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Asian Journal of Dental and Health Sciences 
Open Access to Pharmaceutical and Medical Research 

Copyright  © 2021 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
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A Review on Role of Herbal Antioxidants in Periodontitis 

Sheo Datta Maurya1, Divya Jain2, Omji Porwal3, Ram Chand Dhakar4, R. Jayakumararaj5 

1 Principal, Sarvodaya College of Pharmacy, Azamgarh, India  

2 SRG Hospital & Medical College Jhalawar, Rajasthan, India 

3 Professor, Department of Pharmacognosy, Faculty of Pharmacy, Tishk International University-Erbil, Kurdistan Region, Iraq 

4 Hospital Pharmacy, SRG Hospital & Medical College Jhalawar, Rajasthan, India-326001 

5 PG Department of Botany, Government Arts College, Melur – 625106, Madurai District, TN, India 

Article Info: 
_________________________________________ 

Article History: 

Received 07 November 2021       
Reviewed 14 December 2021 
Accepted 20 December 2022   
Published 25 December 2021   

_________________________________________ 
Cite this article as:  

Maurya SD, Jain D, Porwal O, Dhakar RC, 
Jayakumararaj R, A Review on Role of Herbal 
Antioxidants in Periodontitis, Asian Journal of 
Dental and Health Sciences. 2021; 1(1):14-18 

DOI: http://dx.doi.org/10.22270/ajdhs.v1i1.1                                  

Abstract 
___________________________________________________________________________________________________________________ 

Periodontal disease or Periodontitis is one of the common public health problems in the world and 
is most common reason of tooth loss in peoples. Periodontitis is highly prevalent and can affect up 
to 90% of the world population. Periodontitis is a gum infection that damages the soft tissues and 
bones present around tooth for support.  Herbs and their extracts have long been used as a therapy 
for various diseases in the world due to their safety & low cost. Currently herbal medicines are 
preferred due to their low cost, high safety margin and wider range of medicinal activities. Presence 
of excess free radicals results in oxidative damage of periodontal tissue. Herbal antioxidant reduces 
the deleterious action of free radicals and improves the oral health and decrease of inflammatory 
levels of periodontium. Thus, in this review we described the role of some herbal antioxidants as 
adjuvants for the management and treatment of Periodontitis. 

Keywords: Periodontitis, herbal antioxidants, free radicals, periodontium 

 

*Address for Correspondence:   

Dr. Sheo Datta Maurya, Principal, Sarvodaya College of Pharmacy, Azamgarh, India   Email: meetshiv23@gmail.com 

 

Introduction 

Herbs and their extracts have long been used as a 
therapy for various diseases in the world due to their 
safety & low cost. Currently herbal medicines are 
preferred due to their low cost, high safety margin and 
wider range of medicinal activities. 

Periodontal disease or Periodontitis is one of the 
common public health problems in the world and is 
most common reason of tooth loss in peoples. 
Periodontitis is highly prevalent and can affect up to 
90% of the world population. Periodontitis is a gum 
infection that damages the soft tissues and bones 
present around tooth for support.  The etiology is 
multifactorial with periodontopathogens forming a 
major crux in the initiation and progression of the 
disease. Plaque build-up allows the growth of anaerobic 
bacteria 1 which eventually leads to the recruitment and 
activation of neutrophils. This further results in the 
upregulation of pro-inflammatory cytokines and also 
leads to the release of neutrophilic enzymes and ROS. 
Prolonged exposure of the connective tissue to these 
insults results in the degradation and subsequent loss of 

ligamentous support and alveolar bone, eventually 
leading to tooth loss. 2 

Presence of excess free radicals results in oxidative 
damage of periodontal tissue3. Herbal antioxidant 
reduces the deleterious action of free radicals and 
improves the oral health and decrease of inflammatory 
levels of periodontium4. Numerous studies have shown 
that the total antioxidant capacity in periodontitis 
patients is significantly lower when compared to 
healthy controls. 4, 5 Thus, in this review we described 
the role of oxidative stress in periodontitis & role of 
herbal antioxidants as adjuvants for the management 
and treatment of Periodontitis. 

Role of Oxidative Stress in Periodontitis 

It is well-established that oxidative stress is an 
important cause of cell damage associated with the 
initiation and progression of many chronic diseases 6-8. 

The results of the work carried out by Ivan Borges Jr. et 
al showed an important correlation between oxidative 
stress biomarkers and periodontal disease9. 

                       Open Access                                                                          Review Article                                         DOI: http://dx.doi.org/10.22270/ajdhs.v1i1.1                              

http://jddtonline.info/
http://dx.doi.org/10.22270/ajdhs.v1i1.1
mailto:meetshiv23@gmail.com


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The exact mechanism of periodontitis development, 
including the prior agents or mediators involved, is not 
clear. Periodontitis manifests itself as a multifactor 
phenomenon, including the generation of reactive 
oxygen species (ROS) 9, 10. 

When periodontitis occurs, Reactive Oxygen Species 
(ROS), which are overproduced mostly by hyperactive 
neutrophils, could not be balanced by antioxidant 
defence system and cause tissues damage. This is 
characterized by increased metabolites of lipid 
peroxidation, DNA damage and protein damage. Local 
and systemic activities of antioxidants can also be 
influenced by periodontitis 11.  

The strong evidence linking reactive oxygen species to 
the pathological damages the soft tissues during 
periodontal disease rests on the presence of neutrophils 
infiltration as the main event in the host’s response to 
bacterial invasion 9, 12,13,14. Furthermore, hydroxyl 
radical (•OH) is most active in damaging important 
molecules such as DNA proteins and lipids, while 
hydrogen peroxide (H2O2), even not being considered a 
potent ROS, is capable of crossing the nuclear 
membrane and also damaging the DNA 15. 
Quantitatively, the main source of superoxide anion 
(O2•−) and other ROS responsible for initiation 
reactions is the respiratory chain. However, its presence 
in the periodontal soft tissue results first and foremost 
from the activation of phagocytes (neutrophils and 
macrophages), such as antibacterial agents 12, 13, 16. 

Herbs Used in Periodontitis 

Psidium guajava (Guava) 

Guava is a potential antioxidant owing to it is rich 
source of Ascorbic acid. Guava also has quercetin, 
polyphenols and carotenoids, which increase its 
antioxidant action and reduces the deleterious action of 
free radicals and improves the oral health and decrease 
of inflammatory levels of periodontium. 17, 18, 19 Guava 
leaf extracts and essential oil from the stem have the 
ability to scavenge hydrogen peroxide, superoxide anion 
and inhibit the formation of hydroxyl radical 20, 21. The 
seed of guava contains glycosides, carotenoids, phenolic 
compounds having antimicrobial actions.22 Results from 
study of H Manohar Sharma concluded that 
improvements in clinical and microbiological 
parameters showed that adjunctive use of locally 
delivered 3% P. guajava gel is effective in the 
management of chronic periodontitis. 23  

 

Figure 1: Fresh Fruits of Psidium guajava (Guava) 

Study by Varghese et al showed that guava mouth rinse 
fulfilled the requirement for an effective and useful oral 
care product with desirable substantivity and anti-
biofilm action. In addition, guava reduced the 
inflammation response in HGEK-16 and may be a 
potential oral rinse for oral anti-inflammatory therapies. 
24 

Rubia cordifolia (Indian Madder) 

R. cordifolia contain Mollugin which has shown anti-
inflammatory action 25 Results from study of Baek et al 
showed that mollugin inhibited RANKL-induced 
osteoclast differentiation and bone resorbing activity of 
mature osteoclasts. Mollugin reduced the 
phosphorylation of signaling pathways activated in the 
early stages of osteoclast differentiation, including the 
MAPK, Apt, and GSK3β and inhibited the different genes 
associated with osteoclastogenesis such as Osteoclast-
associated receptor, tartrate resistant acid phosphatase, 
ICAM-1, cathepsin K, DC-STAMP and OC-STAMP. 
Furthermore mice treated with mollugin showed 
significant restoration of lipopolysaccharideinduced 
bone loss as indicated by micro-computed tomography 
and histological analysis of femurs. 17, 26 

Results from study of Mali et al concluded that 
Arimedadi oil is equally effective to Chlorhexidine 
gluconate as an adjunct to mechanical plaque control in 
prevention of plaque accumulation and gingivitis. 
Arimedadi oil could be an effective and safe alternative 
to 2% Chlorhexidine gluconate mouthwash due to its 
prophylactic and therapeutic benefits.27 

 

Figure 2: Rubia cordifolia (Indian Madder) 

Triphala 

Triphala is an excellent herbal antioxidant that consists 
of powder of three fruits Emblica officinalis, Terminalia 
chebula and Terminalia bellirica. Ascorbic acid & 
Polyphenolic contents in Triphala are responsible for 
the antioxidant and radioprotective ability and reduce 
the oxidative stress by converting reactive oxygen free 
radicals to non-reactive products.28 T. chebula extract 
also has Anticaries activity because it inhibits the 
growth and accumulation of S. mutans on the tooth 
surface. 

 

https://www.planetayurveda.com/library/manjistha-rubia-cordifolia/


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Table 1: Botanical description of Triphala 

 Fruit 1 Fruit 2 Fruit 3 

Common Name Amla, Amalaki Black myrobalan, haritaki, harada Belliric myrobalan, bibhitaki, bahera 

Botanical Name Emblica officinalis Terminalia chebula Terminalia bellirica 

Family Phyllanthaceae Combretaceae Combretaceae 

Chemical 
constituents 

Ascorbic acid , Gallic 
Acid, and Flavones 

Ascorbic acid , Gallic Acid and 
tannic acid 

Ascorbic acid, Gallic Acid, tannic 
acid, Syringic acid and epicatechin 

 

 

Figure 3: Composition of Triphala 

 

Study by Bajaj and Tandon shown a significant 
progressive decrease in plaque scores from baseline till 
the end of 9 months in both triphala and chlorhexidine 
groups, whereas increase in plaque scores in negative 
control group. 29 Results from study by Desai et al. 
shown a significant reduction in periodontal indices in 
chlorhexidine and triphala groups who received scaling 
and root planing along with mouthwashes compared to 
a control group that received only scaling and root 
planing.30 Pratibha Mamgain et al carried out the 
comparative study of Triphala and chlorhexidine in 
treatment of gingivitis. Results from this study shows 
that Triphala and Ela decoction has similar efficacy as 
that of chlorhexidine in reducing dental biofilm build-
up, gingivitis, and halitosis. It is easy to prepare, organic, 
and relatively economical compared with chlorhexidine. 
Hence it can be used for effective plaque control, 
gingivitis control, and halitosis31 

Azadirachta indica (Neem) 

Azadirachta indica, commonly referred to as the Neem 
plant. Brushing with Neem stick after every meal and 
chewing a Neem leaves is recommended treatment for 
preventing gingivitis. 

It has shown several pharmacological action such as and 
anti-oxidant, antifungal antipyretic, antibacterial, anti-
inflammatory, antiviral, anticariogenic, antihelminthic, 
analgesic and anti-carcinogenic. Several studies have 
shown that neem is used in the treatment of dental 
caries, gingivitis and periodontitis.32, 33, 34 

Regular brushing with Neem-containing toothpaste will 
reduce the deposition of plaque, prevents caries, and 
enhances the immune response for overall oral health. 
Frequent usage of mouthwash containing Neem extract 
will lessen gingival problems, and also treats halitosis. 33 

Vennila et al used 10% neem oil as a local drug delivery 
system to evaluate the efficacy in the periodontal 
disease management. This study reported that clinical 
parameters showed statistically improved on the neem 
chip sites and presence of P. gingivalis strains were 
significantly reduced on the neem chip sites. Hence, 
10% neem oil local delivery system delivers desired 
effects on P. gingivalis. 32 

 Botelho et al., in their experiments and trials concluded 
that Azadirachta indica is highly efficacious in the 
treatment of periodontal disease thus exhibiting its 
biocompatibility with human periodontal fibroblast.33 

Based on the observations of Singh et al, it can be 
concluded that chlorhexidine gluconate as well as neem 
gel can be effectively used as an adjunct to mechanical 
plaque control in prevention of plaque and gingivitis.34 

Conclusion 

Presence of excess free radicals results in oxidative 
damage of periodontal tissue3. Herbal antioxidants are 
preferred because they reduce the deleterious action of 
free radicals and improve the oral health and decrease 
of inflammatory levels of periodontium4. It is well-
established that oxidative stress is an important cause 
of cell damage associated with the initiation and 
progression of many chronic diseases. 6, 7, 8 Many 
scientific papers reported different application of herbal 
antioxidants in dentistry In the future; it would be of 
great interest to conduct clinical trials that would 
confirm the beneficial effect. Many herbal drugs found 
suitable for the treatment of periodontal disease but 
further pharmacological studies are needed to find out 
and understand the possible toxic effects of Herbal 
drugs in order to improve their biocompatibility. Hence 

https://journals.sagepub.com/action/doSearch?target=default&ContribAuthorStored=Mamgain%2C+Pratibha


Maurya et al                                                                                                                                 Asian Journal of Dental and Health Sciences. 2021; 1(1):14-18 

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we can find out safe and effective herbs for the 
treatment of periodontal disease. 

Conflicts of Interest: 

The authors declare that there are no conflicts of 
interest in this paper. 

Financial support and sponsorship: 

Nil 

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