背景:基于药用植物的漱口水已证明在控制斑块和炎症方面有益处,积极作用于牙龈炎患者的口腔卫生。在传统医学中,石榴已在欧洲国家用于治疗口腔疾病,亚洲,北美,和非洲。
目的:本研究旨在对石榴治疗牙龈炎的牙科应用进行全面综述。包括种族医学用途,随机临床试验分析,对牙龈卟啉单胞菌的抗菌活性,从这种植物中分离出的植物化学物质的作用机制,和临床前毒性。
方法:文献来自GoogleScholar,PubMed®,SciELO,和ScienceDirect®,自2001年发布关于该主题的第一份报告以来,直到2024年3月。
结果:一些临床试验表明,含有石榴的漱口水在治疗牙龈炎患者方面具有与氯己定相同或更好的疗效,确认传统社区使用这种植物的迹象。然而,有关该植物果实提取物的体外抗菌活性的报道尚未显示出对病原体牙龈卟啉单胞菌的临床相关性。从石榴中分离出的ellagitanninpunicalagin已显示出对几种革兰氏阳性和革兰氏阴性细菌菌株的潜力,但是,到目前为止,该化合物尚未对牙龈卟啉单胞菌进行过测试。很可能是类黄酮的作用机制,比如槲皮素,参与抑制RgpA的活性,RgpB,和牙龈卟啉单胞菌的Kgp蛋白酶。
结论:总之,从石榴获得的天然产品没有毒副作用,可以被认为是推荐用于治疗牙龈炎和其他口腔疾病的商业产品的可能替代品。
BACKGROUND: Mouthwashes based on medicinal plants have demonstrated benefits in controlling plaque and inflammation, acting positively on the oral hygiene of patients with gingivitis. In traditional medicine, Punica granatum L. has been used to treat oral diseases in countries in Europe, Asia, North America, and Africa.
OBJECTIVE: The present study aimed to conduct a comprehensive review on the dental applications of Punica granatum L. for the treatment of gingivitis, including ethnomedicinal uses, analysis of randomized clinical trials, antibacterial activity against Porphyromonas gingivalis, mechanisms of action of phytochemicals isolated from this plant, and preclinical toxicity.
METHODS: The literature was retrieved from Google Scholar, PubMed®, SciELO, and ScienceDirect®, since the first report published on the topic in 2001 until March 2024.
RESULTS: Several clinical trials have demonstrated that mouthwashes containing P. granatum have equal or better efficacy than chlorhexidine in treating patients with gingivitis, confirming the indications for use of this plant by traditional communities. However, reports on the in vitro antibacterial activity of extracts from the fruits of this plant have not shown clinical relevance against the pathogen P. gingivalis. The ellagitannin punicalagin isolated from P. granatum has shown potential against several strains of Gram-positive and Gram-negative bacteria, but, to date, this compound has not yet been tested against P. gingivalis. It is likely that the mechanisms of action of flavonoids, such as quercetin, are involved in the inhibition of the activities of the RgpA, RgpB, and Kgp proteases of P. gingivalis.
CONCLUSIONS: In summary, natural products obtained from P. granatum do not present toxic side effects and can be considered as possible substitutes of commercial products recommended for the treatment of gingivitis and other oral diseases.