International Journal of Advanced Education and Research

International Journal of Advanced Education and Research

ISSN: 2455-5746, Impact Factor: RJIF 5.34
www.alleducationjournal.com
Volume 1; Issue 8; August 2016; Page No. 27-31

Pomegranate: Natural remedy for treating periodontal disease

1
Dhalkari Chandulal, 2 Indurkar Maya, 3 Wagatkar Jayshri
1
MDS, Associate Professor, Department of Periodontology Government Dental College, Aurangabad, Maharashtra, India
2
MDS, HOD, professor, Department of Periodontology Government Dental College, Aurangabad, Aurangabad, Maharashtra, India
3
BDS, Senior Resident, Department of Periodontology, Government Dental College, Aurangabad, Aurangabad, Maharashtra, India

Abstract
Pomegranate is one such fruit/ plant which is beneficial with added effect on oral health. This plant has source of polyphenols
which has antioxidant properties, meaning they help to protect cells from damage and may lower the inflammation in the body.
Apart from this various other components of the pomegranate plant such as flowers are rich source flavonoids. Peel extracts have
been demonstrated to have antibacterial and antifungal activity due to the presence of hydrolysable tannins and polyphenols. The
stem part is known to have astringent and antihelminthic properties and the leaves have been used for conjunctivitis. Thus, the
purpose of this review is to summarize the therapeutic benefits of various extracts derived from the pomegranate plant and its
benefits on oral health.

Keywords: Pomegranate, Antiplaque, Antioxidant, Antiinflammatory

Introduction pomegranate is native of the Himalayas in northern India to

Gingivitis is the inflammation of the gingiva. Plaque is a Iran [7].
requirement for the development of gingivitis [1]. Periodontitis
is a polymicrobial disease in which disease expression involves History
intricate interactions of the plaque biofilm with the host The pomegranate, an ancient, mystical, and highly distinctive
inflammatory response and subsequent alterations in bone and fruit, is the predominant member of two species comprising the
connective tissue metabolism [2]. Mechanical plaque control Punicaceae family. In Ayurvedic medicine the pomegranate is
methods are efficient in maintaining adequate levels of oral considered “a pharmacy unto itself” and is used as an
hygiene, studies have shown that patient compliance in antiparasitic agent, a “blood tonic,” and to heal aphthae,
following these methods are not adequate in a large population diarrhoea, and ulcers. However, the name pomegranate
[3]
. In order to overcome the shortcomings of mechanical originates from the genus ‘Punica’, which was the Roman
plaque control methods, various chemotherapeutic agents have name for Carthage, where the best pomegranates were known
been employed [3]. to grow. Pomegranate is known by the French as grenade, the
Herbs have various bioactive components which possess Spanish as Granada, which literally translates to seeded
enormous medicinal value with least side effects [4]. Synthetic (‘granatus’) apple (‘pomum’) [8, 9].
antimicrobial agents and antibiotics are known to cause
antimicrobial resistance, emergence of previously uncommon Phytochemistry
infections probably due to the inappropriate or widespread Pomegranate juice contains anthocyanins, glucose, ascorbic
overuse of antimicrobials. Natural phytochemicals have proven acid, ellagic acid, gallic acid, caffeic acid, catechin,
to be good alternatives to such synthetic agents [5]. Various Epigallocatechin gallate (EGCG), querticin, rutin, iron, and
studies have proven to show excellent medicinal properties of amino acids. Pomegranate seed oil is composed primarily of
different herbal products in various medical and dental punicic acid and sterols. The pericarp (peel, rind) contains
diseases. This review showen pomegranate herbal product, punicalgins, flavones, flavonones, and other flavanols.
their medicinal properties and their uses in the field of Tannins, including punicalin and punicafolin, and flavone
periodontics. glycosides like luteolin and apigenin, form important
constituents of pomegranate leaves. The flowers of
Description pomegranate are composed of ursolic acid, triterpinoids like
The pomegranate tree typically grows 12−16 feet and has maslinic acid, and asiatic acid. Ellagitannins and piperidine
many spiny branches. It can be extremely long lived, as alkaloids are present in pomegranate roots and bark. However,
evidenced by trees at Versailles, France, known to be over 200 current research seems to indicate that the most therapeutically
years old. The leaves are glossy and lance shaped. The bark of beneficial pomegranate constituents include ellagic acid
the tree turns gray as the tree ages. The flowers are large, red, ellagitannins (including punicalagins), punicic acid,
white, or variegated, and have a tubular calyx that eventually flavonoids, anthocyanidins, anthocyanins, and estrogenic
becomes the fruit. The fruit contains many seeds (arils) flavones.
separated by white, membranous pericarp, and each is Pomegranate aril juice provides about 16% of an adult’s daily
surrounded by small amounts of tart, red juice. The vitamin C requirement per 100 ml serving, and is a good

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International Journal of Advanced Education and Research

source of vitamin B5 ( pantothenic acid), potassium, and phosphorylation [31]. Blocking NF-κB, inflammatory cell
natural phenols, such as ellagitannins and flavonoids [10]. signaling pathways that produce various destructive factors
may be a potential strategy to prevent inflammation induced
Functional components of pomegranate parts bone resorption and a promising mechanism to treat
The pomegranate fruit could be considered a functional food periodontitis [30, 32]. Oral ingestion of polyphenol rich extract of
because it has valuable compounds in different parts of the pomegranate fruit extract inhibited COX-1 and COX-2
fruit that display functional and medicinal effects. enzymes. It also inhibited IL-1β induced NO and PGE2
Pomegranate flowers attenuate agingmediated undesirable skin production [33].
abnormalities [11], besides possessing potent antioxidant and
hepatoprotective properties [12]. Additionally, they also D) Other Mechanisms
diminish cardiac toxicity [13] and glucose levels [14]. The Numerous in vitro studies [34, 35, 36] and two human trials [37, 38]
pomegranate peel has been shown to have anti-inflammatory demonstrate the antimicrobial activity of pomegranate extracts.
[15]
, antimutagenic [16], and antifungal activity [17]. Furthermore, The growth of Staphylococcus aureus, Streptococcus
the pomegranate peel extracts also prevents liver fibrosis [18]. pyogenes, Diplococcus pneumoniae, Escherichia coli and
Pomegranate juice, which is rich in tannins, possesses anti- Candida albicans was inhibited via direct bacteriocidal or
atherosclerotic, antihypertensive, anti-aging, and potent anti- fungicidal activity.
[19]
oxidative characteristics . Hence, it provides
[20]
cardioprotective benefits . Pomegranate juice may have General therapeutics of pomegranate
cancer-chemopreventive as well as cancer-chemotherapeutic Pomegranate has many potential effects including bactericidal,
effects against prostate cancer, in humans [21]. Pomegranate antifungal, antiviral, immune modulation, vermifuge,
seed oil exhibits nephroprotective properties [22]. Pomegranate stimulant, refrigerant, astringent, stomachic, styptic, laxative,
bark has been seen to have molluscicidal activity [23]. diuretic and antihelminthic. It has also been widely used in
treatment of cardiovascular diseases, diabetes, diarrhea,
Mechanisms of Action dysentery, asthma, bronchitis, cough, bleeding disorders, fever,
Although pomegranate’s wide-ranging therapeutic benefits inflammation, acquired immune deficiency syndrome,
may be attributable to several mechanisms, most research has dyspepsia, ulcers, bruises, sores, mouth lesions, skin lesions,
focused on its antioxidant, anticarcinogenic, and anti- malaria, prostate cancer, atherosclerosis, hypertension, hyper
inflammatory properties. lipidemia, denture stomatitis, male infertility, vaginitis, erectile
dysfunction, Alzheimer’s disease, obesity, and neonatal
A) Antioxidant Mechanisms hypoxic-ischemic brain injury [6, 7, 39, 40].
An in vitro assay using four separate testing methods
demonstrated pomegranate juice and seed extracts have 2-3 Therapeutic uses of Punica granatum in oral cavity
times the antioxidant capacity of either red wine or green tea Pomegranate Fruit Extract
[24]
. Pomegranate extracts have been shown to scavenge free Pomegranate is fast becoming recognized as an antioxidant
radicals and decrease macrophage oxidative stress and lipid power house, possibly beating green tea and red wine. The
peroxidation in animals [25] and increase plasma antioxidant antioxidants extracted from pomegranate are polyphenols,
capacity in elderly humans [26]. hydrolysable tannins and anthocyanins. These antioxidants
help bind harmful oxygen containing molecules in our body
B) Anticarcinogenic Mechanisms called free radicals and peroxides that otherwise could damage
In vitro assays utilizing three prostate cancer cell lines (DU- DNA, cell membrane and other cell components. These
145, LNCaP, and PC-3) demonstrated various pomegranate hydrolysable tannins are used as botanical ingredients in herbal
extracts (juice, seed oil, peel) potently inhibit prostate cancer supplements for their antioxidant, antibacterial, anti-
cell invasiveness and proliferation, cause cell cycle disruption, inflammatory, anticancer and antiatherosclerotic activities [7].
induce apoptosis, and inhibit tumor growth [27, 28].
Pomegranate Juice
C) Anti-inflammatory Mechanisms According to Guo et al, 250 ml of pomegranate juice given
Cold pressed pomegranate seed oil has inhibited both daily for 4 weeks to healthy elderly subjects increased plasma
cyclooxygenase and lipoxygenase enzymes in vitro. Both these antioxidant capacity from 1.33 to 1.46 mmol, while subjects
are key enzymes in production of various inflammatory consuming apple juice experienced no significant increase in
mediators [7]. Pomegranate fruit extract has a broad inhibitory antioxidant capacity [26].
effect on matrix metalloproteinaises (MMPs) expression and
IL–1β induced tissue destruction [7]. Apart from the above Pomegranate Gel
mechanisms, anti-inflammatory effect of pomegranate could Vanconcelos et al in 2006, investigated the antimicrobial effect
be due its immunoregulatory action on macrophages and T and of pomegranate gel against Streptococcus mutans,
B lymphocytes [29]. Streptococcus mitis and Candida albicans and found that
Pomegranate extract exhibited anti-inflammatory activity pomegranate gel has greater efficiency in inhibiting microbial
through inhibition of NF-κB (nuclear factor kappa-B) activity adherence. Their results suggests that this gel might be used in
and prevention of ERK-1 or ERK-2 (Mitogen activated protein the control of adherence of different microorganisms in the
kinase cascades) activation. It also decreased NO (nitric oxide) oral cavity that is responsible for caries periodontal disease and
and PGE2 synthesis in human intestinal Caco-2 cells. Ellagic stomatitis [42].
acid inhibited NF-κB activation through a mechanism In 2003 Vanconcelos et al conducted in vivo studies using
independent of Iκ-B (inhibitor of nuclear factor kappa B) pomegranate gel as antifungal agent against candidiasis
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International Journal of Advanced Education and Research

associated with denture stomatitis and found that there was a Ohio state study done to compare the use of pomegranate
resolution of the symptoms and an improvement in general mouthwash with a placebo mouthrinse used three times daily
oral health.38 A gel containing the extract of pomegranate fruit for 4 weeks, showed that there was a reduction in saliva total
peel, applied to the gums of patients with candidiasis protein content which is normally higher in people with
associated with denture stomatitis three times daily for 15 days gingivitis and may correlate with the plaque forming bacterial
seems to be as effective as miconazole gel, a topical antifungal count. They also found significant decrease in salivary activity
agent [43]. of the enzyme aspartate aminotransferase, an enzyme
considered as a reliable indicator of cell injury which is
Pomegranate-Methanolic Extract (MEPGP) elevated among periodontitis patients. Pomegranate rinse also
In vitro study conducted by Abdollahzadeh 2011[2] showed that lowers salivary activity of alphaglucosidase, an enzyme that
extract of pomegranate might be used in the control of breaks down sucrose, while it increased activity of
common oral pathogens responsible for caries stomatitis and ceruloplasmin, an antioxidant enzyme [46].
periodontal diseases however, their study requires further
photochemical studies to determine the type of compounds Safety of pomegranate
responsible for the antibacterial effect of pomegranate [41]. Pomegranate and its constituents have been consumed for
centuries without adverse effects [7]. Studies of pomegranate
Pomegranate Hydroalcoholic Extract as Mouthrinse constituents in animals at concentrations and levels commonly
The antibacterial effect on dental plaque microorganisms was used in folk and traditional medicine did not indicate any toxic
tested using 15 ml of hydroalcoholic extract of pomegranate effects [39]. Pomegranate juice, oil or powdered extracts can be
(HAEP) solution in comparison with chlorhexidine (CHX) consumed by healthy individuals without high risk. No adverse
mouthwash. They found that HAEP and CHX were effective effects on renal or liver function were observed in humans
against Staphylococcus, Streptococcus, Klebsiella and Proteus upon administration of up to 1420 mg/day of pomegranate fruit
species as well as E. coli. The ellagitannin, punicalagin extract tablets [49].
fraction is thought to be responsible for pomegranate P450 enzymes play a pivotal role in the metabolism of various
antimicrobial activity [37]. drugs. Pomegranate inhibited this enzyme resulting in altered
drug pharmacokinetics of tolbutamide, carbamazepine and
Pomegranate Extract pentobarbital [50-52]. Future studies should be directed with
The extracts have been found to work against emphasis on bioavailability of compounds, effective and safe
methicillinsensitive as well as methicillin-resistant doses of pomegranate that can be used in dentistry.
Streptococcus aureus, E. coli, Salmonella typhi and some other
species of streptococci [41]. Research shows that pomegranate Conclusion
extract suppresses the ability of these microorganisms to Substantial health benefits of pomegranate has recently
adhere to the surface of the tooth. It inhibits common species become popular among people, unfortunately they are
of streptococcus, preventing it from producing chemicals that consuming only commercially available pomegranate juice and
create favorable conditions for fungi and other microorganisms are missing out many other beneficial parts of the plant, such
to thrive [44]. Plaque may involve four or more different as leaves, flowers and oil from seeds. Each component of
microorganisms combining forces to colonize the surface of pomegranate works together synergistically to maximize its
the teeth. A biodegradable chip impregnated with pomegranate beneficial effects on our health. Currently, numerous clinical
peel extract, meant for sub-gingival use as an adjunct to trials are in progress exploring the therapeutic potential of
scaling in patients with periodontitis, demonstrated decreased pomegranate extracts. Further, studies are required to find their
plaque build-up, pocket depth size and bacterial attachment in effects in order to replace synthetic medications with natural
patients compared to those with the placebo chip after a period remedies. Although, considerable evidence exists regarding the
of six months [45]. antioxidant, antibacterial, anti-inflammatory and antifungal
properties, further human trials are necessary to refute or
Pomegranate Mouthrinse Antiplaque Efficacy substantiate these properties.
Study conducted by Bhadbhad in 2011 tested the mouth rinse
against A. actinomycetemcomitans, P. gingivalis and P. References
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