Periodontitis is a severe gum infection disease that leads to the destruction of the tissues supporting the teeth. The presence of bacterial plaque is one of the main etiologic factors involved in the initiation and progression of periodontitis. These bacteria secrete an innate immune response that results in a periodontal breakdown, causing decay of soft tissues and bone. The primary goal of periodontal therapy is to remove periodontal pathogens, which is usually achieved through a combination of assisting patients with adequate oral hygiene methods, and professional mechanical plaque control. However, this conventional treatment strategy is not always successful. Thus, it is not intended as a monotherapy; the addition of chemical agents as an adjunct is recommended to improve oral health. Modulating the host responses is another treatment. Chemotherapeutic agents have often been used as adjuncts but increasing incidence of failure and the development of resistance to conventional antibiotics have led to the screening of several medicinal plants for their potential antimicrobial activity and host modulating effects.
Throughout the centuries, natural products such as essential oils and other extracts of plants have been considered in the treatment of oral diseases. The World Health Organization (WHO) found that in many countries, traditional medicine practices for primary healthcare are more recognized than hospital-based conventional care.
Furthermore, many spices have been highly noted for their medicinal properties as well as their use in traditional systems of medicine for a long time. Natural plant products represent a significant source of substances to manage plaque-related diseases such as periodontitis and gingivitis. (1) One of the most effective antimicrobial medicinal herbs, widely known, is clove (Syzygium aromaticum). (2) It is a spice derived from its plant, which is known to be a natural medicine for treating various ailments including dental diseases.
The major producers of clove are the West Indies, Madagascar, Tanzania, and Zanzibar. However, Asian countries such as India, Indonesia, Sri Lanka, and Malaysia produce clove in greater quantities. For more than 2000 years, clove has been used in ancient China as a spice and fragrance. It has also been used in ancient times as a traditional remedy to treat medical conditions like dyspepsia, acute or chronic gastritis, and diarrhea.
In vitro studies, they found that clove has bacteriostatic, antiviral, antifungal, bactericidal, anti-oxidant, anti-carcinogenic, anesthetic, and analgesic properties. Clove oil has a specific anti-inflammatory property as it inhibits the cyclo-oxygenase-2 and lipo-oxygenase enzymes. (1) By using animal models, the anesthetic effects of eugenol, the key component of clove, as well as its analgesic and anti-inflammatory effects have been well documented. Anticonvulsant and anti-stress properties of eugenol have also been reported. (3)
Clove is effective against bacteria associated with dental caries, and periodontal disease as well as a large number of other bacteria. (1) Clove essential oil was reported to have a high amount of phenolic, derivatives which results in its antibacterial, antifungal, insecticidal, and antioxidant properties. (2) It reduces infection, relieves pain, and is commonly used for the relief of toothache. (8)
Eugenol is a hydroxyphenyl propene, naturally occurring in the essential oils of several plants belonging to some families, such as Lamiaceae, Lauraceae, Myrtaceae, and Myristicaceae. Eugenol is one of the major constituents of clove oil and is widely used in both foods and cosmetics as a flavoring agent. Currently, enough scientific evidence supports claims from traditional medicine that how beneficial eugenol is for human health. These effects are associated with antioxidant and anti-inflammatory activities. The studies have also found it to be antimicrobial; it reacts against fungi and a wide range of gram-negative and gram-positive bacteria. (4)
Eugenol was reported to play an important role in inhibiting the growth of bacteria. It can denature protein and react with phospholipids in the cell membrane. It also affects the transport of ions and ATP and changes the fatty acid profile of different bacteria. Antimicrobial mechanism of eugenol has been found, affecting not only the membrane but also the envelope of fungal and bacterial cells. (2)
Oral cavity pathogens include Streptococcus mutans, Streptococcus salivarius, Halobacterium sp., Veillonella sp., etc. These bacteria grow and attack the tissues causing gingivitis, which causes the gums to become red and swollen and bleed easily. Poor oral hygiene is the major cause of gum disease. Lifestyle, nutrition, and aging may eventually lead to low immune response and increase the risk of gum disease. (5) Clove and its derivatives are potent anti-plaque and anti-inflammatory agents for the treatment of periodontal disease. (1)
In a study, a crude MeOH extract of clove exhibited preferential growth-inhibitory activity against Gram-negative anaerobic periodontal oral pathogens, including Porphyromonas gingivalis and Prevotella intermedia. Based on spectroscopic evidence, eight active compounds were isolated from this extract and identified as isobiflorin, kaempferol, myricetin, biflorin rhamnocitrin, gallic acid, ellagic acid, and oleanolic acid. The antibacterial activity of these compounds was determined against Streptococcus mutans, Actinomyces viscosus, P. gingivalis, and P. intermedia. The flavones, kaempferol and myricetin, demonstrated potent growth-inhibitory activity against the periodontal pathogens P. gingivalis and P. intermedia. (6)
In a study conducted by Moon SE et. al., the major compounds of clove, eugenol and β-caryophyllene, were tested for their antimicrobial activity alone or in combination with ampicillin or gentamicin. The results suggest that the clove oil and eugenol could be employed as a natural antibacterial agent against cariogenic (causing tooth decay) and periodontal pathogenic bacteria. (7)
Clove oil was used medicinally in France for the first time (1640) as a remedy for treating toothache. (1) In dentistry, clove oil is applied in an undiluted form using a plug of cotton wool soaked in the oil and applied to the cavity of the tooth. (8) It is also used to relieve sore gums. A mixture of eugenol (the major bioactive constituent of clove) and zinc oxide is used for short-term filling of dental cavities. The clove oil is considered safe when consumed in doses (<1.5g/kg). However, the World Health Organization established the acceptable dose of clove 2.5 mg/kg/day in humans. (9)
References
1- Pulikottil, S.J., & Nath, S. (2015). Potential of clove of Syzygium aromaticum in development of a therapeutic agent for periodontal disease. A review. SADJ, 70(3), 108 – 115. Retrieved from http://www.scielo.org.za/pdf/sadj/v70n3/10.pdf
2- Pathirana, H.N.K.S., Wimalasena, S.H.M.P., De Silva, B.C.J., Hossain, S., Gang-Joon, H. (2019). Antibacterial Activity of Clove Essential Oil and Eugenol against Fish Pathogenic Bacteria Isolated from Cultured Olive Flounder (Paralichthys olivaceus). Slov Vet Res, 56 (1), 31–38. Retrieved from https://www.slovetres.si/index.php/SVR/article/view/590/254
3- Kamkar Asl, M., Nazariborun, A., & Hosseini, M. (2013). Analgesic effect of the aqueous and ethanolic extracts of clove. Avicenna Journal of Phytomedicine, 3(2), 186–192. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075701/
4- Marchese, A., Barbieri, R., Coppo, E., Erdogan Orhan, I., Daglia, M., Nabavi, S.F., & Ajami, M. (2017). Antimicrobial activity of eugenol and essential oils containing eugenol: A mechanistic viewpoint. Critical Reviews in Microbiology, 43(6), 668-689. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/1040841X.2017.1295225?src=recsys&journalCode=imby20
5- Gupta, C., Kumari, A., Garg, A.P., Catanzaro, R., Marotta, F. (2011). Comparative Study of Cinnamon Oil and Clove Oil on Someoral Microbiota. Acta Biomed, 82, 197-199. Retrieved from https://www.researchgate.net/publication/229073095_Comparative_study_of_cinnamon_oil_and_clove_oil_on_some_oral_microbiota
6- Cai. L., & Wu, C.D. (1996). Compounds from Syzygium aromaticum Possessing Growth Inhibitory Activity against Oral Pathogens. Journal of Natural Products, 59(10), 987-990. Retrieved from https://pubs.acs.org/doi/pdf/10.1021/np960451q
7- Gupta, P., & Shetty, H. (2018). Use of Natural Products for Oral Hygiene Maintenance: Revisiting Traditional Medicine. Journal of Complementary and Integrative Medicine, 15(3). Retrieved from https://www.degruyter.com/view/journals/jcim/15/3/article-20150103.xml
8- Kumar, P., Ansari, S.H. & Ali, J. (2009). Herbal Remedies for the Treatment of Periodontal Disease - A Patent Review. Recent Patents on Drug Delivery & Formulation, 3, 221-228. Retrieved from https://www.academia.edu/11906993/Herbal_remedies_for_the_treatment_of_periodontal_disease--a_patent_review
9- Hussain, S., Rahman, R., Mushtaq, A., & El Zerey-Belaskri, A. (2017). Clove: A Review of a Precious Species with Multiple Uses. International Journal of Chemical and Biochemical Sciences, 11,129-133. Retrieved from https://www.researchgate.net/publication/337821557_Clove_A_review_of_a_precious_species_with_multiple_uses
