Home | About us | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Subscribe | Advertise | Contact us |  Login 
Pharmacognosy Reviews
Search Article 
  
Advanced search 
 


 
 Table of Contents  
REVIEW ARTICLE
Year : 2014  |  Volume : 8  |  Issue : 16  |  Page : 96-100  

Psidium guajava: A review on its potential as an adjunct in treating periodontal disease


Department of Periodontics, MES Dental College and Hospital, Palachode P.O., Kolathur Via, Malaparamba, Perintalmanna, Malappuram, Kerala, India

Date of Submission29-May-2013
Date of Acceptance05-Jan-2014
Date of Web Publication10-Jun-2014

Correspondence Address:
P. Divyashree
Department of Periodontics, MES Dental College and Hospital, Palachode P.O., Kolathur Via, Malaparamba, Perintalmanna, Malappuram District 679 338, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-7847.134233

Rights and Permissions
   Abstract 

Plants for thousands of years have been used to enhance health and for medicinal purposes. Psidium guajava is one which has an enormous wealth of medicinal value. It for long has been known for its anti-inflammatory, antimicrobial, antioxidant, antidiarrheal, antimutagenic properties. Despite of its widespread biologic uses there is a dearth of information on its therapeutic effect in the treatment of periodontal disease. Hence, this review is an attempt to highlight the potential of P. guajava in the treatment of periodontal disease. Internet databases PubMed, Google Scholar were searched and the most relevant articles were considered for review.

Keywords: Antiplaque, gingivitis, guaijaverin, periodontitis, Psidium guajava, quercetin


How to cite this article:
Ravi K, Divyashree P. Psidium guajava: A review on its potential as an adjunct in treating periodontal disease. Phcog Rev 2014;8:96-100

How to cite this URL:
Ravi K, Divyashree P. Psidium guajava: A review on its potential as an adjunct in treating periodontal disease. Phcog Rev [serial online] 2014 [cited 2017 Sep 19];8:96-100. Available from: http://www.phcogrev.com/text.asp?2014/8/16/96/134233


   Introduction Top


Periodontal disease has been recognized as a major health problem worldwide. Periodontal diseases are infectious diseases caused by bacteria present in dental plaque [1] and a direct relationship exists between the presence of dental plaque and development of gingivitis. [2] Gingivitis is a chronic inflammatory process confined to the gingiva. [3] Periodontitis is a complex disease in which disease expression involves intricate interactions of the biofilm with the host inflammatory response and subsequent alterations in bone and connective tissue metabolism. [4] The goal of periodontal treatment is to cure the inflamed tissues, reduce the number of periodontal pathogens and alter the host response. [5] Mechanical debridement, use of chemotherapeutic agents are some of the clinical methods employed to treat periodontal disease. The major disadvantage of these chemotherapeutic agents is the toxicity and development of bacterial resistance. [5] In an attempt to overcome the limitations of mechanical debridement and adverse effects of chemotherapeutic agents the search for newer and safer chemotherapeutic agents still continues. Natural phytochemicals isolated from plants are considered good alternatives to synthetic chemicals.

In the recent years, the use of plant extracts as well as other forms of medical treatments have resurfaced and gained popularity. [6] Various natural products such as Curcuma zedoaria, calendula, Aloe vera and other herbs have been used effectively to treat oral diseases in Ayurveda [3] and in the form of mouthwashes and toothpastes to treat periodontal disease. [7] A. vera, star anise oil, myrrh gum, calendula extract, fennel oil, tea tree oil, neem extract are few natural products used to control periodontal disease. [8] Psidium guajava is one such plant that has been used to manage various systemic conditions, enhance oral hygiene and consists of bioactive substances. [9],[10]

Internet database PubMed and Google Scholar were searched for P. guajava and periodontitis, gingivitis, periodontal pathogens, antiplaque, oral health. The back references of these articles were hand searched for any suitable articles. Only highly relevant articles were considered for the present review article.

Description

Common names of P. guajava are guava, guayaba, goiaba, perala, pichi, posh, enand. [11] It is found in Kingdom: Plantae, Division: Magnoliophyta, Class: Magnoliopsida, Subclass: Rosidae, Order: Myrtales, Family: Myrtaceae, Subfamily: Myrtoideae, Genus: Psidium and species: guajava, Binomial name: P. guajava. [9],[12],[13] It is a small tree which grows up to 20 feet in height. Leaves are opposite, oblong, three to seven inches in length, with prominent veins below. Flowers are of white color and about one inch in diameter. Fruits of P. guajava (hereafter referred to as guava) are round ovoid to pear shape. It is thin shelled with many seeds embedded in a firm pulp or thick shelled with few seeds. [14]

Phytochemistry and functional components

The important constituents of guava are vitamins, tannins, phenolic compounds, flavonoids, essential oils, sesquiterpene alcohols and triterpenoid acids. [15] Leaves contain phenolic compounds, isoflavonoids, gallic acid, catechin, epicatechin, rutin, naringenin, kaempferol having hepatoprotective, antioxidant, anti-inflammatory, antispasmodic, anticancer, antimicrobial, anti-hyperglycemic, analgesic actions. [15] The leaf contain two important flavonoids quercetin known for its spasmolytic, antioxidant, antimicrobial, anti-inflammatory actions [9],[14] and guaijaverin known for its antibacterial action. [16] Pulp contains ascorbic acid, carotenoids (lycopenes, β-carotene) possessing antioxidant, anti-hyperglycemic, antineoplastic. [15] The seed contains glycosides, carotenoids, phenolic compounds having antimicrobial actions. [15]

General uses

Guava is proven for its antidiarrheal, antimicrobial, antiparasitic, antitussive, hepatoprotective, antioxidant, antigenotoxic, antimutagenic, antiallergic, anticancer and anti-hyperglycemic effects. [13] Acclaimed as the "poor man's apple of the tropic" [17] guava has been used for various purposes in different regions of the world. It has been used in the treatment of diarrhea, dysentery, menstrual disorders, vertigo, anorexia, digestive problems, gastric insufficiency, inflamed mucous membrane, laryngitis, skin problems, ulcers, vaginal discharge, cold, cough, cerebral ailments, nephritis, jaundice, diabetes, malaria and rheumatism to mention a few. [11],[18]


   Therapeutic applications in treating periodontal disease Top


Dental plaque is a prerequisite for periodontal disease. Damage to the periodontium occurs due to direct pathologic effects of bacteria on the periodontal tissues and other indirect means. [19] Bacterial lipopolysaccharides are known to stimulate the production of both catabolic cytokines and inflammatory mediators including arachidonic acid metabolites such as prostaglandin E 2 (PGE 2 ), interleukin-1 (IL-1), interleukin-6 (IL-6), TNF-α (tumour necrosis factor-α). These cytokines and inflammatory mediators stimulate the release of tissue- derived enzymes, the matrix metalloproteinases, which are destructive to the extracellular matrix and bone. [19]

Reactive oxygen species have also been considered as key factor in the pathogenesis of periodontitis. Oxidative stress can lead to direct tissue damage. In addition to direct tissue damage, oxidative stress is a key component of hyperinflammation in periodontitis. It is known to activate key nuclear transcription factors, such as receptor activator of nuclear factor kappa β (NF-kβ) and activated protein-1(AP-1) which further can induce gene transcription for key proinflammatory mediators and osteoclastogenesis stimulation. [19] Thus, periodontitis has a multifactorial etiology.

Guava as an antiplaque agent

Dental plaque is the principal etiologic factor in periodontal disease. Plaque if allowed to accumulate, with no intervention or oral hygiene methods, leads to gingivitis which further progresses to periodontitis. [20] Effective plaque control strategies to prevent or limit bacterial adhesion and further growth on the tooth surface are essential to prevent and control periodontal disease. [21] The paste of tender leaves of guava has been traditionally used to maintain oral hygiene. [22] Guava has shown antibacterial activity against both Gram-positive and Gram-negative bacteria. [23],[24],[25] The antimicrobial activity of guava is mainly attributed to flavonoids, guaijaverin and quercetin. [22],[26],[27],[28] The bark has exhibited antibacterial properties due to the presence of tannins. [29]

Quercetin has shown excellent antibacterial actions against periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn). [30],[31] It has shown inhibitory actions against Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis) and Actinomyces species. [30] The antibacterial action of quercetin is probably due to the disruption of membrane and inactivation of extracellular proteins by forming irreversible complexes. [30] Guaijaverin from leaves of guava has potential as an antiplaque agent due to its bacteriostatic property by inhibiting the growth of S. mutans and Staphylococcus aureus (S. aureus). [22],[32],[33],[34] Guaijaverin decreases the hydrophobicity, one of the most important initial factors for the oral pathogenic bacteria to adhere to the tooth surface. [22] This action is possibly because guava extracts binds to the cell surface proteins reducing the overall cell hydrophobicity and hence guava may have potential for development as a natural antiplaque agent. [22] Guava and Piper betle extracts have shown bacteriostatic effect on the primary colonizers of teeth during plaque formation S. sanguinis, Streptococcus mitis (S. mitis) and Actinomyces. [21],[35] S. mitis and S. sanguinis showed lesser adherence to the experimental pellicle treated with guava extracts when compared with untreated pellicle due to the ability of guava to disrupt the pellicle preventing adherence of bacteria. [36]

Mouthwash containing aqueous extract of the leaves was highly active against S. aureus and  Escherichia More Details coli (E. coli) which could be contributed to the presence of bioactive compounds. [10] Mouthrinse containing guava leaf extract had a profound effect on gingivitis. [37] The aqueous extracts of P. betle and guava were found to have antiplaque activity by their effect on ultrastructure of plaque bacteria by interfering with normal growth cycle and development, [38] reducing the adhering capacity of the acquired pellicle which forms on the surface of tooth during early plaque formation, diminishing the cell surface hydrophobicity of bacteria which are required to assist the adherence process. [39],[40] The cytotoxic property of guava would be of added value for the use of guava as adjuncts in the development of oral health care products. [41] Guava extract has demonstrated in vitro antiplaque actions by inhibiting growth, adherence and co-aggregation of dental plaque bacteria. Guava extracts may inhibit plaque development without disrupting homeostasis of the oral cavity. [42] Thus, guava an excellent antibacterial and antiplaque agent may be a good adjunct to the mainstream periodontal treatment.

Guava as an anti-inflammatory agent

Guava has been known for its anti-inflammatory action. [25],[43] The anti-inflammatory action of guava is in its ability to inhibit prostaglandin, kinin and histamine. [44] Aa is an important periodontal pathogen and is associated with aggressive periodontitis. Guava extract completely neutralized the cytolytic, proinflammatory response of human leukocytes induced by Aa leukotoxin and prevented the release and activation of Interleukin-1β (IL-1β). [45] C-reactive protein (CRP) is a positive acute phase protein [46] whose elevated levels have been demonstrated in periodontitis patients. [47] Guava leaf and stem extracts possess anti-inflammatory effects by decreasing CRP levels which plays a role as modulator of inflammatory response. [46] Guava has also been proven for its immunomodulatory activity on NF-kβ. [48] Fermented guava leaf extract is involved in the inhibition of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). It also inhibited lipopolysaccharide induced NF-kβ activation. [49] Blocking NF-kβ is a potential strategy for preventing inflammatory bone resorption in treating periodontal disease. [50] Guava due to its anti-inflammatory action, ability to inhibit iNOS, COX-2, NF-kβ could be a valuable agent in treating periodontal disease.

Guava as an antioxidant agent

Excessive free radical generation by neutrophils can be stimulated by bacteria associated with periodontal disease leading to damage of tissues. [51] The disequilibrium between oxidative stress and antioxidant activity will lead to periodontal tissue destruction. [52] Decreased antioxidant activities of crevicular fluid and saliva are associated with development of periodontal disease. [53],[54],[55] Periodontitis patients may be predisposed to oxidative stress by possessing reduced glutathione (GSH) buffering capacity, that may be protected by improving overall antioxidant micronutrient intake like vitamin C. [56] Antioxidant rich diets are said to inhibit periodontal disease and progression. [57],[58],[59],[60] Antioxidant micronutrients are important not only for limiting oxidative and tissue damage but also in preventing increased cytokine production. [61] Guava is an excellent antioxidant and a good source of vitamin C. Guava leaf extracts and essential oil from the stem, bark have the ability to scavenge free hydrogen peroxide, superoxide anion radical and inhibit the formation of hydroxyl radical. [62],[63],[64],[65] The antioxidant action can be attributed to quercetin, carotenoids, vitamin C, polyphenols present in guava. [57],[66],[67] Thus, guava could satisfy as an antioxidant based approach to periodontal therapy.

Guava as a wound healer

The gingival, periodontal ligament fibers are composed of collagen. Fibroblasts are the principal cell type present in the connective tissue of periodontium. Vitamin C is essential to maintain the overall integrity of the periodontium. Guava contains high levels of vitamin C (ascorbic acid). [68] Ascorbic acid can modulate the expression of procollagen gene leading to collagen formation, altering the fibroblast differentiation through its effects on extracellular matrix. [69] Vitamin C supports immune functions, maintains structural and functional integrity of epithelial tissues and physiological or metabolic parameters relevant to periodontal health. [70] Vitamin C along with bioflavonoids speed up the healing process. [5] The decoction of root bark is recommended as a mouthwash for swollen gums and decoction of leaves as an effective gargle for swollen, bleeding gums. [16] Guava extracts may contribute toward hastening the tissue healing process. [71]

Safety

Guava has been used for centuries in the folklore medicine without any adverse effects. Toxicity is usually seen when phytochemicals are ingested in excessive amounts. However, treatment of gingival and periodontal disease would not require such toxic levels. [72] There is limited information available about the quality, safety and efficacy of herbal products used in dentistry. A possibility exists for adverse interactions between phytochemicals and conventional drugs, hence caution should be exercised when using them. [73]


   Conclusion Top


This review attempts to shed light on the therapeutic potential of guava as an adjunct in treating periodontal disease. As an excellent antiplaque, antimicrobial, anti-inflammatory, antioxidant agent guava hopefully will be considered in the future for more clinical evaluations and possible applications as an adjunct to conventional periodontal therapy. Nevertheless, we should emphasize the importance of experimental and clinical studies with emphasis on bioavailability of compounds, effective and safe doses to be used. Our efforts in exploring and valuing newer phytotherapeutics in the treatment of periodontal disease should be maintained.

 
   References Top

1.Chaturvedi TP. Uses of turmeric in dentistry: An update. Indian J Dent Res 2009;20:107-9.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Powell RN. The relationship of forming and mature dental plaque to the tooth surface. J Dent Res 1965;44:1171-5.  Back to cited text no. 2
    
3.Somu CA, Ravindra S, Ajith S, Ahamed MG. Efficacy of a herbal extract gel in the treatment of gingivitis: A clinical study. J Ayurveda Integr Med 2012;3:85-90.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.Kornman KS. Mapping the pathogenesis of periodontitis: A new look. J Periodontol 2008;79:1560-8.  Back to cited text no. 4
[PUBMED]    
5.Kumar P, Ansari SH, Ali J. Herbal remedies for the treatment of periodontal disease: A patent review. Recent Pat Drug Deliv Formul 2009;3:221-8.  Back to cited text no. 5
    
6.Alviano DS, Alviano CS. Plant extracts: Search for new alternatives to treat microbial diseases. Curr Pharm Biotechnol 2009;10:106-21.  Back to cited text no. 6
    
7.Groppo FC, Bergamaschi Cde C, Cogo K, Franz-Montan M, Motta RH, de Andrade ED. Use of phytotherapy in dentistry. Phytother Res 2008;22:993-8.  Back to cited text no. 7
    
8.Maxwell SR. Prospects for the use of antioxidant therapies. Drugs 1995;49:345-61.  Back to cited text no. 8
[PUBMED]    
9.Joseph B, Priya RM. Phytochemical and biopharmaceutical aspects of Psidium guajava0 (L.) essential oil: A review. Res J Med Plant 2011;5:432-42.  Back to cited text no. 9
    
10.Esimone CO, Nworu CS, Ekong US, Iroha IR, Okolin CS. A case for the use of herbal extracts in oral hygiene: the efficacy of Psidium guajava-based mouthwash formulations. Res J Appl Sci 2007;2:1143-7.  Back to cited text no. 10
    
11.Kumar A. Importance for life 'Psidium guajava'. Int J Res Pharm Biomed Sci 2012;3:137-3.  Back to cited text no. 11
    
12.Sanda KA, Grema HA, Geidam YA, Bukar-Kolo YM. Pharmacological aspects of Psidium guajava: An update. Int J Pharmacol 2011;7:316-24.  Back to cited text no. 12
    
13.Gupta GK, Chahal J, Arora D. Psidium guajava Linn.: Current research and future prospects. J Pharm Res 2011;4:42-6.  Back to cited text no. 13
    
14.Rishika D, Sharma R. An update of pharmacological activity of Psidium guajava in the management of various disorders. Int J Pharm Sci Res 2012;3:3577-84.  Back to cited text no. 14
    
15.Barbalho SM, Farinazzi-Machado FM, de Alvares Goulart R, Brunnati AC, Ottoboni AM. Psidium guajava0 (Guava): A plant of multipurpose medicinal plants. Med Aromat Plants 2012;1:104.  Back to cited text no. 15
    
16.Mittal P, Gupta V, Kaur G, Garg AK, Singh A. Phytochemistry and pharmacological activities of Psidium guajava: A review. Int J Pharm Sci Res 2010;1:9-19.  Back to cited text no. 16
    
17.Kamath JV, Rahul N, Ashok Kumar CK, Lakshmi SM. Psidium guajava L.: A review. Int J Green Pharm 2008;2:9-12.  Back to cited text no. 17
  Medknow Journal  
18.Joseph B, Priya M. Review on nutritional, medicinal, and pharmacological properties of guava (Psidium Guajava Linn.). Int J Pharma Bio Sci 2011;2:53-69.  Back to cited text no. 18
    
19.Ishikawa I. Host responses in periodontal diseases: A preview. Periodontol 2000 2007;43:9-13.  Back to cited text no. 19
    
20.Bansal S, Rastogi S, Bajpai M. Mechanical, chemical and herbal aspects of periodontitis: a review. Int J Pharm Sci Res 2012;3:1260-7.  Back to cited text no. 20
    
21.Fathilah AR. Piper betle L. and Psidium guajava L. in oral health maintenance. J Med Plant Res 2011;5:156-63.  Back to cited text no. 21
    
22.Prabu GR, Gnanamani A, Sadulla S. Guaijaverin: A plant flavonoid as potential antiplaque agent against Streptococcus mutans. J Appl Microbiol 2006;101:487-95.  Back to cited text no. 22
    
23.Ushimaru PI, Silva MT, Di Stasi LC, Barbosa L, Fernandes A Jr. Antibacterial activity of medicinal plant extracts. Braz J Microbiol 2007;38:717-9.  Back to cited text no. 23
    
24.Joseph B, Priya RM, Helen PA, Sujatha S. Bio-active compounds in essential oil and its effects of antimicrobial, cytotoxic activity from the Psidium Guajava (L.) leaf. J Adv Biotechnol 2010;9:10-4.  Back to cited text no. 24
    
25.Gashe F, Belete A, Gebre-Mariam T. Evaluation of antimicrobial and anti-inflammatory activities and formulation studies on the leaf extracts of Psidium guajava L. Ethiop Pharm J 2010;28:131-42.  Back to cited text no. 25
    
26.Adeyemi OS, Akanji MA, Oguntoye SA. Ethanolic leaf extract of Psidium guajava: Phyto-chemical and trypanocidal activity in rats infected with Trypanosoma brucei. J Med Plants Res 2009;3:420-3.  Back to cited text no. 26
    
27.Arima H, Danno G. Isolation of antimicrobial compounds from guava (Psidium guajava L.) and their structural elucidation. Biosci Biotechnol Biochem 2002;66:1727-30.  Back to cited text no. 27
    
28.Metwally AM, Omar AA, Harraz FM, El Sohafy SM. Phytochemical investigation and antimicrobial activity of Psidium guajava L. leaves. Pharmacogn Mag 2010;6:212-8.  Back to cited text no. 28
    
29.Tona L, Kambu K, Ntondele D, Cimanga K, Luki N. Antimicrobial activity of tannins. Fitoterapia 1994;65:276-8.  Back to cited text no. 29
    
30.Shu Y, Liu Y, Li L, Feng J, Lou B, Zhou X, et0 al. Antibacterial activity of quercetin on oral infectious pathogens. Afr J Microbiol Res 2011;5:5358-61.  Back to cited text no. 30
    
31.Geoghegan F, Wong RW, Rabie AB. Inhibitory effect of quercetin on periodontal pathogens in vitro. Phytother Res 2010;24:817-20.  Back to cited text no. 31
    
32.Abdelrahim SI, Almagboul AZ, Omer ME, Elegami A. Antimicrobial activity of Psidium guajava L. Fitoterapia 2002;73:713-5.  Back to cited text no. 32
    
33.Limsong J, Benjavongkulchai E, Kuvatanasuchati J. Inhibitory effect of some herbal extracts on adherence of Streptococcus mutans. J Ethnopharmacol 2004;92:281-9.  Back to cited text no. 33
    
34.Brötz-Oesterhelt H, Beyer D, Kroll HP, Endermann R, Ladel C, Schroeder W, et al. Dysregulation of bacterial proteolytic machinery by a new class of antibiotics. Nat Med 2005;11:1082-7.  Back to cited text no. 34
    
35.Fathilah AR, Rahim ZH, Othman Y, Yusoff M. Bacteriostatic effect of Piper betle and Psidium guajava extracts on dental plaque bacteria. Pak J Biol Sci 2009;12:518-21.  Back to cited text no. 35
    
36.Nordini Hasnor WI, Fathilah AR, Rahim ZH. Plant extracts of Psidium guajava, Mangifera and Mentha sp. inhibit the growth of the population of single-species oral biofilm. Altern Integr Med 2013;2:102.  Back to cited text no. 36
    
37.Kraivaphan V, Boonyamanound L, Amornchat C, Trirantana T, Kraivaphan P. The effect of a mouthrinse containing Psidium guajava leaf extract on gingivitis. J Dent Assoc Thai 1991;41:323-8.  Back to cited text no. 37
    
38.Fathilah AR, Yusoff M, Rahim ZH. The effect of Psidium guajava and Piper betle extracts on the morphology of dental plaque bacteria. Pak J Med Sci 2009;25:928-33.  Back to cited text no. 38
    
39.Razak FA, Rahim ZH. The anti-adherence effect of Piper betle and Psidium guajava extracts on the adhesion of early settlers in dental plaque to saliva-coated glass surfaces. J Oral Sci 2003;45:201-6.  Back to cited text no. 39
    
40.Razak FA, Othman RY, Rahim ZH. The effect of Piper betle and Psidium guajava extracts on the cell-surface hydrophobicity of selected early settlers of dental plaque. J Oral Sci 2006;48:71-5.  Back to cited text no. 40
    
41.Fathilah AR, Sujata R, Norhanom AW, Adenan MI. Antiproliferative activity of aqueous extract of Piper betle L. and Psidium guajava L. on KB and HeLa cell lines. J Med Plant Res 2010;4:987-90.  Back to cited text no. 41
    
42.John NR, Gala VC, Sawant CS. Inhibitory effects of plant extracts on multi-species dental biofilm formation in-vitro. Int J Pharm Bio Sci 2013;4:487-95.  Back to cited text no. 42
    
43.Weni LH, Widayanti. Anti-inflammatory activity of the extract of guava leaves (Psidium guajava L.) in the rat (Rattus norvegicus L.). Indonesian J Cancer Chemoprevention 2011;2:169-72.  Back to cited text no. 43
    
44.Kavimani S, Ilango R, Vertichelvan T. Anti-inflammatory activity of volatile oil of Psidium guajava. Anc Sci Life 1998;17:300-4.  Back to cited text no. 44
    
45.Kwamin F, Gref R, Haubek D, Johansson A. Interactions of extracts from selected chewing stick sources with Aggregatibacter actinomycetemcomitans. BMC Res Notes 2012;5:203.  Back to cited text no. 45
    
46.Joyce OO, Chinwe ND, Kwaku JP, Tabot PD. Psidium guajava's effect on acute phase protein levels during acute inflammation. Am J PharmTech Res 2012;2:424-33.  Back to cited text no. 46
    
47.Yamazaki K, Honda T, Oda T, Ueki-Maruyama K, Nakajima T, Yoshie H, et al. Effect of periodontal treatment on the C-reactive protein and proinflammatory cytokine levels in Japanese periodontitis patients. J Periodontal Res 2005;40:53-8.  Back to cited text no. 47
    
48.Kaileh M, Vanden Berghe W, Boone E, Essawi T, Haegeman G. Screening of indigenous Palestinian medicinal plants for potential anti-inflammatory and cytotoxic activity. J Ethnopharmacol 2007;113:510-6.  Back to cited text no. 48
    
49.Choi SY, Hwang JH, Park SY, Jin YJ, Ko HC, Moon SW, et al. Fermented guava leaf extract inhibits LPS-induced COX-2 and iNOS expression in Mouse macrophage cells by inhibition of transcription factor NF-kB. Phytother Res 2008;22:1030-4.  Back to cited text no. 49
    
50.Koide M, Kinugawa S, Takahashi N, Udagawa N. Osteoclastic bone resorption induced by innate immune responses. Periodontol 2000 2010;54:235-46.  Back to cited text no. 50
    
51.Asman B, Bergström K. Expression of Fc-gamma-RIII and fibronectin in peripheral polymorphonuclear neutrophils with increased response to Fc stimulation in patients with juvenile periodontitis. Arch Oral Biol 1992;37:991-5.  Back to cited text no. 51
    
52.Petti S, Scully C. Polyphenols, oral health and disease: A review. J Dent 2009;37:413-23.  Back to cited text no. 52
    
53.Diab-Ladki R, Pellat B, Chahine R. Decrease in the total antioxidant activity of saliva in patients with periodontal diseases. Clin Oral Investig 2003;7:103-7.  Back to cited text no. 53
    
54.Sculley DV, Langley-Evans SC. Periodontal disease is associated with lower antioxidant capacity in whole saliva and evidence of increased protein oxidation. Clin Sci (Lond) 2003;105:167-72.  Back to cited text no. 54
    
55.Pavlica Z, Petelin M, Nemec A, Erzen D, Skaleric U. Measurement of total antioxidant capacity in gingival crevicular fluid and serum in dogs with periodontal disease. Am J Vet Res 2004;65:1584-8.  Back to cited text no. 55
    
56.Van der Velden U, Kuzmanova D, Chapple IL. Micronutritional approaches to periodontal therapy. J Clin Periodontol 2011;38 Suppl 11:142-58.  Back to cited text no. 56
    
57.Battino M, Bullon P, Wilson M, Newman H. Oxidative injury and inflammatory periodontal diseases: The challenge of anti-oxidants to free radicals and reactive oxygen species. Crit Rev Oral Biol Med 1999;10:458-76.  Back to cited text no. 57
    
58.Sculley DV, Langley-Evans SC. Salivary antioxidants and periodontal disease status. Proc Nutr Soc 2002;61:137-43.  Back to cited text no. 58
    
59.Ritchie CS, Kinane DF. Nutrition, inflammation, and periodontal disease. Nutrition 2003;19:475-6.  Back to cited text no. 59
    
60.Figuero E, Soory M, Cerero R, Bascones A. Oxidant/antioxidant interactions of nicotine, coenzyme Q10, pycnogenol and phytoestrogens in oral periosteal fibroblasts and MG63 osteoblasts. Steroids 2006;71:1062-72.  Back to cited text no. 60
    
61.Carnelio S, Khan SA, Rodrigues G. Definite, probable or dubious: Antioxidants trilogy in clinical dentistry. Br Dent J 2008;204:29-32.  Back to cited text no. 61
    
62.Fasola TR, Oloyede GK, Aponjolosun BS. Chemical composition, toxicity and antioxidant activities of essential oils of stem bark of Nigerian species of Guava (Psidium guajava Linn.). EXCLI J 2011;10:34-43.  Back to cited text no. 62
    
63.Vyas N, Tailang M, Gavatia NP, Gupta BK. Antioxidant potential of Psidium guajava Linn. Int J PharmTech Res 2010;2:417-9.  Back to cited text no. 63
    
64.Ogunlana OE, Ogunlana OO. In vitro assessment of the free radical scavenging activity of Psidium guajava. Res J Agric Biol Sci 2008;4:666-71.  Back to cited text no. 64
    
65.Chen HY, Yeh GC. Antioxidant activity and free radical-scavenging capacity of extracts from guava (Psidium guajava L.) leaves. Food Chem 2007;101:686-94.  Back to cited text no. 65
    
66.Qian H, Nihorimbere V. Antioxidant power of phytochemicals from Psidium guajava leaf. J Zhejiang Univ Sci 2004;5:676-83.  Back to cited text no. 66
    
67.Dakappa SS, Adhikari R, Timilsina SS, Sunita S. A review on the medicinal plant Psidium guajava Linn. (Myrtaceae). J Drug Deliv Ther 2013;3:162-8.  Back to cited text no. 67
    
68.Oguntibeju OO. The biochemical, physiological and therapeutic roles of ascorbic acid. Afr J Biotechnol 2008;7:4700-5.  Back to cited text no. 68
    
69.Brown LA, Jones DP. The biology of ascorbic acid. In: Cadenas E, Packer L, editors. Handbook of Antioxidants. New York: Marcel Dekker, Inc.; 1996 p. 117-54.  Back to cited text no. 69
    
70.Chapple IL. Role of free radicals and antioxidants in the pathogenesis of the inflammatory periodontal diseases. Clin Mol Pathol 1996;49:M247-55.  Back to cited text no. 70
[PUBMED]    
71.Fernandes KP, Bussadori SK, Marques MM, Wadt NS, Bach E, Martins MD. Healing and cytotoxic effects of Psidium guajava (Myrtaceae) leaf extracts. Braz J Oral Sci 2010;9:449-54.  Back to cited text no. 71
    
72.Rao NJ, Subash KR, Kumar KS. Role of phytotherapy in gingivitis: A review. Int J Pharmacol 2012;1:1-5.  Back to cited text no. 72
    
73.Devi BP, Ramasubramaniaraja R. Dental caries and medicinal plants-An overview. J Pharm Res 2009;2:1669-75.  Back to cited text no. 73
    



This article has been cited by
1 Effects of heat stress on some reproductive parameters of male cavie (Cavia porcellus) and mitigation strategies using guava (Psidium guajava) leaves essential oil
Ngoula Ferdinand,Guemdjo Tekam Maryvonne,Kenfack Augustave,Tadondjou Tchingo Cyrille DæAlex,Nouboudem Sandrine,Ngoumtsop Herman,Tsafack Borice,Teguia Alexis,Kamtchouing Pierre,Marco Galeotti,Tchoumboue Joseph
Journal of Thermal Biology. 2017;
[Pubmed] | [DOI]
2 Trombinol, a bioactive fraction of Psidium guajava, stimulates thrombopoietin expression in HepG2 cells
Guntur Berlian,Olivia Mayasari Tandrasasmita,Raymond Rubianto Tjandrawinata
Asian Pacific Journal of Tropical Biomedicine. 2017;
[Pubmed] | [DOI]
3 Health Effects of Psidium guajava L. Leaves: An Overview of the Last Decade
Elixabet Díaz-de-Cerio,Vito Verardo,Ana Gómez-Caravaca,Alberto Fernández-Gutiérrez,Antonio Segura-Carretero
International Journal of Molecular Sciences. 2017; 18(4): 897
[Pubmed] | [DOI]
4 Psidium guajava L., from ethnobiology to scientific evaluation: Elucidating bioactivity against pathogenic microorganisms
Maria Flaviana B. Morais-Braga,Joara Nalyda P. Carneiro,Antonio Júdson T. Machado,Antonia Thassya L. dos Santos,Débora L. Sales,Luciene F. Lima,Fernando G. Figueredo,Henrique Douglas M. Coutinho
Journal of Ethnopharmacology. 2016; 194: 1140
[Pubmed] | [DOI]
5 A Comparative Evaluation of Microwave and Conventional Soxhlet Extraction Methods for the Antioxidant, Hypoglycemic and Hypolipidemic Potentials of Jordanian Psidium guajava Raw Fruit Peel Extracts
R. Issa,S. Khater,M. Abu- Samak
Research Journal of Phytochemistry. 2016; 11(1): 20
[Pubmed] | [DOI]
6 Phytochemical Investigation and Antimicrobial Activities of Jordanian Psidium guajava Raw Fruit Peel Extract using Soxhlet and Microwave Extraction Methods
Reem A. Issa,,Wamidh H. Talib,Maha Habash
Research Journal of Medicinal Plants. 2016; 10(8): 443
[Pubmed] | [DOI]



 

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

 
  In this article
    Abstract
   Introduction
    Therapeutic appl...
   Conclusion
    References

 Article Access Statistics
    Viewed4236    
    Printed73    
    Emailed4    
    PDF Downloaded35    
    Comments [Add]    
    Cited by others 6    

Recommend this journal