International Journal of Contemporary Pediatrics

Sharma R. Int J Contemp Pediatr. 2024 Jan;11(1):83-93

http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291

DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20233966
Review Article

A review on four medicinal plants in dentistry

Reema Sharma*

Department of Pediatric and Preventive Dentistry, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan,
India

Received: 08 November 2023

Accepted: 08 December 2023

*Correspondence:
Dr. Reema Sharma,
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Dental caries and periodontal problems still remain a global health care burden. In developing and underdeveloped
countries, the unmet treatment needs of a large part of population is a challenge to the service providers. WHO
believes that oral health is a right to everyone. The use of traditional medicine helps in achieving these goals to a large
extent. Medicinal plants are a basis for conventional medicine and a substitute for them. Thus, it becomes a matter
of importance to have a greater understanding of the pharmacologically active components of the herbal components
and their various uses in dentistry. This article aims to understand the phytotherapeutic uses of four commonly used
herbal plants, miswak, moringa, triphala and neem.

Keywords: Dental caries, Herbal mouthwash, Miswak, Moringa, Triphala, Neem, Endodontic irrigant

INTRODUCTION available in English using the key words medicinal plant,

Miswak, Morinda citrifolia, Noni, neem, Azadirachta
Medicinal plants have been used in therapeutic and dental indica, Triphala, caries prevention, herbal irritants,
practices worldwide. Ancient literatures in different dentistry and pediatric dentistry.
languages and cultures have mentioned the use of various
herbs to manage different oral health issues ranging from MISWAK
dental pain ulcers to malodour.1 With all knowledge and
advances in oral health care available dental caries still Miswak, scientifically known as Salvadora persica, is a
remains major problem and both it’s incidence and species of Salvadora belonging to family
prevalence is growing in developing countries. Gum Salvadoraceae. In India, it is commonly known as arak
diseases and managing them is challenge for oral health tree, miswak, peelu, kharjal/jhank. It also serves natural
professionals especially in areas where people lack toothpaste with antibacterial, anti-caries, antiperioptic
awareness and access to health care. Herbal products due disinfectant having anti-plaque and antifungal properties.
to their ease of availability and cost effectiveness can Miswak tree is generally found in Saudi Arabia, Sudan,
greatly help in personal preventive care and community Southern Egypt, Chad, Pakistan and Eastern parts of
level of prevention. Aim was to present 4 widely popular India. Miswak is a popular chewing stick. Miswak used
medicinal plants, Azardirachta indica, Morinda citrifolia, by Babylonians 7000 years ago followed by Greek,
Salvadora persica and Triphala as they are used in Romans, Jews, Egyptians and Islamic empires. Miswak
different ways in maintaining and improving oral health. sticks are being used by majority of people who cannot
afford to buy commercial western toothbrush and
LITERATURE RESEARCH toothpaste mainly in rural areas of developing countries. 1

The Medline, PubMed and Google Scholar databases Many studies carried out to assess the efficiency and
were electronically investigated for pertinent articles potential use of the miswak in dentistry, concluded that

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 Sharma R. Int J Contemp Pediatr. 2024 Jan;11(1):83-93

miswak may offer an alternative to a toothbrush for were obtained in other studies done across different
reducing plaque and gingivitis. Studies have countries.
demonstrated the antibacterial, anti-caries, anti-
periopathic and anti-fungal properties of aqueous extracts Gingival and periodontal health
of miswak. Miswak contains more than ten different
natural chemical compounds considered essential for Sote found that regular users of miswak show decreased
good oral and dental hygiene. They are fluorides, silica, gingival bleeding on probing compared with non-miswak
tannic acid, resins, alkaloids (salvadorine), volatile oils users.12 A study on Ethiopian schoolchildren comparing
(simgrins), sulfur, vitamin C, sodium bicarbonate, miswak with conventional toothbrush found that miswak
chlorides, calcium, benzylisothoicyanate, salicylic acids, is as effective as the toothbrush in removing oral
sterols, trimethylamine, saponins and flavonoids.2 deposits. Al-Obaida et al concluded that 20% Miswak
extract is an effective antifungal and antibacterial agent
Silica in miswak acts as an abrasive material to remove against C. albicans and Enterococcus faecalis.13 Baeshen
stains on teeth.1When denture bases were treated with and Birkhed recommended to use fresh miswak
tannic acid it reduces Candida albicans counts. Miswak impregnated in 0.1% NaF or a maximum of 0.5% NaF for
exerts an astringent effect on the mucous membrane and a day for the prevention of dental caries.14 Gupta et al
reduces the clinically detectable plaque and gingivitis. compared the efficacy of miswak-incorporated toothpaste
Resins are amorphous products which are usually hard, and fluoridated toothpaste. They found that significantly
transparent or translucent. The alkaloid present greater plaque reduction was achieved with the miswak-
in S. persica is salvadorine. It exerts a bactericidal effect incorporated toothpaste compared to the conventional
and stimulatory action on the gingiva. Essential oils have fluoridated toothpaste.15
characteristic aroma, carminative and antiseptic action.
The sulfur compounds present in miswak have a Miswak-incorporated toothpaste has also been compared
bactericidal effect. Calcium saturation of saliva inhibits with other herbal toothpaste, namely the tea tree oil-
demineralization and induces the remineralization of incorporated toothpaste. Varma et al observed a
tooth enamel.3 BIT has virucidal activity (at a significantly greater reduction of plaque with miswak
concentration of 133.3 mg/ml) against herpes simplex toothpaste compared to the tea tree oil toothpaste.8
virus.1,2 It has a broad-spectrum bactericidal activity
which inhibits the growth and acid production of Wassel and Sherief investigated the efficacy of teeth
Streptococcus mutans.4 varnishes incorporated with chitosan, miswak, and
propolis in enhancing remineralization of damaged
Antibacterial enamel. Chitosan and miswak demonstrated significantly
higher remineralization compared to the control varnish,
In terms of oral health, Salvadora persica has been thus, revealing the potential of miswak in
reported to be antibacterial, antifungal, anticariogenic and remineralization of damaged enamel.16
antiplaque. Studies have reported that miswak have
potential to inhibit plaque formation and antibacterial Miswak was superior to tea tree oil in terms of plaque
action against cariogenic bacteria in the oral cavity.5-9 Al reduction. Miswak used is comparable to tooth brushing
Bagieh et al concluded that aqueous extracts of miswak for plaque reduction. Fluoridated miswak has greater
reduces growth of C. albicans at concentrations of 15% fluoride release capacity than the fluoridated toothpaste.17
or above. They also concluded that alcoholic extract is
more effective than aqueous extract for antibacterial Kabil et al incorporated miswak extract with GIC and
activity.10 compared with miswak mixed with chlorhexidne and
deionized water. After follow-up of 3, 6 and 9 months
Miswak is used in commercial preparation of a number of they concluded that miswak incorporated GIC has a
toothpastes worldwide. Some commercially available greater chance of restoration survival after ART.18
toothpaste produced from S. persica plant are as follows:
Sarkan toothpaste (UK), QualiMeswak toothpaste Tooth whitening
(Switzerland) Epident toothpaste (Egypt), Siwak- F
toothpaste (Indonesia), Fluoroswak, Miswak (Pakistan), Halib et al studied the whitening potential of miswak
DentacareMiswak Plus (Saudi Arabia), Dabur miswak extract and concluded that 0.4 and 0.5% miswak paste
and Dantkanti (India). showed potential as teeth whitening agent.19
They investigated the tooth whitening potential of
Caries prevention miswak with extracted human permanent premolar teeth
stained with tea and coffee. Miswak at different
Mustafa et al compared the DMF scores of school concentration, has no significantly different whitening
children using miswak and normal tooth brushing at effect compared to the commercial whitening toothpaste
baseline and after 2 years. They concluded that miswak used as a positive control in this study. The study with
demonstrated better caries prevention.11 Similar results combination of probiotic and miswak spray by Nasry et
al reported greater reduction in staining index with

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miswak compared to the control. However, the difference there was a reduction in the microbial contamination
was not statistically significant.20 without altering the dimensional stability of the
impression.34
Farhadian et al concluded that miswak has similar
efficacy as chlorhexidine mouthwash in improving Mouth rinse
hyperplastic gingiva in orthodontic patient.21 Chewing
gum reinforced with miswak extract can improve Oral infections like gingivitis and periodontitis affects a
gingival health even without teeth scaling.22 majority of the population worldwide. Some of the
factors predisposing to gingivitis and periodontitis
Omikhoda et al in a study on orthodontic chains found includes improper oral hygiene, systemic conditions,
that miswak mouthwash prevents force decay in pregnancy and puberty. Since the ancient times many
orthodontic chains.23 Studies by al Bayatyet al and Dorri herbal products were used in the form of tooth brush,
et al on treatment of extraction sockets with miswak toothpaste, mouth rinse, local drug delivery agents and
mouth rinse concluded that Consistent miswak used regenerative materials as an adjunct to scaling to improve
demonstrated potential to enhance new bone formation the condition of the oral cavity. Extracts from ripe noni
following teeth extraction.24 Miswak mouthwash can also fruits were used as an effective mouth rinse following
improve deteriorating gingival health resulted from mechanical debridement because of their antibacterial,
orthodontic treatment.25 anti-inflammatory properties. Improved gingival status
was observed in those who used noni mouth rinse.35,36.
In developing countries Miswak can be a good alternative
to the toothbrush since it is cost effective and readily Extracts from Noni leaves were used to induce cell
available in most rural areas. Miswak can be proliferation, protein synthesis, and matrix mineralization
recommended as an important and effective tool for in vitro studies. Hence Noni has the promising osteo-
maintenance of good oral and dental health. It also has a inductive potential bone and periodontal tissue
great potential to be used as mouthwash and can be regeneration.37,38 Noni extract was found to act on human
incorporated in chewing gums. periodontal ligament cells, thus improves initiation of
differentiation and proliferation as well as osteoblastic
NONI / MORINDA CITRIFOLIA differentiation of the bone marrow derived stem cells. 39,40
Noni extract was effectively used as a bone substitute
Noni, has been favored by many physicians because of its material in intraosseous defects in a study.41
excellent healing properties. The botanical name of the
commercially available Noni is Morinda citrifolia also Intracanal medicament
known as Indian Mulberry.26,27 Noni has gained
popularity in recent times because of its antibacterial, Intracanal medicaments help in reducing the bacteria
antiviral, antifungal, antitumor, anti-tubercular effect, remaining even after chemo-mechanical instrumentation
analgesic activity, immunological activity. Due to these and can provide an environment conducive to periapical
medicinal properties, it also consumed daily as a tissue repair. Morinda citrifolia gel, along with herbal
supplemental health drink.28,29 Noni has been considered and CHX gels, was evaluated as an intracanal
as a vital herb due to its numerous medicinal properties medicament against E. faecalis after their inoculation in
and has been recently included as a plant of interest in the extracted teeth by microbiological assessment after a
field of dentistry. period of 21 days. Results proved that M. citrifolia gel
had a better antimicrobial activity and showed second
Noni was found to be abundant in major essential best inhibition after CHX gel against E. faecalis. 42 In
components such as scopoletin, octoanoic acid, another study, M. citrifolia gel exhibited good inhibition
potassium, vitamin C, terpenoids, alkaloids, up to the 5th day of application of the gel when colony-
anthraquinones, β-sitosterol, carotene, vitamin A, flavone forming units (CFUs) were evaluated at days 1, 3, and 5.
glycosides, linoleic acid, amino acids, calcium, and This proves that M. citrifolia gel can be used as an
phosphorus.30,31 Preparations from various parts of the intracanal medicament due to its good antibacterial
plant namely bark, leaves, fruits etc. were used in many properties, which can be enhanced with sufficient contact
branches of dentistry.32 Noni juice was identified as first time of the gel with the bacteria.43 Studies also proved the
possible alternative to Sodium hypochlorite solution for efficacy of morinda extract as compared to standard
endodontic irrigation.33 irrigants like NaOCl and chlorhexidine.

Antibacterial Studies on irrigation of MCJ in deciduous teeth assessed

the administration of NaOCl and MCJ and their
Extracts of Morinda citrifolia was found to be effective effectiveness against the bacterial colonies. It was
against oral Streptococcus species because of its concluded that there is a significant reduction in CFU in
antibacterial activity. Noni extracts were added to the both types of drugs.44 According to Murray et al 6% M.
routine impression materials and then the impressions citrifolia, along with EDTA, has shown effective smear
were recorded. The recorded impressions showed that removal than 5.25% sodium hypochlorite. When MCJ is

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to be used as an endodontic irrigant, a flush of EDTA, Azadiracchtin from seed along with nimbolide from seed
followed by a final flush of MCJ, is recommended. The oil. Gallic aid and margolin are present in
MCJ can be used as an endodontic irrigant and bark.49 Neem has also been traditionally used as a skin
medicament due to its better smear layer removal moisturizer.50 Neem extract contains the concentrated
properties and antimicrobial activity. It also does not form of active or principal constituents derived from the
have any major side effects as compared with sodium parts of neem tree. These extracts should be preserved in
hypochlorite and CHX. It also helps in caries prevention their original concentrated form which could be used as
and control.45 such for the preparation of final products. These extracts
can be divided into three divisions based on their source:
Noni pulling 1. neem leaf extract 2. neem seed extract 3. neem bark
extract. Neem dental care products contains neem leaf or
Noni fruit juice was found to be effective against a lot of bark extract. Neem leaf is rich in antioxidants and helps
grams positive and gram-negative bacteria which are to boost the immune response in gum and tissues of the
responsible for a numerous oral infection. Extract mouth.51 Neem offers a good remedy for curing mouth
obtained from noni plant when used as an oral swishing ulcers, tooth decay and acts as a pain reliever in
agent was found to be efficacious for periodontal toothache problems.
disease.41
Antibacterial activity
Morinda citrifolia has been used in multiple ways. Its
antibacterial property as well as ease of procurement has Neem is a natural antibacterial agent. The antimicrobial
made it a material of choice in developing countries. effects of Neem have been reported against S.
From mouthwashes, to incorporated in toothpastes, to a mutans and S. faecalis.51 Ethanolic extract
safe endodontic irrigant to disinfecting impressions, of Neem leaves and sticks and bark exhibited significant
dentistry has a lot to look forward to from the humble antibacterial activity.52 Dried chewing sticks
noni fruit. of neem showed maximum antibacterial activity
against S. mutans compared to other dental caries-causing
NEEM organisms, S. salivarius, S. mitis, and S. sanguis.53

Neem (Azadirachta indica, A. Juss) is a tree which Anti-candidial activity

belongs to the Meliaceae family and is considered to be a
holy medicinal tree found in India. It is also known as Ethanolic and aqueous extract of Neem leaf showed
“Indian neem/margosa tree” or “Indian Lilac” and significant anti-candidial effect against C. albicans.52 A
“Persian Lilac”. It possesses a wide range of biological clinical study demonstrated the effects of the leaf aqueous
activities, such as anti-inflammatory, antimalarial, extract from Azadirachta indica (Neem) on adhesion, cell
antimicrobial, antiviral, antifungal, antipyretic, surface hydrophobicity and biofilm formation, which
antioxidant, analgesic, immune-stimulant, anti-fertility, may affect the colonization by Candida albicans.
anti-acne, anti-hypoglycemic, anti-cancer and nematicidal
properties.46 Neem is a common plant which is cultivated Anti-cariogenic activity
in various parts of India for religious and medicinal
reasons. Neem is considered to be a “village dispensary” Mango and neem extract showed antimicrobial activity
since every part of the tree including the leaves, bark, and against S. mutans, S. salivarius, S. sanguis and S. mitis.
seeds have medicinal properties. chloroform extract of neem leaf inhibited Streptococcus
mutans and Streptococcus salivarius and provides an aid
It is effective in several epidermal dysfunctions such as for treating dental caries.54 Antimicrobial activity of
acne, psoriasis, eczema. Neem leaves have been reported commercially available Himalaya herbal dental cream
to also possess antihyperglycemic, immunomodulatory, containing neem and fluoride-containing cheerio gel
anti-inflammatory, antimalarial, antioxidant, antiviral, toothpaste has been assessed in school children. The
antimutagenic and anticarcinogenic properties. Neem also study reported both the toothpastes showed a good
exhibits antibacterial, antifungal, hepatoprotective, anti- antimicrobial effect on caries producing
ulcer, anti-fertility and anti-nociceptive activity.47 salivary Streptococcus mutans.55 The toothpaste
containing neem as well as fluoridated toothpaste were
Neem twigs are used as oral deodorant, toothache reliever equally efficacious against caries-producing bacteria.
and for cleaning of teeth. Neem bark possesses Acetone extract from the bark of neem is bactericidal
antibacterial and deodorant activity. The phytochemical against S. sobrinus hence indicates its anti-cariogenic
constituents present in neem are nimbidin, nimbin, activity.56
nimbolide, Azadirachtin, gallic acid, epicatechin,
catechin, and margolone. All these exhibits potent Anti-plaque activity
antibacterial activity.48 The chief active constituent
of neem is azadirachtin, which is an effective Aqueous extract of neem stick and the gallotannin-
antimicrobial agent. Nimbidin is extracted from the leaf. enriched extract from Melaphis chinensis inhibited

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insoluble glucan synthesis and results in bacterial observed that bitter gourd demonstrated the maximum
aggregation. It reduces the ability of Streptococci to zones of inhibition, followed by neem, tulsi, and
colonize tooth surfaces.57 Neem oil shows significant calotropis for both E. faecalis and C. albicans.67
antibacterial activity and has been suggested for use in
treating dental plaque..58 Mucoadhesive dental gel Babaji et al in their in vitro analysis, concluded that
containing Azadirachta indica is found to be beneficial in herbal medicines such as neem, M. citrifolia, and A.
reducing the plaque index and salivary bacterial count vera showed inhibitory zones against E. faecalis.
comparatively better than chlorhexidine gluconate Therefore, these can be used as root canal irrigating
mouthwash.59 Studies indicate that leaf extract of A. solutions.68
indica-based mouth rinse is highly efficacious and that it
may be used as an alternative therapy in the treatment of Sundaram et al also tested the herbal irrigants including
periodontal disease.60 Studies indicate that leaf extract neem for their antibacterial efficacy and had suggested its
of A. indica-based mouth rinse is highly efficacious and potential role in the future of endodontics.69
that it may be used as an alternative therapy in the
treatment of periodontal disease. Gingivitis has been In a study conducted to evaluate the efficacy of neem gel
prevented or even reversed with regular use formulation in gingivitis patients it was found that both
of neem toothpaste and mouthwash.61 the mouth gels (neem and chlorhexidine) used in study
were effective in the reduction of plaque and gingival
Endodontic irrigant inflammation in gingivitis patients. This study
demonstrated the use of neem in treating the oral
Aim of endodontic treatment is to eliminate intracanal infections by inhibiting the plaque growth and anti-
tissue and pathogens, aided by antimicrobial substances inflammatory activity. Thus, it can be used as an adjunct
and optimized root canal obturation.57,58The isoprenoid to mechanical therapy for treating plaque induced
group (nimbin, nimbinin, nimbidinin, nimbolide and gingivitis.70
nimbidic acid) of constituents of neem has a broad range
of therapeutic and antimicrobial effects suggesting its Regular brushing with Neem-containing toothpaste will
potential as an endodontic irrigant.49,62 The use of neem reduce the deposition of plaque, prevents caries, and
as an endodontic irrigant may be advantageous because enhances the immune response for overall oral health.
neem is an excellent antioxidant with a very high Frequent usage of mouthwash containing Neem extract
biocompatibility, and thus there is no risk of tissue will lessen gingival problems, and also treats halitosis.
toxicity with its use.63 Biocompatibility of neem to the Incorporation of neem extracts in root canal medicaments
human periodontal ligament fibroblasts has already been and caries preventive gels and varnishes needs to be
proved, and this is an important factor favoring its explored more.
clinical application in endodontics.61
TRIPHALA
Bohora et al compared the antibacterial efficacy of the
neem leaf extract and 2% sodium hypochlorite against E. Triphala has been utilized in Ayurvedic (Indian)
faecalis and C. albicans. They found that there was a medicine for about 2,000 years. It’s formed from the
significant difference between the zone of inhibition of dehydrated and preserved powder of three distinctive
neem leaf extract and the 2% NaOCl against E. fruits, thus bearing the names tri meaning three and phala
faecalis and a mixed culture.64 which means fruit.71,72 Triphala is a vedic compound
made up of balanced portions of three dried astringent
Hegde et al compared the antibacterial efficacy of 2% fruits: Amalaki (Emblica officinalis), Bibhitaki
sodium hypochlorite, propolis, neem leaf extract, (Terminalia bellirica), and Haritaki (Terminalia bellirica)
turmeric and liquorice against E. faecalis and C. albicans, eaten without seed (Terminalia chebula). Triphala is a
using the agar diffusion method. They concluded in their mixture made up of equal portions of three tropical fruits
study that the neem leaf extract showed the highest zone mentioned above, all of which have the efficiency to
of inhibition against E. faecalis and C. albicans.65 reduce pain, inflammation and reverse aging.

Dutta et al in evaluated the in vivo antimicrobial efficacy Active ingredients in triphala are tannins, quinolones,
of 2.5% sodium hypochlorite and 0.2% chlorhexidine flavanols, gallic acid, vit C. Tanins mode of anti-
gluconate, and an experimental irrigant formulated from microbial action may be related to their ability to
the neem tree. It was concluded that neem had good anti- inactivate microbial adhesins, enzymes, and cell envelope
microbial efficacy and could be considered for transport proteins.73 In addition to providing a source of
endodontic use.66 In another study by Arora et stable free radicals, quinones are known to complex
al. compared the antimicrobial potential of herbal irreversibly with nucleophilic amino acids in proteins,
extracts, namely neem (Azadirachta indica), tulsi often leading to inactivation of the protein and loss of
(Ocimum sanctum), bitter gourd (Momordia charantia), function. For that reason, the potential range of quinone
and arka (Calotropis procera) were used as endodontic anti-microbial effects is great. Flavanols activity is
irrigants against E. faecalis and C. albicans. It was probably due to their ability to complex with extracellular

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and soluble proteins and to complex with bacterial cell Triphala mouthwash twice-daily combined with
walls. More lipophilic flavonoids may also disrupt metronidazole 400 mg thrice-daily when compared with
microbial membranes. These compounds have been 0.2% chlorhexidine with metronidazole 400 mg thrice-
shown to inhibit Vibrio cholera, Shigella, Streptococcus daily and triphala mouthwash with oral powder of
mutans in vitro. Inhibition of isolated bacterial triphala in a one month study showed improvement in
glucosyltransferases in S. mutans, and reduction of clinical indices in terms of reduction in tooth mobility,
fissure caries by about 40% has also been pocket depth, bleeding gums, sensitivity to hot and cold,
demonstrated.74,75 Gallic acid is a common phyto- and calculus formation with minimal recurrence in all the
constituent present in all three herbs used in Triphala. It clinical parameters.80 Triphala showed better results than
is reported to possess hepatoprotective and antioxidant Chlorhexidine. 81 6% triphala when used twice a day
activity. It also suppresses growth of cancer cells. 74 Fruit brought down the oral Streptococci count by 17% and
juice of Emblica officinalis (EO) contains the highest 44% compared to 0.2% chlorhexidine group which
vitamin C (478.56 mg/100 mL) content. showed 16% and 45% reduction at the end of 48 h and 7
days respectively suggestive of an anti-oral-Streptococci
Antibacterial efficacy of triphala comparable to that of chlorhexidine.82

Triphala has exhibited anti-bacterial activity against a Anti-oxidant effect of triphala

number of gram-positive and gram-negative human
pathogenic bacterial species. It also exhibits anti-fungal Oxidative stress has been accounted as a predisposing
and anti-viral properties. It has also shown anti- factor in various oral diseases. Disruption of balance
mutagenic/anti-carcinogenic activity, antioxidant activity, between the production of oxygen free radical species
adaptogenic and anti-anaphylactic activities, and inactivation of the same results in diseases. Phenolic
immunomodulatory activity, cytoprotective and compounds present in triphala extracts attributed to its
radioprotective activity. It is also effective in antioxidant property. Emblica officinalis exhibits
hypolipidemia/hypercholesterolemia, improving gastro- remarkable lipid peroxidation properties whereas
intestinal motility with anti-spasmodic activity, diabetes, Terminalia chebula has excellent radical scavenging
retinopathy, and wound healing.73 property. This synergistic effect makes triphala a better
antioxidant.83
Terminalia chebula is valuable in the prevention and
treatment of several diseases of the mouth such as dental Antimicrobial anti caries effect
caries, spongy and bleeding gums, gingivitis, and
stomatitis. Extract of T. chebula may be an effective Triphala has notable antimicrobial action against gram
agent in the treatment of carious teeth, owing to its ability positive and gram-negative bacteria namely
to inhibit the growth and accumulation of S. mutans on Staphylococcus aureus, Staphylococcus epidermidis,
the surface of the tooth. This would prevent the Bacillus subtilis, Escherichia coli and Pseudomonas
accumulation of acids on the surface of the tooth, and aeruginosa. About 5% solution of triphala inhibits 83.7%
thus the further demineralization and the breakdown of Streptococcus mutans. It is due to the tannic acid in
the tooth enamel.76 Triphala which gets adsorbed onto the surface of the
bacterial cell leading to protein denaturation and
Triphala as a mouth rinse ultimately to cell death. Triphala also helps in controlling
dental plaque, microbial growth and gingival
According to the Sushruta Samhita, Triphala can be used inflammation caused by the Lactobacillus and
as a gargling agent in dental diseases. Streptococcus mutans. 84

The 0.6% triphala mouthwash has shown to have In addition, one of the constituents of Triphala,
significant anti-caries activity, which is comparable to Terminalia chebula has shown significant inhibitory
that of chlorhexidine without possessing disadvantages as effect on Candida and is probably due to the gallic acid
staining of teeth and at much less cost although there was components. Triphala is also noted to possess antiviral
no evidence of re-mineralization of tooth structure.77 action against herpes simplex virus 1 (HSV-1) and
Triphala mouth rinse along with scaling and root planing cytomegalovirus and HIV. 85
showed considerable reduction in the plaque, gingival,
and oral hygiene indices of teeth at 7, 30, and 45 days Studies have shown that Terminalia chebula prevents
when compared to chlorhexidine mouth wash.78 plaque formation on the surface of the tooth by inhibiting
sucrose induced adherence and glucan induced
Triphala mouth rinse when combined with scaling and aggregation. It inhibits the growth and accumulation of
root planing showed significant reduction in the plaque, Streptococcus mutans on the surface of the tooth.86 This
gingival, and oral hygiene indices which was comparable in turn prevents the build-up of acids on the tooth surface
to reduction obtained by chlorhexidine mouth rinse in and thus prevents further demineralization. Rinsing of
combination with scaling and root planing.79 mouth with aqueous extracts of triphala has shown to
reduce total bacterial load and total Streptococcal count

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 Sharma R. Int J Contemp Pediatr. 2024 Jan;11(1):83-93

in saliva samples for up to 3 hours. Triphala mouthwash show growing concern with artificial products and side
(0.6%) has shown to have significant anticaries activity, effects of conventional therapies being used. Herbal
which is comparable to that of chlorhexidine without products are gaining importance as a safer and more
causing staining of teeth.87,88 effective caries preventive or mouthwash or a
medicament. There needs to be a better understanding of
Triphala as an analgesic and antipyretic agent the nature, variety and mechanism of action of the
products we use and may be recommending to our
Triphala has both analgesic and antipyretic action by patients in time.
blocking release of the endogenous substances that
produce pain by stimulating nerve endings which is Funding: No funding sources
similar to non-steroidal anti-inflammatory drugs.89 Conflict of interest: None declared
Ethical approval: Not required
Root canal irrigant
REFERENCES
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activity against biofilms after three and six weeks. Herbal 1. Abid Nordin, Aminuddin Bin Saim, Rozalina Ramli.
alternatives to sodium hypochlorite as root canal irrigants Miswak and oral health: An evidence-based review.
prevailed over sodium hypochlorite’s numerous negative Saudi J Biological Sci. 2020;27(7):1801-10.
qualities.72 Triphala is a safe choice to frequently used 2. Al-Ayed MSZ, Asaad AM, Qureshi MA, Attia
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alternatives (triphala and green tea polyphenols),
MTAD, and 5% sodium hypochlorite against Cite this article as: Sharma R. A review on four
Enterococcus faecalis biofilm formed on tooth medicinal plants in dentistry. Int J Contemp Pediatr
substrate: An in vitro study. J Endod. 2010;36:83-6. 2024;11:83-93.

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