Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study
Author(s)
Abiodun Arinola Wright*,
Gbemisola Adewunmi Agbelusi,
Adeyinka Folashade Dayo,
Onomoare Juliana Olunuga
Affiliation(s)
Dental Department, Randle General Hospital, Lagos, Nigeria. Department of Preventive Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria. Department of Preventive Dentistry, Lagos University Teaching Hospital Idiaraba, Lagos, Nigeria.
Dental Department, Randle General Hospital, Lagos, Nigeria. Department of Preventive Dentistry, Faculty of Dental Sciences, College of Medicine, University of Lagos, Lagos, Nigeria. Department of Preventive Dentistry, Lagos University Teaching Hospital Idiaraba, Lagos, Nigeria.
ABSTRACT
Background: Herbal dentifrices appear to have become an attractive alternative for some consumers and its use has gained appreciable acceptance in Nigeria. This could be partly due to the perception that herbal toothpastes like other herbal products are “natural”, devoid of chemicals and therefore superior to regular toothpastes. Aggressive advertisement of the products may also contribute to this new trend. Mucosal symptoms such as glossitis and intolerance to spicy foods seen in patients attending the oral diagnosis clinic are usually associated with anaemia and nutritional deficiency states. The disturbing trend of an increasing number of patients presenting with such oral mucosal symptoms associated with the use of herbal dentifrices prompted this study. This trend was observed in two isolated oral medicine clinics. Objective: To sensitize oral health, allied professionals and consumers on the possible adverse effects of regular use of some herbal dentifrices sold in Nigeria. Materials and Methods: Routine patients of two oral medicine clinics in Lagos, namely the Randle General Hospital and the Lagos University Teaching Hospital who complained of some adverse mucosal signs and symptoms following the regular use of two identified herbal toothpastes made up the study population. The study was conducted between April 2010-April 2011. A detailed history and examination was carried out on these patients and clinical photographs of oral signs observed was taken in consenting patients. Data analysis was done using the Epi-info 6 software. P values ≤ 0.05 was considered statistically significant and data was presented in table format. Results: A total of 45 patients, 9 (20%) males and 36 (80%) fe-males were seen. The age range of patients was 14 - 78 years; mean age 45.5 ± 14.9 years. The duration of use of herbal dentifrices ranged from 2 weeks - 84 months (mean 24 ± 11.5 months). Oral signs and symptoms seen include, burning mouth and peppery sensation, mucosal erythema, lichenoid reaction, xerostomia, loss of taste sensation, angio-oedema and oral and peri-oral pigmentation. In many patients, resolution of symptoms was progressive within 2 weeks of withdrawal of the herbal toothpaste and its replacement with a conventional fluoride toothpaste. Most of the patients however required further treatment. A statistically significant association was found between the use of the identified herbal dentifrices and the following mucosal signs and symptoms namely, burning mouth and peppery sensation ,loss of taste sensation, soreness, erythema and lichenoid straie (p value ≤ 0.05). There was no statistically significant association between the use of herbal toothpaste and mucosal signs and symptoms of xerostomia, angular cheilitis, mucosal itching, angio-oedema and numbness (p value > 0.0.5) Conclusion: The regular use of the herbal dentifrices identified in this study can result in oral signs and symptoms affecting taste , nutrition, aesthetics and general oral physiology in some consumers. These findings suggest that further long term clinical trials need to be conducted on the herbal dentifrices to identify the noxious agents causing these symptoms. The formulation and use of these dentifrices need to be standardized and regulated. There is also a need to formulate a treatment protocol for these patients.
Background: Herbal dentifrices appear to have become an attractive alternative for some consumers and its use has gained appreciable acceptance in Nigeria. This could be partly due to the perception that herbal toothpastes like other herbal products are “natural”, devoid of chemicals and therefore superior to regular toothpastes. Aggressive advertisement of the products may also contribute to this new trend. Mucosal symptoms such as glossitis and intolerance to spicy foods seen in patients attending the oral diagnosis clinic are usually associated with anaemia and nutritional deficiency states. The disturbing trend of an increasing number of patients presenting with such oral mucosal symptoms associated with the use of herbal dentifrices prompted this study. This trend was observed in two isolated oral medicine clinics. Objective: To sensitize oral health, allied professionals and consumers on the possible adverse effects of regular use of some herbal dentifrices sold in Nigeria. Materials and Methods: Routine patients of two oral medicine clinics in Lagos, namely the Randle General Hospital and the Lagos University Teaching Hospital who complained of some adverse mucosal signs and symptoms following the regular use of two identified herbal toothpastes made up the study population. The study was conducted between April 2010-April 2011. A detailed history and examination was carried out on these patients and clinical photographs of oral signs observed was taken in consenting patients. Data analysis was done using the Epi-info 6 software. P values ≤ 0.05 was considered statistically significant and data was presented in table format. Results: A total of 45 patients, 9 (20%) males and 36 (80%) fe-males were seen. The age range of patients was 14 - 78 years; mean age 45.5 ± 14.9 years. The duration of use of herbal dentifrices ranged from 2 weeks - 84 months (mean 24 ± 11.5 months). Oral signs and symptoms seen include, burning mouth and peppery sensation, mucosal erythema, lichenoid reaction, xerostomia, loss of taste sensation, angio-oedema and oral and peri-oral pigmentation. In many patients, resolution of symptoms was progressive within 2 weeks of withdrawal of the herbal toothpaste and its replacement with a conventional fluoride toothpaste. Most of the patients however required further treatment. A statistically significant association was found between the use of the identified herbal dentifrices and the following mucosal signs and symptoms namely, burning mouth and peppery sensation ,loss of taste sensation, soreness, erythema and lichenoid straie (p value ≤ 0.05). There was no statistically significant association between the use of herbal toothpaste and mucosal signs and symptoms of xerostomia, angular cheilitis, mucosal itching, angio-oedema and numbness (p value > 0.0.5) Conclusion: The regular use of the herbal dentifrices identified in this study can result in oral signs and symptoms affecting taste , nutrition, aesthetics and general oral physiology in some consumers. These findings suggest that further long term clinical trials need to be conducted on the herbal dentifrices to identify the noxious agents causing these symptoms. The formulation and use of these dentifrices need to be standardized and regulated. There is also a need to formulate a treatment protocol for these patients.
Cite this paper
Wright, A. , Agbelusi, G. , Dayo, A. and Olunuga, O. (2012) Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study. Open Journal of Stomatology, 2, 27-32. doi: 10.4236/ojst.2012.21005.
Wright, A. , Agbelusi, G. , Dayo, A. and Olunuga, O. (2012) Oral and peri-oral signs and symptoms of herbal dentifrices in patients in two oral medicine clinics in Lagos—A preliminary study. Open Journal of Stomatology, 2, 27-32. doi: 10.4236/ojst.2012.21005.
References
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[1] [1] Jha, V. and Rathi, M. (2008) Natural medicines causing acute kidney injury. Seminars in Nephrology, 28, 416-428. doi:10.1016/j.semnephrol.2008.04.010 [2] Luyckx, V.A. and Naicker, S. (2008) Acute kidney injury associated with the use of traditional medicines. Nature Clinical Practice Nephrology, 4, 664-671. doi:10.1038/ncpneph0970 [3] JHA, V. (2010) Herbal medicines and chronic kidney disease. Nephrology, 15, 10-17. doi:10.1111/j.1440-1797.2010.01305.x [4] Brandt, H.D. and Muller, G.J. (1995) Traditional medicines and acute poisoning. Continuing Medical Education, 13, 1053-1060. [5] Hutchings, A. and Terblanche, S.E. (1989) Observations on the use of some known and suspected toxic lilliflorae in Xhosa and Zulu medicines. South African Medical Journal, 75, 62-69. [6] Steenkamp, V. (2003) Traditional herbal remedies used by South African women for gynaecological complaints. Journal of Ethnopharmacology, 86, 97-108. doi:10.1016/S0378-8741(03)00053-9 [7] Gogtay, N.J., Bhatt, H.A., Dalvi, S.S. and Kshirsagar, N.A. (2002) The use and safety of non-allopathic Indian medicines. Drug Safety, 25, 1005-1009. doi:10.2165/00002018-200225140-00003 [8] Association, B.M. (1993) Complementary Medicine. New Approaches to Good Practice. 1st Edition, Oxford University Press, Oxford. [9] Eisenberg, D., Kessler, R.C., Foster, C., Norlock, F.E., Calkins, D.R. and Delbanco, T.L. (1993) Unconventional medicine in the United States: Prevalence, costs, and patterns of use. New England Journal of Medicine, 328, 246-252. doi:10.1056/NEJM199301283280406 [10] Skidmore-Roth, L. (2001) Mosby’s handbook of herbs and natural supplements. 4th Edition, Mosby, St. Louis. [11] Presser, A.M. (2000) Pharmacist’s guide to medicinal herbs. 1st Edition, Smart Publications, Petaluma. [12] Barrett, B., Kiefer, D. and Rabago, D. (1999) Assessing the risks and benefits of herbal medicine: An overview of scientific evidence. Alternative Therapies in Health and Medicine, 5, 40-49. [13] Cohan, R.P. and Jacobsen, P.L. (2000) Herbal supplements: Considerations in dental practice. Journal of the California Dental Association, 28, 600-610. [14] Gruenwald, J. (2000) PDR for herbal medicine. 2nd Edition, Medical Economics. [15] Rees, A.M. (2001) Extent and usage of complementary and alternative medicine. In: Rees, A.M., Ed., The Complementary and Alternative Medicine Information Source Book, Oryx Press, Phoenix, 3. [16] White, L.B. and Foster, S. (2000) The herbal drugstore: The best natural alternatives to over-the-counter and prescription medicines. Rodale, Inc., Emmaus. [17] Sean, S.L., Zhang, W. and Li, Y. (2004) The antimicrobial potential of 14 natural herbal dentifrices: Results of an in vitro diffusion method study. Journal of the American Dental Association, 135, 1133-1141. [18] Goldstern, B.H. and Epstein, J.B. (2000) Unconventional dentistry, part IV unconventional dental practices and products. Journal of the Canadian Dental Association, 66, 564-548. [19] Moran, J., Addy, M. and Newcombe, R. (1991) Comparison of an herbal tooth-paste with a fluoride toothpaste on plaque and gingivitis. Clinical Preventive Dentistry, 13, 12-15. [20] Thibault, C. (2001) Update on toothpastes. Probe, 35, 25-28. [21] Li, Y. (1997) Toxicological considerations of tooth bleaching using peroxide-containing agents. Journal of the American Dental Association, 128, 31s-36s. [22] Nutrition News Focus (1999) Everywhere you turn: Herbs. http://www.nutritionnewsfocus.com/ [23] Eisenberg, D.M., Davis, R.B., Ettner, S.L., Appel, S., Van Rowpay, M. and Kessler, R.C. (1998) Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. Journal of the American Medical Association, 280, 1569-1575. doi:10.1001/jama.280.18.1569 [24] Estafan, D., Gultz, J., Kaim, J.M., Khaghany, K. and Scherer, W. (1988) Clinical efficacy of a herbal toothpaste. Journal of Clinical Dentistry, 9, 31-33. [25] Mullally, B.H., James, J.A., Coulter, W.A. and Linden, G.J. (1995) The efficacy of a herbal based toothpaste on the control of plaque and gingivitis. Journal of Clinical Periodontology, 22, 686-689. doi:10.1111/j.1600-051X.1995.tb00827.x [26] George, J., Hedge, S., Rajesh, K.S. and Kumar, A. (2009) The efficacy of a herbal based toothpaste in the control of plaque and gingivitis: A clinico-biochemical study. Indian Journal of Dental Research, 20, 480-482. [27] Ozaki, F., Pannuti, C.M., Imbronito, A.V., Pessotti, W., Saraiva, L., De Freitas, N.M., Ferrari, G. and Cabral, V.N. (2006) Efficacy of a herbal toothpaste on patients with established gingivitis—A randomized control trial, Brazilian Oral Research, 20, 172-177. doi:10.1590/S1806-83242006000200015 [28] Anil, S. (2007) Plasma cell gingivitis among herbal toothpaste users: A report of three cases. Journal of Contemporary Dental Practice, 8, 60-66.