aloe-vera: a boon in management of dental disease

Int. J. Pharm. Res. Sci., 2014, 02(1), 18-24. www.ijprsonline.com ISSN: 2348 –0882

============================================================================

18

Aloe-Vera: A Boon In Management Of Dental DiseaseSambhav Jain1, Rohit Rai*1

1. Department of Periodontology and Oral Implantology,Teerthanker Mahaveer Dental College and ResearchCentre,Delhi Road,Moradabad,India

Correspondence Author: Dr Rohit Rai, Department of Periodontology and Oral Implantology,TeerthankerMahaveer Dental College and Research Centre,Delhi Road,Moradabad,India

Email:periodontics07@gmail.com------------------------------------------------------------------------------------------------------------------------------------------

Abstract:Aloe Vera has been used medicinally for a fewthousand years. It was sufficiently in demand thatHannibal was known to have gone to war over it inorder to obtain control over its growing area(N. Africa). It is still very much in use today for awide range of ailments. Orthodoxy it is usedin burns units to great effect and is increasinglybeing used in the treatment of dermatologicallesions. Several studies on burns have beenconducted in comparison trials between Aloeproducts and non-Aloe. The Aloe seems to promotemore rapid healing and pain relief.Aloe vera hasshowen multiple uses in dentistry. Some of itsextreme uses have been observed in the treatment ofgum diseases by reducing bleeding of the gums,acting as antiseptic in gum pockets, and itsantifungal properties help greatly in the problem ofdenture stomatitis.

Keywords: Aloe vera, dentistry, gingivitis,medicine, periodontitis.

Introduction:

The fresh gel or mucilage from Aloe barbadensisMill (family Liliaceae)—otherwise known as aloevera—is a handy home-grown remedy that can be

used both as a moisturizing agent and for thetreatment of minor burns, skin abrasions, andirritations. It has been suggested that externalapplication of aloe vera gel promotes woundhealing. The Aloe barbadensis plant consists of twodifferent parts, each of which produces substanceswith completely different compositions andtherapeutic properties. The parenchymal tissuemakes up the inner portion of the aloe leaves andproduces the aloe vera gel (or mucilage), a clear,thin, tasteless, jelly- like material. This tissue isrecovered from the leaf by separating the gel fromthe inner cellular debris. The other part of the plantis a group of specialized cells known as thepericyclic tubules, which occur just beneath theouter green rind of the leaf. These cells produceexudates that consist of bitter yellow latex withpowerful laxative-like actions. This exudate whichis not to be confused with the gel/mucilage from theparenchymal leaf tissue is available commerciallyfor systemic ingestion to produce catharsis.1 Fig. 1


============================================================================

19

Botanical classification Aloe Vera:

HistoryIts history of health benefits was first recorded inEgyptian medical writings in 1500BC. EvenCleopatra was said to have pampered her skin withAloe gel. History reports that Alexander the Greatcaptured the island of Socotra in the Red Sea,which had abundant Aloe fields, to help heal thebattle wounds of his troops. Aloe was applied tocuts, infections, blisters, insect bites and used forinternal maladies. In America, Aloe Vera has beengrowing in Florida and the Rio Grande Valley ofTexas for some 4000 years. The initial credibleresearch on Aloe Vera was done by Dr. C.E.Collins in 1934, where several cases of RoentgenDermatitis, the ulcerated skin lesions were treatedwith Aloe Vera leaves split and wrapped aroundthe wounds. A markedly improved rate of healingwas observed. Some dermatologists began a seriesof comparable reports. In 1937, Dr J.E. Crewepresented a wider use for the application of AloeVera in treating chronic ulcers, eczema, burns,sunburn, poison ivy, and minor injuries. Hisfindings recorded complete healings and tissue

regeneration without scarring. Many investigationswere pursuing further Aloe Vera studies and in1959, the FDA admitted that Aloe ointmentactually did regenerate skin tissue. Since thosestudies, topical success with Aloe Vera is commonplace, as doctors use it to treat decubitous (bedsores), alopecia (hair loss) and acne.2 Fig. 2

CompositionThe chemical composition of the aloe vera gel is

complex constituting vitamins, enzymes, minerals,sugars, lignin, saponins, salicylic acids, and aminoacids; numerous monosaccharides andpolysaccharides; vitamins B1, B2, B6, and C;niacinamide and choline; several inorganicingredients; enzymes such as acid phosphatase,alkaline phosphatase, amylase, lacticdehydrogenase, and lipase; and numerous organiccompounds such as aloin, barbaloin, and emodin.3

Aloe Vera also consist aluminum, boron, barium,calcium, iron, magnesium, sodium, phosphorous,silicon, and strontium.4

Polysaccharide components in aloe vera consistedof glucomannans some of which were acetylated;polymers of galactose and galacturonic acid.5

It also contains 75 potentially active constituents:vitamins, enzymes, minerals, sugars, lignin,saponins, salicylic acids, and amino acids.6 Fig. 3

Processing Of Aloe VeraThe Aloe barbaden is plant consists of twodifferent parts, each of which produce substanceswith completely different compositions andtherapeutic properties. The parenchymal tissuemakes up the inner portion of the aloe leaves andproduces the aloe vera gel (or mucilage), a clear,thin, tasteless, gelly like material. This tissue isrecovered from the leaf by separating the gel fromthe inner cellular debris.

Kingdom: Plantae

clade: Angiosperms

Order: Asparagales

Family: Xanthorrhoeaceae

Subfamily: Asphodeloideae

Genus: Aloe

Species: A. vera


============================================================================

20

The other part of the plant is a group of specializedcells known as the pericyclic tubules, which occurjust beneath the outer green rind of the leaf. Thesecells produce exudates that consist of bitter yellowlatex with powerful laxative-like actions. Thisexudate which is not to be confused with thegel/mucilage from the parenchymal leaf tissue isavailable commercially for systemic ingestion toproduce catharsis.1

Properties Of Aloe VeraThe constituents of aloe vera are related tobiological effects, which are as follows:

1. Healing properties: - Glucomannan, amannose-rich polysaccharide, and gibberellin, a growthhormone, interacts with growth factor receptors onthe fibroblast, there by stimulating its activity andproliferation, which in turn significantly increasescollagen synthesis after topical and oral Aloe vera.

2. Protective effects: - On skin exposed to UV andgamma radiation: Following the administration ofaloe vera gel, an antioxidant protein,metallothionein, is generated in the skin, whichscavenges hydroxyl radicals and preventssuppression of superoxide dismutase andglutathione peroxidase in the skin. Aloe vera gelhas been reported to have a protective effectagainst radiation damage to the skin.

3. Anti-inflammatory action: - Aloe Vera inhibits thecyclooxygenase pathway and reducesprostaglandin E2 production from arachidonicacid. Recently, the novel anti-inflammatorycompound called C-glucosyl chromone wasisolated from gel extracts.

4. Effects on the immune system: - Alprogen inhibitcalcium influx into mast cells, thereby inhibitingthe antigen-antibody-mediated release of histamineand leukotriene from mast cells. Acemannan

stimulates the synthesis and release of interleukin-1 (IL-1) and tumour necrosis factor frommacrophages which in turn initiates an immuneattack that result in necrosis and regression of thecancerous cells.

5. Antiviral and antitumor activity: - These actionsmay be due to indirect or direct effects. Indirecteffect is due to stimulation of the immune systemand direct effect is due to anthraquinones. Theanthraquinone alone inactivates various envelopedviruses such as herpes simplex, varicella zoster andinfluenza. In recent studies, a polysaccharidefraction has shown to inhibit the binding ofbenzopyrene to primary rat hepatocytes, therebypreventing the formation of potentially cancer-initiating benzopyrene-DNA adducts. An inductionof glutathione S-transferase and an inhibition ofthe tumour-promoting effects of phorbol myristicacetate has also been reported which suggest apossible benefit of using aloe gel in cancerchemoprevention.

6. Moisturizing and anti-aging effect:Mucopolysaccharides in aloe vera help in bindingmoisture into the skin. Aloe stimulates fibroblastwhich produces the collagen and elastin fibersmaking the skin more elastic and less wrinkled.

7. Antiseptic effect:- Aloe Vera contains 6 antisepticagents as Lupeol, salicylic acid, urea nitrogen,cinnamonic acid, phenols and sulfur and haveinhibitory action on fungi, bacteria and viruses.7

8. Use of aloe vera in dentistry: - Uses of aloe verain dental conditions based on its biologic effectsare as follows:

a. Extraction sites heal properly and dry socketformation is prevented when Aloe vera is appliedon extraction site. Lesions are improved by directapplication in gel form on herpetic viral lesions or


============================================================================

21

aphthous ulcers. It has been reported thatacemannan hydrogel accelerates the healing ofaphthous ulcers and reduces the pain associatedwith them.8

b. Studies using aloe vera in toothpastes have shownthat aloe vera tooth gel and the toothpastes wereequally effective against Candida albicans,Streptococcus mutans, Lactobacillus acidophilus,Enterococcus faecalis, Prevotella intermedia, andPeptostreptococcus anaerobius. Aloe Vera toothgel demonstrated enhanced antibacterial effectagainst S. mitis. 9

The dental uses of Aloe Vera are multiple. It isextremely helpful in the treatment of gum disease;it reduces the bleeding of the gums; it ispowerfully antiseptic in gum pockets and itsantifungal properties help greatly in the problem ofdenture stomatitis, i.e. red and sore mucousmembranes which are permanently covered by adenture – this is a form of thrush. Cracked and splitcorners of the mouth are also subject to fungalinfection and this can be cured by Aloe. Itsantiviral properties help in the treatment of coldsores (Herpes Simplex) and shingles (HerpesZoster). It is a powerful healing promoter andwhen inserted into extraction sockets is verybeneficial. It can be used in any surgical wound. Ithas a use in root canal treatment as a sedativedressing, healing promoter and file lubricant. 10

9. Aloe Vera in periodontal disease: - Periodontitisis an infectious inflammatory disease. Bacteriamodulate the inflammatory response and alter thediversity of periodontal disease. In recent years,various host-response modulation therapies andlocal drug therapies have been developed to blockthe pathways responsible for periodontal tissuebreakdown. 11

Treatment of periodontal disease by different typeof local drug delivery system has been investigated.Subgingival administration of aloe vera gel resultsin improvement of periodontal condition. Aloe Veracan be used as a local drug delivery system becauseof its various benefits such as:

1. It is easily available.2. It is cheap3. Easily applicable with minimal

equipmentsAloe latex contains anthraquinones, which arechemical compounds that are used in healing andarresting pain because they are anti-inflammatory innature. But, because aloe vera tooth gel tends to beless harsh on teeth, as it does not contain theabrasive elements typically found in commercialtoothpaste, it is a great alternative for people withsensitive teeth or gums.Application directly to the sites of periodontal

surgery along with periodontal dressing or to gumtissues when they have been traumatized bytoothbrush-dentifrice abrasion, sharp foods, dentalfloss, and toothpick injuries. Existing evidenceindicates that aloe vera used in variety ofconcentrations might be effective in shortening theduration of wound healing.10

The various forms of Aloe used in dentistry are: – The toothpaste is a gelly like

substance for healing promotion,which can also be used for burns,stings, insect bites and many skinlesions:such as “Aloe Dent”, aloetooth gel”, “forever bright”,“Kingfisher aloe vera tooth paste”.12

Mouthwash, floss. Fig. 4


============================================================================

22

The jelly for healing promotion,which can also be used for burns,stings, insect bites and many skinlesions.

The Aloe & Propolis hand creamwhich helps to counteract frequenthand washing and the wearing oflatex gloves. Fig. 5

The Aloe activator spray which isexcellent for throat infections,painful erupting wisdom teeth andjoint pains.

The Aloe juice which is taken as adrink. This is used in conjunctionwith any topical treatment for skinlesions, joint lesions and, in itself, asan amelioration in irritable bowelsyndrome. The juice is also a strongdetoxifying agent and if used inconjunction with the plannedremoval of mercury amalgams act asa scavenging agent for mercury, aneuro-sedative and immuneenhancer. As a routine general tonicit generally makes people feel betterwho are otherwise not well enoughbut not frankly ill. Fig. 6

Contraindications: - Aloe Vera should be usedcautiously in pregnancy, lactating mothers andallergy to lilliacea family.13

Side Effects: - Side effects may be categorized intodue to topical or systemic routes as follows:A. Topical: - It may cause redness, burning andstinging sensation. Allergic reactions are mostly dueto anthraquinones, such as aloin and barbaloin. It isbest to apply it to a small area first to test forpossible allergic reaction.

B. Systemic: - Abdominal cramps, diarrhea, redurine, hepatitis, dependency or worsening ofconstipation. Prolonged use has been reported toincrease the risk of colorectal cancer. Laxativeeffect may cause electrolyte imbalances (lowpotassium levels).7

ConclusionAloe Vera is a natural product having various usesin the field of cosmetology, dermatology, andgastroenterology. In dentistry, aloe vera is useful inmany ways due to its antibacterial, antifungal,antiviral, immunostimulatory and healingproperties. Future research may be directed at thefurther investigations of gel ability to stimulate cellgrowth in tissue culture and its anti microbial, antifungal, antibacterial and anti-inflammatoryproperties in randomized controlled clinical trialsalong with its beneficiary effect in periodontaldisease.Aloe Vera certainly gives scope to the phrase, “the

whole is more than the sum of its parts”.

Fig. 1 Different Parts of Aloe Vera

Fig. 2 Aloe Vera Plant


============================================================================

23

Fig. 3 Constitutes Of Aloe Vera

Fig. 4 Aloe Vera Paste, Mouth Wash, Floss

Fig. 5 Aloe Vera Cream

Fig. 6 Aloe Vera Juice


============================================================================

24

References1. Richard L.et al. Aloe vera gel: Update for

dentistry. General Dentistry 2005:6-9.2. Moore et al. Aloe Vera has been used for

thousands of years. Why is it so important forour health? www.flpirelandshop.com 2006.

3. Hayes SM. Lichen planus—Report ofsuccessful treatment with aloe vera. GenDent 1999; 47:268-272.

4. Yamaguchi I et al. Components of the gelAloe vera(L.) burm. f. Biosci BiotechnolBiochem 1993;57:1350-1352.

5. Reynolds T et al. Aloe vera leaf gel: Areview update. J Ethnopharmacol 1999;68:3-37.

6. Vogler BK et al. Aloe vera: A systematicreview of its clinical effectiveness. Br J GenPract 1999; 49:823-828.

7. Renu et al. Aloe Vera and its uses inDentistry. Indian J Dent Adv 2011; 3(4):656-658.

8. Poor MR et al. Reduction in the incidence ofalveolar osteitis in patients treated with theSaliCept Patch, containing aceman-nanhydrogel. J Oral Maxillofac Surg 2002;60:374-379.

9. George Det al. Comparative evaluation of theantimicrobial efficacy of aloe vera tooth geland two popular commercial toothpastes: Anin vitro study. General Dentistry. 2009; 238-241.

10. Bhat et al. Aloe vera nature’s soothing healerto periodontal disease. J Indian SocPeriodontol 2011; 15:205-209.

11. Kiloy.W.J et al . Controlled local delivery ofantimicrobials in the treatment of

periodontitis. Dent Clinical North Am1998;43:263-283.

12. Mohan.R. et al. Aloe vera in dentistry- TheHerbal Penecca.Ind. J Dent. Spec. Res.2011;29:

13. Moore T.E.The M and M’s of aloe vera-is itfor dentistry? J Okla Dent Assoc. 2001; 9:30-36.

aloe-vera: a boon in management of dental disease

Education