Biomedical & Pharmacology Journal Vol. 9(3), 1171-1182 (2016)

Sanoon: A Specialized Dosage form for Dental Diseases in Traditional Persian Medicine

RAMIN NASIMI DOOST AZGOMI1,2, ABOLFAZL AKBARZADEH3,4, FATEMEH EBRAHIMI5, ZOLEIKHA KHOSHBAKHT5 and AREZOO MOINI JAZANI2,6*

1Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 3Stem Cell Research Center,Tabriz University of Medical Sciences, Tabriz, Iran. 4Universal Scientific Education and Research Network(USERN), Tabriz, Iran. 5Department of Traditional Pharmacy,School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 6Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. *Correspondence author E-mail : [email protected]

http://dx.doi.org/10.13005/bpj/1065

(Received: October 14, 2016; accepted: October 25, 2016)

ABSTRACT

Oral diseases such as tooth loss, periodontal disease, dental caries, oral mucosal lesions and oropharyngeal cancers are chief communal health troubles in the worldwide. Dental caries, as a type of dental diseases, affects 60–90% of school-aged children and the common of adults in the majority industrialized countries. Sanoon is a pharmaceutical dosage form designed for treatment of oral cavity diseasesin the traditional Persian medicine that contains all kinds of mono component or multi component dosage forms with the ability of gum tonic that is finely powdered and used by sprinkling or rubbing it to the gum and dental surfaces. The purpose of the present study is to discuss about different formulation of sanoon dosage form in traditional medicine and find confirmation of their effectiveness in the treatment of dental .

Keywords: Oral diseases, Dental caries, Sanoon, oropharyngeal cancers.

INTRODUCTION From ancient times the mankind has used materials found in nature as a remedy for his various Oral diseases such as dental caries, diseases3. Afterwards the application of herbal, periodontal disease, tooth loss, oral mucosal mineral and animal parts for making medicaments lesions and oropharyngeal cancers are major improved impressively in major traditional public health problems in the worldwide1.Despite medicines: Chinese, Ayurveda and Persian4-5. low mortality of dental diseases, these disorders Among these medical systems Traditional Persian impact considerably on general health and quality Medicine (TPM) is one of the richest and oldest of life. Teeth have important role in eating ability, systems with various medical and pharmaceutical primary digestion the food, speech, facial manuscripts6-7. Medieval Persian physicians and appearance and self confidence2. Dental caries, philosophers had described anatomy of the oral as a kind of dental diseases, affects 60–90% of structure including mouth and tongue, tooth and school-aged children and the majority of adults in gingiva and lips and related diseases and their most industrialized countries1. Dental diseases treatments comprehensively8. A brief search in TPM impose economic burden to health care services. literatures shows more than one hundred dosage In some countries, the cost of treatment of dental forms, including some specialized ones like caries is about 5 to 10 % of its total health budget2. Sanoon6-7. Sanoon is a pharmaceutical dosage form 1172 AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) designed for treatment of oral cavity diseases, most common dosage forms included; oral particularly dental problems in TPM. It contains all fumigation(Bakhoor), gurgle(Gharghareh), kinds of mono component or multi component mouthwash(Mazmazeh), tooth powder(Sanoon), dosage forms with the ability of gum tonic that is oral dusting powder(Zaroor) and oral finely powdered and used by sprinkling or rubbing cooling(Barood). Sanoon, tooth powder, is a specific it to the gum and dental surfaces7 -10. and alternative dosage form for dental diseases that rubbed on the to conventional treatment. teeth and gingiva. Sanoon was used in the form of powder. For preparing Sanoon, medicinal herbs that are used in this dosage form need to be dried METHOD and then usually grinded. According to the indications, the particles of the powder may be In this study, first we searched TPM books very fine or coarse. For example, in strengthener or pharmaceutical manuscripts of Persian scientist Sanoon, used must be grinded finely as during 9th to 18th century AD such as Al-Abniyah possible.In return, particle of polisher Sanoon an haqaiq al-adviyah, the Canon (Qanun-fi-tebb) , should be coarse and incomplete powdered.In this Makhzan-al-Aadvia, Tuhfatul-mumenin, main formulation, salt were parched and added to the Qarabadin books of Traditional Persian Medicine powder. Brushing teeth is necessary before using for finding different dosage forms used in treatment Sanoon and stomach must be empty. For applying of oral cavity diseases. In this preliminary study, we Sanoon,first wet the index finger with water, then found out that sanoon is the most exclusive dosage put the finger into the tooth powder and rub it on the forms in treatment of dental diseases. In the second teeth and gum twice a day. During the usage of part of this study, different types of sanoon were Sanoon, Keep the mouth open and rub it derived from Qarabadins books such as Canon of sequentially. Wait an hour until saliva be removed. Medicine, Qarabadin Kabir, Qarabadin Shafahi, Sanoon as a specific dosage form was Qarabadin Ghaderi, Qarabadin Salehi, Tuhfatul- administered for dental diseases like toothache and mumenin. Qarabadins books are the main inflammation, loose teeth, discoloration of the teeth, Traditional Persian pharmacological (TPP) text aphthous, halitosis, carious teeth, oral sores, books that explain the preparation procedures, gingival sores and gingival health. The shelf life of components and indications of compound drugs. Sanoon was 1-6 month. Table 1 shows medicinal All herbs used in these manuscripts with their plants were used individually in TPP as Sanoon indications and the processes of the preparation with their scientific names, traditional names, nature, were extracted. Then the most repetitive plants were indications and parts used. Nature is the derived and listed. Afterwards we matched listed predominant quality10. Few formulations of Sanoon medicinal names with scientific names. At last dosage forms that were used in TPP have been these plants were screened in electronic databases shown in Table 2. Formulation names, indications, including Google scholar, Scopus, PubMed to find ingredients, scientific names of plant drugs and possible evidence of their efficacy in the treatment preparation procedures are also indicated in of dental diseases in Modern medicine. The positive Table 2. findings have been shown in the result section. Because medicinal plants used individually in a Repetitive medicinal plants used in the form of sanoon,in this part of the study, these herbs formulations of Sanoon are Punica granatum, with their nature and indications were also derived , Tamarix gallica, Cyperus from Makhzan-al-Aadvia, Al-Abniyah an haqaiq al- lungus, Quercus Spp, Piper nigrum L. Peganum adviyah, Tuhfatul-mumenin,Qanun fi- tebb, Al-Havi. harmala, Syzygium aromaticum(Eugenia caryophyllata Thunb) ,, Anacyclus RESULT pyrethrum ,Rosa damascene. Pharmacological properties of these plants have been described in Some types of oral dosage forms the last part of result section. suggested in Traditional Persian Pharmacological text books for treatment of oral cavity disorders. The AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) 1173 arts used Latex branch Root Latex Latex Leaf Latex Flower Latex Seed eakness Aerial parts Gums weakness- aphthous Gums weakness- halitosis scoloration of the teeth- halitosis fruit oothache oothache ooth ache Discoloration of the teeth Discoloration of the teeth- Dental / Gums weaknessDiscoloration of the teeth fruit Gums weakness Gums weakness Gums weakness- gingival bleeding fruit aphthous Toothache- Gums w Toothache- Indications P dry Toothachedry Gums weakness- aphthous Flower fruit ot & dry& ot halitosis Dental / Gums weakness- Toothache- Cold & dry& Cold Discoloration of the teeth- gingival bleedingdry& Cold stem the of part Inner Cold & dry Gums weakness- gingival bleeding Gums/dental weakness - halitosis aphthousdry& Cold Cold & dry Gums weakness- aphthous -toothache Gums weakness compound Fruit Cold & dry compound fruit aphthous Cold & dry Dental Toothache- weakness Aerial parts Cold & dry T Nature astaki H raditional ZeitounNasrinZardchubehOshnanAnisun dry & Hot Ghasab dry & Hot Badam & Hot T Narjil Toothache dry & Hot Soad dry & Hot Di moist & Hot Jolnar dry & Hot HabbolbanSomag dry & Hot Damolakhavein Fodenj / Dental dry & Hot Geshneez Golesorkh dry & Hot Root Kharnoob name EzkherBanj Javoshir dry & Hot dry & Hot T Olea europaea Rosa canina Curcuma longa Seidlitzia rosmarinus Pimpinella anisum Phragmites communis Amygdalus communis Cocos mucifera Quercus lusitanicaCyperus longus Citrus medica chebulaTerminalia Punica granatum Moringa oleifera AfesRhus coriaria Calamus draco wild Halileh zard Mentha pulegium OtrojElletaria cardamomumCoriandrum sativum Cinnamomum comphora Cold & dryRosa damascena Hel/ Dental Kafoor Cold & moist Gums weakness Hot & pulp Fruit Ceratonia siliqua Pistacia lentiscus l. M ( sanoon)Scientific name Cymbopogon citratus Hyoscyamus niger l. Ficus carica l.Opopanax chironium Teen Hot & moist Gums Toothache- weakness- Discoloration of the teeth Fruit-Latex Dental powder T 1174 AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) medications should be grinded medications should be mixed in rst all medications except the last one preparation The medications should be grinded ,sifted , The medications should be grinded ,sifted Seven first medications in equal amounts with triple amounts of The medications should be mixed in equal At the end of process, brushing teeth is necessary. The medications should be mixed in equal amounts and rubbed on teeth The medications should be mixed The medications should be grinded , ng ,halitosis ival bleeding, the teeththe should be burnt and oothache oothache oothache, ndication DiscolorationDiscoloration teeththe of Fi Dental weakness amounts and rubbed on teeth teeth. the teeth, gingival equal amounts and rubbed on teeth Gums weakness halitosis ,sifted and mixed gingival bleeding Gums weakness Gums The medications should be enica volgaris- harmala-Pergamum bambusa grinded ,sifted and mixed eues lusitanica-Phoenix dactylifera- bleedi ingredients i zingiber officinale, piper nigrum,piper longum,Jasminum officinale aquilaria agalocha roxb, AlonCyperus longus, Arundinacea bambusa,Punica granatum,,Acacia arabica,Arhus coriaria sores Oral T used and mixed eighth should be grinded ,sifted and mixed and mixed in equal amounts Cyperus longus, Terminalia chebula, Embelia ribes, chebula, Terminalia Cyperus longus, T Punica granatum, Rhus coriaria, Cyperus longus, T Rosa damascene,Myrtus communis,Aquilaria agalocha roxb, Cyperus longus, salt, catechu chebula,areca Terminalia Cuttle bone,Burnt salt,Honey ging Colshisum autumnale,Eugenia caryophyllata, Santalum chebula, Terminalia harmala, Peganum album,Rosa damascene Alon,Artemisia of herba-alba,Anacyclus pyrethrum` Punica granatum Discoloration ofArhus coriaria-Queues lusitanica- Punica granatum- The Alon,Origanum dictamnus gingival bleeding , sifted and mixed in equal amounts and kneaded with honey gingival bleeding , The curcuma longa-acacia Arabica- Punica granatum- Punica granatum-aquilaria agalocha roxb- G.S G.K GS G.S T.M G.k G.K G.S G.SH m.a (teeth powder) name Traditional Sanoon vajae Sanoon mojarrab Sanoon vajae Sanoon Sanoon jala Sanoon soorenjan Sanoon Sanoon yamani ramak Sanoon jala SanoonSanoon Qu ghate khoon Sanoon taghviat arm AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) 1175 medications should be grinded , grinded ,sifted and mixed The medications should be The medications should be grinded ,sifted and mixed sifted and mixed rubbed on teeth. grinded ,sifted and mixed oothache, halitosisoothache, The gingivitis Dental caries , The medications should be grinded , gingivitis aphthous weakness weakness eganum Discoloration of Piper nigrum,Salt,Gums/ Dental The medications should be

nalis,salt grinded ,sifted and mixed cubeba,Costus sp, Punica granatum, grinded ,sifted and mixed eganum eganum harmala, Cyperus longus,Health teeth The medications should be arundinacea- Arhus coriaria- Cyperus longus- terminalia bellerica-eugenia caryophyllata- portulaca oleracea-Rosa damascena Pistacia lentiscus l, Queues lusitanica Hordeum valgare,Queues lusitanica, Arhus coriaria,P Aquilaria agalocha roxb, Bambusa arundinacea,Rosa damascene, Plantago ovata, Punica granatum Scabiosa arvensis, Bambusa arundinacea- chebula- Plantago Punica`Terminalia major, harmala Europaea, Peganum granatum, Santalum album, Punica granatum,Rosadamascene, Cyperus longus, Pistacia lentiscus , Areca catechu, Aquilaria agalocha roxb, chebula, Eugenia caryophyllata,Terminalia Laurus camphora Commiphora myrrha Engl., Juniperus Sabina,Dental, halitosis Cupressus sempervirens,anacyclus pyrethrumbe should medications The T offici Valeriana grinded ,sifted and mixed sifted and mixed in equal amounts harmala, Elletaria cardamomum,Piper longum,Punica granatum, Cuttle bone,Eugeniacaryophyllata,Anacyclus pyrethrum,salt Feagrans myristica, Cinnamomum zeylanicum, the teeth At the end of process, brushing necessary. is teeth Punica granatum, curcuma longa, Alon,,caries Dental be should medications The G.S G.S G.S G.S G.K G.S G.S G.S G.S lase Sanoon ofoonatlaseh gholae Piper Sanoon Sanoon Sanoon bakhrolfam Sanoon Sanoonhafez sehat P Sanoon Sanoon soorintijan mastaki namak malek 1176 AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016)

Punica granatum The rhizomes of Cyperus lungus are used Equeous and ethanolic extracts of peel in Iranian traditional medicine. Sesquiterpenoids and seed of pomegranatum have demonstrated extracted from a species of Cyperus(Cyperus anticandidial effects and equeous extract has been rotundus)have shown anti hepatit B virus activity24. more effective than ethanolic extract13. In another In an in vitro syudy methanolic extract of cyperus study it has been found that gel content longus acts as analgesic substance18. pomegranatum seeds was as effective as chlorhexidine gel in prevention plaqe formation14 Peganum harmala and this can be linked to antibacterial and anti- Peganum harmala seeds, known as inflammatory activity of pome granatum15. Equeous espand in Persian, are used in several sanoon and ethanolic extract of pomegranatum is also formulations with different purposes such as dental effective in decreasing the entiretime of recurrent and gum restoration, oral cavity disinfection, teeth aphtus and this effect likely connectes to phenolic whitening and aphthous stomatitis treatment26. The component16. Mouthrinsing content chamomile and alkaloids constitute main phytochemicals of pomegranatum extract have an important role in Peganum harmala seeds, specially harmaline and gingival bleeding reduction17. harmine which are toxic in nature.27 The alkaloids are the origin of espand’s antibacterial28-29 Terminalia chebula antifungal, 20 antiparasidal30 and insecticidal27 The of terminalia chebula are used activities. In one study the extract of its β-carboline in Iranian traditional oral dosage forms.studies alkaloids and chiefly harmine showed significant have demonstrated that mouthrinsing content inhibitory effects against Proteus vulgaris, Bacillus terminalia chebula are effective in reduction subtilis and Candida albicans28 In another study microbial plaques, gingival inflammation and Staphylococcus aureus, Saccharomyces nutrilizing salivary PH18. Nayak et al approved a cerievisae and E. coli were much sensitive than reduction of 35-48% at salivary streptococos other microorganisms to ethanolic extract of mutans content forming units at 60 minute after alkaloids.29 Ethyl acetate extract of espand seeds rinsing with ethanolic extract of terminalia chebula exhibited significant analgesic and anti- and streptococos mutans counts were low up to 6 inflammatory effects in compare with aspirin and hours post rinsing.(Terminalia19).The result of in vivo diclofenac as standards in rats.31 The anti-oxidant comparative study of Emblica officinalis and properties of Peganum harmala seeds, extracted Terminalia chebula extract with chlorhexidine as with ethanolic, hydro-alcoholic and aqueous an anti carries agent ,showed that the equeous solvents, were determined by DPPH free radical herbal extract of Terminalia chebula and Emblica scavenging method.32 officinalis were more effective than chlorhexidine mouth wash,but with less time of action than Quercus Spp chlorhexidine.(terminalia20). of Quercus spp. are kind of abnormal plant growth on leaves caused by certain insects. Tamarix gallica They are great source of polyphenol compounds The fruits of this tree are used in the called tannic acid.33-34 (Afes) is used in sanoon formulation of mouth and teeth Iranian traditional formulation for treatment of weak gums and dosage forms. One species of Tamarix (Tamarix aphthous stomatitis7 because of its high boveana) has shown anti oxidant and free radical content nutgall shows antibacterial, antiviral, scavenging activity.(Tamarix21).another antifungal, larvicidal, antioxidant and species(tamarix aphylla)has antimicrobial potential hepatoprotective affects. Antiviral properties of of alkaloids and flavenoids extracted .(tamarix 4).it hydrolysable against herpes simplex virus has also shown anti inflammatory and analgesic (HSV), human immunodeficiency virus (HIV) and effects(Tamarix23). leukemia virus has been demonstrated35 Chursi S showed the abiity of methanol extract of Quercus Cyperus lungus infectoria nutgalls to destroy bacteria cell membrane AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) 1177 in methicillin-resistant Staphylococcus aureus common oral bacteria including four streptococcus infections.28-29 Also the effectiveness of its ethanolic species and E. faecalis. Besides, the extract inhibited extract against a wide range of important bacteria the formation of bacterial biofilm on orthodontic has been studied.30 nutgall wire.43 Several phytochemicals showing antifungal extracts and fractions could properly control the activity are identified from ethanolic extract of Culex pipiens larvae31 and fabrics treated with seeds.44 The phenolic content of sumac gall extracts showed high anticandidal effects.32 comprising anthocyanins and hydrolysable tannins Polyphenols in galls act as free radical scavengers causes it to show strong antioxidant activity.45 In one and with antioxidant activity protect cell in oxidative animal study rats with periodontitis were subjected stress conditions.33-34 Besides, because of potent to systemic administration of ethanolic extract of antioxidant and antiinflamatory effects of oak gall Rhus coriaria and reduction in alveolar bone loss extracts they can be potentially used as by affecting receptor activator of nuclear factor- hepatoprotective compounds35-36. kappa B ligand(RANKL)/ osteoprotegerin(OPG) balance, total oxidant status(TOS) and oxidative Piper nigrum L stress index(OSI) levels were reported.46 Fruits of black pepper have been used in sanoon formulations to fortify gum and teeth and Syzygium aromaticum modulate toothache.(Ref) Alkaloids, glycosides, (Eugeniacaryophyllata Thunb) terpenoids, steroids, flavonoids, tannins and S. aromaticum with traditional name of saponins are phytochemical contents of P. nigrum gharanfol has been used in TPM for treatment of fruits. The ethanolic extract of P. nigrum fruits was mental , respiratory, gastro intestinal,urinary tract examined against several common disease, gums and dental weakness, halitosis. microorganisms which cause infections in oral Saponins, tannins, phenols, cardiac glycoside, cavity. The results demonstrated high antimicrobial Anthracene, flavonoids and alkaloids are the main effects of extract against Enterococcus faecalis, phytochemical compounds of Z. aromaticum flower. Lactobacillus acidophilus , Candida albicans and The antimicrobial effects of clove flower (Syzygium Candida tropicalis compared to chlorhexidine as aromaticum) bud on dental pathogens has been standard.37 The anti-inflammatory properties of shown in some studies47- 48. Aqueous extract of piperine, the main alkaloid of P. nigrum, investigated Cloves flower (S. aromaticum) has antimicrobial using carrageen-induced rat paw edema method. effect on gram positive,gram negative bacteria and The prostaglandin release inhibition occured by fungi including Staphylocococcus epidermis, administering 5 and 10 mg/kg of piperine to rats Escherichia coli, Proteus mirabilis, Klebsiella following by 1% of carrageenan.38further studies pnuemoniae, Aspergillus niger, Candida albicans, showed antipyretic activity of piperin in rats.39 In Rhizopus oryzae47-49. In other study,its aqueous addition, decreasing oxidative stress to the cells extract had antimicrobial activity against some induced by a high-fat diet approved the anti-oxidant standard strains of food—borne pathogen ability of piperine alkaloid.40 bacteria(S. aureus, S. typhimurium and E. coli and normal ûora S. epidermidis and L. Plantarum)50. Rhus coriaria Other study revealed that Eugenia essential oil Rhus coriaria with common name of sumac possessed an excellent antibacterial activity has been used in TPM for treatment of gums against oral streptococci including the cariogenic weakness, aphthous stomatitis and toothache.(Ref) bacteria as well as an excellent antifungal activity51. Many phytochemicals such as tannins, In an in vitro study, the antioxidant activity of water (iso)flavonoids, terpenoids, etc are reported in and ethanol extracts of clove (Eugenia sumac fruits.41 The antimicrobial effects of Rhus carophyllata) buds and lavender (Lavandula coriaria water extract on food borne pathogens has stoechas L.) against various antioxidant systems been shown. Among these gram positive and gram has been shown and compered 52. Based on data negative bacterial strains, Bacillus species were obtained from other in vitro study, clove essential most susceptible.42 In other study its water extract oil and its two active principle(eugenol and eugenyl- possessed antibacterial activity against five acetate) may positively affect the dental erosion 1178 AZGOMI et al., Biomed. & Pharmacol. J., Vol. 9(3), 1171-1182 (2016) process of apple juice through distinct mechanisms. Pseudomonas.aueroginosa was the most In this study, clove-oil-treated teeth showed susceptible61. decreased decalcification with respect to control53. In an in vivo study,Eugenia caryophyllata powder CONCLUSION had anesthetic effect on a kind of fish (Huso Huso )54. Anti-inflammatory effects of eugenol Dental diseases are one of the major nanoemulsion were shown in an animal model public health problems in the worldwide. Traditional study.In this study, O/W nanoemulsion of eugenol Medical literature reviews shows that oral and was used in rats for the evaluation of anti- dental health are important because there are inflammatory effects as a topical delivery system55. separate chapters in the main TPM textbook about oral and dental care.This paper showed that sanoon Anacyclus pyrethrum is a specific dosage forms for the treatment of dental The root of Anacyclus Pyrethrum has diseases with different type of medicinal plants in therapeutic effects. The compounds of this plant are TPM and the general survey of pharmacological Pyrethrine, resinous, pelletonin, tannin, gum, effects of these medicinal plants ( Punica granatum, potassium sulfate and carbonate, potassium Terminalia chebula, Tamarix gallica, Cyperus chloride,calcium phosphate, and carbonate. This lungus, Quercus Spp, Piper nigrum L, Peganum plant has been used for treatment of neurologic, harmala, Syzygium aromaticum(Eugenia respiratory,dental , periodontal and gingival caryophyllata Thunb) ,Rhus coriaria, Anacyclus diseases, Stuttering and toothache in TPM10-56 . In pyrethrum ,Rosa damascene ) used in the multiple an in vitro study, methanolic extract of Anacyclus formulations of sanoon mentioned that these plants Pyrethrum root produced little antibacterial effect have different medicinal properties like antibacterial, against Staphylococcus aureus and Streptococcus antiviral, antifungal, antioxidant, gingival sanguis57. inflammation activity anti-inflammatory, antipyretic, analgesic, prevention plaqe, gingival bleeding Rosa damascena reduction, anti aphtus and reduction microbial This plant has several compounds such as plaques.There fore,modern investigations ter-penes, glycosides, flavonoids, and anthocyanins. The confirmed the efficacy of some plants which have therapeutic uses of R. damascena in TPM include the been traditionally used in Sanoon. Based on the treatment of abdominal, heart and lung diseases, results of the present study and according to the menstrual bleeding, gums and dental weakness, pharmacological characteristics of Sanoon, this halitosis , digestive problems the reduction of dosage form may be useful in the treatment of dental inflammation, coughing, thirst and wound healing10-56.. diseases due to easier,specific and efficient In some animal Model studies, analgesic and anti- delivary of drugs to the oral cavity by lower systemic inflammatory effects of Rosa damascena hydroalcoholic side effects. We suggest making different Sanoon extract has been shown 58-59.The effectiveness of with efficient medicinal herbs to improve oral and mouthwash containing. Rosa damascena extract in the dental health and eventually public health in the treatment of 50 patiant suffering recurrent aphthous community. stomatitis(comparing to the placebo) has been shown in a randomized, double-blinded, placebo-controlled ACKNOWLEDGMENTS clinical trial study60.According to an in vitro study,the ethyl alcohol and acetone water extracts of R. damascene This work is funded by a 2016 grant had antimicrobial effects against P.aueroginosa, Medical Philosophy and History Research C.albicans and E.coli. Among these microorganism, Center,Tabriz University of Medical Sciences.

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