The Health Benefits of Pomegranate in Periodontal Diseases

Abstract

Pomegranate (Punica granatum) is known for its antimicrobial, anti-inflammatory and antioxidant capability. Since ancient times, its consumption has been thought to be beneficial for health. Periodontal disease is a common contributor to adult tooth loss. Previous studies have shown that inflammation is crucial in the pathogenesis and perpetuation of periodontal disease. Multiple herbal remedies have gained popularity recently for the treatment of periodontal disease for the overall safety and effectiveness. Multiple reports have evaluated the effectiveness of pomegranate to combat periodontal disease. Today, the food industry has turned to obtain antioxidants and antimicrobials from natural sources. Pomegranate and its extracts are used in different food products and satisfactory results have been obtained. The purpose of this review was to investigate the benefits of pomegranate for periodontal disease and to create a resource for alternative mouthwash production in the future.

Keywords

• antioxidants
• dentistry
• food
• herbal medicine
• mouthwashes
• periodontitis
• pomegranate

Narın Periodontal Hastalıklarda Sağlık Faydaları

Abstract

Nar (Punica granatum) antimikrobiyal, anti-inflamatuar ve antioksidan özelliğiyle bilinir. Antik çağlardan beri tüketiminin sağlık açısından faydalı olduğu düşünülmüştür. Periodontal hastalık yetişkinlerde diş kaybına neden olan yaygın bir etkendir. Önceki çalışmalar, iltihabın periodontal hastalığın patogenezinde ve devam etmesinde önemli olduğunu göstermiştir. Son zamanlarda periodontal hastalığın tedavisinde genel güvenlik ve etkinlik açısından çok sayıda bitkisel ilaç popülerlik kazanmıştır. Çok sayıda rapor, narın periodontal hastalıkla mücadeledeki etkinliğini değerlendirmiştir. Günümüzde gıda endüstrisi antioksidanları ve antimikrobiyalleri doğal kaynaklardan elde etmeye yönelmiştir. Nar ve özleri farklı gıda ürünlerinde kullanılmış ve tatmin edici sonuçlar elde edilmiştir. Bu incelemenin amacı, narın periodontal hastalık için faydalarını araştırmak ve gelecekte alternatif gargara üretimi için bir kaynak oluşturmaktır.

Keywords

• Antioksidanlar
• Diş hekimliği
• Yiyecek
• Bitkisel Tıp
• Gargaralar
• Periodontit
• Nar

References

1. 1. Salgado AD, Maia JL, Pereira SL, de Lemos TL, Mota OM. Antiplaque and antigingivitis effects of a gel containing Punica granatum Linn extract: a double-blind clinical study in humans. J Appl Oral Sci. 2006 Jun;14(3):162-6. doi: 10.1590/s1678-77572006000300003.
2. 2. Stover, ED, Mercure, EW. The pomegranate: a new look at the fruit of paradise. HortScience 2007; 42(5), 1088-1092.
3. 3. Hajifattahi F, Moravej-Salehi E, Taheri M, Mahboubi A, Kamalinejad M. Antibacterial Effect of Hydroalcoholic Extract of Punica granatum Linn. Petal on Common Oral Microorganisms. Int J Biomater. 2016;2016:8098943. doi: 10.1155/2016/8098943.
4. 4. Zahin M, Aqil F, Ahmad I. Broad spectrum antimutagenic activity of antioxidant active fraction of punica granatum L. peel extracts. Mutat Res. 2010 Dec 21;703(2):99-107. doi: 10.1016/j.mrgentox.2010.08.001.
5. 5. Stowe CB. The effects of pomegranate juice consumption on blood pressure and cardiovascular health. Complement Ther Clin Pract. 2011 May;17(2):113-5. doi: 10.1016/j.ctcp.2010.09.004.
6. 6. Gil MI, Tomás-Barberán FA, Hess-Pierce B, Holcroft DM, Kader AA. Antioxidant activity of pomegranate juice and its relationship with phenolic composition and processing. J Agric Food Chem. 2000 Oct;48(10):4581-9. doi: 10.1021/jf000404a.
7. 7. Cowan LT, Lakshminarayan K, Lutsey PL, Folsom AR, Beck J, Offenbacher S, Pankow JS. Periodontal disease and incident venous thromboembolism: The Atherosclerosis Risk in Communities study. J Clin Periodontol. 2019 Jan;46(1):12-19. doi: 10.1111/jcpe.13029.
8. 8. Loesche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment. Clin Microbiol Rev. 2001 Oct;14(4):727-52, table of contents. doi: 10.1128/CMR.14.4.727-752.2001.

9. 9. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018 Jun;89 Suppl 1:S159-S172. doi: 10.1002/JPER.18-0006.
10. 10. Löe H, Theilade E, Jensen, SB. Experimental gingivitis in man. J Periodontol 1965 May-Jun;36:177-87. doi: 10.1902/jop.1965.36.3.177.
11. 11. Arora V, Tangade P, T L R, Tirth A, Pal S, Tandon V. Efficacy of dental floss and chlorhexidine mouth rinse as an adjunct to toothbrushing in removing plaque and gingival inflammation - a three way cross over trial. J Clin Diagn Res. 2014 Oct;8(10):ZC01-4. doi: 10.7860/JCDR/2014/8807.4943.
12. 12. Haffajee AD, Teles RP, Socransky SS. The effect of periodontal therapy on the composition of the subgingival microbiota. Periodontol 2000. 2006;42:219-58. doi: 10.1111/j.1600-0757.2006.00191.x.
13. 13. Poppolo Deus F, Ouanounou A. Chlorhexidine in Dentistry: Pharmacology, Uses, and Adverse Effects. Int Dent J. 2022 Jun;72(3):269-277. doi: 10.1016/j.identj.2022.01.005.
14. 14. Bhat SS, Hegde KS, Farha M. Effect of pomegranate extract mouth rinse on salivary pH and streptococcus mutans counts in children: An In Vivo Study. Int J of Res in Dent, 2014, 4(1), 12-19.
15. 15. Sajjan P, Laxminarayan N, Kar PP, Sajjanar M. Chlorhexidine as an antimicrobial agent in dentistry–a review. Oral Health Dent Manag, 2016, 15(2), 93-100.
16. 16. BenSaad LA, Kim KH, Quah CC, Kim WR, Shahimi M. Anti-inflammatory potential of ellagic acid, gallic acid and punicalagin A&B isolated from Punica granatum. BMC Complement Altern Med. 2017 Jan 14;17(1):47. doi: 10.1186/s12906-017-1555-0.
17. 17. Thangavelu A, Elavarasu S, Sundaram R, Kumar T, Rajendran D, Prem F. Ancient Seed for Modern Cure - Pomegranate Review of Therapeutic Applications in Periodontics. J Pharm Bioallied Sci. 2017 Nov;9(Suppl 1):S11-S14. doi: 10.4103/jpbs.JPBS_101_17.
18. 18. Nugala B, Namasi A, Emmadi P, Krishna PM. Role of green tea as an antioxidant in periodontal disease: The Asian paradox. J Indian Soc Periodontol. 2012 Jul;16(3):313-6. doi: 10.4103/0972-124X.100902.
19. 19. Kandylis P, Kokkinomagoulos E. Food Applications and Potential Health Benefits of Pomegranate and its Derivatives. Foods. 2020 Jan 23;9(2):122. doi: 10.3390/foods9020122.
20. 20. Paquette DW, Ryan ME, Wilder RS. Locally delivered antimicrobials: clinical evidence and relevance. J Dent Hyg. 2008 Oct;82 Suppl 3:10-5.
21. 21. Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE. Defining the normal bacterial flora of the oral cavity. J Clin Microbiol. 2005 Nov;43(11):5721-32. doi: 10.1128/JCM.43.11.5721-5732.2005.
22. 22. Lamont RJ, Koo H, Hajishengallis G. The oral microbiota: dynamic communities and host interactions. Nat Rev Microbiol. 2018 Dec;16(12):745-759. doi: 10.1038/s41579-018-0089-x.
23. 23. Armitage GC. Comparison of the microbiological features of chronic and aggressive periodontitis. Periodontol 2000. 2010 Jun;53:70-88. doi: 10.1111/j.1600-0757.2010.00357.x.
24. 24. Sela MN. Role of Treponema denticola in periodontal diseases. Crit Rev Oral Biol Med. 2001;12(5):399-413. doi: 10.1177/10454411010120050301.
25. 25. Ma S, Li H, Yan C, Wang D, Li H, Xia X, Dong X, Zhao Y, Sun T, Hu P, Guan W. Antagonistic effect of protein extracts from Streptococcus sanguinis on pathogenic bacteria and fungi of the oral cavity. Exp Ther Med. 2014 Jun;7(6):1486-1494. doi: 10.3892/etm.2014.1618.
26. 26. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005 Nov 19;366(9499):1809-20. doi: 10.1016/S0140-6736(05)67728-8.
27. 27. Widyarman AS, Suhalim OP, Nandary D, Theodorea CF. Pomegranate juice inhibits periodontal pathogens biofilm in vitro. Scientific Dental Journal, 2018, 101-108.
28. 28. Pramadita J, Widyarman AS. In vitro antibiofilm activity of Pomegranate (Punica granatum) juice on oral pathogens. Journal of Indonesian Dental Association, 2019, 2(1), 15-20.
29. 29. Vasconcelos LC, Sampaio FC, Sampaio MC, Pereira Mdo S, Higino JS, Peixoto MH. Minimum inhibitory concentration of adherence of Punica granatum Linn (pomegranate) gel against S. mutans, S. mitis and C. albicans. Braz Dent J. 2006;17(3):223-7. doi: 10.1590/s0103-64402006000300009.
30. 30. Howell AB, D'Souza DH. The pomegranate: effects on bacteria and viruses that influence human health. Evid Based Complement Alternat Med. 2013;2013:606212. doi: 10.1155/2013/606212.
31. 31. Wang L, Hu C, Shao L. The antimicrobial activity of nanoparticles: present situation and prospects for the future. Int J Nanomedicine. 2017 Feb 14;12:1227-1249. doi: 10.2147/IJN.S121956.
32. 32. Naz S, Siddiqi R, Ahmad S, Rasool SA, Sayeed SA. Antibacterial activity directed isolation of compounds from Punica granatum. J Food Sci. 2007 Nov;72(9):M341-5. doi: 10.1111/j.1750-3841.2007.00533.x.
33. 33. Mostafa AA, Al-Askar AA, Almaary KS, Dawoud TM, Sholkamy EN, Bakri MM. Antimicrobial activity of some plant extracts against bacterial strains causing food poisoning diseases. Saudi J Biol Sci. 2018 Feb;25(2):361-366. doi: 10.1016/j.sjbs.2017.02.004.
34. 34. Gumienna M, Szwengiel A, Górna B. Bioactive components of pomegranate fruit and their transformation by fermentation processes. European Food Research and Technology, 2016, 242, 631-640.
35. 35. Bhadbhade SJ, Acharya AB, Rodrigues SV, Thakur SL. The antiplaque efficacy of pomegranate mouthrinse. Quintessence Int. 2011 Jan;42(1):29-36.
36. 36. Dabholkar CS, Shah M, Kathariya R, Bajaj M, Doshi Y. Comparative Evaluation of Antimicrobial Activity of Pomegranate-Containing Mouthwash Against Oral-Biofilm Forming Organisms: An Invitro Microbial Study. J Clin Diagn Res. 2016 Mar;10(3):ZC65-9. doi: 10.7860/JCDR/2016/16478.7475.
37. 37. Somu CA, Ravindra S, Ajith S, Ahamed MG. Efficacy of a herbal extract gel in the treatment of gingivitis: A clinical study. J Ayurveda Integr Med. 2012 Apr;3(2):85-90. doi: 10.4103/0975-9476.96525.
38. 38. Cowan MM. Plant products as antimicrobial agents. Clin Microbiol Rev. 1999 Oct;12(4):564-82. doi: 10.1128/CMR.12.4.564.
39. 39. Abdollahzadeh Sh, Mashouf R, Mortazavi H, Moghaddam M, Roozbahani N, Vahedi M. Antibacterial and antifungal activities of punica granatum peel extracts against oral pathogens. J Dent (Tehran). 2011 Winter;8(1):1-6.
40. 40. Ishikawa I. Host responses in periodontal diseases: a preview. Periodontol 2000. 2007;43:9-13. doi: 10.1111/j.1600-0757.2006.00188.x.
41. 41. Yan H, Peng KJ, Wang QL, Gu ZY, Lu YQ, Zhao J, Xu F, Liu YL, Tang Y, Deng FM, Zhou P, Jin JG, Wang XC. Effect of pomegranate peel polyphenol gel on cutaneous wound healing in alloxan-induced diabetic rats. Chin Med J (Engl). 2013;126(9):1700-6.
42. 42. Cornélio Favarin D, Martins Teixeira M, Lemos de Andrade E, de Freitas Alves C, Lazo Chica JE, Artério Sorgi C, Faccioli LH, Paula Rogerio A. Anti-inflammatory effects of ellagic acid on acute lung injury induced by acid in mice. Mediators Inflamm. 2013;2013:164202. doi: 10.1155/2013/164202. Epub 2013 Feb 27.
43. 43. Ogawa Y, Kanatsu K, Iino T, Kato S, Jeong YI, Shibata N, Takada K, Takeuchi K. Protection against dextran sulfate sodium-induced colitis by microspheres of ellagic acid in rats. Life Sci. 2002 Jul 5;71(7):827-39. doi: 10.1016/s0024-3205(02)01737-x.
44. 44. Promsong A, Chung WO, Satthakarn S, Nittayananta W. Ellagic acid modulates the expression of oral innate immune mediators: potential role in mucosal protection. J Oral Pathol Med. 2015 Mar;44(3):214-21. doi: 10.1111/jop.12223.
45. 45. Cekici A, Kantarci A, Hasturk H, Van Dyke TE. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontol 2000. 2014 Feb;64(1):57-80. doi: 10.1111/prd.12002.
46. 46. Öngöz Dede F, Bozkurt Doğan Ş, Balli U, Durmuşlar MC, Avci B, Gülle K, Akpolat Ferah M. The effect of ellagic acid on the repair process of periodontal defects related to experimental periodontitis in rats. J Appl Oral Sci. 2021 Sep 27;29:e20210160. doi: 10.1590/1678-7757-2021-0160.
47. 47. Kirkwood KL, Cirelli JA, Rogers JE, Giannobile WV. Novel host response therapeutic approaches to treat periodontal diseases. Periodontol 2000. 2007;43:294-315. doi: 10.1111/j.1600-0757.2006.00166.x.
48. 48. Liu YC, Lerner UH, Teng YT. Cytokine responses against periodontal infection: protective and destructive roles. Periodontol 2000. 2010 Feb;52(1):163-206. doi: 10.1111/j.1600-0757.2009.00321.x.
49. 49. Lin Y, Murray MA, Garrett IR, Gutierrez GE, Nyman JS, Mundy G, Fast D, Gellenbeck KW, Chandra A, Ramakrishnan S. A targeted approach for evaluating preclinical activity of botanical extracts for support of bone health. J Nutr Sci. 2014 May 13;3:e13. doi: 10.1017/jns.2014.5.
50. 50. Kim JH, Lee KH, Sung SJ, Kang KM, Lim YK, Kook JK et al. Inhibitory effect of pomegranate extract powder on periodontitis in rat. Oral Biology Research, 2020, 44(1), 37-44.
51. 51. DiSilvestro RA, DiSilvestro DJ, DiSilvestro DJ. Pomegranate extract mouth rinsing effects on saliva measures relevant to gingivitis risk. Phytother Res. 2009 Aug;23(8):1123-7. doi: 10.1002/ptr.2759.
52. 52. Kote S, Kote S, Nagesh L. Effect of pomegranate juice on dental plaque microorganisms (streptococci and lactobacilli). Anc Sci Life. 2011 Oct;31(2):49-51.
53. 53. Umar D, Dilshad B, Farhan M, Ali A, Baroudi K. The effect of pomegranate mouthrinse on Streptococcus mutans count and salivary pH: An in vivo study. J Adv Pharm Technol Res. 2016 Jan-Mar;7(1):13-6. doi: 10.4103/2231-4040.173266.
54. 54. Singla S, Malhotra R, Nd S, Saxena S. Antibacterial Efficacy of Mouthwash Prepared from Pomegranate, Grape Seed and Guava Extracts against Oral Streptococci: An in Vivo Study. J Clin Pediatr Dent. 2018;42(2):109-113. doi: 10.17796/1053-4628-42.2.5.
55. 55. Stefanou V, Tsakni A, Timbis D, Vougiouka PA, Doumi I, Maronikolaki I et al. Pomegranate as an Antibacterial Agent against Pathogens and at the same Time Advantageous to Beneficial Bacteria: A Review. International Journal of Advanced Research in Microbiology and Immunology, 2020, 2(2), 1-13.
56. 56. Patel C, Dadhaniya P, Hingorani L, Soni MG. Safety assessment of pomegranate fruit extract: acute and subchronic toxicity studies. Food Chem Toxicol. 2008 Aug;46(8):2728-35. doi: 10.1016/j.fct.2008.04.035.
57. 57. AlMatar M, Islam MR, Albarri O, Var I, Koksal F. Pomegranate as a Possible Treatment in Reducing Risk of Developing Wound Healing, Obesity, Neurodegenerative Disorders, and Diabetes Mellitus. Mini Rev Med Chem. 2018;18(6):507-526. doi: 10.2174/1389557517666170419114722.
58. 58. Jahromi SB, Pourshafie MR, Mirabzadeh E, Tavasoli A, Katiraee F, Mostafavi E, Abbasian S. Punica granatum peel extract toxicity in mice. Jundishapur Journal of Natural Pharmaceutical Products, 2015, 10(4).
59. 59. Tyagi P, Dodwad V, Kukreja BJ, Kukreja P. A comparison of the efficacy of scaling and root planning with application of pomegranate chip, pomegranate gel, and scaling and root planing in sufferers with adult periodontitis - A prospective study. J Indian Soc Periodontol. 2021 Jan-Feb;25(1):41-46. doi: 10.4103/jisp.jisp_243_20.
60. 60. Takkella BK 3rd, Venkata Anusha N 3rd, Lokanathan Balaji D 3rd, Prabhat MV, Sarat G 4th, Polepalle T 4th, Naffizuddin M 3rd, Ramsunil C 4th, Sujana V 4th, Chaitanya Krishna T. The Comparison of the Anti-inflammatory Efficacy of Phytochemical Extracts in Punica granatum and Lawsonia inermis Among Patients Diagnosed With Chronic Periodontitis. Cureus. 2023 Oct 24;15(10):e47557. doi: 10.7759/cureus.47557.