Volume No:

8, Issue No: 1

ISSN No: 2582-0559

ALOE VERA- THE BIOHEALER IN PERIODONTICS

Dr. Jaishree Tukaram Kshirsagar, Dr. Priyangha. P.T, Dr. Sangeetha. S, Dr. NarmathaDevi. N, Dr. Kalaiselvan. D

Department of Periodontics, Tamilnadu Government Dental College and Hospital, Chennai 600003. India

Address for Correspondence

Dr. P. T. Priyangha, Post Graduate Student,

Department of Periodontics, Tamilnadu Government

Dental College and Hospital, Chennai 600003. India

Email id: tvel1723@gmail.com

Received:

06.02.2021

First Published:

02.03.2021

Accepted:

22.02.2021

Published:

27.03.2021

ABSTRACT

Herbal medicines are in use as traditional mode of treatment for

various ailments in India, as they produce less side effects and are
more economical. Among the herbal medicines, Aloe vera is gaining
increased momentum as it is easily available and has numerous health
benefits. The utilization of Aloe vera dates back to 4

century. The

name Aloe vera is derived from the Arabic word “Alloeh” meaning
shining bitter substance, while “Vera” in Latin means true. Aloe vera
is known by various terminologies like “lilly of the desert” “plant of
immortality” “heaven’s blessing”. The current review article is an
attempt to discuss the history, parts, ingredients, general uses, dental
uses, periodontal uses, contraindications, and side effects of Aloe vera.

KEY WORDS:

Aloe vera, Acemannan, Periodontics

REVIEW ARTICLE

DOI:1.37841/jidam_2021_V8_I1_04

Jaishree et al: Aloe vera in Periodontics

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

INTRODUCTION

Before the emergence of modern medicine, herbs

were considered to be the golden resource and remedy to
treat many ailments.

The WHO has stated that the

medicinal plants are the best source for obtaining various
types of drugs

. Likewise, the implementation of natural

substances for treating dental ailments is attaining
popularity among the population. This is due to the
attraction and interest in the field of natural medicines, as
they are organic and produce comparatively less harmful
side effects and are readily available to the people of low
socioeconomic level status.

3,4,5

Periodontitis is a chronic inflammatory disease,

which leads to the destruction of supporting structures of
the teeth. There is a multifactorial etiology for periodontitis
of which the periodontopathogens play a major role. Since
periodontitis  is  caused  by  many  factors,  the  treatment  of
periodontitis  is  still  a  challenging  task  for  the  dentists.
Since  the  periodontal  disease  is  one  of  the  major  health
problem  of  the  world,  the  periodontal  treatment  mainly
aims to cure the inflamed tissue and to decrease the number
of pathogenic bacteria to eliminate the periodontal disease.
Thus,  herbal  remedies  have  come  to  a  rescue  as  they
possess  antimicrobial,  antioxidant,  antiseptic  and  anti-
inflammatory properties.

BENEFITS OF HERBAL DRUGS

Our country India is famous for its rich agro-

climatic,  cultural  and  ethnic  biodiversity,  which  makes
access easy  to  medicinal plants.  The herbal drugs  have a
long  era  of  use,  and  are  more  easily  affordable  and
accessible than conventional medicines. The herbal drugs
are  considered  to  be  a  reliable  source  as  they  have  good
patient  tolerance  and  better  public  acceptance.  Thus,  for
many  decades,  the  population  around  the  world  have
banked on traditional herbal medicine.

ALOE VERA PLANT

Aloe vera is receiving a lot of attention now-a-days.

Aloe  vera  [Aloe  barbadensis]  is  a  perennial  succulent
xerophyte  which  belongs  to  the  family  Asphodelaceae
[Liliaceae],  native  to  Africa,  Aloe  vera  is  universal  in
availability.    The  name  is  derived  from  Arabic  language
and  ‘alloeh’  means  shining  bitter  substance,  due  to  the
bitter liquid found in leaves, while vera means true. There
are more than 400 known species of this plant which is of
two species,

Aloe barbadensis miller

Aloe arborescens

These are significant species which grow more commonly
in tropical climate and in low rainfall area.

HISTORY OF ALOE VERA

In the field of medicine, the utilization of Aloe vera

and its products dates back to 4th century.

The Egyptian

queens  Nerfertiti  and  Cleopatra  used  Aloe  vera  in  their
routine  beauty  regimens.  Alexander,  the  Great  and
Christopher Columbus used it to treat the wounded soldiers
in war. The ancient Chinese and Egyptians used Aloe vera
in the treatment of burns, wounds and to reduce fever. In
1944, Japanese soldiers exposed to bomb attacks used Aloe
vera  gel  in  their  wounds  and  reported  faster  healing  and
reduced  scarring.  In  ayurvedic  medicine,  which  is  the
traditional  medicine  in  India,  the  Aloe  vera  is  used  as  a
laxative,  antihelminthic  and  uterine  stimulant.  Aloe  are
also used for decorative purposes and is grown indoors.

PARTS OF ALOE VERA

The Aloe vera is a stiff gray green plant with lance

shaped leaves.

Aloe vera leaf has two parts,

Central mucilaginous part

Peripheral bundle sheath

The central part is  made of parenchymal tissue and
produces a clear, thin, tasteless jelly like material made up
of  water,  with  glucomannans, amino acids, lipids, sterols
and  vitamins.

9,10

This is known as Aloe vera gel from

which cosmetic and medicinal products are obtained.

  The mucilage layer holds the plant together and acts
as  a  barrier  to  keep  the  inner  gel  sterile.  The  peripheral
bundle  of  sheath  cells  forms  a  bitter,  yellow,  latex
containing anthraquinones and glycorides named as aloes
/sap/aloe  juice.  These  anthraquinones  acts  as  a  powerful
laxative.

INGREDIENTS OF ALOE VERA

More than 75 active ingredients are recognized from the
inner gel of Aloe vera.

8,9

CLASS

COMPOUND CURATIVE

PROPERTY

Aminoacids

Isoleucine,
leucine, lysine,
methionine,
valine,
threonine,
phenylalanine.

In the body, it houses
proteins

and

muscle

tissues.

Anthraquinone Aloe-emodin,

aloetic

acid,

aloin A and B,
isobarbolin,
emodin

Acts as Analgesic and
antibacterial

Jaishree et al: Aloe vera in Periodontics

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

Vitamins

B1, B2, A, C,
E, B6, folic
acids,

alpha

tocopherols

Antioxidants

neutralizes

the free radicals

Minerals

Calcium,
chlorine,
copper,

iron,

chromium,
magnesium,
zinc, sodium,
potassium and
phosphorus

vital for good health

Enzymes

Alkaline
phosphatase,
amylase,
carboxypeptid
ase, catalase,
bradykinase,
cyclooxidase,
peroxidase,
lipase,
oxidase, super
oxide
dismutase,
carboxy
peptidase.

Anti-fungal, anti-viral but
toxic at high concentrations

Steroids

Lupeol

Anti-inflammatory
lupeol – antiseptic and
analgesic

Sugars

Glucose

and

fructose

Anti-viral,

immune

modulating

activity

acemannan

Carbohydrates

Pure mannan,
acetylated
mannan,
acetylated
glucomannan,
galactan,
xylan,
cellulose,
glucogalactom
annan

Contributes

plastic

property of the gel

Salicylic acid

Analgesic

Saponins

Cleaning and antiseptic

ALOE VERA IN VARIOUS FORMS

The following forms of Aloe vera are currently in use.

10,11

Toothpaste

Mouthwash

Aloe vera topical spray – for throat infections,
painful teeth eruptions, joint pains

Aloe vera juice as systemic – acts as a detoxifying
agent, immune enhancer

As a powerful nutritional supplement.

Aloe vera in gel form for better healing in burns,
stings, insect bites and in skin lesions.

GENERAL USES OF ALOE VERA

1. In wound healing:

Aloe vera helps in wound healing by the following steps.

Keeps the wound moist.

Increases migration of epithelial cells and collagen.

Decreases inflammation.

Glucomannan, a mannose – rich polysaccharide and

gibberellin, a growth hormone - when applied topically
leads to the proliferation of fibroblasts, increases collagen
III synthesis and improves breaking strength.

It also

increases the formation of hyaluronic acid and dermatan
sulphate in the granulation tissue of wound healing.

Thompson et al reported that topical application of Aloe
vera derived allantoin gel stimulate fibroblastic activity
and collagen proliferation.

Yagi et al, reposted that Aloe

vera has a glycoprotein with cell proliferating activity.
Davis et al noted that Aloe vera rinse [Carrington wound
rinse] improves wound healing by providing increase of
blood supply through oxygenation.

2.Anti – inflammatory property:

Bradykinin an inflammatory substance, that induces

pain, is broken down by Bradykinase, a peptidase obtained
from Aloe vera.

Aloe vera gel [Alcortin A] also inhibits

the cycloxygenase pathway which in turn reduces PGE

synthesis from arachidonic acid

. C-glucosyl chromonone

is a recently identified novel anti – inflammatory
compound from the gel extracts of Aloe vera. Aloe vera
[Savila] also plays a vital role as an effective analgesic.

3.Antibacterial property:

Aloe vera [Povizest ointment] has proved to be

effective against both gram-negative and gram-positive
bacteria.

Aloe vera plays a role in amplification of wound

healing by getting rid of the bacteria, which intensifies the
inflammation.

Aloe vera gel is proved to be bactericidal

against

pseudomonas

aeruginosa

and

inhibits

streptococcus pyogenes and streptococcus fecalis.

When

used in-vitro, the inner leaf gel from Aloe vera inhibits the
growth of shigella and streptococcus species.

4.Antifungal property:

Candida paraprilo, Candida krusei and Candida

albicans species are susceptible to the antifungal activity of
purified aloe protein.

Jaishree et al: Aloe vera in Periodontics

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

5.Anti-viral property:

This property can be direct /indirect, direct due to
aloe emodin and indirect due to stimulation of immune
system.

Herpes simplex virus [HSV] type 1 and 2 virus,

pseudorabies virus and influenza virus are susceptible to
the virucidal action of aloe emodin.

The inner leaf of

Aloe  vera  yields  anthraquinones,  which  shows  antiviral
property.  In  a  study  with  two  cultured  target  cell  lines,
acemannan,  which  is  present  in  Aloe  vera  showed  a
reducing  effect  in  HSV  infection.  In  cell  culture,  actins
which are the fractions of AV gel inhibits cytomegalovirus
proliferation by interfering with its protein synthesis.

26,27

6. Anti-oxidant property:

The anti-oxidant effects of Aloe vera occurs by

superoxide dismutase enzymes, phenolic compounds, and
due to the presence of vitamins A, E, and C. They act as a
free radical scavenger and removes toxins and
carcinogenic substances.

7.Antimicrobial property:

The growth of disease-causing microorganisms is

inhibited by the important constituents of Aloe vera
[Biodine -M] like sulphur, salicylic acid, cinnamic acid,
urea, nitrogen and phenol. The bacterial, viral and fungal
origin infections are also diminished successfully.

8.Aloe vera on immune system:

Aloe vera boosts natural immunity and balances

body’s  defense  and  adaptive  mechanisms.  Acemannan,
which  contains  90%  rhodium  and  iridium  acts  as  a
stimulant and increases the WBC and T cells , activation
of  macrophages  leads  to  immunomodulating  effects  ,
which generates nitric oxide, cytokines [TNF – alpha, IL-
1,IL-6,  and  interferon-  gamma],  which  in  turn  leads  to
necrosis and regression of cancerous cells.

9.Antitumour effect:

Glycoproteins[lectins] and polysaccharides from

Aloe vera showed anticancer effects. There is a reduced
tumor necrosis and prolonged survival rates noted with
Aloe vera gel.

10.Anti – aging effect:

The Aloe vera [Acofar derm] skin gel stimulates

fibroblast, which produces collagen and elastin fibers, and
it makes the skin more elastic and less wrinkled.

The

higher  concentration  [0.25%  w/w  and  0.5%  w/w],
improved  skin  hydration  by  humectant  mechanism,
whereby  aloe  vera  attracts  water  from  the  dermis  and
retains it in the stratum corneum.

Aloe vera softens the

skin by exerting cohesive effects on superficial flaking
epidermal cells by making them stick together.

ALOE VERA IN DENTISTRY

The dental uses of Aloe vera are enormous. Aloe

vera when used to treat oral diseases proved to be
beneficial in many ways.

1.Oral lichen planus

Topical application of Aloe vera [Real aloe] for oral

lichen  planus,  gave  excellent  results  when  compared  to
triamcinolone  due  to  its  minimal  side  effects.  Aloe  vera
when  applied  for  3  times  a  day,  reduces  the  pain  and
severity of oral lesions. The oral life quality of patients is
also improved.

2.Recurrent aphthous stomatitis

Aloe vera 2% oral gel[Regenecare] is effective in

decreasing patient’s ulcer size and accelerates wound
healing. A reduction in the erythema and exudation was
observed due to the presence of acemannan.

18, 33

3.Oral submucous fibrosis

Aloe vera when used topically[Lidotrex] manifested

better response in reducing the burning sensation and
increased mouth opening, compared to the antioxidant
effect.

Aloe vera on application leads to dilatation of

capillaries at the injured site which improves healing.

Aloe vera has proved to be effective in the treatment of
burning mouth syndrome.

4.Radiation induced oral mucositis

Aloe vera by its anti – inflammatory mechanism

prevents oral mucositis, by hastening of wound healing and
reduces oral candidiasis in patients undergoing head and
neck radiotherapy, through its anti-fungal and immuno
modulatory action.

5.Alveolar osteitis

A freeze- dried pledget namely salicept patch,

containing acemannan hydrogel when placed in an
extracted socket showed improved healing and formation
of blood clot, compared to clindamycin soaked gelfoam.

The active component of Aloe vera acemannan was found
to be effective in bone regeneration.

6.Denture adhesive

The content acemannan a complex of mannose

carbohydrate, was tried as a denture adhesive and it has
proved to be a stable adhesive in terms of bond strength
and minimum cytotoxicity was noted.

The saponins are

soapy substances containing glycosides, and are used as
denture cleansers.

7.Aloe vera as anti-cariogenic agent

Jaishree et al: Aloe vera in Periodontics

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

The cariogenic and periodontopathic bacteria are

susceptible to Aloe vera gel [Aloevia]. The Aloe vera gel
is capable of producing inhibition zones against all oral
bacteria tested.

8. Aloe vera in obturation of primary teeth

Aloe vera when mixed with sterile water was found

to be having better antimicrobial activity when compared
to zinc oxide, calcium hydroxide with iodoform when used
as a obturating material in primary teeth.

9. Aloe vera in denture stomatitis

Denture stomatitis is most commonly due to the

fungus candida albicans. Aloe vera mouthwash [Aloedent]
as it contains natural anthraquinones helps to treat the
denture stomatitis.

ALOE VERA IN PERIODONTOLOGY

1.Gingivitis

The anti-inflammatory and wound healing activity

of Aloe vera due to the presence of mannose -6-phosphate,
makes it an adjunct to mechanical therapy for the treatment
of plaque induced gingivitis. Aloe vera when used for
gingivectomy showed better healing.

The sterols and

lupeols present in Aloe vera acts as antiinflammatory and
antiseptic respectively, and leads to a decrease in gingival
index.

2.Periodontitis

Subgingival delivery of Aloe vera, showed

improved periodontal conditions in terms of plaque index,
gingival index, probing pocket depth and levels of plaque
accumulation. Reduced swelling, soft tissue edema and
gingival bleeding are noted with Aloe vera.

3.Aloe vera as tooth gel

Since it does not contain the abrasive elements,

Aloe vera tooth gel is less harsh on the teeth, making it as
a good alternative for sensitive teeth and gums. Aloe vera
gel has proved to be an effective anti-bacterial agent
against variety of species like streptococcus mitis,
prevotella intermedia, enterococcus fecalis etc.

The Aloe

vera toothpaste was found to be effective against
streptococcus mutans, candida albicans and enterococcus
fecalis.

4.Aloe vera as LDD

There was a significant reduction in the pocket

depth  when  Aloe  vera  used  as  local  drug  delivery  agent.
Aloe  vera  when  given  sub  gingivally,  as  an  adjunct  to
scaling  and  root  planning  in  patients  with  chronic
periodontitis was proved to be effective.

5.Aloe vera containing dental floss

The antimicrobial and healing properties of Aloe

vera  increases  the  efficacy  of  flossing,  and  aids  in
prevention  of  periodontal  disease  and  caries.  On
comparison  with  the  synthetic  floss  [nylon]  and  organic
floss[beeswax], the Aloe vera containing floss is gentle and
has smoother finish.

6.Implants

Aloe vera is found to be effective in reducing

inflammation  by  its  anti-  microbial  and  anti  –
inflammatory property around implants. Thus, it helps  to
improve  bone  implant  interface  and  prevents  peri-
implantitis.  Aloe  vera  gel  also  stimulates  bone  growth
around and onto the surface of endosseous dental implants
placed  in  sites  with  extended  peri-implant  osseous
defects.

CONTRAINDICATIONS OF ALOE VERA

Aloe vera is contraindicated in children under 10
years of age as more incidences of stomach pain,
cramps and diarrhea was reported.

After topical application of Aloe vera, dermatitis
and hypersensitivity were noted in some cases

Aloe vera should be used cautiously in pregnancy
and in lactating mothers as it leads to stimulations
of uterine contractions and gastrointestinal stress
respectively.

Aloe vera interacts with hypoglycemic drugs and
further intensifies hypoglycemia.

The risk of potassium depletion is observed when
Aloe vera and furosemide are used together. This
leads to the increase in the adverse effects of
digoxin

and

digitoxin

and

reduces

its

effectiveness.

SIDE EFFECTS

TOPICAL

Redness, burning sensation, rarely generalized

edema are noted in sensitive individuals, thus it should be
first tested in a small area for any allergic reaction.

ORAL

Acute toxicity leads to abdominal cramps, diarrhea,

while on prolonged use it increases the risk of colorectal
cancer. The laxative effect causes electrolytic imbalances
leading to low potassium levels.

CONCLUSION

Aloe vera possess a wide array of biological

properties, such as anti-microbial, antioxidant, anti-
inflammatory effects and thus it is acclaimed worldwide

Jaishree et al: Aloe vera in Periodontics

Volume No:

8, Issue No: 1

ISSN No: 2582-0559

since  many  years  for  its  beneficial  properties.  The
utilization of the herbs in dentistry is becoming well known
these  days,  as  they  relatively  produce  less  harmful  side
effects  and  are  more  economical.  Thus,  medicinal  herbs
must be incorporated in regular oral health care practices
to  obtain  maximum  benefits.  Though  there  are  many
advantages of Aloe vera been proved, the studies available
in  literature  are  all  short-term  studies,  thus  long-term
studies are needed to be conducted with large sample size.
Further

attention

and

research

required

standardization  and  quality  assurance  and  long-term  side
effects  of  Aloe  vera  products.  Thus,  a  proper  diagnosis,
knowledge about the risks and benefits of traditional herbs
like Aloe vera is very essential in ensuring success. Thus,
Aloe vera is indeed a nature’s gift to  humanity, provided
we utilize the benefits effectively.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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