|Year : 2015 | Volume
| Issue : 17 | Page : 41-44
Azadirachta indica : A herbal panacea in dentistry - An update
T Lakshmi1, Vidya Krishnan2, R Rajendran3, N Madhusudhanan4
1 Department of Pharmacology, Saveetha Dental College and Hospital, Velappanchavadi, Chennai, India
2 Department of Oral Medicine, SRM Dental College, Kattankulathur, Tamil Nadu, India
3 Green Chem Herbal Extracts and Formulations, Bangalore, Karnataka, India
4 Department of Pharmacology, Sathyabama Dental College, Chennai, Tamil Nadu, India
|Date of Submission||26-Aug-2013|
|Date of Acceptance||29-Aug-2013|
|Date of Web Publication||05-May-2015|
Dr. T Lakshmi
Department of Pharmacology, Saveetha Dental College and Hospital, Velappanchavadi, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Azadirachta indica commonly known as Neem, is an evergreen tree. Since time immemorial it has been used by Indian people for treatment of various diseases due to its medicinal properties. It possesses anti-bacterial, anti-cariogenic, anti-helminthic, anti-diabetic, anti-oxidant, astringent, anti-viral, cytotoxic, and anti-inflammatory activity. Nimbidin, Azadirachtin and nimbinin are active compounds present in Neem which are responsible for antibacterial activity. Neem bark is used as an active ingredient in a number of toothpastes and toothpowders. Neem bark has anti-bacterial properties, it is quite useful in dentistry for curing gingival problems and maintaining oral health in a natural way. Neem twigs are used as oral deodorant, toothache reliever and for cleaning of teeth. The objective of this article is to focus on the various aspects of Azadirachta indica in dentistry in order to provide a tool for future research.
Keywords: Azadirachta indica , anti-bacterial, anti-cariogenic, oral health
|How to cite this article:|
Lakshmi T, Krishnan V, Rajendran R, Madhusudhanan N. Azadirachta indica : A herbal panacea in dentistry - An update. Phcog Rev 2015;9:41-4
|How to cite this URL:|
Lakshmi T, Krishnan V, Rajendran R, Madhusudhanan N. Azadirachta indica : A herbal panacea in dentistry - An update. Phcog Rev [serial online] 2015 [cited 2019 Apr 23];9:41-4. Available from: http://www.phcogrev.com/text.asp?2015/9/17/41/156337
| Introduction|| |
Neem has been extensively used in Ayurveda, Unani and Homoeopathic medicine and has become a wonder tree of modern medicine.  It has been used traditionally for the treatment of inflammation, infections, fever, skin diseases and dental problems.
It is effective in several epidermal dysfunctions such as acne, psoriasis, eczema. Neem leaves have been reported to also possess antihyperglycemic,  immunomodulatory,  anti-inflammatory,  antimalarial,  antioxidant,  antiviral,  antimutagenic  and anticarcinogenic  properties. Neem also exhibits antibacterial,  antifungal,  hepatoprotective,  anti-ulcer,  anti-fertility and anti-nociceptive activity. ,
Neem twigs are used as oral deodorant, toothache reliever and for cleaning of teeth. Neem bark possesses antibacterial and deodorant activity. The phytochemical constituents present in neem are nimbidin, nimbin, nimbolide, Azadirachtin, gallic acid, epicatechin, catechin, and margolone. All these exhibit potent antibacterial activity. The chief active constituent of neem is azadirachtin, which is an effective antimicrobial agent. , Neem has also been traditionally used as a skin moisturizer. 
Objective of the literature review
Azadirachta indica is an evergreen tree having potential medicinal values. It has been found to be active against many dreadful disorders like hepatitis, viral infections, malaria and cancer. It is also effective against periodontal pathogens, and oral acidogenic bacteria responsible for dental caries and dental plaque. The aim of the present review is to focus on the dental aspects of various parts of Neem extract with their chemical constituents and biological activities. Several traditional uses of the miraculous tree have also been briefly discussed. This information may give a bird's eye view for the dentist, and consequently this database might play a major role in future research in the field of dentistry [Figure 1].
Therapeutic role of Azadirachta indica in dentistry
Nimbidin, a major active principle isolated from seed kernels of A. indica exhibits several biological actions. From nimbidin other active constituents like nimbin, nimbinin, nimbidinin, nimbolide and nimbidic acid have been isolated which are responsible for its biological activities. 
Neem dental care products contains Neem leaf or bark extract. Neem leaf is rich in antioxidants and helps to boost the immune response in gum and tissues of the mouth. , Neem offers a good remedy for curing mouth ulcers, tooth decay and acts as a pain reliever in toothache problems.
Dental applications of Neem
Neem is a natural antibacterial agent. Various scientific studies have revealed its antibacterial activity.  The antimicrobial effects of Neem have been reported against S. mutans and S. faecalis.  Ethanolic extract of Neem leaves and sticks and bark exhibited significant antibacterial activity. , Dried chewing sticks of Neem showed maximum antibacterial activity against S. mutans compared to other dental caries-causing organisms, S. salivarius, S. mitis, and S. sanguis. 
Ethanolic and aqueous extract of Neem leaf showed significant anti-candidial effect against C. albicans.  A clinical study demonstrated the effects of the leaf aqueous extract from Azadirachta indica (Neem) on adhesion, cell surface hydrophobicity and biofilm formation, which may affect the colonization by Candida albicans. The results suggest that Neem leaves have a potential anti-adhesive effect on the sample studied in vitro. 
Mango and Neem extract showed antimicrobial activity against S. mutans, S. salivarius, S. sanguis and S. mitis. A combination of chewing sticks is found to be beneficial in eradicating the dental caries-causing organism.  Chloroform extract of Neem leaf inhibited Streptococcus mutans and Streptococcus salivarius and provides an aid for treating dental caries.  Antimicrobial activity of commercially available Himalaya herbal dental cream containing neem and fluoride-containing cheerio gel toothpaste has been assessed in school children. The study reported both the toothpastes showed a good antimicrobial effect on caries producing salivary streptococcus mutans.  The toothpaste containing Neem as well as fluoridated toothpaste were equally efficacious against caries-producing bacteria. Acetone extract from the bark of Neem is bactericidal against S. sobrinus hence indicates its anti-cariogenic activity. 
Aqueous extract of Neem stick and the gallotannin-enriched extract from Melaphis chinensis inhibited insoluble glucan synthesis and results in bacterial aggregation. It reduces the ability of streptococci to colonize tooth surfaces.  Neem oil shows significant antibacterial activity and has been suggested for use in treating dental plaque.  Mucoadhesive dental gel containing Azadirachta indica is found to be beneficial in reducing the plaque index and salivary bacterial count comparatively better than chlorhexidine gluconate mouthwash. 
Efficacy of Neem extract against acidogenic oral bacteria in fixed orthodontic appliance patients
The primary acid-tolerant bacteria associated with dental plaque including Streptococcus mutans, Streptococcus oralis, Streptococcus sobrinus, Lactobacillus acidophilus, Streptococcus salivarius, Streptococcus mitis, Streptococcus sangui, Streptococcus intermedius, and Streptococcus anginosus that surround orthodontic appliances are a common problem in many patients undergoing orthodontic treatment. It has also been reported that presence of fixed orthodontic appliance greatly inhibits oral hygiene and creates new retentive areas for plaque and debris.
Ethanolic leaf extract of Azadirachta indica shows significant antibacterial activity against selected acidogenic oral bacteria causing dental plaque in fixed orthodontic appliance patients. The study conducted by us evaluated the anti-plaque activity of the extract against S. mutans, S. sanguis, and S. mitis. The extract did not inhibit L. acidophilus when tested. 
Efficacy against periodontal pathogens
Brushing with Neem toothpaste after every meal and using a mouthwash with Neem extract is recommended treatment for preventing gingivitis. In a study, Neem-based mouth rinse was given to patients for assessing anti-plaque and anti-gingivitis activity. The findings conclude that Neem mouth rinse is as effective as chlorhexidine in reducing periodontal indices. Neem stick is found to be effective as a toothbrush in reducing dental plaque and gingival inflammation. 
Studies indicate that leaf extract of A. indica-based mouth rinse is highly efficacious and that it may be used as an alternative therapy in the treatment of periodontal disease.  Gingivitis has been prevented or even reversed with regular use of Neem toothpaste and mouthwash. Shefali sharma conducted a study on Soluneem (a water-soluble formulation from the Neem seed kernel from Shefali sharma conducted a study on Soluneem (a water-soluble formulation from the Neem seed kernel from Azadirachta Indica containing Azadirachtin) as an antimicrobial agent and the effective concentration of Soluneem required to inhibit periodontopathic bacteria and to compare it with a known antiplaque agent chlorhexidine (0.2%) in vitro. Study revealed that soluneem extract did not show activity against the organisms (Bacteroids fragilis, B. distatonics, Prevotella corporis, Prevotella melagingogenica, Pepto streptococcus species) tested. 
Also Botelho et al., and Behl et al., in their experiments and trials concluded that Azadirachta indica is highly efficacious in the treatment of periodontal disease thus exhibiting its biocompatibility with human periodontal fibroblast. 
Neem as root canal irrigant
Sodium hypochlorite has been used as root canal irrigant for decades; it causes potential weakening of the tooth structure by decreasing the hardness and structural integrity of the dentin within the root canal. To overcome this disadvantage herbal drugs are used effectively to inhibit E. faecalis that causes root canal failure in patients undergoing endodontic treatment.
Aqueous and ethanolic extract of Neem leaf inhibits S. mutans and E. faecalis which cause root canal failure in endodontic procedure. Its antioxidant and antimicrobial properties makes it a potential agent for root canal irrigation as an alternative to sodium hypochlorite.  Literature suggested that the Neem (Azadirachta indica) leaf extract has significant antimicrobial effect against E. faecalis derived from infected root canal samples. The extract was found to be efficacious compared with 2% sodium hypochlorite.
Neem in dental care industry
Various parts of the Neem tree possess astringent and antiseptic activity. Leaf extracts have been widely used in both traditional and conventional times to manufacture toothpaste and mouthwash in the oral care dentistry. Its antibacterial properties due to the presence of nimbidin, Azadirachtin, and nimbinin help to remove many oral aerobic and anaerobic pathogens existing in the oral cavity.
Neem bark and leaf extract is most effectively used in preventing cavities and gum disease. Mouthwash containing Neem is a remedy for tooth decay, oral infections, prevents bleeding and sore gums. Twigs of Neem tree are used as chewing sticks by people all over India.
| Conclusion|| |
Regular brushing with Neem-containing toothpaste will reduce the deposition of plaque, prevents caries, and enhances the immune response for overall oral health. Frequent usage of mouthwash containing Neem extract will lessen gingival problems, and also treats halitosis.
In this modern, trendy world, we have done enough damage to nature. It is high time we start changing ways, to synchronize ourselves with nature, providing ample space for each other. Here we are trying to retrieve and learn the ancient Indian ways, which can still be infused into our fast-paced lives for a good effect, benefitting our future generations to come. This article hopes to lay a good solid base for further uses of one of nature's best gift-Neem in many more day-to-day functions. If education can be provided in dental and dental hygiene schools about the use of Neem-based and also herbal oral care products, it would help our dentists treat patients more holistically.
| References|| |
Athavale VB. Dentistry in Ayurveda [Danta-Shastra]. New Delhi: Chaukhamba Sanskrit Pratishthan; 1999.
Khosla P, Bhanwra S, Singh J, Seth S, Srivastava RK. A study of hypoglycaemic effects of Azadirachta indica
) in normaland alloxan diabetic rabbits. Indian J Physiol Pharmacol 2000;44:69-74.
van der Nat JM, Klerx JP, van Dijk H, de Silva KT, Labadie RP. Immunomodulatory activity of an aqueous extract of Azadirachta indica
stem bark. J Ethnopharmacol 1987;19:125-31.
Tidjani MA, Dupont C, Wepierre J. Antiinflammatory activity of Azadirachta indica.
Planta Med Phytother 1989;23:259-66.
Dhar R, Zhang K, Talwar GP, Garg S, Kumar NJ. Inhibition of the growth and development of asexual and sexual stages of drug-sensitive and resistant strains of the human malaria parasite Plasmodium falciparum by Neem
(Azadirachta indica) fractions. J Ethnopharmacol 1998;61:31-9.
Rao AD, Devi KN, Thyagaraju KJ. Ayurtox for body Detoxification. Enzyme Inhib 1998;14:85-6.
Rao AR, Sukumar S, Paramasivam TV, Kamalakshi S, Parashuraman AR, Shantha M. Study of antiviral activity of tender leaves of Margosa tre
azadericta) on vaccinia and variola virus: A preliminary report. Indian J Med Res 1969;57:495-502.
Balasenthil S, Arivazhagan S, Ramachandran CR, Ramachandran V, Nagini S. Chemopreventive potential of neem
) on 7, 12-dimethylbenz (a) anthracene (DMBA) induced hamster buccal pouch carcinogenesis. J Ethnopharmacol 1999;67:189-95.
Arivazhagan S, Balasenthil S, Nagini S. Modulatory effects of Garlic
leaf extracts on N-methyl-N′-nitro-N-nitrosoguanidine (MNNG)-induced oxidative stress in Wistar rats. Cell Biochem Funct 2000;18:17-21.
Baswa M, Rath CC, Dash SK, Mishra RK. Antibacterial activity of Karanj
) and Neem
) seed oil: A preliminary report. Microbios 2001;105:183-9.
Jacobson M. Pharmacological and toxicological effe
cts of Neem and Ch
on Warm blooded anim
als. Neem Newslett 1986;3:39-43.
Bhanwra S, Singh J, Khosla P. Effect of Azadirachta Indica (Neem)
leaf aqueous extract on paracetamol-induced liver damage in rats. Indian J Physiol Pharmacol 2000;44:64-8.
Bandyopadhyay U, Chatterjee R, Bandyopadhyay R. US Patent 5,730,986, 1998; corresponding to Indian Patent 1100/Del/95.
Saimbi CS. The efficacy of neem extract -Reported in Jeevaniya Health Care Magazine 1994. Available from: http://www.healthmantra.com/Hctrust/Art6.Shtml. [Accessed at 2013 Oct].
Bhanwara, S, Singh J, Khosla P. Antinociceptive activity of Azadirachta Indica (neem)
in rats. Indian J Physiol Pharmacol 2000;18:17-21.
Sharma P, Tomar L, Bachwani M, Bansal V, Review on Neem (Azadirechta indica
):Thousand Problem One Solution, Int Res J Pharm 2011;2:97-102.
Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of Neem
). Curr Sci 2002;82:1336-45.
Kapoor S, Saraf S. Assessment of viscoelasticity and hydration effect of herbal moisturizers using bioengineering techniques. Pharmacogn Mag 2010;6:298-304.
Subapriya R, Nagini S. Medicinal properties of neem leaves: A Review. Curr Med Chem Anticancer Agents 2005;5:149-6.
Nayak A, Ranganathan N, Sowmya GB, Kishore B, Kudalkar M. Evaluation of antibacterial and anticandidial efficacy of aqueous and alcoholic effect of neem (Azadirachta Indica
): An Invitro
study. Int J Res Ayurveda Pharm 2011;2:230-5.
Siswomihardjo W, Sunarintyas SB, Nishimura M, Hamada T. The difference of antibacterial effect of neem leaves and stick extract. Int Chin J Dent 2007;7:27-9.
Almas K. The antimicrobial effects of extracts of Azadirachta Indica
(Neem) and Salvadora Persica
(Arak) chewing sticks. Indian J Dent Res 1999;10:23-6.
Bohora A, Hegde V, Kokate S. Comparison of antibacterial efficacy of neem leaf extract and 2% sodium hypochlorite against E.Faecalis, C.Albicans
and mixed culture- An In Vitro
study. Endodontology 2010;22:8-12.
Chava VR, Manjunath SM, Rajanikanth AV, Sridevi N. The efficacy of neem extract on four microorganisms responsible for causing dental caries viz Streptococcus Mutans, Streptococcus Salivarius, Streptococcus Mitis
and Streptococcus Sanguis
: An In Vitro
study. J Contemp Dent Pract 2012;13:769-72.
Dhanya Kumar NM, Sidhu P. The antimicrobial activity of Azardirachta Indica, Glycyrrhiza Glabra, Cinnamum Zeylanicum, Syzygium Aromaticum, Accacia Nilotica on Streptococcus Mutans And Enterococcus Faecalis-An In Vitro study. Endodontology. Available from: http://medind.nic.in/eaa/ t11/i1/eaat11i1p16.pdf. [Last accessed on 2013 Sep].
Polaquini SR, Svidzinski TI, Kemmelmeir C, Gasparetto A. Effect of aqueous extract from Neem on hydrophobicity, biofilm formation and adhesion in composite resin by Candida albicans. Arch Oral Biol 2006;51:482-90.
Prashant GM, Chandu GN, Murulikrishna KS, Shafiulla MD. The effect of mango and neem extract on four organisms causing dental caries: Streptococcus Mutans
, Streptococcus Salivavius, Streptococcus Mitis
, Andstreptococcus Sanguis
: An In Vitro
study. Indian J Dent Res 2007;18:148-51.
Packia Lekshmi NCJ, Sowmia N, Viveka S, Raja Brindha J, Jeeva S. The inhibiting effect of Azadirachta indica
against dental pathogens. Asian J Plant Sci Res 2012;2:6-10.
Patil S, Venkataraghavan K, Anantharaj A, Patil S. Comparison of two commercially available toothpastes on the salivary Streptococcus Mutans
count in urban preschool children -An In Vivo
study. International Dentistry SA 2010;12:72-82.
Bhuiyan MM, Nishimura M, Matsumura S, Shimonu T. Antibacterial effects of crude Azadirachta Indica
neem bark extract on Streptococcus Sobrinus
. Pediatr Dent J 1997;7:61-4.
Wolinsky Le, Mania S, Nachnani S, Ling S. The inhibiting effect of aqueous Azadirachta Indica (Neem)
extract upon bacterial properties influencing In Vitro
plaque formation. J Dent Res 1996;75:816-22.
Elavarasu S, Abinaya P, Elanchezhiyan S, Thangakumaran, Vennila K, Naziya KB. Evaluation of anti-plaque microbial activity of Azadirachta Indica
(Neem Oil) In Vitro
: A pilot study. J Pharm Bioallied Sci 2012;4:S394-6.
Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta Indica
leaf extract gel-A 6-week clinical study. J Ethnopharmacol 2004;90:99-103.
Lakshmi T, Aravind Kumar S. Antibacterial evaluation of Azadirachta Indica
ethanolic leaf extract against selected acidogenic oral bacteria causing dental plaque in fixed orthodontic appliance patients - An Invitro
study. J Bot Res 2012;1:30-40.
Bhambal A, Kothari AS, Saxena S, Jain M. Comparative effect of Neem
stick And Toothbrus
h on plaque removal and gingival health - A clinical trial. J Adv Oral Res 2011;2:51-6.
Chatterjee A, Saluja M, Singh N, Kandwal A. To evaluate the antigingivitis and antipalque effect of an Azadirachta Indica
) mouthrinse on plaque induced gingivitis: A double-blind, randomized, controlled trial. J Indian Soc Periodontol 2011;15:398-401.
Sharma S, Suchetha A, Vijayendra R, Bharwani AG. An In Vitro
microbiological study evaluating the efficacy of soluneem (A water soluble Neem
formulation from Azadirachta Indica
) against periodontopathic microorganisms. J Oral Health Commun Dent 2012;6:4-9.
Botelho MA, Santos RA, Martins JG, Carvalho CO, Paz MC, Azenha C, et al
. Efficacy of a mouthrinse based on leaves of the neem tree (Azadirachta indica
) in the treatment of patients with chronic gingivitis: A doubleblind, randomized, controlled trial. J Med Plant Res 2008;2:341-6.
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