1. Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ==========================================================================Punica Granatum: A Natural And Recent Approach Towards Dental Problem Jain Sambhav1, Rai Rohit2, Upadhyaya Ankit Raj 3, Malhotra Garima 4 1 & 2.Department of Periodontology and Oral Implantology,Teerthanker Mahaveer Dental College and Research Centre,Delhi Road,Moradabad,India. 3. Department of Conservative and Endodontics,Teerthanker Mahaveer Dental College and Research Centre,Delhi Road,Moradabad,India. 4. Department of Pedodontics and Preventive Dentistry,Teerthanker Mahaveer Dental College and Research Centre, Delhi Road,Moradabad,India.Correspondence Author:Dr Rohit Rai, Department of Periodontology and Oral Implantology,Teerthanker Mahaveer Dental College and Research Centre,Delhi Road,Moradabad,India.Email:periodontics07@gmail.com -----------------------------------------------------------------------------------------------------------------------------------------The ripe pomegranate fruit can be up to five Abstract: Oral hygiene plays a very important role in inches wide with a deep red, leathery skin, is generalized health of body that is sadly grenade-shaped, and crowned by the pointed overlooked by most doctorsand the patients.Oral calyx. The fruit contains many seeds (arils) health status profoundly impacts diseases ranging separated by white, membranous pericarp, and from type 2 diabetes and cancer to rheumatoid each is surrounded by small amounts of tart, red arthritis and atherosclerosis.Recent scientific juice. Fig.1 studies show that many of the natural nutrients The recent interest for this fruit is not only confers benefits when topically applied in the because of the pleasant taste, but also due to the mouth.Acting as powerful allies in the fight scientific evidences that suggest therapeutic against periodontal disease, these natural activity such as anti-atherogenic, antiparasitic, compounds can help safeguard against lethal ageantimicrobial, antioxidant, anticarcinogenic and related diseases that emanate from our mouths. antiinflammatory effects. These beneficial effects Introduction: were attributed to the antioxidative properties of Pomegranate (Punica granatum L) is considered pomegranate phenolic compounds, tannins and one of the oldest known edible fruits and is the anthocyanins as well as other phytochemicals. The symbolic of abundance and prosperity. For constituents of pomegranate have been thoroughly thousands of years, many cultures have believed investigated, however, clinical trials are in that pomegranate have beneficiary effects on progress to explore the therapeutic potential of 1 health, fertility, longevity and rebirth. pomegranate products, particularly determining The pomegranate tree typically grows 12-16 feet, preventive efficacy of pomegranate extracts in has many spiny branches, and can be extremely cancer, cardiovascular diseases, inflammation, long lived, as evidenced by trees at Versailles, diabetes and ultraviolet radiation-induced skin France, known to be over 200 years old. The damage. 2 leaves are glossy and lanceshaped, and the bark of the tree turns gray as the tree ages. The flowers are large, red, white, or variegated and have a tubular calyx that eventually becomes the fruit. 1

2. Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ========================================================================== The most therapeutically beneficial pomegranate constituents are ellagic acid ellagitannins (including punicalagins), punicic acid, flavonoids, anthocyanidins, anthocyanins, and estrogenic Botanical classification of Pomegranate: flavonols and flavones.2 Kingdom: Plantae (unranked):Angiosperms(unranked):EudicotsOrder:MyrtalesFamily:LythraceaeGenus:PunicaHistory The pomegranate, Punica granatum L., an ancient, mystical, and highly distinctive fruit, is the predominant member of two species comprising the Punicaceae family. It was lauded in ancient times in the Old Testament of the Bible, the Jewish Torah, and the Babylonian Talmud as a sacred fruit conferring powers of fertility, abundance, and good luck. It also features prominently in the ceremonies, art, and mythology of the Egyptians and Greeks and was the personal emblem of the Holy Roman Emperor, Maximilian. Pomegranate is the symbol and heraldic device of the ancient city of Granada in Spain from which the city gets its name. The pomegranate is native from the Himalayas in northern India to Iran but has been cultivated and naturalized since ancient times over the entire Mediterranean region. It is also found in India and more arid regions of Southeast Asia, the East Indies, and tropical Africa. The tree is also cultivated for its fruit in the drier regions of California and Arizona. In addition to its ancient historical uses, pomegranate is used in several systems of medicine for a variety of ailments. In Ayurvedic medicine the pomegranate is considered a pharmacy unto itself and is used as an antiparasitic agent, a blood tonic, and to heal aphthae, diarrhoea, and ulcers. 2 Fig. 2 COMPOSTIONPower of Pomegranate Pomegranate is currently finding important applications in the field of dental health. Clinical studies have shown that this popular antioxidant superstar attacks the causes of tooth decay at the biochemical level, with remarkable vigor.3,4-7 When used regularly in combination with toothpaste that has been reinforced with bioactive botanical extracts and CoQ10, pomegranate containing mouthwash may fight dental plaque and tartar formation by inhibiting the activities of the microorganisms that cause plaque. Additionally, pomegranate compounds possess anti-inflammatory properties that may help soothe irritated tissues.8,9 Pomegranate gets to the root of the problem by literally hitting bacteria where they live. Fascinating research shows that pomegranate extract suppresses the ability of these microorganisms to adhere to the surface of the tooth.3 The trick is to inhibit a common species of Streptococcus, preventing it from producing chemicals that create favorable conditions for fungi and other microorganisms to thrive. Plaque may involve four or more different microorganisms combining forces to colonize the surface of the teeth. Remarkably, natures own pomegranate fights the organisms ability to adhere by interfering with production of the very chemicals the bacteria use as glue.10 In fact, a recent study conducted by Brazilian researchers showed that pomegranate extract was more effective against the adherence of biofilm microorganisms than a pharmaceutical antifungal, when three or four microorganisms were involved.3 The results of this study suggest that this phytotherapeutic agent might be used in the control of adherence of different microorganisms in the oral cavity, concluded researchers.3 2 3. Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ========================================================================== A study conducted at the Human Nutrition Center could promote oral health, including affecting at Ohio State University in 2007 examined the processes related to gingivitis.11 effects of using a mouthwash containing Table.12 Components of pomegranate extract on the risk of gingivitis.11 pomegranate along with the constituents: Investigators noted that pomegranates active PLANT CONSTITUEN components, including polyphenolic flavonoids COMPONEN TS (e.g., punicalagins and ellagic acid), are believed T to prevent gingivitis through a number of Pomegranate anthocyanins; glucose, mechanisms including reduction of oxidative 12-14 juice ascorbic acid; ellagic stress in the oral cavity, direct antioxidant 15,16 acid, gallic acid, caffeic activity; anti-inflammatory effects; 17 acid; catechin, quercetin, antibacterial activity; and direct removal of 5 rutin; numerous plaque from the teeth. They also noted that a minerals, particularly published pilot study has already shown that iron; amino acids pomegranate extract can reduce the clinical signs Pomegranate 95-percent punicic of chronic periodontitis.4 seed oil acid;other constituents, For the Ohio State study, researchers recruited 32 including ellagic acid; healthy young men and women, who were other fatty acids;sterols randomly assigned to rinse with pomegranate mouthwash, or placebo, three times daily for four Pomegranate phenolic punicalagins; weeks. Subjects were instructed to rinse for five pericarp gallic acid and other fatty minutes per rinse. Saliva samples were evaluated (peel, rind) acids; catechin, ; for a variety of indicators related to gingivitis and quercetin, rutin, and periodontitis. Subjects rinsing with pomegranate other flavonols; flavones, solution experienced a reduction in saliva total flavonones; protein content,11 which is normally higher among anthocyanidins people with gingivitis18 and may correlate with Pomegranate tannins (punicalin and plaque-forming bacterial content.19 leaves punicafolin); and flavone Pomegranate-treated subjects also experienced glycosides, including significant decreases in the salivary activity of the luteolin and apigenin enzyme aspartate aminotransferase. This enzyme Pomegranate gallic acid, ursolic acid; is considered a reliable indicator of cell injury and flower triterpenoids, including is elevated among patients with periodontitis.20 maslinic and asiatic acid; Pomegranate rinsing also lowered saliva activities other unidentified of alpha-glucosidase, an enzyme that breaks down constituents sucrose (sugar),21 while it increased activities of Pomegranate ellagitannins, including ceruloplasmin, an antioxidant enzyme.22 The roots and bark punicalin and pomegranate extract-induced increase in punicalagin; numerous ceruloplasmin activity can be expected to piperidine alkaloids strengthen antioxidant defenses, noted PRODUCTION investigators. Subjects who rinsed with placebo Pomegranate can be consumed as fresh, fruit solution did not experience any of these 11 juice, fermented fruit juice, dried aril, frozen aril, changes. Taken together, researchers concluded minimally-processed aril, canned aril, jam, jelly, that these changes in saliva content indicated that routine rinsing with a pomegranate mouthwash, 3 4. Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ========================================================================== wine, vinegar, paste, fruit leather and in The specific antimicrobial action of Punica flavouring products. granatum Linn on dental biofilm bacteria, i.e., After washing, the peel is separated from the Fig. 1 Different Parts of Pomegranate mesocarp, dried in an incubator at 33C for 7 disturbance of polyglycan synthesis, thus acting days. The material is thereafter ground in an on the adherence mechanisms of these organisms electric grinder to produce a powder. to dental surface. The results indicated that the The active principles are isolated and a glucan synthesis and its antimicrobial action gave concentrated extract is obtained. A basic gel this gel an effective control of the already formed consisting of carbopol, water and triethanolamine biofilm, which is considered the primary etiologic is than prepared. agent in caries disease and stomatitis. Next, 0.5 mL of the brute extract, equivalent to 540 mg of the plant powder, was incorporated, thus resulting in the Punica granatum L. gel.23 PROPERTIES OF POMEGRANATE 1. Antioxidant properties:- pomegranate juice and seed extracts have 2-3 times the antioxidant capacity of either red wine or green Fig. 2 Pomegranate Fruit tea.33 Pomegranate extracts have been shown to scavenge free radicals and decrease macrophage oxidative stress and lipid peroxidation in animals and increase plasma antioxidant capacity in elderly humans. 2. Anticarcinogenic properties:pomegranate extracts (juice, seed oil, peel) potently inhibit prostate cancer cell invasiveness and proliferation, cause cell cycle disruption, induce apoptosis, and inhibit tumour growth. These studies also demonstrated combinations of pomegranate extracts from different parts of the fruit were more effective than any single extract. Pomegranate in dentistry:- S. mutans are directly involved in the etiopathogenesis of caries and periodontal diseases, denture associated stomatitis and other infections because they can contribute to alter the equilibrium of oral microbiota by creating favourable conditions to adherence of opportunistic organisms, such as fungi, to the surfaces of teeth, oral tissues and prosthetic appliances. Fig. 3 Pomegranate Paste 3. Pomegranate in periodontal disease: The Punica granatum Linn (pomegranate) gel has an inhibitory activity on the adherence of different bacterial strains and one yeast commonly found in the oral cavity and might be used in the control of bacteria and yeasts responsible for oral infections 4 5. 1.2. 3.4.5.6.Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ========================================================================== such as caries, periodontal disease and granatum extracts. A preliminary study. J Int Acad 24 stomatitis. Fig. 3 Periodontol. 2003 Oct;5(4):106-15. 7. Taguri T, Tanaka T, Kouno I. Antimicrobial activity of 10 different plant polyphenols against bacteria causing food-borne disease. Biol Pharm CONCLUSION Bull. 2004 Dec;27(12):1965 --9. 8. 50. Lansky EP, Newman RA. Punica granatum Good oral hygiene is not simply a matter of (pomegranate) and its potential for prevention and maintaining good appearances. In the poor oral treatment of inflammation and cancer. J care scenario, plaque and tartar will build up, Ethnopharmacol. 2007 Jan 19;109(2):177-206. resulting in gingivitis and in turn progressing to 9. Shukla M, Gupta K, Rasheed Z, Khan KA, Haqqi periodontitis. And periodontitis has been TM. Consumption of hydrolyzable tannins-rich associated with increased risks of conditions pomegranate extract suppresses inflammation and ranging from heart disease to stroke and even joint damage in rheumatoid arthritis. Nutrition. pancreatic cancer. By harnessing natural bioactive 2008 Jul-Aug;24(7-8):733-43. components, such as pomegranate, green tea, 10. Li Y, Wen S, Kota BP, et al. Punica granatum CoQ10, lactoferrin, aloe Vera, folic acid, and flower extract, a potent alpha-glucosidase xylitol, these modern dentifrices have improved inhibitor, improves postprandial hyperglycemia in the odds of winning the battle against dental Zucker diabetic fatty rats. J Ethnopharmacol. 2005 degradation and related systemic illnesses. Jun 3;99(2):239-44. 11. DiSilvestro R, DiSilvestro D, DiSilvestro D. References Pomegranate extract Pomella Mouth Rinsing Akpinar-Bayizit et al. The Therapeutic Potential Effects on Saliva Measures Relevant to Gingivitis of Pomegranate and Its Products for Prevention of Risk. Manuscript Submitted 12-07. Cancer. Cancer Prevention From Mechanisms 12. Seeram NP, Adams LS, Henning SM, et al. In to Translational Benefits 13:331-372. vitro antiproliferative, apoptotic and antioxidant Pomegranate. activities of punicalagin, ellagic acid and a total www.crfg.org/pubs/ff/pomegranate.html pomegranate tannin extract are enhanced in Vasconcelos LC, Sampaio FC, Sampaio MC, et combination with other polyphenols as found in al. Minimum inhibitory concentration of pomegranate juice. J Nutr Biochem. 2005 adherence of Punica granatum Linn Jun;16(6):360-7. (pomegranate) gel against S. mutans, S. mitis and 13. Chidambara Murthy KN, Jayaprakasha GK, C. albicans. Braz Dent J. 2006;17(3):223-7. Singh RP. Studies on antioxidant activity of Sastravaha G, Gassmann G, Sangtherapitikul P, pomegranate (Punica granatum) peel extract using Grimm WD. Adjunctive periodontal treatment in vivo models. J Agric Food Chem. 2002 Aug with Centella asiatica and Punica granatum 14;50(17):4791-5. extracts in supportive periodontal therapy. J Int 14. Battino M, Bullon P, Wilson M, Newman H. Acad Periodontol. 2005 Jul;7(3):70-9. Oxidative injury and inflammatory periodontal Menezes SM, Cordeiro LN, Viana GS. Punica diseases: the challenge of antioxidants to free granatum (pomegranate) extract is active against radicals and reactive oxygen species. Crit Rev dental plaque. J Herb Pharmacother. Oral Biol Med. 1999;10(4):458-76. 2006;6(2):79-92. 15. Madianos PN, Bobetsis YA, Kinane DF. Sastravaha G, Yotnuengnit P, Booncong P, Generation of inflammatory stimuli: how bacteria Sangtherapitikul P. Adjunctive periodontal set up inflammatory responses in the gingiva. J treatment with Centella asiatica and Punica Clin Periodontol. 2005;32(Suppl 6):57-71. 5 6. Int. J. Pharm. Res. Sci., 2014, 02(1), 1-6. www.ijprsonline.com ISSN: 2348 0882 ========================================================================== 16. Aggarwal BB, Shishodia S. Suppression of the nuclear factor-kappaB activation pathway by spice-derived phytochemicals: reasoning for seasoning. Ann NY Acad Sci. 2004 Dec;1030:434-41. 17. Badria FA, Zidan OA. Natural products for dental caries prevention. J Med Food. 2004;7(3):381-4. 18. Narhi TO, Tenovuo J, Ainamo A, Vilja P. Antimicrobial factors, sialic acid, and protein concentration in whole saliva of the elderly. Scand J Dent Res. 1994 Apr;102(2):120-5 19. Rudney JD, Krig MA, Neuvar EK. Longitudinal study of relations between human salivary antimicrobial proteins and measures of dental plaque accumulation and composition. Arch Oral Biol. 1993 May;38(5):377-86. 20. Nomura Y, Tamaki Y, Tanaka T, et al. Screening of periodontitis with salivary enzyme tests. J Oral Sci. 2006 Dec;48(4):177-83. 21. Beighton D, Radford JR, Naylor MN. Glycosidase activities in gingival crevicular fluid in subjects with adult periodontitis or gingivitis. Arch Oral Biol. 1992;37(5):343-8. 22. Bielli P, Calabrese L. Structure to function relationships in ceruloplasmin: a moonlighting protein. Cell Mol Life Sci. 2002 Sep;59(9):141327 23. Vasconcelos et al.Minimum Inhibitory Concentration of Adherence of Punica granatum Linn (pomegranate) Gel Against S. mutans, S. mitis and C. albicans. Braz Dent J (2006) 17(3): 223-227 24. Jurenka.K. et al. Therapeutic Applications of Pomegranate (Punica granatum L.): A Review. Alt Med Rev 2008;13:128-144.6