INTRODUCTION:

Gingivitis is the inflammation of gum tissue caused by oral pathogenic bacteria. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. When gingivitis is not treated, it advances to “Periodontitis”. Periodontitis or pyorrhea is a set of inflammatory disease affecting the periodontium. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontal disease affects most of the adult population, with the prevalence of severe disease increasing with age (1). Periodontitis occurs at greatly different rates in different participants. The chronic forms of the disease are widespread among the population, whereas the aggressive, destructive form of the disease affects 10% of the population, resulting in serious tooth loss before old age (2).

Periodontitis is caused mainly by Gram Negative bacteria like Porphyromonas gingivalis, Aggregatibacter action mycetemcomitans and Prevotella intermedia. Porphyromonas gingivalis mainly colonize the teeth, gingival epithelial cells, and red blood cells or interact with other oral bacteria and proteins through receptors on their surfaces and adhere to it.

Signs of periodontitis:

· Loose or separating teeth.

· A change in the way the teeth fit together when one bites.

· Recurring redness, puffiness, tenderness, or swelling of gums.

· Bleeding of gums while brushing teeth, using dental floss, or biting into hard food. Gums that are pulling away (receding) from the teeth, causing them to look longer.

· Persistent bad breath.

· Persistent metal taste in the mouth.

· Pus between gums and teeth

· A sore or irritation in the mouth that does not improve within two weeks

In recent years, researchers have identified food components and food products which have disease-preventing and health-promoting benefits. Numerous naturally occurring components in fruits and vegetables have been found to prevent and treat periodontitis. The hypothesis is that higher plants and selected foods possess antimicrobial phytochemicals capable of suppressing growth and virulence factors of oral pathogens, thereby benefiting oral health. Many of the active compounds inhibited the growth, metabolism, virulence factors, acidogenicity, and accumulation of periodontal bacteria.

This article will mainly be concentrating on information related to the antibacterial activity of some fruits on periodontal bacteria causing periodontitis. Some of the fruits which have been discovered include:

a) Cranberry.

b) Pomegranate.

c) Grape/ Raisin.

DISCUSSION:

The natural fruits contain chemical compounds that prevent the adhesion of bacteria and slow down progression of the infection, but do not kill or impair the growth of bacteria.

a) Cranberry/ Vaccinium macrocarpon :

Cranberries are a group of evergreen dwarf shrubs. Raw cranberries have moderate levels of Vitamin C, dietary fibre and essential dietary mineral, manganese, as well as a balanced profile of other essential micronutrients in minor amounts (3). Cranberries are a source of polyphenol (4), complex phenolic acids and proanthocyanidins (flavanoid). Cranberry juice contains a high molecular weight non-dializable material that might inhibit formation of plaque (5).

Action:

The colonization of subgingival sites by periodonto pathogens is a critical step in initiation of periodontitis. Porphyromonas gingivalis form biofilms by expressing adhesins which allow them to adhere to host cells. The cranberry NDM fraction is a potent inhibition of biofilm formation. They inhibit the attachment of P. gingivalis to proteins such as type 1 collagen and fibrinogen (6). The cranberry NDM prevents bacterial adhesion rather than inhibiting which is important as it reduces the development of resistant bacteria. Some authors have suggested for the incorporation of cranberry extracts in tooth paste.

b) Pomegranate/ Punica granatum:

The pomegranate is a fruit-bearing deciduos shrub. Botanical name is Punica granatum. Pomegranates have a history of antibacterial use dating back to biblical times. Methanol extracts taken from the peel of the fruit contains hydrolysable tannins, ellagic acid, components of ellagitannins and gallic acid (7). Other compounds like anthocyanins and flavonols have antibacterial properties (8).

Action:

Compounds present in the pomegranate extract reduced activities related to cell injury, reduced levels of the sucrose-degrading enzyme alpha-glucosidase, and increased the activity of the enzyme ceruloplasmin which protects against oxidative stress, these results were collected from a random clinical study(9).

In other in vitro studies, pomegranate extracts inhibited strains of periodontal bacterial like Aggregatibacter actinomycetemcomitans, P. gingivalis, Prevotella intermedia (10).

In a clinical study biodegradable chips made from pomegranate extracts were impregnated subgingivally after scaling and root planning. After few months a decrease in plaque and bacterial attachment were noted. (11)

C) Grape or Raisin/ Vitis vinifera :

Grape is a fruiting berry of the deciduos woody vines. Raisins are dried grapes. Botanical name is Vitis vinifera. Raisins contain polyphenols, flavanoids, high levels of iron that may benefit human health. Polyphenols in raisins are antibacterial and antioxidative natural agents. It has been hypothesized that raisins contain antimicrobial phytochemicals capable of suppressing oral pathogens associated with caries or periodontal diseases and thus benefit oral health.

Action:

Polyphenols contribute to increase the anti-oxidant activity of oral fluids. It helps prevents periodontal tissue destruction (12).

PPs interfere with specific sites of microbial enzymes and proteins and at high concentrations they cause denaturation. PPs interact with microbial membrane proteins, enzymes and lipids of the P. gingivalis, thereby altering cell permeability and permitting the loss of protons, ions and macromolecules (13).

Thompson seedless raisins were chosen in a study because the hexane-soluble fraction of the crude methanol extracts demonstrated growth inhibitory activity against oral pathogens, the cariogenic S. mutans and the periodontopathic Porphyromonas gingivalis.

Grape seed extract (GSE) is a rich source of Proanthocyanidin (PA), which has been reported to strengthen collagen-based tissues by increasing collagen cross-links in the periodontal ligament (14).

CONCLUSION:

Oral health indicates the general wellbeing of one self and relates to the quality of life. Any problem in the oral cavity can lead to systemic disease. Many evidences are available regarding this link. Periodontal disease is one such example for the above. Periodontitis is one of the major oral diseases that affect majority of the population. This is due to ignorance of maintenance of personel oral hygiene.

One of the causes for the development of periodontitis is the oral flora present in the mouth. The Gram Negative Anaerobic bacteria are the main etiological factor for the occurrence of periodontitis. The bacteria adhere to the surface of tooth and periodontal tissue .They attach to the specific receptors on the tissue act upon by secreting bacterial enzymes that degrade the periodontal tissue.

Periodontal disease is conventionally controlled by the administration of antibiotics. But this way of treatment could increase the resistance of the bacteria to the drug and also some drugs might have side effects.

To replace the conventional method of treating periodontitis. Researchers have been done to prove that natural foods like the fruits or vegetables possess antibacterial compounds which prevent the adherence of bacteria but not inhibit its growth. This natural therapeutic treatment is more advantageous as it prevents the bacteria from becoming more resistant. Also, the natural fruits have less side effects than the synthetic drugs.

Presently clinical studies are being done, where antibacterial compounds extracted from fruits like cranberry, pomegranate, grape are used in making biodegradable chips, gels and mouth rinses which promises to be very effective in preventing periodontitis (15).

REFERENCE:

1. U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, NIH; 2000.

2. Kornman KS, Di Giovine FS. Genetic variations in cytokine expression: a risk factor for severity of adult periodontitis. Ann Periodontol. 1998;3:327–38. Medline

3. Cranberries : In-depth nutrient analysis Cranberry in-depth nutrient analysis, World's Healthiest Foods

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5. Blocking tooth decay’ Webmd.com. 2005-11-23. Retrieved 2009-11-13.

6. Labrecque, J., Bodet, C., Chandad, F., and Grenier, D.(2006). Effects of a high- molecular-weight cranberry fraction on growth, biofilm formation and adherence of Porphyromonas gingivalis. J. Antimicrob. Chemother. 58:439-443

7. M.K.Reddy, S.S. Gupta, M. R. Jacob, S. I. Khan, and D. Ferreura, “Antioxidant, antimalarial and antimicrobial activities of tannin-rich fractions, ellagitannins and phenolic acids from Punica granatum L,” Planta Medica, vol.73, no.5, pp. 461-467,2007.

8. S. Naz, R. Siddiqi, S. Ahmad, S. A. Rasool, and S. A. Sayeed, “Antibacterial activity directed isolation of compounds from Punica granatum,” Journal of Food Science, vol. 72, no. 9, pp. M341-M345,2007.

9. R. A. DiSilvestro, D.J. DiSilvestro, and D.J. DiSilvestro, “Pomegranate extract mouth rinsing effects on saliva measures relevant to gingivitis risk,” Phytotherapy Research, vol. 23, no.8,pp. 1123-1127,2009.

10. S.J. Bhadhade, A.B Archarya, S. V. Rodrigues, and S.L. Thakur, “The antiplaque efficacyof pomegranate mouthrinse,” Quintessence International, vol. 42, no.1, pp.29-36,2011.

11. G. Satravaha, G. Gassmann, P.Sangtherapitikul, and W.D. Grimm,”Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts in supportive periodontal therapy,” Journal of the International Academy of Periodontology, vol.7, no.3, pp. 70-79,2005.

12. Petti S, Scully C. Polyphenols, oral health and disease: a review. Journal of Dentistry. 2009;37:413-23

13. Fung DYC, Taylor S, Kahan J. Effects of butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT) on growth and aflatoxin production of Aspergillus flavus. Journal of Food Safety. 1977;1:39-51.

14. Bedran-Russo AK, Pereira PN, Duarte WR, Drummond JL, Yamauchi M. Application of cross linkers to dentin collagen enhances the ultimate tensile strength. J Biomed Mater Res B Appl Biomater. 2007;80:268–72. Medline.

15. Weiss, E.I., Kozlovsky,A., Steinberg, D., Lev-Dor, R., Bar Ness Greenstein, R., Feldman, M., Sharon, N., and Ofek, I. (2004). A high molecular mass cranberry constituent reduces mutans streptococci level in saliva and inhibits in vitro adhesion to hydroxyapatite. FEMS Microbiol. Lett. 232:89-92

Received on 07.12.2013 Modified on 06.01.2014

Research J. Pharm. and Tech. 7(3): Mar., 2014; Page 365-367