Niha Naveed1, Karthikeyan Murthykumar2, Subasree Soundarajan3, Sripradha Srinivasan4
I year BDS1 , III year BDS2 , I yearBDS3, I yearBDS4
Saveetha Dental College and Hospitals, Chennai
Neem (Azadirachta indica ) is perhaps the most useful traditional medicinal plant in India. Each part of the neem tree has some medicinal property and is thus commercially exploitable. It is now considered as a valuable source of unique natural products for development of medicines against various diseases and also for the development of industrial products. The biological activities of some of the neem compounds isolated, pharmacological actions of the neem extracts, clinical studies and plausible medicinal applications of neem along with their safety evaluation are of utmost importance now. Neem-based mouth rinse is equally efficacious with fewer side effects as compared to chlorhexidine and may be used as an adjunct therapy in treating plaque induced gingivitis. Neem has been long considered to have an astringent, antiseptic, insecticidal, antiulcer and for medical properties. It is used for periodontitis and other dental diseases. The antibacterial activity of neem has been evaluated and known from ancient times. Other than this, the leaf extract of neem has also shown superior antiviral and antihyperglycemic activity in vitro and in vivo on animals.
The Neem tree (Azadirachta indica) has been known as the wonder tree for centuries in the Indian subcontinent. It has become important in the global context today because it offers solutions to the multiple concerns faced by mankind. Each part of the Neem tree has some medicinal property and the broad range of biologic activities and pharmacologic actions of Neem tree are very well established. Although literature search reveals that Neem tree has multiple potential uses in dentistry, its application is limited in routine dental practice. Neem finds immense use in a number of products ranging from cosmetics to agriculture and from pharmaceuticals to Ayurveda.1 Although literature search reveals that Neem tree has multiple potential uses in dentistry, its application is limited in routine dental practice. The current manuscript highlights various usage of Neem tree related to oral health and suggests including Neem derivatives in conventional dental practices. The inclusion of Neem based products into future dental practice will be a major improvement over the existing practice.
NEEM- SCIENTIFIC CLASSIFICATION:
Azadirachta indica, also known as Neem, Nimtree, and Indian Lilac is a tree in the mahogany family Meliaceae. It is one of two species in the genus Azadirachta, and is native to India, Pakistan, and Bangladesh growing in tropical and semi-tropical regions.2 The neem tree is described as Azadirachta indica as early as 1830 by De Jussieu and in taxonomic position belongs to order Rutales but recent literature describes that belongs to order Sapindales (Biswas et al, 2002) as shown below:
Kingdom : Plantae
Division : Magnoliophyta
Order : Sapindales
Family : Meliaceae
Genus : Azadirachta
Species : A. indica
DESCRIPTION OF THE PLANT:
Neem is a fast-growing tree that can reach a height of 15–20 metres (49–66 ft), rarely to 35–40 metres (115–131 ft). It is evergreen, but in severe drought it may shed most or nearly all of its leaves. The branches are wide and spreading. The fairly dense crown is roundish and may reach a diameter of 15–20 metres (49–66 ft) in old, free-standing specimens. The opposite, pinnate leaves are 20–40 centimetres (7.9–15.7 in) long, with 20 to 31 medium to dark green leaflets about 3–8 centimetres (1.2–3.1 in) long. The terminal leaflet is often missing. The petioles are short. The (white and fragrant) flowers are arranged in more-or-less drooping axillary panicles which are up to 25 centimetres (9.8 in) long. The inflorescences, which branch up to the third degree, bear from 150 to 250 flowers. An individual flower is 5–6 millimetres (0.20–0.24 in) long and 8–11 millimetres (0.31–0.43 in) wide. Protandrous, bisexual flowers and male flowers exist on the same individual tree. The fruit is a smooth (glabrous) olive-like drupe which varies in shape from elongate oval to nearly roundish, and when ripe is 1.4–2.8 centimetres (0.55–1.10 in) by 1.0–1.5 centimetres (0.39–0.59 in). The fruit skin (exocarp) is thin and the bitter-sweet pulp (mesocarp) is yellowish-white and very fibrous. The mesocarp is 0.3–0.5 centimetres (0.12–0.20 in) thick. The white, hard inner shell (endocarp) of the fruit encloses one, rarely two or three, elongated seeds (kernels) having a brown seed coat.3
ECOLOGY OF NEEM:
A.indica is said to grow ‘almost anywhere’ in the lowland tropics. Under natural conditions, it does not grow gregariously. In India, it is present in mixed forest with Acacia spp. and Dalbergiasissoo; in Indonesia, it is naturalized in lowland monsoon forest. In Africa, it is found in evergreen forest and in dry deciduous forest. Adult A. indica tolerates some frost, but seedlings are more sensitive. It quickly dies in waterlogged soils.4A. indica requires large amounts of light, but it tolerates fairly heavy shade during the 1st few years. Altitude: 0-1500 m, Mean annual temperature: Up to 40 deg. C, Mean annual rainfall: 400-1200 mm Soil type: It grows on a wide variety of neutral to alkaline soils but performs better than most species on shallow, stony, sandy soils, or in places where there is a hard calcareous or clay pan not far below the surface. It grows best on soils with a pH of 6.2-7.Neem is considered a weed in many areas, including some parts of the Middle East, and most of Sub-Saharan Africa including West Africa and Indian Ocean states. Ecologically, it survives well in similar environments to its own, but its weed potential has not been fully assessed.
IMPORTANCE OF ORAL HYGIENE:
Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems, most commonly, dental cavities, gingivitis, and bad breath. There are also oral pathologic conditions in which good oral hygiene is required for healing and regeneration of the oral tissues. These conditions included gingivitis, periodontitis, and dental trauma, such as subluxation, oral cysts, and following wisdom tooth extraction. Good oral hygiene helps to prevent cavities and stained or yellowed teeth, as well as bad breath. Bacteria in the mouth build up over time and mix with food particles and white blood cells to form a transparent, sticky film called plaque.5 The acids in the plaque break down your tooth enamel, weakening it, and allowing cavities to form. If you do not brush and floss regularly, this plaque hardens and forms tartar, a hard, yellow substance that cannot be removed easily. Tartar is not only unsightly; it also increases your chances of developing periodontal disease. Aside from benefiting your dental health and making your teeth look and feel better, good oral hygiene is essential to your overall health as well. Poor oral health has been linked to a variety of general health problems, such as heart disease and strokes. Medical researchers discover more links between oral and general health each year.6
NEEM IN DENTAL CARE:
People in both India and Africa have used neem twigs as tooth brushes for centuries. Neem twigs contain antiseptic ingredients necessary for dental hygiene. Neem powder is also used to brush teeth and massage gums. In Germany many researchers have shown that neem extracts prevent tooth decay and periodontal disease. Infections, tooth decay, bleeding and sore gums have all been treated successfully with daily use of neem mouth rinse or neem leaf extract added to the water. Some people have reported a total reversal of gum degeneration after using neem for only a few months.7
ANTIBACTERIAL EFFICIENCY OF NEEM EXTRACT ON MICRO ORGANISMS CAUSING DENTAL CARIES:
The microbial flora of the mouth is
highly complex, containing a wide variety of bacterial species. The most common
oral disease, dental caries is related to dental plaque and seem to occur when
the normal balance between the microorganisms and the host is disturbed.
Extracts from Neem sticks or bark have been shown to inhibit the growth
of Streptococcus mutans and significant reductions in
bacterial adhesion in vitro, suggesting that it can reduce the
ability of some streptococci to colonize tooth surfaces. Neem extract produced
the maximum zone of inhibition on Streptococcus mutans at 50%
concentration.8 In addition, other Streptococcus species
which are involved in the development of dental caries such as Streptococcus
salivarius, Streptococcus mitis and Streptococcus sanguis are
also inhibited by Neem extracts. A considerable antibacterial
activity of Neem aqueous extract on Lactobacillus sp has also
been noticed at higher concentrations.
NEEM EXTRACT AS A POTENT ROOT CANAL IRRIGANT:
Candida albicans and Enterococcus faecalis are the most predominant microorganisms recovered from root canals of teeth.9Thorough debridement of an infected root canal and complete elimination of microorganisms are objectives of an effective endodontic therapy. Several in vitro studies have shown that Neem leaf extract is a viable medicament against C. albicans, E. faecalis and even their mixed state. However, preclinical and clinical trials are needed to evaluate biocompatibility and safety before Neem can conclusively be recommended as an intracanal irrigating solution, but in vitro observation of Neem effectiveness appears promising.10
EFFICIENCY OF NEEM EXTRACT IN THE TREATMENT OF CHRONIC GINGIVITIS AND PERIODONTAL DISEASES:
The most effective method of prevention and maintenance of periodontal diseases is mechanical oral hygiene combined with proper professional maintenance. However in reality the degree of motivation and dexterity required for an optimal oral hygiene level may be beyond the ability of the majority of the patients. From this perspective, the utilization of antimicrobial mouth rinses has been considered as a useful adjunct to oral hygiene. Various studies have demonstrated that Azadirachta indica based mouth rinses are highly efficacious and may be used as an alternative therapy in the treatment of periodontal diseases.11 Periodontal disease is characterized by inflammation and/or destruction of supporting tissue of the teeth. The most effective method of prevention and maintenance of periodontal disease is mechanical as well as chemical plaque control. Several chemical plaque control agents have been evaluated for their effectiveness on supragingival plaque including bisbiguinaides, essential oils, enzymes, and even herbal extract.12 Some of these substances have been associated with various side effects incapacitating their long term use, so new formulation of equal efficacy and fewer side effects are required to be evaluated. For thousands of years, humans have sought to fortify their health and cure various aliments with herbal remedies. The possible mechanism of anti inflammatory action of neem is by inhibiting prostaglandin E and 5 HT and thus reducing the inflammation.13 The antibacterial action can be explained by “Azadiachtin” that is known to destroy bacterial cell wall and thus inevitably inhibit the growth of bacteria, also the breakdown of cell wall disturb osmotic pressure and leads to cell death. But still, its use of treatment for gingivitis and perodontitis is not very clear. Hence, aim of the present study was “to assess the anti-gingivitis and antiplaque properties of an A. indica based mouthrinse in plaque induced gingivitis.”14,15
USAGE OF NEEM EXTRACT IN ORAL CARE INDUSTRY:
Neem bark is used as an active ingredient in a number of tooth pastes and tooth powders because of its antibacterial properties. It's usage are proven to be beneficial for tooth and gums health. Herbal ingredients like Neem tree extracts have become very popular in last few years not only because of their therapeutic value but also because of no adverse side effects. Neem's pain-relieving compounds will reduce the discomfort of a toothache. The vasodilation and anti-inflammatory compounds will reduce the pressure on nerves that can cause the toothache.16 Brushing with neem toothpaste after every meal and using a mouthwash with neem extract is recommended treatment for preventing and correcting gingivitis. Neem extracts have helped millions of people in south Asia to avoid cavities despite a very limited access to modern dental care. Regular brushing with neem toothpaste and rinsing with neem mouthwash destroys cavity-causing bacteria, enhances mouth immunity, prevents tartar/plaque build up and subsequently freshens breath. Neem toothpastes and mouthwashes prevent cavities, heal gum diseases and rejuvenate the tissues of the mouth.17 Neem contains one of the strongest natural analgesics known, results will be very apparent within 4-5 Days. One of the amazing traits of Neem is its ability to prevent cell adhesion and hence with regular use plaque becomes evident in only very small amounts.18
ANTI-CARCINOGENIC PROPERTIES OF NEEM EXTRACTS:
Isolated components of Neem tree have shown impressive efficacy against cancer cells and in boosting the body's immune response against carcinogenesis. Various mechanisms have been suggested in this context such as boosting the lymphocytic and cell mediated immunity, including the natural killer cells, which are able to destroy viruses, bacteria and cancer cells. Neem extracts can also protect against chemically induced carcinogenesis and liver damage by increasing the antioxidant levels of body.19
Various other important therapeutic effects have been associated to Neem extract like treating diabetes mellitus, improving liver functions, neuroprotective effects, stress and ulcer reduction, treatment of sexually transmitted diseases, skin diseases and malaria. The best information is that Neem may be helpful in prevention and cure of acquired immune deficiency syndrome (AIDS). It may be possibly treated by ingesting whole Neem leaves or Neem tree extracts.20 As oral health is deeply related to overall systemic health of the individuals, management of various systemic diseases will automatically improve the oral health.
Neem helps to prevent and heal gum disease, prevent cavities, eliminate bacteria that cause cavities and inflammation of the gums, prevent bacteria from adhering to your teeth (reduce plaque), enhance mouth immunity in general, and through all this freshen the breath. Neem, has pain-relieving compounds that can reduce the discomfort of a toothache. The vasodilatation and anti-inflammatory compounds in neem prevent cell adhesion and kill the bacteria that cause tooth decay. Neem alkalizes the gums and mouth, and kills the bacteria that cause Pyorrhea and Gingivitis. Neem obliterates the calcium-forming organisms and the organisms that cause cavities. Neem is 'arista,' which in Sanskrit means “perfect, complete, and imperishable.” Neem has been used in Ayurvedic traditions for thousands of years in agriculture, food storage, and medicine. Many research studies prove that neem is fungicidal, miticidal, and antibacterial. Neem oil is an ideal remedy to eliminate periodontal and tooth infection. It can be applied locally around the teeth and gums and also benefits the gastrointestinal tract.
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18. Canadian Journal of Botany, 1990, 68(1): 1-11, 10.1139/b90-001
19. Journal of Ethnopharmacology, Volume 67, Issue 2, November 1999, Pages 189–195
20. Current Medicinal Chemistry - Anti-Cancer Agents, Volume 5, Number 2, March 2005, pp. 149-156(8)
Received on 09.05.2014 Modified on 01.06.2014
Accepted on 10.06.2014 © RJPT All right reserved