especially on the dorsum been used to treat fever in some viral infections in children. of tongue, buccal mucosa.23 The cariogenic properties of Jinzhen oral liquid improves the clinical symptoms of HFMD S. mutans and S. salivarius result in the production of insoluble including fever, oral ulcers, and vesicles on hand or foot, and glucans from sucrose which adheres to tooth surfaces and have other symptoms in multiple organs or systems.35 acidogenicity properties.24 Rhus coriaria L. is a commercially available species of Sumac and its water extract reduces Oral submucous fibrosis is a high-risk premalignant condition bacterial biofilm formation on orthodontic wire.25 Emodin a of the oral cavity, pharynx and upper digestive tract which is natural anthraquinone derived from the roots and rhizomes of characterized by progressive inability to open the mouth and a number of plants including Rheum undulatum and Polygonum also by inflammation and progressive fibrosis of submucosal cuspidatum markedly suppresses the production of acid and tissues.36 Oxitard, an herbal antioxidant containing the extracts insoluble glucan by S. mutans in rats. This finding suggests that of Mangifera indica, Withania somnifera, Daucus carota, emodin may be responsible for the anti-cariogenic activity of Glycyrrhiza glabra, Vitis vinifera, powders of Emblica officinalis, R. undulatum and P. cuspidatum.26 and Yashada bhasma; oils of Triticum aestivum can significantly improve clinical symptoms of oral submucous fibrosis.37 Gingivitis and periodontitis Biofilm is a dense non-calcified mass composed of micro- Aphthous stomatitis is a very common oral painful ulcerative organisms mainly Streptococcus mitis and Streptococcus sanguis. lesion.38 Ginger, a native eastern Indian medicinal plant with Mechanical and chemical oral hygiene methods control anti-inflammatory effect, has been used for the treatment of dental biofilm. Pomegranate and chamomile plant extracts aphthous stomatitis. A significant decrease in the severity in the form of mouth rinse reduce the gingival bleeding. of pain, in the diameter of inflammatory zone has been
990 Herbal medicine … Irani S Journal of International Oral Health 2016; 8(10):989-994 observed after treatment with mucoadhesive containing Oral cancer ginger.39 Chamomilla tincture, a herbal medicine, has anti- Oral squamous cell carcinoma (SCC) comprises 90% of inflammatory and analgesic, anti-spasm, anti-bacterial, all head and neck cancers which has a poor prognosis.52 and fungal effects.40 Chamomilla mouth rinse is effective in Chemotherapy is suggested therapy for advanced stages of the the treatment of recurrent aphthous stomatitis in rats by disease, but resistance of cancer cells to chemotherapy drugs controlling the pain and burning sensation without producing limits the efficiency of chemotherapy.53 Herbal medicine has any adverse side effects.41 Quercetin, an antioxidant, has been been shown to offer protection against different cancers.54-56 used in the treatment of different systemic and oral lesions In Asian countries, herbal medicine is used to treat a variety like aphthous ulcers42,43 but has no effect on the treatment of of diseases. Some advanced diseases such as cancers require oral lichen planus.44 multi-targeting treatment. Synergy of herbs has a better therapeutic efficacy than that of a single herb.57 Pterostilbene Zeng Ye decoction extracted from figwort, Ophiopogon has been identified in several plants of the genus Pterocarpus japonicus, and Rehmannia glutinosa Libosch has a significant and has antioxidant activity, and therefore, can inhibit DNA therapeutic effect on primary Sjogren’s syndrome through synthesis.58 Pterostilbene induces apoptosis of oral cancer up-regulation of the levels of aquaporin −1 and −5, integral 45 cells via activation of caspase-3, -8, and -9. Pterostilbene membrane pore proteins. also induces autophagy on human oral cancer cells through modulation of Akt and mitogen-activated protein kinase Dry mouth is a common complication of radiotherapy for pathway.59 Grape seed extract (V. vinifera) induces apoptosis head and neck cancer.46 Malva sylvestris L and Alcea digitata in oral SCC.60 Insect tea a natural organic tea has a preventive (Boiss) Alef is traditional Persian medicine which has effect on the buccal mucosa cancer in mice via inducing antitussive, antioxidant, expectorant, anti-inflammatory, apoptosis.61 Iranian orthodox black tea extracts and hydro antimicrobial, and laxative therapeutic properties.47 These methanolic purified fractions (40%, 60%, 80% and 100%) herbs can decrease the grade of dry mouth in patients who 62 received radiotherapy due to cancer in the head and neck induce apoptosis in oral cancer cells in vitro. Scutellariae area.48 Cis-platinum (II) diammine dichloride is an anticancer radix is one of the most widely used anticancer herbal medicines in several Asian countries induces apoptosis in agent, and can be used for cancer therapy but has serious side- 63 effects, including xerostomia. To reduce the adverse effect of chemo-resistant human tongue cancer cells. The dried root chemotherapy on salivary gland function, some additional of Saussurea lappa Dance which has been traditionally used for drugs are needed.49 Two Chinese medical herbal extracts abdominal pain in Asia inhibits oral cancer cell proliferation 64 from the root barks of Juncus effususand Paeonia suffruticosa via apoptosis pathway. A previous study on adenoid protect salivary gland acinar cells from apoptosis. Hence, they cystic carcinoma indicated that intratumoral high-dose can be attractive alternative drugs to prevent Cis-platinum injections of ABNOBAviscum Quercus and ABNOBAviscum caused xerostomia.50 FraxiniViscum album extracts which are endotoxin-free plant extracts from European Viscum album extract could decrease After mumps, Juvenile recurrent parotitis (JRP) is the second the size of tumor without any side effects such as fever, local most common infectious salivary gland disease during inflammation, swelling, and pain.65 Although low-dose adjunct childhood. Huangqi granule is a preparation of an extract of VAE treatment has shown any side effect on head and neck Radix astragali, a Chinese traditional medicine, and completely cancer patients, cytotoxic effects of VAE have been observed treats the JRP patients with a significant reduction of average in head and neck SCC cell lines.66 Table 1 summarizes the recurrence frequency.51 effect of herbal medicine in oral health.
Table 1: The effect of herbal medicine in oral health. Oral epithelium Oral Dental caries Gingivitis and periodontitis Oral disease Oral cancer microbiome Hangeshashinto (HST) P. lanceolata Rhus coriaria L. Pomegranate extract (P. granatum) Jinlianqingre Effervescent Pterostilbene Juncus effuses Persica Emodin Chamomile extract Reduning Vitis vinifera Paeonia suffruticosa Clove and gall nut Rokumigan Baikal skullcap Insect tea extracts B. dracunculifolia Canavanine Oxitard Iranian orthodox black tea Ginger Scutellariae radix Chamomilla tincture Saussurea lappa dance Quercetin European Viscum album extract Zeng Ye decoction Malva sylvestris L. Alcea digitata (Boiss) Alef Huangqi granule
991 Herbal medicine … Irani S Journal of International Oral Health 2016; 8(10):989-994
Discussion 8. Kim A, Im M, Ma JY. Anisi stellati fructus extract Herbal medicine is a complementary/alternative effective attenuates the in vitro and in vivo metastatic and angiogenic therapy for several diseases. Despite the development of many potential of malignant cancer cells by downregulating chemical drugs, the use of herbal medicine is highly demanded. proteolytic activity and pro-angiogenic factors. Int J Oncol Although some allergic reactions and adverse side effects have 2014;45(5):1937-48. been reported, they can still be used to treat diseases. If there 9. Yim NH, Kim A, Liang C, Cho WK, Ma JY. Guibitang, will be some proof for therapeutic effects of herbal medicine a traditional herbal medicine, induces apoptotic death for the treatment of serious diseases, especially cancers, they in A431 cells by regulating the activities of mitogen- can be used as alternative or adjuvant drugs. It is worthy to note activated protein kinases. BMC Complement Altern Med that not always herbal medicine has therapeutic effects. There 2014;14:344. are a few reports indicating some allergic reactions or adverse 10. Su WT, Chen XW. Stem cells from human exfoliated deciduous teeth differentiate into functional hepatocyte- side effects for herbal medicine. For instance, developing like cells by herbal medicine. Biomed Mater Eng hepatitis and Sjogren’s syndrome after taking some unknown 2014;24(6):2243-7. herbal medicine,67 or inducing plasma cell gingivitis after using 68 11. Palombo EA. Traditional medicinal plant extracts and toothpaste containing Acacia have been reported. In addition, natural products with activity against oral bacteria: inducing hand-foot syndrome after topical use of henna Potential application in the prevention and treatment 69 ameliorated, and developing Stevens–Johnson syndrome due of oral diseases. 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