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Aloe Vera: General and Dental Implications – Overview of Literature

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Abstract

Plants have been a major source of medicine since ancient times. Natural plant products have been used throughout human history for various purposes. Natural plant medicines have been a boon in the health care of both ancient and modern cultures. A wide range of disorders have been treated by the Indian system of holistic medicine known as " Ayurveda, " which uses mainly plant-based drugs or formulations. Aloe vera is a medicinal plant with anti-inflammatory, antimicrobial, antioxidant and immuneboosting properties. The use Aloe vera in treatment of various oral and dental conditions is increasing day by day, thereby gaining attention by the researchers. This article briefly reviews the history, mechanism of action and uses of Aloe vera in dermatological and dental conditions.
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1 Journal of Orofacial and Health Sciences 5(1), 2014
Aloe Vera: General and Dental Implications – Overview
of Literature
Shamimul Hasan
1
*, Sarah Asif
2
, Shakeba Quadri
2
ABSTRACT
Plants have been a major source of medicine since ancient times. Natural plant products have
been used throughout human history for various purposes. Natural plant medicines have been
a boon in the health care of both ancient and modern cultures. A wide range of disorders have
been treated by the Indian system of holistic medicine known as “Ayurveda,” which uses mainly
plant-based drugs or formulations. Aloe vera is a medicinal plant with anti-inflammatory,
antimicrobial, antioxidant and immuneboosting properties. The use Aloe vera in treatment of
various oral and dental conditions is increasing day by day, thereby gaining attention by the
researchers. This article briefly reviews the history, mechanism of action and uses of Aloe vera
in dermatological and dental conditions.
Keywords: Aloe vera, Dentistry, Medicinal plants
1Assistant Professor,
Department of Oral Medicine
and Radiology, Faculty of
Dentistry Jamia Millia Islamia,
New Delhi, India.
2Z.A. Dental College &
Hospitals Aligarh Muslim
University Aligarh, India.
Received : 15/02/14
Review completed : 11/03/14
Accepted : 19/03/14
INTRODUCTION
Prevention and treatment of oral infections has been
taken care by many medicinal plants and their products,
and among them Aloe vera is of particular interest and
has been used therapeutically for a long time. The name
Aloe vera is derived from the Arabic word “Alloeh”
meaning shining bitter substance and “vera” in Latin
means true. The Greek scientists considered aloe vera
as the universal panacea.
Aloe vera is a cactus plant that belongs to the Liliaceae
family. More than 300 species of aloe plants exist, but
only 2 species Aloe barbadensis Miller and Aloe
aborescens have been studied. The aloe plant is grown
in warm, tropical areas and cannot survive freezing
temperatures. The efficacy of Aloe barbadensis Miller
increases when the plant is harvested after years of
growth, but its nutritive potency decreases after 12 years
of growth. If aloe vera is exposed to sunlight for more
than hours, it will lose its complete potency (because of
easy oxidation); therefore, it is necessary to stabilize it
under pharmaceutical standards for ready use and longer
shelf life.
The Aloe barbadensis plant consists of two different
parts, each part produces substances with completely
different compositions and therapeutic properties. The
parenchymal tissue makes up the inner portion of the
aloe leaves and produces the aloe vera gel (or mucilage),
a clear, thin, tasteless, jelly-like material. This tissue is
recovered from the leaf by separating the gel from the
inner cellular debris. The other part of the plant is a group
of specialized cells known as the pericyclic tubules,
which occur just beneath the outer green rind of the leaf.
These cells produce an exudate that consists of bitter
yellow latex with powerful laxative-like actions. This
exudate which is not to be confused with the gel/
mucilage from the parenchymal leaf tissue is available
commercially for systemic ingestion to produce
catharsis.
HISTORICAL BACKGROUND
Aloe vera has been used for medicinal purposes in
several cultures for millennia: Greece, Egypt, India,
Mexico, Japan and China. Egyptian queens Nefertiti and
Cleopatra used it as part of their regular beauty regimes.
Alexander the Great and Christopher Columbus used it
Address for correspondence:
Shamimul Hasan
Email id: shamim0571@gmail.com
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2Journal of Orofacial and Health Sciences 5(1), 2014
Aloe Vera: General and Dental Implications – Overview of Literature Shamimul Hasan
et al.
to treat soldiers wounds. The first reference to aloe vera
in English was a translation by John Goodyew in 1655
A.D. of Dioscoridesí Medical treatise De Materia
Medica.
BIOLOGICAL EFFECTS
1. Wound-Healing Effects. Glucomannan, a
mannose-rich polysaccharide, and gibberellin, a growth
hormone, interact with growth factor receptors on the
fibroblast, thereby stimulating their activity and
proliferation, which in turn significantly increases
collagen synthesis after topical and oral aloe vera
treatment. Aloe gel increases the collagen content of the
wound and also alters the collagen composition (more
type III), thus increasing the collagen cross linking. This
hastens the wound contraction and increases the breaking
strength of the resultant scar tissue Reports of increased
hyaluronic acid and dermatan sulphate in the granulation
tissue of healing wound following oral or topical aloe
vera treatment has also been documented. Davis et al
noted that aloe vera gel improved wound healing by
increasing blood supply; increased oxygenation, which
results in increased fibroblast activity and collagen
proliferation.
2. Moisturizing Effects: The moisturizing effect of aloe
vera gel appears to be due to the mix of water and
polysaccharide components, creating a jelly-like
consistency that holds the water within the mix and
minimizes its evaporation, providing a sustained moist
environment when applied to drying tissues and
humectant properties that promote retention of moisture
in tissuesThe amino acid also softens the hardened skin
cells and zinc acts as an astringent to tighten pores. It
also improves skin integrity in patients with dry skin
due to occupational exposure, decreasing the appearance
of fine wrinkles and erythema.
3. Prevention of Radiation Damage to the Skin: Aloe
vera gel has been reported to have a protective effect
against radiation damage to the skin. Following the
administration of aloe vera gel, an antioxidant protein,
metallothionein, is generated in the skin, which
scavenges hydroxyl radicals and prevents suppression
of superoxide dismutase and glutathione peroxidase in
the skin. Aloe vera also reduces the formation and release
of keratinocyte-derived immunosuppressive cytokines
like interleukin-10 (IL-10) and hence prevents ultraviolet
induced suppression of delayed type hypersensitivity.
4. Anti-inflammatory Effects: Reports by various
research showed that aloe vera has anti-inflammatory
action. Fujita et al stated that carboxypeptidase in aloe
vera relieves pain by inactivating bradykinin by 67%.
Bautista et al stated that carboxypeptidase in aloe vera
inhibits prostaglandin synthesis andarachidonic acid,
thus a potent anti-inflammatory agent. Salicylate
magnesium lactate decarboxylase in aloe vera inhibits
histidine, thus preventing the formation of histamine
from histidine in mast cells. Vazquez et al stated that
aloe vera decreases edema and number of neutrophils
and also prevents the migration of poly morpho nuclear
leuocytes (PMNs). Aloe vera inhibited cyclo-oxygenase
and lipo-oxygenase pathways by inhibiting the
stimulated granulocyte matrix metalloproteinases
(MMPs). Hart et al in an in vivo study stated that aloe
vera depleted the chemical and alternate pathways of
complement activity to inhibit the production of free
oxygen radicals by activated PMNs.
5. Effects on the Immune System: Alprogen inhibit
calcium influx into mast cells, thereby inhibiting the
antigen antibody mediated release of histamine and
leukotriene from mast cells.Acemannan stimulates the
synthesis and release of IL-1 and necrosis factor from
macrophages in mice, initiating an immune response and
resulting in necrosis and regression of the cancerous
cells.
6. Antibacterial, Antifungal and Antiviral Effects: The
antimicrobial effects of aloe vera have been attributed
to the plant’s natural anthraquinones: aloe emodin,
aloetic acid, aloin, anthracine, anthranol, barbaloin,
chrysophanic acid, ethereal oil, ester of cinnamonic acid,
isobarbaloin, and resistannol. In relatively small
concentrations together with the gel fraction, these
anthraquinones provide analgesic, antibacterial,
antifungal and antiviral activity; in high concentrations,
they can be toxic. It is noteworthy that some compounds
like anthraquinones and saponin present in aloe vera gel
have direct antibacterial activities, while some other
components, such as acemannan, have been considered
to exert indirect bactericidal activity through the
stimulation of phagocytosis.
7. Anti-tumor Effects: In recent studies, a
polysaccharide fraction has shown to inhibit the binding
of benzopyrene to primary rat hepatocytes, thereby
preventing the formation of potentially cancer-initiating
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Aloe Vera: General and Dental Implications – Overview of Literature Shamimul Hasan
J et al.
Aloe vera was used in the gingivectomy sites and showed
that healing was better and faster. Aloe vera can also be
used as a local drug delivery system.
2. Wound Healing of Extraction Sites: Application of
aloe vera to the extraction sites results in proper healing
and prevention of dry socket formation. Studies
suggested that the SaliCept Patch (containing acemannan
hydrogel) resulted in significant reduction in the
incidence of alveolar osteitis as compared to
clindamycin-soaked Gelfoam.
3. Lichen Planus With Systemic Involvement: Hayes
first described the use of aloe vera juice and aloe vera
gel for the treatment of oral lichen planus. Choonhakarn
et al. used 70% aloe vera gel for lichen planus,that
healing was better and faster. Treatment regimen
involved 3 times daily drinking of 2 ounces of aloe vera
juice and topical application with aloe vera lip balm and
aloe vera cream for itching hands. Treatment caused
clearing of oral lesions within 4 weeks, although the
systemic took some longer time to clear.
4. Apthous ulcers: Studies have shown that acemannan
hydrogel accelerates the healing of aphthous ulcers and
reduces the pain associated with them. Acemannan
hydrogel is advantageous as it does not have a
disagreeable taste and texture associated with traditional
therapies and does not sting when applied. Garnick et al
evaluated the effect of a gel containing allantoin, aloe
vera and silicon dioxide on apthous ulcers of the oral
cavity. Application of the gel on the ulcers for a period
of 3 to 4 months resulted in the reduction of number,
size, duration, interval and pain associated with apthous
ulcers. A recent study using 2% aloe vera oral gel was
carried out, and it not only decreased the pain score and
wound size but also decreased the apthous wound
healing period.
5. In Denture Adhesive Formulations: The inherent
sticky/viscous nature of makes it ideal for denture
adhesive formulations. Studies have reported that
acemannan formulations of 150:1 (containing 0.05%
benzalkonium chloride, 0.1% methylparaben and 0.01%
hyamine 1622) exhibited ideal adhesive strength and pH
and minimal cytotoxicity.
6.Anti-Caries Agent: Studies using aloe vera in
toothpastes have shown that aloe vera tooth gel and the
toothpastes were equally effective against Candida
benzopyrene–deoxyribonucleic acid adducts. An
induction of glutathione S-transferase and an inhibition
of the tumour-promoting effects of phorbol myristic
acetate have also been reported, suggesting a possible
benefit of using aloe gel in cancer chemoprevention.
8. Other Effects: Aloin and aloe–emodin possess
laxative, hepatoprotective, and antineoplastic
characteristics. Saponins, which contain glycoside, are
soapy substances that have both cleansing and antiseptic
properties. Aloe vera is a potent nutraceutical, as aloe
vera gel showed a significant increase in body weight
and hematological parameters and antioxidant
properties.
GENERAL USES OF ALOE VERA
Aloe vera may be used in a variety of clinical conditions,
although controlled trials are essential to determine its
effectiveness in the following conditions:
1. Uses based on scientific evidence: These uses have
been tested in humans or animals and safety and
effectiveness have not always been proved.
Conditions: Seborrheic dermatitis, psoriasis vulgaris,
genital herpes, skin burns, diabetes type 2), HIV
infection, cancer prevention, ulcerative colitis, pressure
ulcers, mucositis, radiation dermatiti, acne vulgaris,
frostbite and constipation.
2. Uses based on tradition or theory: These have not
thoroughly been tested and safety and effectiveness have
not always been proved.
Conditions: Alopecia, bacterial and fungal skin
infections, chronic leg wounds, parasitic infections,
systemic lupus erythematosus, arthritis and tic
douloureux.
USES OF ALOE VERA IN DENTISTRY
Aloe vera is used in a variety of oral conditions.
1. Gingival and Periodontal Conditions: Periodontal
conditions show marked improvement after subgingival
administration of aloe vera gel. Aloe vera is extremely
helpful in the treatment of gum diseases like gingivitis
and periodontitis. Bleeding, inflammation and swelling
of the gums is markedly reduced. It works as a powerful
antiseptic in pockets where normal cleaning is difficult.
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4Journal of Orofacial and Health Sciences 5(1), 2014
Aloe Vera: General and Dental Implications – Overview of Literature Shamimul Hasan
et al.
albicans, Streptococcus mutans, Lactobacillus
acidophilus, Enterococcus faecalis, Prevotella
intermedia and Peptostreptococcus anaerobius. Aloe
vera tooth gel demonstrated enhanced antibacterial effect
against Streptococcus mitis. As these microorganisms
are the causative agents in dental caries, aloe vera has a
role as anti-caries agent.
7. Radiation Ulcers of Mucous Membranes: Modern
use of aloe vera was first documented in the 1930s to
heal radiation burns. Role of aloe vera in the treatment
of radiation ulcerations of the mucous membranes has
also been documented.
8. Root Canal Medicament: Aloe vera has been used
in root canal treatment as a sedative dressing and file
lubrication during biomechanical preparation.
9. Miscellaneous Uses: Aloe vera sprays can be used
for painful tooth eruptions, joint pains and throat
infections.
ADVERSE EFFECTS
Rarely, cases of reversible hepatotoxicity, contact
dermatitis, and mild itching have been documented,
although no adverse side effects of aloe vera have been
reported in humans. Risk of colorectal cancer may be
seen on prolonged use. Electrolyte imbalances (low
potassium levels) may be seen due to the plant’s laxative
property.
PRECAUTIONS
Use of aloe vera should be done with precautions during
pregnancy, lactation and in case of allergy toLiliaecea
family. Aloe vera can cause stimulation of uterine
contractions during pregnancy and during lactation, it
may cause gastrointestinal distress in the nursing infant.
CONCLUSION
Aloe vera is a natural plant that has gained importance
in cosmetic field. Dental implications of this medicinal
plant are increasing day by day, although controlled trials
are essential to determine the real efficacy.
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How to cite this article: Hasan S, Asif S and Quadri S, Aloe Vera: General
and Dental Implications – Overview of Literature. JOHS 2014; 5(1), 1-5
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... This is causing damage the cell membrane of bacteria results in bacterial lysis and death. (29,31) This result was in agreement with Prabhakar et al., 2015 (11) who evaluated the efficacy of Aloe Vera and propolis as cavity disinfecting agents for minimally invasive hand excavation of dental caries. They found Aloe Vera extracts showed a significant reduction in the bacterial counts. ...
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