Journal of Indian Society of Periodontology
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REVIEW ARTICLE
Year : 2014  |  Volume : 18  |  Issue : 2  |  Page : 132-135  

Role of Triphala in dentistry


Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India

Date of Submission23-Jan-2012
Date of Acceptance21-Sep-2013
Date of Web Publication23-Apr-2014

Correspondence Address:
Shobha Prakash
Professor and Head, Department of Periodontics, College of Dental Sciences, Davangere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.131299

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   Abstract 

Ayurveda is considered as the "science of life," because the ancient Indian system of health care focused views of man and his illness. India has an age-old heritage of traditional herbal medicine. Conventional drugs usually provide effective antibiotic therapy for bacterial infections, but there is an increasing problem of antibiotic resistance and a continuing need for new solutions. Hence, now herbal drugs are being preferred to synthetic antibiotics. 'Triphala' is a well-known powdered preparation in the Indian system of medicine (ISM). It consists of equal parts of the Emblica officinalis, Terminalia chebula, and Terminalia belerica. Currently, Triphala is being extensively researched for its various therapeutic effects including its anti-caries, antioxidant, anti-collagenase, and anti-microbial activities. The present review will focus on the comprehensive appraisal of Triphala and its several applications in dentistry.

Keywords: Emblica officinalis , dental caries, periodontitis, Terminalia chebula, Triphala


How to cite this article:
Prakash S, Shelke AU. Role of Triphala in dentistry. J Indian Soc Periodontol 2014;18:132-5

How to cite this URL:
Prakash S, Shelke AU. Role of Triphala in dentistry. J Indian Soc Periodontol [serial online] 2014 [cited 2019 Dec 12];18:132-5. Available from: http://www.jisponline.com/text.asp?2014/18/2/132/131299


   Introduction Top


Ayurveda is considered as the "science of life." The ancient Indian system of health care focused on views of man and his illness. [1] India has an ancient heritage of traditional herbal medicine. Long before the advent of modern medicine, herbs were the mainstream remedies for nearly all ailments. Herbal medicines are being used increasingly as dietary supplements to fight or prevent common diseases. [2] Herbal medicines were in great demand in the developed as well as in developing countries for primary health care because of their wide biological and medicinal activities, higher safety margin, and lower costs. [3] The World Health Organization estimates that about 80% of the populations living in the developing countries rely almost exclusively on traditional medicine for their primary health care needs. Conventional drugs usually provide effective antibiotic therapy for bacterial infections, but there is an increasing problem of antibiotic resistance and a continuing need for new solutions. Hence, now a days, herbal drugs are preferred to synthetic antibiotics. [2]

'Triphala' is a well-known powdered preparation in the Indian system of medicine (ISM), being used in Ayurveda since ancient time. Triphala consists of equal parts of the Emblica officinalis, Terminalia chebula, and Terminalia belerica. [4]


   Ingredient-Wise Main Chemical Constituents of Triphala Top


Tannins
"Tannin" is a general descriptive name for a group of polymeric phenolic substances capable of tanning leather or precipitating gelatin from solution, a property known as astringency. This group of compounds, especially green teas and red wines, has received a great deal of attention in recent years since they can cure or prevent a variety of ills. Many human physiological activities, such as stimulation of phagocytic cells, host-mediated tumor activity, and a wide range of anti-infective actions, have been assigned to tannins. One of their molecular actions is to complex with proteins through so-called non-specific forces such as hydrogen-bonding and hydrophobic effects, as well as by covalent bond formation. Thus, their mode of anti-microbial action may be related to their ability to inactivate microbial adhesins, enzymes, and cell envelope transport proteins. [5]

Quinones

Quinones are aromatic rings with two ketone substitutions. They are ubiquitous in nature and are characteristically highly reactive. The individual redox potential of the particular quinine-hydroquinone pair is very important in many biological systems. Vitamin K is a complex naphthoquinone with anti-hemorrhagic activity. In addition to providing a source of stable free radicals, quinones are known to complex irreversibly with nucleophilic amino acids in proteins, often leading to inactivation of the protein and loss of function. For that reason, the potential range of quinone anti-microbial effects is great. Probable targets in the microbial cell are surface-exposed adhesins, cell wall polypeptides, and membrane-bound enzymes. Quinones may also render substrates unavailable to the microorganism. [5]

Flavones, flavonoids, and flavonols

Flavones are phenolic structures containing one carbonyl group (as opposed to the two carbonyls in quinones). The addition of a 3-hydroxyl group yields a flavonol. Flavonoids are also hydroxylated phenolic substances, but occur as a C6-C3 unit linked to an aromatic ring. Since they are known to be synthesized by plants in response to microbial infection, it should not be surprising that they have been found in vitro to be effective anti-microbial substances against a wide array of microorganisms. Their activity is probably due to their ability to complex with extracellular and soluble proteins and to complex with bacterial cell walls. More lipophilic flavonoids may also disrupt microbial membranes. These compounds have been shown to inhibit Vibrio cholera O1, Shigella, Streptococcus mutansin vitro. Inhibition of isolated bacterial glucosyltransferases in S. mutans, and reduction of fissure caries by about 40% has also been demonstrated. [5]

Gallic acid

Gallic acid is a common phyto-constituent present in all three herbs used in Triphala. It is reported to possess hepatoprotective and antioxidant activity. It also suppresses growth of cancer cells. [4]

Vitamin C

Fruit juice of Emblica officinalis (EO) contains the highest vitamin C (478.56 mg/100 mL) content. The fruit when blended with other fruits boosted their nutritional quality in terms of vitamin C content. Vitamin C in EO accounts for approximately 45-70% of the antioxidant activity. [6] Evidences have been reported for the relation between vitamin C and periodontal disease. Significant gum bleeding can occur in vitamin C deficiency. Vitamin C along with bioflavonoid helps to speed up the healing process. [7]


   Individual Components of Triphala Top


Emblica officinalis (Amalaki)

(Individual chemical ingredient: Vitamin C, carotene, nicotinic acid, riboflavin, and tannins). [8]

Amalaki is known by the botanical name Emblica officinalis and also known in Sanskrit as Dhatri (The nurse), which is a reference to its incredible healing properties. Amalaki can be taken individually in powder form, a decoction or as a confection. Amalaki fruit is known to be one of the best rasayanas in Ayurveda, with anti-oxidant and anti-aging properties. It has its beneficial role in cancer, diabetes, liver treatment, heart trouble, ulcer, anemia, and various other diseases. Similarly, it has application as immunomodulatory, anti-pyretic, analgesic, cytoprotective, anti-tussive, and gastroprotective agent. Additionally, it is useful in memory enhancing, ophthalmic disorders, and lowering cholesterol level. It is also helpful in neutralizing snake venom and as an anti-microbial agent against  Escherichia More Details coli, K. ozaenae, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, S. paratyphi A, S. paratyphi B and Serratiamarcescens. The drug is not reported to have any side-effects even after prolonged use. [6]

Terminalia chebula (Hiritaki or Black myrobalan)

(
Individual chemical ingredient: Tannins, anthraquinones, and polyphenolic compounds). [8]

Terminalia chebula is a plant species belonging to the genus Terminalia, family Combretaceae. The fruit of the tree has been used as traditional medicine for household remedy against various human ailments, since antiquity. Terminalia chebula has been extensively used in Ayurveda, Unani, and Homoeopathic medicine and has become a cynosure of modern medicine. Terminalia chebula is rich in tannin. The chief constituents of tannin are chebulic acid, chebulagic acid, corilagin, and gallic acid.

Terminalia chebula exhibited anti-bacterial activity against a number of Gram-positive and Gram-negative human pathogenic bacterial species. It also exhibits anti-fungal and anti-viral properties. It has also shown anti-mutagenic/anti-carcinogenic activity, antioxidant activity, adaptogenic and anti-anaphylactic activities, immunomodulatory activity, cytoprotective and radioprotective activity. It is also effective in hypolipidemia/hypercholesterolemia, improving gastro-intestinal motility with anti-spasmodic activity, diabetes, retinopathy, and wound healing. [3]

Terminalia belerica (Bibhitaki)

(Individual chemical ingredient: Gallic acid, tannic acid, and glycosides). [8]

Terminalia bellerica Roxb. (Combretaceae), commonly known as "belleric myrobalan" and locally as "bahera," is a large deciduous tree, found throughout central Asia and some other parts of the world. Its fruit is used in folk medicine to treat asthma, cancer, colic, diarrhea, dysuria, headache, hypertension, inflammations, and pain. The plant is reported to contain termilignan, thannilignan, anolignan B, gallic acid, ellagic acid, ί-sitosterol, arjungenin, belleric acid, bellericosidem, flavonoids, and tannins. T. belerica possesses antioxidant, anti-spasmodic, bronchodilatory, hypercholesterolemic, anti-bacterial, cardioprotective, hepatoprotective, hypoglycemic, and hypotensive properties. [9]


   Marketed formulation of Triphala Top


Triphala tablet, Triphala choorna

Formulation of choornam: This is a dry fine powder form of the drug choornam, which can be used both internally and externally.

Preparation: The drug selected is washed cleaned and dried. It is crushed to a fine powder using a pulverizer. The fineness of the powder improves the therapeutic efficacy. In case of compound choorna, each drug should be powdered separately, and finally all individual drug powders are mixed together. The choorna should be fine of atleast 80 mesh sieve. [10]

Decoction form: This form can be used as an eyewash or mouthwash.

Preparation: After cleaning the dried fruits and removing seeds, the powder is made separately from the three dried fruits. Three powders are mixed together in equal amounts to form a uniform mixture. This mixture is added to 16 times water for an hour and then boiled till half of the water remains. The decoction is filtered through fine cotton cloth and stored in a clean bowl or jug. Slightly warm decoction should be used for washing eyes at the earliest after its preparation. [10]


   Triphala in Dentistry Top


Anti-caries activity

Despite several anti-plaque agents available in the market, the search for an effective agent still continues. Several undesirable side-effects associated with these agents stimulated the search for alternate agents. Plants or plant products used in folk dental practices or prescribed in Unani, homeopathic, or Ayurvedic remedies are now gaining attention in view of their acclaimed medicinal properties.

Terminalia chebula is valuable in the prevention and treatment of several diseases of the mouth such as dental caries, spongy and bleeding gums, gingivitis, and stomatitis. The extract could successfully prevent plaque formation on the surface of the tooth, as it inhibited the sucrose-induced adherence and the glucan-induced aggregation, the two processes which foster the colonization of the organism on the surface of the tooth. Thus, the extract of T. chebula may be an effective agent in the treatment of carious teeth, owing to its ability to inhibit the growth and accumulation of S. mutans on the surface of the tooth. This would prevent the accumulation of acids on the surface of the tooth, and thus the further demineralization and the breakdown of the tooth enamel. [11]

Triphala as a root canal irrigant

Primary endodontic infections are caused by oral microorganisms, which are usually opportunistic pathogens that may invade a root canal containing necrotic tissue and establish an infectious process. The number of facultative anaerobic bacteria increases when the root canal remains infected for long periods. Enterococcus faecalis, a facultative anaerobic gram-positive coccus, is the most common Enterococcussp. cultured from non-healing endodontic cases. Sodium hypochlorite (NaOCl) is an efficient irrigant used in eliminating E. faecalis biofilms in vitro, but its main disadvantages are its unpleasant taste, high toxicity, and its inability to remove the smear layer. Triphala has shown significant anti-bacterial activity against three and six week biofilms. The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl. [12]

Anti-collagenase activity of Triphala

Matrix metalloproteinases play a vital role in periodontal destruction, and this knowledge lead to a new concept involving the chemotherapeutic inhibition of these enzymes. Doxycycline is most potent tetracycline for collagenase/gelatinase inhibition. However, long-term tetracycline therapy has certain disadvantages. Use of herbal product extract in treating periodontal disease does not produce side-effects of tetracycline compounds as well as other synthetic drugs. Triphala has strong inhibitory activity against PMN-type collagenase, especially MMP-9 at a 1500 μg/ml concentration, which is well within the safety profile of toxicological studies. [13]

Anti-microbial and anti-oxidant effect of Triphala

Anti-microbial and anti-oxidant effect of Triphala has been proven in-vitro as it has been shown to inhibit Streptococcus mutans at concentrations as low as 50μg/ml. This anti-plaque effect probably may be due to the tannic acid in Triphala, which is adsorbed well to the groups on the surface of the bacterial cells, which result in protein denaturation and ultimately to bacterial cell death.

The strong antioxidant activity of Triphala may be attributed to T. belerica, which is the most active antioxidant followed by E. officinalis and T. chebula. The major ingredients of T. belerica are ellagic and gallic-acid; E. officinalis has several gallic acid derivatives including epigallocatechingallate and in T. chebula, gallic acid is the major ingredient. The presence of these active ingredients of phenolic nature may be responsible to scavenge the free radicals. [14]

Triphala as a mouth rinse

Ayurvedic drugs have been used since ancient times. Oral rinses made from these are used in periodontal therapy. Triphala is one of these with wide spectrum of activity. According to the Sushruta Samhita, Triphala can be used as a gargling agent in dental diseases.

0.6% Triphala mouthwash has shown to have significant anti-caries activity, which is comparable to that of chlorhexidine without possessing disadvantages as staining of teeth and at much less cost although there was no evidence of re-mineralization of tooth structure. [15]

Triphala mouth rinse when combined with scaling and root planing showed significant reduction in the plaque, gingival, and oral hygiene indices without any evidence of staining of teeth at seven, 30, and 45 days, which was comparable to reduction obtained by chlorhexidine mouth rinse in combination with scaling and root planing. [7]

Triphala mouthwash twice-daily combined with metronidazole 400 mg thrice-daily when compared with 0.2% chlorhexidine with metronidazole 400 mg thrice-daily and Triphala mouthwash with oral powder of Triphalain a one month study showed improvement in clinical indices in terms of reduction in tooth mobility, pocket depth, bleeding gums, sensitivity to hot and cold, and calculus formation with minimal recurrence in all the clinical parameters. [16]


   Conclusion Top


Triphala is a novel drug with an array of therapeutic activities gifted by Ayurveda to the world. It has potential to treat a variety of human ills with minimal or no side-effects. Dentistry is still in search of a drug for diseases affecting hard and soft tissues of oral cavity. Triphala seems to fulfill most of these requirements without any adverse effect on oral tissues and at very minimal cost as compared to commercially available products today. Hence, further research exploring various therapeutic actions of Triphala should be encouraged in dentistry.

 
   References Top

1.Samy RP, Pushparaj PN, Ponnampalam G. A compilation of bioactive compounds from Ayurveda. Bioinformation 2008;3:100-10.  Back to cited text no. 1
    
2.Tambekar DH, Dahikar SB, Lahare MD. Antibacterial potentials of some herbal preparations available in India. Res J Med Med Sci 2009;4:224-7.  Back to cited text no. 2
    
3.Chattopadhyay RR, Bhattacharyya SK. Terminalia chebula: An update. Pharmacogn Rev 2007;1:151-6.  Back to cited text no. 3
    
4.Mukherjee PK, Rai S, Bhattacharyya S, Debnath P, Biswas TK, Jana U, et al. Clinical Study of 'Triphala': A well known phytomedicine from India. Iran J Pharmacol Ther 2006;5:51-4.  Back to cited text no. 4
    
5.Cowan MM. Plant products as antimicrobial agents. Clinical Microbiology Reviews 1999;12:564-82.  Back to cited text no. 5
    
6.Khan KH. Roles of Emblica officinalis in medicine: A review. Bot Res Int 2009;2:218-28.  Back to cited text no. 6
    
7.Desai A, M Anil, Debnath S. A clinical trial to evaluate the effects of Triphala as a mouthwash in comparison with chlorhexidine in chronic generalized periodontitis patient. Indian J Dent Adv 2010;2:243-7.  Back to cited text no. 7
    
8.WHO, 2010. Traditional Herbal Remedies for Primary Health Care. India: World Health Organization; 2010.  Back to cited text no. 8
    
9.Khan A, Gilani AH. Antisecretory and analgesic activities of Terminalia bellerica. Afr J Biotechnol 2010;9:717-9.  Back to cited text no. 9
    
10.Bele AA, Jadhav VM, Kadam VJ. Potential of Tannnins: A Review. Asian J Plant Sci 2010;9:209-14.  Back to cited text no. 10
    
11.Jagtap AG, Karkera SG. Potential of the aqueous extract of Terminalia chebula as an anticaries agent. J Ethnopharmacol 1999;68:299-306.  Back to cited text no. 11
    
12.Prabhaka, M Senthilkumar, MS Priya, K Mahalakshmi, Sehgal PK, Sukumaran VG. Evaluation of antimicrobial efficacy of herbal alternatives (Triphala and Green Tea polyphenols), MTAD, and 5% Sodium Hypochlorite against Enterococcus faecalis Biofilm Formed on Tooth Substrate: An In Vitro Study. J Endod 2010;36:83-6.  Back to cited text no. 12
    
13.Abraham S, Kumar MS, Sehgal PK, Nitish S, Jayakumar ND. Evaluation of the inhibitory effect of Triphala on PMN-type Matrix Metalloproteinase (MMP-9). J Periodontol 2005;76:497-502.  Back to cited text no. 13
    
14.Jagdish L, Anand Kumar VK, Kaviyarasan V. Effect of Triphala on dental biofilm. Indian J Sci Technol 2009;2:30-3.  Back to cited text no. 14
    
15.Tandon S, Gupta K, Rao S, Malagi KJ. Effect of Triphala mouthwash on caries status. Int J Ayurveda Res 2010;1:93-9.  Back to cited text no. 15
[PUBMED]  Medknow Journal  
16.Maurya DK, Mittal N, Sharma KR, Nath G. Role of triphala in the management of Periodontal disease. Anc Sci Life 1997;17:120-7.  Back to cited text no. 16
    




 

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