|
 
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| REVIEW ARTICLE |
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| Year : 2013 | Volume
: 4
| Issue : 3 | Page : 119-124 |
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Aloe vera: Magic or myth
Akhil Agarwal1, Nidhi Dwivedi2
1 Department of Orthodontics and Dentofacial Orthopedics, Babu Banarsi Das College of Dental Sciences, Uttar Pradesh, India
2 Department of Oral Pathology and Microbiology, Babu Banarsi Das College of Dental Sciences, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 20-Nov-2013 |
Correspondence Address:
Nidhi Dwivedi
2/308, Vibhav Khand, Gomti Nagar, Lucknow, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0976-433X.121638
Aloe vera is a versatile plant with a numerous health benefits. It has various outstanding features like anti-inflammatory, anti-bacterial, anti-viral and anti-tumor which help in accelerating wound healing and in treating various lesions of the oral cavity. Although it has clinically proven benefits, its practical use in repairing oral lesions still warrants further research. The A. vera plant, its properties, mechanism of action and clinical uses in dentistry are briefly reviewed in the current article. Keywords: Aloe vera, dentistry, oral lesions
How to cite this article:
Agarwal A, Dwivedi N. Aloe vera: Magic or myth
. SRM J Res Dent Sci 2013;4:119-24 |
| Introduction | |  |
The Aloe vera plant has been known and its used for centuries for its health, beauty, medicinal and skin care properties. The name A. vera derives from the Arabic word "Alloeh" meaning "shining bitter substance," while "vera" in Latin means "true." [1]
2000 years ago, Greek scientists regarded A. vera as an universal panacea. [2]
The virtues of A. vera have been recorded for thousands of years by many ancient civilizations including Egypt, Persia, Greek, India and Africa. [3]
There are over 250 different species of A. vera plants grown around the world, ranging from tiny little one-inch plants to others as tall as a tree. However, only two species are grown today commercially, with Aloe barbadensis Miller and Aloe arborescens being the most popular. In the United States most of the Aloe is grown in the Rio Grande Valley of South Texas, Florida and Southern California. Internationally Aloe can be found in Mexico. The Pacific Rim countries, India, South America, Central America, the Caribbean, Australia and Africa.
A. vera is one of the most versatile plants on the face of the earth. It can aid to treat many ailments both externally and internally and comes in the form of tea, gel, juice, salve, capsule and decoction forms. [4]
The Egyptians called Aloe "the plant of immortality." Today, the A. vera plant has been used for various purposes. The pharmacological actions of A. vera, as studied in vitro or in animals (in most cases the total leaf extract was used), include anti-inflammatory and anti-arthritic activity, and antibacterial and hypoglycemic effects. [5]
Egyptian history refers to Aloe as favorite herb in Cleopatra's bath. A. vera has been used for medicinal purposes in several cultures for millennia: Greece, Egypt, India, Mexico, Japan, and China. [6]
A. vera has been used medicinally since the last few 1000 years. History states that wars have been fought, as by Hannibal, in order to obtain control over its growing area in North Africa around 1750 BC. Its uses are mentioned in various books and Mesopotamian clay tabloids in various countries such as Egypt, Greece, South Africa, India, China, Mexico and Japan for various ailments such as burns, hair loss, skin infections, hemorrhoids, sinusitis and gastrointestinal pain. [7]
Alexander the Great and Christopher Columbus used it to treat wounds of soldiers. The first reference to A. vera in English was a translation by John Goodyew in AD 1655 of Dioscoridesν Medical Treatise De Materia Medica. [8],[9]
Modern use of A. vera was first documented in the 1930s to heal radiation burns. [10] A. vera juice taken internally has been shown to have various beneficial effects on the body. [11]
The plant has triangular, fleshy leaves with serrated edges, yellow tubular flowers and fruits that contain numerous seeds. Each leaf is composed of three layers: (1) An inner clear gel that contains 99% water and the rest is made of glucomannans, amino acids, lipids, sterols and vitamins. (2) The middle layer of latex is a bitter yellow sap and contains anthraquinones and glycosides. (3) The outer thick layer of 15-20 cells is called a rind, which has a protective function and synthesizes carbohydrates and proteins. Inside the rind are vascular bundles responsible for transportation of substances like water (xylem) and starch (phloem). [7]
| Active components with its properties | | |
A. vera contains 75 potentially active constituents: Vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids and amino acids. [12],[13],[14]
- Vitamins: It contains vitamins A (beta-carotene), C and E, which are antioxidants. It also contains vitamin B12, folic acid, and choline. Its antioxidant properties neutralize free radicals.
- Enzymes: It contains nine enzymes: Aliiase, alkaline phosphatase, amylase, bradykinase, carboxypeptidase, catalase, cellulase, lipase, and peroxidase. Bradykinase helps to reduce excessive inflammation when applied to the skin topically, while others help in the breakdown of sugars and fats.
- Minerals: It contains calcium, chromium, copper, selenium, magnesium, manganese, potassium, sodium and zinc. These are essential for the proper functioning of various enzyme systems in different metabolic pathways and few are antioxidants.
- Sugars: It contains monosaccharides (glucose and fructose) and polysaccharides (glucomannans/polymannose). These are derived from the mucilage layer of the plant and are known as mucopolysaccharides. The most prominent monosaccharide is mannose-6-phosphate and the most common polysaccharides are called glucomannans [beta-(1,4)-acetylated mannan]. Acemannan, a prominent glucomannan, has also been isolated. Recently a glycoprotein with anti-allergic properties called alprogen and a novel anti-inflammatory compound, C-glucosyl chromone, have been isolated from A. vera gel. [15],[16]
- Anthraquinones: It contains 12 anthraquinones, which are phenolic compounds traditionally known as laxatives. Aloin and emodin act as analgesics, antibacterials and antivirals.
- Fatty acids: It contains four plant steroids: Cholesterol, campesterol, β-sitosterol and lupeol. All these have anti-inflammatory action and lupeol also possesses antiseptic and analgesic properties.
- Hormones: Auxins and gibberellins that help in wound healing and have anti-inflammatory action are present.
- Others: It contains 20 out of the 22 human required amino acids and 7 out of the 8 essential amino acids. It also contains salicylic acid that possesses anti-inflammatory and antibacterial properties. Lignin, an inert substance, when included in topical preparations, enhances the penetrative effect of the other ingredients into the skin. Saponins, that are the soapy substances, form about 3% of the gel and have cleansing and antiseptic properties.
| Mechanism of actions | | |
Healing properties
Glucomannan, a mannose-rich polysaccharide and gibberellin, a growth hormone, interact with growth factor receptors on the fibroblast, thereby stimulating its activity and proliferation, which in turn significantly increases collagen synthesis after the application of topical and oral A. vera. Aloe gel not only increases collagen content of a wound but also changes collagen composition (more type III) and increases the degree of collagen cross linking. Due to this, it accelerates wound contraction and increases the breaking strength of resulting scar tissue. [17] An increased synthesis of hyaluronic acid and dermatan sulfate in the granulation tissue of a healing wound following oral or topical treatment has been reported. [18]
Various animal models have been used to study the promotion of wound healing by topical A. vera preparations. [19],[20],[21],[22],[23] On the whole, these investigations do seem to suggest that A. vera does enhance wound healing, although its mechanism of action is still unclear.
Effects on skin exposure to ultra violet (UV) and gamma radiation
A. vera gel has been reported to have a protective effect against radiation damage to the skin. [24]
Its exact role is not known, but following the administration of A. vera gel, an antioxidant protein, metallothionein, is generated in the skin, which scavenges hydroxyl radicals and prevents suppression of superoxide dismutase and glutathione peroxidase in the skin. It reduces the production and release of skin keratinocyte-derived immunosuppressive cytokines such as interleukin-10 (IL-10) and hence prevents UV-induced suppression of delayed type hypersensitivity. [25]
Anti-inflammatory action
A. vera inhibits the cyclooxygenase pathway and reduces prostaglandin E2 production from arachidonic acid. Recently the novel anti-inflammatory compound called C-glucosyl chromone was isolated from gel extracts. [26] Several studies emphasize the anti-inflammatory properties of A. vera in mice and rats. [27],[28],[29]
Effects on the immune system
In a study on mice that had previously been implanted with murine sarcoma cells, acemannan stimulates the synthesis and release of IL-1 and tumor necrosis factor from macrophages in mice, which in turn initiated an immune attack that resulted in necrosis and regression of the cancerous cells. [16] Several low-molecular-weight compounds are also capable of inhibiting the release of reactive oxygen free radicals from activated human neutrophils. [30]
Laxative effects
Anthraquinones present in Aloe containing latex are a potent laxative. It increases intestinal water content, stimulates mucus secretion and increases intestinal peristalsis. [31]
Antiviral and antitumor activity
These actions may be due to indirect or direct effects. One indirect effect is due to stimulation of the immune system and a direct effect is due to the action of anthraquinones. The anthraquinone aloin inactivates various enveloped viruses such as herpes simplex, varicella zoster and influenza. [32] In recent studies, a polysaccharide fraction has shown to inhibit the binding of benzopyrene to primary rat hepatocytes, thereby preventing the formation of potentially cancer-initiating benzopyrene-deoxyribonucleic acid adducts. An induction of glutathione S-transferase and an inhibition of the tumor-promoting effects of phorbol myristic acetate has also been reported, which suggest a possible benefit of using Aloe gel in cancer chemoprevention. [33]
In a recent study the in vitro anti-tumor activity of A. vera extract in cultured B16F10 melanoma cell line was evaluated and the results revealed that A. vera showed its best activity in the concentration of 300 μg/ml. Evaluation of in vitro anti-tumor activity revealed that A. vera extract exhibits effective cytotoxic activity. [34]
Moisturizing and anti-aging effect
Mucopolysaccharides help in binding moisture into the skin. Aloe stimulates the fibroblast which produces the collagen and elastin fibers that make the skin more elastic and less wrinkled. It also has cohesive effects on the superficial flaking epidermal cells by sticking them together, which softens the skin. The amino acids in Aloe also soften hardened skin cells and zinc acts as an astringent to tighten pores. Its moisturizing effects have also been studied in the treatment of dry skin associated with occupational exposure where A. vera gel gloves improved the skin integrity, decreases the appearance of fine wrinkle and erythema. [35] It also has anti-acne effect.
Antiseptic effect
A. vera contains six antiseptic agents: Lupeol, salicylic acid, urea nitrogen, cinnamonic acid, phenols and sulfur. They all have inhibitory action on fungi, bacteria and viruses. The antimicrobial activity of Aloe extracts was postulated as early as 1939. Isolates from A. vera were shown to inhibit microbes like Staphylococcus spp. and Candida spp. [36]
Anti-diabetic effect
An early clinical trial in India where over 3000 "mildly" diabetic patients were fed with bread incorporating Aloe gel, demonstrated a reduction in blood sugar levels in over 90% of the cases. [37]
Dried Aloe exudate has been used in Arabia in diabetes treatment. Administration to non-insulin dependent human patients in a small trial resulted in a sustained lowering of blood sugar levels. [38]
Again, a number of diabetic patients in Thailand were treated orally with "A. vera juice", to their benefit. Blood sugar and triglyceride levels fell during the treatment period. [39] In parallel trials, patients that failed to respond to other anti-diabetic medication responded to the Aloe treatment in a similar way. [40]
The question arises whether A. vera is safe. Studies in mice revealed no acute toxicity in therapeutic doses. In high doses, however, a decrease of central nervous system activity was noticed. During chronic treatment, there was a decrease in red cell count and significant sperm damage. [41] No systematic investigations exist in humans. In the reviewed trials, no withdrawals or serious adverse reactions were reported. Three patients experienced allergic reactions. [42],[43],[44],[45] All adverse effects were reversible and A. vera was generally very well tolerated. This corresponds with anecdotal reports relating to contact dermatitis and hyper-sensitivity [46],[47] A. vera may delay wound healing after topical application. It may also cause diarrhea and hypokalemia with oral use. [48]
Drug interactions
Aloe gel might enhance the ability of hydrocortisone to reduce swelling if applied topically. [49] If ingested, it might lead to increased hypoglycemia in conjunction with oral anti-diabetics or insulin. [50] A. vera inner gel may significantly increase the absorption of vitamins C and E after oral application. [49] A. vera gel for systemic application is not recommended in combination with anti-diabetic, diuretic or laxative drugs; sevoflurane or digoxin. [51]
| Uses of A. Vera in dentistry | | |
A. vera is used in dentistry for several pathological conditions, and it is still in the explorative stage.
In the treatment of oral lichen planus (OLP)
Different treatment modalities have been used for symptomatic OLP, with variable results, perhaps due to the refractory nature of the disease. In a recent study, the efficacy of the topical application of A. vera in OLP compared with placebo was evaluated. The results of this study showed that the topical application of A. vera improves the total quality of life in patients with OLP. [52 It has been suggested that A. vera can inhibit the inflammatory process through interference with the arachidonic acid pathway via cyclooxygenase. Recent data suggested than A. vera also exerted anti-inflammatory effects through the reduction of leukocyte adhesion and TNF-a levels. [13],[53],[ 54 ]
As a periodontal dressing
Applications are directly to the sites of periodontal surgery along with periodontal dressing or to gum tissues when they have been traumatized by toothbrush-dentifrice abrasion, sharp foods, dental floss and toothpick injuries. Existing evidence indicates that A. vera used in variety of concentrations might be effective in shortening the duration of wound healing. [56]
A recent study highlighted the properties of A. vera as a medicament in periodontal pocket. They concluded that the administration of A. vera gel resulted in improved periodontal condition. Therefore, A. vera can be used as a local drug delivery system. [55]
In endodontics and oral surgery
In a recent study, A. vera gel was applied in 15 cases of the extraction of primary molars. The results showed positive signs of healing after histopathological examination was done following extraction. The authors concluded that A. vera can be used as an anti-inflammatory agent in endodontic procedures like pulpotomy. [56]
The anti-microbial activity of A. vera was evaluated to determine its effectiveness in decontaminating gutta-percha cones. A concentrated extract of A. vera was used to check for the antimicrobial efficacy using the agar well diffusion method. The results showed that A. vera was effective as a gutta-percha decontaminant and it holds a promising future as a medium of storage of gutta-percha cones. [57]
According to one study extraction sites heal properly and dry socket formation is prevented when A. vera is applied on the extraction site. [58]
Oral recurrent ulceration
Acute mouth lesions are improved by direct application of A. vera in gel form on herpetic viral lesions or aphthous ulcers. It has been reported that acemannan hydrogel accelerates the healing of aphthous ulcers and reduces the pain associated with them. [59]
According to one study, A. vera showed 78.72% and 80% inhibition of micro-organisms at depths of 200 and 400 μm from day 1 to 5. The possible reason for antimicrobial action of A. vera could be the presence of 75 potentially active constituents: Vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids. [60]
A double-blind (case control) clinical trial was conducted on 40 patients with oral minor aphthous. It was found that the duration of complete wound healing, pain score, wound size and inflammation zone diameter in the A. vera treated group were significantly lower than the control group (P ≤ 0.05) on specific time points after treatment. It was likely that A. vera 2% oral gel was not only effective in decreasing the recurrent aphthous stomatitis patients' pain score and wound size but also decreased the aphthous wound healing period. [61]
A. vera in the treatment of oral submucous fibrosis (OSMF)
According to a preliminary study carried out to compare the efficacy of A. vera with antioxidants in the treatment for OSMF it was found that A. vera recepient's responded better in all the parameters assessed and responded in all the clinic-histopathological stages, particularly in those with mild-stage clinically and early-stage histopathologically. Overall assessment of the parameters indicated that the A. vera group showed a better treatment response compared to the antioxidants group. It reduced the burning sensation and improved mouth opening ability thereby enhancing the patients' compliance. [62]
A. vera as denture adhesives
Because of the sticky and viscous nature of acemannan, aprototype acemannan was formulated into a denture adhesive and evaluated for adhesive strength in both wet and dry conditions; the adhesive also was used to evaluate cytotoxicity to human gingival fibroblasts. An optimal formula with a high and relatively stable adhesive bond strength and minimum cytotoxicity was observed. [63]
Other uses of A. vera in dentistry
The anti-microbial effect of a dentifrice containing A. vera has been demonstrated in an in vitro study, in which this phytotherapic agent inhibited the growth of diverse oral microorganisms, such as Streptococcus mutans, Streptococcus sanguis, Actinomyces viscosus and Candida albicans[64]
.
| Conclusion | | |
A. vera has been known for its healing properties since ancient times, but its use in dentistry is still limited. There is lack of clinical studies with randomized control trials elaborating the role of A. vera which limits its use for clinical application. Further research is needed to substantiate the usefulness of this herbal remedy for oral lesions. Owing to its anti-inflammatory and wound healing properties it can be an effective, cheap and natural substitute to costly treatment for many oral lesions. In conclusion, A. vera has a promising future in dentistry, but further studies with larger sample size are needed to popularize its widespread use.
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