Exploring the Potential of Plant-Based Remedies in Periodontal Treatment: A Mini Review

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Exploring the Potential of Plant-Based Remedies in Periodontal Treatment: A Mini Review

   

Shervin Molayem1*, Carla Cruvinel Pontes2

1Periodontist; Private Practice, Director of the Mouth Body Research Institute, Los Angeles, California, USA
2Researcher, Mouth-Body Research Institute, Cape Town, South Africa

*Corresponding author: Periodontist; Private Practice, Director of the Mouth Body Research Institute, Los Angeles, California, USA.

Citation: Molayem S, Pontes CC. (2023) Exploring the Potential of Plant-Based Remedies in Periodontal Treatment: A Mini Review. J Oral Med and Dent Res. 4(2):1-14.

Received: June 12, 2023 | Published: July 03, 2023

Copyright©2023 by Molayem S, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 

DOI: http://doi.org/10.52793/JOMDR.2023.4(2)-36

Abstract

Periodontal diseases pose a significant challenge to oral and general health with their multifactorial etiology and complex pathogenesis. Traditional treatment approaches primarily rely on mechanical debridement and periodontal surgery. However, emerging research has sparked interest in the potential of phytochemicals in natural remedies in periodontics. This mini-review aims to summarize the current scientific evidence on the use of various plant-based remedies in periodontics. Through an examination of herbal extracts, essential oils, plant-based formulations, and other natural products, this mini-review sheds light on their antimicrobial, anti-inflammatory, antioxidant, and immunomodulatory properties. Additionally, the review discusses the potential applications, side effects, limitations, and future perspectives concerning the integration of natural remedies as adjuncts in periodontal care.

 

Keywords

Periodontal diseases; Natural remedies; Herbal extracts; Essential oils; Plant based remedies; Dentistry; Phytochemicals; Periodontal treatment

Introduction

Periodontal diseases, characterized by inflammation of the supporting structures of the teeth, are among the most prevalent conditions globally [1]. Traditional treatment approaches in periodontics involve mechanical debridement and surgical therapy, sometimes combined with antimicrobial agents [2]. There is a growing interest in investigating the advantages of plant-based remedies. Plants harbor diverse phytochemicals, which have garnered attention due to their favorable impact on human health. Extensive research is underway to unravel the benefits these bioactive compounds may offer [3]. The benefits of adding natural remedies to periodontal therapy include possible reduction of the microbial load, microbiome support, immunomodulation, down-regulation of inflammatory mediators, and oxidation[4–6]. They present fewer adverse effects and are compatible with holistic and integrative approaches promoting well-being and supporting the body's inherent healing abilities. They can enhance the effectiveness of standard interventions, possibly improving treatment outcomes [4-7].

Many patients are increasingly interested in natural and alternative treatment options. By incorporating natural remedies into periodontal treatment, clinicians can enhance patient satisfaction, engagement, and adherence to therapy, as patients feel more involved in their treatment [8]. This mini-review aims to summarize the current scientific evidence regarding natural remedies in the management of gingivitis and periodontitis.

Herbal formulations in periodontal treatment
Plant-based remedies in various formulation types have been investigated in periodontal treatment, including:
 
1. Herbal extracts: Extracts derived from medicinal plants, such as aloe vera, chamomile, or green tea, can be used topically to provide antimicrobial, anti-inflammatory, and antioxidant effects [9–12].
 
2. Essential oils: Obtained from plants like tea tree, clove, or peppermint can be used topically or incorporated into dental products. Many possess medicinal properties, including antimicrobial and anti-inflammatory activity [13-14].
 
3. Mouthwashes: Natural oral rinses can be formulated with herbs, essential oils, or botanical extracts to provide antimicrobial and anti-inflammatory effects [15-16].
 
4. Gels and irrigation solutions: Plant-based gels or solutions containing herbal extracts or botanical ingredients, like aloe vera and curcumin, can be applied to periodontal pockets. They may promote healing, reduce inflammation, alleviate pain, and decrease the bacterial load [14,17–19].
 
5. Chewing sticks: Chewing sticks made from the branches of certain plants, such as Salvadora persica (miswak) or Neem (Azadirachta indica), have been traditionally used for oral hygiene, particularly in certain parts of Africa, Asia, and the Middle East. Natural compounds are released with antimicrobial properties and can help maintain oral health [20–22].
 
6. Toothpaste: herbal toothpaste can be formulated with various herbal ingredients, such as aloe vera, curcumin, neem, myrrh, or clove. Their effectiveness in maintaining oral health and managing gingivitis has been described as comparable to conventional toothpaste [23-24].
 
Nature's Solutions in Periodontology: A Focus on Plant-Based Remedies
Some of the most studied plant-based remedies used in periodontal therapy are presented below. A more comprehensive list of medicinal plants explored in periodontology is presented in Table 1.
 
Green Tea (Camellia sinensis)
Green tea is made from the Camellia sinensis leaves, and is rich in polyphenols, particularly epigallocatechin-3-gallate (EGCG), which has demonstrated antimicrobial, anti-inflammatory, and antioxidant properties. Green tea extracts have been investigated for their potential to inhibit the growth of periodontal pathogens, reduce inflammation, and promote periodontal tissue healing [25–28]. The subgingival use of green tea catechins during scaling and root planing (SRP) can enhance pocket depth reduction [26]. Positive effects have been reported for different green tea formulations (tea sachets, strips, gel, chewing gum, and toothpaste) in plaque and gingival index, bleeding on probing, and pocket depth reduction [27-28]. Regular green tea consumption can enhance periodontal treatment outcomes [29].
 
Aloe vera (Aloe barbadensis)
Aloe vera (Aloe barbadensis) is a succulent plant with a long history of medicinal use. It has become popular due to its anti-inflammatory, antimicrobial, and wound-healing properties. Aloe vera gel contains various bioactive components, including polysaccharides, anthraquinones, vitamins, minerals, and enzymes [23-30]. Furthermore, aloe vera components can inhibit the production of inflammatory cytokines and nitric oxide [31-32]. It stimulates fibroblast proliferation and collagen synthesis, possibly aiding tissue repair and regeneration [32]. Aloe Vera mouthwash has been reported to have comparable effects to chlorhexidine in many studies regarding plaque index without causing tooth discoloration and taste alterations, which are frequently associated with chlorhexidine [30-33–35].
 
Propolis and bee products
Propolis is a resinous product produced by bees from plant sources. It possesses antimicrobial, anti-inflammatory, and immunomodulatory properties [4]. When combined with SRP, propolis extracts demonstrated the ability to inhibit periodontal pathogens and reduce inflammation, surpassing the effects of traditional treatment alone with rare adverse reactions reported [36]. A systematic review by [37] reported the effectiveness of propolis mouthwash in reducing plaque formation and improving gingival inflammation [37]. Existing in vitro and in vivo evidence indicates that propolis has the potential to benefit periodontal therapy [4-36-37]. Honey and royal jelly also present antimicrobial activity against periodontal pathogens in vitro [38]. Purified bee venom presents anti-inflammatory effects in vitro, reducing induced periodontal bone loss in animals [39-40]. The evidence supporting the use of royal jelly, bee venom, and honey in periodontics is limited, but their promising efficacy requires further investigation.
 
Curcumin (Curcuma longa)
The active compound in the turmeric root is curcumin (Curcuma longa). It exhibits potent anti-inflammatory and antioxidant effects [41]. In the context of periodontal disease, studies report its potential to inhibit tissue destruction, modulate the immune response, lower periodontal pathogen counts, and reduce gingival inflammation combined with non-surgical treatment [23-42–44]. Curcumin gel holds promise in gingivitis and periodontitis treatment thanks to its antiplaque and anti-inflammatory properties and rare side effects. Additionally, patients seem to prefer turmeric gel over chlorhexidine gel [45-46]. Animal studies indicate that modified curcumin, owing to its increased bioavailability, has the potential to yield more substantial clinical enhancements when used in periodontal treatment [47].
 
Tea Tree Oil and Other Essential Oils
Essential oils have been investigated for their potential effects on periodontal health. Some commonly studied essential oils include tea tree, eucalyptus, peppermint, clove, and thyme oil. Tea tree oil is extracted from the Melaleuca alternifolia plant, presenting robust anti-inflammatory and antimicrobial properties. The use of tea tree oil irrigating solution in non-surgical periodontal treatment of patients with stage 2 periodontitis improved clinical parameters and reduced matrix metalloproteinase-8 (MMP-8) levels in the gingival crevicular fluid up to 6 months after treatment [19].  However, an unpleasant taste was reported in the tea tree oil group [19]. The clinical effects of tea tree oil gel have been investigated in a systematic review by [6]. Tea tree oil gel reduced periodontal inflammation similarly to chlorhexidine but was less effective at controlling biofilm formation [6]. Another systematic review of clinical trials found that mouthwashes containing 0.2% to 0.5% tea tree oil reduced dental plaque, and subgingival application of a 5% gel enhanced the outcomes of SRP [14].

Herbal & Natural Products

Scientific Name

Main Active
Ingredients

Form

Properties

Summary of Research Findings

Magnolia bark

Magnolia spp.

Magnolol
Honokiol

Gel
Toothpaste
Gum
Oral rinse

Antioxidant
Anti-inflammatory Antispasmodic
Antimicrobial

In vitro: improved wound healing and inflammation; antimicrobial effect on periodontopathogens
Chewing gum and mouthwash: reduced gingival inflammation in clinical studies.

Chamomile

Matricaria chamomilla

Terpenoids
Coumarins
Flavonoids
Spiroether

Oral rinse
Toothpaste

Anti-inflammatory
Antimicrobial

Essential oil: antibacterial against periodontal pathogens.
In vitro, animal and clinical studies: reduced plaque and gingival index.

Green tea

Camellia sinensis

Epigallocatechin-3 gallate (EGCG)
Epicatechin-3-gallate (ECG) 

Gel
Toothpaste
Gum
Oral rinse
Strips

Anti-inflammatory
Antiplaque
Anti-carcinogenic
Antimicrobial
Antioxidant

In vitro, animal and human studies: tendency to improve immune response and inflammation, optimizing periodontal health as an adjunctive therapy.

Pomegranate

Punicagranatum

Flavonoids, anthocyanins, punicicacid, ellagitannins, alkaloids

Gel
Lozenge
Oral rinse
Chip

Antiatherogenic
Antihypertensive
Anti-inflammatory
Antiplaque

In vitro: inactivation of Pg and Aa
Gel and mouthwash: reduced gingivitis similar to CHX.
Chip: improved clinical periodontal results.

Baikal Skullcap
Root

Scutellariabaicalensis

Baicalin

Gel
Rinse
Toothpaste

Antibacterial
Regulation of inflammatory mediators, MMPs, innate immune response

In vitro and animal studies: antimicrobial against periodontal pathogens, inhibition of collagenases, decrease in inflammatory mediators, promotion of osteogenesis.

Calamus rhizome

Acorus calamus

β-asarone monoterpene quinone sesquiterpene phenylpropanoid

Essential oil
Liquid extract
Mouthwash

Adaptogenic
Antibacterial
Antioxidant
Anti-inflammatory

Clinical studies: calamus rhizome and other herbs had positive effects as adjuncts to SRP.

Peppermint

Mentha piperita

Menthol
Methyl salicylate

Essential oil
Mouthwash

Antimicrobial
Anti-inflammatory
Antioxidant

In vitro studies: antibacterial and antiplaque.
Clinical studies: mouthwash reduced plaque and gingival indexes in gingivitis combined with SRP.

Oak bark

Quercus spp

Tannins
Phenolic acids

Gel

Antibacterial
Anti-inflammatory

In vitro: gel combined with aloe vera had anti-lipoxygenase and antimicrobial activity.

Sage

Salvia officinalis
Salvia sclarea

Carnosol, rosmarinic acid, carnosic acid, terpenes

Gel
Toothpaste
Essential oil
Oral rinse

Antioxidant
Anti-inflammatory

In vitro: moderate antibacterial effect against periodontal bacteria exposed to the extract.

Aloe vera

Asphodelaceae spp.
Aloe barbadensis

Aloe-emodin, aloin, aloesin, amodin, and acemannan

vitamins, minerals, enzymes

Gel
Oral rinse
Toothpaste
Mouthwash

Wound healing
Immunomodulatory
Anti-Inflammatory
Antioxidant
Antimicrobial

Systematic reviews: aloe vera mouthwash, gel, and toothpaste can reduce gingival inflammation and improve periodontal parameters combined with SRP.

Blackberry

Rubusfruticosus

Epicatechin, ellagic acid, quercetin, hyperoside

Extract

Anti-inflammatory
Antioxidant

Antiviral

In vitro: antibacterial activity against periodontopathogens.

Cranberry

Vaccinum macrocarpon

Anthocyanins, proanthocyanidins, quercetin

Extract

Antiadhesive, Antibacterial
Inhibition Of Collagenase, Proteinase

In vitro: inhibition of NF-κB and MMP-3, and periodontopathogens.

Pepper-rosmarin
or LippiaSidoides

Verbenaceae spp.

Thymol
Carvacrol
Eugenol

Gel
Essential oil
Mouthwash

Antimicrobial

Animal studies: gel reduced myeloperoxidase, TNF-a, IL-1b, and alveolar bone loss in rats
Clinical studies: mouthwash shows comparable results to CHX.

Resveratrol

Resveratrol

Resveratrol

Nanoparticles

Anti-inflammatory
Antioxidant

In vitro: nanoparticles showed anti-inflammatory effects.

Calendula

Calendula officinalis

Quercetin
Triterpenoid

Oral rinse
Toothpaste

Anti-inflammatory Antioxidant, Antimicrobial, Wound healing

Clinical study: calendula oral rinse improved inflammation, plaque index and bleeding in gingivitis patients.

Curcumin/
Turmeric

Curcuma longa

Curcumin

Gel
Mouthwash
Irrigating solution

Anti-inflammatory Antioxidant
Antimicrobial, Anti-tumor Antispasmodic
Wound healing

Clinical studies: mouthwash, gel, and irrigating solution reduced plaque and gingival inflammation combined with SRP. Gel used on palatal donor sites for gingival grafts lowered postoperative pain.

Basil

Ocimum spp.

Terpenes
Phenylpropanoids

Mouthwash
Gel
Toothpaste

Anti-inflammatory
Antioxidant

Clinical studies: mouthwash presented antiplaque and antinflammatory effects. Lower plaque and gingival indexes observed after use of herbal toothpaste.

Neem tree

Azadirachtaindica

Azadirachtin, nimbolinin, nimbin, nimbidin, nimbidol, salannin, quercetin

Chewing stick
Mouthwash

Anti-Inflammatory Antipyretic, Analgesic Immunostimulant  Hypoglycaemic  Antimicrobial  Anticarcinogenic  Antioxidant

Clinical study: 3-week use of neem improved gingival inflammation and plaque index.

Oregano

Origanum vulgare

Carvacrol

Mouthwash

Anti-Inflammatory Antioxidant

Ntimicrobial

Anti-Osteoclastic

Anti-Diabetic

In vitro and animal studies: potential to improve gingival inflammation.

Frankincense

Boswellia spp.

Boswellic acids

Essentiall oil
Gel
Extract
Mouthwash
Chewing gum

Antimicrobial

Anti-Inflammatory
 Immune Modulator Wound Healing

In vitro and animal studies: potential to improve gingival inflammation.
Clinical studies: few have confirmed anto-inflammatory effect.

Lemon

Citrus limon

Naringenin
Hesperidin

Essentiall oil

Antimicrobial

Anti-Inflammatory Antioxidant

Osteogenic

Collagen Stimulator

In vitro and animal studies: osteogenic and anti-inflammatory potential.

Clove

Syzygiumaromaticum

Eugenol

Essentiall oil
Mouthwash
Toothpaste

Antimicrobial

Anti-Inflammatory Antiplaque

In vitro: effective against periodontal pathogens.

Cinnamon

Cinnamomum spp.

Cinnamaldehyde

Essential oil
Extract

Antimicrobial

Anti-Inflammatory Antioxidant

Antiplaque

In vitro: effective againt periodontal pathogens.
Animal studies: suppressed dysbiosis, improved inflammatory response in ligature-induced periodontitis in rats.
Clinical studies: lower gingival inflammation and plaque index in gingivitis patients after 4 weeks.

Rosemary

Salvia rosmarinus

Abietane diterpenes, carnosol, carnosic acid, ursolic acid

Essential oil
Extract

Antimicrobial

Anti-Inflammatory Antioxidant

Antiplaque

 Immune Modulator

In vitro and animal studies: antiplaque and anti-inflammatory properties.
Clinical studies: polyherbal mouthwash after SRP improved periodontal status, decreased bacterial levels in gingivitis patients.

Eucalyptus

Eucalyptus

Cineole, a-pinene

Essential oil
Extract
Chewing gum

Antiseptic

Antioxidant

Analgesic

 Immune Stimulator

In vitro: antibacterial properties against periodontal pathogens.
Clinical studies: chewing gum improved plaque index, bleeding, and inflammation in gingivitis patients.

Ginger

Zingiberofficinale

Gingerols, shogaols, zingerone, paradol, gingerenone, galanal, gingerdiols, gingerdiones

Mouthwash
Tablets
Extract

Antimicrobial

Anti-Inflammatory Antioxidant

Analgesic

In vitro and animal studies: ginger extract reduced MMP and IL-8 expression from gingivval fibroblasts. Shogaol reduced induced periodontitis in mice.
Clinical sudies: ginger tablets as effective as NSAIDs in reducing pain after surgical and non-surgical periodontal treatment.

Elderberry

Sambucus nigra

Anthocyanins, flavonols, phenolic acids

Mouthwash
Extract
Patch

Antimicrobial

Anti-Inflammatory Antioxidant

In vitro: reduced inflammation linked to periodontal pathogens.
Clinical studies: herbal patch containing Centellaasiatica, Echinacea purpurea and Sambucus nigra promotes wound healing, reducing inflammation.

Gum arabic

Acacia arabica

Tannins, cyanogenic glycosides, oxidases, peroxidases and pectinases

Gel
Extract

Antimicrobial

Anti-Inflammatory

Clinical studies: antiplaque and anti-inflammatory properties in gingivitis and periodontitis patients when combined with SRP.

Cashew tree

Anacardiumoccidentale Linn.

Cardanol
Cardol

Extract
Gel

Antimicrobial

Anti-Inflammatory

Animal studies: decreased periodontal inflammation in rats.
Clinical studies: reduced dental plaque and gingival inflammation in gingivitis patients.

Lemongrass

Cymbopogon

Citral
Geraniol

Gel
Dressing

Antimicrobial

Anti-Inflammatory

Animal study: dressing improved gingival wound healing in rats.
Clinical studies: topical gel combined with SRP as effectve as doxycicline in reducing bacterial counts and gingival inflammation.

Suriname cherry
or pitanga

Eugenia uniflora

Galli acid, ellagic acid, myricitrin

Toothpaste
Extract

Antimicrobial

Anti-inflammatory

In vitro: anti-inflammatory effects on gingival fibroblasts.
Clinical study: toothpaste showed anti-gingivitis properties in children aged 10-12 years

Tea tree

Melaleuca alternifolia

Terpinolene, α-terpineol, α-pinene

Mouthwash
Gel

Irrigation

Antimicrobial

Anti-inflammatory

Clinical studies: mouthwash has antiplaque properties; gel may be beneficial as adjunct to SRP.

Centella

Centellaasiatica

Asiaticoside

Gel
Patch
Extract

Antimicrobial

Anti-inflammatory Osteogenic

Clinical studies: patch containing Centellaasiatica, Echinacea purpurea and Sambucus nigra promoted wound healing, reducing inflammation in periodontitis patients. Extract of centellaand pommegranate beneficial combined with SRP.

 Echinacea

 Echinacea purpurea

Caffeic acid
Alkamides

Toothpaste
Patch

Antimicrobial

Anti-Inflammatory Antioxidant

Clinical studies: polyherbal toothpaste can reduce inflammation in gingivitis patients. Patch containing Centellaasiatica, Echinacea purpurea and Sambucus nigra promoted wound healing, reducing inflammation in periodontitis patients.

Garlic

Allium
sativum

 

Allicin

Gel
Mouthwash
Tables

Anti-Inflammatory Antimicrobial

Antioxidant

In vitro antimicrobial action against P. gingivalis and A.actinomycetemcomitans. Clinical improvement in plaque index and gingival inflammation.

Bee products

Propolis

Honey

Royal jelly

Bee venom

Hydrogen peroxide, flavonoids, organic essential oils, organic compounds, vitamins, enzymes

Injectable liquid
Dressing
Mouthwash
Strips

Anti-Inflammatory Antimicrobial

Wound Healing

Moisture Retention

Barrier Formation

Propolis gel may reduce plaque, inflammation, and gingival bleeding. The other bee products seem promising but require more

Table 1: Overview of natural remedies investigated in the context of periodontal treatment.

Polyherbal Formulations

Polyherbal formulations contain multiple herbal extracts or essential oils used as therapeutic adjuvants in managing periodontal conditions. Their primary advantage is the synergistic effects of the multiple natural components [48]. Polyherbal mouthwashes in periodontal care may include a variety of herbal extracts such as tea tree oil, eucalyptus oil, peppermint oil, clove oil, neem extract, myrrh extract, and others. Each herb may contribute its own antimicrobial, anti-inflammatory, or wound-healing properties to the formulation [16]. Oral rinses are the most studied polyherbal formulations in periodontics.

Various polyherbal mouthwashes present similar clinical efficacy in reducing plaque formation, gingival inflammation, and the growth of periodontal pathogens to enhance the benefits of scaling and root planning when compared to chlorhexidine with rare side effects [16,23,48–50].

In an in vitro study assessing the antimicrobial properties of Desplac®, a gel composed of Green Tea, Aloe Vera, Propolis, Calendul, and Cranberry. Desplac® hindered the formation of biofilms and disrupted existing ones, decreasing Tannerella forsythia levels [17].

A polyherbal oral recovery kit including oral rinse, gel, and spray has been studied for oral lesions, and postoperative use to reduce infection, pain, swelling, and discomfort, thus possibly improving wound healing after periodontal and implant surgery, as well as tooth extractions[5-51]. This novel recovery kit (VEGA Oral Care Recovery Kit, StellaLife) contains 16 active ingredients recognized in the Homeopathic Pharmacopeia of the United States (HPUS). It has gained popularity as more evidence supporting its biocompatibility and analgesic properties continues to accumulate. It has the potential to reduce the US opioid crisis [5-51–53].

Mechanisms of Action of Plant-Based Remedies
Antimicrobial Effects: Numerous natural remedies can inhibit periodontal pathogens' growth. Various herbal extracts and essential oils can inhibit bacterial growth. Their antimicrobial properties can help control bacterial overgrowth and reduce the risk of disease progression[4-13-15-17].

Anti-inflammatory and Immunomodulatory Properties:various natural remedies possess anti-inflammatory and immunomodulatory properties. Herbal extracts like curcumin and green tea polyphenols can inhibit pro-inflammatory mediators and enzymes, modulating the immune response and potentially attenuating periodontal inflammation [26-28-29-45-47].

Antioxidant Activity:The ability to scavenge free radicals and reduce oxidative damage has been reported for different medicinal herbs and plants. Incorporating these natural antioxidants into periodontal therapy may help mitigate tissue destruction and promote healing [11-25-48].

General Benefits of Plant-Based Remedies in Non-Surgical Periodontal Treatment

Natural formulations can help improve periodontal therapy outcomes based on their numerous medicinal properties (Table 1) [17-23-25-26-30-37-38-47].

  1. Non-surgical periodontal treatment: plant-based adjuncts can promote immunomodulation, reduction of bacteria in periodontal tissues, plaque inhibition, improvement in gingival index, pocket depth, and periodontal wound healing. Ultimately, natural remedies can support a healthy microbiome, improve oral hygiene, enhance the outcomes of SRP, and possibly reduce the need for surgery.
  2. Surgical periodontal treatment: plant-based remedies are biocompatible and can promote wound healing and tissue regeneration, optimizing surgical outcomes.
  3. Maintenance: As adjuncts to regular oral hygiene practices, these remedies may help control plaque formation and pathogenic bacteria, lowering the risk of disease recurrence. Plant-based formulations should not replace adequate brushing, flossing, and professional dental care [4-23].

Safety Considerations, Limitations, and Challenges

Natural remedies are typically associated with fewer side effects than conventional medications. Nevertheless, adverse reactions can occur, particularly if misused or used excessively[54]. Their safety should be evaluated on a case-by-case basis. The lack of regulation and standardization in the production and labeling can pose challenges in ensuring the safety and quality of plant-based formulations[55]. When considering the integration of these remedies into periodontal treatment protocols, it is essential to exercise caution regarding potential allergies in susceptible individuals, usage during pregnancy and breastfeeding, individual factors such as pre-existing health conditions, and interactions with other medications. These precautions can ensure the safety and appropriate utilization of these remedies within personalized patient care [9-55-56].

Future Perspectives
Natural remedies have gained attention due to their potential benefits and fewer side effects [4-5-23-57]. Plant-based formulations offer alternative approaches to improve treatment outcomes with a low risk of adverse reactions. Targeted delivery systems, such as nanoparticles or bioadhesive formulations, may improve the local release of natural compounds, likely increasing their bioavailability and efficacy [57-58]. Future efforts should focus on standardizing guidelines, regulations, and quality standards. Educating patients about the appropriate use, potential limitations, and adjunctive nature of these remedies can foster acceptance and informed decision-making. More rigorous research is necessary to establish the long-term efficacy, safety, potential side effects, and optimal dosage to ensure consistent therapeutic effects.[5] More robust evidence will help integrate these therapies into evidence-based practice [5-16-48].

Conclusion
Natural remedies show promise and should be used under the guidance of dental professionals without replacing regular oral hygiene practices or professional care. The present mini-review highlights the potential of natural remedies as adjunctive therapies in the management of periodontal diseases. While substantial evidence supports their antimicrobial, anti-inflammatory, antioxidant, and immunomodulatory effects, further research is warranted to establish their long-term efficacy and safety profiles. By integrating natural remedies into periodontal care, clinicians can potentially enhance treatment outcomes and provide a more holistic approach to oral health.

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