Herbal Medicines in Endodontics: An Overview

Abstract

Natural products have been used since ancient times in folk medicine. Herbal medicines are the drugs of plant origin used to treat diseases and to attain or maintain a condition of improved health. Herbs with medicinal properties are a useful and effective source of treatment for various diseases. Many drugs used in Western medical science (called allopathic medicine) have their origin in medicinal plants. This review focuses on various natural drugs and products as well as their therapeutic applications when used as phytomedicine in endodontics.

Keywords: Endodontics; Herbal; Phytomedicine; Dental caries

Introduction

Herbal medicines (Botanical medicine, Phytomedicine, or Phytotherapy) refer to herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other materials as active ingredients. Today the Herbal or natural products have become more popular due to their high antimicrobial activity, biocompatibility, anti-inflammatory and anti-oxidant properties [1]. As the incidence of increased resistance by pathogenic bacteria to currently used antibiotics and chemotherapeutics agents is more, the researchers are developing interest towards alternative treatment options and products for oral diseases. Hence, the natural phytochemicals isolated from plants used in traditional medicine are considered as good alternatives to synthetic chemicals.

According to the World Health Organization (WHO), as many as 80% of the world’s people depend on traditional medicine (herbal) for their primary healthcare needs [2]. Herbal remedies have a long history of use for gum and tooth problems. In many traditional cultures, the use of herbal “chewing sticks” taken from plants, shrubs or trees with high anti-microbial activity are common. A herb may exhibit one or more following unique therapeutic properties like anti-bacterial, anti-inflammatory, astringents, anaesthetic, immune strengtheners, anticariogenic, anti plaque agents and tooth whitener [3]. Herbs may be good alternatives to current treatments for oral health problems but there is lack of information about the effect of herbs in oral tissues, mechanism of effect, and side effects. So the more research is required to explore these traditional medicines [3]. Dental caries are still one of the most common diseases in the world. Streptococcus mutans has the central role in the initiation of caries on tooth surfaces [4]. Today, herbal medicines are introduced into the tooth pastes to prevent dental caries. The anti-cariogenic property of polyphenols is mainly due to a direct effect against S. mutans. It inhibits the adherence of bacterial cells to the tooth surface by interacting with the microbial membrane proteins [5]. In endodontics herbs are mainly used for the disinfection of the root canal. There is increased research towards the herbal irrigants due to the some adverse effects of the most of synthetic intracanal medicaments. E. Faecalis is most common bacteria responsible for root canal treatment failure cases [6]. Sodium hypochlorite is used to eliminate E. faecalis from the root canal but there are several disadvantages of sodium hypochlorite like unpleasant taste, toxicity, and potential weakening of the tooth structure by decreasing the hardness and structural integrity of the dentin within the root canal [7]. Thus the aim of this review is to enlist and describe the various herbal alternatives available today for use as effective endodontic medicaments and caries control agents. Articles were collected using PubMed and Google Scholar search engine in relation to herbal medicine, dentistry and endodontics.

Aloe Barbadensis (Aloe vera gel)

Green leaf of Aloe vera leaves contains clear gel that is used to produce juice. It contains alloins and barbadoins as main chemical constituents. In dentistry, Aloe vera is used in cases of apthous ulcers, lichen planus, alveolar osteitis [8]. Gel has inhibitory effects on S. pyogens and E. faecalis because of anthra quinine [8]. Aloe vera gel was used effectively for the disinfection of gutta-percha cones from E.coli, E.faecalis and S. aureus within a short duration [9]. Endodontic treatment using a mixture of zinc oxide powder and aloe vera gel in primary teeth has shown good clinical and radiographic success [10].

Azadirachta aindica (Neem)

It is known as Indian neem tree having medicinal property by each part of the tree. It has anti viral, anti fungal, anti bacterial and anti carcinogenic activity [11]. Nimbidin is a major active component isolated from seed of A. indica. From nimbidin other constituents like nimbin, nimbinin, nimbidinin, nimbolide and nimbidic acid has been isolated which are responsible for its biological activities [12]. The dental gel containing Neem extract was responsible to reduce plaque index and bacterial count significantly [13]. The antimicrobial effects of Neem have been reported against S. mutans, E. faecalis and C. albicans [14]. The Minimum Inhibitory Concentration (MIC) of the aqueous neem extract were 1.88%, 7.5% and 3.75 % for E. Faecalis, S. Mutans, C. albicans respectively [14]. Leaf extract has significant antimicrobial effect against E.faecalis derived from infected root canal samples thus can be used as an alternative to sodium hypochlorite [15].

Acacia nilotica (Babool)

Acacia nilotica also known as the gum Arabic tree, possesses good anti microbial, anti oxidant, anti fungal, anti viral and antibiotic activity [16,17]. It contains tannins, phenolic compounds, essential oil, and flavonoids which are responsible for antimicrobial activity [18]. Babul plant has medicinal used as anticancer, anti tumours, antiscorbutic, astringent, anti-oxidant, natriuretic, antispasmodial, diuretic, diarrhea, malaria, sore throat and toothache [18]. Babool has antibacterial activity against S. mutans and E. faecalis [19]. It was found that babool at a concentration of 50% had the highest activity against E.faecalis [19].

Arctium lappa

Arctium lappa is widely used in popular medicine all over the world for its well-known therapeutic applications. A. lappa showed the significant antimicrobial activity against microorganisms specifically found in endodontic infections [20]. It was used as intracanal medicament in teeth infected with C. albicans, S. mutans, E. coli, P. aeruginosa and L. acidophylus, was showed inhibition of microbial growth after 14 days [20]. Similarly the phytotherapeutic agent extracted from A. Lappa inhibited the growth of S. mutans, C. albicans, E. coli, P. aeruginosa and L. acidophilus, [21].

Aroeira-da-praia

In an in vitro study conducted to evaluate the anti microbial activity and root canal cleaning potential of Aroeira-da-praia against E.faecalis. It was found that Aroeira-da-praia showed anti microbial activity at all concentrations [22]. Martinez Guerra et al. evaluated the activity of aroeira-da-praia extract at 100% and 50% concentrations and it is effective against Gram+ , Gram- bacteria, as well as against Candida albicans, at all concentrations [23].

Carvacrol

Carvacrol (Thymol isomer) is present in the essential oil of Origanum vulgare. It has a broad spectrum of antibacterial activity; it works by inhibiting ATPase activity and increasing the nonselective permeability of bacterial cell membranes [24]. Therefore, it not only inhibits microbial colonization, but also makes microbes more sensitive to antibacterial agents [24]. Carvacrol also has the antiinflammatory effect. It can restrain neutrophilic elastase enzyme and suppresses prostaglandin production [25]. Carvacrol has antibacterial action on E. coli, Salmonella enteritidis and Salmonella Essen, P. aeruginosa and E. faecalis [26]. The 0.6% of Carvacrol was used effectively for disinfection of root canals [27]. It stimulates the pulpal fibres and helps in repair of periapical tissues due to the presence of phenolic component [27,28].

Casearia sylvestris (Gulkhair-wild coffee)

This plant species has been widely used in popular medicine as an antiseptic, topical anaesthetic, anti-tumor, anti-ulcer and antiophidian agent [29]. Alcoholic extract of C. sylvestris is a rich source of phospholipase A2 inhibitors, which reduce the acute phase of the inflammatory process and prolongs the regenerative phase [29]. Stamatis et al. in their study showed the antimicrobial efficacy of C. sylvestris extract against bacteria and fungi associated with oral diseases, such as dental caries, periodontitis and candidosis [30]. It can be used as an alternative short term intracanal medicament [31].

Curcuma longa (Turmeric)

The active constituents of turmeric are the flavonoid curcumin (diferuloylmethane) and various volatile oils, including tumerone, atlantone, and zingiberone. It possess good antioxidant, hepatoprotective, antimicrobial, anti-inflammatory and anticancer activity [32,33]. It has been hypothesized that curcumin inhibits the assembly of a Protein - Filamenting Temperature Sensitive Mutant Z [FtsZ] protofilaments and also increases the GTPase activity of FtsZ. The perturbation of the GTPase activity of FtsZ assembly is lethal to bacteria [34]. For an irrigant to be effective against biofilms, the action on biofilms should involve the elimination of the extracellular polysaccharide matrix as well as the bacteria [35]. Curcumin in surfactant preparations showed its potential as a photosensitizer in antibacterial photodynamic therapy [36]. 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 photosensitization of a microbial cell is the binding of the photosensitizer to the outer membrane [36]. Curcumin in aqueous preparations exhibits phototoxic effect against gram positive and gram negative bacteria [37]. It had significant antibacterial activity against E. faecalis [32,33]. It was effective against 2 day and 2 week biofilms of E. faecalis similar to that of 3% NaOCl and thus can be used in endodontics for root canal failure cases [38].

Cranberry

Cranberries contain numerous biologically active compounds including phenolic acids, anthocyanins, condensed tannins, and flavonoids which have antimicrobial activity [39]. It prevents the formation of dental plaque by inhibiting the enzymes responsible for the formation of the dental plaque polysaccharide matrix film, and also stops the bacteria sticking to the tooth surfaces [40]. The compounds prevent acid formation and reduce the acid tolerance of the bacteria that cause decay hence prevent tooth decay and gum disease [41]. Yamanaka et al. assessed the effect of cranberry juice on the ability of several oral species of Streptococcus to adhere to hydroxyapatite pellets. When the bacteria were exposed to cranberry juice, their adhesion to the pellets decreased significantly [42].

Marticaria recutitia (German chamomile)

It is used as table tea. Flower of chamomile plant contains a wide variety of active chemical components like chamazolene, capric acid, caprylic and chlorgenic acid. It is effectively used for removal of smear layer [43]. Chamomile was found to be effective when used as a mouthwash to treat irritations and minor infections of the mouth and gingiva [44].

Allium sativum (Garlic)

The main active component of garlic is allicin which is equivalent to that of penicillin (1mg of allicin is equated to that of 15 IU of penicillin) [45]. It has been shown to have wide range of antibacterial activity and more specific against the Gram-negative oral pathogens [46]. Extracts of garlic are bactericidal and are effective against E.coli, S.aureus B.cereus, Salmonella, listeria, Proteus and Streptococcal species [47]. This compound has an inhibitory effect upon the key enzymes involved in cholesterol biosynthesis, such as 3-hydroxy- 3-methyl-glutaryl-CoA reductase [48]. Allicin destroys the cell wall and cell membrane of root canal bacteria [49]. Fanni et al. revealed that garlic extract had significantly inhibited the growth of MDR S. mutans at MIC range of 4-32 mg/ml [50]. Houshmand et al. found that the 5%, 10%, 20%, and 100% concentrations of garlic extracts had similar antibacterial effects on dental plaque bacteria [51]. Thus the tooth paste or the mouth wash containing optimum concentration of garlic extract might be useful for prevention of dental caries.

Green Tea

It is a tea solely from the leaves of Camellia sinesis. The main flavonoids in tea are the catechins, making up 30–40% of the watersoluble solids in green tea [52]. Catechins bind to the bacterial lipid bilayer cell membrane and cause the membrane destruction [53]. It exhibits antibacterial activity agaist E. Faecalis as well as act as a good chelating agent [54]. Green and black teas both contain flavonoids that inhibit the growth and activity of the bacteria associated with tooth decay [55]. Tea also contains natural fluoride, which may be helpful in preventing dental caries [56]. Studies of Green tea polyphenols has significant anti microbial activity on E.faecalis biofilm formed in tooth substrate [54,57].

Glycyrrhiza glabra (Yashtimadhu -liquorice)

A number of pharmaceutical effects of liquorice are known antiinflammatory, antiviral and anticarcinogenic [58]. The study reported that liquorice extract was as effective as triamcinolone acetonide, but safer and may be used as an alternative treatment for lichen planus [59]. Liquorice extract prevent the plaque formation by inhibiting the growth and adherence of S. Mutans [60]. The flavonoid content of liquorice extract is also a strong inhibitor of oxygen consumption in bacterial cells; the site of inhibition is thought to be between CoQ and cytochrome C in the bacterial respiratory electron transport chain [61]. Glycyrrhizin, a triterpenoid compound, accounts for the sweet taste of liquorice root. This compound represents a mixture of potassium-calcium-magnesium salts of glycyrrhizic acid that varies within a 2–25% range [62]. Glycyrrhizin act by altering the surface tension of the extracellular medium and has membranolytic properties [63].

Morinda citrifolia (Indian Mulberry- Noni)

M. Citrifolia has been reported to have a broad range of health benefits for cancer, infection, arthritis, diabetes, asthma, hypertension and pain [64]. Antibacteial action of Morinda Citrifolia Juice (MCJ) is mainly due to the presence of L-asperuloside and alizarin [65]. It has antimicrobial action against P. aeruginosa, Proteus morgaii, S. aureus, Baciillis subtilis, E. coli, Salmonella, Shigella, E. Feacalis and C. Albicans [66]. In the studies conducted to evaluate M. Citrifolia as an endodontic irrigant, it was concluded that MCJ was more effective than CHX and was similar in efficacy to NaOCI [67,68]. MCJ was more effective than calcium hydroxide against E. faecalis at different depth in dentin [67]. It has an inhibitory effect on caries causing oral streptococci [69]. MCJ is a biocompatible irrigant that promotes dental pulp stem cell attachment to root canal dentin, which is essential to accomplish regenerative endodontic treatment [70].

Mimusops Elengi (Bakul)

Bakul is a small to large tree found all over India. It has shown significant anti-inflammatory, analgesic and antipyretic activity [71]. The bark of M. elengi is used as a gargle for inflammatory and bleeding gums [72]. The tender stems are used as tooth brushes [73]. Different types of glycosides, alkaloids, phenols, tannins and saponins have been screened in the methanolic extract of this plant [74]. M. elengi was most effective agent against E. faecalis at 3 mg. concentration [75]. The extract of M. elengi was found to be effective against Streptococci isolated from tooth tartar [76].

Melaleuca Alternifolia (Tea Tree Oil)

It contains terpinen-4-ol [typically 30- 40%] as a major component responsible for antibacterial and antifungal activity [56]. Tea tree oil causes lysis and the loss of membrane integrity of bacteria by the leakage of ions and the inhibition of respiration [77]. In dentistry, tea tree oil has been used to destroy microorganisms in the mouth before dental surgery, removal of smear layer and to relieve mouth soreness [78]. Tea tree oil removed the smear layer and showed comparable inhibition of bacterial growth with sodium hypochlorite when used as root canal irrigant [43,79]. An in vitro study, antimicrobial effect of tea tree oil for C. albicans (MIC: 0.5 μl/ml) was found at the lowest concentration followed by S. aureus (MIC: 1 μl/ml) and E. coli (MIC: 2 μl/ml), lastly E. faecalis (MIC: 64 μl/ml) [80]. The recommended therapeutic concentration for tea tree oil is 2.5 to 5 %, in which it can retain its antimicrobial property without any toxic effects [81].

Myristica fragrans (Nutmeg) and Terminalia chebula

Myristica fragrans contains myristic acid which is responsible for its antibacterial activity [82]. Yanti et al. reported anti-biofilm activity of macelignan, isolated from nutmeg against oral bacteria. Macelignan activity at 10 μg/mL for 30 minutes exposure could remove more than half of each single oral biofilm formed by S. mutans, S. sanguinis and A. viscosus at 24 hrs [82]. Terminalia species are a rich source of flavonoids, tannins, and many phenolic derivatives, it also has antioxidant capabilities [83]. Chebulinic acid, tannic acid and ellagic acid are responsible for the anti bacterial action of terminalia Chebula [84]. The antioxidant property of phenolic compounds is attributed to their ability to absorb and neutralize free radicals [83]. It is evident in vitro study that T.Chebula showed a definite reduction in the microbial activity and an increase in the pH resulting in marked anticariogenic effect [85].

Myrtus communis

The main constituents of the essential oil are 1, 8-cineole (28.62%), a-pinene (17/8%), and linalool (17.53%) [86]. Essential oil from M. Communis leaves has exhibited satisfactory antifungal, antibacterial, and antioxidant activities [87]. This plant has anti bacterial activity against both gram positive and gram negative organisms. M. communis essential oil was an effective antimicrobial agent against persistent endodontic microorganisms with the minimum inhibitory concentration in the range of 0.032-32 μg/mL [86,87]. Suliman et al. showed that M. communis has the antimicrobial effect at different concentration and the best being at 35% concentration which is nearly similar to 5.25% sodium hypochlorite and 0.2% Chlorhexidine [88].

Ocimum sanctum (Tulsi)

Tulsi is a time-tested premier medicinal herb that is used in ayurvedic medicine since ancient times. Different parts of the plant have shown antimicrobial, anti-inflammatory, analgesic, antipyretic, antiulcer, antidiabetic, antioxidant and anticancer activity [89]. The leaves of Tulsi contain 0.7% volatile oil comprising about 71% eugenol and 20% methyl eugenol [89]. Eugenol is the most prominent phytoconstituents present in this plant which may be responsible for antimicrobial activity [90]. O. Sanctum was the most effective against S. Mutans at 3mg. concentration [75]. The essential oil extract of O. Sanctum showed antibacterial efficacy against E. Feacalis, which improved with an increase in concentration and contact period [91]. It exhibited minimum bactericidal concentration at 40% [92].

Orange oil

Orange essence oil was composed 94% of d-limonene and 3% of myrcene [93]. It is suggested as an alternative to chloroform or xylene for gutta-percha softening and also in dissolving the endodontic sealers [94]. Rehman et al. in a vitro study found that there was 5.19 mm of remaining gutta-percha in the orange oil group and 5.37 mm in the chloroform group [95]. Similar results were found with other investigators suggesting orange oil equally efficient in dissolving gutta-percha and biocompatible than chloroform and xylene [96,97]. Chloroform as gutta-percha solvents has an effect on the mineral contents of root dentin leading to transportation of root dentin. Orange oil showed less dentin transportation than chloroform [98].

Propolis (Propolis resin)

It is prepared from resin collected by bees from the trees of poplars and conifers or from flowers of genera clusia. Pharmacologically active constituents in propolis are Flavonoids and cinnamic acid [99]. It exhibits various biologic activities, including antimicrobial, anti-inflammatory, antioxidant, anaesthetic and cytotoxic properties [100]. The anti-inflammatory property of propolis is due to the presence of caffeic acid and phenethyl ester in propolis [31]. In dental practice it is used as a pulp capping agent, intracanal medicament, intracanal irrigant, mouth rinse, cariostatic agent, storage media for avulsed tooth to maintain viability of periodontal ligaments, treatment of periodontitis and denture stomatitis [31,101-107]. Propolis was effective against the E faecalis [101]. Ehsani M et al. suggested that the hydroalcoholic extract of propolis could be a good anti-microbial agent against E. faecalis especially following direct contact to this microorganism [108]. Propolis showed antimicrobial activity equal to that of sodium hypochlorite [109]. Awawdeh et al. also evaluated the effectiveness of propolis and calcium hydroxide in Ex-vivo as a short-term intracanal medicament against E. faecalis and found that the propolis is very effective in rapidly eliminating E. faecalis [110]. Natural honey showed antibacterial action against anaerobic bacteroides present in dental abscess and osteomyelitis [111]. Studies suggested that chewing “honey leather” can reduce gingival inflammation [112,106]. Direct pulp capping with propolis in rats may delay dental pulp inflammation and stimulate reparative dentin [104]. Another study conducted to evaluate the antimicrobial activity of two experimental pastes containing propolis extract associated with calcium hydroxide against polymicrobial cultures collected from 16 necrotic and fistulae root canals in primary molars. The association between propolis and calcium hydroxide was effective in controlling dental infections in vitro [113].

Psidium guajava (Guava)

The fruits and leaves of P. Guajava contain essential oil rich in cineol, tannins, tripentnes and flavonoids. Ethanol extracts of it has higher antimicrobial activity, especially against E. faecalis [114]. The active flavonoid compound gujaverin isolated from the methanol leaf extract of P. guajava act as a potential antiplaque agent by inhibiting the growth, adherence and co-aggregation of dental plaque bacteria. Guava extracts may inhibit plaque development without disrupting homeostasis of the oral cavity [115].

Salvadora persica (Miswak)

Miswak is chewing stick commonly used as a brush to clean the teeth. Its chewing stick contains trimethyl amine, salvadorime chloride, and fluoride in large amounts [116]. 10% water extraction of Miswak is an effective antimicrobial agent when utilized as root canal irrigant with necrotic pulps [117]. S. Persica extract stimulates parotid gland secretion and raise the plaque pH, suggesting a potential role in caries prevention [118]. S. Persica has good antimicrobial activity with a low level of cytotoxicity to the host cells at an optimal therapeutic concentration [119]. 20% S. Persica extract was completely effective in inhibiting the growth of E. Feacalis and C. Albicans after 6 and 24 hrs of exposure [120]. Almas et al. showed that E. faecalis is the most sensitive microorganism affected by the use of S. Persica, and noted no significant difference in the antimicrobial effects of freshly cut and 1-month-old S. Persica [121]. It can be used as substitute for sodium hypochlorite and chlorhexidine as root canal irrigant [122]. Baeshen et al. recommended the use of fresh miswak impregnated in 0.1% sodium fluoride (NaF) or a maximum of 0.5% NaF for a day for the prevention of dental caries [123].

Triphala

It is a mixer of Amulaki (Emblica Officinalis), Bibhitaki (Terminalia bellirica) and Halituki (Terminalia chebula). It can be used as an effective antiplaque agent as it inhibited the sucrose induced adherence and the glucan induced aggregation, the two processes which foster the colonization of the organism on the tooth surface [124]. It also showed complete eradication of 3-week E. faecalis biofilm [54,57]. Shakouie et al. compare the antimicrobial activity of Triphala with different concentrations of sodium hypochlorite and found that the Triphala exhibited better antimicrobial activity against E. faecalis compared to 0.5 and 1% NaOCl [125]. In another vitro study Triphala was found to be as efficacious as sodium hypochlorite [126]. Its fruit is rich in citric acid thereby act as chelating agent [68].

Conclusion

Herbal medicines are the emerging trend in dental treatment. The major advantages of using herbal alternatives are easy availability, cost effectiveness, increased shelf life, low toxicity and lack of microbial resistance. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, as antiseptics, antioxidants, antimicrobials, antifungals, antibacterial, antivirals and analgesics. The knowledge and understanding of natural approach of treatments is still the area of interest of researchers.

References

1. Anees T.P. International market scenario of traditional Indian herbal drugs: India declining. Int. J. Green. Pharm. 2010; 122: 184-190.
2. Azaizeh H, Fulder S, Khalil K, Said O. Ethnomedicinal knowledge of local Arab practitioners in the Middle East Region. Fitoterapia. 2003; 74: 98-108.
3. Taheri JB, Azimi S, Rafieian N, Zanjani AH. Herbs in dentistry. Int Dent J. 2011; 61: 287-296.
4. Burne RA. Oral streptococci products of their environment. J Dent Res. 1998; 77: 445-452.
5. Ferrazzano GF, Amato I, Ingenito A, Zarrelli A, Pinto G, Pollio A. Plant Polyphenols and Their Anti-Cariogenic Properties: A Review. Molecules. 2011; 16: 1486-1507.
6. Stuart HC, Schwartz SA, Beeson TJ. Enterococcus faecalis: its role in root canal treatment failure and current concepts and retreatment. J Endod. 2006; 32: 93-97.
7. Davis JM, Maki J. An in vitro comparison of antimicrobial effects of various endodontic medicaments on Enterococcus faecalis. J Endod. 2007; 33: 567- 569.
8. Wynn RL. Aloe vera gel: update for dentistry. Gen Dent. 2005; 53: 6-9.
9. Athiban PP, Borthakur BJ, Ganesan S, Swathika B. Evaluation of antimicrobial efficacy of Aloe vera and its effectiveness in decontaminating gutta percha cones. J Conserv Dent. 2012; 15: 246-248.
10. Khairwa A, Bhat M, Sharma R, Satish V, Maganur P, Goyal AK. Clinical and radiographic evaluation of zinc oxide with aloe vera as an obturating material in pulpectomy: an in vivo study. J Indian Soc Pedod Prev Dent. 2014; 32: 33-38.
11. Ganguli S. Neem; A therapeutic for all seasons. Curr Sci. 2002; 82: 1304.
12. Sharma P, Tomar L, Bachwani M, Bansal V. Review on Neem (Azadirechta indica): Thousand Problem One Solution. Int Res J Pharm. 2011; 2: 97-102.
13. Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel-A 6-week clinical study. J Ethnopharmacol. 2004; 90: 99-103.
14. Nayak A, Nayak RN, Soumya GB, Bat K, Kundalkar M. Evaluation of Antibacterial and Anti candidial efficacy of Aqueous and Alcoholic extract of Neem (Azadhiracta indica)-An In Vitro study. Int J Res Ayu Pharma. 2011; 2: 230-235.
15. Bohora A, Hegde V. Kokate S. Comparison of antibacterial efficacy of neem leaf extract and 2 % sodium hypochlorite against E. feacalis, C. Albicans and mixed culture- an in vitro study. Endodont. 2010; 22: 8-12.
16. Khan R, Islam B, Akram M, Shakil S, Ahmad A, Ali SM, et al. Antimicrobial activity of five herbal extracts against multi drug resistant (MDR) strains of bacteria and fungus of clinical origin. Molecules. 2009; 14: 586-597.
17. Duganath, Rupesh Kumar S, Kumanan R, Jayaveera KN. Evaluation of antidenaturation property and anti-oxidant activity of traditionally used medicinal plants. Int J Pharma Bio Sciences. 2010; 1: 1-7.
18. Saini ML, Saini R, Roy S, Kumar A. Comparative Pharmacognostical and antimicrobial studies of Acacia species (Mimosaceae). J Med Plant Res. 2008; 2: 378-386
19. Kumar D, Sidhu P. The Antimicrobial Activity Of Azardirachta Indica, Glycyrrhiza Glabra, Cinnamum Zeylanicum, Syzygium Aromaticum, Accacia Nilotica On Streptococcus Mutans and Enterococcus Faecalis – An In Vitro Study. Endodont. 2011; 23: 16-23
20. Pereira J, Bergamo D, Franca S, Pietro R, Silva- Sousa Y. Antimicrobial activity of articum lappa against microorganisms commonly found in endodontic infections. Braz Dent J. 2005; 16: 192-196.
21. Gentil M, Pereira JV, Sousa YT, Pietro R, Neto MD, Vansan LP, de Castro França S. In vitro evaluation of the antibacterial activity of Arctium lappa as a phytotherapeutic agent used in intracanal dressings. Phytother Res. 2006; 20:184-186.
22. Brito Costa EMM, Araújo Evangelista AP, Medeiros ACD, Dametto FR, Carvalho RA. In vitro evaluation of the root canal cleaning ability of plant extracts and their antimicrobial action. Braz Oral Res. 2012; 26: 215-221.
23. Martínez MJ, Betancourt J, Alonso-González N, Jauregui A. Screening of some Cuban medicinal plants for antimicrobial activity. J Ethnopharmacol. 1996; 52: 171-174.
24. Helander IM, Alakomi HL, Latva Kala K, Mattila Sandholm T, Pol I, Smid EJ, et al. Characterization of the action of selected essential oil components on gram-negative bacteria. J Agric Food Chem. 1998; 46: 3590-3595.
25. Nosrat A, Bolhari B, Sharifian MR, Aligholi M, Mortazavi MS. The effect of Carvacrol on Enterococcus faecalis as a final irrigant. Iran Endod J. 2009; 4: 96-100.
26. Pealver P, Huerta B, Borge C, Astorga R, Romero R, Perea A. Antimicrobial activity of five essential oils against origin strains of the Enterobacteriaceae family. APMIS. 2005; 113: 1-6.
27. De Vincenzi M, Stammati A, De Vincenzi A, Silano M. Constituents of aromatic plants: Carvacrol. Fitoterapia. 2004; 75: 801-804.
28. Seghatoleslami S, Samadi N, Salehnia A, Azimi S. Antibacterial activity of endemic Satureja Khuzistanica Jamzad essential oil against oral pathogens. Iran Endod J. 2009; 4: 5-9.
29. Basile AC, Sertie JA, Panizza S, Oshiro TT, Azzolini CA. Pharmacological assay of Casearia sylvestris. Preventiveanti-ulcer activity and toxicity of the leaf crude extract. J Ethnopharmacol. 1990; 30: 185-187.
30. Stamatis G, Kyriazopoulos P, Golegou S, Basayiannis A, Skaltsas S, Skaltsa H. In vitro anti-Helicobacter pylori activity of Greek herbal medicines. J Ethnopharmacol. 2003; 88: 175-179.
31. Silva FB, Almeida JM, Sousa SM. Natural medicaments in endodontics–A comparative study of the anti-inflammatory action. Braz Oral Res. 2004; 18: 174-179.
32. Chaturvedi TP. Uses of turmeric in dentistry: An update. Indian J Dent Res. 2009; 20: 107-109.
33. Neelakantan P, Subbarao C, Subbarao CV. Analysis of Antibacterial Activity of Curcumin against Enterococcus Fecalis. Int J Cur Res Rev. 2011; 3: 37-42.
34. Rai D, Singh JK, Roy N, Panda D. Curcumin inhibits FtsZ assembly: an attractive mechanism for its antibacterial activity. Biochemical J. 2008; 410: 147-155.
35. Ozdemir HO, Buzoglu HD, Calt S, Stabholz A, Steinberg D. Effect of ethylenediaminetetraacetic acid and sodium hypochlorite irrigation on Enterococcus faecalis biofilm colonization in young and old human root canal dentin: in vitro study. J Endod. 2010; 36:842-846.
36. Jori G, Coppellotti O. Inactivation of pathogenic microorganisms by photodynamic techniques: Mechanistic aspects and perspective applications. Antiinfect Agents Med Chem. 2007; 6: 119-131.
37. Haukvik T, Bruzeli E, Kristensen S, Tønnesen H. Photokilling of bacteria by curcumin in selected polyethylene glycol 400 [PEG 400] preparations. Studies on curcumin and curcuminoids, XLI. Pharmazie. 2010; 65: 600-606.
38. Neelakantan P., Subbarao S., Sharma S., Subbarao CV, Garcia-Godoy F, Gutmann JL. Effectiveness of curcumin against enterococcus faecalis biofilm Acta Odontol Scand. 2013; 71: 1453-1457.
39. Bodet C, Grenier D, Chandad F, Ofek I, Steinberg D, Weiss EI. Potential oral health benefits of cranberry. Crit Rev Food Sci Nutr. 2008; 48: 672-680.
40. Koo H, Duarte S, Murata RM, Scott-Anne K, Gregoire S, Watson GE, et al. Influence of cranberry proanthocyanidins on formation of biofilms by Streptococcus mutans on saliva-coated apatitic surface and on dental caries development in vivo. Caries Res. 2010; 44: 116-126.
41. Sethi R, Govila V. Inhibitory effect of cranberry juice on the colonization of Streptococci species: An in vitro study. J Indian Soc Periodontol. 2011; 15: 46-50.
42. Yamanaka A, Kimizuka R, Kato T, Okuda K. Inhibitory effects of cranberry juice on attachment of oral streptococci and biofilm formation. Oral Microbiol Immunol. 2004; 19: 150-154.
43. Sadr LMS, Raoof KHR, Heady R, Yazdani D. The effect of German chamomile (Marticaria recutita L.) extract and tea tree (Melaleuca alternifolia L.) oil used as irrigants on removal of smear layer: A scanning electron microscopy study. Int Endod J. 2006; 39: 190-195.
44. Pistorius A, Willershausen B, Steinmeier EM, Kreisler M. Efficacy of subgingival irrigation using herbal extracts on gingival inflammation. J Periodontal. 2003;74: 616-622.
45. Durairaj S, Srinivasan S, Lakshmanaperumalsamy P. Invitro antibacterial activity and stability of Garlic extract at different PH and temperature. Electronic J Biol. 2009; 5: 5-10.
46. Bakri IM, Douglas CWI. Inhibitory effect of garlic extract on oral bacteria. Arch Oral Biol. 2005; 50: 645-651.
47. Maidment C, Dembny Z, King P. Investigations into the antibacterial properties of garlic using the disc assay method. J Biol Educ. 1998; 32: 162-165.
48. Choudhary R. Benificial effect of Allium sativum and Allium tuberosum on experimental hyperlipidemia and atherosclerosis. Pak J Physiol. 2008; 4: 7-9.
49. Dhinahar S, Lakshmi T. Role of botanicals as antimicrobial agent in management of dental infections – A Review. Int J Pharma Biosciences. 2011; 2: 690-704.
50. Fani MM, Kohanteb J, Dayaghi M. Inhibitory activity of garlic (Allium sativum) extract on multidrug-resistant Streptococcus mutans. J Indian Soc Pedod Prev Dent. 2007; 25: 164-168.
51. Houshmand B, Mahjour F, Dianat O. Antibacterial effect of different concentrations of garlic (Allium sativum) extract on dental plaque bacteria. Indian J Dent Res. 2013; 24: 71-75.
52. Wang Y, Ho CT. Polyphenolic chemistry of tea and coffee:a century of progress. J Agric FoodChem. 2009; 57: 8109-8114.
53. Sirk TW, Brown EF, Sum AK, Friedman M. Molecular dynamics study on the biophysical interactions of seven green tea catechins with lipid bilayers of cell membranes. J Agric FoodChem. 2008; 56: 7750–7758.
54. Prabhakar J, Senthilkumar M, Priya MS, Mahalakshmi K, Seghal PK, Sukumaran VG. Evaluation of antimicrobial efficacy of herbal alternatives (Triphala and Green tea polyphenols), MTAD and 5 % sodium hypochlorite against Enterrococcus feacalis biofilm formed on tooth substrate: an in vitro study. J Endod. 2010; 36: 83-86.
55. Margaret A, Berkowitz S, Dhir R, Gould V, Gupta A, Li E, et al. The inhibitory effects of green tea (Camellia sinensis) on the growth and proliferation of oral bacteria. GSJ Park. 2010; 3: 1-19.
56. Pujar M, Makandar S. Herbal usage in endodontics-A review. Int J Contemp Dent. 2011; 2: 34-37.
57. Pujar M, Patil C, Kadam A. Comparison of antimicrobial efficacy of Triphala, (GTP) Green tea polyphenols and 3% of sodium hypochlorite on Enterococcus faecalis biofilms formed on tooth substrate: in vitro. J Int Oral Health. 2011; 3: 23-30.
58. Olukoga A, Donaldson D. Historical perspectives on health. The history of liquorice: The plant, its extract, cultivation, commercialisation and etymology. J R Soc Promot Health. 1998; 118: 300-304.
59. Shoreibah EA, Soliman OA, Badria FA, Abdel-Gawad AH. Efficacy of topical delivery of corticosteroid versus glycyrrhizin in the treatment of Lichen planus using bioadhesive patches. Egypt Dent J. 2000; 46: 2105-2113.
60. Segal R, Pisanty S, Wormser R, Azaz E, Sela MN. Anticariogenic activity of Liquorice and glycyrrhizine I: Inhibition of in vitro plaque formation by Streptococcus mutans. J Pharm Sci. 1985; 74, 79-81.
61. Bodet C, La VD, Gafner S, Bergeron C, Grenier D. A Liquorice extract reduces lipo polysaccharide induced pro inflammatory cytokine secretion by macrophages and whole blood. J Periodontol. 2008; 79: 1752-1761.
62. Burgess JA, van der Ven PF, Martin M, Sherman J, Haley J. Review of over-the-counter treatments for aphthous ulceration and results from use of a dissolving oral patch containing glycyrrhiza complex herbal extract. J Contem Dent Pract. 2008; 9: 88-98.
63. Haraguchi H, Tanimoto K, Tamura X, Mizutani K, Kinoshita T. Mode of antibacterial action of retrochalcones from Glycyrrhiza inflata. Phytochemistry. 1998; 48: 125-129.
64. Morton JF. The Ocean-going Noni or Indian mulberry (Morinda citrifolia, Rubiaceae) and some of its ‘colorful’ relatives. Economic Botany. 1992; 46: 241-256.
65. Wang MY, West BJ, Jensen CJ, Nowicki D, Su C, Palu AK, et al. Morinda citrifolia (Noni): a literature review and recent advances in Noni research. Acta Pharmacol Sin. 2002: 23; 1127-1141.
66. Neelakantan P, Jagannathan N, Nazar N. Ethnopharmacological approach in endodontic treatment: A focused review. Int J Drug Dev Res. 2011; 3: 68-77.
67. Kandaswamy D, Venkatesh Babu N, Gogulnath D, Kindo AJ. Dentinal tubule disinfection with 2% chlorexidine gel, propolis, Morinda citrifolia juice, 2% povidine iodine and calcium hydroxide. Int Endod J. 2010; 43: 419-423.
68. Murray PE, Farber RM, Namerow KN, Kuttler S, Garcia-Godoy F. Evaluation of Morinda citrifolia as an endodontic irrigant. J Endod. 2008; 34: 66-70.
69. Kumarasam B, Manipal S, Duraisamy P, Amzed A, Mohanganesh SP, Jeevika C. Role of aqueous extract of Morinda Cetrifolia (Indian Noni) ripe fruits in inhibiting dental caries-causing Streptococcus Mutans and Streptococcus Mitis. J Dent (Tehran) 2014;11;703-710.
70. Moghazy HA, Shafei MEI, Abulezz HA, Baz SEI. The effect of morinda citrifolia on human dental pulp stem cells attachment to root canal dentine walls a comparative invitro study. Egyptian Dent J. 2015; 61: 1-8.
71. Purnima A, Koti BC, Thippeswamy AH, Jaji MS, Swamy AH, Kurhe YV, et al. Anti-inflammatory, analgesic and antipyretic activities of Mimusops elengi Linn. Indian J Pharm Sci. 2010; 72: 480-485.
72. Kritikar KR, Basu BD. Indian Medicinal Plants. 1991; 1494-1496.
73. Satyavati GV, Gupta AK. Medicinal Plants of India. New Delhi: Indian Council of Medical Research. 1987; 257-261.
74. Prabhat, Ajaybhan, Navneet, Chauhan A. Evaluation of antimicrobial activity of six medicinal plants against dental pathogens. Rep Opin. 2010; 2: 37-42.
75. Mistry KS, Sanghvi Z, Parmar G, Shah S. The antimicrobial activity of Azadirachta indica, Mimusops elengi, Tinospora cardifolia, Ocimum sanctum and 2% chlorhexidine gluconate on common endodontic pathogens: An in vitro study. Eur J Dent. 2014; 8: 172-177.
76. Murudkar A, Mundhada SS, Tatke PA. Antibacterial activity of Mimusops Elengi Linn. Bark against dental pathogens. Indian J Pharm Educ Res. 2007; 41: 114-120.
77. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) oil: A review of antimicrobial and other medicinal properties. Clin Microbiol Rev. 2006; 19: 50-62.
78. Soukoulis S, Hirsch R; The effects of a tea tree oil-containing gel on plaque and chronic gingivitis. Aust Dent J. 2004; 49: 78-83.
79. Kamath U, Sheth H, Ramesh S, Singla K. Comparison of the antibacterial efficacy of tea tree oil with 3% sodium hypochlorite and 2% Chlorhexidine against E.faecalis: An in vitro study. J Contemp Dent. 2013; 3: 117-120.
80. Thosar N, Basak S, Bahadure RN, Rajurkar M. Antimicrobial efficacy of five essential oils against oral pathogens: An in vitro study. Eur J Dent. 2013; 7: 71-77.
81. Sharaf N, Aboul-Enein N, Hassan M, Ayad M, Zaazou M, Farrag A. Effect of MTAD and tea tree oil irrigation before pulp capping on healing of exposed dental pulp. Australian J Basic and applied sciences. 2012; 6: 553-557.
82. Yanti, Rukayadi Y, Kim KH, Hwang JK. In vitro anti-biofilm activity of macelignan isolated from Myristica fragrans Houtt. against oral primary colonizer bacteria. Phytother. Res. 2008; 22: 308-312.
83. Bajpai VK, Yoon JI, Kang SC. Antioxidant and antidermatophytic activities of essential oil and extracts of Magnolia liliflora Desr. Food Chem Toxicol. 2009; 47: 2606-2612.
84. Saleem A, Hushum M, Harkonen P, Pihlaja K. Inhibition of cancer cell growth by crude extract and phenolics ofTerminalia chebula fruit. J Ethnopharmacol. 2002; 81: 327-336.
85. Chung JY, Choo JH, Lee MH, Hwang JK. Anticariogenic activity of macelignan isolated from Myristica fragrans (nutmeg) against Streptococcus mutans. Phytomed. 2006; 13: 261-266.
86. Nabavizadeh M, Abbaszadegan A, Gholami A, Sheikhiani R, Shokouhi M, Shams MS, et al. Chemical constituent and antimicrobial effect of essential oil from Myrtus communis leaves on microorganisms involved in persistent endodontic infection compared to two common endodontic irrigants: An in vitro study J Conserv Dent. 2014; 17: 449-453.
87. Zomorodian K, Moein M, Goeini Lori Z, Ghasemi Y, Rahimi MJ, Bandegani A, et al. Chemical composition and antimicrobial activities of the essential oil from myrtus communis leaves. J Essent Oil Bear Pl. 2013; 16: 76-84.
88. Suliman RT. The Antibacterial Effect of Myrtus communis as Root Canal Irrigant: A comparative Study. Al-Rafidain Dent J. 2009; 9: 289-296.
89. Prakash P, Gupta N. Therapeutic uses of Ocimum sanctum Linn (Tulsi) with a note on eugenol and its pharmacological actions: A short review. Indian J Physiol Pharmacol. 2005; 49: 125-131.
90. Bhatt MK, Shankar MB, Saluja AK, Dholwani KK, Captain AD. Evaluation of antimicrobial activity of Ocimum Sanctum Methanolic extract. J Pharm Sci Innov. 2012; 1: 39-41.
91. Navin M, Ajay L, Naseem S, Seema S, Surendra S, Isha N. Preliminary ex-vivo and an animal model evaluation of Ocimum sanctum's essential oil extract for its antibacterial and anti-inflammatory properties. Oral Health Dent Manag. 2013; 12: 174-179.
92. Gupta A, Duhan J, Tewari S, Sangwan P, Yadav A, Singh G, et al. Comparative evaluation of antimicrobial efficacy of Syzygium aromaticum, Ocimum sanctum and Cinnamomum zeylanicum plant extracts against Enterococcus faecalis: a preliminary study. Int Endod J. 2013; 46: 775-783.
93. O'Bryan CA, Crandall PG, Chalova VI, Ricke SC. Orange essential oils antimicrobial activities against Salmonella spp. J Food Sci. 2008; 73: 264-267.
94. Batista N, Etchebehere L, Maria J, Villela FLC, Mario. Effectiveness of three solvents and two associations of solvents on gutta-percha and resilon. Braz Dent J. 2011; 22: 41-44.
95. Magalhaes BS, Johann EJ, Lund RG, Martos J, Del Pino FAB. Dissolving efficacy of some organic solvents on gutta-percha. Braz Oral Res. 2007; 21: 303-307.
96. KarloviE Z, AniE I, MiletiE I, JukiE S, Bopnjak A, JuriE H. Revision of the Endodontic Filling with Solvents Eucalyptol, Halothane and Orange Oil. Acta Stomatol Croat. 2001; 35: 221-224.
97. Martos J, Bassotto APS, Gonzalez-Rodríguez MP, Ferrer-Luque CM. Dissolving efficacy of eucalyptus and orange oil, xylol and chloroform solvents on different root canal sealers. Int Endod J. 2011; 44: 1024-1028.
98. Karatas E, Kol E, Bayrakdar IS, Arslan H. The effect of chloroform, orange oil and eucalyptol on root canal transportation in endodontic retreatment. Aust Endod J. 2016; 42: 37-40.
99. Kosalec I, Pepeljnjak S, Bakmaz M, Vladimir Knezevic S. Flavonoid analysis and antimicrobial activity of commercially available propolis products. Acta Pharm. 2005; 55: 423- 430.
100. Koo H, Rosalen PL, Cury JA, Park YK, Bowen WH. Effects of compounds found in propolis on Streptococcus mutans growth and on glucosyltransferase activity. Antimicrob Agents Chemother. 2002; 46: 1302-1309.
101. Oncag A, Cogulu D, Uzel A, Sorkun K. Efficacy of propolis as an intracanal medicament against Enterococcus faecalis. Gen Dent. 2006; 54: 319-22.
102. Martin MP, Pillegi R. A quantitative analysis of Propolis: a promising new storage media following avulsion. Dent Traumatol. 2004; 20: 85-89.
103. Ferreira FB, Torres SA, Rosa OP, Ferreira CM, Garcia RB, Marcucci MC, et al. Antimicrobial effect of propolis and other substances against selected endodontic pathogens. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104: 709-716.
104. Sabir A, Tabbu CR, Agustiono P, Sosroseno W. Histological analysis of rat dental pulp tissue capped with propolis, J Oral Sci. 2005; 47: 135-138.
105. Hayacibara MF, Koo H, Rosalen PL, Duarte S, Franco EM, Bowen WH, et al. In vitro and in vivo effects of isolated fractions of Brazilian propolis on caries development. J Ethnopharmacol. 2005; 101: 110-115.
106. Ozan F, Sumer Z, Polat ZA, Er K, Ozan U, Deger O. Effect of mouth rinse containing propolis on oral microorganisms and human gingival fibroblast. Eur J Dentistry. 2007; 11: 195-200.
107. Toker H, Ozan F, Ozer H, Ozdemir H, Eren K, Yeler HJ. A morphometic and histopathologic evaluation of the effects of Propolis on alveolar bone loss in experimental periodontitis in rats. J Periodontol. 2008; 79: 1089-1094.
108. Ehsani M, Marashi MA, Zabihi E, Issazadeh M, Khafri S. A Comparison between Antibacterial Activity of Propolis and Aloe vera on Enterococcus faecalis (an In Vitro Study). Int J Mol Cell Med Summer. 2013; 2: 110-117.
109. Saxena D, Saha SG, Saha MK, Dubey S, Khatri M. An in vitro evaluation of antimicrobial activity of five herbal extracts and comparison of their activity with 2.5% sodium hypochlorite against Enterococcus faecalis. Indian J Dent Res. 2015; 26: 524-527.
110. Awawdeh L, Al-Beitawi M, Hammad M. Effectiveness of propolis and calcium hydroxide as a short-term intracanal medicament against Enterococcus faecalis: a laboratory study. Aust Endod J. 2009; 35: 52-58.
111. Elbagoury EF, Rasmy S. Antibacterial action of natural honey on anaerobic bacteroides. Egypt Dent J. 1993; 39: 381-386.
112. English HK, Pack AR, Molan PC. The effects of manuka honey on plaque and gingivitis: A pilot study. J Int Acad Periodontol. 2004; 6: 63-67.
113. de Rezende GP, da Costa LR, Pimenta FC, Baroni DA. In vitro antimicrobial activity of endodontic pastes with propolis extracts and calcium hydroxide: A preliminary study. Braz Dent J. 2008; 19: 301-305.
114. Sanches NR, Cortez DA, Schiavini MS, Nakamura CV, Filho BP. An evaluation of antibacterial activities of Psidium guajava. Braz Arch Biol Technol. 2005; 48: 429-430.
115. John NR, Gala VC, Sawant CS. Inhibitory effects of plant extracts on multi-species dental biofilm formation in-vitro. Int J Pharm Bio Sci. 2013; 4: 487-95.
116. Almas K. The antimicrobial effects of extracts of Azadirachta indica (Neem) and Salvadora persica (Arak) chewing sticks. Indian J Dent Res. 1999; 10: 23-26.
117. Al-Salman TH, Al-Shaekh Ali MG, Al-Nu’aimy OM. The antimicrobial effect of water extraction of Salvadora persica (Miswak) as a root canal irrigant. Al-Rafidain Dent J. 2005; 5: 33-36.
118. Sofrata A, Lingstrom P, Baljoon M, Gustafsson A. The effect of miswak extract on plaque pH. An in vivo study Caries Res. 2007; 41: 451-454.
119. Mohammad M. Haque, Saeed A. Alsareii. A review of the therapeutic effects of using miswak (Salvadora Persica) on oral health. Saudi Med J. 2015; 36: 530-543.
120. Al-obaida M, Al-Essa M, Asiri AA, Al-Rahla A. Effectiveness of 20% miswak extract against the mixture of Candida albicans and Enterococcus feacalis. Saudi Med J. 2010; 31: 640-643.
121. Almas K, Al-Bagieh N, Akpata E. In vitro antimicrobial effects of freshly cut and 1-month old miswak (chewing stick). Biomed Lett. 1997; 56:145-149.
122. Al-Subawi NAK, Abdull-Khalik K, Mahmud Y, Taha MY, Abdul A. Antimicrobial activity of Salvadora persica solution (Miswak Siwak) as root canal irrigant. Univ Sharjah J Pure Appl Sci. 2007; 4: 69-91.
123. Baeshen H, Birkhed D. Release of fluoride from fresh and old NaF-impregnated chewing sticks (Miswaks) in vitro and oral retention in vivo. Oral Health Prev Dent. 2010; 8: 93-99.
124. Prakash S, Shelke AU. Role of triphala in dentistry. J Indian Soc Periodontol. 2014; 18: 132-135.
125. Shakouie S, Eskandarinezhad M, Gasemi N, Milani AS, Samiei M, Golizadehb S. An in vitro comparison of the antibacterial efficacy of triphala with different concentrations of sodium hypochlorite. Iran Endod J. 2014; 9: 287-289.
126. Garg P, Tyagi SP, Sinha DJ, Singh UP, Malik V, Maccune ER. Comparison of antimicrobial efficacy of propolis, Morinda citrifolia, Azadirachta indica, triphala, green tea polyphenols and 5.25% sodium hypochlorite against Enterococcus fecalis biofilm. Saudi End J. 2014; 4: 122-127.