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Mar-Aprl 2015

ALOE VERA: THE MIRACLE MEDICINE

MEDIC MENTOR

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ABSTRACT Naturopathy is picking up as the treatment option of choice in the western countries. Due to minimal side effects, highly effective treatment outcomes and increasing patient awareness, the naturopathy treatment is in vogue. One such agent is the Aloe Vera plant. A native of North Africa, it requires least amount of rainfall for its survival. The medicinal properties of this plant are incomparable and it is gradually sighting its use in dentistry also. The aim of this article is to highlight the current uses in medicine and dentistry and its potential uses in dentistry.

INTRODUCTION Aloe vera is a stemless or very short-stemmed succulent plant growing to 60–100 cm height and spreads by offsets. The leaves are thick and fleshy, green to greygreen, with some varieties showing white flecks on the upper and lower stem surfaces.1 The margins of the leaf are serrated and has small white teeth. The flowers are produced in summer on the spike, each flower being pendulous, with a yellow tubular corolla.2,3

Dr. Puneeta Duggal

Aloe, First Aid Plant.3,4 The species vera means “true” or “genuine”.4 It is also known as the “Lily of the Desert” as it most commonly grows in arid (tropical environment).

Aloe Vera plant is remarkable because it is one of the most durable plants known to mankind. The plant has a miraculous ability to self-seal, and contains all the nutrients within its leaf in order to survive. When the leaf is damaged, the plant seals the wound and regenerates in a short time. Also, it thrives in an arid environment and can withstand extreme heat and physical abuse.

This plant is also known as the ‘Medicine Plant’. It can be easily grown at home and used in common at home remedies.

The Aloe vera leaf consists of 2 different parts: central mucilaginous part and peripheral bundle sheath cells.

The parenchymal tissue makes up the inner portion of the aloe leaves and produces a clear, thin tasteless jelly-like material called Aloe vera gel.4 In recent years, various cosmetic and medical products are made from the mucilaginous tissue present in the center of the Aloe vera leaf in the form of Aloe vera gel. The problem with Aloe is maintaining its therapeutic function because it is unstable and oxidises rapidly like any cut leaf or fruit, therefore the Aloe Vera gel has to be Stabalized using anti-oxidants (that is generally done in the commercial products).

HISTORICAL ASPECT Aloe Vera has a prestigious history, as the medicinal uses of the Aloe Vera plant traces back to the PreChristian times. It also sights its reference in the Bible.

Aloe Vera plant known as Aloe Barbadensis Miller and is commonly known as Babosa belongs to family Liliaceace. The gel and mucilage from this plant is used as a natural remedy for the treatment of various systemic and oral conditions.

The other common names of this plant are Chinese Aloe, Indian Aloe, True Aloe, Barbados Aloe, Burn

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The earliest record of Aloe Vera was seen in 2100 BC in Sumerian era. Aloe Vera has been found described in writings in many different cultures and as far back as the Greek, Egyptians, and Roman eras.5 Ancient Hebrew tribes used to uproot their aloe plants when they migrated, replant them upon arriving at their destination, and the plants would flourish again.

Mar-Aprl 2015 A resurgence of interest in the healing capabilities of the Aloe Vera plant developed in the 1950’s when Dr. Collins and Dr. Wright worked with patients suffering radiation burns. They saw a phenomenal improvement in these patients on application of the Aloe Vera gel.5,6 Soon in 1959 the FDA concluded from studies conducted by the Atomic Energy Commission at the radiation burn center at Los Alamos Laboratories in New Mexico that Aloe gel had a healing effect on skin tissue and hence gave its approval to the usage of Aloe Vera gel as a medicinal agent.13

This gel also contains various glycoproteins whose molecular weights ranged from 15,000–77,000 Daltons. 10 MECHANISM OF ACTION Aloe vera has strong anti inflammatory action as it inhibits the cyclo-oxygenase pathway and reduces prostaglandin E2 production from arachidonic acid.9 It is particularly known for its penetrating capacity to reach deeper layers of the dermis when applied topically.

It has strong antiseptic, bactericidal, fungicidal and virucidal properties. It promotes cell growth. It is neurologically calming to the nerves and also acts as a detoxifying agent. 11

COMPOSITION The composition of Aloe Vera gel is complex and it has around 75 active ingredients including vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids.7,8 It contains vitamins like B1, B2, B6, and C; niacinamide and choline and several inorganic ingredients and trace elements like aluminum, boron, barium, calcium, iron, magnesium, sodium, phosphorous, silicon, and strontium. 11 It also contains enzymes such as acid phosphatase, alkaline phosphatase, amylase, lactic dehydrogenase, and lipase; and numerous organic compounds such as aloin, barbaloin, and emodin.9

The second reason for its limited usage was due to the inadequacy of Aloe Vera gel as a commercially viable product, because of it’s “perishability.” When a leaf is harvested, it is dissected to gain access to its gel.

Exposure to air causes Aloe Vera to oxidize, and its potency is only maintained for about 48 hours at room temperature. Beyond this time, the plant can become contaminated, which often led to disappointing results on the part of people who were unaware of the shelflife problem of the gel. but this property has now been taken care of, with the commercial stabilization process.

MEDIC MENTOR

WHY ALOE VERA DID NOT FIND ITS MEDICINAL USES EARLY? Although the plant is one of the most durable plants in the world, it is a succulent, and cannot survive extreme cold, damp, freezing climates. Therefore, knowledge of Aloe Vera did not spread into Northern Europe or Great Britain, where there are profound freezing winters.

In these areas of the world, familiarity with the plant and its uses is still limited.

Around 28 types of different monosaccharides and polysaccharides have been isolated from this plant leaves. The major types of polysaccharides have been described by Reynolds and Dweck. These consisted of glucomannans of various composition (long chains of glucose and mannose units hooked together). Some of which were acetylated; polymers of galactose and galacturonic acid also have been found in the gel.10 The presence of this acetylated glucomannans closely resembles the body fluids in composition, viscosity and rheological properties and this type of gel composition is rarely found in any other plant.

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Mar-Aprl 2015

MEDIC MENTOR

GENERAL USES Aloe Vera gel formula to be nontoxic, bactericidal, virucidal, and fungicidal against a broad range of microorganisms, and a stimulator of cellular life-extension. It can be used to control bladder and kidney infections, stomach and intestinal disorders, peptic and duodenal ulcers.10 Anti-Bacterial Properties Various percentages of Aloe Vera gels were tested in culture media consisting of the following organisms: Staphylococcus aureus, Streptococcus viridans, Candida albicans, and the five strains of Streptococcus mutans most commonly found in dental plaque. The gel was bactericidal against the above bacteria and fungicidal against Candida albicans (the cause of moniliasis or ‘denture sore mouth.’)

Virucidal Studies The Aloe Vera gel formula was found to be virucidal against Herpes simplex and Herpes zoster viruses.

Anti-inflammatory Studies: Prednisolone and Indomethacin (common antiinflammatory drugs) were utilized in a comparative study with the Aloe Vera gel to observe the effects on tissue culture cells. The gel was found to be just as effective as Prednisolone and Indomethacin, without having the long term toxicity of either drug.

Moisturizing actions The moisturizing effect of aloe vera gel appears to be due to the mix of water and polysaccharide components, creating a jelly-like consistency that holds the water within the mix and minimizes its evaporation, providing a sustained moist environment when applied to drying tissues and humectant properties that promote retention of moisture in tissues.14 Wound healing effects It has been noted that aloe vera gel improved wound healing by increasing blood supply, which increased oxygenation as a result.

The healing powers of Aloe Vera gel has been mainly attributed to high molecular weight polypeptide that contributes to cell proliferating-promoting activity.(15) The aloe vera gel polysaccharide acemannan was shown to activate macrophages, an effect that improved wound healing in a rat model. (17) A mannose-6-phosphate component of the gel has been credited with a wound healing effect.

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Aloe Vera contributes to angiogenesis, fibroblast proliferation and therefore helps in growth of new blood capillaries and is a part of tissue regeneration.

A study showed that topical application of aloe vera gel re-established vascularity of burn tissues in a guinea pig models. 18 Anti-Inflammatory Effects The literature has many reports concerning the antiinflammatory effect of aloe vera gel; Hanley et al reported that an aloe vera extract (described as 5.0% leaf homogenate) decreased inflammation by 48% in a rat adjuvant-induced arthritic inflammatory model.24,25 More recently, the peptidase bradykinase was isolated from aloe and shown to break down the bradykinin, an inflammatory substance that induces pain. 17 Anti-Oxidant Effects Finally, a glycoprotein fraction from aloe vera (14kDa) showed a radical scavenging activity against superoxide anion, generated by a free radical generating system known as the xanthine-xanthine oxidase system; this fraction also inhibited COX-2 and reduced Tx A2 synthase levels in vitro.41 The authors of this study suggested that both specific glycoproteins and aloesinrelated compounds played an important role in the antiinflammatory activity of gel from Aloe Vera leaves. 10 DENTAL USES Healing of Aphthous Ulcer: The gel containing Aloe Vera has given evidence of healing aphthous ulcers fasters, better and reducing the associated pain. These gels did not have a disagreeable taste or texture as compared to the conventional home remedies and therefore improved patient compliance. 10 Healing of the extraction socket: It was observed that the incidence of Aleolar Osteitis was significantly reduced when treated with a gel foam soaked with clear Aloe Vera as compared to any other treatment. 15 Healing of Lichen Planus (with systemic involvement also): The administration of aloe vera to the patients suffering from Lichen Planus has shown complete success at eliminating the symptoms. The patient’s treatment involved drinking 2.0 ounces of stabilized aloe vera juice daily for three months with additional topical application using aloe vera lip balm and aloe cream to reduce itching. The oral lesions cleared up within four weeks, although the systemic lesions took longer. 14 Denture Adhesive: Because of the sticky and viscous nature of acemannan (acetylated glucomannans), was formulated into a denture adhesive and evaluated for

Mar-Aprl 2015 adhesive strength in both wet and dry conditions. The adhesive has also shown to have less cytotoxicity to human gingival fibroblasts.

Healing of Chronic Oral Lesions: Gingival lesions associated with Lichen Planus, Benign Pemphigus, Leukemia and AIDS have supposed to heal well on application of Aloe Vera gel due to the properties discussed above.14

Aloe Science Council.” The (IASC) was established to standardise and promote research activity for the Aloe industry. In the absence of such standardization Aloe Vera is prone to dilution in quality. It has established standards so that adulterations of Aloe could not occur, thus allowing the wary public to know that the amount of Aloe, quality and purity was acceptable when the certification stamp was placed on finished goods.

Use in Endodontic Treatment

COMMERCIAL PREPARATIONS

a. The effectiveness of Aloe Vera gel was checked against three common Gutta Percha contaminants namely, E.coli, E.faecalis and Staph. aureus. The decontamination was supposed to be effective when gutta percha was disinfected for 1minute using Aloe Vera gel. Hence, Aloe Vera gel can be used as a storage media for Gutta Percha.19

c. Used in Pulpotomies: Aloe Vera gel has been used in paediatric cases in pulpotomies. After removal of carious dentin, placement of Aloe Vera gel on the exposed pulp horns has reported no post-operative pain/ discomfort upto 6 months.

OTHER ASPECTS OF ALOE VERA GEL: Stabilization Process: An important finding by Zimmerman was that the dramatic effects of the Aloe gel were not apparent until there was at least a 70% concentration of the gel. To achieve a 70% or greater concentration, an Aloe Vera gel must be stabilized with anti-oxidants in order to minimize the otherwise necessary preservatives which lessen the percentages of Aloe Vera in the product. The process includes the steps of rapidly heating the Aloe vera gel to a temperature in the range of from about 35° C. to about 80° C, adding to the heated Aloe Vera gel one or more stabilizing antioxidants, and rapidly cooling the heated Aloe Vera gel to a temperature in the range of from about 20° C. to about 30° C. The stabilizing antioxidants may be a tocotrienol/tocopherol blend, rosmarinic acid, polyphenols, or any combination thereof. 12 Standardization: As the research work for the utilization of Aloe Vera is gaining momentum across the world, it is essential to standardise and accredit the amount and quality of Aloe Vera present in a particular product.

Therefore it is now essential for all the consumable products containing Aloe Vera to bear a label of accreditation “Seal of Approval of the International

ALOE VERA MOUTH WASH AND TOOTH PASTE: can be used against Halitosis and reduce Plaque accumulation

ALOE VERA DRINKS: these are energy drinks that boost up the immunity.

MEDIC MENTOR

b. The research work carried out at the Loma Linda University states that the alcohol and chloroform extracts of Aloe Vera have shown to be effective against the otherwise resistant micro-organisms like the Candida albicans and E Faecalis.20

ALOE VERA GEL: used in case of skin burns, abrasions, scalds

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Mar-Aprl 2015

MEDIC MENTOR

ALOE VERA GEL: Containing aloe vera and Propolis are used in patients suffering from eczema, dermatitis.

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CONCLUSION This is a phenomenal plant having excellent medicinal properties. The gel and the mucilaginous content has shown to have anti bacterial, anti-oxidant , anti-viral, anti-inflammatory properties which have been proven in lab researches and in clinical medicine. These properties should be exploited in dentistry for giving a better and alternate treatment option to the patients. Aloe Vera definitely holds an exciting future in dentistry.

11. Yamaguchi I, Mega N, Sanada H. Components of the gel Aloe vera (L.) burm. f. Biosci Biotechnol Biochem 1993;57:1350-1352.

12. Yaron A. Aloe vera: Chemical and physical properties and stabilization. Israel J Botany 1991;40:270.

13. Oral ulcers remedy gets FDA clearance. J Am Dent Assoc 1994;125: 1308-1310.

14. Meadows TP. Aloe as a humectant in new skin preparations.

Cosmetics Toiletries 1980;95:51-56.

15. Heggers JP, Kucukcelebi A, Listengarten D, Stabenau J, Ko F, Broemeling LD, Robson MC,Winters WD. Beneficial effects of aloe on wound healing in an excisional wound model. J Altern Complement Med 1996;2:271-277.

16. Yagi A, Egusa T, Arase M, Tanabe M, Tsuji H. Isolation and characterization of the glycoprotein fraction with a proliferation-promoting activity on human and hamster cells in vitro from aloe vera gel. Planta Medica 1997;63:18-21.

17. Davis RH, Leitner MG, Russo JM, Byrne ME. Antiinflammatory activity of aloe vera against a spectrum of irritants. J Am Podiat Med Assoc 1989;79:263-276.

18. Thompson JE. Topical use of aloe vera derived allantoin gel in otolaryngology. Ear Nose Throat J 1991;70:56.

REFRENCES 1. PDR for herbal medicines, ed. 1. Montvale, NJ: Medical Economics Company;1998:631.

2. 2004 Red Book: pharmacy’s fundamental reference (Red Book drug topics). Montvale, NJ: Thomson Healthcare;2004:53.

3. Tarro VE. The honest herbal: A sensible guide to the use of herbs and related remedies, ed. 3. New York: Pharmaceutical Products Press;1993:25-28.

4. Krinsky DL, Hawkins EB, Pelton R,Willis NA, Lavalle JB. Natural therapeutics pocket guide, ed. 2. Cleveland: LexiComp, Inc.;2003:379.

5. Vogler BK, Ernst E. Aloe vera: A systematic review of its clinical effectiveness. Br J Gen Pract 1999;49:823-828.

6. Townsend J. Aloe vera. The UK reference guide to complimentary medicine. London: Chartwell House Publishing;1998.

7. Atherton P. Aloe vera revisted. Br J Phytotherapy 1998;4:176-183.

8. Shelton RM. Aloe vera. Its chemical and therapeutic properties. Int J Dermatol 1991;30:679-683.

9. Hayes SM. Lichen planus—Report of successful treatment with aloe vera. Gen Dent 1999;47:268-272.

10. Reynolds T, Dweck AC. Aloe vera leaf gel: A review update. J Ethnopharmacol 1999;68:3-37.

About Author Dr. Puneeta Duggal Senior Lecturer, Department of Conservative Dentistry and Endodontics, Sri Rajiv Gandhi Dental College and Hospital Bangalore