Neem in Oral Diseases - an Update

Review Article

Neem in Oral Diseases - An Update

Akhilanand Chaurasia

Assistant Professor, Dept. of Oral Medicine and Radiology King George Medical University, Shah Mina Road, Chowk, Luknow, Uttar Pradesh – 226003 E-mail: [email protected]

Abstract Herbal Medicines are a fast emerging trend in recent times, as they provide safer, effcective and economical treatment to patients. Azadirachta indica (neem) has been an integral part of health and oral care since times immemorial. It has shown to be an effective antimicrobial, antinflammatory and anticancer agent. In india it has been an indespensible part of oral care and is still a popular dental care agent in rural india. Incorporation of neem extract in oral health care products provides a natural solution to oro-dental problems and in maintaining oral health.

Keywords: Azadirachta indica, Antibacterial, Anti inflammatory, Anticancer.

Access this article online Part of Pharmacological activity Quick Response tree Code: Website: Leaf Antifungal activity, Antibacterial www.innovativepublication.com activity, Antiviral activity, Anti- carcinogenic activity, Antiulcer effect, Hypoglycaemic activity, DOI: Hepatoprotective activity, central 10.5958/2395-6194.2016.00001.1 nervous system depressant, anxiolytic. Introduction bark anti-inflammatory, antibacterial, Azadirachta indica (Neem) belongs to the analgesic, antiseptic, Antiulcer and mahogany family meliaceae and is a species of immunomodulatory genus Azadirachta. Neem has two species: A. Indica, A. Seed Antimalarial activity, Antifungal Juss and M. Azedarac which are known as Indian neem activity, Antibacterial activity, (margosa tree) or Indian lilac and Persian lila Antioxidant activity, Antifertility respectively [1]. Neem is a perinenial plant found in effect tropical and semi-tropical regions of India, Pakistan, and Bangladesh [2]. Azadirachta indica is derived from Therapeutic Effect of Neem in Oral Diseases Persian “Azad” meaning free and “dirakat” meaning Anti-bacterial action- Azadirachtin and nimbinin are tree, indica means of Indian origin hence it principal constituents of neem extract responsible for its signifies“free tree of india”. Neem has been antibacterial properties[6]. Neem leaf extract has shown indespensible herb in ayurveda, unani and other significant reduction in plaque index and bacterial traditional medicine therapies since prehistoric times. count especially S.mutans and lactobacilli species[7]. Neem continues to be a cheap and effective drug for Elavarasu et al also demonstrated in their study definite various health ailments in indian folk medicine and anti plaque activity of neem oil[8]. Hedge & Kesaria thereby popularly termed as “village dispensary”[3]. compared antimicrobial efficacy of neem, propolis, Siddiqui was first to identify medicinal properties of turmeric, liquorice and sodium hypochlorite as root neem in 1942. He isolated Nimbin and nimbinin along canal irrigants against E. Faecalis and C. Albicans in with a bitter component nimbidin from neem. He stated their study. They showed excellent efficacy of neem that nimbidin has antiarthritic, antiulcer and anti- extract in inhibition of most resistant species E. fecalis inflammatory properties whereas former two had and candida in root canal disinfection[9]. Adyanthaya et antipyretic and anti inflammatory properties[4]. Various al studied antimicrobial effect of methanol extract of parts of neem plant have shown medicinal properties neem twig. They found efficacy of neem extract in such as anti-inflammatory, antipyretic, analgesic, reducing cariogenic as well as periodontal disease antimicrobial, anti-tumourogenic, antioxidant, antiulcer causing bacteria and suggested incorporation of and immunostimulant activity [5]. methanol extract of neem twig into oral care products [10].

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Antifungal Properties- Neem oil and leaves have Anticancer action- Neem exerts anticancer effect on demonstrated antifungal properties and have been malignant cells by inhibition of cell proliferation, effective in reduction of candida induced denture induction of cell death, suppression of cancer Stomatitis [11]. Mahmoud et al. conducted a study to angiogenesis, restoration of cellular reduction/oxidation evaluate the effect of aqueous, ethanolic and ethyl (redox) balance and enhancement of the host immune acetate extracts from neem leaves on growth of various responses against tumor cells. Though mechanism fungi (Aspergillus flavus, Aspergillus fumigatus, pathway for the above activity is unclear but the Aspergillus niger, Aspergillus terreus, Candida albicans suppression of NF-κB signaling pathway has been and Microsporum gypseum) in vitro. They found that involved. Neem extracts not only exerts anticancer alchol based neem extract have excellent inhibitory activity but also sensitizes cancer cells to effect on fungi and can be used as an antifungal agent immunotherapy and radiotherapy thereby enhancing the [12]. efficacy of other chemo and radio therapeutic agents [22]. Subapriya et al studied chemopreventive effects of Anti-cariogenic Effect- Neem bark and twigs have ethanolic neem leaf extract in the initiation and post- been used as natural toothbrush since ages. Neem bark initiation phases of hamster buccal pouch (HBP) extract has shown significant anti cariogeneic properties carcinogenesis. She demonstrated that ethanolic neem on various cariogenic bacteria inhabiting oral flora. leaf extract inhibits carcinogenesis by protecting against Bhuiyan et al showed anti cariogeneic effect of acetone oxidative stress [23]. Hence neem extract can be extract of neem on S.sorbinus [13]. Almas Khalid in his employed as an effective anticancer agent or as an study showed inhibition of Strept mutans and Strept adjunct to chemo-radiotherapy of oral and head and faecalis at 50% concentration of neem bark extract [14]. neck carcinomas. Neem extract has demonstrated inhibition of Streptococcus mutans, Streptococcus salivarius, Conclusion Streptococcus mitis, and Streptococcus sanguis at Neem is an omnipotent tree and nature’s gift to various concentrations, antibacterial properties were mankind for prevention and treatment of various health seen at even 5% of concentration [15]. N. C. J. Packia ailments. In past years extensive research on therapeutic Lekshmi et al evaluated the antibacterial activity of benefits of neem in oral and dental problems had neem extracts againt oral pathogenic bacteria using disc proved its efficacy as an excellent and cheap diffusion method. She found significant reduction in antimicrobial, antinflammatory and anticancer agent. Streptococcus salivarious and Fusobacterium It’s time that neem extracts are incorporated in present nucleatum. she concluded that chloroform extracts of day oral and dental care products as well as in treatment neem has a strong antimicrobial activity and suggest of various oral premalignant and malignant lesions. that it can be useful in the treatment of dental caries [16]. Conflict of Interested: None Source of Support: Nil Antinflammatory Role- Neem extract have shown efficacy in reducing acute as well as chronic References inflammation [17]. Bothello et al. suggested in their 1. Natarajan V, Venugopal PV, Menon T. Effect of azadirachta study that neem based mouth rinses can be used in indica (neem) on the growth pattern of dermatophytes, gingival and periodontal diseases as neem extract Indian J Med Microbiol. 2003 Apr-Jun;21(2):98-101. 2. Hao F, Kumar S, Yadav N, Chandra D. Neem components showed significant reduction in plaque and gingival as potential agents for cancer prevention and treatment. inflammation [18]. Chatterjee et al. suggested in their Biochim Biophys Acta. 2014 Aug;1846 (1):247-57. study that neem extract based mouth rinses are efficient 3. Venugopalan Santhosh Kumar, Visweswaran Navaratnam. in controlling plaque induced gingivitis and had fewer Neem (Azadirachta indica): Prehistory to contemporary long term usage side effects than cholorhexidiene based medicinal uses to humankind. Asian Pac J Trop mouthwashes [19]. Biomed. 2013 July; 3(7): 505–514. 4. Siddiqui, S.1942, A note on the isolation of the three new bitter principles from the nim oil. Curr. Sci. 11: 278-279. Antioxidant properties- Neem extract prevents 5. Kausik Biswas, IshitaChattopadhyay, Ranajit K. Banerjee oxidative and hydroxyl ion induced mucosal damage and UdayBandyopadhyay. Biological activities and thereby exerting an antiulcer effect [20]. Pandey et al medicinal properties of neem (Azadirachta indica). Current studied phytochemicals in neem for antioxidant Science, Vol. 82, No. 11, 10 June 2002. properties. They found presence of β-sitosterol, lupeol, 6. T. Lakshmi, Vidya Krishnan, R Rajendran, N. Madhusudhanan Azadirachta indica: A herbal panacea in rutin, ellagic acid, ferulic acid and quercetin and the dentistry – An update. Pharmacogn Rev. 2015 Jan-Jun; extract showed significant free radical scavenging 9(17): 41–44. activity there by implicating its incorporation in various 7. Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque orofacial and skin ailments [21]. activity of Azadirachta indica leaf extract gel--a 6-week clinical study. J Ethnopharmacol. 2004 Jan;90(1):99-103. 8. Sugumari Elavarasu, P. Abinaya, S. Elanchezhiyan, Thangakumaran, K. Vennila, K. B. Naziya. 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