Aloe vera - an ancient herb for modern dentistry

Review ArticleAloe vera An Ancient Herb for ModernDentistrymdashA Literature Review

Arbaz Sajjad1 and Samia Subhani Sajjad2

1 Department of Prosthodontics Specialist Dental Center King Abdul Aziz Super Speciality Hospital CompoundMinistry of Health Al-Jouf Sakaka-42421 Saudi Arabia

2 Kamineni Institute of Dental Sciences Andhra Pradesh India

Correspondence should be addressed to Arbaz Sajjad baaz911gmailcom

Received 7 August 2013 Accepted 15 September 2013 Published 21 January 2014

Academic Editor Luis Junquera

Copyright copy 2014 A Sajjad and S Subhani Sajjad This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Objectives To review composition actions and clinical applications of Aloe vera plant in dentistry and to establish its effectivenessas an invaluable adjunct in the treatment of dental diseases Method A manual and electronic literature (MEDLINE CochraneCentral Register of Controlled Trials and Google Scholar) search was performed up to July 2013 for in vitro and in vivo studiesand research presenting clinical microbiological immunological and patient-centered data to validate the efficacy of Aloe veragel in dentistry A total of 38 titles abstracts and full-text studies were selected and reviewed Aloe vera has various medicinalproperties like anti-inflammatory antibacterial antiviral and antitumor which accelerates wound healing and helps in treatingvarious lesions in oral cavity Benefits associated with Aloe vera have been attributed to the polysaccharides contained in the gel ofthe leaves Conclusion The pharmacological attributes of Aloe vera have been revalidated in modern sciences through various invivo and in vitro studies The herb has immense potential as a dental therapeutic Even though Aloe vera is a promising herb withvarious clinical applications in medicine and dentistry more clinical research needs to be undertaken especially to validate andexplain the action of acemannan hydrogel in accelerating the healing of aphthous ulcers and to validate the efficacy of Aloe gel onplaque and gingivitis so that it can be established in the field of dentistry

1 Introduction

The use of natural products in the prevention and treatmentof oral conditions has increased recently and could beof benefit to low socioeconomic level in urban and ruralcommunities [1] Among the various currently availableherbal agents the most popular and currently receiving alot of scientific attention is Aloe vera The name Aloe verais derived from the Arabic word ldquoAlloehrdquo meaning ldquoshiningbitter substancerdquo while ldquoverardquo in Latin means ldquotruerdquo Theplant Aloe vera has a history dating back to biblical timesIt is a perennial succulent xerophyte which develops water-storage tissue in the leaves to survive in dry areas of low orerratic rainfall The plant has stiff grey-green lance-shapedleaves containing clear gel in a central mucilaginous pulpBenefits associated with Aloe vera have been attributed to thepolysaccharides contained in the gel of the leaves [2]

There are over 250 species of Aloe grown around theworld Only two species are grown commercially Aloebarbadensis Miller and Aloe arborescens The Aloe plant isgrown in warm tropical areas and cannot survive freezingtemperatures such as during winters In the United Statesmost of the Aloe is grown in the Rio Grande Valley of SouthTexas Florida and Southern California Internationally Aloecan be found in Mexico the Pacific Rim countries IndiaSouth America Central America the Caribbean Australiaand Africa [3] Over the years this plant has been known bya number of names such as ldquothe wand of heavenrdquo ldquoheavenrsquosblessingrdquo and ldquothe silent healerrdquo

2 Parts of Aloe vera Plant

The Aloe barbadensis plant consists of two different partseach of which produces substances with completely different

Hindawi Publishing CorporationJournal of Dental SurgeryVolume 2014 Article ID 210463 6 pageshttpdxdoiorg1011552014210463

2 Journal of Dental Surgery

compositions and therapeutic properties The parenchymaltissue makes up the inner portion of the aloe leaves andproduces the Aloe vera gel (or mucilage) a clear thintasteless jelly-like material This tissue is recovered fromthe leaf by separating the gel from the inner cellular debrisThe other part of the plant is a group of specialized cellsknown as the pericyclic tubules which occur just beneath theouter green ring of the leaf These cells produce an exudatethat consists of bitter yellow latex with powerful laxative-likeactions This exudate which is not to be confused with thegelmucilage from the parenchymal leaf tissue is availablecommercially for systemic ingestion to produce catharsis [4]

3 Active Ingredient of Aloe vera

More than 75 active ingredients from inner gel have beenidentified including vitamins minerals enzymes sugarsanthraquinones or phenolic compounds lignin saponinssterols amino acids and salicylic acid Active ingredients ofAloe vera leaf pulp and exudates [5] were depicted in Table 1

4 Biological amp Pharmacological Actions ofAloe vera Gel

A number of investigations have attempted to relate thechemical constituents in the gel to specific biological effects

41 Wound-Healing Effects Different mechanisms have beenproposed for the wound-healing effects of Aloe gel whichinclude keeping the wound moist increasing epithelial cellmigration more rapid maturation of collagen and reduc-tion in inflammation [6] A 1996 study reported that ahigh molecular weight polypeptide constituent from thegel demonstrated a healing effect on excisional wounds inrats [13] Glucomannan a mannose-rich polysaccharide andgibberellin a growth hormone interact with growth factorreceptor on the fibroblast thereby stimulating its activity andproliferation which in turn increases collagen synthesis aftertopical and oral application [7]

Yagi et al reported that Aloe vera gel contains a gly-coprotein with cell proliferating-promoting activity whileDavis et al noted that Aloe vera gel improved wound healingby increasing blood supply (angiogenesis) which increasedoxygenation as a result [8 9] Angiogenesis is the growthof new blood capillaries and is a part of tissue regenerationA 1993 study showed that topical application of Aloe veragel reestablished vascularity of burn tissue for a guineapig although no specific constituents were identified [10]The Aloe vera gel polysaccharide acemannan was shown toactivate macrophages an effect that improved wound healingin a rat model [11 12] Two years later Davis et al reportedthat the low molecular weight component of freeze-driedAloe vera gel stimulated blood vessel formation in a chickchorioallantoicmembrane (ie a vascularmembrane derivedfrom developing chicken eggs) in addition a methanol-soluble fraction of the gel which contains a glycoprotein withmainly cell proliferating-promoting activity stimulated the

proliferation of artery endothelial cells in an in vitro assay andinduced them to invade a collagen substrate [13]

42 Skin Hydration Effect It was proposed that the Aloe veragel formulations with higher concentrations (025 ww and05 ww) improved skin hydration possibly by means of ahumectant mechanism Humectant mechanism means thatthe Aloe gel works by attracting water from the dermis belowand by helping to keep this water bound in the stratumcorneum [14]

43 Anti-Aging Effect Aloe has excellent anti-aging effect byproducing the collagen and elastin fibres making the skinmore elastic and less wrinkled as reported in an in vivo studyconducted onmouse ears by Davis et al [15] One of themainreasons for this lies in the plantrsquos unique ability to increaseproduction of human fibroblast cells between six and eighttimes faster than normal cell production Fibroblast cells arefound in the dermis of the skin and are responsible for thefabrication of collagen the skinrsquos support protein which keepsskin firm supple and youthful looking It was found thatAloe vera not only improved fibroblast cell structure but alsoaccelerated the collagen production process

44 Anti-Inflammatory Effects It inhibits the cyclooxygenasepathway and reduces prostaglandin E2 Recently the novelanti-inflammatory compound called C-glucosyl chromonewas isolated from gel extracts [16] In addition the peptidasebradykinase was isolated fromAloe and shown to break downthe bradykinin an inflammatory substance that induces pain[17]

45 Antibacterial Property The activity of Aloe vera innergel against both Gram-positive and Gram-negative bacte-ria has been demonstrated by several different methods[18] Streptococcus pyogenes and Streptococcus faecalis aretwo microorganisms that have been inhibited by Aloe veragel [19] Aloe vera gel reportedly was bactericidal againstPseudomonas aeruginosawhile acemannan prevented it fromadhering to human lung epithelial cells in a monolayerculture [20]

46 Antifungal Property A processed Aloe vera gel prepara-tion reportedly inhibited the growth ofCandida albicans [19]

47 Antiviral Property This actionmay be direct and indirectindirect due to stimulation of immune system and directdue to aloe emodin [21] Aloe emodin in Aloe vera makesit so that certain viruses are not able to function ThereforeAloe vera is virucidal to Herpes simplex virus type 1 and type2 Varicella zoster virus pseudorabies virus and influenzavirus according to the research of Thomson [22] Duringthe course of these studies it was found that the virucidalactivity was due to the anthraquinones extracted from theinner leaf ofAloe and the roots bark or leaves of a number ofother anthraquinone-containing plantsThe results indicatedthat aloe emodin directly affected both DNA- and RNA-containing enveloped viruses but had no effect on naked

Journal of Dental Surgery 3

Table 1 Active ingredients of Aloe vera leaf pulp and exudates

Class CompoundsVitamins B1 B2 B6 C A (120573120573-carotene) choline folic acid 120572120572-tocopherol

EnzymesAlkaline phosphatase amylase carboxypeptidase catalase bradykinase cyclooxidaseperoxidase carboxypeptidase cyclooxygenase lipase oxidase phosphoenolpyruvatecarboxylase superoxide dismutase

Anthraquinones Aloe emodin aloetic acid anthranol aloin A and B (or collectively known as barbaloin)isobarbaloin emodin ester of cinnamic acid

Inorganic compounds Calcium chlorine chromium copper iron magnesium manganese selenium zincpotassium phosphorous sodium

CarbohydratesPure mannan acetylated mannan acetylated glucomannan (acemannan) galactanglucogalactomannan galactogalacturan galactoglucoarabinomannan arabinogalactanpectic substance xylan cellulose

Saccharides Mannose glucose L-rhamnose aldopentose

Organic compounds and lipids Arachidonic acid 120574120574-linolenic acid steroids (campesterol cholesterol 120573120573-sitosterol)triglycerides triterpenoid gibberellin lignins potassium sorbate salicylic acid uric acid

Chromones8-C-glucosyl-(21015840-O-cinnamoyl)-7-O-methylaloediol A 8-C-glucosyl-(S)-aloesol8-C-glucosyl-7-O-methyl-(S)-aloesol 8-C-glucosyl-7-O-methylaloediol8-C-glucosyl-noreugenin isoaloeresin D isorabaichromone

Nonessential and essential amino acids Alanine arginine aspartic acid glutamic acid glycine histidine hydroxyproline isoleucineleucine lysine methionine phenylalanine proline threonine tyrosine valine

(unenveloped) viruses It was concluded that under theconditions tested the anthraquinones acted directly on theenvelope of the anthraquinone-sensitive viruses resulting inthe prevention of virus adsorption and subsequent replica-tion

48 Immunomodulating Effects Aloe vera a great immunestimulant contains 90 rhodium and iridium (trace min-erals) in the acemannan which is one of the polysaccha-rides which dramatically increases the white blood cellsor macrophages and T cells Thus immunomodulatingeffects occur via activation of macrophage cells to generatenitric oxide secrete cytokines (eg tumor necrosis factorinterleukin-1 interleukin-6 and interferon-120574) and presentcell surfacemarkers [23 24] It helps enlarge the thymus glandin size by 40The thymus is what produces the T cells of theimmune system

49 Antioxidant Property Aloe vera has very strong antiox-idant nutrients Glutathione peroxide activity superoxidedismutase enzymes and a phenolic antioxidant were found tobe present inAloe vera gel whichmay be responsible for theseantioxidant effects [25] Apart from these it also contains AC and E vitamins These free radical components get rid ofthe toxins and carcinogenic properties we have in our bodiesfrom the pollution and poor quality foods we eat We acquirethese free radicals in our bodies through absorption of ourskin and through digestion

410 Antitumor Effect The two fractions from Aloes thatare claimed to have anticancer effects include glycoproteins(lectins) and polysaccharides [6] Different studies indicated

antitumor activity forAloe vera gel in terms of reduced tumorburden tumor shrinkage tumor necrosis and prolongedsurvival rates

An induction of glutathione S-transferase and an inhi-bition of the tumor-promoting effect of phorbol myristicacetate have also been reported which suggest Aloe gelin cancer chemoprevention Indirect action on antitumoractivity is stimulation of the immune response [26 27]

411 Laxative Effect Anthraquinones increase intestinewatercontent stimulate water secretion and increase intestinalperistalsis [28] And as mentioned earlier a group of special-ized cells known as the pericyclic tubules which occur justbeneath the outer green ring of the leaf produce an exudatethat consists of a bitter yellow latexwith powerful laxative-likeactions [4]

5 Clinical Applications of Aloe vera inDentistry

51 Aphthous Ulcer It has been reported that acemannanhydrogel accelerates the healing of aphthous ulcers andreduces the pain associated with them [29] Researchersevaluated a gel that combined allantoinAloe vera and silicondioxide and its effects on aphthous ulcers of the oral cavity[30] Each patient used a daily diary to document the numberand duration of aphthous ulcers the interval between ulcersulcer size and ulcer pain over a period of 3-4 months Thereduced duration of the lesions in one arm of the study andthe increased interval between lesions in the other arm ofthe study both were significant statistically The gel did notdemonstrate any consistent effectiveness on ulcers in the oralcavity


52 Oral Lichen Planus The efficiency of Aloe vera intreatment of oral lichen planus has been measured by manyresearchers In one study a patient of lichen planus withsystemic involvement was placed on Aloe vera therapy Thepatientrsquos treatment involved drinking 20 ounces of stabilizedAloe vera juice daily for 3 months topical application usingAloe vera lip balm and Aloe cream for itching hands Theoral lesions cleared up within 4 weeks although the systemiclesions took longer [31] In another study 46 patients withOLP were randomly divided into 2 groups Each groupwas treated with Aloe vera mouthwash and triamcinoloneacetonide 01 (TA) respectively The treatment period forboth groups was 4 weeks Patients were evaluated on days 8and 16 and after completing the course of treatment (visit 1ndash3) Aloe vera mouthwash is an effective substitute for TA inthe treatment of OLP [32]

In another double-blind study 64 patients with OLPweredivided in two groups and treated with either Aloe vera (32patients) or placebo (32 patients) at a dose of 04mL (70concentration) three times a dayThe patients were evaluatedafter 6 and 12 weeks In the Aloe vera group complete painremissionwas achieved in 312 of the cases after 6weeks andin 61 after 12 weeks In the placebo group these percentageswere 172 and 416 respectively It was concluded thatAloevera improves the total quality of life score in patients withOLP [33]

53 Gingivitis Several studies have been conducted to testthe efficacy of Aloe vera in treating gingivitis In a double-blind study a total of 120 subjects were requested to abstainfrom oral hygiene (tooth brushing) for 14 days The subjectswere then randomly divided into group A (test group)who received 100 Aloe vera group B (negative controlgroup) who received placebo (distilled water) and group C(positive control group) who received 02 chlorhexidinePlaque accumulation was assessed by plaque index (PI) andgingivitis was assessed by modified gingival index (MGI)and bleeding index (BI) at baseline (0) 7th 14th and 22nddays Mouthwash containing Aloe vera showed significantreduction of plaque and gingivitis but when compared withchlorhexidine the effect was less significant It was concludedthatAloe veramouthwash can be an effective antiplaque agentand with appropriate refinements in taste and shelf life can bean affordable herbal substitute for chlorhexidine [34]

Another study evaluated the effect of a toothpaste con-taining high concentrations of Aloe vera on the reductionof plaque and gingivitis Fifteen subjects participated in thisrandomized double-blind study Participantswere nonsmok-ers with signs of gingivitis (bleeding index 30) and nosigns of periodontitis Subjects were followed for three 6-month periods during which they used either an Aloe veratoothpaste or control toothpasteThere was a statistically andclinically significant reduction of about 20 of the plaqueand gingivitis indices at the end of the clinical trial comparedto baseline values but no differences between the Aloe veraand the control toothpaste It was concluded that in patientsmotivated to improve their oral hygiene habits the use of atoothpaste containing Aloe Vera showed no additional effect

on plaque and gingivitis compared to a control toothpaste[35]

54 Alveolar Osteitis Currently special medical bandages(SaliCept Patch) are available for intraoral use followingextraction of teeth The SaliCept Patch is a freeze-driedpledget that contains acemannan hydrogel (Carrington Lab-oratories) obtained from the clear inner gel of Aloe vera In2002 a retrospective evaluation was performed of the recordsof 587 patients (1031 sockets) whose extraction sites had beentreated with clindamycin-soaked gelfoam A prospective trialwas conducted in which 607 patients (1064 sockets) had 2SaliCept Patches placed immediately after extraction Resultsshowed that 78 of 975 sites (80) in the gelfoam groupdeveloped AO whereas only 11 of 958 sites (11) in theSaliCept group developed AO (119875 lt 0001) Further analysisof all extraction sites revealed that the incidence of AO in thegelfoam group was 76 compared with 11 in the SaliCept-treated group (119875 lt 0001) Therefore it was concluded thatthe SaliCept Patch significantly reduces the incidence of AOcompared with clindamycin-soaked gelfoam [36]

55 Denture Adhesive As previously discussed Acemannana complex mannose carbohydrate and one of the main ingre-dients of theAloe vera gel has an inherent stickinessviscosityIt is this property that led to the production of prototypeacemannan denture adhesives These new denture adhesiveformulations were evaluated for pH changes cytotoxicity tohuman gingival fibroblasts and adhesive strength in bothdry and wet conditions The denture adhesive formulationstested consisted of five combinations of acemannan withvarying concentrations of preservatives The pH and cyto-toxity of each formulation was measured over 24 hoursand the adhesive strength was evaluated with a universaltesting The experiment concluded that acemannan dentureadhesive formulation 150 1 and preservative concentration offormulation 4 with an initial pH value of 60 was an effectiveherbal substitute for traditional denture adhesives [37]

Other applications in dentistry [3 38]

(1) applications directly at sites of periodontal surgery

(2) as an adjunct to Scaling and root planning in peri-odontitis

(3) chemical burns caused by accidents with aspirin arequickly relieved

(4) extraction sites respond comfortably and emptypurses do not develop when aloe vera is applied

(5) angular Chelitis

(6) burning mouth syndrome

(7) patients with sore gums and teeth with denturesmaladaptive may also benefit

(8) Aloe vera can also be used around dental implants tocontrol inflammation caused by bacterial contamina-tion


6 Conclusion

The pharmacological attributes of Aloe vera have been reval-idated in modern sciences through various in vivo and invitro studies These scientific studies are good enough proofthat drug has immense potential as a dental therapeutic Soproper diagnosis knowledge of the traditional medicine andimplementation of that knowledge to the treatment plan areimportant in ensuring success with this dental therapeuticagent As a footnote though Aloe vera is a promising herbwith its various clinical applications in medicine and den-tistry the authors feels that more clinical research needs tobe undertaken especially to validate and explain the action ofacemannan hydrogel in accelerating the healing of aphthousulcers and to validate the efficacy of Aloe gel on plaque andgingivitis so that it can be established in the field of dentistry

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] M A Botelho N A P Nogueira G M Bastos et al ldquoAntimi-crobial activity of the essential oil fromLippia sidoides carvacroland thymol against oral pathogensrdquoBrazilian Journal ofMedicaland Biological Research vol 40 no 3 pp 349ndash356 2007

[2] F J A Matos M P Sousa A A Craveiro and M E OMatos Constituintes Quımicos Ativos e Propriedades Biologicasde Plantas Medicinais Brasileiras Editora da UFC FortalezaBrazil 2nd edition 2004

[3] J Harrison DDS and FAGD ldquoAloe vera in dentistry book aloeverardquo in Naturersquos Medicine Chest p 19 2001

[4] V E Tyler The Honest Herbal A Sensible Guide to the Use ofHerbs and Related Remedies Pharmaceutical Products PressNew York NY USA 3rd edition 1993

[5] J H Hamman ldquoComposition and applications of Aloe vera leafgelrdquoMolecules vol 13 no 8 pp 1599ndash1616 2008

[6] T Reynolds and A C Dweck ldquoAloe vera leaf gel a reviewupdaterdquo Journal of Ethnopharmacology vol 68 no 1ndash3 pp 3ndash371999

[7] J P Heggers A Kucukcelebi D Listengarten et al ldquoBeneficialeffect of Aloe on wound healing in an excisional woundmodelrdquoJournal of Alternative and Complementary Medicine vol 2 no2 pp 271ndash277 1996

[8] A Yagi T Egusa M Arase M Tanabe and H Tsuji ldquoIsola-tion and characterization of the glycoprotein fraction with aproliferation-promoting activity on human and hamster cells invitro fromAloe vera gelrdquo Planta Medica vol 63 no 1 pp 18ndash211997

[9] R H Davis M G Leitner J M Russo and M E ByrneldquoAnti-inflammatory activity of Aloe vera against a spectrum ofirritantsrdquo Journal of the American PodiatricMedical Associationvol 79 no 6 pp 263ndash276 1989

[10] J PHeggers R P Pelley andMC Robson ldquoBeneficial effects ofAloe in wound healingrdquo Phytotherapy Research vol 7 pp S48ndashS52 1993

[11] B Maxwell H Chinnah and I Tizard ldquoActivated macrophagesaccelerate wound healing in aged ratsrdquoWound Repair Regener-ation vol 4 p 165 1996

[12] I Tizard D Busbee B Maxwell and M C Kemp ldquoEffectsof acemannan a complex carbohydrate on wound healing inyoung and aged ratsrdquoWounds vol 6 pp 201ndash209 1994

[13] R H Davis J J Donato G M Hartman and R C HaasldquoAnti-inflammatory and wound healing activity of a growthsubstance in Aloe verardquo Journal of the American PodiatricMedical Association vol 84 no 2 pp 77ndash81 1994

[14] S E DalrsquoBelo L R Gaspar and PMMaia Campos ldquoMoisturiz-ing effect of cosmetic formulations containing Aloe vera extractin different concentrations assessed by skin bioengineeringtechniquesrdquo SkinResearch andTechnology vol 12 no 4 pp 241ndash246 2006

[15] R H Davis ldquoBiological activity of Aloe verardquo SOFW Journalvol 119 pp 646ndash649 1993

[16] J A Hutter M Salman W B Stavinoha et al ldquoAnti-inflammatory C-glucosyl chromone from Aloe barbadensisrdquoJournal of Natural Products vol 59 no 5 pp 541ndash543 1996

[17] S Ito R Teradaira H Beppu M Obata T Nagatsu andK Fujita ldquoProperties and pharmacological activity of car-boxypeptidase in Aloe arborescens Mill var natalensis BergerrdquoPhytotherapy Research vol 7 pp S26ndashS29 1993

[18] FHabeeb E Shakir F Bradbury et al ldquoScreeningmethods usedto determine the anti-microbial properties of Aloe vera innergelrdquoMethods vol 42 no 4 pp 315ndash320 2007

[19] J P Heggers G R Pineless and M C Robson ldquoDermaidealoeAloe vera gel comparison of the antimicrobial effectsrdquoJournal of the American Medical Technologists vol 41 no 5 pp293ndash294 1979

[20] A O Azghani I Williams D B Holiday and A R JohnsonldquoA beta-linked mannan inhibits adherence of Pseudomonasaeruginosa to human lung epithelial cellsrdquo Glycobiology vol 5no 1 pp 39ndash44 1995

[21] R J Sydiskis D G Owen J Lohr K H Rosler and R NBlomster ldquoInactivation of enveloped viruses by anthraquinonesextracted fromplantsrdquoAntimicrobial Agents andChemotherapyvol 35 no 12 pp 2463ndash2466 1991

[22] H I Thomson PDR for Herbal Medicines Thomson PDRMontvale NJ USA 3rd edition 2004

[23] J Tai-Nin Chow D A Williamson K M Yates and W JGoux ldquoChemical characterization of the immunomodulatingpolysaccharide of Aloe vera Lrdquo Carbohydrate Research vol 340no 6 pp 1131ndash1142 2005

[24] S A Im S T Oh S Song et al ldquoIdentification of optimalmolecular size of modified Aloe polysaccharides with maxi-mum immunomodulatory activityrdquo International Immunophar-macology vol 5 pp 271ndash279 2005

[25] M A Khan M Tania D Zhang and H Chen ldquoAntioxidantenzymes and cancerrdquo Chinese Journal of Cancer Research vol22 no 2 pp 87ndash92 2010

[26] H S Kim and B M Lee ldquoInhibition of benzo[a]pyrene-DNAadduct formation by Aloe barbadensis Millerrdquo Carcinogenesisvol 18 no 4 pp 771ndash776 1997

[27] V Steenkamp and M J Stewart ldquoMedicinal applications andtoxicological activities of Aloe productsrdquo Pharmaceutical Biol-ogy vol 45 no 5 pp 411ndash420 2007

[28] Y Ishii H Tanizawa and Y Takino ldquoMechanism of catharticeffectrdquo Biological and Pharmaceutical Bulletin vol 17 no 5 pp651ndash653 1994

[29] ldquoOral ulcers remedy gets FDA clearancerdquo The Journal of theAmerican Dental Association vol 125 pp 1308ndash1310 1994


[30] J J Garnick B Singh and G Winkley ldquoEffectiveness of amedicament containing silicon dioxide aloe and allantoin onaphthous ulcersrdquo Oral Surgery Oral Medicine Oral PathologyOral Radiology and Endodontics vol 86 no 5 pp 550ndash5561998

[31] S M Hayes ldquoLichen planusmdashreport of successful treatmentwith Aloe verardquo General Dentistry vol 47 no 3 pp 268ndash2721999

[32] A Mansourian F Momen-Heravi M Saheb-Jamee M Esfe-hani O Khalilzadeh and J Momen-Beitollahi ldquoComparisonof Aloe veramouthwash with triamcinolone acetonide 01 onoral lichen planus a randomized double-blinded clinical trialrdquoTheAmerican Journal of the Medical Sciences vol 342 no 6 pp447ndash451 2011

[33] N Salazar-Sanchez P Lopez-Jornet F Camacho-Alonso andM Sanchez-Siles ldquoEfficacy of topical Aloe vera in patients withoral lichen planus a randomized double-blind studyrdquo Journal ofOral Pathology and Medicine vol 39 no 10 pp 735ndash740 2010

[34] B Chandrahas A Jayakumar A Naveen K Butchibabu and PK Reddy ldquoA randomized doubleblind clinical study to assessthe antiplaque and antigingivitis efficacy of Aloe vera mouthrinserdquo Journal of Indian Society of Periodontology vol 16 pp543ndash548 2012

[35] H Namiranian and G Serino ldquoThe effect of a toothpastecontaining Aloe vera on established gingivitisrdquo Swedish DentalJournal vol 36 no 4 pp 179ndash185 2012

[36] MR Poor J EHall andA S Poor ldquoReduction in the incidenceof alveolar osteitis in patients treated with the SaliCept patchcontaining Acemannan hydrogelrdquo Journal of Oral and Maxillo-facial Surgery vol 60 no 4 pp 374ndash379 2002

[37] C G Tello P Ford and A M Iacopino ldquoIn vitro evalua-tion of complex carbohydrate denture adhesive formulationsrdquoQuintessence International vol 29 no 9 pp 585ndash593 1998

[38] H K Virdi S Jain and S Sharma ldquoEffect of locally deliveredAloe vera gel as an adjunct to scaling and root planing inthe treatment of chronic periodontitis a clinical studyrdquo IndianJournal of Oral Sciences vol 3 pp 84ndash89 2012

Submit your manuscripts athttpwwwhindawicom

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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compositions and therapeutic properties The parenchymaltissue makes up the inner portion of the aloe leaves andproduces the Aloe vera gel (or mucilage) a clear thintasteless jelly-like material This tissue is recovered fromthe leaf by separating the gel from the inner cellular debrisThe other part of the plant is a group of specialized cellsknown as the pericyclic tubules which occur just beneath theouter green ring of the leaf These cells produce an exudatethat consists of bitter yellow latex with powerful laxative-likeactions This exudate which is not to be confused with thegelmucilage from the parenchymal leaf tissue is availablecommercially for systemic ingestion to produce catharsis [4]

3 Active Ingredient of Aloe vera

More than 75 active ingredients from inner gel have beenidentified including vitamins minerals enzymes sugarsanthraquinones or phenolic compounds lignin saponinssterols amino acids and salicylic acid Active ingredients ofAloe vera leaf pulp and exudates [5] were depicted in Table 1

4 Biological amp Pharmacological Actions ofAloe vera Gel

A number of investigations have attempted to relate thechemical constituents in the gel to specific biological effects

41 Wound-Healing Effects Different mechanisms have beenproposed for the wound-healing effects of Aloe gel whichinclude keeping the wound moist increasing epithelial cellmigration more rapid maturation of collagen and reduc-tion in inflammation [6] A 1996 study reported that ahigh molecular weight polypeptide constituent from thegel demonstrated a healing effect on excisional wounds inrats [13] Glucomannan a mannose-rich polysaccharide andgibberellin a growth hormone interact with growth factorreceptor on the fibroblast thereby stimulating its activity andproliferation which in turn increases collagen synthesis aftertopical and oral application [7]

Yagi et al reported that Aloe vera gel contains a gly-coprotein with cell proliferating-promoting activity whileDavis et al noted that Aloe vera gel improved wound healingby increasing blood supply (angiogenesis) which increasedoxygenation as a result [8 9] Angiogenesis is the growthof new blood capillaries and is a part of tissue regenerationA 1993 study showed that topical application of Aloe veragel reestablished vascularity of burn tissue for a guineapig although no specific constituents were identified [10]The Aloe vera gel polysaccharide acemannan was shown toactivate macrophages an effect that improved wound healingin a rat model [11 12] Two years later Davis et al reportedthat the low molecular weight component of freeze-driedAloe vera gel stimulated blood vessel formation in a chickchorioallantoicmembrane (ie a vascularmembrane derivedfrom developing chicken eggs) in addition a methanol-soluble fraction of the gel which contains a glycoprotein withmainly cell proliferating-promoting activity stimulated the

proliferation of artery endothelial cells in an in vitro assay andinduced them to invade a collagen substrate [13]

42 Skin Hydration Effect It was proposed that the Aloe veragel formulations with higher concentrations (025 ww and05 ww) improved skin hydration possibly by means of ahumectant mechanism Humectant mechanism means thatthe Aloe gel works by attracting water from the dermis belowand by helping to keep this water bound in the stratumcorneum [14]

43 Anti-Aging Effect Aloe has excellent anti-aging effect byproducing the collagen and elastin fibres making the skinmore elastic and less wrinkled as reported in an in vivo studyconducted onmouse ears by Davis et al [15] One of themainreasons for this lies in the plantrsquos unique ability to increaseproduction of human fibroblast cells between six and eighttimes faster than normal cell production Fibroblast cells arefound in the dermis of the skin and are responsible for thefabrication of collagen the skinrsquos support protein which keepsskin firm supple and youthful looking It was found thatAloe vera not only improved fibroblast cell structure but alsoaccelerated the collagen production process

44 Anti-Inflammatory Effects It inhibits the cyclooxygenasepathway and reduces prostaglandin E2 Recently the novelanti-inflammatory compound called C-glucosyl chromonewas isolated from gel extracts [16] In addition the peptidasebradykinase was isolated fromAloe and shown to break downthe bradykinin an inflammatory substance that induces pain[17]

45 Antibacterial Property The activity of Aloe vera innergel against both Gram-positive and Gram-negative bacte-ria has been demonstrated by several different methods[18] Streptococcus pyogenes and Streptococcus faecalis aretwo microorganisms that have been inhibited by Aloe veragel [19] Aloe vera gel reportedly was bactericidal againstPseudomonas aeruginosawhile acemannan prevented it fromadhering to human lung epithelial cells in a monolayerculture [20]

46 Antifungal Property A processed Aloe vera gel prepara-tion reportedly inhibited the growth ofCandida albicans [19]

47 Antiviral Property This actionmay be direct and indirectindirect due to stimulation of immune system and directdue to aloe emodin [21] Aloe emodin in Aloe vera makesit so that certain viruses are not able to function ThereforeAloe vera is virucidal to Herpes simplex virus type 1 and type2 Varicella zoster virus pseudorabies virus and influenzavirus according to the research of Thomson [22] Duringthe course of these studies it was found that the virucidalactivity was due to the anthraquinones extracted from theinner leaf ofAloe and the roots bark or leaves of a number ofother anthraquinone-containing plantsThe results indicatedthat aloe emodin directly affected both DNA- and RNA-containing enveloped viruses but had no effect on naked







































6 Conclusion




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Health & Medicine

Aloe vera - an ancient herb for modern dentistry