Ramin Nasimi Doost Azgomi¹, Abolfazl Akbarzadeh ^3,4, Fatemeh Ebrahimi ² and Zoleikha  Khoshbakht² and Arezoo Moini  Jazani¹

¹Medical Philosophy and History Research Center , School of Traditional Medicine, Tabriz University of Medical Siences, Tabriz, Iran.

²Department of Traditional Pharmacy,School of Traditional Medicine,Tabriz University of medical Sciences,Tabriz,Iran.

³Stem Cell Research Center,Tabriz University of Medical Sciences, Tabriz, Iran.

⁴Universal Scientific Education and Research Network(USERN), Tabriz, Iran.

Corresponding Author E-mail: dr.moeeni@yahoo.com

DOI : https://dx.doi.org/10.13005/bpj/1065

Abstract

Oral diseases such as tooth loss, periodontal disease, dental caries, oral mucosal lesions and oropharyngeal cancers are chief communal health troubles in the worldwide. Dental caries, as a type of dental diseases, affects 60–90% of school-aged children and the common of adults in the majority industrialized countries. Sanoon is a pharmaceutical dosage form designed for treatment of oral cavity diseases that  contains all kinds of mono component or multi component dosage forms with the ability of gum tonic that is finely powdered and used by sprinkling or rubbing it to the gum and dental surfaces. The purpose of the present study is to discuss about different formulation of sanoon dosage form and find confirmation of their effectiveness in the treatment of dental.

Keywords

Oral diseases; Dental caries; Sanoon; oropharyngeal cancers

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Copy the following to cite this article: Azgomi R. N. D, Akbarzadeh A, Ebrahimi F, Khoshbakht Z, Jazani A. M. Sanoon: A Specialized Dosage form for Dental Diseases in Traditional Persian Medicine. Biomed Pharmacol J 2016;9(3).

Copy the following to cite this URL: Azgomi R. N. D, Akbarzadeh A, Ebrahimi F, Khoshbakht Z, Jazani A. M. Sanoon: A Specialized Dosage form for Dental Diseases in Traditional Persian Medicine. Biomed Pharmacol J 2016;9(3). Available from: http://biomedpharmajournal.org/?p=9665

Introduction

Oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers are major public health problems in the worldwide .Despite low mortality  of dental diseases, these disorders impact considerably on general health and quality of life. Teeth have  important role  in eating ability, primary digestion the food, speech, facial appearance and self confidence (2). Dental caries, as a kind of dental diseases, affects 60–90% of school-aged children and the majority of adults in most industrialized countries (1). Dental diseases impose economic burden to health care services. In some countries, the cost of treatment of dental caries  is  about 5 to 10 % of its total health budget(2).

From ancient times the mankind has used materials found in nature as a remedy for his various diseases (3). Afterwards the application of herbal, mineral and animal parts for making medicaments improved impressively in major traditional medicines: Chinese, Ayurveda and Persian(4),(5) .Among these medical systems Traditional Persian Medicine is one of the richest and oldest systems with various medical and pharmaceutical manuscripts(6, 7). Medieval Persian physicians and philosophers had described anatomy of the oral structure including mouth and tongue, tooth and gingiva and lips and related diseases and their treatments comprehensively(8). A brief search in TPM literatures shows more than one hundred dosage forms, including some specialized ones like Sanoon(6),(7). Sanoon is a pharmaceutical dosage form designed for treatment of oral cavity diseases, particularly dental problems in TPM. It contains all kinds of mono component or multi component dosage forms with the ability of gum tonic that is finely powdered and used by sprinkling or rubbing it to the gum and dental surfaces(7, 9, 10). and alternative to conventional treatment.

Method

In this study, first we searched TPM books or pharmaceutical manuscripts of Persian scientist during 9th to 18th century AD such as Al-Abniyah an haqaiq al-adviyah, the Canon )Qanun fi- tebb(, Makhzan-al-Aadvia, Tuhfatul-mumenin, main Qarabadin books of Traditional Persian Medicine for finding different dosage forms used in treatment of oral cavity diseases. In this preliminary study, we found out that sanoon  is  the most exclusive dosage forms in treatment of dental diseases. In the second part of this study, different types of sanoon were derived from Qarabadins books such as Canon of Medicine, Qarabadin Kabir, Qarabadin Shafahi, Qarabadin Ghaderi, Qarabadin Salehi, Tuhfatul-mumenin. Qarabadins books are the main Traditional Persian  pharmacological text books that explain the preparation procedures, components and indications of compound drugs.  All herbs used in these manuscripts with their indications and the processes of the preparation were extracted. Then the most repetitive plants were derived and listed. Afterwards we matched listed medicinal plant names with scientific name. At last these plants were screened in electronic databases including Google scholar, Scopus, PubMed  to find possible evidence of their efficacy in the treatment of dental diseases in Modern medicine. The positive findings have been shown in the result section. Because medicinal plants used  individually in a form of sanoon,in this part of the study, these herbs with their nature and indications were also derived from Makhzan-al-Aadvia, Al-Abniyah an haqaiq al-adviyah, Tuhfatul-mumenin,Qanun fi- tebb, Al-Havi.

Result

Some types of oral  dosage forms suggested in Traditional Persian Pharmacological text books for treatment of oral cavity disorders. The most common dosage forms included; oral fumigation(Bakhoor), gurgle(Gharghareh), mouthwash(Mazmazeh), tooth powder(Sanoon), oral dusting powder(Zaroor) and oral cooling(Barood). Sanoon, tooth powder, is a specific dosage form for dental diseases that rubbed on the teeth and gingiva. Sanoon was used in the form of powder. For preparing  Sanoon, medicinal herbs that are used in this dosage form need to be dried  and then usually grinded. According to the indications, the particles of  the powder may be very fine or coarse. For example, in  strengthener Sanoon, used plants must be grinded finely as possible.In return, particle of polisher Sanoon should be coare and incomplete powdered.In this formulation, salt were parched and added to the powder. Brushing teeth is necessary before using Sanoon and stomach must be empty. For applying Sanoon,first wet the index finger with water, then put the finger into the tooth powder and rub it on the teeth and gum twice a day. During the usage of Sanoon, Keep the mouth open and rub it sequentially. Wait an hour until  saliva be removed. Sanoon as a specific dosage form was administered for dental diseases like

toothache and inflammation, loose teeth, discoloration of the teeth, aphthous, halitosis, carious teeth, oral sores, gingival sores and gingival health. The shelf life of Sanoon was 1-6 month. Table 1 shows medicinal plants were used individually in TPP as Sanoon with their scientific names, traditional names, nature, indications and parts used. Nature is the predominant quality(10). Few formulations of Sanoon dosage forms that were used in TPP have been shown in Table 2. Formulation names, indications, ingredi­ents, scientific names of plant drugs and preparation procedures are also indicated in Table 2. Repetitive medicinal plants used in the formulation of Sanoon are Punica   granatum, Terminalia chebula, Tamarix gallica, Cyperus lungus, Quercus Spp,Piper nigrum L. Peganum

Table 1 Click here to View table

Punica granatum

Eques and ethanolic  extracts of peel and seed of poom granatum have demonstrated anticandidia effects and equeous extract has been more effective than ethanolic extract(11). In another study it has been found that gel content pomgranatum seeds was as effective as chlorhexidine gel in prevention plaqe formation(12).and this can be linked  to antibacterial and anti-inflammatory activity of pome granatum(13).Equeous and ethanolic extract of pome granatum is also effective in decreasing the entiretime of recurrent aphtus and this effect likely connectes to phenolic component(14).mouthrinsing content chamomile and pome granatum extract have an important role in gingival bleeding reduction(15).

Terminalia chebula

The fruit  of terminalia chebula are used in iranian  traditional oral  dosage forms.studies have demonstrated that mouth  rinsing  content  terminalia chebula are effective in reduction microbial plaques,  gingival  inflammation and nutrilizing salivary PH(16).Nayak et al  approved a reduction of 35-48% at salivary streptococos mutans content forming  units at 60 minute after rinsing  with  ethanolic extract of terminalia chebula  and streptococos  mutans counts were  low up to 6  hours post rinsing.(terminalia 6).The result of in vivo  comparative study of   emblica officinalis  and terminalia chebula extract  with chlorhexidine as an anti carries agent ,showed that the equeous  herbal extract of terminalia chebula  and emblica officinalis were more effective  than chlorhexidine mouth wash,but with less time of action than chlorhexidine.(terminalia 4).

Tamarix gallica

The fruits of this tree are used in the formulation of mouth  and teeth Iranian traditional  dosag form .one species of tamarix (tamarix boveana) has shown anti oxidant and free radical scavenging  activity .(tamarix 3).another species(tamarix aphylla)has antimicrobial potential of alkaloids and flavenoids extracted .(tamarix 4).it has also shown anti inflammatory and analgesic effects(tamarix 5).

Cyperus lungus

The rhizomes of cyperus lungus are used in iranian traditional medicine.sesquiterpenoids extracted from a species of cyperus(cyperus rotundus)have shown anti hepatit B virus activity(17).in an in vitro syudy  methanolic extract of cyperus longus acts  as analgesic  substance(18).

Peganum harmala

Peganum harmala seeds, known as espand in Persian, are used in several sanoon formulations with different purposes such as dental and gum restoration, oral cavity disinfection, teeth whitening and aphthous stomatitis treatment.(Ref) The alkaloids constitute main phytochemicals of P. harmala seeds, specially harmaline and harmine which are toxic in nature.(19) The alkaloids are the origin of espand’s  antibacterial (20),(21) antifungal, (20) antiparasidal (22)and insecticidal(19) activities. In one study the extract of its β-carboline alkaloids and chiefly harmine showed significant inhibitory effects against Proteus vulgaris, Bacillus subtilis and Candida albicans.(20) In another study Staphylococcus aureus, Saccharomyces cerievisae and E. coli were much sensitive than other microorganisms to ethanolic extract of alkaloids.(21) Ethyl acetate extract of espand seeds exhibited significant analgesic and anti-inflammatory effects in compare with aspirin and diclofenac as standards in rats.(23) The anti-oxidant properties of P. harmala seeds, extracted with ethanolic, hydro-alcoholic and aqueous solvents, were determined by DPPH free radical scavenging method. (24)

Quercus Spp.

Galls of Quercus spp. Are kind of abnormal plant growth on leaves caused by certain insects. They are great source of polyphenol compounds called tannic acid.(25, 26) gall (Afes) is used in sanoon formulation for treatment of weak gums and aphthous stomatitis. (ref)  because of  its high tannin content nutgall shows antibacterial, antiviral, antifungal, larvicidal, antioxidant and hepatoprotective affects. Antiviral properties of hydrolysable tannins against herpes simplex virus (HSV), human immunodeficiency virus (HIV) and leukemia virus has been demonstrated.(27) Chursi S showed the abiity of methanol extract of Quercus infectoria nutgalls to destroy bacteria cell membrane in methicillin-resistant Staphylococcus aureus infections.(28, 29) Also the effectiveness of its ethanolic extract against a wide range of important bacteria has been studied.(30) Quercus infectoria nutgall extracts and fractions could properly control the Culex pipiens larvae(31) and fabrics treated with oak gall extracts showed high anticandidal effects.(32) Polyphenols in galls act as free radical scavengers and with antioxidant activity protect cell in oxidative stress conditions.(33, 34) Besides, because of potent antioxidant and antiinflamatory effects of oak gall extracts they can be potentially used as hepatoprotective compounds(35, 36).

Piper nigrum L

Fruits of black pepper have been used in sanoon formulations to fortify gum and teeth and modulate toothache.(Ref) Alkaloids, glycosides, terpenoids, steroids, flavonoids, tannins and saponins are phytochemical contents of P. nigrum fruits. The ethanolic extract of P. nigrum fruits was examined against several common microorganisms which cause infections in oral cavity. The results demonstrated high antimicrobial effects of extract against Enterococcus faecalis, Lactobacillus acidophilus , Candida albicans and Candida tropicalis compared to chlorhexidine as standard.(37) The anti-inflammatory properties of piperine, the main alkaloid of P. nigrum, investigated using carrageen-induced rat paw edema method. The prostaglandin release inhibition occured by administering 5 and 10 mg/kg of piperine to rats following by 1% of carrageenan. (38)further studies showed antipyretic activity of piperin in rats.(39) In addition, decreasing oxidative stress to the cells induced by a high-fat diet approved the anti-oxidant ability of piperine alkaloid.(40)

Rhus coriaria

Rhus coriaria with common name of sumac has been used in TPM for treatment of gums weakness, aphthous stomatitis and toothache.(Ref) Many phytochemicals such as tannins, (iso)flavonoids, terpenoids, etc are reported in sumac fruits.(41) The antimicrobial effects of Rhus coriaria water extract on food borne pathogens has been shown. Among these gram positive and gram negative bacterial strains, Bacillus species were most susceptible.(42) In other study its water extract possessed antibacterial activity against five common oral bacteria including four streptococcus species and E. faecalis. Besides, the extract inhibited the formation of bacterial biofilm on orthodontic wire.(43) Several phytochemicals showing antifungal activity are identified from ethanolic extract of sumac seeds.(44) The phenolic content of sumac comprising anthocyanins and hydrolysable tannins causes it to show strong antioxidant activity.(45) In one animal study rats with periodontitis were subjected to systemic administration of ethanolic extract of Rhus coriaria and reduction in alveolar bone loss by affecting receptor activator of nuclear factor-kappa B ligand(RANKL)/ osteoprotegerin(OPG) balance, total oxidant status(TOS) and oxidative stress index(OSI) levels were reported.(46)

Syzygium aromaticum(Eugenia caryophyllata Thunb)

S. aromaticum with traditional name of gharanfol has been used in TPM  for  treatment of mental , respiratory, gastro intestinal,urinary tract disease, gums and dental weakness, halitosis. Saponins, tannins, phenols, cardiac glycoside, Anthracene, flavonoids and alkaloids are the main phytochemical compounds of Z. aromaticum flower.  The antimicrobial effects of clove flower (Syzygium aromaticum) bud on dental pathogens  has been shown  in some studies(47, 48). Aqueous extract of Cloves flower (S. aromaticum)  has antimicrobial effect on gram positive,gram negative bacteria and fungi including Staphylocococcus epidermis, Escherichia coli, Proteus mirabilis, Klebsiella pnuemoniae, Aspergillus niger, Candida albicans, Rhizopus oryzae(47, 49). In other study,its aqueous extract had antimicrobial activity against some standard strains of food—borne pathogen bacteria(S. aureus, S. typhimurium and E. coli and normal flora S. epidermidis and L. Plantarum)(50).  Other study revealed that Eugenia essential oil possessed an excellent antibacterial activity against oral streptococci including the cariogenic bacteria as well as an excellent antifungal activity(51). In an in vitro study, the antioxidant activity of water and ethanol extracts of clove (Eugenia carophyllata) buds and lavender (Lavandula stoechas L.) against various antioxidant systems has been shown and compered (52). Based on data obtained from other in vitro study, clove essential oil and its two active principle(eugenol and eugenyl-acetate) may positively affect the dental erosion process of apple juice through distinct mechanisms. In this study, clove-oil-treated teeth showed decreased decalcification with respect to control(53). In  an in vivo study,Eugenia caryophyllata  powder had anesthetic effect on a kind of fish (Huso Huso )(54). Anti-inflammatory effects of eugenol nanoemulsion were shown in an animal model study.In this study, O/W nanoemulsion of eugenol was used in rats for the evaluation of anti-inflammatory effects as a topical delivery system(55).

Anacyclus pyrethrum 

The root of Anacyclus Pyrethrum has therapeutic effects. The compounds of this plant are Pyrethrine, resinous, pelletonin, tannin, gum, potassium sulfate and carbonate, potassium chloride,calcium phosphate, and carbonate. This plant has been used for treatment of neurologic, respiratory,dental , periodontal and gingival diseases, Stuttering and toothache in TPM(10, 56) . In an in vitro study, methanolic extract of Anacyclus Pyrethrum root produced little antibacterial effect against Staphylococcus aureus and Streptococcus sanguis(57).

Rosa damascena 

This plant  has several compounds such as ter­penes, glycosides, flavonoids, and anthocyanins. The therapeutic uses of R. damascena in TPM include the treatment of abdominal, heart  and lung diseases, menstrual bleeding, gums and dental weakness, halitosis , digestive problems the reduction of inflammation, coughing, thirst and wound healing(10, 56).. In some animal Model studies, analgesic and anti-inflammatory effects of Rosa damascena hydroalcoholic extract has been shown (58, 59).The effectiveness of mouthwash containing Rosa damascena extract in the treatment of 50 patiant suffering recurrent aphthous stomatitis(comparing to the placebo) has been shown in a randomized, double-blinded, placebo-controlled clinical trial study (60).According to an in vitro study,the ethyl  alcohol and acetone water extracts of R. damascene had antimicrobial effects against P.aueroginosa,C.albicans and E.coli. Among these microorganism, Pseudomonas.aueroginosa was the most susceptible(61).

Conclusion

Dental diseases are one of the major public health problems in the worldwide. Traditional Medical literature reviews shows that oral and dental health are important because there are  separate chapters in the main TPM textbook about oral and dental care.This paper showed that sanoon is a specific dosage forms for the treatment of dental diseases with different type of medicinal plants in TPM and the general survey of  pharmacological effects of these medicinal plants ( Punica   granatum, Terminalia chebula, Tamarix gallica, Cyperus lungus, Quercus Spp,Piper nigrum L., Peganum harmala, Syzygium aromaticum(Eugenia caryophyllata  Thunb) ,Rhus coriaria, Anacyclus pyrethrum ,Rosa damascene ) used in the multiple formulations of sanoon mentioned that these plants have different medicinal properties like antibacterial, antiviral, antifungal, antioxidant, gingival  inflammation activity anti-inflammatory, antipyretic, analgesic, prevention plaqe, gingival bleeding reduction, anti aphtus and reduction microbial plaques.There fore,modern investigations confirmed the efficacy of some plants which have been traditionally used in Sanoon. Based on the results of the present study and according to the  pharmacological characteristics of Sanoon,  this dosage form may be useful in the treatment of dental diseases due to easier,specific  and efficient delivary of drugs to the oral cavity  by lower systemic side effects. We suggest making different Sanoon with efficient medicinal herbs to improve oral and dental health and eventually public health in the community.

Authors ’ contributions

AA conceived of the study and participated in its design and coordination. EA, and YP participated in the sequence alignment and drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgments

This work is funded by a 2015 grant Stem Cell Research Center,Tabriz University of Medical Sciences.

Declaration of interest

The authors report no declaration of interest. The authors alone are responsible for the content and writing of the paper

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