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REVIEW ARTICLE
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 32-36

Aloe vera: A natural remedy


Department of Periodontology, VSPM Dental College and Research Institute, Nagpur, Maharashtra, India

Date of Web Publication16-Mar-2018

Correspondence Address:
Dr. Surekha Ramrao Rathod
Professor, Department of Periodontics and Implantology, VSPM Dental College and Research Centre, Nagpur - 440 019, Maharashtra
India
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DOI: 10.4103/srmjrds.srmjrds_20_17

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  Abstract 

Aloe vera is gaining popularity for its many health benefits. Healing is a complex procedure mainly occurs by subsiding inflammation which can be done by immunomodulatory properties of gel polysaccharides, especially acetylated mannans from A. vera. It helps in improving conditions such as diabetes mellitus, arthritis, and appearance of the skin, but apart from these, it has a tremendous role in dentistry and is beneficial in many oral conditions. Due to its antibacterial qualities, it is effective in gingivitis, periodontitis, and stomatitis. Direct application of A. vera gel on herpetic lesions, aphthous ulcer has improved the condition. Apart from this, acemannan also increases alkaline phosphatase activity and also help in bone healing. Due to its action on Enterococcus faecalis it can be used as an intracanal medicament. It can also be used in several oral lesions such as oral submucous fibrosis and oral lichen planus. Anticancer drugs have numerous side effects so natural product such as A. vera is very useful in this condition.

Keywords: Aloe vera gel, antibacterial, antifungal, antiviral


How to cite this article:
Rathod SR, Raj A, Sarda T, Maske S. Aloe vera: A natural remedy. SRM J Res Dent Sci 2018;9:32-6

How to cite this URL:
Rathod SR, Raj A, Sarda T, Maske S. Aloe vera: A natural remedy. SRM J Res Dent Sci [serial online] 2018 [cited 2018 May 27];9:32-6. Available from: http://www.srmjrds.in/text.asp?2018/9/1/32/227762


  Introduction Top


The use of natural products in the prevention and treatment of oral conditions has increased. It could benefit to low socioeconomic level in urban and rural communities. One such product which is receiving a lot of scientific attention is Aloe vera. A. vera (synonym: Aloe Barbadensis Miller) belong to the liliacea family. A. vera is a cactus-like plant that grows readily in hot, dry climates, and cannot survive in freezing temperature such as winter.


  Parts of Aloe Veraplant Top


Two major parts of A. vera leaf includes outer green rind – the vascular bundles and inner colourless parenchyma containing the aloe gel or mucilaginous jelly. Technically, the term pulp or “parenchyma tissue” refers to the intact fleshy inner part of the leaf, including the cell walls and organelles, while gel or mucilage refers to the viscous clear liquid within the parenchymal cells. Mucilage or gel consists of 99.5% water.[1] The remaining 0.5%–1% solid material consists of vitamins, minerals, enzymes, polysaccharides, phenolic compound, and organic acid [Table 1].
Table 1: Contents of Aloe vera extract and its mechanism of action


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  Biological and Pharmacological Actions of Aloe Veragel Top


Wound healing effect

Wound healing is a complex process and intervention of aloe gel is likely to be multifarious. The use of aloe gel in wound healing is one of the excellent uses of material. Keeping the wound moist, increasing epithelial cell migration more rapid maturation of collagen and reduction in inflammation are different mechanisms proposed for the wound healing effects of aloe gel.[2] Glucomannan, a mannose-rich polysaccharide, and gibberellin, a growth hormone, interact with growth factor receptor on the fibroblast, thereby stimulating its activity and proliferation, which in turn increases collagen synthesis after topical and oral application.[3] Davis et al. noted that A. vera gel improved wound healing by increasing blood supply (angiogenesis) and oxygenation. Yagi et al. reported that A. vera gel contains a glycoprotein with cell proliferating–promoting activity.[4] Thompson reported that topical application of the A. vera derived allantoin gel stimulated fibroblast activity and collagen proliferation.[5] Heggers et al. in 1993 conducted a study and concluded that topical application of A. vera gel reestablished vascularity of burn tissue for a guinea pig, although no specific constituents were identified. Lee et al. reported that the low molecular weight component of freeze-dried A. vera gel stimulated blood vessel formation in a chorioallantoic membrane; in addition, a methanol-soluble fraction of the gel stimulated proliferation of artery endothelial cells in an in vitro assay and induced them to invade a collagen substrate.[6]

Anti-inflammatory effect

Inflammation is a reaction by the body due to injury and is characterized by swelling, pain, redness, heat, and loss of function. Although this inflammatory process can delay healing, it is prejudicial to suppress inflammation before its purpose is accomplished. Promotion of prostaglandin synthesis and increased infiltration of leukocytes are two methods by which A. vera gel reduces inflammation.[2] Both aqueous and chloroform extract of A. vera were found to inhibit the edema formation close to that of well-established anti-inflammatory agents (i.e., indomethacin and dexamethasone). The aqueous and chloroform extracts decreased edema and number of migrating neutrophils. The aqueous extract inhibited prostaglandin E2 production from arachidonic acid. The anti-inflammatory activity of the extracts of A. vera probably occurs through an inhibitory action on the arachidonic acid pathway through cyclooxygenase.[7]

Microbiological effect

Over the years, there has been interest in the effect of aloe on microorganisms. Infections hinders wound healing, and it may be that part of the efficacy of aloe gel lies in its antibiotic property:

Antibacterial property

All the three extract of A. vera, i.e., aqueous, ethanol, and acetone has antimicrobial effect, but the effect of ethanol and acetone is more pronounced than aqueous extract.[8] Both A. vera leaf and gel have an inhibitory effect on the growth of Staphylococcus aureus. A. vera gel possesses antimicrobial activity against Gram-positive bacteria such as Bacillus sphaericus, S. aureus, mycobacterium smegmatis, Enterococcus faecalis, Streptococcus pyogenes. Apart from these, aloe shows antimicrobial activity against Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Salmonella typhimurium.[9]

Antifungal property

Antifungal activity has not been given much attention. However, A. vera gel preparation has an inhibitory action on growth of candida albicans.[10] Apart from this, it also has an inhibitory effect on trichophyton metagrophytes.[11]

Antiviral property

Antiviral effect is more remarkable, especially activity against human immunodeficient virus type 1. The antiviral effects of acemannan against HIV-1 and other enveloped viruses appear to be related to the modification of glycosylation of viral glycoproteins.[12] The antiviral property of A. vera is due mainly due to anthraquinone aloin which inactivates various enveloped viruses such as herpes simplex, varicella zoster, and influenza.

Antioxidant property

Reactive oxygen species include free radicals such as superoxide anion radicals, hydroxyl radical, and nonfree radical species such as hydrogen peroxide and singlet oxygen. During oxidative stress, catalase activity decreases, hydrogen peroxide accumulates, and thereby more peroxidation of lipids is favored. Apart from this, there is drastic fall in glutathione level.[13]A. vera gel has its antioxidant effects due to glutathione peroxidase activity, superoxide dismutase enzyme, and a phenolic antioxidant.

Immunomodulating effect

The stimulatory effect of A. vera on humoral and cell-mediated immune response occur through activation of macrophage cells to generate nitric oxide, secrete cytokines (e.g., tumor necrosis factor-α, interleukin-1, interleukin-6, and interferon-γ). The mechanism of action of the polysaccharides was therefore explained by their effects on antigen presenting cells and the cytokine cascade.[14]

Antitumor effect

Glycoprotein (lectins) and polysaccharides are two components of A. vera that have anticancer effect.[15] Induction of glutathione S-transferases activity or inhibition of DNA adduct formation are various ways which clarify the chemopreventive nature of aloe gel.[16] Aloin A and B, aloesin, and aloeresin were devoid of antitumor effects on human k562. Leukemia cell lines acemannan has demonstrated activity against feline leukemia virus and solid.[17]A. vera gel has also shown chemopreventive and anti-genotoxic effects on benzo(α)pyrene-DNA adducts.[18] Apart from this, it also has stimulatory effect on immune response.[19]


  Clinical Application of Aloe Verain Dentistry Top


A. vera is one of the natural ways to treat periodontal disease due to its antimicrobial, anti-inflammatory actions, wound-healing, antioxidant effect, etc.

Effect of Aloe vera on bone mineralization and bone formation

Boonyagul et al. noted significant increase in alkaline phosphatase activity, bone marrow stromal cell proliferation, bone sialoprotein and expression and mineralization, as in vitro effect of acemannan and in vivo results, there was higher bone mineral density and faster bone healing in acemannan-treated groups in comparison to control group.[20]

Effect of Aloe vera on gingivitis and periodontitis

It can be used in a various periodontal condition such as gingivitis, chronic periodontitis and so on. A. vera gel shows significant results when used as an adjunct to scaling and root planning in cases of chronic periodontitis.[21]

Subgingival administration of A. vera results in improved periodontal condition. Hence, A. vera gel can be used as a local drug delivery system in periodontal pockets.[22]

Also, A. vera mouthwash showed a remarkable reduction of plaque and gingivitis in comparison to chlorhexidine. Apart from its antiplaque quality it is also well accepted by patients due to appropriate refinement in taste and affordable shelf life.[23]

Significant reduction in the gingival index is mainly imputed to its anti-inflammatory, antibacterial and wound healing property. Carboxypeptidase present in A. vera inactivate bradykinin, reduce prostaglandin synthesis and inhibit oxidation of arachidonic acid due to which inflammation is reduced, and also magnesium lactate present in A. vera prevent the formation of histamine from histamine in mast cell. Apart from this, A. vera also inhibits stimulated granulocyte matrix metalloproteinases inhibiting cyclooxygenase and lipooxygenase pathways and block polymorphonuclear leukocytes thus decreases edema.

Effect of Aloe vera in alveolar osteitis

Salicept patch a freeze-dried pledget that contains acemannan hydrogel shows a significant reduction in the incidence of alveolar osteitis when compared to clindamycin-soaked gelfoam.[24]

Effect of Aloe vera in oral lesion

Apthous ulcer

A. vera is useful in conditions like aphthous ulcer, canker sores due to its anti-inflammatory nature. Application of 2% aloe gel 3 times a day for 10 days on the singular lesion of aphthous ulcer shows a reduction in the duration of complete wound healing, pain score, wound size, and inflammation zone diameter.[25]

Oral lichen planus

Application of 70% aloe mucilage in hydrophilic gel base for 3 times a day on erosive and ulcerative lesions of oral lichen planus for 8 weeks showed good responses.[26]

A double-blind study was carried out in 64 patients with oral lichen planus in which 32 patients received placebo at a dose of 0.4 ml (70% concentration) 3 times a day. As a result of 31.2% A. vera group showed complete remission after 6 weeks, and 61% showed complete remission after 12 weeks thus it was concluded that A. vera improves the total quality of life score in patients.

A single-blinded study was done on 20 patients with bilateral lesions of oral lichen planus. A. vera gel was applied 3 times daily on affected sides and reviewed after 4 and 8 weeks showed complete remission, 10% partial remission.[27]

Oral submucous fibrosis

A. vera is also useful in the treatment of oral submucous fibrosis. In comparison to other antioxidant group A. vera showed a better result as it reduces the burning sensation and improves mouth opening in patients of oral submucous fibrosis.[28]

Aloe vera as obturative material of primary teeth

A. vera has proved to be good obturative material from primary teeth. A. vera along with sterile water have maximum antimicrobial activity against most of the microorganisms followed by calcium hydroxide + A. vera, ZOE + A. vera.[29]

Aloe vera as intracanal medicament

Since A. vera has antimicrobial property it can be used in intracanal medication. Retention of microorganism in dentinal tubule is main reason of persistent endodontic infection. E. feacalis is the main organism which is responsible for this and A. vera is found to be effective against E. feacalis so it can serve as a good intracanal medicament.[30]

Anti-diabetic effect

A.vera juice has anti-diabetic effect. Blood sugar and triglyceride levels fell during the treatment period with A. vera.[31] Polysaccharide fraction from extracts of whole leaves of A. vera were found to lower blood glucose levels in normal mice.[32] Both Arboran A and Arboran B lowered blood glucose levels in alloxan-induced diabetic mice. Apart from this, subcutaneous injection of A. vera gel promote wound healing, reduced abnormal sensitivity to pain and reduced edema.[33]

Role in burning mouth syndrome

Burning mouth syndrome is a painful condition, which includes symptoms such as by burning sensation in tongue, lips, palate, or throughout the mouth. A study has reported to assess the efficacy of A. vera patient with burning mouth syndrome. For that subjects were divided into three groups: Group 1 include tongue protector worn for 15 min three times a day, Group 2 were treated by tongue protractor and 0.5 ml A. vera at 70% 3 times a day, Group 3 were treated with tongue protector and 0.5 ml placebo three times a day. A 3 months treatment showed the better result with Group 2, concluding A. vera is effective in the treatment of burning mouth syndrome.[34]


  Other Applications in Dentistry Are Top


  1. A. vera can also be used around dental implants to control inflammation from bacterial contamination
  2. Extracting sites respond more comfortably and dry sockets do not develop when A. vera is applied
  3. It can also be used in burns due to its anti-thromboxane effect, anesthetic effect and bactericidal effect
  4. Gingival abscesses are soothed by its application
  5. Denture patients with sore ridges and ill-fitting dentures
  6. Applications directly at sites of periodontal surgery.



  Conclusion Top


Various in vivo and in vitro studies have revalidated the pharmacological attributes of A. vera, and these studies have proved that this drug has a great potential as a dental therapeutic. Hence, a proper diagnosis, knowledge of the traditional medicine, and its implication to the treatment plan are essential for ensuring success with this dental therapeutic agent. Even though the therapeutic properties of the herb, A. vera has been proved, still more research needs to be done to explain the action of A. vera gel on dental diseases so that it can be firmly established in the field of dentistry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Montaner JS, Gill J, Singer J, Raboud J, Arseneau R, McLean BD, et al. Double-blind placebo-controlled pilot trial of acemannan in advanced human immunodeficiency virus disease. J Acquir Immune Defic Syndr Hum Retrovirol 1996;12:153-7.  Back to cited text no. 16
    
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Boonyagul S, Banlunara W, Sangvanich P, Thunyakitpisal P. Effect of acemannan, an extracted polysaccharide from Aloe vera, on BMSCs proliferation, differentiation, extracellular matrix synthesis, mineralization, and bone formation in a tooth extraction model. Odontology 2014;102:310-7.  Back to cited text no. 20
    
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