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Author: DR.RUCHI SINGLA.

Abstract:
Recent interest and advances in the field of alternative medicine has promoted the use of various herbal and natural products for multiple uses in the field of dentistry. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research. Though there are various indications for its use, controlled trials are needed to determine its real efficacy. The aloe vera plant, history, mechanism of action and dental applications are discussed in this article.

Introduction:
Recent interest and advances in the field of alternative medicine has promoted the use of various herbal and natural products for multiple uses in the field of dentistry. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research. Though there are various indications for its use, controlled trials are needed to determine its real efficacy. The aloe vera plant, history, mechanism of action and dental applications are discussed in this article.
The generic name “aloe” comes from the Arabic term “alloeh” that means a bright and bitter substance and vera means a true or genuine prickly plant. Aloe vera is a succulent plant that belongs to the Liliaceae family. There are more than 300 species of the aloe plant but the Aloe barbadensis species exhibits the best medicinal properties.1 Ideal environment to grow this plant is tropical climate and low-rainfall areas.2
The Aloe vera leaf consists of 2 different parts: central mucilaginous part and peripheral bundle sheath cells. The parenchymal tissue makes up the inner portion of the aloe leaves and produces a clear, thin tasteless jelly-like material called Aloe vera gel.3 In recent years, various cosmetic and medical products are made from the mucilaginous tissue present in the center of the Aloe vera leaf in the form of Aloe vera gel. But, the problem with Aloe is maintaining its therapeutic function because it is unstable and oxidises rapidly like any cut leaf or fruit.

History:
Aloe vera has been found described in writings in many different cultures and as far back as the Greek, Egyptians, and Roman eras. References have also been found in writings from the Indian and Chinese early cultures.4 Ancient records show that the benefits of Aloe vera have been known for centuries, with its therapeutic advantages and healing properties surviving for over 4000 years. The earliest record of Aloe vera is on a Sumerian tablet dating from 2100 BC. The gel or mucilage from Aloe barbadensis Miller (otherwise known as aloe vera) is a convenient homegrown remedy that can be used both as a moisturizing agent and for treating minor burns and skin abrasions.5 Modern use of aloe vera was first documented in the 1930s to heal radiation burns.6 Aloe vera juice taken internally has been shown to have various beneficial effects on the body.7

Mechanism of Action:
Aloe veracontains 75 potentially active constituents: vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids and amino acids.8 It acts in many ways. Aloe verais a potent anti inflammatory agent it inhibits the cyclooxygenase pathway and reduces prostaglandin E2 production from arachidonic acid.9 It is particularly known for its penetrating capacity to reach deeper layers of the dermis when applied topically. It has strong antiseptic properties being bactericidal, fungicidal and virucidal. It promotes cell growth. It is neurologically calming and also acts as a detoxifying agent. Aloe vera has been shown to enhance defense mechanisms, and it has a variety of components to help combat periodontal disease and other oral conditions.10

Dental Applications:
Dental uses of Aloe vera are multiple.11,12 It is extremely helpful in the treatment of gum diseases like gingivitis, periodontitis.2 It reduces bleeding, inflammation and swelling of the gums. It is a powerful antiseptic in pockets where normal cleaning is difficult, and its antifungal properties help greatly in the problem of denture stomatitis,13 Acute mouth lesions are improved by direct application of it on herpetic viral lesions, aphthous ulcers, canker sores, and cracks occurring at the corners of our lips.14 Chronic oral diseases Lichen Planus and Benign Pemphigus also respond with aloe vera. Even gum problems associated with AIDS and Leukemia patients receive relief. It is a powerful healing promoter and can be used following extractions.15 It has been used in root canal treatment as a sedative dressing and file lubrication during biomechanical preparation.11
Recently, aloe vera has gained popularity as an active ingredient in tooth gel. A study has shown that aloe vera as a tooth gel is as effective in controlling bacteria that causes cavities as any other commercially available toothpaste. Aloe vera gel’s ability to kill and remove harmful microorganisms is due to compounds called anthraquinones, which are anti-inflammatory. Aloe vera gel doesn't contain the abrasives found in most toothpastes, making it is gentler on the teeth and gum, and therefore attractive to people with sensitive teeth or gums.16

Conclusion:
Aloe vera has wide spectrum of properties and dental uses. Standardization and quality assurance of aloe vera products plays a key area which needs to be focused. Further, controlled studies are also required in future to prove the effectiveness of aloe vera under various conditions.

References:
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4. Marshall JM. Aloe vera gel: What is the evidence? Pharma Jr 1990;24:360-2.
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6. Collins CE. Alvagel as a therapeutic agent in the treatment of roentgen and radium burns. Radiol Rev Chicago Med Rec 1935;57:137-138.
7. Krinsky DL, Hawkins EB, Pelton R, Willis NA, Lavalle JB. Natural therapeutics pocket guide, ed. 2. Cleveland: Lexi-Comp, Inc.; 2003. p.379.
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9. Michael. G. Newman, henry .h. Takei, fermin .a .carranza .clinical periodontology;1997. p.347.
10. Moore TE. Aloe Vera: Its Potential Use in Wound Healing and Disease Control in Oral Conditions. www.aloe research.com.
11. Sudworth R. The use of Aloe Vera in Dentistry. Philadelphia: Positive Health Publications Ltd; 2002.
12. Available from: http://www.aloeveragelfacts.com [last cited on 2010 Sep 21].
13. Tello CG, Ford P, Iacopino AM. In vitro evaluation of complex carbohydrate denture adhesive formulations. Quintessence Int 1998;29:588-93.
14. Mandeville FB. Aloe vera in the treatment of radiation ulcers of mucous membranes. Radiology 1939;32:598-9.
15. Poor MR, Hall JE, Poor AS. Reduction in the incidence of alveolar osteitis in patients treated with the salicept patch containing Acemannan hydrogel. J Oral Maxillofac Surg 2002;60:374-9.
16. Academy of General Dentistry. "Tooth Gel: Healing Power Of Aloe Vera Proves Beneficial For Teeth And Gums, Too." ScienceDaily, 28 Jul. 2009. Web. 22 Oct. 2011.

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