| Abstract|| |
In this age of high technology, Phytotherapeutics influence the daily life of million of people around the world. More often, it had been largely ignored; some of these practices have found places in today's medical & dental knowledge. Identification & isolation of "Digoxin" from Digitalis lanata, "Reserpine"from Rauwalfa serpentina, "Vincrystin "and "Vinblastin "from Catharanthus rosea," Gutta percha "from Palaquiam species. "Eugenol "from Svgygium aromaticum are some of the examples.
Recently there have been trends of regaining faith & increasing awareness on natural products.
In Conservative Dentistry & Endodontics, variety of dental materials & medicaments are being used originated from plants.
This paper tries to trace out the natural roots of different dental materials & medicaments used in our specialty which will not only help us to know the accurate source of such ingredient but also help us to explore the possibilities of developing indigenous & economic dental materials & medicaments.
Keywords: Phytotherapeutics, Agarophytes, Alginophytes
|How to cite this article:|
Jyoti BB. Phytotherapeutics in conservative dentistry & endodontics -a review. J Conserv Dent 2005;8:31-9
| Introduction|| |
In this age of high technology, Phytotherapeutics influence the daily life of million of people around the world.
"Eugenol", part & parcel of every dental office, very commonly used to alleviate odontalgia, is derived from clove tree (Svgygium aromaticum of Myrtacea family).
The term "Phytotherapeutics" is derived from "Phyt (o)"- meaning plant, an organism of vegetable kingdom & "Therapeutics" is the science & art of healing or scientific account of the treatment of disease. Therefore, "Phytotherapeutics" means use of plants & their products in the process of treating disease directly or indirectly.
Objectives: The main objectives of this paper is to:
1) Trace out & review the dental materials & medicaments containing phytotherapeutics.
2) Know the botanical name of the plant
3) Specify the area of their availability with vernacular name if possible.
From literature survey, it is found that following phytohterapeutics are being used in our specialty. It can be broadly classified as
VII. Others. e.g. Brazilian tree extract, Neem extract etc.
I.a) Agar-agar: It is one of the important impression material giving accurate details, belongs to the category of reversible hydrocolloid, an organic hydrophilic colloid(polysaccharide), a sulfuric ester of linear polymer of galactose, extracted from red sea weed. The basic constituent of agar-agar impression is agar in a concentration of 8-15% along with other ingredient.
In true terms, agar is a "Phycocolloid" i.e. colloid derived from algae. The term agar is originated from Malay word used in double i.e. agaragar referred to jelly of certain sea weeds especially of Eucheuma muricatum.
Sea weeds that yield agar are known as agarophytes. The red sea weeds are being used as raw material for manufacturing agar.
The main genera are-Gelidium (Gelidiaceae), Gracilaria (Gracilariaceae), Ahnfeltia (Phyllophoraceae), & Pterocladia (Gelidiaceae) etc. Different species are Gelidium acerosa, Gelidium cartilagineum, Gelidium amansii, Gelidium liatutuin, Gelidium lingulatum, Gelidium pacificum, Gelidium pristoides, Gelidium sequipedale, Pterocladia capilacea, Pterocladia lucida, Ahnfeltia plicata.
Araki (1937) referred it as gel forming substance obtainable from certain species of red sea weeds called agarophytes composed of neutral gelling molecules agarose & to a lesser extent acidic non gelling molecule agaropectin. 
Dr Tseng (1945) defined agar as "The dried amorphous gelatinous nitrogenous extract from Gelidium & other agarophytes, being the sulfuric acid ester of a linear galactan in cold but soluble in hot water, one percent neutral solution of which sets at 35°- 50 o to a firm gel & melts at 80°-100°. 
In medical field, Robert Koch (1882) first used agar as culture medium in his famous experiments on tuberculosis bacteria . 
I.b)Alginate impression material: At the end of 19 th century, E.C.C. Standford (1881) , a chemist from Scotland noticed that certain brown sea weed yielded a peculiar mucous extract which he termed as "Algin".  It was done by extracting Lamineria stenophylla (Laminariaceae) with alkali. When mineral acid was added, a gelatinous precipitate was obtained which dried to a hard, horny substance. He identified this as a new acid named as "Alginic acid".
In England, 40 years later another chemist S. William Wilding received a basic patent for use of algin as a dental impression material.
Alginic acid in weed is mainly present as calcium, magnesium & sodium salts which are insoluble in water. To convert insoluble calcium & magnesium salts into soluble sodium alginate ion exchange is done under alkaline condition.
M(Alg)+ 2Na + a OH 2Na alg + M++
Algin is a brown sea weed polysaccharide, a common constituent of cell wall of the said algae. The genera & species yielding algin are known as Alginophytes. Major part of commercial algin is produced from-Macrocystis, Laminaria, Ascophyllus, Eisenia, Nereocystis, Lessonia etc.
Different species are-Mycrocystis pyrifera, Mycrocystis leukeana, Laminaria hyperborean, Laminaria digitata, Laminaria saccharina, Laminaria japonica. Ascophrllus nodosum, Lessonia sps., Ecklonia sps., Alaria sps., Durvillea sns. etc.
II. a). Copal resin: Cavity varnish is a form of solution liner ranges from 2-51 which is used as protective coating for the freshly cut tooth structure of prepared cavity. It is principally a natural gum such as Copal resin or synthetic resin dissolved in an organic solvent such as chloroform, acetone, or ether. Cavity varnish helps not only to reduce post operative sensitivity but also to reduce marginal microleakage.
Source : Copal resin is derived from a tropical incense tree native to Latin America of torchwood family (Burseraceae) botanical name being Protium copal.
Due to the presence of an aromatic chemical i.e. terpine, it is volatile & flammable. Typical fragrance of copal incense is due to the same reason. It is commonly used by Maya of Guatemala highlands. Mexican medical practitioners used it in general as well as dental pain. It can be used as stimulant if ground up with tea. Mesoamerican civilization utilized the resin for variety of purposes.
There is another topical American tree native to Caribbean, of legume family which, yield copal resin. Botanical name is Hymenea courbaril L.(Fabaceae) var. stillocarpa L., Hyrnenea stigonocapa (Mart). Vernacular names are -Jitai, Jutai, Jataiba, Farinheira.
IIb). Rosin: Rosin is basically a natural gum or solid form of resin obtained from pines & some other plants mostly conifers, produced by heating fresh liquid resin to vaporize the volatile terpene component. It is semitransparent & varies in colors from yellow to black. It is brittle in room temperature but melts at stove top temperature. Chief chemical constituent of rosin is abietic acid. It is used in manufacturing soldering fluxes.
The hydrogenated resins are obtained from the rosin hydrogenation. This process consists of adding hydrogen to a molecule, by the reaction with gaseous hydrogen, with or without the presence of a catalyst, lowering the number of double links of an unsaturated chain. hydrogenated rosin is one of the ingredient of regular as well as resin modified zinc oxide eugenol cement.
Bruaer I.M. et al(1983)  developed a cement comprising a liquid made up of vanillic ester such as n-hexyl vanillate, a chelating agent, zinc oxide, aluminium oxide & hydrogenated rosin powder. Addition of hydrogenated rosin increases the strength, improves working qualities, reduces brittleness & imparts cohesiveness to the set mass thereby decreases its solubility & disintegration in oral fluid.
Proco- sol, an endodontic root canal sealer powder constitutes 36% of this resin.
Sources: Different species of Pine tree .a)Pinus contorta (Pinaceae)- shore pine. seen in western north America, b) Pinus strodus-Eastern white pine native to eastern north America, c) Pinus nigra Austrian pine, native to central Italy, Greece, d) Pinus banksjana -Jack pine, native near the central arctic circle in Alaska south & east to great lakes of States & northern New England states, e) Pinus flexilis-Limber pine, f) Pinus resinosa-Red pine, g) Pinus sylvestris-Scot pine etc.
IIc). Gum dammar / Dammar / damar resin: It is one of the important ingredients of inlay wax, a natural resin, added to improve the smoothness in molding. It makes inlay wax more resistant to cracking & flaking, also increases the toughness of wax & enhances the luster & smoothness of the surface. It is made up of a & a resin fraction of Damarolic acid with terpenic essential oils. It is soluble in white turpentine & other hydrocarbon of aromatic family.
Sources: Basically any of various hard resins from trees of the family dipterocarpaceae of genus agathis especially the amboynas pine. (A'gathis dam'mara, Richerd). It is available in East Indies. Another tree yielding dammar resin is Shorea wiesneri from Indonesia. It is also known as cat's eye resin which is straw colored, odorless & tasteless. There are two varieties of dammar resin - brown & white.
II. d). Oleo resin: Oleo resin is one of the important constituent of variety of dental cement & endodontic sealers. Kerr (Reckert's) sealer contains 16-30% & Tubliseal contains 18.5-21.3% oleo resin. 
Source: The Elephant tree (Bursera microphvlla), a fat stemmed tree native to the Anza Borrego desert of southeastern California & south into Maxico. Another variety of tree yielding oleo resin is known as Gum mastic tree i.e. Pistacia lantiscus. It is cultivated on Greek island of Chios. As it is looking like tear drops, it is known as "Chios tear". It is also used in perfumes, chewing gum & pharmaceuticals.
IIe). Gutta -percha: It is a dried coagulated extract of plants of Palaquiam, blanco genus of Sapotaceae family. Edwin Truman introduced guttapercha into dentistry as filling material.  Hill (1847) developed first gutta percha root canal filling material known as Hill's stoping.  It is not used in its pure form for practical purposes. To give the desirable working qualities as restorative material other ingredient like white wax, zinc oxide, calcium oxide, magnesium oxide, burgundy pitch, are added  . For endodontic uses zinc oxide, metal sulfates, resin & waxes are added. It is supplied as GP stick (low heat, medium heat, high heat) for restorative & other uses & cones or points for regular endodontic use. Recently carrier GP, thermoplastisized GP, medicine coated GP are also introduced.
Sources: There are many species of Palaquiam genus that yield G P. 
I.P. ellipticum Benth, 2.P. bourdilloni, sp. Nova.
1. Leaves velvety beneath
a) P.polyanthum, Benth, b) P. guna, Burck, c) P. oblongifolium, Burk.
2. Leaves entirely glabrous i.e. smooth & bare.
a) P. ovovatum, c.b. Clarke b) P. helferi, c. b. Clarke.
III.a). Eugenol: Eugenol is the most important medicament seen in a dental office. Besides its pure form as sedative dressing, obtundent, it is used in varieties of zinc oxide eugenol cement formulations & liquid of endodontic sealers.
It is also known as allyl guaiacol or eugenic acid, an odoriferous principle, the active ingredient of oil of cloves, comprises 70-80% of its bulk. Oil of cloves has been used in the treatment of dental caries since long time & its inclusion in combination with zinc oxide in dental cements was reported over 100 years ago. Zinc oxide & its modification have found wide application in Conservative Dentistry & Endodontics ranging from temporary restoration, intermediate restoration, thermal insulating base, liners, temporary & permanent cementing material, sedative dressing, pulp capping agent to root canal sealer etc. Eugenol is the liquid constituent of different types of root canal sealer. e.g. Grossman's sealer. Kerr's sealer. Endomethasone. Proco- sol, RC-2B sealer etc. 
Eugenol is bactericidal at relatively high concentrations of 10 -2 - 10 -3 Mol/L. Although beneficial, but this high concentration is toxic to the pulp. At a low concentration, it acts as a local anesthetic due to its action on sensory nerves. Besides, it has analgesic, anti-inflammatory & antibacterial properties also.
Sources: Clove trees most commonly found in Molucca & Pemba, but can also be seen in East & West Indies, Jamaica, Mauritius & Brazil . In India it is seen in parts of Kerala. the highest spice producing state of our country. Eugenol content is highest in its flower i.e. 108,655-180,000ppm followed by leaf & stem i.e. 8500-9000ppm. 
III.b).Eucapyptus oil & Eucalyptol :It is one of the Gutta -percha solvent. Cinol & Cajuputol are the synonym for eucalyptol. Chemical formula is C 10 H 18 O. It is a cctforless, with a camphoraceous odour & a pungent, spicy cooling taste. In freezing, it solidifies to a mass of colorless crystals.
Morse & Wilcko( 1978),  Morse & Wilcko (1980)  recommended eucalyptol as a solvent to form euchapercha. It shrinks 10% less than Chloropercha as a sealer & noted that it shrinks less than gutta percha & gutta-perchalchloropercha.
Hunter, K.R. et al suggested eucalyptol as alternative for softening gutta- percha. 
Yancich, P.P. et a1 & Smith J.J. & Montgomery,S.  compared the apical seal of chloroform versus eucalyptol dipped & chloroform versus halothan dipped technique respectively.
Sources: Derived from Eucalyptus genus of trees, native of Australia & Tasmania. There are almost 600 species out of which few species are found in New Guinea & Indonesia. It is an evergreen tree. An essential oil extracted from eucalyptus tree i.e. eucalyptolis a powerful natural disinfectant. The name "Eucalyptus" means "Well Covered". Species Eucalyptus regnaus are among the tallest trees in the world. Other species are Eucalyptus paciflora, Eucalyptus loccifera, Eucalyptus subcrenulata, Eucalyptus gunnii etc. Different species of Eucalyptus trees are seen in different states of India.
III.c) Olive oil: Olive oil is one of the constituent of ordinary & resin modified zinc oxide eugenol cement & zinc oxide eugenol impression paste. It acts as a plasticizer & reduces the irritating effect of eugenol in the said cement & helps to increase the flow in the impression paste.
Source: Olive tree botanical name of which is Olea europa (Oleaceae family).
III.d). Sweet oil of Almond: lt is one of the ingredient of Proco-Sol liquid, a root canal sealer, constitute 16.7% of the liquid. 
Source:There are two varieties of almond, sweet & bitter. Former yields about 45% & later yields about 40% oil.
Botanical name: Prunus ainygdalus, Batsch var.dulci's (sweet almond), Prunus amygdalus, Batsch var.amara (Bitter almond) of Rosaceae family. Sweet variety is available in Spain, Southern France & bitter variety is available in Morocco & Sicily. Oil is expressed by cold expression method. Chemical composition is oleic acid, & small quantity of palmitic acid & myristic acid. It is seen in Jammu and Kashmir, Himachal Pradesh.
111.e) Thymol: It is one of the ingredient used as antimicrobial agent in resin reinforced zinc oxide eugenol  . Root canal sealer like Tubliseal & Endomethasone also contains thymol.
It is a white, crystalline, aromatic compound chemical formula being C 10 H 14 O It is derived from thyme oil & other oils or can be made synthetically
Source :Common thyme plant, botanical name of which is Thymus valgaris. It can also derived from biblical mint i.e. Mentha longifolia.
IV.a) Tartaric acid :It is one of the ingredient of Glass ionomer cement liquid . It increases working time but reduces the setting time. Besides distilled water, liquid used for "Anhydrous" glass ionomer is tartaric acid.
Tartaric acid was first isolated by alchemist Jabbir Ibn Hayyan from potassium tartrate  . The modern process was developed by Swedish chemist Carl Wilhelm Scheel.
Sources : It is a white crystalline organic acid found in grapes & tamarind. Grape is the fruit of vine in the Vitacea family. There are varieties of species e.g. Vitis vinifera ( wine making grapes from Europe), Vitis vilabrusca, (north American juice & table grape) Vitis riparia ( north American wild grapes), Vitis linececumii, Vitis berlandieri, Vitis cinereae, Vitis rustrisare etc.
Tamarind (Tamarindus indica, of fabacea family) is also known as Indian dates, very commonly seen in different parts of India, a tropical tree originally from east Africa but now seen in tropical Asia & Latin America. It is the provincial tree of Phetchahun province of Thialand. In Malayasia it is called "Asam" in malay.
IV.b). Maleic acid : Most of the Current Glass ionomer cement contain copolymer of poly acrylic acid like maleic acid ( other being iticonic & tricarballylic acid)which tends to increase the reactivity of the liquid , decrease the viscosity & reduce the tendency of gelation.
Source :It is a tart-testing organic acid that plays role in man% sour or tart food. Apple contains this acid which contributes to the sourness of a green apple. apple is a pomaceous fruit of plant of genus Malus of Rosaceae family. Common apple is Malus domestica or now hybrids of it is also planty. Malus sieversii is the ancestor of Malus domestica. It is found in central Asia , Kazakhstan, Tajikistan,Kyrgyzstan Xinjiang of China. Apple production is highest in India in Jammu and Kashmir & Himachal Pradesh.
IV.c)Tannic acid :Tannic acid is sometimes added to the liquid of Glass ionomer cement as it can adhere to collagen. It is a commertial form of tannin which is not a true acid but an acid like substance known as polyphenol., chemical formula being C 76 H 52 0 46 .
Source :It is present in the bark of red wood sequoias. Several species of tree with red or redish colored wood e.g.
1. Family Cupressaceae e.g. Sequoia sempervions (local name cost red wood), sequoindendron giganteum. (local name sierra red wood)
2.Family Pinaceae (cornifers)e.g. Pinus svlvestris( scot pine)
3. Family Fabaceae e.g. Casalpinia sappan (East Indian red wood), Casalpinia echinta (South Americacan red wood). Pine trees are seen in hill stations of India.
IV.d) Phosphoric acid : 37-50% of Phosphoric acid is used as acid etching gel/solution for acid etching prior to composite resin restoration. It is also known as orthophosphoric acid or phosphoric(v) acid. It is used to acidify foods & beverages Such as various colas & provides a tangy taste. It occurs as rhombic crystals or a viscous liquid melts at 42°C.
Source : It is natural constituent of many fruits & their juices  .
IV.e) Citric acid : It is used usually as weak acid to remove smear layer both in conservative dentistry as well as endodontics. Synonym: 2-hydroxy1, 2, 3-propanotricarboxylic acid.
Tidmark B.G.(1978)  & used 50% citric acid and found that it gave the cleanest dentine without smear layer.
Wayman(1979)  also reported excellent filling results after preparation with 20% citric acid followed by 2.6% Sodium hypochlorite solution & final flush of 10% citric acid solution.
Smith et al(1986)  evaluated the antimicrobial effectiveness of citric acid using two different organism. 50 % citric acid was effective in destroying the aerobic organism.
Source : Citrus fruits. Citrus fruit is a common term & genus of flowering plant in the family Rutaceae. It is originated in tropical & subtropical Southeast Asia.
Citrus media (Citron), Citrus maxima (Pomelo), Citrus reticulate (Manderine, Tangerine) yield highest proportion of citric acid.& give them characteristic astringent odor & flavour. Lemon (Citrus limonum) is very commonly seen in Indian Kitchen.
V.a) Carnauba wax: It is one of the ingredient of inlay casting wax. It is harder than other natural & many synthetic wax & has a relatively high melting point. It helps to decrease the flow at mouth temperature & increase the glossiness of the wax surface. It produces the shiny surface of gummy worms, gummy hears, jelly beans & marsh mallows & many other candies.
Source: It can be obtained from the leaf epidermidis of Brazilian canauba palm tree i.e. Copernicia prunifera of Arecaceae family. Dried leaves are beaten to dislodge the wax. Besides dental use, it is exported to other countries for other uses like car wax, floor wax, shoe polish etc.
V.b) Candelilla wax: It is also on of the ingredient of inlay wax. It provides the same properties as carnauba wax but its melting point & hardness is lower than carnauba wax.
Source: A leafless shrub of Euphorbiaceae family native to the Chinhuahuan desert along .the united states Mexican boarder, the botanical name of which is Euphorbia antisyphilitica The stems are collected & boiled in water. The waxy coating of the stem melts & floats to the surface. It is then skimmed off & allowed to harden.
VI. Antimicrobial agents used in endodontics It can be largely divided into two groups.
a) Local or Conventional antiseptics & b) Systemic or Chemotherapeutics.
As systemic antimicrobial agents have limited uses, the first group is considered as local intra-canal antiseptics. Although use of intra canal medicament is regarded as controversial, their uses have been demonstrated to be useful & beneficial in some clinical situations. They proposed to disinfect the root canal by means of antibacterial agents by reducing the peri apical inflammatory reaction & by inducing healing. Following are common groups of suggested intracanal antiseptics in endodontic procedure.
1. Alcohol, 2. Phenolic compounds, 3. Salt of heavy metals, 4. Detergents, 5. Oxidizing agents.
Because of their poor antimicrobial effect alcohol are not recommended as antiseptics. It can be used for dehydration of dentine in root canal improves the sealing ability of some endodontic sealers.
VI.1.a) Benzyl alcohol may be used for the said purpose.
Source: Clove tree (Sygygium aromaticum), Licorice (Glycyrrhiza glabra), Grapes (Vitis vinifera).
VL2.a) Phenol : Although its use is diminishing Phenol or carbolic acid was use extensively as antimicrobials in dentistry.1-2% solution is effective.
Source :Licorice root (Glycyrrhiza glabra), Tea leaf (Camelia sinensis).
V1.2b) Camphor : It is used as a vehicle & diluent to reduce the irritating effect of parachlorophenol.
Source : Camphor tree : Cinamommum camphora.
VI.2c) Creosote : It is a mixture of phenol & phenol derivatives . Guaiacol, the methyl ether of pyrocatechin constitutes 60-90% of creosote. Beechwood creosote has long been used in endodontic therapy. It is present in 1.8% in the liquid of Wach's paste , a root canal sealer.
Source : Creosote bush (Larrea tridentate).
Source of Guciacol : Celery leaf (Apium graveolens),Coffee (Coffea Arabica), Licorice root( Glycyrrhiza glabra).
Phytotherapeutics & natural medication are gradually the respect of many patients as well as health professionals.
deSilva,F.B., Almeida,J.M., desousa,S.M.G (2004)  , in their article "Natural Medication in Endodontics-A Comparative Study of the Anti inflammatory inflammatory Action." concluded that natural medicament tested may offer a good alternative for endodontic treatment. They had used Brazilian plant Casearia sylvestris & Propolis, a resin widely used in folk medicine. Propolis contains biologically active flavonoids & cinnamic acid derivatives.
Vanka, A, Tandon, S., Rao SR, Udupa N (2001)  studied the antibacterial effect of indigenous neem (Adirechta indica) muoth wash against salivery levels of Sreptococcus mutans & Lactobacilli. Their growth has been tested over a period of two months. Its effect to reverse the incipient carious lesions was assessed. While Streptococcus mutans was inhibited by neem mouth wash with or without alcohol & by chlorhexidine. Lactobacillus growth was inhibited by chlorhexidine alone. The initial data appears to prove its effect in inhibiting Streptococcus mutans & reversing incipient carious lesions. Longer clinical trial are essential.
| Conclusion|| |
Although we are not aware, we have been using many phytotherapeutics in our speciality. Systematic study & proper exploration into the problems will reveal much more details in this direction which will not only help us to know the accurate source but also to explore the possibilities in developing indigenous & economic dental materials & medicaments as most of the sources of the fore said phytotherapeutics are either available in India or other species of Indian origin exist.
| References|| |
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Borthakur Bikash Jyoti
Mahatma Gandhi Dental College & Hospital, Pondicherry
Source of Support: None, Conflict of Interest: None