ABSTRACT
Natural products have received a lot of attention in a variety of medical sectors, including dentistry. Cissus, a flowering plant genus, has long been used for its therapeutic benefits. The purpose of this review is to thoroughly investigate the possibilities of Cissus extracts in dentistry. To that end, we used specific selection criteria for the selection of pertinent scientific articles published in the scientific information databases of PubMed, Web of Science, Google Scholar, Scopus, and ProQuest. We found that the diverse array of bioactive compounds found in varied species of Cissus holds promise for applications ranging from oral wound healing to periodontal health. This review summarizes known studies on antibacterial, anti-inflammatory, and tissue-regenerative characteristics of Cissus extracts, shedding light on their potential significance in modernizing modern dental practices. It exerts that Cissus extracts have the potential to supplement established dentistry therapies by providing all-natural remedies for a variety of oral health conditions.
KEYWORDS: Bioactive compounds, bone regeneration, Cissus, dental implants, oral health, periodontal diseases, wound healing
INTRODUCTION
Due to their possible therapeutic benefits and diminished adverse effects, the use of natural products in dentistry has garnered increasing attention. The grape family (Vitaceae) contains the genus Cissus, which is made up of several species that have historically been utilized for therapeutic purposes in several civilizations. It has been used in a variety of ways for the management of different conditions in a variety of disciplines due to its promising potential. The potential uses of Cissus extracts in enhancing oral health and treating dental problems have come under increased scrutiny in recent years.[1]
MATERIALS AND METHODS
This study is a narrative review that aims to gather information pertinent to the properties of Cissus extracts that can be used in a variety of dental ailments and applications. We reviewed published articles in scientific databases of PubMed, Web of Science, Google Scholar, Scopus, and ProQuest from January 1960 to June 2023. The search in the databases was conducted using keywords of “Cissus” and “Bioactive compounds,” or “Bone regeneration,” or “Dental Implants,” or “Oral Health,” or “Periodontal diseases,” or “Wound healing” or “Oral Cancer.”
There were 123 relevant articles found during the preliminary search phase. After that, redundant and duplicate articles were eliminated. 86 papers were chosen for inclusion after entire texts were examined. After screening, 57 papers were chosen and analyzed by two authors for final review. The results are summarized below under the following headings:
Bioactive compounds in cissus
The bioactive substances such as flavonoids, triterpenoids, polyphenols, and carotenoids are abundant in Cissus extracts. Testing has shown that Cissus extracts contain a substantial concentration of vitamin C per gram of newly formed paste in addition to calcium oxalate. These substances are possible candidates for dental uses because they have anti-inflammatory, antibacterial, wound healing, antioxidant, and other beneficial qualities. Notably, the research has shown that Cissus extracts can limit the growth of oral bacteria, which has important implications for the avoidance and treatment of dental diseases.[2]
Role in periodontal health
Periodontal diseases are a set of inflammatory illnesses that affect the teeth’s supporting components.[3] Luteolin, one of the components included in Cissus quadrangularis (CQ), along with flavonoids decreases the inflammatory process by inhibiting lipoxygenase. Additionally, it successfully upregulates HO-1 while downregulating iNOS and Tumor Necrosis Factor.[4] Hence, CQ extracts are promising candidates in the management of periodontal diseases.
Healing of oral wounds
Cissus extracts have been studied for their ability to hasten the healing of wounds. The chondroblasts, osteoblasts, and fibroblasts of mesenchymal origin are stimulated by Cissus. Studies show that it promotes the production of collagen fibers. This ability to promote angiogenesis, collagen production, and fibroblast growth may assist in the recovery of oral mucosal injuries, postoperative wounds, and ulcers. The addition of Cissus extracts to dental care products or postoperative care could enhance tissue regeneration and recovery.[5]
Maxillofacial fractures
As already discussed, Cissus also includes vitamins A and C, both of which are useful for the production of collagen. As a result, it accelerates the speedy formation of the chemical composition of the bone, thereby hastening the bone repair process.[5] According to Brahmkshatriya H. et al., C. quadrangularis accelerated the healing of fractured jaw bones and helped to reduce pain and edema.[6]
Osseous defects
In a study, the osteogenic capacity CQ in the restoration of healthy bone in the healing of two to three-walled infra osseous defects in the periodontium showed tremendous potential.[7]
Dental implants
Dental implants have transformed restorative dentistry by providing an effective way to replace missing teeth. These devices made of titanium or titanium alloy are put into the jawbone to act as simulated tooth roots and support artificial crowns. Despite their high success rates, issues including peri-implantitis and delayed osseointegration can shorten the lifespan of implants.[8]
It has been studied whether Cissus extracts can improve osseointegration. According to studies, certain phytochemicals found in Cissus, such as quercetin, may raise bone mineral density, decrease osteoclastogenic marker expression, and stimulate osteoblast activity. Its ethanolic extracts have been demonstrated to activate osteoprotegerin (OPG) and decrease the production of receptor activators of nuclear factor ligand (RANKL).[9] These factors can hasten dental implant integration with host bone.
Antimicrobial activity
Saliva plays a role in the biofilm (plaque)-induced acid demineralization of enamel or dentin that is known as dental caries. Streptococcus mutans and Lactobacillus acidophilus are two essential components of the biofilm’s complex microbial population that contribute significantly to the development and spread of caries.[10]
Natural plant products might provide new antibacterial agents. The existence of secondary metabolites including tannins, terpenoids, alkaloids, and flavonoids could be responsible for this antimicrobial activity. This is true for both fresh and dried cissus stems. In an in vitro investigation, Kesavaraj B et al. discovered that CQ had antibacterial action against the cariogenic organisms: S. mutans and L. acidophilus.[11] This makes them strong potential candidates for cariostatic agents to preclude dental decay in the most susceptible populations.
Precancerous oral lesions
Precancerous oral lesions are a critical prelude to the development of invasive malignancies, making oral cancer a major worldwide health concern. The treatment of these precancerous lesions is critical to preventing the development of mouth cancer. There have been several theories put out to elucidate how Cissus extract might work to treat precancerous oral lesions:
Antioxidant qualities: Cissus extract is a rich source of several antioxidants that can combat oxidative stress, a major factor in the development of oral cancer.[1]
Effects on inflammation: Precancerous oral lesions grow and advance in a manner that is strongly correlated with chronic inflammation. The probability of malignant transformation may be decreased by using Cissus extract to control inflammation.[1]
Cellular apoptosis: According to certain research, Cissus extract may cause malignant and precancerous cells to undergo apoptosis (programmed cell death), potentially halting the growth of oral diseases. In a study, the biological effects of CQ ethanolic extract on the KB oral epidermoid carcinoma cell line were assessed in vitro and validated by in silico analysis.[12]
CONCLUSION
The extensive range of bioactive qualities that have been shown in cissus extracts has the potential to transform contemporary dentistry. This study concludes that Cissus extracts have the potential to complement traditional dentistry therapies as this field of study develops, providing all-natural treatments for a range of oral health issues.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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