|Year : 2017 | Volume
| Issue : 1 | Page : 16-21
Complementary Medicine − A Novel Therapeutic Approach for Oral Diseases
Deepankar Misra1, Shalu Rai1, Mansi Khatri1, Akansha Misra2
1 Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Pathology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
|Date of Web Publication||1-Mar-2017|
Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Kadrabad, Modinagar, Uttar Pradesh 201201
Source of Support: None, Conflict of Interest: None
With the increasing concern among patients about the adverse effects of conventional medicines’ increased resistance by bacteria to antibiotics and challenges faced by the medical personnel in managing chronic disease and their symptoms, it is becoming essential for the health professionals to have a sound knowledge of complementary and alternative modalities for the treatment of these chronic ailments. Oral physicians and dental health care professionals also face challenges in the management of few dental conditions as a result of resistance of oral microflora due to drug tolerance leading to persistence of symptoms and emergence of other side effects of conventional therapies. Therefore, it is often necessary for the dentists to be aware of complementary and alternative modalities which are popular, safe, effective, and economical alternative treatment regimen. Complementary medicine comprises treatment modalities such as herbal medicines, traditional Chinese medicine, naturopathy, Ayurveda, aromatherapy, homeopathy, acupuncture, magnetic field therapy, ozone therapy, Mora therapy, and many more.
Keywords: Complementary medicine, homeopathy, oral diseases
|How to cite this article:|
Misra D, Rai S, Khatri M, Misra A. Complementary Medicine − A Novel Therapeutic Approach for Oral Diseases. MAMC J Med Sci 2017;3:16-21
|How to cite this URL:|
Misra D, Rai S, Khatri M, Misra A. Complementary Medicine − A Novel Therapeutic Approach for Oral Diseases. MAMC J Med Sci [serial online] 2017 [cited 2018 May 21];3:16-21. Available from: http://www.mamcjms.in/text.asp?2017/3/1/16/201105
| Introduction|| |
With the increasing concern among patients about the adverse effects of conventional medicines’ increased resistance by bacteria to antibiotics and challenges faced by the medical personnel in managing chronic disease and their symptoms, it is becoming essential for the health professionals to have a sound knowledge of complementary and alternative modalities for the treatment of these chronic ailments. Many of these modalities and their therapeutic effects have been very well established globally and have been used since antiquity., Oral diseases are major health problems, with dental caries and periodontal diseases being the most important global infectious diseases. Oral health influences the general quality of life, and poor oral health is linked to chronic conditions and systemic diseases. The association between oral diseases and the oral microbiota is well established. Oral physicians and dental health care professionals also face challenges in the management of few dental conditions as a result of resistance of oral microflora due to drug tolerance leading to persistence of symptoms and emergence of other side effects of conventional therapies., Therefore, it is often necessary for the dentists to be aware of complementary and alternative modalities which are popular, safe, effective, and economical alternative treatment regimen.,
Complementary and alternative medicine (CAM) represents a group of diverse medical and health care systems, practices, and products that are not considered to be a part of conventional medicine. It comprises treatment modalities such as herbal medicines, traditional Chinese medicine, naturopathy, Ayurveda, aromatherapy, homeopathy, acupuncture, magnetic field therapy, ozone therapy, Mora therapy, and many more. Traditional medicine includes diverse health practices, approaches, knowledge and beliefs incorporating plant, animal, and/or mineral based medicines, spiritual therapies, manual techniques, and exercises applied singularly or in combination to maintain well being, as well as to treat, diagnose, or prevent illness.,
Classifications of Complementary and Alternative Medicine
The National Institute of Health established the National Centre for Complementary and Alternative Medicine (NCCAM) to provide leadership to the public regarding the use of CAM., NCCAM classifies CAM into five categories [Table 1].
Herbal medicine (phytomedicine or botanical medicine) consists of concentrated tincture of herbs, herbal materials, preparations, and products. It is of two basic types: one that follows the Western tradition and consists of single herb and the other that follows non-Western tradition and consists of multiple herbs. The standard tinctures used in Western tradition herbal medicines use alcohol to dissolve the plant and the final product is not diluted. These remedies are concentrated highly potent preparations and are usually taken as the unmodified liquid tincture. Other preparations used in herbal remedies include lotions and creams for topical application., Commonly used herbal medicines with proven effects supported with clinical trials have been reviewed,, [Table 2].
|Table 2: Commonly used herbal medicines with proven effects supported with clinical trials|
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Dental uses of herbal medicines:
- Herbal substances such as cinnamon bark oil, papua-mace extracts, and clove bud oil and constituents of these extracts such as cinnamic aldehyde and eugenol have cidal activity against cariogenic bacteria and inhibition of glycolytic acid production that results in dental caries.
- The use of herbal extracts from Drosera peltata (Droseraceae), Abies canadensis (Pinaceae), Albizia julibrissin (Fabaceae), Chelidonium majus (Papaveraceae), Ginkgo biloba (Ginkgoaceae), Juniperus virginiana (Cupressaceae), Pinus virginiana (Pinaceae), Rosmarinus officinalis (Lamiaceae), Sassafras albidum (Lauraceae), Tanacetum vulgare (Asteraceae), and Thuja plicata (Cupressaceae) has been effectively found against treatment for dental caries and showed broad-spectrum activity against Streptococcus mutans and S. sobrinus.,
- A boiling water extract of Coptidis rhizoma (Ranunculacea), a traditional Chinese medicinal plant, is effective against periodontitis.
- Centella asiatica and Punica granatum medical herbs promote tissue healing and modulate host immune responses in healing of periodontal tissues following scaling and root planning.
- Subgingival irrigation with herb-based mouthwash can be used as an adjunct to reduce gingival inflammation.
- Herbal remedies have a potential to impact the safety of invasive or prolonged dental procedures.
- Lippia citriodora plant extract is a herbal substance which has proven antifungal properties and is an effective antifungal drug useful for Candida albicans infection.
- Triphala plant has anticariogenic properties and is effective against cariogenic bacteria such as S. mutans by inhibiting formation of biofilm over tooth surface.
- The resin exuded by Pistacia lentiscus (Anacardiaceae), known as mastic gum, is used against oral malodor.
- Tea, Camellia sinensis (Theaceae), demonstrates anticariogenic effects through various modes of action, including bactericidal effects on oral bacteria and prevention of adherence of bacteria to tooth surfaces.,
- Xylitol, a sugar alcohol naturally found in plants, exhibits anticariogenic effects by inhibiting growth of S. mutans while not affecting other streptococci that are part of the normal oral flora.,
- Cranberry juice constituents inhibited biofilm formation responsible for dental plaque formation.,
Side effects of herbal medicines:
Harmful effects or toxicity associated with herbal medicines could be due to accidental or deliberate exposure of lead, mercury, cadmium, pesticides, microorganisms, and fumigants. Other source of toxicity is intrinsic or plant-associated. In some cases, the manufacturer ignores the known toxicity of a plant or constituent in the herbal product. Sometimes, highly concentrated or specifically processed extract causes these reactions. Common side effects associated with the use of herbal medicines are bleeding with ginkgo biloba, stomach upset, tiredness, dizziness, confusion, dry mouth, high blood pressure, arrhythmias, nervousness, headache, heart attack, stroke with sleepiness, rash, and motor dysfunction of skeletal muscles.
The basic principle of the use of homeopathy is the selection of a remedy, which, if given to an individual who is healthy, will produce a range of symptoms similar to those observed in the patients who are ill. Only minute amounts are given in the form of tablets, tinctures, and pellets. A number of homeopathic drugs have been found to be used for dental diseases, [Table 3].
Ayurvedic system of healing embraces the metaphysical and physical health and disease, happiness and sorrow, and pain and pleasure. It defines life as an expression of cosmic consciousness. Although dentistry is not a specialized branch of Ayurveda, still it is included in its system of surgery. In Ayurveda, dental health (danta swasthya in Sanskrit) is held to be very individualistic, varying with each person’s constitution (prakriti) and climatic changes resulting from solar, lunar, and planetary influences (kala-parinama).
Common Ayurvedic herbs used in dentistry:
- Chewing sticks: They have several medicinal and anticariogenic properties. Ayurveda insists on the use of herbal brushes, approximately 9 in. long and the thickness of one’s little finger. These herb sticks should be either "kashaya" (astringent), "katu" (acrid), or "tikta" (bitter) in taste. Fresh stems of neem (margosa or the Azadirachta indica) is a famous herbal chewing stick. Chewing on these stems is believed to cause attrition of teeth, stimulate salivary secretion, and help in plaque control and antibacterial action.
- The miswak (miswaak, siwak, and sewak) is a teeth cleaning twig made from a twig of the Salvadora persica tree. Almas (1999) assess antimicrobial activity of miswak chewing stick in vivo, especially on S. mutans and lactobacilli, concluded that miswak had an immediate antimicrobial effect compared to the toothbrush.
- Liquorice (Glycyrrhiza glabra) and black catechu or the cutch tree (Acacia catechu Linn.) chewing stems are recommended in patients with atrophic and receding gums. Patients with pale, hypertrophic gums and kapha dosha dominant are recommended to use stems of fever nut (Caesalipinia bonduc) and the common milkweed plant (Calotropis procera).
- Oil pulling: Involves swishing oil in the mouth for oral and systemic health benefits. It prevents decay, oral malodor, bleeding gums, dryness of the throat, and cracked lips, and it strengthens the teeth, the gums, and the jaw. Oil pulling therapy can be done using oils such as sunflower oil or sesame oil. Oil pulling can be used to clean the oral cavity in patients where brushing is contraindicated, for example, in patients with mouth ulcer, fever, indigestion, or those with tendency to vomit, asthma, and cough.
- Gandusha and Kavala Graha are two primary oral cleansing techniques, with specialized therapy to treat as well as to prevent oral diseases. In Gandusha, the oral cavity is filled completely with liquid medicine, held for about 3–5 min, and then released. In Kavala Graha, a comfortable amount of fluid is retained with the mouth closed for about 3 min, and then gargled. It is a simple rejuvenating treatment, which, when done routinely, enhances the senses, maintains clarity, brings about a feeling of freshness, and invigorates the mind. These oral cleansing techniques can also benefit bad breath, dry face, dull senses, exhaustion, anorexia, and loss of taste.
- Rasayana herb, amla (the fruit of a tree), taken orally as 1–2 g per day in capsules, has long-term benefits to the teeth and the gums by promoting healing of the gums.
- Bilberry fruit and hawthorn berry stabilize collagen and strengthen the gums.
CAM therapies such as physical therapies in conjunction with dental therapies are useful in the treatment of orofacial disorders., Acupuncture has been used as an analgesic and anesthetic agent and to treat conditions associated with chronic orofacial pain, postoperative pain, and other temporomandibular disorders. Studies have found that relaxation therapy and chiropractic treatment are the most common methods for their treatment.,,
Complementary and alternative medicine and cancer care
CAM comprises a vast array of treatment modalities that can be used in palliative and curative treatment of cancer and are beneficial for the management of patients suffering from cancer. These modalities include treatment with Ayurvedic, Siddha, Unani, and homeopathic drugs, the use of naturopathy including foods, vitamins, and herbs, and energy medicines such as reiki and manipulative and body-based practices including massage, yoga, and meditation.,
Complementary and alternative medicine and human immunodeficiency virus/acquired immune deficiency syndrome
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a chronic illness, with a range of physical symptoms and psychosocial issues. The effectiveness of the use of CAM in the management of individuals infected with HIV is remarkable; however, this is not known by many people. These treatment modalities are classified as “cure” and “care.” While the former category yields few encouraging results, the latter group of studies has more substantial results. In particular, CAM is used in the management of stress in these patients and is an effective method to increase their quality of life.
Vitamins, herbs, and supplements are the common treatment modalities, followed by prayer, meditation, and spiritual approaches in CAM used by these patients. CAM acts as a self-management approach, providing these patients with an active role in their healthcare.
| Conclusion|| |
As established by the studies quoted in this review, there are substantial data to prove that CAM has the potential to be acknowledged as a part of primary health and dental care, provided quality products and practices are ensured. The traditional and herbal medicines along with various other extracts from the plants together with other therapies can be used as preventive or treatment modalities for oral diseases. The justification for the inclusion of complementary and alternative treatment modalities for oral health practices in modern dental care could be achieved through scientific validation and more evidence-based clinical trials in dentistry.,,
Further studies of the safety and efficacy of these agents will be important to establish whether they offer therapeutic benefits, either alone or in combination with conventional therapies, which can help to reduce the overall burden of oral diseases worldwide. Countries with a history of traditional medicine should support and integrate traditional medicine into national health systems in combination with national health policy. It is also required to ensure patient’s safety by upgrading the skills and knowledge of dental practitioners. Publicity of these techniques using appropriate media would benefit the general population by giving more confidence in these ancient practices, thus preventing dental disorders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Little JW. Complementary and alternative medicine: Impact on dentistry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:137-45.
Palombo EA. Traditional medicinal plant extracts and natural products with activity against oral bacteria: Potential application in the prevention and treatment of oral diseases. Evid Based Complement Altern Med 2011; 2011:15. doi: 10.1093/ecam/nep067.680354
Najm W. Complementary and alternative medicine. In: Noble J, editor. Textbook of Primary Care Medicine. 3rd ed. St. Louis: Mosby; 2001. p. 130-70.
Tichy J, Novak J. Extraction, assay, and analysis of antimicrobials from plants with activity against dental pathogens (Streptococcus
sp.). J Altern Complement Med 1998;4:39-45.
WHO guidelines for the assessment of herbal medicines. Herbal Gram 1993;28:13-4.
Ahmad I, Mehmood Z, Mohammad F. Screening of some Indian medicinal plants for their antimicrobial properties. J Ethnopharmacol 1998;62:183-93.
Ghasempour M, Omran SM, Moghadamnia AA, Shafiee F. Effect of aqueous and ethanolic extracts of Lippia citriodora
on Candida albicans
. Electron Physician 2016;8:2752-8.
Prabhakar J, Balagopal S, Priya MS, Selvi S. Evaluation of antimicrobial efficacy of Triphala (an Indian Ayurvedic herbal formulation) and 0.2% chlorhexidine against Streptococcus mutans
biofilm formed on tooth substrate: An in vitro study. Indian J Dent Res 2014;25:475-9.
Eames S, Darby P. Homeopathy and its Ethical use in dentistry. Br Dent J 2011;210:299–301.
Newadkar UR, Chaudhari L, Khalekar YK. Homeopathy in dentistry: Is there a role? Pharmacognosy Res 2016;8:217.
Torwane NA, Hongal S, Goel P, Chandrashekhar BR. Role of Ayurveda in management of oral health. Pharmacogn Rev 2014;8:16-21.
Al-lafi T, Ababneh H. The effect of the extract of the miswak (chewing sticks) used in Jordan and the Middle East on oral bacteria. Int Dent J 1995;45:218-22.
Almas K. The antimicrobial effects of extracts of Azadirachta indica
(Neem) and Salvadora persica
(Arak) chewing sticks. Indian J Dent Res 1999;10:23-6.
Asokan S. Oil pulling therapy. Indian J Dent Res 2008;19:169.
Singh A, Purohit B. Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health. J Ayurveda Integr Med 2011;2:64-8.
Amai K, Negalur VB. Critical analysis of role of Kavala and Gandusha in the management of halitosis. J Ayurveda Holist Med 2016;4:72-9.
Hansen PE, Hansen JH. Acupuncture treatment of chronic facial pain − A controlled cross-over trial. Headache 1983;23:66-9.
Lao L. Acupuncture techniques and devices. J Altern Complement Med 1996;2:23-5.
Berman BM. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract 1999;48:213-8.
Rosted P. Introduction to acupuncture in dentistry. Br Dent J 2000;189:136-40.
Raphael KG, Klausner JJ, Nayak S, Marbach JJ. Complementary and alternative therapy use by patients with myofascial temporomandibular disorders. J Orofac Pain 2003;17:36-41.
Ramamoorthy A, Janardhanan S, Jeevakarunyam S, Jeddy N, Eagappan S. Integrative oncology in Indian subcontinent: An overview. J Clin Diagn Res 2015;9:XE01-3.
Rosenthal DS, Dean-Clower E. Integrative medicine in hematology/oncology: Benefits, ethical considerations, and controversies. Hematol Am Soc Hematol Educ Program 2005;491-97.
Cramer H, Cohen L, Dobos G, Witt CM. Integrative oncology: Best of both worlds − Theoretical, practical, and research issues. Evid Based Complement Altern Med 2013;2013:383142.
Power R, Gore-Felton C, Vosvick M, Israelski DM, Spiegel D. HIV: Effectiveness of complementary and alternative medicine. Prim Care 2002;29:361-78.
Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: Issues for patient care. AIDS Patient Care STDS 2013;27:503-10.
Ozsoy M, Ernst E. How effective are complementary therapies for HIV and AIDs? − A systematic review. Int J STD AIDS 1999;10:629-35.
Ernst E, Pittler MH. Herbal medicines. Med Clin North Am 2002;86:149-61.
Johnson NW. Complementary medicine in dentistry. Oral Dis 1998;4:69.
Goldstein BH. Unconventional dentistry: Part III. Legal and regulatory issues. J Can Dent Assoc 2000;66:503-6.
[Table 1], [Table 2], [Table 3]