Indian Journal of Dental ResearchIndian Journal of Dental ResearchIndian Journal of Dental Research
HOME | ABOUT US | EDITORIAL BOARD | AHEAD OF PRINT | CURRENT ISSUE | ARCHIVES | INSTRUCTIONS | SUBSCRIBE | ADVERTISE | CONTACT
Indian Journal of Dental Research   Login   |  Users online: 759

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size         

 


 
Table of Contents   
ORIGINAL RESEARCH  
Year : 2016  |  Volume : 27  |  Issue : 4  |  Page : 364-369
Clinical effect of a mouthwash containing Anacardium occidentale Linn. on plaque and gingivitis control: A randomized controlled trial


1 Department of Periodontology, School of Dentistry, University of Fortaleza, UNIFOR, Fortaleza, CE, Brazil
2 Department of Organic Chemistry, School of Pharmacology, University of Fortaleza, UNIFOR, Fortaleza, CE, Brazil

Click here for correspondence address and email

Date of Submission09-May-2016
Date of Decision19-Jun-2016
Date of Acceptance08-Aug-2016
Date of Web Publication10-Oct-2016
 

   Abstract 

Background: Plaque-associated gingivitis is a prevalent disease and research in its treatment using herbal agents must be encouraged to verify which would be a useful addition to the current range or chemotherapeutic treatment options.
Aims: The aim of this study was to evaluate the clinical effect of a mouth rinse containing 10% Anacardium occidentale (AO) Linn., a typical plant commonly found in the Northeast Region of Brazil, on the reduction of plaque and gingivitis in comparison to a gold-standard chemotherapeutic agent.
Materials and Methods: Thirty normosystemic adult volunteers of both genders, who had a minimum of twenty natural teeth, aging between 18 and 32 years, were enrolled in this crossover, controlled, examiner-blind clinical study. They were randomly allocated into three groups: 10% AO Linn. (n = 10); 0.12% chlorhexidine digluconate (CLX, n = 10); or placebo (PB, n = 10). All volunteers were instructed to brush their teeth with a fluoridated dentifrice two times a day (12/12 h) and to rinse for 1 min with one of the mouthwashes (AO, CLX, or PB) 30 min after tooth brushing for 1 month. Plaque index (PLI) and gingival bleeding index (BLI) were recorded on days 0 and 30. Nonparametric Kruskal-Wallis and Wilcoxon tests (α = 0.05) were performed to evaluate statistical differences among groups.
Results: There was a significant reduction (P < 0.05) on plaque and gingivitis at day 30 just in CLX ([PLI = 0.47 ± 0.16; -30%]; [BLI = 0.15 ± 0.09; -55.8%]) and AO ([PLI = 0.49 ± 0.21; -31%]; [BLI = 0.13 ± 0.10; -56.6%]) groups, but no statistically significant difference was observed among them (P > 0.05).
Conclusion: Mouthwash containing 10% AO was effective as an antiplaque and antigingivitis agent, in a similar manner that 0.12% CLX.

Keywords: Anacardium occidentale Linn., chlorhexidine, dental plaque, gingivitis, oral hygiene

How to cite this article:
Gomes CE, Cavalcante DG, Filho JE, da Costa FN, da Silva Pereira SL. Clinical effect of a mouthwash containing Anacardium occidentale Linn. on plaque and gingivitis control: A randomized controlled trial. Indian J Dent Res 2016;27:364-9

How to cite this URL:
Gomes CE, Cavalcante DG, Filho JE, da Costa FN, da Silva Pereira SL. Clinical effect of a mouthwash containing Anacardium occidentale Linn. on plaque and gingivitis control: A randomized controlled trial. Indian J Dent Res [serial online] 2016 [cited 2020 Apr 1];27:364-9. Available from: http://www.ijdr.in/text.asp?2016/27/4/364/191883
The role of dental plaque in the etiology of periodontal diseases, mainly gingivitis, is well recognized.[1],[2],[3],[4] Regular plaque removal by effective mechanical tooth cleaning is the main goal of the prevention of gingival inflammation and a crucial component in its treatment.[2],[5] In spite of mechanical cleaning of teeth being a simple and efficient method in control of gingivitis, its effectiveness is influenced by the individual's manual ability and motivation.[5],[6]

Therefore, in addition to mechanical oral hygiene, the use of antiseptics is strongly recommended.[1],[2],[3] In this scope, chlorhexidine digluconate (CLX) is considered the gold-standard chemical agent and has been used in the treatment of inflammatory diseases associated with dental plaque accumulation.[1],[2],[7],[8],[9] However, due to undesirable effects after prolonged use, such as pigmentation and taste disturbance,[1],[3] herbal agents had been researched recently showing encouraging results.[3],[5],[10],[11],[12]

Anacardium occidentale (AO) Linn. (cashew), a member of the family Anacardiaceae and presently cultivated in many regions of the world, is a tropical tree originally indigenous and commonly found in the Northeast of Brazil.[13],[14],[15] The fruits, stem bark, and leaves extracts have been traditionally used in folk medicine for the treatment of mouth and peptic ulcers, intestinal disturbances, dyspepsia, asthma, diabetes, sore throat, bronchitis, and inflammatory diseases.[13],[14],[15] Its antinociceptive, anti-inflammatory, and antimicrobial potentials are highlighted in clinical and laboratorial studies.[15],[16]

The previous studies indicated that AO Linn. had shown in vitro potent antimicrobial activity against fungi and Streptococcus mutans, Streptococcus mitis, Streptococcus sanguis, Streptococcus sobrinus, and  Lactobacillus casei Scientific Name Search the first settlers in dental plaque.[17],[18] Recently, a dentifrice containing this herbal agent showed antimicrobial action against Candida tropicalis, Candida stellatoidea, and Lactobacillus acidophilus.[19]

There are no in vivo studies about the clinical effect of AO Linn. on dental plaque and gingivitis control. Thus, a trial in humans was conducted to evaluate the antiplaque and antigingivitis effects of a mouth rinse containing this herbal agent in comparison to CLX.


   Materials and Methods Top


Subjects

Thirty adult patients from the University of Fortaleza (15 female and 15 male, age 18-32 years) were enrolled in this examiner-blinded, crossover, controlled clinical trial from August 2012 to November 2012. All participants were randomly screened, informed about the nature of the study, and provided written informed consent for participation, in compliance with the guidelines of the Brazilian National Health Council and Declaration of Helsinki. The study protocol was approved by the Institutional Research Ethics Committee (Coetica/Unifor Report No. 200/2011).

The criteria for inclusion were a bleeding index (BLI)[20] ≥20%, the presence of at least twenty natural teeth, and the absence of plaque-retentive factors such as restoration excess, dental caries, or calculus. Smokers, pregnant women, subjects with medical disorders, and those under antimicrobial therapy or using mouth rinses containing chemical agents for the last 3 months were excluded from the trial. Volunteers with a history of allergy to mouth rinses or toothpaste and those with a probing depth ≥3 mm were not included in this clinical study.

Essential oil extraction, preparation, and composition

AO Linn. essential oil was prepared from stem bark samples collected in September 2012 of the medicinal herb Garden at the University of Fortaleza, Ceará, Brazil. Essential oil was extracted using a modified Clevenger apparatus by the hydrodistillation technique.[5],[10] The volume of essential oil obtained was measured and then it was stored in hermetically sealed glass receptacles with rubber stoppers, covered with aluminum foil to protect the contents from light, and kept under refrigeration at 8°C until use.[5],[10] The chemical composition was determined by high-performance thin layer chromatography. The major constituents of the essential oil were, respectively, tannins, cardol, and anacordol.

Preparation of the mouth rinses

Initially, 1 ml of essential oil from AO Linn. was diluted in 9 ml of ethyl alcohol (1:9), preparing a 10% mixture (V/V) (AO group).[3] A mouth rinse containing just distilled water (placebo [PB] group) and other containing 0.12% CLX (CLX group) were formulated too. In all groups, the following substances were in common: Deionized water (q.s.), 0.2% nipagin (24 g), 2.5% glycerin (300 ml), 5% sorbitol (600 ml), 0.2% saccharine (24 g), and flavoring (q.s.) and color agents (q.s.). Due to the incompatibility between CLX and saccharine, this was replaced by 0.2% aspartame (24 g). These values were calculated for the production of 600ml of each solution.

First, nipagin was dissolved in deionized water at room temperature, and after this, saccharine or aspartame was dissolved in hot deionized water because it was not completely solubilized at room temperature. In sequence, glycerin and sorbitol were added. In the CLX group, 0.12% CLX (144 ml) was added; in the AO group, 10% AO Linn. (600 ml) was added, and in the PB group, just distilled water was used (600 ml). Then, the color and flavoring agent was added in the PB and CLX groups until reaching a color similar to AO group that had a natural color. The solutions were shaken for 10 min and the sedimentation and organoleptic characteristics were observed to verify its acceptability.

Finally, the mouth rinses were packed into bottles, previously cleaned with 70° alcohol in the Pharmaceutics' Laboratory at the University of Fortaleza. The bottles were coded to warrant that neither the examiner nor the participants knew their content, which was revealed by the pharmacist just after the study was completed.

Experimental design

Volunteers were designed initially to either the PB group (n = 10), CLX group (n = 10) or the AO group (n = 10), by random allocation using a computer-generated random table made by a person, not participant of the study. Participants were examined for plaque and gingivitis at baseline and after 30 days, in three experimental phases with a 1-month washout interval between them until all subjects had rinsed with each formulation. A single, previously calibrated examiner scored the plaque index (PLI)[21] and BLI[20] index, which were observed on the buccal and lingual surfaces of all teeth. The values of the two sites of each tooth were averaged to determine the BLI and PLI for each subject. In addition, the hard and soft tissues of the oral cavity were visually inspected for the presence of any adverse effect by the same examiner. Intraexaminer calibration was achieved by two records in ten patients, with a 24-h interval among them, obtaining 0.78 kappa coefficient.[5]

After the initial examination, a personal kit containing a new toothbrush (Leader, Facilit Odontológica e Perfumaria Ltda., Rio de Janeiro, RJ, Brazil) and a test or control mouth rinse (600 ml) was given to all participants. They were instructed to brush their teeth with a fluoridated dentifrice two times a day (12/12 h) for 1 min using their habitual technique. After 30 min, the participants were instructed to rinse for 1 min with one of the mouth rinses and then expectorate it. Verbal and written instruction about the correct use of oral hygiene products was given to all subjects as well. After 30 days, indexes were recorded by the same examiner and the teeth were polished with pumice.

Statistical analysis

Nonparametric Kruskal-Wallis analysis was performed to evaluate statistical differences among groups on days 0 and 30 (α = 0.05). In each group, the mean scores of all indexes were compared between baseline and the end of the trial with Wilcoxon test (α = 0.05). However, for illustrative purposes, the results are presented as means and standard deviations. The linear regression coefficients were realized to evaluate the association among PLI and BLI indexes as well.


   Results Top


Three patients were excluded from the study. None of the patients showed any adverse reaction with the different formulations. At baseline, there was no statistically significant difference among groups with respect to mean PLI and BLI indexes (P = 0.2531) [Table 1] and [Table 2]. These findings indicated that all groups were well balanced at baseline.
Table 1: Plaque index on day 0 and day 30, placebo and test groups (mean±standard deviation)


Click here to view
Table 2: Bleeding index on day 0 and day 30, placebo and test groups (mean±standard deviation)


Click here to view


At day 30, there was no statistically significant difference among groups for the PLI (P = 0.0760) and BLI (P = 0.7692) indexes [Table 1] and [Table 2], but just AO and CLX groups significantly reduced the PLI and BLI indexes in a similar manner, when comparison of means between baseline and day 30 was performed (CLX = P = 0.00251; AO = P = 0.0417); [Table 1] and [Table 2].

The relation between PLI and BLI indexes is shown in [Figure 1], [Figure 2], [Figure 3]. The linear regression coefficients were R2 = 0.23, R2 = 0.12 e, R2 = 0.32 for the CLX, AO, and PB groups, respectively.
Figure 1: Linear regression analysis between plaque index and bleeding index for CLX group at day 30

Click here to view
Figure 2: Linear regression analysis between plaque index and bleeding index for AO group at day 30

Click here to view
Figure 3: Linear regression analysis between plaque index and bleeding index for placebo group at day 30

Click here to view



   Discussion Top


The present work showed the data of a clinical study where a herbal agent in mouthwash was used by patients with gingivitis and compared with CLX. The design was based on previous studies and it was chosen to generate the best possible clinical evidence in a short-term period.[5],[11]

In the PB group, PLI and BLI indexes remained at baseline levels at the end of the experiment, for example, the plaque accumulation was reduced just 5.8%, indicating the inability of this adult population to perform an effective mechanical plaque control. The tooth brushing was not modified to avoid concealment of the actual effect of the test agents,[5],[11] in contrast with other studies, in which volunteers were instructed to use the Bass technique.[22],[23]

CLX has been tested and its efficacy and safety have been confirmed in several in vivo studies.[1],[2],[5],[7],[8],[9] Likewise, the absence of adverse effects with the use of the AO showed that it was well tolerated, supporting its safety profile for clinical use. These results were already expected as the biocompatibility of this herbal agent has been reported previously in animal studies.[15] Unfortunately, chlorhexidine has some disadvantages, such as discoloration in teeth and tongue, and a reversible effect on taste.[1],[3],[8] In a recent study, 30% of the patients using CLX showed these adverse effects after 3 months.[11] A factor that could explain this difference is the time of the experiment, in spite of other studies presented this intercorrence in a short-term period.[10],[24]

The previous in vitro studies showed that AO presented high inhibition action on microorganisms from supragingival dental plaque, such as S. mutans, S. mitis, S. sanguis, S. sobrinus, and L. casei.[17],[18],[25] In spite of the fact that, in-vitro conditions do not fully reproduce the oral environment, this fact led us to deduce that AO could be used as an antiplaque agent. This hypothesis was confirmed in this study, in which the plaque accumulation was significantly reduced similarly to CLX; however, the comparison between other studies is difficult because, to the best of our knowledge, this study is the first to evaluate the effect of a mouthwash containing AO in the plaque control.

The antimicrobial activity of AO can be explained by the presence of phenolic compounds that causes disturbances in the bacterial membrane and inhibits the enzymatic system for its formation.[26] Indeed, anacardic acids, which are present, namely, in the nut and fruit juice, were also found in the stem bark in the present study, even though in low concentrations.[15] The concentration of AO essential oil used in this trial was based on a previous study, in which S. mutans and S. sanguis were sensitive to AO.[25] Moreover, other studies evaluating herbal agents used similar concentrations.[11],[18],[23]

In the present work, the mouthwash containing AO reduced gingivitis in a similar manner that CLX did (56.6% vs. 55.8%), agreeing with previous studies, in which other herbal agents were tested,[5],[10],[11] and disagreeing with others that did not show gingivitis reduction in comparison to PB group.[18],[23] In the PB group, it had a reduction of 30% of sites with bleeding, so AO almost duplicated the reduction of gingivitis, showing that it has potential as an antigingivitis agent.

The anti-inflammatory effect of AO could be explained by the presence of tannins that act by inhibiting the cyclooxygenase and arachidonic acid metabolic pathways, blocking prostaglandins formation, which is responsible for the inflammatory events.[27] The stem bark is astringent and rich in tannins, as observed in the present study, which possibly supports its popular use as an anti-inflammatory agent.[15],[28]

Other studies pointed that AO inhibits other enzymes, such as acetilcolinesterase and tirosinase.[15],[29],[30] By inference, studies showed antinociceptive and antiedematogenic effects in rats,[15],[27] and clinical trials presented anti-inflammatory and healing effects in skin and oral lesions after use of compounds containing AO.[15]

The data of regression analysis presented a weak association among PLI and BLI indexes, namely, in the AO group, indicating that its antimicrobial and anti-inflammatory actions occurred independently, because just 34% of the sites with gingivitis can be attributed to plaque accumulation, while in the CLX and PB groups were 48% and 56%, respectively. These data agree with the results of a recent work, in which another herbal agent was tested as an antiseptic agent, in comparison to CLX.[11]

Home-use mouth rinse studies can be influenced by the Hawthorne and Novelty effects[5],[11],[22] that can mask the superiority of a test agent over the control. To minimize this event, the participants were asked to bring the bottle at the end of the trial so that we could evaluate indirectly patient compliance. Significant reduction on gingival inflammation in CLX and AO groups showed that they used the mouthwash correctly. Finally, the results revealed that AO was effective on plaque and gingivitis control comparatively with CLX and it should be advantageous in situations, in which tooth brushing is compromised, such as physically challenged and hospitalized patients. However, long-term studies must be performed to evaluate if these positive results are maintained over time and if this herbal agent is effective in other more complex infect-inflammatory oral diseases, for example, chronic periodontitis.


   Conclusion Top


Within the limits of this clinical study, it may be concluded that the mouth rinse containing AO was effective in plaque and gingivitis control, comparable to CLX.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M, Hoffmann T. Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol 2006;33:561-7.  Back to cited text no. 1
[PUBMED]    
2.
Mouchrek Junior JC, Nunes LH, Arruda CS, Rizzi Cde C, Mouchrek AQ, Tavarez RR, et al. Effectiveness of oral antiseptics on tooth biofilm: A study in vivo. J Contemp Dent Pract 2015;16:674-8.  Back to cited text no. 2
[PUBMED]    
3.
Rodrigues IS, de Oliveira DB, de Menezes PC, da Costa FN, Carlos MX, Pereira SL. Effect of Lippia sidoides in mouthrinses on de novo plaque formation: A double-blind clinical study in humans. Indian J Dent Res 2013;24:533-6.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Van der Weijden FA, Van der Sluijs E, Ciancio SG, Slot DE. Can chemical mouthwash agents achieve plaque/gingivitis control? Dent Clin North Am 2015;59:799-829.  Back to cited text no. 4
[PUBMED]    
5.
Pereira SL, Praxedes YC, Bastos TC, Alencar PN, da Costa FN. Clinical effect of a gel containing Lippia sidoides on plaque and gingivitis control. Eur J Dent 2013;7:28-34.  Back to cited text no. 5
    
6.
Hugoson A, Sjödin B, Norderyd O. Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease. J Clin Periodontol 2008;35:405-14.  Back to cited text no. 6
    
7.
Baehni PC, Takeuchi Y. Anti-plaque agents in the prevention of biofilm-associated oral diseases. Oral Dis 2003;9 Suppl 1:23-9.  Back to cited text no. 7
[PUBMED]    
8.
Graziani F, Gabriele M, D′Aiuto F, Suvan J, Tonelli M, Cei S. Dental plaque, gingival inflammation and tooth-discolouration with different commercial-formulations of 0.2% chlorhexidine rinse: A double-blind randomised controlled clinical trial. Oral Health Prev Dent 2015;13:101-11.  Back to cited text no. 8
[PUBMED]    
9.
Quirynen M, Avontroodt P, Peeters W, Pauwels M, Coucke W, van Steenberghe D. Effect of different chlorhexidine formulations in mouthrinses on de novo plaque formation. J Clin Periodontol 2001;28:1127-36.  Back to cited text no. 9
[PUBMED]    
10.
Botelho MA, Bezerra Filho JG, Correa LL, Fonseca SG, Montenegro D, Gapski R, et al. Effect of a novel essential oil mouthrinse without alcohol on gingivitis: A double-blinded randomized controlled trial. J Appl Oral Sci 2007;15:175-80.  Back to cited text no. 10
[PUBMED]    
11.
Pereira SL, de Oliveira JW, Angelo KK, da Costa AM, Costa F. Clinical effect of a mouth rinse containing Ocimum gratissimum on plaque and gingivitis control. J Contemp Dent Pract 2011;12:350-5.  Back to cited text no. 11
[PUBMED]    
12.
Hebbar SS, Harsha VH, Shripathi V, Hegde GR. Ethnomedicine of Dharwad district in Karnataka, India - plants used in oral health care. J Ethnopharmacol 2004;94:261-6.  Back to cited text no. 12
[PUBMED]    
13.
Agra MF, França PF, Barbosa-Filho JM. Synopsis of the plants known as medicinal and poisonous in Northeast of Brazil. Braz J Pharmacogn 2007;17:114-40.  Back to cited text no. 13
    
14.
Falcão HS, Lima IO, Santos VL, Dantas HF, Diniz MF, Barbosa-Filho JM. Review of the plants with anti-inflammatory activity studied in Brazil. Braz J Pharmacogn 2005;15:381-91.  Back to cited text no. 14
    
15.
Silva MI, de Melo CT, Vasconcelos LF, de Carvalho AM, Sousa FC. Bioactivity and potential therapeutic benefits of some medicinal plants from the Caatinga (semi-arid) vegetation of Northeast Brazil: A review of the literature. Braz J Pharmacogn 2012;22:193-207.  Back to cited text no. 15
    
16.
Olajide OA, Aderogba MA, Adedapo AD, Makinde JM. Effects of Anacardium occidentale stem bark extract on in vivo inflammatory models. J Ethnopharmacol 2004;95:139-42.  Back to cited text no. 16
[PUBMED]    
17.
Araújo CR, Pereira JV, Pereira MS, Alves PM, Higino JS, Martins AB. Minimum bactericidal concentration of cashew extract on bacteria biofilm. Brazilian Research in Pediatric Dentistry and Integr Clin 2009;9:187-91.  Back to cited text no. 17
    
18.
Pereira JV, Sampaio FC, Pereira MS, Melo AF, Higino FS, Carvalho AA. In vitro antimicrobial activity of an extract from Anacardium occidentale Linn. on Streptococcus mitis, Streptococcus mutans, and Streptococcus sanguis. Odontol Clín Cient 2006;5:137-41.  Back to cited text no. 18
    
19.
Carvalho FG, Negrini Tde C, Sacramento LV, Hebling J, Spolidorio DM, Duque C. The in vitro antimicrobial activity of natural infant fluoride-free toothpastes on oral micro-organisms. J Dent Child (Chic) 2011;78:3-8.  Back to cited text no. 19
    
20.
Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975;25:229-35.  Back to cited text no. 20
    
21.
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 1970;41:41-3.  Back to cited text no. 21
    
22.
de Oliveira SM, Torres TC, Pereira SL, Mota OM, Carlos MX. Effect of a dentifrice containing Aloe vera on plaque and gingivitis control. A double-blind clinical study in humans. J Appl Oral Sci 2008;16:293-6.  Back to cited text no. 22
    
23.
Pereira SL, Lima MS, Costa FN, Carlos MX, Kayatt FE. Evaluation of the effect of a gel containing Myracrodruon urundeuva extract in the treatment of gingivitis. A clinical study in humans. Acta Odontol Venez 2009;47:1-8.  Back to cited text no. 23
    
24.
Zanatta FB, Antoniazzi RP, Rösing CK. Staining and calculus formation after 0.12% chlorhexidine rinses in plaque-free and plaque covered surfaces: A randomized trial. J Appl Oral Sci 2010;18:515-21.  Back to cited text no. 24
    
25.
Melo AF, Santos EJ, Souza LF, Carvalho AA, Pereira MS, Higino JS. In vitro antimicrobial activity of an extract of Anacardium occidentale L. against Streptococcus species. Rev Bras Farmacogn 2006;16:202-5.  Back to cited text no. 25
    
26.
Silva JG, Souza IA, Higino JS, Siqueira-Junior JP, Pereira JV, Pereira MS. Antimicrobial activity of the hydroalcoholic extract of Anacardium occidentale Linn. against multi-drug resistant strains of Staphylococcus aureus. Rev Bras Farmacogn 2007;17:572-7.  Back to cited text no. 26
    
27.
Vanderlinde FA, Landim HF, Costa EA, Galdino PM, Maciel MA, Anjos GC. Evaluation of the antinociceptive and anti-inflammatory effects of the acetone extract from Anacardium occidentale L. Braz J Pharm Sci 2009;45:437-42.  Back to cited text no. 27
    
28.
Ojewole JA. Potentiation of the antiinflammatory effect of Anacardium occidentale (Linn.) stem-bark aqueous extract by grapefruit juice. Methods Find Exp Clin Pharmacol 2004;26:183-8.  Back to cited text no. 28
    
29.
Barbosa-Filho JM, Vasconcelos TH, Alencar AA, Batista LM, Oliveira RA, Guedes DN. Plants and their active constituents from South, Central, and North America with hypoglycemic activity. Rev Bras Farmacogn 2005; 15:392-414.  Back to cited text no. 29
    
30.
Barbosa-Filho JM, Medeiros KC, Diniz MF, Batista LM, Athayde-Filho PF, Silva MS. Natural products inhibitors of the enzyme acetylcholinesterase. Rev Bras Farmacogn 2006;16:258-85.  Back to cited text no. 30
    

Top
Correspondence Address:
Prof. Sérgio Luís da Silva Pereira
Department of Periodontology, School of Dentistry, University of Fortaleza, UNIFOR, Fortaleza, CE
Brazil
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.191883

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]

This article has been cited by
1 Efficacy of local phytotherapy in the nonsurgical treatment of periodontal disease: A systematic review
M. G. Moro,M. L. Silveira Souto,G. C. N. Franco,M. Holzhausen,C. M. Pannuti
Journal of Periodontal Research. 2018; 53(3): 288
[Pubmed] | [DOI]
2 Efficacy of local phytotherapy in the nonsurgical treatment of periodontal disease: A systematic review
M. G. Moro,M. L. Silveira Souto,G. C. N. Franco,M. Holzhausen,C. M. Pannuti
Journal of Periodontal Research. 2018; 53(3): 288
[Pubmed] | [DOI]



 

Top
 
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed2495    
    Printed52    
    Emailed0    
    PDF Downloaded110    
    Comments [Add]    
    Cited by others 2    

Recommend this journal