Open access peer-reviewed chapter

Dental Caries, Etiology, and Remedy through Natural Resources

Written By

Lubna Tahir and Rabia Nazir

Submitted: 08 November 2017 Reviewed: 25 February 2018 Published: 05 November 2018

DOI: 10.5772/intechopen.75937

From the Edited Volume

Dental Caries

Edited by Zühre Akarslan

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Caries and oral mucosal and periodontal diseases are the major cause of oral health problems. They are prevalent in all ages and demographic and socioeconomic groups. Irrespective of geographic location in the world, both males and females are affected from the condition. Dental caries’ etiology has four main factors: bacteria, time, susceptible tooth surface, and fermentable carbohydrates. Due to the high prevalence of oral disease and increased microbial resistance against antibiotics, there is a need for alternative methods. Therefore, the search for viable alternative products is of paramount importance. Phytochemicals isolated from plants, which are used in traditional medicines, are considered to be safe and effective alternatives compared to synthetic chemicals. This situation diverted efforts toward finding natural products as the potential medicine for treating dental caries. The chapter will focus on the etiology of dental caries and different remedies using the natural resources for prevention and treatment of the disease. A wide variety of secondary metabolites in medicinal plants having in vitro antimicrobial activities provide a hope for novel drug compounds.


  • dental caries
  • etiology
  • natural resources
  • bacteria

1. Introduction

1.1. Dental caries

Oral diseases, a major health issue in the world [1], are economically affecting people of developed countries as 10% of the health expenditure is related to dental care. Even though there is an improvement in oral health in most of the developed countries, there are still dentally disadvantaged people, usually with low socioeconomic status [2].

1.2. Prevalence in the world

Caries and oral mucosal and periodontal diseases are the major oral health problems in developing countries [3]. They are prevalent in all ages and demographic and socioeconomic groups. Irrespective of geographic location in the world, both males and females are affected from the condition. Dental caries is most prevalent in Latin America, South Asia, and the Middle East and least common in China [4]. Dental caries increase with age due to denture use and poor hygiene. The presentation of caries varies among people, but the risk factors and developmental stages are the same [5]. According to a survey by the National Health and Nutrition Examination Survey (NHANES) in the United States (1992–2004), conducted among adults between 20 and 64 years old, there was a decline in cases up to 97% in the 1990s, but still the prevalence is high, affecting 92% of people. In developing countries, this percentage rose to 96% [6]. Oral diseases like tooth loss, oropharyngeal cancers, dental caries, oral mucosal and periodontal diseases, and HIV/AIDS-related oral diseases are the main public health problems globally [1, 7]. Out of total 291 diseases and injuries evaluated in global burden of disease, untreated tooth decay has the highest rate of prevalence between 70 and 90% of populations [8], and it is also one of the most common reasons for tooth extraction.


2. Etiology of dental caries

Caries is a chronic, multifactorial disease, which causes destruction and demineralization of hard tissues of teeth by acid production occurring from bacterial fermentation of food [9]. Figure 1 represents the common factors involved in caries formation.

Figure 1.

Common factors causing dental caries.

2.1. Dental plaque and biofilm

Biofilms are usually associated with the etiopathogenesis of periodontal diseases [10]. In order to survive in a niche, the ability of microbes to adhere to tooth surface and multiply in protected environments like tooth cervices and periodontal pockets is very important. This accumulation of microbes on the tooth surface is called plaque, which can be defined as “a structure entity in which the microbes are embedded in a highly organized intercellular matrix,” These microbes are involved in different metabolic, physical, and molecular interactions. This consortium provides advantages to the participating microbes for resistance to antimicrobial agents, increased pathogenicity, growth, and host defenses [11]. Four stages involved in the biofilm formation are summarized in Figure 2.

Figure 2.

Stages of biofilm formation.

The primary colonizers of tooth form the biofilm by auto-aggregation and co-aggregation resulting in different morphological structures. The microenvironment moves from aerobic to facultative anaerobic [10]. The bacteria multiply and in matured biofilm occur. Quorum sensing is another important characteristic seen in biofilm-associated bacteria, which actually involves the regulation of specific gene expression. This occurs by means of accumulation of different signaling compounds that facilitate the intercellular communication. This gives biofilm their unique characteristics [12].

2.2. Microbiology of dental caries

The interaction between bacteria and its surrounding epithelium is acute element in bacterial infections. If left untreated pain, infection, and tooth loss depending on the severity will occur. Dental plaque is a sticky substance that sticks to the surface of the teeth. It is considered as complex biofilm that is also the main cause of dental caries [13]. Dextran, produced by the dietary sucrose fermentation by Streptococcus mutans, is responsible for the stickiness of plaque. As a result of fermentation, S. mutans produce lactic acid, which ultimately starts enamel decalcification. This plays a role in initiation of enamel caries. In fact, the development of dental plaque depends on the result of interaction between the plaque adhesion to the tooth surface and the physical shear forces involved in dislodging and removal of plaque [14]. If the dental plaque is not removed properly, tooth decay will flourish [15]. The mature dental plaque is embedded in a matrix of bacteria and host polymer that includes proteins, DNA secreted by cells, and polysaccharides [16, 17, 18, 19]. This provides the protection of bacteria against host defenses and predators, from desiccation and enhanced resistance against antimicrobial compounds [20]. Streptococcus mutans, S. mitis, S. constellatus, S. sanguis, S. salivarius, S. anginosus, S. gordonii, S. intermedius, and S. oralis are some of the primary acid-tolerant bacteria that are associated with dental plaque [21]. Accumulation of plaque in gingival and subgingival regions shifts the microflora from gram positive to gram negative. This can cause the periodontal diseases [22]. Dental caries is linked with high blood pressure, diabetes, heart diseases, and sometimes multiple sclerosis along with continuous pain that gets aggravated by cold, heat, sugar, and drinks [23, 24].

Four main factors are associated with dental caries etiology. These factors are bacteria, time, susceptible tooth surface, and fermentable carbohydrates [25, 26]. Along with these factors, there are certain behavioral and sociodemographic factors that are likely to increase the risk of caries. These include poor oral hygiene, age, improper tooth brushing habits, plaque, and sugar-containing drinks [27].

The oral cavity of human is considered as a complex ecosystem which has both acid-producing and acid-tolerant bacteria. Almost 700 different bacterial species have been known for human oral cavity [28, 29, 30], and nearly 200–300 species have been identified for dental plaque [31] using different culture-dependent and culture-independent techniques. S. mutans is considered as the main organism responsible for human dental caries. Certain factors like ability to form biofilms, tolerance of frequent and rapid environmental fluctuations, and metabolizing carbohydrates are considered to be responsible for the virulence of these bacteria [32, 33]. In addition, the mutans is also associated with bacterial endocarditis, inflammation of heart valves. Synthesis of the extracellular polysaccharides by S. mutans from sucrose through glucosyltransferases (GTFs) is considered another important virulence factor that causes caries in humans [34]. This not only facilitates the adhesion and accumulation of the organism on the tooth surface but also provides protection against host immune defenses along with provision of increased resistance against antibiotics and gene expression [35]. This combination of virulence properties allow the mutans to colonize the surface of tooth and modify the nonpathogenic to highly cariogenic dental biofilm that ultimately leads to caries formation [36].


3. From synthetic to herbal products

The second primary cause of death in the world is infectious diseases. Treatment of these diseases is problematic today because of severe side effects of different antimicrobials and the growing resistance against all the lifesaving drugs due to their continuous use [37, 38]. The issue becomes much worst with almost 70% of bacteria that cause common infections in hospitals develop resistance to at least one of the common antibiotic that is used for treatment [39, 40]. Even the antibacterial agents can enhance the development of resistant bacterial strains [41]. Different antibiotics like erythromycin and penicillin are effective against dental caries in humans and animals, but because of their adverse effects, they are not recommended in clinical application [42]. Chlorohexidine, penicillin, cephalothin, ampicillin, methicillin, and digluconate are some of the other antibiotics that have effect on dental caries [22]. Recently, resistance has also been observed in cariogenic bacteria against these antibiotics. The development of resistant strains and the associated side effects of these medicines have resulted in diversion of research toward screening of natural products (plants) for anticaries activity as some plants have shown potential against dental caries-causing pathogens [43, 44].

3.1. Herbal medicines from plants

The use of natural remedies from medicinal plants could be an alternative for the side effects of antibiotics like supra-infections, hypersensitivity, and teeth staining. Due to this the search for new antibiotics continues persistently. In fact the failure of different chemotherapeutics and increasing resistant against antibiotics also led to screening of different medicinal plants and their potential use against these microbial pathogens [45]. The significant contribution of medicinal plants to the drug industry, all over the world, was due to the increasing number of phytochemical and biological studies. Medicinal plants are important sources of developing new therapeutic agents. Almost 100 new plant-based medicines were introduced in the United States during 1950–1970. These include vinblastine, deserpidine, etc. From 1991 to 1995, 2% of drugs were introduced in the world including irinotecan, paclitaxel, topotecan, and many others [46]. Drugs derived from plants are used to treat cancer, tuberculosis, different skin diseases, diabetes, hypertension, and many more [47]. The National Cancer Institute collected around 35,000 plants from 20 different countries and evaluated almost 114,000 extracts for potential anticancer activity [48]. Among the approved anticancer drugs worldwide, between 1983 and 1994, 60% are of natural origin [49]. Some medicinal plants that are used to treat different diseases are given in Table 1.

Plant namePart of plantApplicationReference
Asteracantha longifoliaDiabetic patients[50]
Mangifera indicaLeavesAntidiabetic activity[51]
Citrus lemon L.PeelAntibacterial[52]
Soymida febrifuga, Tinospora cordifolia (Willd.)Whole plantAntioxidant, anti-inflammatory[53]
Terminalia chebula, Ocimum sanctumWhole plantUrinary tract infections[54]
Syzygium cuminiLeavesDental caries[55]
Diospyros blancoi, Phoenix dactylifera, and Morus nigraLeavesAntibacterial, caries[56]
Capsicum annuumFruitAntibacterial, antimicrobial[57, 58]
Psidium guajava LLeavesAntimicrobial, antioxidant[59, 60]
Aloe vera LLeaves/gelAntimicrobial, skin infections[61, 62, 63]
Azadirachta indicaWhole plant, leavesAntimicrobial, antioxidant[64, 65]

Table 1.

Medicinal plants used in traditional medicines.

Today, oral care products combined with medicinal plant extracts are gaining high interest due to their low toxicity [66, 67]. Cetylpyridinium chloride, amine fluorides, triclosan, and chlorhexidine are not only toxic, but they cause staining of teeth.


4. Secondary metabolites of plants

Different secondary metabolites produced by plants like terpenoids, flavonoids, alkaloids, and tannins are new sources of antimicrobial substances which help in combating resistant pathogens. Plants synthesize different useful substances, majority of which are secondary metabolites and almost 12,000 of them have been isolated [68]. Owing to their diverse structures, synthesizable analogues [69] and frequent usage [70] natural products have become an important source of medicine. Plants have evolved multiple defense systems for their survival because of plethora of rivals in order to fight the environmental stresses [71]. Plants are in fact the complex storehouse of undiscovered bioactive compounds with great potential to be used in medicines [72].

Basically the chemicals produced by plants are divided into two categories, the primary and the secondary metabolites [73]. The primary metabolites are involved in the synthesis of the basic building blocks of the plant, while the secondary metabolites are involved in the defense mechanism of the plant against different microbial infections [74]. The important secondary metabolites in medicine include flavonoids, alkaloids, terpenes, tannins, and phenolic compounds [75, 76, 77, 78]. Unlimited opportunities for drug discovery have been provided by plant extracts, whether pure compounds or standardized extracts, because of their chemical diversity [79]. All the plants that are used in traditional medicine contain diverse substances that can be used to treat different infectious and chronic diseases [80, 81].

The significant contribution of medicinal plants to the drug industry is due to the increasing number of phytochemical and biological studies. In developing countries the herbal medicines are important sources of products in order to treat different infectious diseases and also to overcome the problems related with the available antimicrobial agents. Herbal remedies are getting popularity as they provide safe alternatives for treating various types of cancers [82, 83, 84, 85]. These remedies are gaining interest because of their multidimensional health benefits like they are even used in different alternative treatments like acupuncture and massage therapy and by various traditional practitioners. The medicinal uses of the plants range from administration of leaves, stem, barks, seeds, and roots to using of the decoction from different plants [86]. There has been an increase in the demand of different herbal products in the last few decades and even in countries like United States, herbal remedies are in use in the form of different dietary supplements [84, 87, 88].

Figure 3 represents the general layout of extraction of useful secondary metabolites from plants taking Syzygium cumini as an example using different solvents.

Figure 3.

Extraction and fractionation from the leaves of Syzigium cumunii.


5. Why to go for natural resources

The commercially available chemicals, if not all, to most of the antibiotics commonly available to treat oral infections, can alter the oral microbiota along with certain undesirable side effects [41, 89] and bacterial resistance [90]. An alteration in the microenvironment like wounds, malnutrition, abrasions, and different pathological conditions enhances disease development [91]. Also, the presence of ethanol that is commonly found in mouth washes has been linked to oral cancer [66, 67, 92, 93]. As a result of this, the indiscreet use of allopathic drugs and improper diagnosis of microbial infections not only lead to untargeted therapy, but it also gives way to resistant pathogens [94, 95]. Therefore, the search for alternative methods and products continues, and for that the phytochemicals isolated from plants that are used in traditional medicines are proving to be the good alternative to synthetic chemicals [96].

In developing countries the herbal medicines are proving to be an important source of products in order to treat different infectious diseases and also to overcome the problems related with the available antimicrobial agents. Herbal remedies are also getting popularity for treating various types of cancers as they provide safe alternative [82, 83, 84, 85].


6. Conclusion

Prevention of dental caries is challenging, as the incidence of the disease is very high in general population and it occurs in economically deprived people who cannot afford the commercially available oral hygiene products [97]. Even though caries is known to be an infectious disease for decades, very little effort has been done to use this information clinically [98]. Different from other commercially available chemicals, they not only alter the oral microbial environment but also play a role in developing the resistant strain. Hence, in order to prevent dental caries, it is time to focus our attention toward natural resources which have vast abilities to inhibit the growth of microbes that are responsible for caries. For this, we need to isolate the bioactive compounds from plants with little or no harmful effects.


  1. 1. Petersen PE. The burden of oral disease: Challenges to improving oral health in the 21st century. Bulletin of the World Health Organization. 2005;83:3-3
  2. 2. Jamieson LM, Parker EJ, Armfield JM. Indigenous child oral health at a regional and state level. Journal of Paediatrics and Child Health. 2007;43(3):117-121
  3. 3. Saparamadu K. Prevention of oral diseases in developing countries. International Dental Journal. 1984;34(3):166-169
  4. 4. Petersen PE. World Health Organization global policy for improvement of oral health-World Health Assembly 2007. International Dental Journal. 2008;58(3):115-121
  5. 5. Guido JA, Martinez Mier EA, Soto A, Eggertsson H, Sanders BJ, Jones JE, Weddell JA, Villanueva Cruz I, de la Concha A, Luis J. Caries prevalence and its association with brushing habits, water availability, and the intake of sugared beverages. International Journal of Paediatric Dentistry. 2011;21(6):432-440
  6. 6. Hicks J, Garcia-Godoy F, Flaitz C. Biological factors in dental caries: Role of remineralization and fluoride in the dynamic process of demineralization and remineralization (part 3). Journal of Clinical Pediatric Dentistry. 2004;28(3):203-214
  7. 7. Javed F, Ramalingam S, Ahmed HB, Gupta B, Sundar C, Qadri T, Al-Hezaimi K, Romanos GE. Oral manifestations in patients with neurofibromatosis type-1: A comprehensive literature review. Critical Reviews in Oncology/Hematology. 2014
  8. 8. Marcenes W, Kassebaum N, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray C. Global burden of oral conditions in 1990-2010 a systematic analysis. Journal of Dental Research. 2013;92(7):592-597
  9. 9. Selwitz RH, Ismail AI, Pitts NB. Dental caries. The Lancet. 2007;369(9555):51-59
  10. 10. Chandki R, Banthia P, Banthia R. Biofilms: A microbial home. Journal of Indian Society of Periodontology. 2011;15(2):111
  11. 11. Lang N, Mombelli A, Attström R. Oral biofilms and calculus. In: Clinical Periodontology and Implant Dentistry. Oxford, UK: Blackwell Munksgaard; 2008. pp. 197-205
  12. 12. Processor J. Quorum sensing in biofilms. In: Dental Plaque revisited. Cardiff: Bioline; 1999. pp. 79-88
  13. 13. Benson PE, Douglas C, Martin MV. Fluoridated elastomers: Effect on the microbiology of plaque. American Journal of Orthodontics and Dentofacial Orthopedics. 2004;126(3):325-330
  14. 14. Roberts A. Bacteria in the mouth. Dental Update. 2005;32(3):134-136, 139-140, 142
  15. 15. Hardie J. Oral microbiology: Current concepts in the microbiology of dental caries and periodontal disease. British Dental Journal. 1992;172(7):271-278
  16. 16. Baelum V, Pongpaisal S, Pithpornchaiyakul W, Pisuithanakan S, Teanpaisan R, Papapanou PN, Dahlen G, Fejerskov O. Determinants of dental status and caries among adults in southern Thailand. Acta Odontologica. 2002;60(2):80-86
  17. 17. Fejerskov O, Kidd EA, Fejerskov O, Kidd EA. Dental Caries. Munksgaard: Blackwell; 2003
  18. 18. Featherstone J. The continuum of dental caries—Evidence for a dynamic disease process. Journal of Dental Research. 2004;83(suppl 1):C39-C42
  19. 19. Featherstone J. Dental caries: A dynamic disease process. Australian Dental Journal. 2008;53(3):286-291
  20. 20. Scheie AA, Petersen FC. The biofilm concept: Consequences for future prophylaxis of oral diseases? Critical Reviews in Oral Biology & Medicine. 2004;15(1):4-12
  21. 21. Dye BA, Tan S, Smith V, Lewis B, Barker L, Thornton-Evans G, Eke P, Beltrán-Aguilar E, Horowitz A, Li C. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital and health statistics series 11. Data from the National Health Survey; 2007(248):1-92
  22. 22. Iwaki K, Koya-Miyata S, Kohno K, Ushio S, Fukuda S. Antimicrobial activity of Polygonum tinctorium Lour: Extract against oral pathogenic bacteria. Journal of Natural Medicines. 2006;60(2):121-125
  23. 23. Wright J, Hart T. The genome projects: Implications for dental practice and education. Journal of Dental Education. 2002;66(5):659-671
  24. 24. Taylor GW, Manz MC, Borgnakke WS. Diabetes, periodontal diseases, dental caries, and tooth loss: A review of the literature. Compendium of Continuing Education in Dentistry (Jamesburg, NJ: 1995). 2004;25(3):179-184, 186-178, 190; quiz 192
  25. 25. Keyes P, Jordan H. Periodontal lesions in the Syrian hamster—III: Findings related to an infectious and transmissible component. Archives of Oral Biology. 1964;9(4):377-398
  26. 26. König K. Caries and Caries Prevention. Munich, Germany: Goldmann; 1971. pp. 11-68
  27. 27. Declerck D, Leroy R, Martens L, Lesaffre E, Garcia-Zattera MJ, Broucke SV, Debyser M, Hoppenbrouwers K. Factors associated with prevalence and severity of caries experience in preschool children. Community Dentistry and Oral Epidemiology. 2008;36(2):168-178
  28. 28. Paster BJ, Boches SK, Galvin JL, Ericson RE, Lau CN, Levanos VA, Sahasrabudhe A, Dewhirst FE. Bacterial diversity in human subgingival plaque. Journal of Bacteriology. 2001;183(12):3770-3783
  29. 29. Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. Journal of Clinical Microbiology. 2005;43(11):5721-5732
  30. 30. Paster BJ, Olsen I, Aas JA, Dewhirst FE. The breadth of bacterial diversity in the human periodontal pocket and other oral sites. Periodontology 2000. 2006;42(1):80-87
  31. 31. Islam B, Khan SN, Khan AU. Dental caries: From infection to prevention. Medical Science Monitor. 2007;13(11):RA196
  32. 32. Banas J, Vickerman M. Glucan-binding proteins of the oral streptococci. Critical Reviews in Oral Biology & Medicine. 2003;14(2):89-99
  33. 33. Lemos JA, Burne RA. A model of efficiency: Stress tolerance by Streptococcus mutans. Microbiology. 2008;154(11):3247-3255
  34. 34. Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiological Reviews. 1986;50(4):353
  35. 35. Watnick P, Kolter R. Biofilm, city of microbes. Journal of Bacteriology. 2000;182(10):2675-2679
  36. 36. Jeon J-G, Rosalen P, Falsetta M, Koo H. Natural products in caries research: Current (limited) knowledge, challenges and future perspective. Caries Research. 2011;45(3):243-263
  37. 37. Sydney S, Lacy R, Bakhtiar M. The Betalactam Antibiotics Penicillin and Cephalosporin in Perspective. Hodder and Stongton: London, UK; 1980
  38. 38. Mehrgan H, Mojab F, Pakdaman S, Poursaeed M. Antibacterial activity of Thymus pubescens methanolic extract. Iranian Journal of Pharmaceutical Research. 2010:291-295
  39. 39. Nascimento GG, Locatelli J, Freitas PC, Silva GL. Antibacterial activity of plant extracts and phytochemicals on antibiotic-resistant bacteria. Brazilian Journal of Microbiology. 2000;31(4):247-256
  40. 40. Bisht R, Katiyar A, Singh R, Mittal P. Antibiotic resistance-A global issue of concern. Asian Journal of Pharmaceutical and Clinical Research. 2009;2(2):34-39
  41. 41. Tenover FC. Mechanisms of antimicrobial resistance in bacteria. The American Journal of Medicine. 2006;119(6):S3-S10
  42. 42. Kubo I, Muroi H, Himejima M. Antimicrobial activity of green tea flavor components and their combination effects. Journal of Agricultural and Food Chemistry. 1992;40(2):245-248
  43. 43. Tsai T-H, Tsai T-H, Chien Y-C, Lee C-W, Tsai P-J. In vitro antimicrobial activities against cariogenic streptococci and their antioxidant capacities: A comparative study of green tea versus different herbs. Food Chemistry. 2008;110(4):859-864
  44. 44. Tellez N, Tellez M, Perdomo M, Alvarado A, Gamboa F. Anticariogenic activity of the active fraction from Isertia laevis against S. mutans and S. sobrinus: Comparison of two extraction methods. Acta Odontologica Latinoamericana: AOL. 2009;23(3):188-195
  45. 45. Vaghasiya Y, Chanda S. Screening of some traditionally used Indian plants for antibacterial activity against Klebsiella pneumonia. Journal of Herbal Medicine Toxicology. 2009;3:161-164
  46. 46. Farnsworth N, Blowster R, Darmratoski D, Meer W, Cammarato L. Studies on Catharanthus alkaloids IV evaluation by means of TLC and ceric ammonium sulphate spray reagent. Lloydia. 1967;27:302-314
  47. 47. Chatterjee I, Chakravarty A, Gomes A. Daboia russellii and Naja kaouthia venom neutralization by lupeol acetate isolated from the root extract of Indian sarsaparilla Hemidesmus indicus R. Br. Journal of Ethnopharmacology. 2006;106(1):38-43
  48. 48. Shoeb M. Cytotoxic Compounds from the Genus Centaurea. 2005.
  49. 49. Cragg GM, Newman DJ, Snader KM. Natural products in drug discovery and development. Journal of Natural Products. 1997;60(1):52-60
  50. 50. Fernando M, Wickramasinghe SN, Thabrew M, Ariyananda P, Karunanayake E. Effect of Artocarpus heterophyllus and Asteracanthus longifolia on glucose tolerance in normal human subjects and in maturity-onset diabetic patients. Journal of Ethnopharmacology. 1991;31(3):277-282
  51. 51. Aderibigbe A, Emudianughe T, Lawal B. Antihyperglycaemic effect of Mangifera indica in rat. Phytotherapy Research. 1999;13(6):504-507
  52. 52. Dhanavade MJ, Jalkute CB, Ghosh JS, Sonawane KD. Study antimicrobial activity of lemon (Citrus lemon L.) peel extract. British Journal of Pharmacology and Toxicology. 2011;2(3):119-122
  53. 53. Shaikh R, Pund M, Dawane A, Iliyas S. Evaluation of anticancer, antioxidant, and possible anti-inflammatory properties of selected medicinal plants used in Indian traditional medication. Journal of Traditional and Complementary Medicine. 2014;4(4):253-257
  54. 54. Sharma A, Chandraker S, Patel VK, Ramteke P. Antibacterial activity of medicinal plants against pathogens causing complicated urinary tract infections. Indian Journal of Pharmaceutical Sciences. 2009;71(2):136-139
  55. 55. Tahir L, Ahmed S, Hussain N, Perveen I, Rahman S. Effect of leaves extract of indigenous species of Syzygium cumini on dental caries causing pathogens. International Journal of Pharma and Bioscience. 2012;3(3):1032-1038
  56. 56. Tahir L, Aslam A, Ahmed S. Antibacterial activities of Diospyros blancoi, Phoenix dactylifera and Morus nigra against dental caries causing pathogens: An in vitro study. Pakistan Journal of Pharmaceutical Sciences. 2017;30(1):163-169
  57. 57. Koffi-Nevry R, Kouassi KC, Nanga ZY, Koussémon M, Loukou GY. Antibacterial activity of two bell pepper extracts: Capsicum annuum L. and Capsicum frutescens. International Journal of Food Properties. 2012;15(5):961-971
  58. 58. Bacon K, Boyer R, Denbow C, O’Keefe S, Neilson A, Williams R. Antibacterial activity of jalapeño pepper (Capsicum annuum var. annuum) extract fractions against select foodborne pathogens. Food Science & Nutrition. 2017;5(3):730-738
  59. 59. Biswas B, Rogers K, McLaughlin F, Daniels D, Yadav A. Antimicrobial activities of leaf extracts of Guava (Psidium guajava L.) on two gram-negative and gram-positive bacteria. International Journal of Microbiology. 2013;2013:7
  60. 60. Gonçalves FA, Andrade Neto M, Bezerra JN, Macrae A, Sousa OV, Fonteles-Filho AA, Vieira RH. Antibacterial activity of GUAVA, Psidium guajava Linnaeus, leaf extracts on diarrhea-causing enteric bacteria isolated from Seabob shrimp, Xiphopenaeus kroyeri (Heller). Revista do Instituto de Medicina Tropical de São Paulo. 2008;50(1):11-15
  61. 61. Arunkumar S, Muthuselvam M. Analysis of phytochemical constituents and antimicrobial activities of Aloe vera L. against clinical pathogens. World Journal of Agricultural Sciences. 2009;5(5):572-576
  62. 62. Alemdar S, Agaoglu S. Investigation of in vitro antimicrobial activity of Aloe vera juice. Journal of Animal and Veterinary Advances. 2009;8(1):99-102
  63. 63. Mantle D, Gok MA, Lennard T. Adverse and beneficial effects of plant extracts on skin and skin disorders. Adverse Drug Reactions and Toxicological Reviews. 2001;20(2):89-103
  64. 64. Heyman L, Houri-Haddad Y, Heyman SN, Ginsburg I, Gleitman Y, Feuerstein O. Combined antioxidant effects of Neem extract, bacteria, red blood cells and lysozyme: Possible relation to periodontal disease. BMC Complementary and Alternative Medicine. 2017;17(1):399
  65. 65. Gupta SC, Prasad S, Tyagi AK, Kunnumakkara AB, Aggarwal BB. Neem (Azadirachta indica): An indian traditional panacea with modern molecular basis. Phytomedicine. 2017;34:14-20
  66. 66. Knoll-Köhler E, Stiebel J. Amine fluoride gel affects the viability and the generation of superoxide anions in human polymorphonuclear leukocytes: An in vitro study. European Journal of Oral Sciences. 2002;110(4):296-301
  67. 67. Neumegen RA, Fernández-Alba AR, Chisti Y. Toxicities of triclosan, phenol, and copper sulfate in activated sludge. Environmental Toxicology. 2005;20(2):160-164
  68. 68. Lai P, Roy J. Antimicrobial and chemopreventive properties of herbs and spices. Current Medicinal Chemistry. 2004;11(11):1451-1460
  69. 69. Paterson I, Anderson EA. The renaissance of natural products as drug candidates. Science. 2005;310(5747):451-453
  70. 70. Chin Y-W, Balunas MJ, Chai HB, Kinghorn AD. Drug discovery from natural sources. The AAPS Journal. 2006;8(2):E239-E253
  71. 71. Ballhorn DJ, Kautz S, Heil M, Hegeman AD. Cyanogenesis of wild lima bean (Phaseolus lunatus L.) is an efficient direct defence in nature. PLoS One. 2009;4(5):e5450
  72. 72. Plotkin MJ. Conservation, ethnobotany, and the search for new jungle medicines: Pharmacognosy comes of age… again. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 1988;8(5):257-262
  73. 73. Agosta WC. Bombardier Beetles and Fever Trees: A Close-up Look at Chemical Warfare and Signals in Animals and Plants. USA: Helix Books; 1996
  74. 74. Cowan MM. Plant products as antimicrobial agents. Clinical Microbiology Reviews. 1999;12(4):564-582
  75. 75. Kazmi MH, Malik A, Hameed S, Akhtar N, Noor Ali S. An anthraquinone derivative from Cassia italica. Phytochemistry. 1994;36(3):761-763
  76. 76. Omulokoli E, Khan B, Chhabra S. Antiplasmodial activity of four Kenyan medicinal plants. Journal of Ethnopharmacology. 1997;56(2):133-137
  77. 77. Cosentino S, Tuberoso C, Pisano B, Satta M, Mascia V, Arzedi E, Palmas F. In-vitro antimicrobial activity and chemical composition of Sardinian thymus essential oils. Letters in Applied Mirobiology. 1999;29(2):130-135
  78. 78. Edeoga H, Okwu D, Mbaebie B. Phytochemical constituents of some Nigerian medicinal plants. African Journal of Biotechnology. 2005;4(7):685-688
  79. 79. Cos P, Vlietinck AJ, Berghe DV, Maes L. Anti-infective potential of natural products: How to develop a stronger in vitro ‘proof-of-concept’. Journal of Ethnopharmacology. 2006;106(3):290-302
  80. 80. Duraipandiyan V, Ayyanar M, Ignacimuthu S. Antimicrobial activity of some ethnomedicinal plants used by Paliyar tribe from Tamil Nadu, India. BMC Complementary and Alternative Medicine. 2006;6(1):35
  81. 81. Aziz MM, Raza MA, Saleem H, Wajid M, Bashir K, ur Rehman MI. Medicinal values of herbs and plants, importance of phytochemical evaluation and ethnopharmacological screening: An illustrated review essay. Journal of Pharmaceutical and Cosmetic Sciences. 2014;2(1):6-10
  82. 82. Lampronti I, Martello D, Bianchi N, Borgatti M, Lambertini E, Piva R, Jabbar S, Shahabuddin Kabir Choudhuri M, Tareq Hassan Khan M, Gambari R. In vitro antiproliferative effects on human tumor cell lines of extracts from the Bangladeshi medicinal plant Aegle marmelos Correa. Phytomedicine. 2003;10(4):300-308
  83. 83. Yadav R, Agarwala M. Phytochemical analysis of some medicinal plants. Journal of Phytology. 2011;3(12):10-15
  84. 84. Tiwari AA, Ayello J, van de Ven C, Barth MJ, Cairo MS. Obinutuzumab (GA101) significantly increases overall survival against CD20+ rituximab-sensitive and-resistant Burkitt (BL) and acute lymphoblastic leukemia (B-ALL): Potential targeted therapy in patients with high risk BL and pre-B-ALL. Cancer Research. 2014;74(19 Supplement):2902-2902
  85. 85. Yarney J, Donkor A, Opoku SY, Yarney L, Agyeman-Duah I, Abakah AC, Asampong E. Characteristics of users and implications for the use of complementary and alternative medicine in Ghanaian cancer patients undergoing radiotherapy and chemotherapy: A cross-sectional study. BMC Complementary and Alternative Medicine. 2013;13(1):16
  86. 86. Ogbulie J, Ogueke C, Nwanebu F. Antibacterial properties of Uvaria chamae, Congronema latifolium, Garcinia kola, Vemonia amygdalina and Aframomium melegueta. African Journal of Biotechnology. 2007;6(13):1549-1553
  87. 87. Briskin DP. Medicinal plants and phytomedicines. Linking plant biochemistry and physiology to human health. Plant Physiology. 2000;124(2):507-514
  88. 88. Rahal A, Prakash A, Kumar Verma A, Kumar V, Roy D. Proximate and elemental analyses of Tinospora cordifolia stem. Pakistan Journal of Biological Sciences. 2014;17(5):744-747
  89. 89. Park K, You J, Lee H, Baek N, Hwang J, Kuwanon G. An antibacterial agent from the root bark of Morus alba against oral pathogens. Journal of Ethnopharmacology. 2003;84(2):181-185
  90. 90. Palombo EA. Traditional medicinal plant extracts and natural products with activity against oral bacteria: Potential application in the prevention and treatment of oral diseases. Evidence-based Complementary and Alternative Medicine. 2011;2011(90):1-15
  91. 91. Madenspacher JH, Azzam KM, Gowdy KM, Malcolm KC, Nick JA, Dixon D, Aloor JJ, Draper DW, Guardiola JJ, Shatz M. p53 integrates host defense and cell fate during bacterial pneumonia. The Journal of Experimental Medicine. 2013;210(5):891-904
  92. 92. Lachenmeier DW, Sohnius E-M. The role of acetaldehyde outside ethanol metabolism in the carcinogenicity of alcoholic beverages: Evidence from a large chemical survey. Food and Chemical Toxicology. 2008;46(8):2903-2911
  93. 93. McCullough M, Farah C. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Australian Dental Journal. 2008;53(4):302-305
  94. 94. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, Chaudhary U, Doumith M, Giske CG, Irfan S. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular, biological, and epidemiological study. The Lancet Infectious Diseases. 2010;10(9):597-602
  95. 95. Ewam UPCVV. Evidence based antibacterial potentials of medicinal plants and herbs countering bacterial pathogens especially in the era of emerging drug resistance: An integrated update. International Journal of Pharmacology. 2014;10(1):1-43
  96. 96. Prabu G, Gnanamani A, Sadulla S. Guaijaverin—A plant flavonoid as potential antiplaque agent against Streptococcus mutans. Journal of Applied Microbiology. 2006;101(2):487-495
  97. 97. Meyerowitz C, Watson GE. The efficacy of an intraoral fluoride-releasing system in irradiated head and neck cancer patients: A preliminary study. The Journal of the American Dental Association. 1998;129(9):1252-1259
  98. 98. Tanzer JM, Livingston J, Thompson AM. The microbiology of primary dental caries in humans. Journal of Dental Education. 2001;65(10):1028-1037

Written By

Lubna Tahir and Rabia Nazir

Submitted: 08 November 2017 Reviewed: 25 February 2018 Published: 05 November 2018