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 Table of Contents  
SHORT REVIEW
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 3-5

Tulsi: From the desk of a periodontist


Department of Periodontics, Institute of Dental Sciences, University of Jammu, Jammu, Jammu and Kashmir, India

Date of Submission13-Mar-2021
Date of Decision20-Mar-2021
Date of Acceptance17-Apr-2021
Date of Web Publication18-Jun-2021

Correspondence Address:
Malvika Singh
Department of Periodontics, Institute of Dental Sciences, Jammu, Affiliated to University of Jammu Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_38_21

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  Abstract 


Introduction: Role of tulsi in periodontal disease is a polymicrobial infection primarily caused by periodontal pathogens existing within the subgingival plaque. The conventional method of lowering the bacterial load in the periodontal pocket constitutes scaling and root planning, but to prevent recolonization the use of adjunctive methods has been advocated. Tulsi (Ocimum sanctum) is being widely used in dentistry in the form of mouthwashes, dentifrice, gels, and oral irrigants. Objective: The objective behind writing this article was to assess the relevance of and effectiveness of Tulsi (O. sanctum) in the treatment of periodontal disease. Data Source: Internet database Medline/PubMed search for word “Tulsi” resulted in 1000 articles. Review Methods: Articles with Medline/PubMed were only considered in writing this review. The result showed that Tulsi has been widely used as a mouthwash, dentifrice, and oral irrigant in the field of periodontics. Conclusions: Although highly effective, the use of Tulsi has not been popularized in today's day and age and needs to be done the same.

Keywords: Dentifrice, herbal medicine, mouthwash, periodontal disease, Tulsi (Ocimum sanctum)


How to cite this article:
Singh M. Tulsi: From the desk of a periodontist. CHRISMED J Health Res 2021;8:3-5

How to cite this URL:
Singh M. Tulsi: From the desk of a periodontist. CHRISMED J Health Res [serial online] 2021 [cited 2021 Oct 19];8:3-5. Available from: https://www.cjhr.org/text.asp?2021/8/1/3/318789




  Introduction Top


Periodontal disease is a chronic inflammatory disease characterized by the loss of connective tissue, alveolar bone resorption, and formation of periodontal pockets as a result of the complex interaction between pathogenic bacteria and the host's immune response. It starts as gingival inflammation which, if left untreated eventually leads to the destruction of the entire periodontal attachment apparatus of the affected teeth. The therapeutic approach for periodontitis is to remove the bacteria, either with hand instrumentation or with electronic instrumentation. Another approach is to use chemotherapeutic agents systemically or locally to limit the bacteria. Adjunctive use of chemicals would therefore appear to be a way of overcoming deficiencies in mechanical tooth cleaning habits. Among all of the anti-plaque and anti-gingivitis agents available, chlorhexidine continues to remains the gold standard.[1] However, it has several side effects which at times compel the patient to try alternatives such as herbal medicine. Lately, there has been a re-emergence of interest in traditional medicine due to cultural familiarity, affordability, and availability and because of the fact that oral hygiene has side effects with it. Tulsi (Ocimum tenuiflorum) is widely used in all the parts of India and is considered holy in the Hindu religion. Often referred to as queen of herbs, Tulsi mouthwashes and dentifrices have become quite popular these days, particularly in Western world.

It is quite surprising, despite the widespread use of Tulsi since ancient times; relatively little scientific attention has been paid to its oral health beneficial effects. Hence, the aim of this review article is to discuss various pharmacological, therapeutic as well as periodontal aspects of Tulsi and also to discuss literature publishing use of Tulsi as mouthwashes and dentifrice by clinicians. A total of 1000 articles with the word Tulsi and oral health were found on Internet. However, internet database Medline/PubMed search for word “Tulsi” resulted in 179 articles, “Tulsi and oral health” showed 49 articles, “Tulsi and Periodontal disease/Periodontitis” revealed seven articles. Only highly relevant articles from manual and PubMed search in the English language were considered for the present review article.


  Historical Background Top


Tulsi or Ocimum sanctum commonly known as holy basil is an aromatic plant in the family Labiatae. The genus Ocimum includes aromatic herbs yielding essential oils and has tropical distribution with nearly two-third of the 160 species reported from West Africa and the remaining one-third from Asia and America. India is represented by nine species of Ocimum, among which O. sanctum is most prevalent.[2] Tulsi (O. sanctum Linn) is considered as a holy plant in mythology. It had been used since Atharvaveda time in the medicinal practice. In India, the earliest references of use of Tulsi in medicine appear in Rigveda 3500–1600 B. C. in Ayurveda, Tulsi (O. sanctum L.) is described as Dashemani Shwasaharni (antiasthmatic) and antikaphic drugs (Kaphaghna).

Discussion: Tulsi in periodontal disease has been widely used as it has following properties:

  1. As an antimicrobial: Tulsi is known to have strong antimicrobial properties toward Streptococcus mutans. Aqueous extract of holy basil has shown growth inhibition for Klesbiella, Escherichia coli, Proteus, and Staphylococcus aureus sp. while alcoholic extract has shown growth inhibition for Vibrio cholerae, Bacillus pumilus, Pseudomonas aeruginosa, and S. aureus[3]
  2. As anti-gingivitis agent: The anti-gingivitis effect of O. sanctum extract dentifrice can be attributed to compounds isolated from O. sanctum extract. Civsilineol, Civsimavatine, Isothymonin, Apigenin, Rosavinic acid, and Eugenol compounds in Tulsi were considered to have anti-inflammatory activity or cyclooxygenase (COX) inhibitory activity[4]
  3. In reduction of oral malodor: The use of tulsi mouth rinse reduces the effect of oral malodor in 15 days and its effect on malodor was assessed after 15 days
  4. Anticancer activity of O. sanctum: Tulsi has been shown to possess an excellent anticancer activity[5]
  5. As an antioxidant: Phenolic compounds such as cirsilineol, apigenin and rosmarinic acid, and eugenol in Tulsi extract render the protection from radiation poisoning and can repair cells damaged by exposure to radiation.[6] It also has the ability to scavenge highly reactive-free radicals
  6. Modulates immunity: The alcoholic extract of Tulsi modulates immunity, thus promoting immune system function[7]
  7. As an antiulcer agent: The essential oil of tulsi possesses antiulcer activity due to its lipoxygenase inhibitory, histamine antagonistic, and antisecretory effects[8]
  8. As analgesic, antipyretic, and anti-inflammatory: Methanolic extract and aqueous suspension of Tulsi acts a COX-2 inhibitor, proving its anti-inflammatory property.[2]


Periodontal applications of Tulsi: Tulsi can be used as following agent:

  1. As mouthwash: Tulsi mouthwash has been found to be effective in reducing plaque and gingivitis.[9] When taken in the concentration of 4%, it has been found effective in reducing volatile sulphur compounds.[10] These mouthwashes have been found to decrease periodontal indices by reducing plaque accumulation, gingival inflammation and bleeding and does not have any side effect as compared to chlorhexidine.[9] Thus, it be effectively used as an alternative chlorhexidine and can be prescribed for longer duration without any side effects for the management of oral problems[11]
  2. As a dentifrice: When used as a dentifrice using 4% Tulsi extract, it showed significant reduction in the plaque and gingival scores after 21 days and also reduced the plaque formation during the 21 days of the trial[12]
  3. As gel: When used as 2% Tulsi, it caused reduction in both gingival and plaque indices[13]
  4. As intracanal irrigant: Tulsi has shown to be effective intracanal irrigant when used in the concentration of 4% in primary molars at a concentration.[14]



  Conclusion Top


Periodontal disease is a polymicrobial infection primarily caused by periodontal pathogens existing within the subgingival plaque. The conventional method of lowering the bacterial load in the periodontal pocket constitutes scaling and root planning, but to prevent recolonization the use of adjunctive methods has been advocated. A combination with tooth brushing, daily use of the tested mouthwashes may result in a higher interproximal plaque reduction than daily flossing. Adjunctive use of chemicals would therefore appear to be a way of overcoming deficiencies in mechanical tooth cleaning habits. Among all of the anti-plaque and anti-gingivitis agents available, chlorhexidine continues to remain the “gold standard.” However, it comes at the cost of several side effects. Hence, its long-term use is not advocated. The field of medicine is increasingly receptive to the use of antimicrobials derived from plant sources, as traditional antimicrobial agents become ineffective against both existing and new microbial diseases. The increasing problems of resistance to synthetic antimicrobials have encouraged the search for alternative natural products. Plants are the source of more than 25% of prescriptions and over-the-counter preparations, and the potential of natural agents for oral prophylaxis can therefore be considered.

The present review revealed a growing interest in the use of herbs in dentistry, particularly in periodontal diseases. Herbal medicines have been used for many years, and their history can be rooted from the ancient civilization, where their role as a primary source of medication has been evident. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Tulsi is being widely used in dentistry in the form of mouthwashes, dentifrice, gels and oral irrigants for reducing inflammation, as antimicrobial plaque agents, for preventing the release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterial, antivirals, and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis and thereby improving immunity. Owing to no side effects and cost-effectiveness of Tulsi, its mouthwashes, gels, and dentifrices should be commercialized more so that it can be made available for the consumption of common man.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Page RC, Kornman KS. The pathogenesis of human periodontitis: An introduction. Periodontol 2000 1997;14:9-11.  Back to cited text no. 1
    
2.
Prakash P, Gupta N. Therapeutic uses of Ocimum sanctum Linn (Tulasi) with a note on eugenol and its pharmacological actions: A short review. Indian J Physiol Pharmacol 2005;49:125-31.  Back to cited text no. 2
    
3.
Agarwal P, Nagesh L, Muralikrishnan. Evalation of the antimicrobial activity of various concentrations of tulasi extract against Streptococcus mutans: An in vitro study. Indian J Dent Res. 2010;21:367-9.  Back to cited text no. 3
    
4.
Kelm MA, Nair MG, Strasburg GM, DeWitt DL. Antioxidant and cyclooxygenase inhibitory phenolic compounds from Ocimum sanctum Linn. Phytomedicine 2000;7:7-13.  Back to cited text no. 4
    
5.
Uma Devi P. Radioprotective, anticarcinogenic and antioxidant properties of the Indian holy basil, Ocimum sanctum (Tulasi). Indian J Exp Biol 2001;39:185-90.  Back to cited text no. 5
    
6.
Devi PU, Ganasoundari A. Modulation of glutathione and antioxidant enzymes by Ocimum sanctum and its role in protection against radiation injury. Indian J Exp Biol 1999;37:262-8.  Back to cited text no. 6
    
7.
Mondal S, Varma S, Bamola VD, Naik SN, Mirdha BR, Padhi MM, et al. Double-blinded randomized controlled trial for immunomodulatory effects of Tulsi (Ocimum sanctum Linn.) leaf extract on healthy volunteers. J Ethnopharmacol 2011;136:452-6.  Back to cited text no. 7
    
8.
Singh S, Majumdar DK. Evaluation of the gastric antiulcer activity of fixed oil of Ocimum sanctum (Holy Basil). J Ethnopharmacol 1999;65:13-9.  Back to cited text no. 8
    
9.
Gupta D, Bhaskar DJ, Gupta RK, Karim B, Jain A, Singh R, et al. A randomized controlled clinical trial of Ocimum sanctum and chlorhexidine mouthwash on dental plaque and gingival inflammation. J Ayurveda Integr Med 2014;5:109-16.  Back to cited text no. 9
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10.
Pooja A, Nagesh L, Murlikrishnan. Evaluation of the antimicrobial activity of various concentrations of Tulsi (Ocimum sanctum) extract against Streptococcus mutans: An in vitro study. Indian J Dent Res 2010;21:357.  Back to cited text no. 10
    
11.
Sharma K, Acharya S, Verma E, Singhal D, Singla N. Efficacy of chlorhexidine, hydrogen peroxide and tulsi extract mouthwash in reducing halitosis using spectrophotometric analysis: A randomized controlled trial. J Clin Exp Dent 2019;11:e457-63.  Back to cited text no. 11
    
12.
Nadar BG, Usha GV, Lakshminarayan N. Comparative evaluation of efficacy of 4% tulsi extract (Ocimum sanctum), Fluoridated and placebo dentifrices against gingivitis and plaque among 14-15 years school children in davangere City, India – A Triple blinded randomized clinical trial. Contemp Clin Dent 2020;11:67-75.  Back to cited text no. 12
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13.
Prabhakar AR, Krishna Murthy VV, Chandrashekar Y. Ocimum sanctum as an intracanal irrigant in contemporary paediatric endodontics – An in vivo study. Int J Oral Health Med Res 2015;2:6-9.  Back to cited text no. 13
    
14.
Hosadurga RR, Rao SN, Edavanputhalath R, Jose J, Rompicharla NC, Shakil M, et al. Evaluation on 2% Ocimum sanctum gel in the treatment of experimental periodontitis. Int J Pharma Investig 2015;5:35-42.  Back to cited text no. 14
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