The oral cavity is ubiquitous of various bacteria due to steady assaults of various food substances, soft drinks, alcohol, tobacco products etc. Antioxidants are substances that inhibit oxidation and prevent the formation of free radicals, which are responsible for cellular damage. Since the oral tissues are vulnerable to cellular damage caused by free radicals and oxidation process hence maintenance, a good level of antioxidants is very essential to achieve optimal oral health. This review highlights the role of antioxidants in the prevention of oral diseases

Datla, Asmita

GS, Shwetha

Hazari, Puja

Khare, Sumit

Mahajan, Harsh

Yadav, Geetika

English

Atharva Scientific Publications (E-Jounals)

Shwetha GS et al                                                                                                         Antioxidants and Oral Health 
Vol 8| Issue 3| Jul-Sept 2019                                                                                                              J Orofac Res 32 
Review Article 
Antioxidants and Oral Health 
Shwetha GS
1
, Harsh Mahajan
2
, Sumit Khare
2
, Puja Hazari
3
, Asmita Datla
4
, Geetika Yadav
5  
From
 1
Professor, Department of Orthodontics and Dentofacial Orthopedics, Rajarajeswari Dental College & Hospital, 
Bangalore,
2
Professor, 
3
Reader, Department of Prosthodontics, 
4
Intern, 
5
Intern Professor, People’s Dental Academy, Bhopal, 
Madhya Pradesh, India.  
Correspondence to: Dr. Puja Hazari, Department of Prosthodontics, People’s Dental Academy, Bhopal, Madhya Pradesh, 
India. E-mail: hazaripuja@yahoo.co.in 
Received - 20 May 2019                                           Initial Review – 29 May 2019                                        Accepted– 02 July 2019 
ABSTRACT 
The oral cavity is ubiquitous of various bacteria due to steady assaults of various food substances, soft drinks, alcohol, tobacco 
products etc. Antioxidants are substances that inhibit oxidation and prevent the formation of free radicals, which are 
responsible for cellular damage. Since the oral tissues are vulnerable to cellular damage caused by free radicals and oxidation 
process hence maintenance, a good level of antioxidants is very essential to achieve optimal oral health. This review highlights 
the role of antioxidants in the prevention of oral diseases. 
Keywords: Antioxidants, Free Radicals, Oral Health 
 
ral health is the essence of general health and 
equally important to pursue a quality life.   In a 
developing country like India, regardless of the 
advancement of treatment modalities, dental diseases are 
still a leading problem.  Dental diseases including dental 
caries, periodontitis, gingivitis, and periapical pathology, 
oral cancers affect the normal day-to-day activities of a 
person and may be life-threatening.
 
Antioxidants are the 
substances that inhibit oxidation of other molecules, which 
produces free radicals. These free radicals are responsible 
for harmful chain reactions for cell damage or cell death 
that is responsible for carcinogenesis or low-density 
lipoprotein (LDL) oxidations in various diseases [1].  
Free radical is defined as any molecular species that 
contains an unpaired electron capable of independent 
existence. The most important oxygen-containing free 
radicals are hydroxyl radical, superoxide anion radical, 
hydrogen peroxide, oxygen singlet, hypochlorite, nitric 
oxide radical, and peroxynitrite radical. These are highly 
reactive species capable in damaging of biologically 
relevant molecules such as DNA, proteins, carbohydrates, 
and lipids and leading to cellular damage and homeostatic 
disruption [2, 3]. Antioxidants neutralize these radicals by 
donating their electrons and ending the electron taking 
reaction [1]. Antioxidants present in all biological species, 
body fluids including saliva and foods like carrots, berries, 
spinach, pumpkin, mangoes, and apricots are the cheapest 
and readily available source of antioxidants [4]. Human 
beings have extremely multifaceted antioxidant systems 
which act synergistically to prevent cells and organs with 
free radical [5]. Oral tissues are extremely delicate and 
vulnerable for cellular damage by oxidative stress and 
salivary composition plays an enormous role in controlling 
and maintaining oxidative stress because of its antioxidant 
activity [6].   
Hence, antioxidants are an important role in the protection 
of oral tissues against cellular damage; therefore, the aim 
of this review is too high lighten the facts of antioxidants 
against good oral health. 
CLASSIFICATIONS OF ANTIOXIDANTS 
1. Based on their dietary supplements [5]  
Endogenous and Exogenous  
 
O 
Shwetha GS et al                                                                                                         Antioxidants and Oral Health 
Vol 8| Issue 3| Jul-Sept 2019                                                                                                              J Orofac Res 33 
2. Based on their Properties [7] 
Enzymatic Non- Enzymatic 
Primary enzymes: 
SOD, Catalase, 
Glutathione Peroxidase 
Secondary Enzymes: 
Glutathione reductase, 
glucose 6-phosphate 
dehydrogenase 
Minerals: Zinc, Selenium 
Vitamins: Vit A, E, C, K 
Carotenoids: beta carotene, 
lycopene 
Low molecular weight 
antioxidants: Glutathione, Uric 
acid 
Antioxidant cofactor: 
Coenzyme Q10  
Polyphenols: Flavonoids, 
Phenolic acid 
3. Based on their mode of action as [8] 
Preventive Scavenging (Chain Breaking) 
Enzymes Superoxide 
dismutase (SOD), catalase 
(CAT), glutathione 
peroxidase (GPx), 
glutathione reductase 
(GR), DNA repair 
enzymes 
Ascorbate (vitamin C), 
carotenoids (including retinol – 
vitamin A), uric acid, α-
tocopherol (vitamin E), 
polyphenols (flavonoids). 
ROLE OF ANTIOXIDANTS IN DIFFERENT 
DENTAL PROBLEMS 
Dental caries 
Dental caries is an infectious microbiologic disease of 
teeth that results in localized dissolution and destruction of 
calcified structures. Oxidative stress is an important factor 
in the initiation and progression of dental caries and saliva 
provides the first line of defense against oxidative stress 
[4]. Various physio-chemical properties of saliva like pH, 
buffering capacity, salivary flow rate, the concentration of 
various components like proteins, calcium, and antioxidant 
defense system play a major role in the development of 
caries [9]. A study conducted by Hegde at al found that 
total antioxidant capacity of saliva positively correlated 
with the incidence of early childhood and rampant caries 
[10]. According to Motamayel AF et al oxidative stress 
marker, which has an important role in caries progression 
was higher in the caries prone individual than the healthy 
control group [11]. All these studies showed that 
antioxidant is a crucial role in dental caries progression. 
Antioxidants and Periodontal disease 
Periodontitis is an inflammatory disease of the oral cavity, 
which has multi-factorial etiology. However, according to 
various researches loss of balance between reactive oxygen 
species and antioxidant defense mechanism results in 
periodontal diseases and according to Chapple IL et al, 
oxidative stress involves in the pathogenesis of 
periodontitis [12]. Superoxide dismutase (SOD) enzyme, 
which is a potent antioxidant present in periodontal 
ligaments, reduced in activity with increasing age. 
Sometimes impulsive production of superoxide (free 
radicals) in gingival crevicular fluid demonstrated in 
periodontitis patients in early nineties [13, 14]. Uric acid, 
which is a strong antioxidant of saliva, contributes 
approximately 70% of the total salivary antioxidant 
capacity and fight against various oral diseases. According 
to Moore et al, uric acid levels vary according to the 
severity of disease and low in a patient with periodontal 
disease [15]. Similarly, a study by Diab-Ladki et al found 
that decrease concentration of three main antioxidants (uric 
acid, ascorbic acid, and albumin) in saliva increases the 
severity of periodontal disease [16]. According to an in 
vitro study, SOD and catalase activity promote ROS 
production, which in turn causes tissue destruction. GCF 
and plasma total antioxidant capacity significantly reduced 
in patients with periodontal disease in comparison to 
periodontally healthy controls [17, 18]. All these studies 
showed that antioxidant level has potent inhibitor in 
periodontal diseases and according to Mathur A et al and 
Chandra RV et al, antioxidants could use as a promising 
treatment modality in periodontal diseases [19, 20]. 
Oral cancer 
Oral cancer is the biggest public health problem worldwide 
and ranks as the eighth most common cancer in developing 
countries. In Indian sub-continent, high incidence of oral 
cancer observed which accounts one-third burden of oral 
cancer worldwide. According to various studies, alteration 
in antioxidant levels due to the presence of carcinogens in 
the blood plays a key role in the development of malignant 
states.  A study conducted by Madhulatha G et al showed 
that antioxidant protection mechanism comprises an 
imperative defense system against the free radical injury, 
therefore, the antioxidants play the essential role and 
valuable markers in diagnosing oral cancer [21].  Various 
antioxidants use as adjunctive treatment modalities of oral 
precancerous lesions e.g. Vitamin-E can use as an 
antioxidant in oral lesions because it inhibits the reactions 
of the tobacco-specific nitrosamine (carcinogens). Other 
antioxidants like β carotene, provitamin A, vitamin-C, 
vitamin-E, zinc, selenium and spirulina also have a potent 
role in the prevention of oral cancer [22]. Balwant Rai et al 
proved that Vitamin-C and Vitamin-E could utilize in the 
treatment of oral Lichen planus [23] and antioxidant 
combinations as Vitamin A, E, and C proved to be most 
effective with maximum clinical resolution and regression 
of dysplasia recorded [24]. 
CONCLUSION 
This review concludes that antioxidants protect the body 
against the harmful effects of free radicals and prevent 
cellular damage. Considerable evidence present that 
Shwetha GS et al                                                                                                         Antioxidants and Oral Health 
Vol 8| Issue 3| Jul-Sept 2019                                                                                                              J Orofac Res 34 
indicates optimal antioxidants level in the body provides a 
barrier against various oral diseases.  Therefore, 
antioxidant enzymes act as a useful biomarker for various 
oral diseases, therefore, supplementation of antioxidants 
provides may reduce the prevalence of oral problems.  
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How to cite this article: Shwetha GS, Mahajan H, Khare 
S, Hazari P, Dalta A, Yadav G. Antioxidants and Oral 
Health. J Orofac Res. 2019;8(3):32-34. 
Funding: None; Conflict of Interest: None Stated. 


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