Journal of Dietary Supplements

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Critical Review on Eliminating Endodontic Dental

Infections Using Herbal Products

Vineet Agrawal MDS, Sonali Kapoor MDS & Isha Agrawal MDS

To cite this article: Vineet Agrawal MDS, Sonali Kapoor MDS & Isha Agrawal MDS (2017) Critical
Review on Eliminating Endodontic Dental Infections Using Herbal Products, Journal of Dietary
Supplements, 14:2, 229-240, DOI: 10.1080/19390211.2016.1207004

To link to this article: http://dx.doi.org/10.1080/19390211.2016.1207004

Published online: 11 Aug 2016.

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Journal of Dietary Supplements, 14(2):229–240, 2017
Copyright C Taylor & Francis Group, LLC
DOI: 10.1080/19390211.2016.1207004

REVIEW

Critical Review on Eliminating Endodontic Dental

Infections Using Herbal Products

Vineet Agrawal, MDS1 , Sonali Kapoor, MDS1 , & Isha Agrawal, MDS2
1
Department of Cons Endo, M. P. Dental College and ORI, Vadodara, India,
2
Department of Periodontology and Implantology, M. P. Dental, Vadodara, India

ABSTRACT. The main purpose of a root canal treatment is to eliminate the

bacteria and their products from the pulp space. Chemomechanical preparation
(chemical—refers to irrigating solutions, i.e., either synthetic chemicals or herbal solu-
tions and mechanical—refers to instrumentation of a root canals with endodontic files)
of a root canal system plays a major role in obtaining the rationale of root canal treat-
ment. Various synthetic chemicals known as endodontic irrigants play a major role in
disinfection, but also have undesirable properties like allergic potential, toxicity, unac-
ceptable taste, etc. Today there is a major change in trend towards the use of natural
herbal medicines as a part of dental treatment due to its easy availability, less toxicity,
and cost effectiveness. This article aims to provide a comprehensive review of various
herbal endodontic irrigants evaluated for their effectiveness in the disinfection of a root
canal system. This literature review is conducted using electronic databases “PubMed,”
“Google Scholar,” and “Scopus,” and articles were limited to those in the English lan-
guage and published between 1980 and 2014.

KEYWORDS. herbal medicine, Morinda citrifolia, propolis, tea tree oil, triphala

INTRODUCTION
The success of root canal therapy depends on complete eradication of micro flora,
debris, and irritants from the root canal system and prevents its recontamination.
Irrigant solutions play an important role during root canal preparation, as they aid
in the cleaning of the root canal, lubricate the files, flush out debris, have antimi-
crobial effect, provide tissue dissolution without damage to the periapical tissues,
and some have bleaching effect on teeth (Jain & Ranjan, 2014).
A wide plethora of synthetic antibacterial agents have been used over years as
endodontic irrigants. The ideal properties of a root canal irrigant are: it should be
nontoxic, should not harm the periodontal tissues, should not cause an anaphylac-
tic reaction, should possess a broad antimicrobial spectrum, should be capable of
dissolving necrotic pulp tissue, inactivating endotoxins, and either preventing the

Address correspondence to: Vineet Agrawal, 15 Sakar Bunglows, Behind Dayawadi, Akota, Vadodara, PIN-
390020, Gujarat, India. (Email: vineetdent@yahoo.co.in)
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ijds.

229
230 Agrawal et al.

formation of a smear layer or dissolving it once it has formed (Zehnder, 2006).

Sodium hypochlorite (NaOCl) is one of the most widely used endodontic irrigants
because of its ability to destroy a broad spectrum of microbes, but it has adverse
effects such as tissue toxicity, allergic potential, and disagreeable taste and inabil-
ity to remove the smear layer (Mohammadi, 2008). Other irrigants also are ineffi-
cient such as Ethylenediaminetetraacetic acid (EDTA), which does not have tissue
dissolving and disinfective ability; chlorhexidine also does not dissolve tissue and
may stain the teeth (Hulsmann, Heckendorff, & Lennon, 2003; Gomes et al., 2013).
Newer irrigants such as MTAD (Mixture of tetracycline, citric acid and detergent)
[Available as: Biopure MTAD, Dentsply Tulsa Dental, Tulsa, OK] also have some
disadvantages such as high cost, reduced shelf life, less compatibility dental pulp
cells (Singla, Garg, & Gupta, 2011). The potential side effects, safety concerns and
increased resistance to this antimicrobial solution has led to shifting to preparations
from medicinal plants (herbal alternatives).
For thousands of years, herbal or natural products have been used in dental and
medical practice and have become even more popular today due to their high an-
timicrobial activity, biocompatibility, anti-inflammatory and anti-oxidant proper-
ties (Cogulu, Uzel, & Sorkun, 2006). According to WHO (World Health Organi-
zation), herbal medicine is defined as plant derived material or preparation that
contains raw or processed ingredients from one or more plants with therapeutic
values (Parle & Bansal, 2006). Botanically speaking, a herb is any plant that lacks
the woody tissue characteristics of shrubs or trees (Pujar & Makandar, 2011).
With the increasing popularity of traditional and holistic/alternative medicines
due to their natural origin, easy availability, efficacy, safety and fewer side effects,
the aim of this review is to enlist and describe the various herbal alternatives avail-
able today for use as effective endodontic irrigants. (Figure 1).

MATERIAL AND METHODS

A literature review is conducted using electronic databases “PubMed”, “Google
Scholar” and “Scopus”, using keywords “Herbal Medicine”, “Morinda citrifolia”,
“Propolis”, “Triphala” and all other herbal irrigants mentioned below. Further,
advanced or refined search was carried out using the key words “Endodontics”,
“Root canal Therapy”, “Irrigation”, “Herbal Endodontics” and “Endodontic Dis-
infection.” Articles were limited to those in the English language and those that
were published between 1980 and 2014. A total of 215 articles were selected out
of which 55 were of no significance to us and hence not considered. Article search
was carried out systematically and reviewed by two independent reviewers.

DIFFERENT HERBAL ALTERNATIVES AS ROOT CANAL IRRIGANTS

Morinda citrifolia (Noni)

Morinda citrifolia commercially known as Noni, discovered by ancestors of Poly-
nesians, is considered as an important folkmedicine (Zhu & Woerdenbag, 1995).
It is also known as Indian Mulberry, Ba titian, Nono or Nonu, Cheese fruit and
Nhan in various cultures throughout the world. Its juice has a broad range of
 Eliminating Endodontic Dental Infection 231

FIGURE 1. Synthetic vs. Herbal root canal irrigants.

therapeutic effects including antibacterial, anti-inflammatory, antiviral, antitumor,

antihelmenthic, analgesic, hypotensive, anti-inflammatory and immune enhancing
effects (Morton, 1992). Major components showing antibacterial properties identi-
fied in Noni plant are scopoletin, octoanoic acid, potassium, vitamin C, terpenoids,
alkaloids, anthraquinones [such as nordamnacanthal, morindone, rubiadin, and
rubiadin-1-methyl ether, anthraquinone glycoside], G-sitosterol, carotene, vitamin
A, flavone glycosides, linoleic acid, Alizarin, amino acids, acubin, L-asperuloside,
caproic acid, caprylic acid, ursolic acid, rutin, and a putative proxeronine (Levand
& Larson, 1979;Neelakantan, Jagannathan, & Nazar, 2011).
An in vitro study compared the effectiveness of MCJ (M. citrifolia juice) with
NaOCl and CHX in conjunction with EDTA to remove the smear layer from the
root canal walls of instrumented teeth. It was concluded that the efficacy of M.
citrifolia was similar to NaOCl in conjunction with EDTA as an intracanal irrig-
ant (Murray et al., 2008). The antimicrobial activity of CHX, propolis, MCJ, and
Ca(OH)2 has been compared on Enterococcus faecalis infected root canal dentin
at two different depths and three intervals. Results of in vitro study showed that
propolis and M. Citrifolia were effective against E. faecalis in dentin on extracted
teeth compared to CHX and Ca(OH)2 (Kandaswamy et al., 2010). In a study con-
ducted by Prabhakar, Basavraj, & Basappa (2013) M. citrifolia was compared with
chlorhexidine as anti-microbial endodontic irrigants. From this study, M. citrifo-
lia was found to have significant anti-bacterial activity which is attributed to its
232 Agrawal et al.

contents alizarin, scopoletin, aucubin, and L-asperuloside. However, it was lower

than 0.2% Chlorhexidine. M. citrifolia was identified as a possible alternative to the
use of NaOCl as an intracanal irrigant.

Propolis
Propolis (bee glue) is a resinous material that honeybees [Apismellifera L.] collect
from various plant species and mix with wax and other substances. The chemical
composition of propolis is complex due to the variability of plant species growing
around the hive, from which the bees collect the exudates. In addition, propolis
composition can vary depending on the seasonality, illumination, altitude, collec-
tor type, and food availability and activity developed during propolis exploitation.
Flavonoids and cinnamic acid derivatives have been considered as the main pri-
mary biologically active components. Propolis exhibits a wide range of biologic
activities, including antimicrobial, anti-inflammatory, antioxidant, anesthetic and
cytotoxic properties (Ferreira, Torres, & Rosa, 2007). The anti-inflammatory prop-
erty of propolis is due to the presence of caffeic acid and phenethyl ester (CAPE)
in propolis. Propolis being a good antimicrobial and anti-inflammatory agent, can
serve as a better intracanal irrigant and intracanal medicament (Pujar & Makandar,
2011; Ferreira, Torres, & Rosa, 2007; Parolia, Thomas, & Kundabala, 2010).
In a comparative evaluation conducted by Al-Qathami and Al-Madi (2003) on
microbial efficacy of propolis, NaOCl and saline when used as intracanal irrigants
indicated that the propolis has antimicrobial activity equal to that of NaOCl. The
antibacterial efficacy of three commonly used intracanal medicaments with propo-
lis against E. faecalis has been compared by Kandaswamy et al. (2010) who con-
cluded that propolis had good in vitro antibacterial activity against E. faecalis in
the root canals, suggesting that it could be used as an alternative intracanal medica-
ment. Recently, Tyagi (Tyagi et al., 2013) studied antimicrobial efficacy of propolis,
M. citrifolia, Azadirachta indica (Neem), and 5% sodium hypochlorite on Candida
albicans biofilm formed on tooth substrate and results showed sodium hypochlo-
rite and propolis groups exhibited highest antimicrobial efficacy against C. albicans
followed by the A. indica (Neem) group and M. citrifolia (Tyagi et al., 2013). This
research by Tyagi SB determined anti-fungal activity of propolis.

Triphala and Green Tea Polyphenols

Triphala is one of the well-known Indian Ayurvedic herbal formulation consisting
of dried and powdered fruits of three medicinal plants namely Terminalia Bellerica,
Terminalia Chebula, and Emblica Officinalis. Triphala has been proven to be safe,
containing active constituents that have beneficial physiologic effect apart from
its curative property (i.e. antioxidant, antiinflammatory, antipyretic, analgesic, an-
tibacterial, antimutagenic, wound healing, anticariogenic, antistress, adaptogenic,
hypoglycemic, anticancer, chemoprotective, radioprotective, and chemopreventive
effects), and may have an added advantage over the traditional root canal irrigants
(Prabhakar, Senthikumar, & Priya, 2010).
Green tea polyphenols (GTPs) is a traditional drink of Japan and China. It is
prepared from the young shoots of tea plant Camelliasinensis (Taylor, Hamilton-
Miller, & Stapleton, 2005). The leaves from the tea plant contain polyphenolic com-
ponents with activity against a wide spectrum of microbes. Green and black teas
 Eliminating Endodontic Dental Infection 233

both contain flavonoids that inhibit the growth and activity of the bacteria asso-
ciated with tooth decay. Tea also contains natural fluoride, which may be help-
ful in preventing dental caries (Prabhakar, Senthikumar, & Priya, 2010; Taylor,
Hamilton-Miller, & Stapleton, 2005).
In an in vitro study conducted by J. Prabhakar et al., triphala and GTPs were
found to have significant anti-microbial activity against E. faecalis biofilm formed
in tooth substrate (Prabhakar, Senthikumar, & Priya, 2010). This study showed
that Triphala was as effective as NaOCl and a doxycycline-based irrigant on root
canal biofilms that were 3 weeks old. It brought about an 8 log reduction in E.
faecalis counts, when compared to saline. Moreover, triphala is also a very good
chelating agent because of the fruits that are rich in citric acid, and it holds promise
in the removal of smear layer. In another study by Madhu Pujar, Patil, & Kadam
(2011) antimicrobial efficiency of triphala, GTPs and 3% sodium hypochlorite were
compared against E. faecalis, and it was observed that triphala and GTPs showed
significantly better antibacterial activity against 2 week biofilm.
In a recent study by Garg et al., propolis, triphala, and GTPs are found to be
equally efficacious as NaOCl against E. faecalis biofilm, and they concluded that
these can be used as root canal irrigation solutions which might prove to be advan-
tageous considering several unfavorable properties of NaOCl (Garg et al., 2014).

Arctium Lappa
Arctium lappa is a plant brought from Japan and acclimated in Brazil. It has
anti-bacterial and antifungal activity, diuretic, anti-oxidant and anxiolytic action,
platelet anti-aggregating effect and HIV-inhibitory action. Arctium lappa has been
investigated against endodontic microorganisms and has shown a great microbial
inhibition which opened perspective for its use as an intracanal medication (Vianna,
Baldoqui, & Odair, 2005; Meena Kumari, Punia, & Punia, 2014).

German Chamomile
The German chamomile (Marticariarecutitia L.) has been used for centuries as a
medicinal plant mostly for its anti-inflammatory, analgesic, anti-microbial, anti-
spasmic, and sedative properties. It is an annual plant, native to Europe and West-
ern Asia, and is used in parts of the world as a table tea. It is in fact the flower
of the chamomile plant, which contains a wide variety of active chemical compo-
nents that are thought to be responsible for many of its medicinal applications. In
a SEM (Scanning Electron Microscope) study conducted to overcome the undesir-
able effects of sodium hypochlorite, it was observed that chamomile when used as
an irrigant was more effective in removing smear layer when compared to sodium
hypochlorite used alone but less effective than sodium hypochlorite combined with
EDTA (Sadr Lahijani, Raoof Kateb, & Heady, 2006).

Tea Tree Oil

Tea tree oil (Melaleuca alternifolia), is a native Australian plant with many proper-
ties such as being an antiseptic and an antifungal agent (Parle & Bansal, 2006).
It also has a mild solvent action, hence can be of potential use in dissolving
necrotic tissues during root canal therapy. Tea tree oil’s major active component is
234 Agrawal et al.

terpinen-4-ol (typically 30–40%). This compound is responsible for its antibacterial

and antifungal properties (Parle & Bansal, 2006).
In a study by Kamath et al. (2013), anti-bacterial efficacy of tea tree oil was
compared with 3% sodium hypochlorite and 2% chlorhexidine against E. faecalis.
It was found that maximum anti-microbial activity was shown by 2% chlorhexidine
followed by tea tree oil and then sodium hypochlorite (Kamath et al., 2013).

Neem (Azadirachta indica A. juss)

Neem is a commonly seen medicinal tree in India, which is considered holy and
known as “Indian neem/Margosa tree” or “Indian lilac.” In Sanskrit, it is called
“arishtha” meaning “reliever of sickness” and is regarded as the village dispen-
sary of India. Importance of neem tree has been recognized by the U.S. National
Academy of Sciences where neem is entitled as “a tree for solving global problems”
(Biswas et al., 2002). Each part of the neem tree has some medicinal property as it
has antibacterial, antifungal, antiviral, antioxidant, anti-inflammatory, antipyretic,
and analgesic and immunostimulant properties. More than 140 compounds have
been isolated from different parts of neem. Bitter taste associated with this plant
can be altered by different formulations due to the addition of sweeteners and fla-
vors to increase the patient compliance and acceptability.
Arathi et al. observed that ethanolic extract of neem had significant anti-
microbial activity against E. faecalis (Arathi et al., 2011). In another study by Ros-
aline et al., the effects of herbal extracts such as M. citrifolia, A. indica, and green tea
were studied. The most to least effective irrigants were: A. indica, sodium hypochlo-
rite, green tea, M. citrifolia, and saline. Thus, it is an effective herbal alternative to
the more commonly used irrigant sodium hypochlorite (Rosaline et al., 2013).

Turmeric (Curcuma longa)

Turmeric is extensively used as a spice, food preservative and coloring material in
India, China, and South East Asia. It has been used in traditional medicine for the
treatment of numerous diseases. C. longa, botanically related to ginger [Zingiber-
aceae family], is a perennial plant having a short stem with large oblong leaves and
bears ovate, pyriform or oblong rhizomes, which are often branched and brownish-
yellow in color. It is also considered as auspicious and is a part of religious rit-
uals. In old Hindu medicine, it is extensively used for the treatment of sprains
and swelling caused by injury (Banerjee & Nigam, 1978). In recent times, tradi-
tional Indian medicine uses turmeric powder for the treatment of biliary disorders,
anorexia, coryza, cough, diabetic wounds, hepatic disorders, rheumatism, and si-
nusitis. The coloring principle of turmeric is the main component of this plant and
is responsible for the anti-inflammatory property (Satoskar, Shah, & Shenoy, 1986).
Curcumin [diferuloylmethane], the main yellow bioactive component of turmeric
has been shown to have a wide spectrum of biological actions, including antimi-
crobial, anti-inflammatory and antioxidant activities (Neelakantan, Subbarao, &
Subbarao, 2011). Components of turmeric are named curcuminoids [curcumin
[diferuloyl methane], demethoxycurcumin, and bisdemethoxycurcumin]. These
components are polyphenols with a strong antioxidant function (Chattopadhyay
et al., 2004).
 Eliminating Endodontic Dental Infection 235

A recent report by Haukvik et al. (2010) in Phamazie, suggested that curcumin

in aqueous preparations exhibits a phototoxic effect against gram positive and
gram negative bacteria (Haukvik et al., 2010). Curcumin in surfactant preparations
showed its potential as a photosensitiser [PS] in antibacterial photodynamic ther-
apy [aPDT] in vitro. The killing effect was shown to be dependent on curcumin
concentration, radiant exposure, post-irradiation incubation time, bacteria species
and pharmaceutical preparation. The exact mechanism by which curcumin causes
light-induced cell death has not yet been established, but it is generally accepted
that a prerequisite for photo sensitization of a microbial cell is the binding of the PS
to the outer membrane (Jori & Coppellotti, 2007). In an in vitro study conducted
by Neelakantan (Neelakantan, Subbarao, & Subbarao, 2011), it has been shown
that curcumin has significant anti-bacterial activity against E. faecalis and can be
used as an alternative to sodium hypochlorite for root canal irrigation. Thus, this
herb can be used especially in endodontics for root canal failure cases. All studies
evaluating the effect of turmeric on endodontic bacteria are in vitro to date and its
efficacy in vivo has yet to be determined.

Babool (Acacia nilotica)

Also known as the gum Arabic tree, babool (Acacia nilotica) possesses good anti-
microbial, anti-oxidant, anti-fungal, anti-viral, and antibiotic activity. Khan et al.
conducted in vitro study and showed that this tree possesses anti-bacterial activ-
ity against Streptococcus mutans and E. faecalis (Khan et al., 2009). In another in
vitro study by Kumar et al., extracts of liquorice, clove, cinnamon, and babool were
investigated for their anti-microbial activity. It was shown that babool at a concen-
tration of 50% had the highest activity against E. faecalis (Kumar et al., 2011).

Aloe Vera (Aloe barbadensis miller)

Aloe vera possesses good anti-bacterial and anti-fungal activity. In an in vitro study
conducted by Sureshchandra (2011), the antimicrobial effect of water, alcohol,
chloroform extracts of aloe vera gel were investigated, and it was found that chlo-
roform extract of aloe vera had significant anti-microbial effect against E. faecalis
(Sureshchandra & Kumar, 2011). It also has been found to be effective against the
resistant microorganisms commonly found in the pulp. Although a recent in vitro
study by Sahebi et al. (2014) showed that aloe vera is not as effective as NaOCl
against E. faecalis and is not recommended as a root canal irrigator.

Meswak (Salavadora persica)

It is a medical plant whose roots, twigs or stems have been used for centuries as oral
hygiene tools in many parts of the world, particularly in Saudi Arabia. In an in vitro
study conducted by Al-Sabawi et al. (2007), alcoholic extract of Salvadora persica
was compared with 5.25% sodium hypochlorite, 0.2% chlorhexidine, and normal
saline. Fifteen percent alcoholic extract of Salvadora persica had antimicrobial ef-
fect that was equal to sodium hypochlorite and chlorhexidine when compared to
normal saline.
236 Agrawal et al.

Nutmeg (Myristica fragrans)

Myristica fragrans possesses anti-bacterial property that is mainly due to its chief
constituent myristic acid. In an in vitro study conducted by Ma et al. (2010), five
different herbal extracts were evaluated as anti-microbial endodontic irrigants. The
efficiency of the extracts in descending order was as follows: A. indica, C. Longa,
Myristica fragrans, Terminalia Chebula, and Aloe Vera.

Garlic (Allium sativum)

Its main active component is allicin which destroys the cell wall and cell membrane
of root canal bacteria and, thus, can be used as an irrigant alternative to sodium
hypochlorite (Jain & Ranjan, 2014; Ma et al., 2010). In an in vitro study conducted
by Gopalakrishnan, Rajesh, & Jotish (2014), they evaluate the antimicrobial effi-
cacy of cinnamon and garlic as endodontic irrigants against E. faecalis with compar-
ison of 5.25% sodium hypochlorite and 2% chlorhexidine. They concluded 5.25%
sodium hypochlorite and 2% chlorhexidine showed complete inhibition, whereas
cinnamon and garlic showed inhibition which suggest that they have an antimi-
crobial action but not up to the extent of sodium hypochlorite and chlorhexidine
(Gopalakrishnan, Rajesh, & Jotish, 2014).

Jieeryin Solution
This is a Chinese herbal compound with anti-bacterial, anti-inflammatory, and
detoxifying effects. Jieeryin lotion is a pure Chinese herbal compound prepara-
tion, with the main components of osthol, sophoraflavescens, cork, atractylodes,
artemsiaargyi, etc.; the agent has heat-clearing and detoxifying, antibacterial, ster-
ilization, anti-inflammatory effects, etc. Jieeryin lotion was originally mainly used
for damp-heat vaginal discharge and fungal treatment for women, trichomonas, and
non-specific vaginitis and other disorders. Because there are some oral and vaginal
similar to the ecological environment, Jieeryin as a root canal disinfection washing
fluid may play an anti-inflammatory, analgesic and promote the role of drainage.
Jieeryin lotion can be used for ultrasonic root canal irrigation; research confirms
that 30% of the concentration of the washing lotion Jieeryin has a similar effect to
the current clinically used sodium hypochlorite (Wang, Xiong, & Lin, 2006).

Aroeira-Da-Praia and Quixabeira

Edja Maria Melo de Brito Costa et al. (Edja Maria Melo de Brito Costa, 2012) stud-
ied (in vitro) antimicrobial activity and root canal cleaning potential of Aroeira-da-
praia and Quixabeira against E. faecalis. It was concluded that Aroeira-da-praia
showed antimicrobial activity at all concentrations tested, whereas Quixabeira was
effective only at 100% and 50% concentrations.

Myrtus Communis
Suliman (Suliman, 2009) studied (in vitro) the anti-bacterial effect off Myrtus com-
munis alcoholic extract solution when used as an intracanal irrigant, and it was eval-
uated and compared with the currently used root canal irrigants. It was found that
Myrus communis showed antimicrobial effect at different dilutions, the best being
 Eliminating Endodontic Dental Infection 237

TABLE 1. Safety and drug interactions

Herbs Side Effects Interacts With Interactions

Aloe vera Abdominal cramps, Diarrhea Corticosteroids Cardiovascular

Hyperactivity
Orange oil GI irritation Aspirin Increased bleeding
Green tea Irritability, Sleeplessness, anxiety, Atropine Decreased drug effect
dizziness
Chamomile Allergic Conjunctivitis Aspirin, Benzodiazepine Increased bleeding
and increased
sedation
Garlic Halitosis, Mouth ulcer, Bowel Aspirin Acetaminophen Increased Bleeding
irritation, Nausea, Bleeding
Ginger Diarrhea, Increased bleeding Aspirin Increased Bleeding

at 35% concentration. Its effect was comparable to 5.25% sodium hypochlorite and
0.2% chlorhexidine solution and showed nearly similar effect.

Spilanthes Calva DC
Dube et al. (Dube et al., 2013) compared the anti-bacterial efficacy of methanolic
extract of Spilanthes calva DC roots with 2% chlorhexidine, 3% sodium hypochlo-
rite and doxicycline at different concentrations against E. faecalis. From this in vitro
study, it was concluded that Spilanthes calva DC root extract had comparable anti-
bacterial activity to sodium hypochlorite. Thus, it may have potential as a root canal
irrigant.

SAFETY AND DRUG INTERACTIONS OF HERBAL IRRIGANTS

Herbal products are usually safe though some reports have described their adverse
effects and drug interactions as described in Table 1 (Groppo et al., 2008).

PERSPECTIVES AND CONCLUSION

The major advantages of herbal irrigants are safety, easy availability, increased
shelf life, cost effectiveness, and lack of microbial resistance so far. Today is the
era of evidence-based medicine—hence any medicine to be used on humans has to
undergo extensive research both in vitro and in vivo. The in vitro observations of
herbal products appear promising, but preclinical and clinical trials are needed to
evaluate the biocompatibility and safety factor before they can conclusively be rec-
ommended as intracanal irrigating solutions and medicaments. Herbs are generally
safe if used with proper knowledge, but they can be harmful if misused.

Declaration of Interest: The authors report no conflict of interest.

ABOUT THE AUTHORS

Dr. Vineet Agrawal is affiliated with M. P. Dental College, hospital and oral re-
search institute, and is a researcher in the field of esthetics and endodontic den-
tistry. He has been published in many national and international publications.
238 Agrawal et al.

Dr. Sonali Kapoor is affiliated with M. P. Dental College, hospital and Research
institute, and is postgraduate course director in the same institute. She is also the
head of the research committee of the institute. Dr. Isha Agrawal has done her
postgraduate work at M. P. Dental College, hospital and oral research institute in
the subject of periodontology and implantology.

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