The interest in evaluating therapeutic effects of plants has&nbsp;increased dramatically with more and more people inclining toward alternative medicine for their health care needs as theyare effective, nontoxic, economical and usually have no sideeffects.&nbsp;Pomegranate is one such fruit/ plant which is beneficial&nbsp;with added effect on oral health.&nbsp;This plant source of polyphenols has antioxidant properties,&nbsp;meaning they help protect cells from damage and may lower&nbsp;the inflammation in the body. Apart from this various other&nbsp;components of the pomegranate plant such as flowers are rich&nbsp;source flavonoids. Peel extracts have been demonstrated to&nbsp;have antibacterial and antifungal activity due to the presence of&nbsp;hydrolysable tannins and polyphenols. The stem part is known&nbsp;to have astringent and antihelminthic properties and the leaves&nbsp;have been used for conjunctivitis.&nbsp;Thus, the purpose of this review is to summarize the&nbsp;therapeutic benefits of various extracts derived from the&nbsp;pomegranate plant and its benefits on oral health

Guru, Sanjeela

Rajan, Sukanya

Ravi, J

Suresh, Aparna

English

Atharva Scientific Publications (E-Jounals)

Sukanya Rajan et al
38
JAYPEE
REVIEW ARTICLE
Hidden Secrets of ‘Punica Granatum’ Use and
Its Effects on Oral Health: A Short Review
Sukanya Rajan, J Ravi, Aparna Suresh, Sanjeela Guru
ABSTRACT
The interest in evaluating therapeutic effects of plants has
increased dramatically with more and more people inclining
toward alternative medicine for their health care needs as they
are effective, nontoxic, economical and usually have no side-
effects. Pomegranate is one such fruit/ plant which is beneficial
with added effect on oral health.
This plant source of polyphenols has antioxidant properties,
meaning they help 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, Anti-
inflammatory, Antifungal.
How to cite this article: Rajan S, Ravi J, Suresh A, Guru S.
Hidden Secrets of ‘Punica Granatum’ Use and Its Effects on
Oral Health: A Short Review. J Orofac Res 2013;3(1):38-41.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Pomegranate is scientifically termed as Punica granatum
and is a member of the family Punicaceae. It is an ancient,
mystical, unique fruit borne on a small long living tree
cultivated throughout Himalayas in Northern India up till
Iran. It has been cultivated and naturalized since ancient
times over the entire Mediterranean region, Southeast Asia,
the East Indies, and tropical Africa.1
In recent decades the interest in evaluating therapeutic
effects of plants has increased dramatically, as 80% of the
world relies on alternative medicine for their health care
needs.2 Significant progress has been made in establishing
the pharmacological mechanism of pomegranate. The
extracts of all parts of the fruit appear to have therapeutic
properties and some studies report the bark, roots and leaves
of the tree also have medicinal benefits.1 The dried flowers
are used in hematuria, hemorrhoids, hemoptysis and
dysentery. The powdered flower buds are being used in
bronchitis (Ross et al 2001).3 Flower juice is recommended
as a gargle for sore throat, in leukorrhea, hemorrhages and
ulcers of the uterus and rectum (Ali et al 2006).4 The root
bark and stem bark of the plant are used as an astringent
and anthelmintic specification against tapeworms.
The rind is valued as an astringent in diarrhea and
dysentery. The seeds are considered to be stomachic and
the pulp as cardiac and stomachic. The leaves are made
into a paste and applied in conjunctivitis (Li et al 2005).5
The flower extracts of Punica granatum and rind of this
plant have been reported to exert some glucose lowering
action in animals (Jafri et al 2000).6
The use of antioxidant property of pomegranate in oral
cavity has been explored in recent times and studies have
shown promising results. This article reviews the various
forms of pomegranate and their applicability in promoting
oral health.
THERAPEUTIC USES OF PUNICA GRANATUM
IN ORAL CAVITY
Pomegranate Fruit Extract
Pomegranate is fast becoming recognized as an antioxidant
power house, possibly beating green tea and red wine. The
antioxidants extracted from pomegranate are polyphenols,
hydrolysable tannins and anthocyanins. These antioxidants
help bind harmful oxygen containing molecules in our body
called free radicals and peroxides that otherwise could
damage DNA, cell membrane and other cell components.
These hydrolysable tannins are used as botanical
ingredients in herbal supplements for their antioxidant,
antibacterial, anti-inflammatory, anticancer and
antiatherosclerotic activities.7
Pomegranate Juice
According to Guo et al, 250 ml of pomegranate juice given
daily for 4 weeks to healthy elderly subjects increased
plasma antioxidant capacity from 1.33 to 1.46 mmol, while
subjects consuming apple juice experienced no significant
increase in antioxidant capacity.8
Pomegranate-Methanolic Extract (MEPGP) on
Oral Pathogens
In vitro study conducted by Abdollahzadeh 20112 showed
that extract of pomegranate might be used in the control of
common oral pathogens responsible for caries stomatitis
10.5005/jp-journals-10026-1061
Hidden Secrets of ‘Punica Granatum’ Use and Its Effects on Oral Health: A Short Review
Journal of Orofacial Research, January-March 2013;3(1):38-41 39
JOFR
and periodontal diseases however, their study requires further
photochemical studies to determine the type of compounds
responsible for the antibacterial effect of pomegranate.2
Pomegranate Gel
Vanconcelos et al in 2006,9 investigated the antimicrobial
effect of pomegranate gel against Streptococcus mutans,
Streptococcus mitis and Candida albicans and found that
pomegranate gel has greater efficiency in inhibiting
microbial adherence. Their results suggests that this gel
might be used in the control of adherence of different
microorganisms in the oral cavity that is responsible for
caries periodontal disease and stomatitis.9
In 2003 Vanconcelos et al conducted in vivo studies
using pomegranate gel as antifungal agent against
candidiasis associated with denture stomatitis and found
that there was a resolution of the symptoms and an
improvement in general oral health.10
A gel containing the extract of pomegranate fruit peel,
applied to the gums of patients with candidiasis associated
with denture stomatitis three times daily for 15 days seems
to be as effective as miconazole gel, a topical antifungal
agent.11
Pomegranate Extract
The extracts have been found to work against methicillin-
sensitive as well as methicillin-resistant Streptococcus
aureus, E. coli, Salmonella typhi and some other species of
streptococci.7 Research shows that pomegranate extract
suppresses the ability of these microorganisms to adhere to
the surface of the tooth. It inhibits common species of
streptococcus, preventing it from producing chemicals that
create favorable conditions for fungi and other
microorganisms to thrive.12
Plaque may involve four or more different
microorganisms combining forces to colonize the surface
of the teeth. Remarkably, natures own pomegranate fights
the organism’s ability to adhere by interfering with
production of the very chemicals the bacteria use as a glue.
Pomegranate Hydroalcoholic Extract
as Mouthrinse
The antibacterial effect on dental plaque microorganisms
was tested using 15 ml of hydroalcoholic extract of
pomegranate (HAEP) solution in comparison with
chlorhexidine (CHX) mouthwash. They found that HAEP
and CHX were effective against Staphylococcus,
Streptococcus, Klebsiella and Proteus species as well as
E. coli.
The ellagitannin, punicalagin fraction is thought to be
responsible for pomegranate antimicrobial activity.13
Pomegranate Mouthrinse Antiplaque Efficacy
Study conducted by Bhadbhad in 2011 tested the mouth
rinse against A. actinomycetemcomitans, P. gingivalis and
P. intermedia strains in vitro. The results showed that the
extract was effective against these organisms and can be
used as an antiplaque agent, but its efficacy as a long-term
antiplaque rinse with prophylactic benefits should be further
explored.14
When used regularly in combination with toothpaste that
has been reinforced with bioactive botanical extracts,
pomegranate containing mouthwash may fight dental plaque
and tartar formation by inhibiting the activities of the
microorganisms that causes plaque. Additionally,
pomegranate compounds possess anti-inflammatory
properties that may help soothe irritated tissues.15
The addition of pomegranate-polyphenols extract
(POMx) to various oral agents, including toothpaste and
mouthwash, gave these agents an antimicrobial effect which
gives even better results compared to that of white tea and
green tea extracts.16
Pomegranate Mouthrinse
Ohio state study done to compare the use of pomegranate
mouthwash with a placebo mouthrinse used three times daily
for 4 weeks, showed that there was a reduction in saliva
total protein content which is normally higher in people
with gingivitis and may correlate with the plaque forming
bacterial count. They also found significant decrease in
salivary activity of the enzyme aspartate aminotransferase,
an enzyme considered as a reliable indicator of cell injury
which is elevated among periodontitis patients.
Pomegranate rinse also lowers salivary activity of alpha-
glucosidase, an enzyme that breaks down sucrose, while it
increased activity of ceruloplasmin, an antioxidant
enzyme.15
Anti-inflammatory Activity
Studies by Lee et al 2010, Chakraborthy 2008 also showed
that it has antipyretic and analgesic activity.
Inhibition of inflammation by pomegranate components
involves inhibition of both cyclooxygenase (COX) and
lipoxygenase (LOX) enzymes (Sehuburt et al 1999), and
reduction in the prostaglandin levels from the cells
(Polagrauts et al 2003). The phytochemical analysis of the
flower extract also reveals that it contains flavonoids (Bagri
et al 2010). Flavonoids are known for their ability to inhibit
Sukanya Rajan et al
40
JAYPEE
pain perception and also have anti-inflammatory properties
due to their inhibitory effects on enzymes involved in the
production of chemical mediator of inflammation (Owoyele
et al 2005).17
The anti-inflammatory effect of pomegranate may be
attributed to its considerable immune regulatory activity
over macrophage and T and B lymphocyte subsets (Ross et
al).4 In vivo study conducted by Grindwit et al in 200318
tested the effects of combined extracts from Centella
asiatica, commonly known as Asiatic pennywort, and
Pomegranate pericap on periodontal wound healing
following scaling and root planing. The placement was done
subgingivally after scaling and root planing. All treatment
sites demonstrated a trend toward decreasing plaque and
significant improvements were noted in pocket depth and
attachment level at 3 months compared to placebo. They
also found significant decrease in IL-1 and IL-6 at 3 and 6
months compared to baseline.18
Several recent studies have documented that
supplementation with pomegranate fruit extract inhibits
inflammatory symptoms in vivo. However, the molecular
basis of the observed effects has not fully revealed.
According to Meeenakshi et al in 2008, they determined
the effect on rabbit plasma obtained after ingestion of a
polyphenols rich extract (PFE) of pomegranate fruit extract
on COX enzyme activity ex vivo and the IL-1 induced
production of nitric oxide (NO) and prostaglandin (PGE2)
in chondrocytes in vitro. Plasma samples collected after oral
ingestion of PFE were found to inhibit the IL-1 induced
PGE2 and NO production in chondrocytes. These plasma
samples also inhibited both COX-1 and COX-2 enzyme
activity ex vivo but the effect was more pronounced on the
enzyme activity of COX-2 enzyme. Furthermore, their study
suggests that PFE-derived bioavailable compounds may
exert an anti-inflammatory effect by inhibiting the
inflammatory cytokine-induced production of PGE2 and NO
in vivo.19
CONCLUSION
Substantial health benefits of pomegranate has recently
become popular among people, unfortunately they are
consuming only commercially available pomegranate juice
and are missing out many other beneficial parts of the plant,
such as leaves, flowers and oil from seeds. Each component
of pomegranate works together synergistically to maximize
its beneficial effects on our health. Currently, numerous
clinical trials are in progress exploring the therapeutic
potential of pomegranate extracts. Further, studies are
required to find their effects in order to replace synthetic
medications with natural remedies. Although, considerable
evidence exists regarding the antioxidant, antibacterial, anti-
inflammatory and antifungal properties, further human trials
are necessary to refute or substantiate these properties.
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ABOUT THE AUTHORS
Sukanya Rajan
Professor, Department of Periodontics, Vydehi Institute of Dental
Sciences, Whitefield, Bengaluru, Karnataka, India
Correspondence Address: 949, 2nd E Cross, 9th A Main, Ist Block
HRBR Layout, Kalyan Nagar, Bengaluru-560043, Karnataka, India
Phone: 09480090172, e-mail: drsukraj@yahoo.co.in
J Ravi
Senior Lecturer, Department of Periodontics, Vydehi Institute of
Dental Sciences, Whitefield, Bengaluru, Karnataka, India
Aparna Suresh
Senior Lecturer, Department of Periodontics, Vydehi Institute of
Dental Sciences, Whitefield, Bengaluru, Karnataka, India
Sanjeela Guru
Reader, Department of Periodontics, Vydehi Institute of Dental
Sciences, Whitefield, Bengaluru, Karnataka, India


Hidden Secrets of ‘Punica Granatum’ Use and Its Effects on Oral Health: A Short Review

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