Table 6.

Therapeutic potential of Punica granatum on mouth and teeth

Model	Activity	Plant part/compd.	Study design	Mechanism	Ref.
Bacterial	Antimicrobial activity against Streptococcus mutans	Pericarp extract	Disc inhibition zone method and broth dilution assay; Control=chlorhexidine 0.2%	Growth inhibition; MIC= 50 mg/ml	(153)
Bacterial	Antifungal efficacy on Candida albicans	PPE (aqueous decoction)	Disc diffusion method; The zones of microbial (cultures of Candida albicans) inhibition at 18 and 24 hr	Antifungal activity (P<0.01); Inhibition zone 18.8 mm after 24h and 22 mm after 48 h	(154)
Bacterial	Antimicrobial inhibition as a mouthwash	PPE (methanol extract)	Agar well method (n=3); Incubated at 37 °C for 24 hr; Repeated 3 times; Bacterial strains: Staphylococcus mutants, Staphylococcus aureus, E. coli, Klebsiella pneumonia, Streptococcus gaseous, and Streptococcus faecalis; 25%, 50%, and 75% methanol extract; Control=chlorhexidine gluconate mouthwash	The 50% and 75% extracts exhibited the highest inhibition on S. mutants	(155)
Bacterial	Antibacterial activity against dental caries and gingivitis S. mutans	PPE (hot and cold aqueous extracts)	Agar disk diffusion method; S. mutans was isolated from fifty-five patients; 10 μl of aqueous peels extract or 0.2% chlorhexidine (standard); incubated at 37 °C for 24 hr	Inhibition zones: hot (31 mm), cold (27 mm), chlorhexidine (25 mm)	(156)
Bacterial	Antibacterial activity against Enterococcus faecalis and Candida albicans in root canal dressing	PPE (ethanol extract)	Inocula of 5.0 × 105 CFU/ml E. faecalis and 1.0 × 103 CFU/ml of C. albicans	↓Cell viability, biofilm formation; C. Albicans MIC= 62.50 µg/ml; E. faecalis MIC= 15.62 µg/ml	(157)
Cellular	Anti-cancer activity against oral cancer	PPE (ethanol extract)	KB 3-1 oncogenic cell culture; MTT assay; Extract concentrations of 50, 100, 150, 200, 250, 300, and 350 µg	↓Cell viability	(158)
Animal	Antifungal activity against oral candidiasis	PPE (methanol extract)	Male Wistar rats immunosuppressed with cyclosporine (40 mg/kg/d) and hydrocortisone acetate (500 μg/kg/d) except the control group; Induction of oral candidiasis via the oral administration of Candida albicans on the palate and tongue; extract 125, 250, and 500 μg/ml/kg and nystatin 100000 U/ml/kg by gavage daily; 15 days	↓Growth of C. albicans 100% cure in all the doses after 15 days; Most effective Conc.: 500 μg/ml after 5 days	(159)
Clinical	Antimicrobial prophylactic activity on oral bacteria	Fresh fruit juice	20 patients; A group received 0.2% chlorhexidine mouthwash (10 ml), the other group was given freshly prepared PJ as a mouthwash (75 ml for 2 min); salivary sample pre-rinse and after 15 min	↓Colony-forming units by pomegranate mouthwash (51.1%) and chlorhexidine mouthwash (71.3%)	(160)
Clinical	Gingival bleeding reduction	Fruit (ethanol extract)	Double-blind, interventional, experimental, longitudinal, and prospective RCT, with an inductive approach; N= 55, 18-56 years old; Control=chlorhexidine 0.12% solution mouthwash; Study groups: pomegranate extract mouthwash (twice daily, 1 min long, with 10 ml of the solution); Ainamo and Bay gingival bleeding index (GBI) on 0, 7, and 15 days	↓Gingival bleeding index (P<0.001)	(161)
Clinical	Reduction of gingivitis risk	PomElla® (pomegranate extract)	Single-blinded RCT; 19–25 years old, n=32, split evenly among both genders; 4 weeks; saliva sample donation before and after the experiment; randomly assigned pomegranate extract PomElla® dissolved in water or placebo: cornstarch in water (three times a day for 1 min per rinse)	↓Total protein (P<0.01), aspartate aminotransferase activity (P<0.005), α-Glucosidase activity (P<0.05); ↑Antioxidant enzyme ceruloplasmin activities (P<0.05), radical scavenging capacity (P<0.05)	(162)
Clinical	Antibacterial activity against S. mutans	Fruit (mouthwash)	A single-blinded, parallel-group RCT; n=20; experimental group (I): P. granatum and controlled group (II): chlorhexidine mouthwash; plaque samples evaluated for S. mutans at baseline and 15th day	↓Mean plaque both groups (group I P=0.043 and group II P=0.047); No significant difference between the two groups at 7th day	(163)
Clinical	Treatment of minor recurrent aphthous stomatitis	P. granatum flowers (pleniflora, sweet Alak, and Saveh black varieties) (ethanol and aqueous extracts)	Double-blind method; n=210 (69 F and 141 M); experimental group: alcoholic or water extracts (both 10% in 100 ml), negative control: received nothing; using mouthwash for 10 min, four times a day, for 10 days; measuring the size of lesions at days 1,2,4,6,8, and 10, The pain satisfactory degree was recorded	↓Entire-time of complete treatment; ↑Patients’ satisfactory	(164)
Clinical	Antimicrobial activity against S. mutans	Pericarp extract	RCT; 30 children, 6-12 years; Control=chlorhexidine 0.2%; Samples collected before and after mouth rinse	↓Salivary S. mutans count; No statistically significant difference between PPE and chlorhexidine	(153)