Role of Medicinal Herbs in Periodontal Therapy: A Systematic Review.

Aims and Objectives: The use of medicinal herbs to prevent gingival and periodontal diseases has become increasingly popular due to their anti-inflammatory and antioxidant properties. This systematic review aims to provide the current literature to validate the traditional use of medicinal herbs in the management of gingival and periodontal diseases. Materials and Methods: An online literature search was conducted to identify research papers published from 2010 to 2022 in three major scientific databases, PubMed, Scopus, and Web of Science, in June 2022. Original research studies, case reports, and systematic reviews on medicinal plants' application in oral health care were selected to be included in this systematic review. Only high-quality articles identified in the quality assessment were included for evidence synthesis. Results: Initial keyword research yielded 726 free-text articles published between 2010 and 2022. Of these, 14 articles (8 research papers and 6 reviews) were included for evidence synthesis. The review's findings indicate that the antibacterial property of medicinal plants is due to their alkaline nature and prevents plaque and calculus formation by maintaining acid-alkali balance in saliva. Various parts of medicinal plants help maintain periodontal health. Glycyrrhiza glabra, Ficus religiosa, and Plantago major effectively inhibit primary plaque colonizers and periodontal pathogens. Medicago sativa, Aloe barbadensis Miller, and Trifolium pratense have excellent applications in treating periodontal diseases. Mangifera indica, Pongamia pinnata, the husk of Cocos nucifera, the root of G. glabra and Curcuma longa, leaves of Psidium guajava and Azadirachta indica, fruits of Citrus medica and Punica granatum, Ocimum Moringa oleifera extract, and pomegranate peel extract can serve as a promising alternative in managing chronic gingivitis. Conclusion: The anti-inflammatory, antioxidant, antibacterial, and astringent action of extracts obtained from various parts of medicinal plants make them effective in reducing gingival and periodontal diseases. Herbal medicine may be a viable alternative to contemporary pharmaceuticals as an adjuvant to scaling and root planning procedures.

Microbial-stem cell interactions in periodontal disease.

Periodontitis is initiated by hyper-inflammatory responses in the periodontal tissues that generate dysbiotic ecological changes within the microbial communities. As a result, supportive tissues of the tooth are damaged and periodontal attachment is lost. Gingival recession, formation of periodontal pockets with the presence of bleeding, and often suppuration and/or tooth mobility are evident upon clinical examination. These changes may ultimately lead to tooth loss. Mesenchymal stem cells (MSCs) are implicated in controlling periodontal disease progression and have been shown to play a key role in periodontal tissue homeostasis and regeneration. Evidence shows that MSCs interact with subgingival microorganisms and their by-products and modulate the activity of immune cells by either paracrine mechanisms or direct cell-to-cell contact. The aim of this review is to reveal the interactions that take place between microbes and in particular periodontal pathogens and MSCs in order to understand the factors and mechanisms that modulate the regenerative capacity of periodontal tissues and the ability of the host to defend against putative pathogens. The clinical implications of these interactions in terms of anti-inflammatory and paracrine responses of MSCs, anti-microbial properties and alterations in function including their regenerative potential are critically discussed based on literature findings. In addition, future directions to design periodontal research models and study ex vivo the microbial-stem cell interactions are introduced.

Understanding the microbial components of periodontal diseases and periodontal treatment-induced microbiological shifts.

In the mid-1960s the microbial aetiology of periodontal diseases was introduced based on classical experimental gingivitis studies . Since then, numerous studies have addressed the fundamental role that oral microbiota plays in the initiation and progression of periodontal diseases. Recent advances in laboratory identification techniques have contributed to a better understanding of the complexity of the oral microbiome in both health and disease. Modern culture-independent methods such as human oral microbial identification microarray and next-generation sequencing have been used to identify a wide variety of microbial taxa residing in the gingival sulcus and the periodontal pocket. The first theory of the 'non-specific plaque' hypothesis gave rise to the 'ecological plaque' hypothesis and more recently to the 'polymicrobial synergy and dysbiosis hypothesis'. Periodontitis is now considered to be a multimicrobial inflammatory disease in which the various bacterial species within the dental biofilm are in a dysbiotic state and this imbalance favours the establishment of chronic inflammatory conditions and ultimately the destruction of tooth-supporting tissues. Apart from the known putative periodontal pathogens, the whole biofilm community is now considered to play a role in the establishment of inflammation and the initiation and progression of periodontitis in a susceptible host. Treatment is unlikely to eliminate putative pathogens but, when it is thoroughly performed it has the potential to establish a healthy ecosystem by altering the microbial community in numbers and composition and also contribute to the maturation of the host immune response.

Molecular Detection of Porphyromonas gingivalis in Chronic Periodontitis Patients.

AIM: In the current study, Porphyromonas gingivalis was identified in chronic periodontitis patients and healthy subjects by polymerase chain reaction (PCR) and its presence correlated with the severity of clinical periodontal parameters. MATERIALS AND METHODS: Subgingival plaque samples were collected with sterile curette and subjected to deoxyribonucleic acid (DNA) extraction and subsequent PCR for detection of P. gingivalis. RESULTS: Porphyromonas gingivalis was detected in 60% of patients of group II (pocket depth up to 5 mm), and in 93.33% of patients of group III (pocket depth more than 5 mm). One periodontally healthy subject in group I (probing depth < 3 mm) showed the presence of P. gingivalis. CONCLUSION: Detection frequency of bacterium increased significantly with increase in probing pocket depth (PPD), loss of attachment (LOA), and gingival index (GI). CLINICAL SIGNIFICANCE: Porphyromonas gingivalis is strongly associated with chronic periodontitis and its detection frequency positively correlates with the severity of periodontal destruction.