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Abstract

Oral health plays a vital role in overall public health and well-being globally. To preserve good oral health, it is important to take a proactive, interdisciplinary approach for prevention/early-treatment of common illnesses. Owing to public safety and efficacy in preventing dental caries and other dental diseases, the whole population is prone to natural components as it currently being more acceptable than synthetic formulations based on chemicals. There are few traditional folk procedures that have demonstrated greater effectiveness in maintaining dental hygiene, such as chewable sticks, oil pulling method and wood ash. Considering that there were no chemicals involved in traditional procedures, and with an immense literature survey the authors found it as safer alternative of the modernized chemical based oral care. To achieve some possible improvements in the public health with better oral care, this review disseminates the revamping of modern oral care method by incorporating traditional touch to achieve the better oral health as in future aspects with natural ingredients.

Keywords

Public health, Natural ingredients, Public Safety, Traditional folk techniques, Oral Health, Dental hygiene.

Introduction

In upcoming five years, elderly population of India will be approximate 196 million. With the world ageing at a rapid rate, it is estimated that by 2030 there will be over 20% population above 65 years, as shown in Fig.01[1]. As the population ages, so the burden of chronic disease also increases. Whereas, the chronic diseases of oral cavity are among the most common diseases affecting elder adults including dental infections (e.g. caries, periodontitis), tooth loss, mucosal lesions and oral cancer.

 

 

 

Figure 01: Systemic impact of poor oral health in the elderly population

 

These conditions can adversely affect nutrition, self-esteem, quality of life, and general health[2]. According to World Health Organization "Health" is defined as "the condition of total physical, mental, and interpersonal well-being, irrespective of a lack of illness or infirmity"[3]. Similarly, poor oral health leads to altered oro-facial form and function i.e. difficulty in speaking or mastication etc. As a result, a person's social wellbeing or quality of life is negatively impacted, either directly or indirectly[4]. Conversely, dental health has a significant impact on systemic health; in fact one should have proper oral health to achieve better health. Few reports indicate a direct correlation between cardiovascular diseases and periodontitis with other oral infections. Oral infections may exacerbate cardiovascular diseases through a number of possible mechanisms, including the development of atheroma in the endothelium as a direct result of microorganisms, indirect host-mediated reactions, or a genetic predisposition for the pathogenesis. Individuals with poor dental health are at higher risk for infective endocarditis, heart attacks, bacterial pneumonia, premature birth, and digestive problems in the elderly persons. Even though patients who have received organ transplants or rheumatic fever are susceptible to develop infective endocarditis and other systemic issues if they come into contact with oral bacteria[5].  Similar to heart conditions, a mother's dental health has a big impact on the health of her unborn child. The development of preeclampsia, premature birth, and the delivery of a tiny for-gestational-age infant have all been linked to periodontal disease during pregnancy. Additionally, it has been discovered that a mother's higher cariogenic flora predisposes her infant to developing caries and that the mother's oral flora is passed to her newborn[6]. It's been claimed that the mouth is the window to overall health, and that oral signs and symptoms can be used to diagnose a variety of illnesses, including diabetes, HIV, osteoporosis, and several endocrine issues.

Our everyday well-being and quality of life are significantly impacted by poor dental health. There is a significant correlation between dental issues in children and a decrease in both parental work days and school attendance[7], whereas a child's well-being is impacted in terms of its social, psychological, and functional aspects. Children who suffer from oral pain suffer from terrible consequences such as poor learning, poor growth, behavioral issues, and lack of sleep; additionally impacted the vital developmental processes like socialization, communication, and self-esteem. On the other hand, periodontal disease, tooth loss, and dental cavities are more being more common in the elderly population. The overall health-related quality of life of older persons is negatively impacted by a number of issues, including eating and food choices caused by edentulousness, xerostomia, soft tissue lesions, or poorly fitting dentures[8].

In India, almost 74% of people reside in rural areas[9]. There are differences in the ways that various civilizations and tribes maintain dental hygiene and clean their teeth using natural or alternative ways is still common, in spite of using toothbrushes and toothpaste. Apart from Asia, certain regions of Africa and the Middle East also follow this tradition. Among the materials used are chewing sticks fashioned from local plant species' twigs, roots, or stems. The applications can be credited to their simplicity of availability and inexpensive cost. It has been noted that the mechanical action and increased salivation of chewing sticks make them effective at removing tooth plaque. Certain components with antimicrobials activity have been found by some investigators[10]. In some cultures, brushing teeth with table salt and charcoal is a common custom, particularly for the elderly. Nonetheless, it is well known that these have a high abrasive content[11]. Additionally, ash, mud, and brick powder are used to clean teeth in some rural areas of India. Few civilizations use the bark of the walnut tree to rub their teeth whiter. Areca nuts and betel quid are used as dental cleaners in various regions. The literature also documents the rudimentary practice of using bones and feathers as teeth picks. In order to conceal halitosis, Masahiro Yoneda et al. described a case of severe tooth wear and hypersensitivity brought on by overindulging in lemon and vinegar[12].

Another old ritual called "oil pulling" involves swishing sesame, coconut, olive, or sunflower oil in the mouth in an attempt to remove poisons and microorganisms. When combined with appropriate dental care, it may be advantageous[13].  For optimal dental hygiene, extracts of cranberries, ginger, guava, holy basil (tulsi), and Indian gooseberry (amla) are still used. Originated in the country's northeast part, the gums are kept healthy and teeth are cleaned by the neem twigs/sticks also known as the Margosa/Persian lilac; it is well known to have antimicrobial qualities. For teeth whitening, one of the plants used is turmeric, which has antibacterial and anti-inflammatory properties. As an anti-plaque agent, triphala is a most commonly used potent natural remedy. In addition to being high in antioxidants, aloevera (Aloe barbadensis) possesses antibacterial and anti-inflammatory qualities. Hence, it is widely used to keep gingival health and whiten teeth. The inclusion of herbal extracts in commercially accessible over-the-counter dental products, such as mouthwashes, toothpastes, and toothbrushes, has increased in recent years. But the only way to encourage improved oral hygiene is to highlight the judicious combination of using new and traditional tooth cleaning tools under supervision, as well as patient education and incentive. Some fascinating facts and discoveries can be obtained by going back to the conventional techniques and supporting them with high-caliber randomized controlled clinical studies that provide scientific proof[14]. In different places of the world, different plants are utilized as chewing sticks due to their antibacterial properties against oral germs which have been the subject of numerous investigations. Comparing the antibacterial properties of seven distinct varieties of chewing sticks that are available in Pakistan and other Asian nations was the main objective of a study held by Almas K., where the antibacterial activity of seven Asian chewing sticks was tested using the ditch plate method. It was discovered that 50% concentrations of Arak (Salvadora persica) from Saudi Arabia and Kikar (Acacia arabica) from Pakistan had an antibacterial impact on Streptococcus fecalis[15]. Utilizing plants to enhance dental health and encourage good oral hygiene has a long and illustrious history. The plant is rich in phytochemicals with strong defensive and therapeutic properties including tannins, alkaloids, flavonoids and essential oils. People from many communities and cultures inhabit the large nation of India. Indians have long employed a wide range of species of medicinal plants from different families to treat and prevent a wide range of severe dental conditions. It might be possible to encourage more dental science research by properly documenting traditional knowledge[16]. In order to investigate the traditional knowledge of the residents of the Almora district in the Indian state of Uttarakhand, an ethno-medical study was carried out in 2007–2008. The findings show that the locals have traditionally used 17 kinds of medicinal plants from 15 families to treat and prevent a wide range of tooth conditions. In order to encourage more dental science research, traditional knowledge should be well documented[17].

MAIN TEXT

Basic Principles behind the Oral Care and Overall Health

Since, WHO says that "health" is the condition of full mental, social, and physical well-being rather than merely being free of illness or disability, eventually every person, including patients and healthcare professionals, understands that there is a link between the systemic health and oral health issues. Within the conceptual model, some of these interactions may be considered to be contributing to handicaps, while others may directly cause or worsen actual diseases[18]. Among other: A range of direct and indirect impacts, including structural, functional, cognitive, emotional, and social ones, contribute to these effects and their interactions. There are numerous psychological and pathophysiological mechanisms at play. Even though they have nothing to do with HIV/AIDS specifically[19], provide persuasive instances of how poor oral health conditions impact systemic health, quality of life, and economic productivity, all of which have an impact on daily living. A counterproductive example is xerostomia. Affected individuals frequently experience it due to several reasons, including medicine side effects and illnesses like Diffuse Infiltrative Lymphocytic Syndrome. Inosculation (particularly kissing), halitosis, swallowing, speech, mastication, taste, and aesthetics are among the many areas it may impact[20]. In the broadest sense, localized oropharyngeal infections cause leukocytosis, cytokinemias, leucopenias, and other leukodyscrasias which in turn cause and worsen systemic inflammation and malaise[21]. Immunosuppressed patients are susceptible to disease-causing microorganisms such as bacteria, viruses, and yeasts that can grow and proliferate in the mouth. The migration of pathogenic bacteria in the mouth and their toxic effects to other organs and tissues can occur both directly, as in the instance of necrotizing gingivitis and periodontitis, which can lead to a certain degree of restricted destruction of connective tissue (necrotizing stomatitis)[22], and subsequently, through lymph nodes and circulatory systems, potentially reaching the central nervous system. Hippocrates claimed that extracting teeth might cure arthritis. William Hunter (1901) and W.D. Miller (1890) questioned modern "conservative dentistry" techniques, believing that oral infections were the root cause of many systemic disorders[23][24]. Throughout the 20th century, debates about periodontal illnesses and their links to ischemic heart disease, stroke, preterm low birth weight, and other conditions appeared and passed[25][26]. In the past ten years, these debates have returned. There is no doubt that biological legitimacy exists[27]

The Most Common Pathological Oral Conditions

Among senior patients, the most prevalent oral diseases are caries, periodontal disease, xerostomia, edentulism, and oral cancer. These problems are linked to malnourishment, reduced life expectancy, higher risk of developing diseases, worse outcomes for diabetes, cardiovascular disease, and other systemic conditions common in senior citizens. Health practitioners might overlook opportunities to enhance oral health because they may not recognize the significance of dental health for general well-being and quality of life. The most common oral conditions/diseases found during literature survey are mentioned in Fig. 02.

 

 

 

Figure 02: Common Oral Health Conditions among Elderly Population (60+ Age Group) in India

 

Applied Material and Methods of Ancient Dentistry

Oil Pulling Methodology:

According to Ayurveda, there are connections between the tongue and the kidneys, heart, lungs, small intestine, spine, and other organs[64]. It is thought that oil pulling aids in the salivary excretion of harmful heavy metals[65]. Oil pulling triggers the activation of salivary enzymes, which draw toxins from the blood such as chemical, bacterial, and environmental toxins and eliminate them via the tongue[66,67]. As a result, oil pulling cleanses and detoxifies the entire body. On the other hand, some contend that because the mouth mucosa is not a semi-permeable membrane, bodily poisons drawn from the blood cannot cross it. Organic oils that are cold pressed like coconut, sesame and sunflower oils are beneficial for oil pulling; whereas refined oil can also be used to "pull" germs, viruses, and protozoa out of the mouth cavity. Cold pressed oils are suitable for oil pulling since they don't contain trans fats, unlike commercial oils that are extracted using potent petroleum-based solvents[68]. When it comes to oil pulling, sesame oil has historically been recommended[69]. It is also known to use olive oil, milk and extracts from mangoes and gooseberries for oil pulling[70]. Gingivitis caused by plaque has been reported to be lessened by sesame and sunflower oils[51]. Presence of chloro-sesamone  in  sesame  (Sesamum indicum) roots, makes it an antifungal compound[71]. Additionally, the polyunsaturated fatty acids in sesame oil lessen oral cavity damage by free radicals. Antioxidants produced by oil pulling harm and ultimately destroy bacterial cell walls[72]. These oils will attract lipids found in bacterial cell membranes, which will then stick to them which causes the oil to become more emulsified and increases its surface area. The oil emulsification process begins after five minutes of extracting the oil[73]. This oil prevents the growth of plaque and bacterial co-aggregation by coating the teeth and gingiva regeneration. As a result, the oral cavity is free of the plaque-forming bacteria that cause gum disease, periodontitis, dental cavities, and foul breath. The issue of bleeding gums is resolved, and gums get pink and healthy. The symptoms of chapped lips and dry mouth/throat can also be relieved by oil pulling. Along with teeth that are whiter, breath that is fresher, and stronger jaws and muscles in the oral cavity results good oral hygiene[74]. In addition to reducing tooth discomfort, oil pulling helps to accomplish rigorous oral cleanliness, avoid dental caries, gingivitis, oral candidiasis, and periodontitis[75][76]. It is stated that regular oil pulling nourishes, revitalizes, and enhances the senses. It can help with anorexia, hazy vision, sore throat, dry cheeks, and loss of taste, as coconut oil has the high saponification index. Its lauric acid content reacts with salivary alkalis such sodium hydroxide and bicarbonates to produce sodium laureate, a soap-like material that has a cleansing effect and lowers plaque adhesion and accumulation[77]. Lauric acid is good for oral health, reduces dental cavities, and has antibacterial and anti-inflammatory qualities. In addition to all of this it also tastes good[78]. In an in vitro biofilm model, coconut oil exhibits antibacterial action and is efficacious against Streptococcus mutans and Candida albicans. In addition to its antiseptic qualities, coconut oil is safe to use as a moisturizer and emollient. The negative effects of chlorhexidine, such as brown stains and changed flavor perception, are not present in coconut oil. Monounsaturated fatty acids make up 70% of olive oil, with oleic acid being the main component. In addition, it has phytosterols, squalen, vitamin A, E, and K, and plant phenolic compounds. These ingredients contain antibacterial, immune-suppressive, and antioxidant properties. It is said that using olive oil for oil pulling can stop bad breath[79]. While mouthwashes based on olive oil are thought to decrease plaque production and inhibition, mouth rinses using almond oil are thought to produce low gingival scores. Sesame oil has detoxifying, antioxidant, and antibacterial properties since it include sesamin, sesamolin, and sesaminol. Furthermore, it stops lipid peroxidation. Sesame oil is also five to six times less expensive than chlorhexidine. Staining results by using mouthwashes with phenols and stannous fluoride over an extended period of time. Additionally, zinc and stannous salts have an organoleptic issue. Microorganisms like Staphylococcus aureus, Candida spp., Helicobacter pylori, Escherichia vulneris and Enterobacter spp. can be effectively inhibited by the monolaurin found in coconut oil. A theory suggests that monolaurin kills bacteria by changing their cell walls, breaking down their cell membranes, and preventing the action of enzymes involved in the transfer of nutrients and energy. In addition to its virucidal properties, monolaurin dissolves lipids and phospholipids in the viral outer shell, causing the virus to disintegrate[80]. Coconut lauric acid works well to prevent mouth sores. Because S. mutans reduces glycolysis and sucrose oxidation, coconut sucrose monolaurate possesses anti-caries effects that help to prevent dental plaque forming[81]. It is important to remember that oil pulling cannot cure pre-existing dental cavities, thus routine dental checkups are still necessary.

Traditional Abrasives (Ashes and Charcoal Dentifrices)

Charcoal dentifrices are the growing trend in dental hygiene products designed for brushing teeth, removing external stains, and "tooth whitening"[389]. The purpose of abrasive substances is to provide teeth a smooth and glossy surface by effectively removing soft deposits and external stains. An ideal level of abrasiveness is necessary for toothpaste. The agent will not be able to remove the soft deposits or stains if its abrasive capacity is extremely low. Conversely, abrasion of the teeth occurs if it is extremely high. Dentifrices should have a enough abrasive component to remove stains without causing damage to the tooth structure[390][391]. The most frequent abrasives added to dentifrices are silicas, carbonates, and phosphates. Ash and charcoal were popularly employed as all-natural dental cleaners. These materials' abrasive qualities made it easier to effectively clean teeth, get rid of stains, and encourage good oral care[392].

In traditional Chinese and Indian medicine, various oral care therapies are mentioned, although mouthwashes are one of them. Primarily it was preferred as a treatment for periodontal disease instead of a plaque reduction strategy. Conventional Ayurvedic medicine does not advocate the use of chemotherapeutic drugs, such as mouthwashes, for the purpose of controlling plaque. But because of disparities in sociocultural customs, Indians have always eaten with their hands rather than silverware. An estimated 50% of Indians rinse their mouths after meals in addition to washing their hands as part of their customary post-meal ritual[393]. Occasionally it is combined with finger brushing as practice among the elderly and those who experienced less exposure to Western civilization and its conventions. Even in spite of any chemotherapy treatment, the simple act of cleansing the mouth with water may help prevent food buildup within the oral cavity[394]. The Charaka Samhita recounts two forms of mouthwashes, gan doosha and kavalagra, that were used for various reasons. Kavalagra was made out of diluted herbal concoctions in the form of a paste or bolus. The kavalagra was then inserted into the mouth and held there unless nasal discharge or lacrimation happened. Conversely, Gan doosha was typically filled with liquids, primarily essential oils. After using this type of mouthwash to the fullest capacity, the mouth was forcefully rinsed. Plants including triphala, dasamoola, guggulu, pippali, and sarshapashunti were among the often utilized gan dooshas. For mouthwash, these were both pulverized and then combined with hot water to gargle, or they were combined with honey or cow's milk. The treatment of periodontal disease also involved the use of mouthwashes with major oil content, such as sahacharadi taila and irimedadi taila. In rural India, people still use sesame oil for oil pulling, which is the oral hygiene technique of holding oil in the mouth for a few minutes before spitting it out without washing it out. Studies have shown that it is useful as an antibacterial agent[395] and in enhancing gingival parameters[396].

Herbs as Potent Dental Protective in Periodontal Diseases

  • Shloka in Sanskrit[82]:

??????????? ?????????? ???????????????? ???????????????????????????????? ??????????????? ? ??????? ???????????????? ??????????????????? ??????? ?????????‌?????? ???????????????? ???????????????????

  • Meaning: Keeping a view on the condition of his body, the individual should pass urine and faeces, clean teeth with any of the twigs of following herbs – Arka (Calotropis procera),Vata (Ficus benghalensis), Khadira (Acacia catechu), Karanja (Pongamia pinnata), Kakubha (Terminalia arjuna),etc. To use the twig as tooth brush, the thickness of the twig should be approximately equal to the tip of one's little finger. It should be 12 Angula lengths. The tip of the twig should be chewed a little to make it as brush. The twig should be of astringent, pungent and bitter in taste.
  • Other herbs/trees/plants with oral health care properties: Table 01, summarizes the collection of various researches and review literatures in management of oral health care with natural ingredients, herbs and their activities against different oral conditions and the clinical case studies held by the researchers.

 

Table 01: Medicinal properties of various herbs including Oral Care

Sr. No.

Herbs

Common Name in India

Literature Survey on Research Work Done on Medicinal Properties of Following Herbs
  1.  

Acacia arabica

Babul

Preserves dental hygiene[83], antibacterial and antiprotease properties[84][85], efficient at treating gingivitis, preventing plaque, and reducing bacterial counts without causing any of the negative effects associated with CHX[86,87].
  1.  

Acacia nilotica

Garad

A. nilotica leaves and bark include tannin[88], gallic acid, catechin, epigallocatechin-7-gallate, catechin derivatives[89][90], ellagic acid, kaempferol, and quercetin[91]. It has a wide range of pharmacological properties, including anti-HIV-1 protease[92], antibacterial[93], antioxidant, anti-carcinogenic[94], and anti-inflammatory properties[95]. The bark of A. nilotica possesses inhibitory and antibacterial properties, it can also be used to treat periodontal disease treatments in the future and as an adjuvant antioxidant in mouthwashes[96].
  1.  

Allium sativum

Garlic

Antiviral, antibacterial, and antifungal qualities when used as medication[97][98]. Infection, diabetes, and heart disease are among the traditional uses of Allium sativum[99]. The compounds found in garlic extract (GE), such as sodium acetate, methiin, and alliin, are beneficial to health[100]. Allicin, an antibacterial substance with potential for treating periodontal disease, dental caries, and oral cancer, is produced when garlic alliin is converted by alliinase[101]. With the discovery of new concepts like aged garlic extract (AGE), which has been used as medicine since 3000 BC, innovative ideas have been developed and researchers found that AGE reduced patients' levels of periodontitis[102]. The anti-inflammatory, anti-viral, anti-fungal, and anti-mutagenesis properties of garlic are well established[103][104]. There have been reports of several new garlic-based products that are consumer-friendly and reasonably priced ways to improve oral health, including gels, gums, toothpaste, and medicinal strips[105].
  1.  

Aloe barbadensis Miller

Aloe Vera

Aloe vera gel possesses pharmacokinetic activities that include anti-inflammatory, antibacterial, antioxidant, immune-stimulating, and hypoglycemic effects[106][107]. On Streptococcus pyogenes and Enterococcus faecalis, it has antimicrobial effects[108][109]. Isorabaichromone, feruoylaloesin, p-coumarylaloesin and three aloesin derivatives have demonstrated the potential to scavenge radicals and superoxide anions[110][111]. It is perfect for treating gingivitis and periodontitis[112][113]. Its antifungal qualities also aid in the treatment of angular cheilitis, aphthous ulcers, and denture stomatitis, gingival tissue irritation, bleeding, and edema are lessened[114], after extractions using it can be a powerful healer[115], it has been utilized as a sedative dressing and file lubricant in root canal treatments[116]. Numerous investigations have been conducted to find out if aloe vera can truly treat gingivitis. In a double-blind study, 120 participants were asked to forgo brushing their teeth for two weeks with Aloe vera. Aloe vera mouthwash was found to be effective in reducing plaque and gingivitis[117]. Another study looked at the effect of toothpaste containing a lot of aloe vera on the resolution of gingivitis and plaque[118]. A study conducted by Geetha et al. highlighted the use of Aloe vera as a treatment in periodontal pockets[119].
  1.  

Amphipterygium adstringens

Cuachalalate

Amphipterygium adstringens is a Mexican indigenous plant of the Julianaceae family[120].According to recent studies, the main component in charge of the plant's powers is Anacardic acid[121],  which contains antibacterial[122], antiulcer, anti-inflammatory[123], anticancer  and antioxidant properties[124].
  1.  

Azadirachta indica

Neem

Extracts from different parts of the neem tree have been shown to contain a range of polyphenols, including flavonoids, lignins, and tannins, which are powerful anti-inflammatory, antibacterial, antioxidants, and immuno-modulators[126][127][128][129]. Neem aqueous formulations have demonstrated antibacterial effects by preventing the growth of some bacteria, breaking down their cell membranes, and lowering their surface adherence[130][131][132][133]. Following oral neem extract therapy, there was a significant reduction in both plaque accumulation and bacterial counts[134]. A neem extract's antioxidant qualities may help lower the oxidative stress linked to periodontal disease and may also have anti-inflammatory effects. By inhibiting prostaglandin-E and 5-hydroxytryptamine (5-HT), neem might possess anti-inflammatory qualities[135].
  1.  

Berberis vulgaris

Ambarbaris

The main active element of Berberis vulgaris (Berberidaceae family) root extracts, berberine has antibacterial activity against periodontal bacteria. Berberine has been demonstrated by researchers to prevent the growth of P. gingivalis and A. a.[136][137][138]. Berberine's bacteriostatic qualities prevent P. intermedia, Actinomyces naeslundii, and Prevotella nigrescens from growing[139]. Dental gel that contained extract from barberry root was tested for microbiological activity. The growth of P. gingivalis was inhibited at 0.015 mg/g, which can be explained by the synergistic antibacterial activity of the protoberberine alkaloid a study evaluating the effectiveness of a dental gel, the plaque index (PI) was shown to have dropped. The plaque index (PI) was found to have decreased in a trial of the efficacy of a dental gel[140].
  1.  

Camellia sinensis

Green Tea

The polyphenolic components of green tea or catechins are responsible for its health benefits[141]. Green tea has higher polyphenol content (30–40% vs. 3–10%) than black tea, and it has potent anti-inflammatory, antibacterial, antiviral, antimutagenic, and anti-aging properties[142][143][144]. It also has a beneficial effect on inflammation and periodontitis. Therefore, studies back up green tea's potential as a periodontal disease treatment and preventive[145].
  1.  

Cinnamomum zeylanicum

Ceylon Cinnamon

Studies on cinnamon have been conducted on diabetic control[146] and gynecological disorders[147]. Its properties include anti-inflammatory, antibacterial, anti oxidative, cardio protective, and anti-inflammatory properties[148]. A group of over 250 evergreen trees in the Lauraceae family are collectively referred to as cinnamon[149]. Numerous species have been investigated, particularly those connected to oral health care. Two of the most researched varieties of cinnamon are Cinnamomum verum and Cinnamomum zeylanicum[150]. Cinnamaldehyde and CBEO present in cinnamon have antifungal, antibacterial, anti-inflammatory, and anticancer effects[151][152][153]. Wang et al. claim that P. gingivalis is inhibited by the cinnamaldehyde in C. zeylanicum bark EO[154].
  1.  

Citrus sinensis

Oranges

It combats bacterial and viral infections in addition to preventing and treating vitamin deficiencies, colds, the flu, and scurvy[155]. Antibacterial properties have also been reported for orange peel[156]. Dubey et al. demonstrated the robust antibacterial properties of orange peel extracts against different bacteria using the disk diffusion method[157]. The effectiveness of orange peel extract against Klebsiella pneumoniae has been demonstrated by Jabuk et al.[158]. Numerous studies have revealed that Citrus sinensis can also treat periodontal disease[159].
  1.  

Coffea canephora

Coffee

The major phenolic acid in coffee, chlorogenic acid, has a variety of health benefits, including antioxidant, anti-inflammatory, and antibacterial characteristics[160][161][162][163][164] [165]. In a clinical trial, the amount of oral bacteria S. mutans was reported to be decreased by the chlorogenic acid in green coffee extract[166]. Coffee extract has been shown to be antibacterial and to block the action of proteases made by periodontitis-causing bacteria such P. gingivalis [167].
  1.  

Copaifera pubiflora

Copaiba

For defense against bacteria, fungus, and animals; during their secondary metabolism a by-product is generated[168][169]. Research has indicated that Copaifera may have antibacterial properties against the microorganisms that cause dental cavities and endodontic infections[170][171][172]. However, Abrao et al. investigated the antibacterial and antivirulence activities against P. gingivalis and Aggregatibacter actinomycetemcomitans (A. a) Against periodontal infections, these substances worked well as antimicrobials[173].
  1.  

Coptidis rhizoma

Canker root

A research suggests that the main active component of CR extract is a substance known as berberine (BBR). Different antibacterial, anti-inflammatory, antifungal, ant diarrheic, and other properties are possessed by CR and BBR[174][175]. BBR treatment reduces inflammation and the damage that periodontitis causes to periodontal tissue by blocking MMP-2 and MMP-9 activation[176]. BBR has the potential to decrease leucocyte infiltration into the periodontium by inhibiting the production of monocyte chemo attractant protein-1 from impacted PDL cells[177]. Similarly a case study shown that oral BBR therapy dramatically reduced alveolar bone loss in a seven-week period in a rat periodontitis model[178]. In a rat model of periodontitis, BBR successfully decreased both local and systemic inflammation by reducing the generation of TNF-α and IL-17 as well as the quantity of IL-17A+ cells in the alveolar bone[179]. BBR inhibits the inflammatory process that leads to the loss of alveolar bone in rats with ligation-induced periodontitis, according to an in vivo study by Gu and colleagues[180].
  1.  

Curcuma longa

Turmeric

Curcumin is a well-known anti-inflammatory constituent with its ability to block human LOX and COX activities[181][182]. Curcumin has its anti-inflammatory properties through modulating inflammatory pathways and stimulating transcription factors including MAP Kinase, activator protein-1, and NF-κB of stimulated B-cells[183][184]. Furthermore, research indicates that curcumin effectively inhibits the induction of inflammatory mediators, which has a therapeutic effect on gingival inflammation and periodontal diseases[185]. When curcumin is contrasted with ornidazole gel, the periodontal parameters are also improved[186][187][188]. There were no discernible differences observed among CHX and curcumin gels in the plaque or GI treatments, according to Kandwal et al.[189]. Researchers are looking into a potential treatment for periodontitis because curcumin inhibits the actions of Toll-like receptors[190]. The chemical compositions of the several forms of curcumin are meta-analyzed to investigate curcumin's impact on alveolar bone loss; similarly in case of bone volume fraction, the chemically modified curcumin produced the best outcomes in terms of millimetres[191].
  1.  

Cymbopogon citratus

Lemongrass

Various studies have indicated that flavonoids and phenol present in lemongrass have antioxidant, anti-inflammatory, and antimutagenic properties[192]. Additionally, bacteria can be inhibited by lemongrass essential oil (EO) at concentrations lower than 2%[193]. Hong khun thian et al. found that it also had antibacterial properties against periodontal germs that had previously developed a resistance to tetracycline[194][195]. Mouthwash with lemongrass essential oil is a useful non-surgical supplement to gingivitis treatment[196][197]. In the deep periodontal pocket area, which is challenging for conventional mouthwashes to reach, muco-adhesive polymer-based semi-solid formulations have been proposed to enhance contact quality and prolong the dosage form's durability[198]. These essential oils may have antioxidant properties, which could account for their anti-clastogenic effects[199].
  1.  

Eucalyptus globulus

Blue gum

Essential oils (EO) derived from eucalyptus are being used globally, regarded as non-toxic, safe and authorized for use as food flavoring ingredients[200]. The presence of flavonoids, tannins, and essential oils (EO) in eucalyptus leaves are thought to be the source of their fumigant, anthelmintic, larvicidal, and antioxidant characteristics[201]. Antibacterial ethanol extracts derived from E. globulus leaves target oral bacteria that frequently include oral pathogens like streptococci[202]. Furthermore, the extracts prevent these bacteria's extracellular glucosyltransferase from generating insoluble glucan[203]. Periodontal bacteria like P. gingivalis and P. intermedia were also susceptible to the antibacterial effects of ethanol extracts of E. globulus leaves[204].
  1.  

Garcinia mangostana

Mangosteen

This plant has pericarps that are rich in tannins, fructose, sucrose, garcinone, sesquiterpenoids, gartanin, and other healthy compounds[205]. Aside from aromatase inhibition, mangostana's other benefits include antibacterial, antioxidant, anticancer, antiproliferative, and pro-apoptotic actions[206][207]. A polyphenol compound with important biological characteristics- xanthones, is abundant in mangosteen, flavonoids and anthocyanins[208][209]. Frequent consumption of mangostana may also help prevent a variety of degenerative conditions brought on by inflammation and oxidative stress[210]. In an investigation, Mangostana pericarp gel extracted with 80% ethanol at a minimum inhibitory concentration (MIC) of 3.91 g/mL was found to inhibit P. gingivalis growth[211]. The generation of IL-6, IL-8 and PGE2 in immortalized human cells treated with P. gingivalis lipopolysaccharides was shown to be greatly reduced by mixing mangosteen and propolis extract, as per a recent study[212].
  1.  

Glycyrrhiza glabra and

Glycyrrhiza uralensis

Chinese Licorice

Glycyrrhiza is native to Europe and Asia which has been extensively utilized in Chinese and Ayurvedic medicine for years[213]. The main isoflavans from Chinese licorice (Glycyrrhiza uralensis), licorisoflavan A and licicidin, suppressed P. gingivalis proliferation, the production of sulphur-based volatile compounds and the protease activity that causes halitosis[214]. It can help maintain dental health and stave against gingivitis. Witttschier et al. observed that pre-treatment of P. gingivalis with licorice root polysaccharides may limit bacterial binding from host cells. Inhibiting bacterial adhesion, the study found that G. glabra polysaccharides[215]. Licorice extract exhibits potent anti-inflammatory properties by decreasing the periodontopathogen-induced IL-1β, IL-6, IL-8, and TNF-α responses when macrophages are activated with A. a and P. gingivalis[216]. Licorice extract exhibits potent anti-inflammatory properties by decreasing the periodontopathogen-induced IL-1β, IL-6, IL-8, and TNF-α responses when macrophages are activated with A. a and P. gingivalis[217]. Licochalcone A inhibits P. gingivalis's ability to produce biofilms and the host immune response[218]. It has recently been determined that licorice extract effectively prevents host cells from producing MMP in individuals with chronic periodontitis[219].
  1.  

Hibiscus sabdariffa

Gakhro/Lal Ambari

It thrives in regions that are tropical or subtropical[220][221]. The calyx of the roselle contains a variety of secondary metabolites, including hibiscetin, flavonoids, alkaloids, and saponins[222][223]. Additionally, delphinidin-3-sambubioside, which reduces the synthesis of inflammatory mediators, suppresses osteoclastogenesis in roselle. Owing to its antibacterial and anti-inflammatory characteristics, alveolar bone loss may be treated with it[224][225][226][227]. The antibacterial properties of roselle may aid in delaying the formation of plaque and so halting additional bone deterioration[228][229][230][231]. Past studies on its extract have also demonstrated its anti-inflammatory qualities[232][233][234].
  1.  

Inula viscosa

False Yellowhead

Ditrichia viscosa is a member of the Asteraceae family and is primarily found in the region of the Mediterranean[235]. It is still unknown whether I. viscosa's antibacterial action will affect early oral biofilms in situ. It is used as a folk medicine plant to treat scabies and skin irritations like eczema[236][237]. It has been shown that I. viscosa extract possesses anticancer, antioxidant, antifungal, antibacterial, and hypoglycemic activities[238]. Furthermore, I. viscosa tea reduced the adhering bacteria in the main in-vivo oral biofilm without impairing the salivary pellicle's acid-resistance[239]. According to a research, particularly when each of its components comes in touch with the oral mucosa, I. viscosa has a great deal of potential to protect oral   health. Kurz et al. investigated the antibacterial activity of Inula viscosa extract by using it to prevent microbial adherence in the oral cavity[240].
  1.  

Juglans regia

Akrot

The walnut tree, derum, dandasa and sewak or Juglans regia is one of the most useful medicinal plants in both the cosmetic and therapeutic fields[241]. Among other things, Juglans regia's shells, kernels, seeds, and bark have all been the subject of numerous research[242]. In the cosmetics business, Juglans regia bark is utilized as a teeth-cleaning agent and as a lip colorant[243]. Juglans regia bark is a fibrous, resinous, and aromatic portion that can take on a variety of shapes and dimensions[244] which possesses anti-inflammatory, blood-purifying, anticancer, depurative, diuretic, and antioxidant qualities that make it useful in treating a wide range of conditions[245]. It has been demonstrated that its antifungal and antibacterial qualities have an inhibiting effect[246]. The plant Juglans regia is utilized in oral hygiene products because it includes terpenoids, alkaloids, steroids, phenols, and flavonoids[247]. The bioactive component of Juglans regia, juglone, has been shown to suppress the growth of P. gingivalis and its antibiofilm effect, specifically against S. sobrinus, A. viscosus, and S. mutans Leaf and septa extracts showed only a small amount of toxicity in rats and mice. Because Juglans regia has antiplaque activity, it is a wonderful substance for improving oral and dental health[248][159].
  1.  

Lippia sidoides

Jalapippali

A medicinal Verbenaceae shrub with aromatic properties found in northeastern Brazil namely "Pepper-Rosmarin or Lippia sidoides"[249][250] yield EOs and other extracts that contain monoterpenes with antibacterial characteristics, like thymol and carvacrol[251][252]. Extracts from L. sidoides are used as a topical antiseptic in traditional Brazilian medicine to treat diseases of the skin and mucous membranes[253][254]. This plant has apparently shown good outcomes when used in dentistry, especially when it comes to controlling supragingival biofilm and having antiplaque and antigingivitis properties on humans[255][252][256][257] as well as studies using animals. By lowering pro-inflammatory cytokines including TNF-α and IL-1β, as well as myeloperoxidase activity, researchers were able to decrease gingival neutrophil infiltration and regulate periodontal inflammation[258][259][260].
  1.  

Mangifera indica

Mango

A member of the Anacardiaceae family, Mangifera indica (mango) contains 10% mangiferin. This tropical and subtropical tree has been used for a variety of medical applications[261]. The fact that mangiferin is a glycosylated xanthone with anti-inflammatory and immunomodulatory qualities is one of the processes at work[262][263]. In lumbar vertebrae, an experiment revealed bone anti-resorption actions[264]. Additionally, this plant works well against some periodontal bacteria[265].
  1.  

Manuka honey

Manuka honey

Honey has been used to heal infections and other illnesses since the dawn of time[266]. Because honey has antibacterial qualities, especially against wound infections and germs resistant to antibiotics, researchers are now again interested in this substance[267][268]. This resulted in the approval of Manuka honey for the treatment of burns, ulcers, and bacterial infections[269][270][271]. The antibacterial components of honey include methylglyoxal, flavonoids, hydrogen peroxide, bee defensin-1, numerous protein-rich compounds, the hyperosmolarity effect, an acidic pH and phenolic compounds[272][273]. Among the majority of honey varieties, hydrogen peroxide exhibits the strongest antibacterial properties[274]. Manuka honey has antibacterial properties against both planktonic and biofilm microorganisms[275][276][277]. Planktonic bacteria when cultivated[278][279], Although P. gingivalis[280] and A. a.[281] are susceptible to manuka honey, P. gingivalis is significantly more resistant when it forms a biofilm[282]. Manuka honey strips have been discovered by English et al. to minimize gingival bleeding and plaque growth[283].
  1.  

Matricaria aurea and

Matricaria chamomilla

Babuna & Chamomilla

Its oil and flower extracts are used to cure a wide range of illnesses[284]. It has a high concentration of active ingredients including terpenoids, flavonoids, coumarins, and spiroether[285][286]. MTC extract contains anti-inflammatory components such as spigenin, chamazulene, and bisabolol, which block the production of NO, TNF-α, hyaluronidase, collagenase, cyclooxygenase, prostaglandin E2, and interleukins (1β, 6, 12)[287][288]. Plaque accumulation, gingival irritation, and recurrent stomatitis have all been demonstrated to be alleviated by utilizing  MTC mouth rinse[289][290][291][292][288]. The Saudi Arabian native plant Matricaria aurea (M. aurea), which is a member of the genus Matricaria, has drawn attention recently due to its potential as a rich source of antioxidants and antimicrobials as well as its therapeutic uses[293][294]. This species and Matricaria chamomilla have numerous chemical traits in common[295]. According to recent research by Ahmad et al., this extract may contain a variety of compounds that could aid in the creation of the next generation of medications used to treat chronic periodontitis[296].
  1.  

Morus alba

Mulberry

Historically, Morus alba has been used to treat fevers, improve vision, fortify joints, and lower blood pressure[297]. Mulberry fruit is additionally utilized to treat anemia, weakness, weariness, early hair graying, renal support, and blood replenishment. Mulberry root bark is anti-inflammatory, hypoglycemic, and antibacterial. It also shows anti-inflammatory properties[298]. The ethanolic extract from the stems of mulberry tree has the highest concentration of oxyresveratrol (2,30,4,50-tetrahydroxystilbene), while the leaf extract has the lowest concentration[299]. Oxyresveratrol from M. alba possesses anti-oxidant and radical-scavenging properties. Prenylated flavonoids, among other ingredients, may have anti-inflammatory properties by inhibiting the production of nitric oxide (NO). M. alba has been shown to be effective in treating periodontitis in a number of studies[300].
  1.  

Myristica fragrans

Nutmeg

It consists of four parts: mace, seeds, flesh, and skin[301]. Numerous derivatives of alkyl benzene are present in Myristica fragrans[302][303]. The chemical components of Myristica fragrans have been studied by scientists from a variety of sectors for its antioxidant, antibacterial, hypolipidemic, and hypocholesterolemic properties, among others. In contrast to the mace's anti-inflammatory[304], anti-carcinogenic[305], and anti-papillomagenic effects, the seed kernel has antithrombotic, antiplatelet, and antifungal qualities and more. The compound trimyristin, which is extracted from Myristica fragrans seeds, has demonstrated antibacterial properties against both Gram-positive and Gram-negative bacteria[306]. Zaleha Shafiei et al. observed lower bacterial concentrations in preparations of the extracts made with mace, seeds, and meat of Myristica fragrans[307].
  1.  

Ocimum sanctum

Tulsi

Aromatic plants of the Labiatae family include holy basil, also known as Tulsi or Ocimum sanctum are utilized in various areas as it can prevent radiation poisoning and cataract formation, and because of its COX2 inhibitory properties, it possesses antioxidant properties as well[308][309][310]. It has been shown to possess antimicrobial,  antioxidant, and antigingivitis because of compounds like apigenin, eugenol, civsilineol, civsimavatine, isothymonin and rosavinic acid, as well as antiseptic  properties  by  inhibiting COX through the method of scavenging free radicals through phenolic compounds like eugenol, rosmarinic acid, and eugenol[311].
  1.  

Pinus pinaster

Pine

It contains constituents such as catechins, epicatechins phenolics, glycosides, cinnamic acids, and polyphenolic monomers[312]. Several research has indicated that the extract and some fractions may possess antioxidant qualities in perfused organs, cultured cells, and in vivo settings[313] [314]. The PYC compound has been shown in human trials to have anti-inflammatory properties[315][316]. According to a study, chewing PYC gum can stop gingival bleeding and plaque from forming[317].
  1.  

Piper marginatum and

Ilex guayusa

Piper and

Guayusa

This plant is also known as "small cord" and "tooth healer" in Colombia. P. marginatum leaf extracts have demonstrated antibacterial, antimycotic, and antiviral properties against illnesses in humans, animals, and plants[318][319]. The Aquifoliaceae plant "Ilex guayusa," which grows in tropical and subtropical regions, is commonly referred to as "guayusa." Its leaves are used to make infusions that stimulate muscles and nerves and heal gastrointestinal issues, respiratory issues, and colds[320]. According to Gamboa et al., the plant leaves' extract has antibacterial qualities that can combat germs that cause periodontal disorders[321].
  1.  

Pistacia lentiscus

Mastic Gum

The  antibacterial, anti-inflammatory, and analgesic qualities of Pistacia lentiscus plants and their processed products have long been valuable[322][323]. Pistacia lentiscus is used in numerous applications due to its antibacterial and antifungal characteristics[324]. Mastic gum of the plant contains limonene, β-pinene, β-myrcene, and β-caryophyllene, among other volatile substances[325], also contains high bactericidal capabilities, particularly against H. pylori, and its main active ingredient is triterpenic acids[326]. Recently a study showed that anaerobic oral infections such P. gingivalis, F. nucleatum, and P. intermedia can be successfully treated with mastic gum[327]. Similarly, Pistacia lentiscus resin is utilized to create dental powder, which is used to clean teeth and get rid of foul breath[328].
  1.  

Psidium guajava

Guava

Guava has wound-healing, antiplaque, anti-inflammatory, and antioxidant properties. Oral hygiene is usually improved using a paste formed from fragile guava leaves. In ancient days chewing sticks of guava stems and fresh leaves were used by amongst the population to clean the oral cavity, it is believed that anti-inflammatory and wound healing properties of P. guajava seems to be helpful in treatment of bleeding gum and painful tooth[329].
  1.  

Punica granatum

Pomegranate

Pomegranate, a member of the Punicaceae family, is scientifically known as Punica granatum[330]. Pomegranates are known as "a pharmacy unto themselves" because of their advantages. Numerous potential health benefits of pomegranates include treating bacterial, fungal, viral, immunological, vermifuge, stimulant, refrigerant, stomachic, styptic, diuretic, and helminthic illnesses[331].
  1.  

Rosmarinus officinalis

Rosemary

The plant's properties are influenced by a number of leaf constituents such as phenols, flavonoids, terpenoids, and essential oils[332][333][334][335]. Santoyo et al.'s study identified the EOs that have the antibacterial effect after analyzing the data, they found that verbenone, camphor and borneol had the greatest antibacterial activity[336]. In bone cells, rosmarinic acid was investigated by Lee et al. Its ability to greatly increase alkaline phosphatase activity and improve osteoblast mineralization raises the possibility that it could be utilized to stop the deterioration of bone[337].
  1.  

Salvadora persica

Miswak

In the Muslim world, this chewing stick is referred to as the Miracle Twig or Brush tree; other names for it include Miswak, Arak, Meswak or the Toothbrush Tree[338]. According to WHO guidelines, the antibacterial characteristics of Salvadora persica has fibrous branches which make them suitable for use in oral hygiene. This plants belong to family Salvadoraceae[339][340]. The plant is primarily found in the Middle East, the Indian subcontinent, and the dry and subtropical parts of Africa[341]. Throughout pre-Islamic and Islamic times, Arab and Islamic communities employed Salvadora Persica (SP), an ancestor of toothbrushes, to clean their teeth and maintain better oral health[342]. The pharmacologically active components and mechanical action of SP when brushed contribute to its favorable effects on oral and dental health. Tannins are a group, one of its chemically active substances; they inhibit the glucosyltransferase enzyme to lessen periodontal disease and plaque[343]. There is currently not much knowledge about the physiologically active substances that give S. persica miswak its purportedly positive effects on oral health. According to certain in-vitro research, S. persica extracts slowed the growth of C. albicans and other oral aerobic and anaerobe bacteria. Such extracts have also been shown to inhibit the growth, plaque formation and acid generation of several cariogenic bacteria in vitro[344][345][346]. A recent study by Almas & Al-Bagieh revealed that S. persica bark, pulp, and the entire part of miswak tree, were all effective against a variety of bacteria, including S. mutans, although there were some differences in the antibacterial activity of the bark and pulp extracts[347]. As an efficient and different dental hygiene tool, the World Health Organization[348] has supported and advocated using these sticks. The core tenets of the Primary Health Care Approach, which emphasize community involvement, prevention, and the use of suitable technology, are also supported by this proposal[345].
  1.  

Satureja hortensis

Summer Savory

Referred to as summer savory (Satureja hortensis), this annual herbaceous crop species belongs to the Lamiaceae family and features linear leaves with heavy branching. Serine compounds, pyrocatechols, mucilage, tannins, flavonoids, steroids, volatile oils, acids, and gums are among the main bio-molecules found in S. hortensis extracts and EO. These compounds have a range of antioxidant, antibacterial, and anti-inflammatory properties that make them useful in the treatment of some systemic illnesses[349]. The study by Gursoy et al. found that S. hortensis EO had a mediocre anti-biofilm impact at sub-inhibitory levels when applied at a dose that was safe for keratinocytes. However, it stopped the growth of periodontal bacteria[350].
  1.  

Syzygium aromaticum

Clove

Clove is a spice made from the dried blossom buds of the Syzygium aromaticum (Myrtaceae) clove tree[351]. Clove has a high sensitivity to numerous germs and pathogens that cause periodontal disorders and tooth damage[352]. Furthermore, studies have demonstrated the antifungal, anti-carcinogenic, antiallergic, and antimutagenic qualities of Syzygium aromaticum[353][354]. Eugenol is one of the primary ingredients in clove oil and has anti-inflammatory and antioxidant properties[355]. Clove possesses antibacterial properties against two Gram-negative anaerobic periodontal pocket infections, P. gingivalis and P. intermedia. It may inhibit TNF-α, COX-2, and IL-6 and alter the NF-?B signaling pathway, potentially lowering periodontal inflammation[356][357][358][359]. Cloves possess antioxidant qualities in addition to their anti-inflammatory ones[360][361]. Its antioxidant activity may help to lessen the joint oxidative stress associated with periodontal disorders[362]. Additionally, Karmarkar et al. discovered that dried clove buds have a high eugenol content as well as that its derivatives can stop bone loss, which makes them beneficial for treating periodontal illnesses[363].
  1.  

Terminalia chebula

Harad/Harra

It has been suggested that the plant Terminalia chebula (Combretaceae family) possesses antibacterial and anti-cariogenic properties in addition to anti-inflammatory and antioxidant properties. It has been demonstrated that mouth rinses containing this substance have antibacterial qualities against oral pathogens. The fruit of this plant has been used to prevent and treat dental caries, gingivitis, and stomatitis[364]. These beneficial benefits seem to be caused by a variety of phytochemical substances, including polyphenols, terpenes, anthocyanins, flavonoids, alkaloids, and glycosides[365]. A crucial element of Ayurvedic therapy is the composition known as "Triphala" made with Haritaki : Bibhitaki : Amlaki[366]. The liquid extract, pills, or bulk powder of triphala is used to treat dental and oral conditions[367].
  1.  

Vicia faba

Bakala

These plants are not so much used as food for humans as they are as cow fodder and soil nitrogen boosters in the Mediterranean and Far East.[368] Based on the size of the seeds, Vicia faba is classified into three varieties: minor, quina and major[369]. Broad fava beans have antioxidants, fiber, and vitamins that help decrease cholesterol and triglycerides[370][371]. Flavan-3-ols, which include epicatechin and catechin, flavonols, and flavones, are the main constituents of Vicia faba and are responsible for the plant's anti-inflammatory and antioxidant properties[372]. Numerous articles offer information regarding periodontal problems, considering the preliminary study outcomes[373].
  1.  

Vitis vinifera

Grape

The metabolites of Vitis vinifera are rich in naturally occurring antioxidants. Bioactive compounds found in winery residues have been found to have cytoprotective, antioxidant, and anti-inflammatory qualities[374][375]. Considered the most important active ingredients, phenolic compounds are responsible for the majority of the health benefits associated with vine extracts. Inhibiting virulence factors or acting directly against oral infections, phenolic compounds have been shown in numerous investigations to possess antibacterial, antifungal, and antiviral properties[376][377]. It has also been shown that V. vinifera extracts can regulate the oxidative stress imbalance and bacterially generated inflammatory response in periodontal disorders[378].
  1.  

Zanthoxylum armatum

Winged prickly ash

Zanthoxylum armatum belongs to the family Rutaceae. It is possible to enhance dental health by using various Zanthoxylum species[379][380][381]. The plant components of Zanthoxylum species are rich in lignins, terpenoids, phenolic acids, sterols, and alkaloids. When combined with honey, Zanthoxylum armatum bark powder stops gingival bleeding, sometimes the tree referred to as the toothache tree, also used to relieve inflammatory tooth pain[382]. All of the bacterial strains   investigated till now were susceptible to the effects of EOs extracted from Zanthoxylum armatum leaves[383]. Zanthoxylum armatum EOs may possess antibacterial qualities because of their terpenoids[384].
  1.  

Zingiber officinale

Ginger

Ginger or Zingiber officinale, is a plant of the Zingiberaceae family that is used medicinally in many countries[385]. The active chemicals found in ginger, such as β-bisabolene, shogaol, gingerol, and paradol possess the ability to regulate blood sugar levels, reduce inflammation, fight cancer, and prevent obesity[386][387]. Recent research by Mahyari et al. examined the efficacy of herbal mouthwash consisting of hydroalcoholic extracts of Z. officinale, Rosmarinus officinalis, and Calendula officinalis and compared it to CHX. Comparable to CHX, the polyherbal mouthwash was as effective[388].
 

CONCLUSION

By 1900, a paste made of hydrogen peroxide and baking soda was recommended for use with toothbrushes. Premixed toothpastes were first marketed in the 19th century, but did not surpass the popularity of tooth-powder until World War-I. In 20th Century, various type of dentifrices has undergone considerable changes such as liquids/solutions have been sharply differentiated into those intended to whiten the teeth and into the antiseptic mouthwashes. Fluoride toothpastes became the standard during the late 1950’s and 1960’s. And from 1980’s to the present day have seen all kind of additions – gels, whitening agents, toothpaste for sensitive teeth and so on. The most recent advances in toothpastes have included the development of whitening toothpastes and toothpaste containing Triclosan. Whereas, according to recent researches Triclosan impairs thyroid homeostasis, neurodevelopment impairment, metabolic disorders, cardio toxicity and the increased cancer risk. In few researches, the cytotoxicity reports has shown that the ingredients of commonly used toothpastes such as sodium lauryl sulphate, cocamidopropyl betaine, zinc lactate, paraben, sodium fluoride (other fluorides) can be carcinogenic. These ingredients can also cause embriotoxicity, reproductive toxicity, cardio toxicity, hepatotoxicity, genotoxicity, neurotoxicity and inhibition of melanogenesis too. Several oral conditions such as hypersensitivity at the cementoenamel junction can be alleviated by products containing potassium, strontium or sodium salts. In that case, consumption of oral aids made with such harmful chemicals can increase the risk of medical disaster. Oral cancer accounts for approximately 5% of all cancers globally, while in India it is about 40% of all types of cancer. It is estimated, that in India nearly 50,000 new cases of oral cancer are reported annually. Oral cancer mortality increased by 11.18% nationally from 1990 to 2021. Similar to tobacco and alcohol consumption, oral dentifrices with such harmful ingredients can also lead to oral cancer. Production of modern dentifrices with natural ingredients instead of chemicals could result into a great revolution amongst the world. After all, “A clean mouth will lead to clean body, and a safe oral care will lead to safe world”.

Oral care system has improved dramatically in recent decades, a trend that oral care companies in a multibillion dollar business have sought to exploit. A society that once survived using neither toothpaste nor mouth rinse now has a bewildering array of pastes and tastes from which to choose, including those with whiteners and fluorides, products for tartar control and sensitive teeth and all combinations thereof. Due to lack of evidences about the traditional dental care, slowly the historical dentifrices got replaced with advanced dental technologies. While looking forward for a safer lifestyle and a healthy life, these modern dentifrices composed of hazardous chemicals need to be replaced with natural ingredients. However, in past few years, Natural/Herbal approach for overall health care is being in trends amongst the researchers. Many of the researchers have already worked on the herbal medications to prove the claims of traditional health care systems, and oral care is one amongst it. In the dynamic field of medicines, new technologies and modern methodologies are transforming the dental practices on next level across the industry for consumers and providers with significant advancements, making dental care more accessible, efficient, and comfortable. While keeping aside the pros, this modernized innovation possesses more cons like incorporation of different type of chemicals and hazardous ingredients such as triclosan, sodium lauryl sulfate, and artificial sweeteners which are responsible for several oral health problems. Due to this, there is a growing need for natural oral care products that put human health and environmental safety first. 

The efficacy of Ayurvedic treatment is a historic Indian medical system predicated more on strengthening the body's defense mechanisms than on getting rid of external infections. However, over the last few years, there has been an increase in the use of herbal extracts in over-the-counter dental products that are sold in stores, such as mouthwashes, toothbrushes, and toothpaste. Pure phytochemicals, essential oils, and plant extracts offer a wealth of evidence to support the possibility of developing drugs that might be used to treat or prevent periodontitis, gingivitis and many of the oral disorders. Though many clinical trials for these products are encouraging, more research on the safety and effectiveness of these products is needed to determine whether they have medicinal value, either by themselves or in combination with traditional treatment options, which can help minimize the overall economic impact of oral diseases globally. Nevertheless, the only way to encourage better oral hygiene is to highlight the judicious combination and usage of modern and traditional teeth cleaning tools under patient education and motivational monitoring. There may be some fascinating information to be discovered by going back to the conventional approaches and supporting them with high-caliber randomized controlled clinical studies. Reviewing the data that is accessible on the effects of ancient dentifrices including herbal medications and rural alternatives like ashes, implemented as supplements or therapies for periodontal diseases and oral health care was the purpose of writing this article. This narrative review sought to review and synthesize the literature into a cohesive summary of the traditional knowledge related to oral hygiene and modern research studies to claim the traditional benefits of oral health care in older adults as well as overall population to increase awareness of its importance and addressing gaps between modern population and traditional health care.

ABBREVIATIONS

HIV: Human Immunodeficiency Virus

WHO:  World Health Organization

OC: Oral Cancer

DAI: Dental Aesthetics Index

S. mutans: Streptococcus mutans

spp.: Species

CHX: Chlorhexidine

AGE: Aged Garlic Extract

COX: Cyclooxygenase

PGE2: Prostaglandin E2

P. gingivalis: Porphyromonas gingivalis

A. a.: Aggregatibacter actinomycetemcomitans

CBEO: Essential Oil of Cinnamon Bark

EO: Essential Oil

CR: Coptidis rhizoma

BBR: Berberine

MMP: Matrix Metalloproteinase

PDL: Periodontal Ligament

IL: Interleukin

TNF: Tumor Necrosis Factor

LOX: Lipoxygenase

MAP kinase: Mitogen-Activated Protein kinase

NF-κB: Nuclear Factor kappa B

SRP: Scaling and Root Planing

GI: Gastrointestinal

S. sobrinus: Streptococcus sobrinus

A. viscosus: Actinomyces viscosus 

NO: Nitric Oxide

PYC: Pycnogenol 

DECLARATIONS  

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Availability of data and material

Not applicable

Competing interests

The authors declare that they have no competing interests

Conflict of interest

Funding

Not applicable

Author’s information

Authors and affiliations

Bio-processing and Herbal Division, Mahatma Gandhi Institute for Rural Industrialization Wardha – 442 001 Maharashtra, (INDIA)

Jaykishor A. Chhangani, Soumya Gulab Katre and Adarsh Kumar Agnihotri

Author’s Contribution

Katre SG is major contributor behind the basic concept, literature survey, review, creation of manuscript content and referencing of the manuscript; Chhangani JA and Agnihotri AK contributed in examination, correction and editing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jaykishor A. Chhangani

Acknowledgements

The Authors are grateful to Mahatma Gandhi Institute for Rural Industrialization, Wardha, Maharashtra and Ministry of MSME, Government of India, New Delhi for constant support and providing research facilities.

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Jaykishor Chhangani
Corresponding author

Bio-processing and Herbal Division, Mahatma Gandhi Institute for Rural Industrialization, Maganwadi, Wardha-442 001, Maharashtra, India

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Soumya Katre
Co-author

Bio-processing and Herbal Division, Mahatma Gandhi Institute for Rural Industrialization, Maganwadi, Wardha-442 001, Maharashtra, India

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Adarsh Kumar Agnihotri
Co-author

Bio-processing and Herbal Division, Mahatma Gandhi Institute for Rural Industrialization, Maganwadi, Wardha-442001, Maharashtra, India

Jaykishor Chhangani*, Soumya Katre, Adarsh Kumar Agnihotri, Harnessing Natural Ingredients for Oral Health: A Review of Traditional Dental Practices in India, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 6, 3670-3720. https://doi.org/10.5281/zenodo.15723542

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