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REVIEW ARTICLE Role of herbs in endodontics Rajendra Kumar Tewari, Bhumika Kapoor, Surendra Kumar Mishra, Ashok Kumar Department of Conservative Dentistry and Endodontics, Dr. Ziauddin Ahmad Dental College, AMU, Aligarh, Uttar Pradesh, India
ABSTRACT Medicinal plants and herbs have attracted a lot of attention since the past few years. The market for drugs extracted from these plants and made from herbal extracts has seen a significant rise. India is known for its rich stock of medicinal plants. Among many, some herbs are rich in phytochemical content. These phytochemicals are useful in generating phytomedicines which have effects on the human body. In the field of endodontics, phytomedicines are a boon. They have been popularly used as analgesic, anti‑inflammatory, sedatives, and antibiotics. They are most significantly used as endodontic irrigants. Phytotherapy has been a grand entrant in the drug market. The reason why herbal extracts have the potential to be highly popular is due to the side effects of synthetic medicines which alter microbiota.
Key words: Endodontics, herbs, medicinal plants, phytotherapy
Use of Herbs in Root Canal Treatment
Various Kinds of Herbs Used in Endodontics
The anatomy of root canals is complex. The challenging part of a root canal treatment is to disinfect the root canal most effectively. Irrigation and intracanal medication primarily reduce the bacteria. Irrigants such as sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA) solution, and chlorhexidine (CHX) have harmful side effects. Rarely, patients may be allergic to NaOCl and CHX. Intracanal medicaments such as calcium hydroxide cause collagen breakdown and hence weakening of radicular dentin. Triple antibiotic paste using minocycline, metronidazole, and ciprofloxacin have potential side effects of tooth discoloration. Such triple antibiotic paste also cause demineralization of dentin. Therefore, herbs that are more biofriendly and suited for dental irrigation prove to be better alternatives.[1‑3] They are rich in antioxidant, antimicrobial, sedative, anxiolytic, and anti‑inflammatory properties, thereby making them ideal for root canal disinfection.
Plants, animals, and minerals are all sources of phytotherapeutic substances. Various such herbs are as follows:
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DOI: 10.4103/2249-4987.192248
According to Prabhakar et al., 5% of NaOCl exhibited excellent antibacterial activity in both 3‑week and 6‑week biofilm, whereas triphala and mixture of a tetracycline isonomer, citric acid, and a detergent showed complete eradication only in 3‑week biofilm.[5]
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Dr. Bhumika Kapoor, Department of Conservative Dentistry and Endodontics, Dr. Ziauddin Ahmad Dental College, AMU, Aligarh ‑ 202 002, Uttar Pradesh, India. E‑mail:
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This is used as a chelating agent due to the presence of citric acid in its fruits. The presence of tannins, quinones, flavonoids, gallic acid, and Vitamin C makes it an ideal agent to remove the smear layer. It is a good replacement to NaOCl for root canal irrigation.[4] Its free radical scavenging and antimicrobial property is an efficient tool to prevent the formation of biofilm. Triphala (IMPCOPS Ltd., Chennai, India) is an Indian Ayurvedic herbal formulation consisting of dried and powdered fruits of three medicinal plants, Terminalia bellirica (Bibhitaki), Terminalia chebula (Halituki), and Emblica officinalis (Amalaki) (green tea polyphenols [GTPs]; Essence and Flavours, Mysore, India).
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Triphala
How to cite this article: Tewari RK, Kapoor B, Mishra SK, Kumar A. Role of herbs in endodontics. J Oral Res Rev 2016;8:95-9.
© 2016 Journal of Oral Research and Review | Published by Wolters Kluwer ‑ Medknow
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Tewari, et al.: Role of herbs in endodontics
Morinda citrifolia It is popularly known as Indian mulberry. Owing to its antibacterial and antimicrobial properties, it is popularly used as a root canal irrigant. Its prime components are L‑asperuloside and alizarin.[6] Other phytochemicals present in it are lignans, oligopolysaccharides, flavonoids and catechins. Besides, it also displays antitumor, anthelmintic, analgesic, hypotensive, anti‑inflammatory, and immune‑enhancing properties. It is an effective chelating agent and can inhibit carcinogen‑DNA adduct formation.[7,8] Murray et al. evaluated Morinda citrifolia juice (MJC) in conjunction with EDTA as a possible alternative to NaOCl. The efficacy of MJC was similar to NaOCl in conjunction with EDTA as an intracanal irrigant. MJC appears to be the first fruit juice to be identified as a possible alternative to the use of NaOCl as an intracanal irrigant.[5]
oils (eucalyptus oil and orange oil) were found similar in their ability to dissolve Apexit Plus and Endomethasone N.[16] Mushtaq et al. concluded that xylene, refined orange oil, and tetrachloroethylene can be used for softening GP/resilon during retreatment with various techniques. Xylene proved to be best solvent both for GP and resilon.[17] Orange oil is an excellent alternative solvent as compared to potentially toxic solvents, being used either on zinc oxide‑eugenol cement or to soften and dissolve GP.[18]
Oncag et al. evaluated the efficacy of propolis as an intracanal medicament against Enterococcus faecalis. The study revealed that propolis had good in vitro antibacterial activity against E. faecalis in the root canals, suggesting that it could be used as an alternative intracanal medicament.[11]
An in vitro mammalian test system was done to find genotoxic or cytotoxic effects of chloroform and eucalyptol by single cell gel (comet) assay and trypan blue exclusion test, respectively. Chloroform and eucalyptol were exposed to Chinese hamster ovary cells in culture directly for 3 h at 37°C at final concentrations ranging from 1.25 to 10 µl/mL. The negative control group was treated with vehicle control (phosphate‑buffered solution), and the positive control group was treated with methyl metasulfonate (MMS, at 1 µg/mL concentration). The results showed that both GP solvents were cytotoxic at concentrations of 2.5, 5, and 10 µl/mL (P
