Role of Medicinal Herbs in Periodontal Therapy: A Systematic Review

A state-of-the-art review of the recent advances in drug delivery systems for different therapeutic agents in periodontitis

Periodontitis (PD) is a chronic gum illness that may be hard to cure for a number of reasons, including the fact that no one knows what causes it, the side effects of anti-microbial treatment, and how various kinds of bacteria interact with one another. As a result, novel therapeutic approaches for PD treatment must be developed. Additionally, supplementary antibacterial regimens, including local and systemic medication administration of chemical agents, are necessary for deep pockets to assist with mechanical debridement of tooth surfaces. As our knowledge of periodontal disease and drug delivery systems (DDSs) grows, new targeted delivery systems like extracellular vesicles, lipid-based nanoparticles (NPs), metallic NPs, and polymer NPs have been developed. These systems aim to improve the targeting and precision of PD treatments while reducing the systemic side effects of antibiotics. Nanozymes, photodermal therapy, antibacterial metallic NPs, and traditional PD therapies have all been reviewed in this research. Medicinal herbs, antibiotics, photothermal therapy, nanozymes, antibacterial metallic NPs, and conventional therapies for PD have all been examined in this research. After that, we reviewed the key features of many innovative DDSs and how they worked for PD therapy. Finally, we have discussed the advantages and disadvantages of these DDSs.

Anti-Inflammatory Properties of Yellow Passion Fruit Bagasse Extract and Its Potential Role in Periodontal Wound Healing In Vitro

Background/Objectives: Periodontal disease involves chronic immunoinflammatory processes and microbial dysbiosis, making phytochemicals with anti-inflammatory properties potential therapeutic agents. This study aimed to assess the modulatory effects of yellow passion fruit bagasse extract (PFBE) on periodontal cells under microbial condition. Methods: A human periodontal ligament (PDL) cell line was exposed to F. nucleatum ATCC 25586 to simulate a microbial environment in vitro in the presence and absence of PFBE containing three different concentrations (0.25, 0.50, and 1.00 µg/mL) of piceatannol. Pro-inflammatory markers (TNF-α, IL-8, CCL2), the antioxidant enzyme SOD2, and the protease marker MMP-1 were analyzed by real-time PCR. Protein levels were assessed via ELISA and NF-κB nuclear translocation by immunofluorescence. Cell viability was investigated using live/dead and alamarBlue assays, and in vitro wound healing was evaluated by an automated scratch assay. Results: PDL cells exposed to F. nucleatum significantly increased the gene and protein expression of all inflammatory markers. The stimulatory effects of F. nucleatum were significantly reduced when PDL cells were simultaneously exposed to PFBE. F. nucleatum triggered the NF-κB nuclear translocation while PFBE abrogated the F. nucleatum-stimulated NF-κB nuclear translocation at 60 min. Viability assays demonstrated that neither PFBE nor F. nucleatum were toxic or significantly affected PDL cell viability. In vitro wound closure was improved by the addition of PFBE to F. nucleatum. Conclusions: PFBE exhibited anti-inflammatory and anti-proteolytic effects while improving in vitro wound healing, suggesting a potential modulatory role of PFBE in periodontal disease prevention and treatment.

Proanthocyanidin B2 alleviates Pg.LPS-induced RAW264.7 cellular inflammation and oxidative stress via PI3K/Akt/NFkB pathway

Periodontitis is a multifactorial chronic inflammatory infectious disease associated with systemic diseases. Proanthocyanidin B2 (PB2), a polyphenol, has been investigated to exhibit antioxidant, anti-inflammatory and anti-cancer pharmacological properties. PB2 has shown good efficacy in treating hepatocellular carcinoma, type 2 diabetes mellitus, and ulcerative colitis. There are few studies on PB2 in treating periodontitis, and the molecular mechanism is unknown. This research focused on the effects of PB2 in Porphyromonas gingivalis-derived lipopolysaccharide (Pg. LPS)-stimulated RAW264.7 cells, as well as the potential mechanisms. CCK-8 assay was used to assess the cytotoxic effects of PB2. qRT-PCR assay and ELISA assay were used to evaluate the expression of inflammatory cytokines. DCFH-DA probe and other assay kits were employed to detect oxidative stress indicators. Western blot was conducted to assess important proteins of the PI3K/Akt/NFκB pathway. The results showed that PB2 downregulated the overproduction of pro-inflammatory mediators IL-1β, IL-6, and TNF-α; reduced the generation of ROS, MDA, and NO; Enhanced the activities of anti-inflammatory factor IL-10 and the total antioxidant capacity; and inhibited the activation of PI3K/Akt/NFκB pathway. In addition, the PI3K agonist 740Y-P was able to partially reverse the effects of PB2. This study indicates that PB2 exhibits significant anti-inflammatory and antioxidant effects in P. gingivalis LPS-stimulated RAW264.7 cells, primarily through the inhibition of the PI3K/Akt/NFκB signaling pathway.

In Silico Docking of Medicinal Herbs Against P. gingivalis for Chronic Periodontitis Intervention

OBJECTIVE

This study aimed to explore the therapeutic potential of medicinal herbs for chronic periodontitis by examining the molecular interactions between specific herbal compounds and the heme-binding protein of Porphyromonas gingivalis, a key pathogen involved in the disease.

METHODS

The crystal structure of heme-binding protein was obtained from the Protein Data Bank. Herbal compounds were identified through an extensive literature review. Molecular docking simulations were performed to predict binding affinities, followed by Absorption, Distribution, Metabolism, and Excretion (ADME) parameter prediction. Drug-likeness was assessed based on Lipinski's Rule of Five, and pharmacophore modeling was conducted to identify key molecular interactions.

RESULTS

The molecular docking simulations revealed that chelidonine, rotenone, and myricetin exhibited significant binding affinities to the heme-binding protein, with docking scores of -6.5 kcal/mol, -6.4 kcal/mol, and -6.1 kcal/mol, respectively. These compounds formed stable interactions with key amino acid residues within the binding pocket. ADME analysis indicated that all 3 compounds had favourable pharmacokinetic properties, with no violations of Lipinski's rules and minimal predicted toxicity. Pharmacophore modeling further elucidated the interaction profiles, highlighting specific hydrogen bonds and hydrophobic interactions critical for binding efficacy.

CONCLUSIONS

Chelidonine, rotenone, and myricetin emerged as promising therapeutic candidates for chronic periodontitis due to their strong binding affinities, favorable ADME profiles, and lack of significant toxicity. The detailed pharmacophore modeling provided insights into the molecular mechanisms underpinning their inhibitory effects on the heme-binding protein of P. gingivalis. These findings suggest that these compounds have the potential for further development as effective treatments for chronic periodontitis. Future research should focus on in vitro and in vivo validation of these findings to confirm the efficacy and safety of these compounds in biological systems.

Green Tea: A Novel Perspective on the Traditional Plant's Potential in Managing Periodontal Diseases

Green tea (Camellia sinensis) exhibits significant potential in oral health due to its antioxidant, anti-inflammatory, and antimicrobial properties. This review explores its role in managing periodontal disease, a common condition characterized by inflammation, microbial imbalances, and tissue destruction. The primary bioactive components, particularly epigallocatechin-3-gallate (EGCG), contribute to green tea's therapeutic effects by inhibiting bacterial adhesion, modulating inflammatory pathways, and reducing oxidative stress. Clinical studies suggest green tea improves periodontal health by reducing pocket depth, inflammation, and bleeding. It can serve as an adjunct to conventional therapies, including scaling and root planing, and be incorporated into oral care products such as mouthwashes and dentifrices. Furthermore, green tea presents a natural alternative to chemical agents like chlorhexidine, potentially mitigating side effects and addressing concerns about antibiotic resistance. However, its efficacy remains moderate compared to established treatments, highlighting the need for further research to optimize its formulation and therapeutic applications. Green tea represents a sustainable and biocompatible approach to periodontal therapy, supporting its integration into preventive and therapeutic oral health strategies.

Quantitative determination of the antibacterial activity of licorice (Glycyrrhiza glabra) and tetracycline gel against Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) - a microbiological in vitro study

OBJECTIVES

The aim of this study was to evaluate and compare the antibacterial efficacy of licorice gel and tetracycline gel against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia.

METHODS

An indigenously prepared 50 μL licorice and tetracycline gel was subjected to antibacterial sensitivity test (thrice) against Aa, Pg, Pi by agar well diffusion method using Brain Heart Infusion media. Colonies of Aa, Pg, Pi were transferred into broth and incubated at 37 °C for 24 h and diameter of inhibition zone was measured.

RESULTS

The drug release profile of licorice gel at six regular intervals was higher when compared to tetracycline. MIC of licorice gel (50 μg/mL) against Aa (14 mg), Pg (7 mg), Pi (7 mg) respectively. The diameter of inhibition zone of licorice gel was significant against Aa when compared to tetracycline gel. However, tetracycline gel exhibited significant diameter of inhibition zone against Pg and Pi when compared to licorice gel. There was a statistical significance difference between licorice and tetracycline gel against Aa (p=0.043*), Pg (p=0.037*), Pi (p=0.046*) while assessing antibacterial sensitivity test.

CONCLUSIONS

Licorice gel has anti-inflammatory and anti-microbial properties which can act against periodontal pathogens and can be considered in treating periodontal disease at low concentrations. Therefore, it can be used as an adjunctive local drug delivery agent to non-surgical periodontal therapy (NSPT) in treating periodontal disease.

The potential anti-inflammatory effect of hyaluronic acid gel alone or in combination with grapefruit seed extract on induced periodontitis in mandibular molars of Wistar rats

OBJECTIVES

Antimicrobial agents have been used in conjunction with conventional chemomechanical therapy to improve the treatment outcomes of periodontitis. This study aimed to evaluate the ameliorating effect of topical application of hyaluronic acid (HA) with or without grapefruit seed extract (GFSE) (5, 10, and 15 wt %) in induced periodontitis in rats.

METHODS

Surgical alveolar bone defects were created in 30 adult male Wistar rats, followed by the introduction of a ligature impregnated with Escherichia coli lipopolysaccharide for four weeks to induce periodontitis. Rats were distributed into five groups (n = 6); an untreated periodontitis group and four treated groups in which gel (HA±GFSE) was injected into the sulcus once weekly for two weeks. All rats were euthanized six weeks after starting the experiment, and the mandibles were prepared for histopathological and histomorphometric analyses. Enzyme-linked immunosorbent assay was used for measuring tissue levels of tumor necrosis factor-alpha (TNF-α), transforming growth factor-β1 (TGF-β1), and paraoxonase-1 (PON-1) enzyme.

RESULTS

HA enhanced new bone formation at defect margins, thereby diminishing defect width. This effect significantly increased as HA was combined with GFSE in a dose-dependent manner. Moreover, the HA and GFSE mixture suppressed the tissue levels of TNF-α and TGF-β1, thereby increasing PON-1.

CONCLUSION

The HA and GFSE mixtures exhibited synergistic therapeutic potential for the treatment of chronic periodontitis in a dose-dependent manner.

Phytotoxic and Antifungal Effects of Plantago major and Sambucus nigra Bioextracts on Key Agricultural Pathogens: Corynespora cassiicola, Fusarium oxysporum, and Penicillium oxalicum

Sustainable agricultural practices increasingly focus on natural bioactive agents for managing phytopathogens. This study investigates the antifungal and phytotoxic properties of methanolic bioextracts derived from Plantago major leaves (MBPm) and Sambucus nigra roots (MBSn) to explore their potential applications. Bioextracts were prepared through methanolic maceration, with yields of 6.02% (P. major) and 6.42% (S. nigra). Antifungal assays evaluated inhibitory effects on Fusarium oxysporum, Corynespora cassiicola, and Penicillium oxalicum, while phytotoxicity assays assessed concentration-dependent impacts on Solanum lycopersicum seed germination. A qualitative evaluation of major polyphenolic compounds was conducted using Ultra-Performance Liquid Chromatography coupled with a Photodiode Array Detector and Electrospray Ionization Mass Spectrometry (UPLC-PDA-ESI-MS) to identify bioactive compounds known for their significant biological activity. P. major bioextracts demonstrated significant inhibition of F. oxysporum (90.06%) and C. cassiicola (83.19%), while S. nigra bioextracts achieved 89.65% and 92.16% inhibition, respectively. Both bioextracts showed minimal impact on P. oxalicum, with effects observed only at 50 mg/mL. Low concentrations of S. nigra bioextract enhanced seed germination, whereas higher doses inhibited it. Identified bioactive compounds included acteoside, isoacteoside, chlorogenic acid, and dicaffeoylquinic acid isomers. The findings highlight the potential of these bioextracts as biocontrol agents and modulators of seed germination processes, contributing to sustainable agricultural strategies. While this study was conducted under controlled laboratory conditions, these results provide a strong foundation for future evaluations in field settings to explore their broader agricultural applications.

A Natural Approach to the Prevention and Treatment of Gingivitis and Periodontitis: A Review of Pomegranate's Bioactive Properties

(1) Background: This systematic review explores the bioactive properties of Punica granatum (pomegranate) and its potential applications in the prevention and treatment of gingivitis, periodontitis, and other oral diseases. (2) Methods: A comprehensive literature search was conducted using PubMed and Google Scholar, focusing on pomegranate and oral diseases. Inclusion criteria included studies evaluating the effects of pomegranate on oral health, while exclusion criteria eliminated non-peer-reviewed and non-English articles. This review aims to assess the efficacy of pomegranate extracts as a natural alternative to synthetic pharmaceuticals in oral health care. A structured search strategy included key terms such as "pomegranate", "oral health", "gingivitis", and "periodontitis". A total of 125 relevant references were reviewed to identify the most pertinent findings. (3) Results: The results indicate that pomegranate extracts have demonstrated efficacy in reducing plaque, inhibiting harmful oral microorganisms, and promoting overall oral health. Furthermore, clinical studies highlight the potential of pomegranate-based products, such as mouthwashes and gels, as viable alternatives to conventional pharmaceuticals, particularly in resource-limited settings. However, the review also notes the need for further research, particularly in the form of clinical trials, to establish optimal formulations and long-term safety. (4) Conclusions: Pomegranate presents a promising, natural solution for preventing and treating gingivitis and periodontitis. Further studies should focus on long-term effects and clinical efficacy.

Exploring the therapeutic potential of medicinal plants and their active principles in dental care: A comprehensive review

Since the human population realized how important it was to maintain overall health and the weight of disease, they have been looking for therapeutic qualities in natural environments. The use of plants having medicinal qualities for the treatment and prevention of illnesses that may have an impact on general health is known as herbal medicine. There has been a noticeable increase in interest lately in the combination of synthetic contemporary medications and traditional herbal remedies. About 80 % of people rely on it for healthcare, particularly in developing nations. One important aspect of overall health is said to be oral healthcare. The World Health Organization views oral health as a crucial component of overall health and well-being. Because they are more readily available, less expensive, and have fewer adverse effects than pharmaceutical treatments, using natural medicines to treat pathologic oro-dental disorders can make sense. The current evaluation of the literature sought to investigate the range and scope of the use of herbal products and their secondary metabolites in maintaining oral health, encompassing several oral healthcare domains such as halitosis, gingivitis, periodontitis, and other oral disorders. Therefore, there are many herbs discussed in this work and their mechanism in the treatment and improvement of many oral ailments. Besides, compounds that are useful in oral treatment with their natural sources and the cases where they can be used. To prevent any possible side effects or drug interactions, a doctor's consultation is necessary before using dental medicine. Although herbal therapy is safe and with minimum side effects, it is also strongly advised to do a more thorough preclinical and clinical evaluation before using herbal medicines officially.

Formulation of Neem and Echinacea Gel for Oral Health Along With the Evaluation of Antimicrobial, Cytotoxic, Anti-inflammatory, and Free Radical Scavenging Activity: An In Vitro Study

Background Herbs have been used in medical practice for centuries and continue to play a significant role in modern complementary and alternative medicine. Phytochemicals in these herbs possess strong antioxidant and anti-inflammatory properties, which are beneficial in targeting oral health issues, such as dental plaque, gingivitis, and oral microbial infections. As research progresses, the challenge remains to translate these natural compounds into safe, effective, and accessible treatments for a wide range of diseases. Aim The aim of this research was to formulate the neem and echinacea gel along with the evaluation of antimicrobial, anti-inflammatory, free-radical scavenging activity, and cytotoxic potential. Materials and methods The neem and echinacea gel was prepared using a concentrated powdered mixture of neem and echinacea (5 grams each) to which 100 ml of distilled water was added, and the mixture was boiled for 30 minutes at 60°C. The 10 ml concentrate was mixed with 20 ml of a carbopol and carboxymethyl cellulose (CMC) mixture and mixed thoroughly, which resulted in neem and echinacea gel. Then, the antimicrobial, anti-inflammatory, cytotoxic potential, and free-radical scavenging activity of the gel were evaluated. The data obtained were statistically analyzed with the help of a paired t-test, where a p-value of less than 0.05 was considered statistically significant. Results The antimicrobial assay showed that neem and echinacea gel at the concentration of 100 micrograms showed a greater zone of inhibition against Staphylococcus aureus (3.15 ± 0.26), Streptococcus mutans (2.48 ± 0.45), Enterococcus faecalis (2.89 ± 0.15), and Candida albicans (4.28 ± 0.87). The cytotoxic test revealed that even at an 80 µg concentration of the extract, more than 70% of the nauplii were vital, which indicated that the gel was not cytotoxic. The highest anti-inflammatory activity (78.39 ± 1.82) of the gel was seen at 50 micrograms when compared with diclofenac sodium (73.16 ± 1.80). The free radical scavenging activity showed that the 2,2-diphenyl-1-picrylhydrazyl (DPPH) absorbance of the neem and echinacea extract was highest at 50 micrograms.  Conclusion The combination of neem and echinacea extract-based gel possessed high antimicrobial and anti-inflammatory activity when compared with standard drugs, such as amoxicillin and diclofenac sodium. The antioxidant activity of the gel was equal to butylated hydroxytoluene (BHT), and also the gel has a low cytotoxic potential even at its higher concentrations. Hence, the gel can be used as a natural remedy with minimal side effects, making it a valuable alternative to chemical agents.

Investigating the antimicrobial and anti-inflammatory effects of Lactobacillus and Bifidobacterium spp. on cariogenic and periodontitis pathogens

Background

The use of probiotics is emerging as an innovative approach to managing oral health issues and mediating the immune system. The current study assessed the in vitro impacts of non-orally isolated probiotics on periodontitis and tooth decay pathogens.

Methods

Briefly, the persistence of probiotics in exposure to oral cavity enzymes, hydrogen peroxide, and saliva samples was examined. It was also investigated the biofilm formation and aggregation ability of probiotics, the adherence of probiotics in human gingival fibroblast cell (HGFC) lines and molar teeth samples, and the potential of probiotics to co-aggregate with oral pathogens. Additionally, the current study evaluated the effects of live probiotics on virulence gene expression, biofilm production of main oral pathogens, and changes in inflammation markers.

Results

The probiotics remained alive when exposed to enzymes in the oral cavity, hydrogen peroxide, and saliva at baseline, 1, 3, and 5 h after incubation at 37°C (p-value <0.05). Probiotics demonstrated to produce biofilm and aggregation, as well as adherence to HGFCs and maxillary molars (p-value >0.05). They showed significant co-aggregation with oral pathogens, which were recorded as 65.57% for B. bifidum 1001 with S. mutans, 50.06% for B. bifidum 1005 with P. gingivalis, 35.6% for L. plantarum 156 with F. nucleatum, and 18.7% for B. longum 1044 with A. actinomycetemcomitans after 8 h of incubation. A balance between pro-inflammatory and anti-inflammatory cytokines, along with inhibition of biofilm formation and changes in virulence gene transcripts, were observed. However, most of these changes were not statistically significant (p-value >0.05).

Conclusion

This study demonstrated the direct link between adhesiveness, aggregation, and biofilm formation with probiotic antibacterial activity. In addition to the careful selection of suitable probiotic strains, the concentration and origin of probiotic isolates should be considered.

Preparation and Characterization of Ginseng Gel and In Vivo Evaluation of Its Clinical Efficacy in Generalized Chronic Gingivitis Patients

Aim The aim of the present study was to prepare and characterize ginseng gel and then to evaluate its clinical efficacy in terms of plaque index (PI), gingival index (GI) among generalized chronic gingivitis patients. Materials and methods Ginseng gel was prepared using 250 g of ginseng powder. The antimicrobial activity of prepared ginseng gel and chlorhexidine gel was checked at various concentrations (25, 50, 75, 100, 125, 150, 175, 200, 225, 250 and 275 µg) against anaerobic organisms to find the concentration with maximum antimicrobial activity. The concentration with highest antimicrobial activity was subjected to in vivo analysis. A total of 30 generalized chronic gingivitis patients were subjected to scaling and then divided into two groups for intraoral gel application - Group I (ginseng gel) and Group II (chlorhexidine gel) for one month. The clinical parameters PI, GI were measured at baseline (pre scaling) and one month (post scaling) comparing ginseng gel and chlorhexidine gel (Hexigel - chlorhexidine gluconate 1.0% w/w). Independent t test and paired t test were done for statistical analysis. Results At 275 µg, ginseng gel showed highest antibacterial action against anaerobic oral microorganisms. In Group I, the reduction in PI from baseline was (2.52±0.02) to follow up after one month (0.75±0.05), GI from baseline (2.2±0.35) to follow up after one month (0.9±0.02). In Group II, the reduction in PI from baseline was (2.54±0.01) to follow up after one month (0.79±0.02), GI from baseline (2.1±0.42) to follow up after one month (0.8±0.01). Conclusion Ginseng gel showed equal clinical efficacy to chlorhexidine gel in terms of PI and GI. Though chlorhexidine was effective in lower concentrations, it has considerable adverse effects such as taste alteration. Hence it is better to encourage the use of herbal-based products for the management of gingivitis to prevent side effects of synthetic preparations.