Natural Conservative Dentistry: An Alternative Approach to Solve Restorative Problems E-Book
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- Herausgeber: Bentham Science Publishers
- Kategorie: Fachliteratur
- Sprache: Englisch
- Veröffentlichungsjahr: 2024
In nature lies the solution to restore teeth with minimal damage. In this groundbreaking book, the management of dental challenges is presented from a new perspective. Natural Conservative Dentistry: An Alternative Approach to Solve Restorative Problems provides evidence-based solutions to dental challenges to researchers, practitioners and dental service providers. The main attribute of all these solutions is that they are all derived from natural ingredients. Natural ingredients are an effective alternative for dental care and management in contrast to synthetic products that have multiple side effects.
This book fills a knowledge gap on alternative and sustainable solutions derived from nature to respond effectively to dental challenges encountered in dental treatment for the conservation of the tooth. It is a compilation of the work of expert dentists that has been carried out in clinics for the management of dental problems.
Key Features
- Provides an insightful look at the prevention of dental diseases through evidence-based interventions using natural products in 8 referenced chapters
- Contains valuable contributions in restorative dentistry, such as caries prevention, enamel and dentin remineralization, dentin biomodification, dentin desensitization, vital pulp therapy, antioxidants, and tooth bleaching
- Provides an update on the current status of different ingredients used in oral health care products developed for commercial markets
- Includes notes on pathophysiology and diagnosis on specific conditions and sources of natural ingredients
The book is a valuable reference for trainees and professionals who want to enhance their restorative dentistry practice in the clinic.
Readership
Dentistry residents, clinicians and administrators
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FOREWORD
Natural Conservative Dentistry is a comprehensive guide that explores the use of herbs in the prevention and treatment of various dental challenges. The global need for alternative treatment of oral diseases that are safe, effective, and economical arises from the rise in disease incidence, increased resistance of pathogens to currently used chemotherapeutics, opportunistic infections in immunocompromised individuals, and financial consideration. Despite the availability of different approaches for the discovered drugs, plants remain the main reservoirs of natural medicine.
The book delves into traditional herbal remedies in oral healthcare and highlights the scientific evidence supporting their efficacy. It starts with an introduction to the principles of herbal medicine and the importance of natural products in promoting dental health. It then provides an overview of restorative dentistry's most commonly used herbs, including their active constituents, mechanisms of action, and potential side effects.
The book's subsequent chapters discuss the role of herbal products in providing alternative therapy to restorative conditions, such as caries, loss of dental tissues like enamel, dentin, and cementum, as well as dental hypersensitivity, tooth discolouration, and issues encountered with bonding to the tooth tissues. The authors provide a detailed analysis of the scientific evidence supporting the use of herbal remedies in each of these conditions and practical recommendations for their safe and effective use. The book also covers other topics related to herbal products in dental conditions, such as the formulation of herbal preparations, the manipulation of herbal products, and comparative analysis between selected herbal remedies and conventional synthetic agents.
Overall, the book is invaluable for dental professionals, researchers, and students interested in integrating herbal medicine into their clinical practice and research. It provides a comprehensive overview of the current knowledge of the use of herbal products in dental health and offers practical guidance for their safe and effective use.
PREFACE
First, I sincerely thank the authors for their hard work and dedication in compiling this vital resource. This book will inspire other dentists to explore the use of herbal products in restorative dentistry and contribute to the advancement of our profession.
We are pleased to introduce this innovative book on using herbal products in restorative dentistry. As academic and practicing dentists, we constantly seek effective treatment methods, and this book offers valuable insights into using natural remedies to promote dental health. To develop this book, the authors have done an outstanding job of compiling the latest research on the use of herbal products in restorative dentistry and presenting it in a clear and accessible manner.
Throughout its chapters, the book provides practical guidance on how to incorporate these products into your practice, with information on the formulation of herbal preparations, the manipulation of herbal products, and comparative analysis between selected herbal remedies and conventional synthetic agents.
We are confident that this book will be a valuable addition to the library of any dentist interested in incorporating herbal medicine into their practice.
DEDICATION
This book is dedicated to all professional dentists who defy the status quo and continuously strive to provide their patients with the best possible care using natural and sustainable remedies.
As the authors of this book, we hope that the knowledge shared in these pages inspires you to incorporate herbal remedies into your practice and benefit patients in their restorative dental treatments.
List of Contributors
Natural Anti-cariogenic Agents
Fatma Hussein1,*Abstract
Tooth decay is primarily caused by demineralization resulting from acids secreted by bacteria, especially Streptococcus mutans and lactobacillus, which ferment dietary carbohydrates. This occurs in plaque biofilms, which attach to the surfaces of the tooth and become laden with bacteria. Thus, over time, dental caries result from the interaction of three main contributing factors: a diet containing carbohydrates, caries-producing bacteria, as well as sensitive tooth structure. The use of an antibacterial strategy for treating caries has evolved as a result of (1) identifying certain types of the oral microbiome as the main cariogenic flora and (2) increasing the knowledge of the specific ecology of these cariogenic florae. Combined with this concept, control, and prevention of caries have been sought by reducing the number of bacteria colonizing. Reducing bacterial populations or completely eradicating them from the oral flora would provide an additional reason to prevent dental caries. Several undesirable side-effects of conventional antimicrobial agents include tooth discoloration and the emergence of bacterial resistance. These side effects stimulate the search for alternative natural anti-microbial agents.
INTRODUCTION
Dental caries is caused by the interaction of specific bacteria and their metabolites with components of saliva and diet containing carbohydrates on tooth surfaces. The synthesis of extracellular polysaccharides in the biofilm matrix, acid production, and the low pH at the tooth-biofilm interface are the main modulating
animus factors regulating the pathogenesis of caries. While many micro-organisms may be included in the pathogenesis of the carious process. Streptococcus mutans have a significant role in the formation of toxic biofilm [1-4]. This bacterium efficiently metabolizes sucrose for the synthesis of extracellular polysaccharides via the activity of glucosyltransferases (Gtfs), and Fucosyltransferases bind to the surface of saliva-coated tooth enamel. Bacteria tenaciously adhere to the dextran-coated surface. It is both acid-producing and acid-resistant.
The extracellular polysaccharides are mainly composed of glucans that are formed by Gtfs enzymes in salivary pellicles (almost all GtfC) and that bind to the bacterial cell surface (almost all GtfB) among sucrose. In situ formed glucan provides the following functions binding sites for Streptococcus mutans, the matrix holds microbial cells together to form co-aggregated cell clusters called micro-colonies [5]. If these microcolonies are regularly exposed to a diet containing carbohydrates and not removed from the tooth surface (especially sucrose), Streptococcus mutans and other acid-producing and tolerant bacteria in the biofilm will ferment sucrose to organic acids [5].
Chemotherapeutic Strategies to Control Biofilm
Biologically active chemical agents on biofilm components may be promising for preventing or reducing the frequency of the caries process. Such components may have the following mechanism: (1) block Gtfs adhesion to the salivary pellicle, (2) inhibit the secretion of extracellular-polysaccharides, (3) modify the composition of extracellular polysaccharides matrix, (4) inhibit bacterial colonization, (5) disrupt acid formation and adaptation process, (6) suppress the growth of oral microorganisms, and (7) modify the biofilm ecology and biochemistry. Chlorhexidine, triclosan, and essential oils (e.g., Listerine) are broad-spectrum nonspecific microbicides, they are the most commonly used types. The research focused on chemotherapeutic strategies focused on decreasing the expression of Streptococcus mutans virulence factors without the destruction of the pathogen.
Strategies to control the biofilm are based on the disturbance of EXPs synthesis on the surfaces. Extracellular polysaccharides matrix may act as an adsorbent, thereby reducing antimicrobials that can interact with biofilms. Therefore, extracellular polysaccharide-inhibiting materials enhance the efficacy of antibacterial agents on plaque biofilm [6].
Effect of Natural Agents on Caries-producing Pathogens and Streptococcus mutans Physiology
Natural agents remain the main source of promising therapeutics for the management of human diseases [7, 8]. Research on the use of natural agents to inhibit or cure dental caries received limited regard in medicine. The biological effects of natural agents are as follows:
(i) Sugar substitute.
(ii) Inhibit exopolysaccharide synthesis.
(iii) Inhibit intracellular-polysaccharide synthesis, and decrease acid production.
(iv) Inhibition of bacterial adherence.
(v) Antibacterial effect: inhibit metabolism and growth of acid-producing and tolerated species.
(vi) Enhance salivary buffering capacity.
(vii) Improve acid resistance of enamel.
Classifications of Natural Anti-cariogenic Agents
1-Plant extract
2-Spices
3-Fruit extract
4-Sweetener
5-Natural micro-organisms (probiotics)
PLANT EXTRACTS
Due to their high content of antimicrobial agents, medicinal plants are useful in the management of different diseases, including bacterial diseases. Many phytochemicals, including antimicrobials, are derived from edible plants and have been shown to have antibacterial properties against Streptococcus mutans [8].
Tea (Camellia Sinensis)
Tea is a worldwide beverage made of Camellia sinensis plant leaves. According to the manufacturing process, there are three main types of tea [9], as represented in (Table 1).
Green Tea
Green tea is made by frying or steaming fresh leaves and then drying them to suppress the active enzymes. Chemically, it has many components, such as; polyphenolic catechins, epigallocatechin-gallate, epigallocatechin, caffeine, and vitamin C [9].
Black Tea
It is made by crushing the leaves of withered tea, enhancing enzyme-mediated oxidation reactions to initiate the fermentation procedures, and synthesizing oligomers. The black type of tea contains a lower monomer content compared to the green type, it also contains Theaflavins, thearubigins, and the content of fluorine is five times higher than that of green tea [9].
Oolong Tea
A partially fermented product contains certain amounts of catechins and oligomerized catechins [9].
Anti-cariogenic Effect of Tea
1- Anti-streptococcal (bactericidal): the bactericidal effect against Streptococcus mutans and Streptococcus sobrinus, the minimum inhibitory concentration of catechins 50-500% mg/l, flavored compounds in green tea also found inhibitory activity, the total flavor 7mg/l [10].
2- Inhibition of adhesion: It inhibits Streptococcus mutans adherence to saliva-coated tooth surfaces. The prevention of bacterial adherence to teeth decreases the hydrophobicity, which induces cellular aggregation of bacterial biofilm, easily washed by saliva.
3- Inhibition of glucosyltransferases, thereby reducing the synthesis of viscous glucan.
4- Inhibition of bacterial amylases: black and green tea repress amylase activity from Streptococcus mutans, black tea is more active than green tea due to the high molecular weight of polyphenols.
5- Enhancing the anti-acidity of teeth: About 300 ppm of fluoride was extracted into the tea infusion. Fluoride found in the enamel in the form of fluorapatite is known to enhance the acid resistance of the enamel, and the aluminum content of tea can increase the acid resistance of the enamel [10].
Anti-cariogenic Effect of Green Tea
The main anti-caries effects have been reported to be attributed to catechin, epigallocatechin gallate, and epigallocatechin, which have the following functions:
1-Inhibit Glucosyltransferases mechanism, hence reducing caries index in rats infected with Streptococcus mutans [10].
2- Catechins inhibit the growth and viability of bacteria, GTF activity, and amylase salivary activities [10].
3- EGCg reduces MGS and acid formation by bacteria in dental plaque [10].
Green tea inhibits the adhesion of Streptococcus mutans, Porphyromonas. gingivalis, and Streptococcus sobrinus. Bacteria adhere to the tooth surface to form a glycocalyx film, hence plaque formation. Glucan formed in the film from sucrose by the activity of glucosyltransferases enzyme, controls bacterial adhesion [11-13]. Camellia sinensis. leaves extract contains polyphenols, which are active against different types of microorganisms. Previous studies reported that polyphenolic catechins in green tea, such as; epigallocatechin gallate and epicatechin gallate, suppress gram-positive and gram-negative bacteria [11-13].
The antibacterial effect of green tea was higher than that of antibiotics. The tea polyphenols significantly reduced the bacterial count of Streptococcus mutans after 5-10 minutes of exposure, it suppresses dextran and levan formation from sucrose by Streptococcus mutans [13]. Inhibition zones against Streptococcus mutans using EGCG extract were recorded at different concentrations of EGCG extract [14].
Anti-cariogenic Effect of Black Tea
The anti-cariogenic effect of black tea is linked to its polymer polyphenols (Theaflavins and Thearubigins), which were found to inhibit dental plaque, decrease the PH of dental plaque, and inhibit cariogenic microflora. Moreover, the anti-cariogenic effect of polyphenols in tea and the antibacterial activity may be attributed to the fluoride, as black tea contains more fluoride than green tea [15]. Both types of tea (green-black), presented the largest zone of inhibition at concentrations of 400mg/ml in comparison to 0.2% chlorhexidine. Black tea showed higher antibacterial activity than green tea [15]. On the other hand, green tea showed the lowest inhibitory zone compared to chlorhexidine, pomegranate, and ginger [16].
Coffea rubiaceae (Coffee)
There are eighty types of coffee, the common types are called Coffea arabica, and Coffea canephora. The chemical profile of the green type depends on the variety, fruit maturity, agricultural practices, primary and secondary processing procedures, and the condition of storage [17].
Chemical Composition
Different types of coffee and their compositions are represented in Table 2.
Anti-cariogenic Activity of Coffee
In a previous study, the authors reported that coffee components inhibited the glucosyltransferase synthesis by caries producing micro-organisms. They related that inhibition to the polyphenols action, secondary metabolites are thought to be involved in photochemical defense against predators [18]. The antibacterial effects of polyphenols are linked to their capability to suppress bacterial by-products [19].
Catechin inhibits different types of bacterial species; they produce H2O2 and alter bacterial cell membrane permeability [19]. Caffeic acid, 5-caffeoylquinic, and polyphenols found in coffee inhibited the growth of Streptococcus mutans [19]. Furthermore, natural components like Trigonelline, Caffeine, and Alpha-Dicarbonyl compounds have an inhibitory effect against Streptococcus mutans [20]. Coffee has an anti-cariogenic effect; it has an inhibitory effect on the growth of Streptococcus mutans [21]. The anti-cariogenic potency of a substance through its antibacterial effect by inhibiting the metabolites of Streptococcus mutans, as well as their physicochemical activity by inhibiting the demineralization and enhancing the minerals’ participation in the tooth [22].
Myrtus Communis Linn (Myrtaceae), (Myrtle)
Myrtus communis L grows spontaneously in the Mediterranean area. Ethanol extract type is used in the preparation of alcoholic beverages in the Mediterranean regions.
Chemical Composition of Myrtus communis L. Extracts
The major secondary products of Myrtle are polyphenols and essential oils. They are rich in volatile flavonoids, tannins, anthocyanins, fatty acids, and terpinolene, tannins, and flavonoids [23]. The leaves and flowers contain essential oils, phenolic acids, flavonoids, and tannins. The berry consists of tannins, anthocyanins, and fatty acids. Its content depends on the extraction solvent used. The popular components that are usually found in Myrtle leaves and flowers are α-pinene and 1,8-cineole [24, 25].
Anti-cariogenic Effects
The antimicrobial effect of Myrtle extract has been attributed to polyphenolic compounds and flavonoids. Myrtle has no significant effect on gram-negative bacteria; the antibacterial effect of this extract against gram-positive bacteria is associated with active compounds such as Mirtocomolone A and B [26]. Gram-negative bacteria that have an outer membrane of glycolipid polysaccharide and some channels involved in the transport of substances, which are resistant to antibiotics, hydrophilic dyes, and toxins [27]. High concentrations of Myrtle extract and essence have antimicrobial properties against antibiotic-resistant strains of Staphylococcus aureus [28]. Streptococcus mutans showed the highest susceptibility to ethanol extract, which has the highest extractive and phenolic compounds, which may explain the antibacterial activity of Myrtle extract [26]. Extracted alcohol is a polar compound; therefore, the more sensitivity of gram-positive bacteria was related to the extract polarity, as polar substances penetrate more easily through the membranes of Gram-positive cells (i.e. Streptococcus mutans) [26]. The MIC and MBC of Myrtle ethanol extract were 3.12 mg/mL and 6.25 mg/mL, respectively [28].
Neem (Azadirachta indica)
Azadirachta indica is named the Indian neem, margosa tree, and Indian lilac. It contains essential ingredients such as; alkaloid margosine, resins, gums, chlorides, fluorides, silica, sulfur, tannins, oils, flavonoids, and calcium [29].
Antimicrobial Activity of Neem
Neem contains fluoride with its anti-caries effect and silica, which acts as abrasive. Neem plant belongs to Gallotannins. In the early stage of plaque formation, Gallotannins inhibit the association of biofilm-producing pathogen with the tooth surface, increasing the physical removal of bacteria in the mouth through aggregate formation, potent inhibition of the Glucosyltransferases activity, and reduction of bacterial adhesion [30]. Neem extract inhibited streptococci colonization to the surfaces of the tooth. It was reported that 5% of neem extract showed no antibacterial effect [30].
Babool Chewing Sticks (Datun)
Babool has similar effects to neem. Babool's antibacterial activity is related to hydrophilic ingredients; polyphenols, (polysaccharides), and tannin. Accumulating evidence supports the relatively high content of bioactive secondary compounds in plants of the genus Acacia [31]. The antimicrobial activity of Babool extract increased by increasing the extract concentration.
There was no antibacterial effect observed using 5% of babool extract. On the other hand, there was an antibacterial effect observed with 10% of the extract [30]. This was supported by the finding of previous research, which showed no antimicrobial effect of babool’s extract on Streptococcus mutans [32].
Tulsi (Ocimum sanctum)
Ocimum sanctum (Fig. 1) is native to India. Tulsi extract treats different diseases such as; diabetes mellitus, arthritis, bronchitis, and skin diseases, its antibacterial effect was evaluated against different types of microorganisms such as; Staphylococcus aureus, Klebsiella, Candida albicans, E. coli, and Proteus sp.
Fig. (1)) Tulsi, Ocimum sanctum.Composition
Eugenol is the active component in tulsi, it is mainly accountable for their therapeutic effect, other important compounds such as; ursolic acid, and carvacrol [33].
Anti-cariogenic Effect
The antibacterial effect of O. sanctum is linked to its components. O. sanctum leaves extract showed maximum antimicrobial activity against cariogenic bacteria at the 10% concentration level, although 5-2.5% were also effective. 10% of the extract showed potent antibacterial activity against Streptococcus mutans and Streptococcus sanguis with 10% extract [34]. On the other hand, a previous study recorded the maximum antimicrobial potential against Streptococcus mutans at 4% concentration and a zone of inhibition of 22 mm [35].
Miswak Chewing Sticks (Twigs of Salvadora persica)
Miswak is known as a cleaning stick, people use it to clean teeth and gums. These sticks are chewed or tapered at one end till they are worn down into a brush. They are used to clean the teeth in a similar way to the toothbrush [36].
Technique of Handling
During cleaning your teeth and mouth with Miswak, the stick is held in one hand as a pen-like grip, and the end of the brush with an up-and-down or rolling motion. Two-finger/five-finger grasping techniques have been described in the literature. The stick fails when the brushed edge crumbles after a few times of use [37].
Historical and Religious Background
People in Arab countries before the emergence of Islam used Miswak. Miswak was used by Ancient Arabs to make their teeth white with shiny surfaces [38]. Prophet Mohammad (Peace Be Upon Him) practiced using miswak sticks before sleeping, after rising, after entering the house, before and after meals, during fasting, and before performing prayers and reading the holy book. The Prophet Mohammad (Peace Be Upon Him) said, “If I had not found it hard for my followers or the people, I would have ordered them to clean their teeth with Siwak (Miswak) for every prayer” [38]. Therefore, Islam has influenced the spread and practicing of chewing miswak sticks in different areas of the world.
Today, miswak sticks and toothbrushes are used by Muslims worldwide. Miswak promotes good oral health and efficient cleansing of teeth by different mechanisms, including: (i) mechanical action through miswak fibers, (ii) release of beneficial substances, such as trimethylamine, salvadorine, mustard oil, vitamin C, resins, flavodine, saponins, sterols, and fluoride. They have benefits due to the combination of mechanical and chemical effects [39-42], thus these bioactive substances of Salvadora persica have an important role in oral health [43].
-Sulfur has a bactericidal effect.
-Vitamin C helps in tissue healing and repair.
-Silica acts as an abrasive and helps remove discolorations from tooth surfaces.
-Tannins have an astringent effect, reduce clinically detectable gingivitis, and inhibit the mechanism of action of Glucosyltransferases, thereby reducing plaque and gingivitis.
-Resin forms a layer on tooth enamel and protects it against dental caries.
-Salvadorine is an alkaloid that exerts a bactericidal and antifungal effect and stimulates the gingival mucosa.
-Essential oils promote salivary flow; acting as a buffering agent.
-Chloride inhibits the formation of calculus and aids in removing stains from the tooth surface.
-Fluoride Miswak contains about 1.0μg/lg of fluoride, which has an anti-cariogenic effect and tooth remineralization potential.
-Benzyl isothiocyanate acts as a chemo-preventive agent, as an anticancer and has a toxic effect on the gene. It has antibacterial activity, and antiviral effect.
-Trimethylamine has an antibacterial, antiphlogistic, and gingiva-stimulating effect.
-N-benzyl-2-phenylacetamide prevents calculus formation, suppresses human collagen-induced platelet aggregation, and has inhibitory effect against Escherichia coli.
Anti-cariogenic Effect
It was reported that Miswak has strong anti-caries properties in a previous study, which showed that those who used Miswak had less plaque formation and caries progression than those who used artificial toothbrushes [44]. Miswak has been reported to have anti-caries effects due to its fluoride content [45]. Furthermore, the spicy taste of Miswak and its chewing mechanism increase the secretion of saliva, thus improving its buffering capacity [46]. Petersen and Mzee 1998 reported that dental caries' prevalence was higher in urban regions [47].
Miswak's aqueous extract significantly inhibited the growth of caries-producing bacteria [48]. The use of Miswak immersed in 0.5%-0.1% sodium fluoride for a day was found to be promising in preventing caries [49]. The regular use of fluoride-containing Miswak remineralizes white spot lesions in orthodontic patients [50]. Those findings were linked to bioactive compounds and the antibacterial agents released from miswak sticks. They inhibit bacterial growth and control aggregation of cariogenic Streptococcus. Mutans on tooth surfaces [51]. It was reported that toothpaste containing Miswak had the lowest minimum inhibitory concentration (MIC) against Streptococcus. Mutans, Lactobacillus, and Staphylococcus compared to the control without Miswak [52]. Miswak may be a promising therapy to inhibit caries development, initial adherence, and subsequent biofilm formation by caries-producing microorganisms [53].
Effect on saliva
It has the mechanism to release components into saliva and influences oral health as it raises the pH of plaque [54].
Efficacy of Miswak on Oral Hygiene
It is an effective oral hygiene therapy. Various studies assessed the cleaning effect of Miswak. For patients with severe plaque accumulation, toothbrushes are more effective than chewing sticks for controlling plaque. However, chewable sticks are as effective as toothbrushes for patients with moderate plaque accumulation [55]. Miswak was effective for plaque removal, similar to tooth brushing. The reason is the synergetic effect of mechanical cleansing, increased salivary secretion, and the release of antibacterial components [56, 57].
Clove (Syzygium aromaticum)
Clove (Fig. 2) is related to the Myrtaceae family; it is a dried and unopened inflorescence of clove tree, ranges about ½ - ¾ inch in length. It contains 14-20% essential oils. It is considered a strong irritant due to its high eugenol content. The chemical substances found in clove inhibit bacterial growth. Clove is considered like an antibiotic, which has a broad antibacterial activity to gram-positive and gram-negative bacteria [58].
Fig. (2)) Clove.Composition
Clove extract contains many chemical components with many biological activities such as; free eugenol, eugenol acetate, caryophyllene, sesquetrepene ester, phenyl propanoid, beta-caryophyllene, eugenol and acetyl eugenol, tannins, flavonoids, and myricetin [60, 61].
Anti-cariogenic Effect
Essential oils are one of the essential constituents of clove, terpenoid is the main components of essential oils. They are slightly water-soluble. The antibacterial activity of terpenoids is linked to the ability to disrupt lipid structures [61]. Terpenoids lead to the disturbance of the membrane integrity, and inhibition of intracellular pH homeostasis (Ouattara et al., 1997) [61]. Rashad, 2008, evaluated the effect of clove extract, versus the effect of chlorhexidine gluconate and deionized water on acid secretion by the Mutans streptococci; Chlorhexidine showed the most percent of bacterial reduction followed by clove extract [62]. Clove can be added to fluoride-free toothpaste to enhance its inhibitory effect on bacteria associated with dental caries and periodontal disease [63].
Rosemary (Rosmarinus officinalis)
Rosemary (Fig. 3) is the medicinal plant of the Lamiaceae family [64]. It is native to the Mediterranean region and characterized by its sessile, curved edges, dark green leaves, and sharp smell [65].
Fig. (3)) Rosemary (Rosmarinus officinalis).Composition and Anti-cariogenic Effect
Rosemary extract contains various bioactive substances such as; phenolic monoterpenes, diterpenes, flavonoids, and Caffeol derivatives [65]. The antimicrobial activity of rosemary is linked to the binding potential in adhesin of the cell wall of Streptococcus mutans; rosemary can be a potent aid in combating caries in dental products [66, 67].
SPICES
Garlic (Allium sativum)
For about 3,000 years, the Chinese and Egyptians have used garlic as a flavor-enhancing food and folk medicine. Garlic has a strong smell, strong taste, and significant physiologic effects, inducing tearing, sweating, and salivation [68].
Components of Garlic
Thioethers occur naturally in garlic in the form of diallyl sulfide. Chemical analyses of garlic revealed (1-3%) concentration of sulfur-containing compounds [69].
Protective Properties in the Oral Cavity
Garlic has two protective properties: antimicrobial activity and salivary secretion stimulation by garlic taste. Garlic decreases acid production by Streptococcus mutans. Furthermore, it inhibits their growth in the long term period for 14 days, whereas, in the short term period, within 24 hrs., the acid production is controlled with the salivary stimulation associated with the spicy flavor of garlic. The spicy flavor stimulates salivary flow [70]. Saliva which is stimulated with garlic contains high concentrations of bicarbonates, hence increasing the salivary buffering capacity, thus the ability to neutralize and clear acids in plaque, therefore, improving the salivary pH and increasing the enamel resistance to dental caries. Salivation stimulated by garlic consumption reduces the drop in plaque pH, which may lead to demineralization of tooth structure and increase the likelihood of remineralization [70]. Mouthwashes are considered as an alternative to chlorhexidine mouthwash [71].
Comparable Effect with other Agents
Garlic mouthwash was effective in a similar way to chlorhexidine, it minimized the decrease in salivary pH after a cariogenic challenge. Moreover, the best results were obtained when they were combined together to stimulate their synergistic effect [72]. Garlic with lime oral rinse has a significant antimicrobial effect; it significantly decreased the salivary count of Streptococcus mutans compared to chlorhexidine 0.12% mouthwash [73].
Allium cepa (Onion)
Onion belongs to the Allium Cepa family. Since 6000 years ago, it was cultivated in the nile valley. Its chemical profile contains many minerals and few vitamins. It was used as a type of spicy food, and it also used in medicine. For medicinal purpose, it was recommended to use raw onion due to the fact that boiling it loses its effect [74].
Composition
Onions contain many active components such as; sulphur which can inhibit the inflammatory reactions of the tissue, another component is the thiosulfinate, which can dissolve thrombi and superoxide dismutase, which has ant-oxidative properties. Uronic acid, glucose, and arabinose, xylose, fructose, and galactose are the main components of union cell wall [74]. Alkyl cysteine sulphoxide is responsible for the taste and odor of onion, whereas, anthocyanin is responsible for the red, purple, and yellow colors of onion [75]. Onion is rich in many minerals such as; sodium, magnesium, calcium, phosphorus, and potassium. It was reported that flavonoid content of onion showed enhanced antibacterial, antifungal, and anti-viral activities [75].
Anti-cariogenic Effect
Onion extract showed significant inhibitory effect against Streptococcus mutans. The red type of onion showed a significant inhibitory effect compared to the yellow and green types. On the other hand, the green type showed the least significant inhibitory effects. It was reported that, the antibacterial activity of different types of onions increased as the concentration of the onions increased [76].
Nutmeg (Myristica fragrans)
Nutmeg (Fig. 4) is the seed of the tree, it has roughly egg-shaped and about 20 to 30 mm (0.8 to 1) in length and 15 to 18 mm (0.6 to 0.7) in width, 5-10 g in weight, mace is dried “lacy” reddish covering of the seed [77].
Fig. (4)) Nutmeg (Myristica fragrans).Composition
Nutmeg contains 5%-15% volatile oils, the main components are camphene or Sabinene, Dipentene, Dlinalool, Dborneol, Terpineol, Geraniol, Myristiine, Macelignan, Safrole, Eugenol, and Isoeugenol. It suppresses bacterial adherence [77, 78].
Anti-cariogenic Effect
Surface hydrophobicity is an important property of nutmeg oils. It separates lipids in the cell membrane of bacteria and results in a permeable cell wall. Excessive loss or expulsion of the essential substances from bacterial cells leads to death [78]. The structural property of Gram-negative cell wall enteric bacteria is the key to their drug resistance. Gram-negative bacteria contain about 15-20% of polysaccharides and 10-20% of lipids in their cell wall, on the other hand, gram positive bacteria contain about 35-60% of polysaccharides and 0-2% of lipids. The polysaccharides and lipid contents of the cell wall affect the permeability of active components. Gram positive bacteria are more sensitive to the antimicrobials in spices compared to the gram negative bacteria [79]. Myristicin, Myristic acid, Trimyristin, Elemicin, and Safrole are essential oils extracted from nutmeg. These active components have good antimicrobial activity and were effective against endodontic microorganisms and can be used as an effective medicament in the treatment of endodontic infections [80].
Nigella sativa L. (Black Cumin)
Nigella sativa L. seeds (Fig. 5) contain a large amount of fixed oil with the main component of seed extract being thymoquinone.
Fig. (5))Nigella sativa L, black cumin.Composition and Anti-cariogenic Activity
Thymoquinone, Thymohydroquinone, and Dithymoquinces in Steviaone, and Thymol, carvacrol, nigellicine, Nigellimine-x-oxide, Nigellidine, and alpha Hedrin are the active substances in sativa [81]. Nigella sativa nanoemulsion showed similar antimicrobial activity against Streptoccocus Mutans, Streptococcus sobrinus, and Streptococcus Salivarius. In contrast, Enterococcus Faecalis and Lactobacillus. acidophilus were the most resistant and susceptible bacteria to Nigella sativa nanoemulsion. This is linked to the structural differences of the bacterial cells. This result may be related to that, Enterococcus Faecalis is an opportunistic bacterium that produces lactic acid, which is highly effective against antibiotic resistance. Therefore, its tolerance to nanoemulsion is predictable. The outer membrane of gram-negative bacteria reduces the penetration of Nigella sativa molecules (due to their molecular size) to a definite expansion and results in the death of bacteria [81].
Ajowan Caraway (Trachyspermum ammi, T.ammi)
Ajowan caraway is an aromatic spice similar to thyme in flavor. It is native to Egypt and is distributed in Mediterranean regions. It is used as the principal source of thymol [82], T. ammi significantly reduced its adherence as well as biofilm formation, insoluble glucan formation, and cell surface hydrophobicity [83].
Turmeric (Terra merita)
The name turmeric is derived from Terra merita the Latin word (merited earth) or turmeryte. Turmeric. It is a yellow-orange spice used for flavoring [84].
Composition
It contains curcuminoids comprising curcumin, which is the main curcuminoid. It contains about 2-5% of turmeric contents which is responsible for the yellowish color of turmeric and its properties [84].
Anti-cariogenic
Curcumin suppresses the growth of Streptococcus, Staphylococcus, and Lactobacillus. Curcumin's antibacterial activity is related to the destruction of the peptidoglycan in the bacterial cell wall. The antibacterial activity is dependent on different factors such as; curcumin concentration, bacterial types, and pharmaceutical processing [85]. 1% of curcumin nanoparticles have a potent inhibitory effect against caries-producing bacteria. However, one of the main disadvantages of curcumin nanoparticles is related to their lower solubility [86]. Curcumin is lethal to the bacterial cell wall; which causes the destruction of peptidoglycan; thus considered a potent antibacterial drug [87]. Turmeric mouthwash may be a promising therapy adjunctive to plaque control by mechanical methods. 10 mg of curcumin can be dissolved in 100 ml of distilled water, and the flavor may be stimulated using peppermint oil [88].
Theobroma cacao L. (Cacao Bean Husk, CBS)
CBS is a source of nutrients and interesting substances like fiber, cocoa volatile compounds, proteins, minerals, vitamins, and polyphenols. CBS is an additive for functional foods [89].
Active Components and Mode of Action
It has an antibacterial effect against Streptococci. It has an inhibitory effect on water-insoluble substances, polymer glucan formation, adhesion, and acid production by streptococci. It inhibits plaque formation and caries development in rats infected with Streptococcus mutans or Streptococcus. Sobrinus, due to its active components [90]. It has high molecular weight polyphenolic compounds (Epicatechine), which have strong anti-GTF activity and inhibit the formation of glucan. It has unsaturated fatty acids (Oleic acid and Linoleic acid), showing strong bactericidal activity against Streptococcus mutans. The application of Caco bean is recommended by Badiyani et al., 2013 [90] in the follow ways:
1- When a water-based extract is incorporated into the food causing caries such as white chocolate which contains about 35% of sucrose; it inhibits the cariogenic effect using this diet.
2- Toothbrushes could be stored in Cocoa bean media, as it is used to reduce Streptococcus mutans count from contaminated toothbrushes.
3- Can be used as drinking water.
Cinnamomum verum/Cinnamon
It used for treating many systemic diseases and is related to the Lauraceae family. Cinnamon has been used as a spice for thousands of years in a dried form [91].
Active Ingredients
Essential oils: Cinnamaldehyde content followed by eugenol and Carvacro.
Anti-cariogenic Effect
Essential oils are responsible for the antibacterial effect of cinnamon due to their surface hydrophobicity. They cause separation of lipids from bacterial cell membranes, disturb cell components, and increase their permeability, thus leading to bacterial death [91]. The antimicrobial properties of cinnamon are mainly related to its content of Cinnamaldehyde, then Carvacol and Eugenol ingredients [92]. The water extract of cinnamon showed a statistically significant reduction of bacterial count compared to the control [93].
Cinnamon ethanol extract contains many phytochemical compounds. The extract concentration of 6.25%, 12.5%, and 25% showed antibacterial activity in vitro against Streptococcus Mitis, Streptococcus Sanguinis, Streptococcus Salivarius, Streptococcus Pluranimalium, Streptococcus Pneumonia, and Streptococcus Alactolyticus [94]. Cinnamon extract used as mouth rinse, showed a successful antimicrobial activity and can be a promising natural alternative to chlorhexidine [95].
FRUITS EXTRACT
Plum Tree, (Prunus Mume)
Plum is a famous fruit in Asia and Chinese medicine. It contains carotenoids (B- carotene), which are responsible for the distinctive yellow and orange colors of the pulp and peel of most Prunus species [96]. One of the main important characteristics of carotenoids is the precursors of vitamin A. Some of the benefits of carotenoids are related to their antioxidant properties as they react with singlet oxygen and peroxyl radicals [96]. Other components, such as ascorbic acid, organic acids (Citric acid, oxalic, and tartaric acid), Vitamin E, phenolic compounds proanthocyanidins (PAs) and tannins, and phenolic acids [97]. Prunus mume is a key ingredient in antibacterial mouthwashes. It is incorporated into toothpaste to prevent dental caries and periodontal diseases. The suspension of 2 g/mL of Prunus mume extract inhibited all tested bacterial species, but not the fungal species using the agar diffusion assay [98].
Strawberry Guava, (Psidium Cattleianum)
It belongs to the Myrtaceae family. Psidium species are used to cure a variety of diseases. Phenolic compounds in Cattleianum which have an antibacterial activity, are three flavonoids and one is tannin [99].
Mode of Action
Cattleya leaf extract inhibits protein expression which is involved in general metabolic activities, mainly those included in the metabolism of carbohydrates in Streptococci [100, 101]. The extracts reduced the accumulated Streptococcus mutans and demineralization of tooth enamel due to the richness of phenolic compounds. Recently, a crude organic extract (COE) of guava leaves and three partitions (aqueous, butanol, and chloroform) were evaluated for their antibacterial activity and anti-adhesion effect against cariogenic biofilm model (Streptococcus mutans and Streptococcus Gordonii) [102]. COEs and their chloroform partitions are antimicrobials against Streptococcus Gordonii, making them a promising alternative for caries prevention. This is due to the presence of phenolic compounds such as sterols, flavonoids, alkaloids, saponins, glycosides, and tannins found when chloroform was used as the solvent. The presence of these phyto-constituents supports the significant bioactivity exhibited by crude extracts [102].
Pomegranate (Punicagranatum linn)
Punica granatum Linn belongs to the Punicaceae family, which is found in India. It is a deciduous spreading shrub or small thorny tree. Pomegranate peel is the inedible part of the pomegranate juice process [103].
Composition
Pomegranate peel is rich in tannic acid, flavonoids, polyphenols, and some anthocyanins such as delphinidins and Cyanidins. All compounds of pomegranate peel show therapeutic properties. Pomegranate peel extract has an antibacterial effect against bacterial strains [103].
Anti-cariogenic Effect
Punica Granatum Linn interferes with polysaccharides’ formation and inhibits the adherence of pathogens to the tooth surface. Other researchers have also documented its ability to control the adhesion of different microorganisms in the oral cavity [104]. The hydrolyzed tannin is the antibacterial substance in pomegranate, and it forms high molecular weight complexes with the soluble type of proteins, hence increasing the lysis of the bacteria and interfering with their adherence [105, 106].
25mg/ml of pomegranate peel aqueous extract was used as an antibacterial agent to prevent bacterial colonization and Streptococcus mutans adhesion to the tooth surfaces compared to 0.2% chlorhexidine gluconate [107]. The antimicrobial effect of ginger, green tea, and pomegranate peel was compared to chlorhexidine with sucrose and stevia. All natural products exhibited antibacterial effects against Streptococcus mutans compared to the control. The antibacterial effect of each extract was attributed to the plant’s natural components [16].
Pomegranate (Punica granatum) showed the highest antibacterial effect in all tests. Pomegranate peel polyphenols, especially tannins are the main constituents in pomegranate peel extract and are associated with antimicrobial potential i.e. antiviral, antifungal, and antibacterial activity. Pomegranate tannins penetrate and attach to cell surfaces that are composed of a variety of polysaccharides and proteins [16].
Cranberry, (Vaccinium Macrocarpon)
American cranberry is native to North America, and it is known in the USA as a healthy drink containing a lot of vitamin C [107].
Chemical Composition and Mode of Action
Cranberry ingredients have been shown to have anti-cariogenic properties. Hydrophobicity of the cell surface is a major factor in the adhesion of microbial communities to the tooth. The hydrophobicity of Streptococcus mutans is associated with its cell surface protein [107]. The hydrophobicity of streptococci Mutans is reduced by adding cranberry polyphenol fractions [108, 109]. Polyphenol components, especially proanthocyanidins, bind to and/or mask hydrophobic proteins on the surface of oral streptococci [110, 111].
Gooseberry E. officinalis/Amla/Indian Gooseberry
Emblica officinalis Gaertn belongs to the Euphorbiaceae family (Fig. 6). Amalaka, Aavalaa, Amla, Amlaki, and Indian gooseberry, are common and known names of it [112].
Fig. (6))Gooseberry E. officinalis /Amla/Indian Gooseberry.Gooseberry fruit is rich in Vitamin C (600 mg/100g). Leaves, fruit, bark, and root bark were used to treat many diseases. The fruit has antiviral, antibacterial, anticancer, antiallergy, and antimutagenic activities [112].
Composition and Mode of Action
Amla fruit has good antifungal and antibacterial activities, respectively, and can be used as a potential source of new antibacterial agents used for treating dental caries [112]. It has a variety of medicinal uses; all aqueous and organic extracts of Amla can inhibit the growth of Streptococcus mutans, with an average diameter of the highest inhibition zone of 18.96 mm and MIC of 50mg/ml. Tannin present in the fruit, is responsible for the antibacterial activity of E. Officinalis. The fruits have 28% of the total tannins distributed in the whole plant [113].
NATURAL SWEETENER
Glycyrrhiza Roots (Licorice Root)
Licorice (Glycyrrhiza) is used as a remedy and sweetener for different ailments. The root of Licorice contains high concentrations of flavonoids, triterpene, saponin, and glycyrrhizin ranging from 2.5 to 9%, depending on the source of the drug and post-processing. Glycyrrhizin is responsible for the positive properties of the drug [114]. It is the source of the sweetness of licorice, and since it is a saponin, has emollient and expectorant properties. The presence of α, β-unsaturated carbonyl in Aglycon confers corticosteroid and anti-inflammatory effects on glycyrrhizin (and glycyrrhetinic acid). Despite being a saponin, glycyrrhizin does not have characteristics of saponins, namely the ability to induce hemolysis of red blood cells [114].
Effect of Glycyrrhizin
Glycyrrhizin inhibits the growth of cariogenic bacteria, significantly inhibits their adhesion, and almost completely inhibits plaque formation at 0.5-1% concentration [114]. The experimental licorice fermented relatively well by Streptococcus mutans. Alcohol-containing licorice root extract was more effective against Streptococcus mutans and Lactobacillus acidophilus than the aqueous form and chlorhexidine [115]. The extract is used to develop some sugar-free lollipops, which are used twice/day, one time after breakfast in the morning, and the second time after cleaning of teeth, repeated for ten days (2 -4 times/year). It promoted a marked reduction of caries producing bacteria in human studies. The inhibitory effects of the alcoholic extracts were superior to the aqueous ones and chlorhexidine [116].
Because Licorice has a less bitter taste, it is considered very useful as a mouthwash ingredient. Natural mouthwashes containing licorice extract play an excellent role as anti-cariogenic, and their effectiveness as a natural antibiotic will contribute to the improvement of oral health by replacing the synthetic types of mouthwashes. The antibacterial activity of this extract is due to the decrease in acid production capacity and significant suppression of the cariogenic bacteria [117].
Stevia Rebaudiana Bertoni (Candyleaf, Sweetleaf, or Sugarleaf)
It is known as sweet grass. It was used as a sweetener to counteract the bitter taste of medicines. The sweeteners are mostly concentrated in the leaves. Stevia has two glycosides, stevioside, and rebaudioside A, the latter one with higher commercial value due to its nice flavor profile compared to the artificial sweeteners that have a metallic taste, or the same steviosides that have a bitter flavor [118]. The difference between those glycosides is the presence of glucose, whose weight fraction is about 5-10% for stevioside and 2-4% for rebaudioside A. They have higher quality sweetness compared to sugars in terms of smoothness, freshness, and a lower transient sweetness compared to sucrose, [118].
Chemical Composition of the Stevia
Fresh leaves of stevia contain a high water content (80- 85%). In addition to the above components (glycosides), the leaves contain other components such as; Ascorbic Acid, ß-Carotene, Chromium, Cobalt, Magnesium, Iron, Potassium, phosphorus, Riboflavin, Thiamin, Tin, Apigenin, Austroinilina, Avicularin, ß Sitosterol, Caffeic Acid, Campesterol, Caryophyllene, Centaureidin, Chlorogenic acid, Chlorophyll, Kaempferol, Luteolin, Quercetin, and Stigmasterol [119, 120].
Anti-cariogenic Effect
Researchers who used stevia showed:
• Antibacterial effect: It suppresses the growth of Streptococcus mutans and Lactobacillus acidophilus.
• Low acidogenic potential: Sucrose is fermented by oral flora in dental plaque and results in acid secretion. The acids demineralize tooth tissue during the carious process.
• Anti-plaque activity: Stevia decreases the intracellular polysaccharides (IPS) and extracellular polysaccharides (EPS) secreted by Streptococcus mutans.
• EPS accounts for about 40% of the biofilm. They enhance bacterial adherence to the acquired pellicle and are used as a scaffold for biofilm maturation, hence increasing the structure porosity and diffusion of sugar within the biofilm. It was reported that the antimicrobial effect of different types of stevia extract was directly proportional to their concentration [121-123]. 20% Stevia extract on Streptococcus sobrinus inhibited the growth and reduced bacterial acid production [124]. The growth of Streptococcus mutans suppressed in the medium containing stevioside than the media with sucrose, glucose, or fructose [125]. Hexanoic Stevia extract showed the highest inhibitory growth against Streptococcus mutans and Lactobacillus acidophilus [126, 127].
• Stevia, sucralose, and saccharin significantly increased the hardness of enamel, this fact was attributed to the lower viable cells of (Streptococcus mutans) in the biofilm and decreased acid production [128]. Plus, Stevia and sucralose have an anti-plaque effect due to their tendency to inhibit biofilm formation. This fact is related to the significant reduction of the intracellular polysaccharides (IPS) and extracellular polysaccharides’ (EPS) production by Streptococcus mutans [129]. The minimum pH of rinsing with rebaudioside A was 6.92, significantly higher than that of sucrose at 5.62, confirming its low acid production potential and meeting the FDA standards for non-cariogenic sweeteners [130].
Previous studies evaluated the inhibitory activity of stevia extract against Streptococcus sobrinus; their results showed a statistically significant reduction in the surface hydrophobicity, inhibition of EXP secretion, and adherence of bacterial cells to the surfaces [124, 131, 132].
Xylitol, Xylos (Wood or Cotton Tree)
Xylitol is a natural five carbons sugar obtained from birch trees. It is a non-toxic sugar alcohol sweetener [133].
Anti-cariogenic Effect
Cariogenic bacteria do don't ferment Xylitol, and therefore, don't lower the Ph. of plaque. They reduce the acidogenicity and plaque formation on tooth surfaces. They accumulate within MS and inhibit bacterial growth. Xylitol reduces pathogenic bacterial count by altering the metabolism of Streptococcus mutans and suppressing the proportion of Streptococcus mutans in plaque, hence reducing its acidogenicity [124
