Open Journal Systems

Cover Image

Complementary therapy for periodontal diseases: Antimicrobials and antioxidants

Ridhima Seth


Background: It is a well-known fact that reactive oxygen species (ROS) play a key role in the pathogenesis of chronic inflammatory diseases such as periodontal diseases. Antioxidants are the molecules that inhibit oxidation reaction and thereby terminate the chain reaction caused by free radicals, hence preventing cell damage. There are multiple sources of antioxidants which include cereals, fruits, vegetables, chocolate, oils, and beverages such as tea, coffee, wine, and fruit juices. The periodontal tissues require an optimum level of antioxidants to prevent as well as to reduce tissue damage caused by ROS generated by pathogenic bacteria in dental plaque. Recent studies have started focussing on the use of antioxidants in the treatment of periodontal diseases as well as to maintain gingival health. Aim: Earlier studies that investigated the effects of antioxidants on periodontal diseases have demonstrated that antioxidants have anti-inflammatory properties. Although numerous studies demonstrated the relationship between antioxidants and periodontal diseases, the number of studies in humans is limited. The present review discusses the importance of antioxidants and antimicrobials in maintaining periodontal health and hence, their role as a complementary therapy in periodontal diseases. Conclusion: Dietary antioxidants play a key role in the maintenance of oral health and have the potential to influence periodontal disease management, which positively affects clinical outcomes. Thus, obtaining enough antioxidants through our diet to promote healthier tissues is essential to reduce the unwanted effects of free radicals. This explains the indispensable role of dietary antioxidants in periodontal health. Clinical Significance: The application of antioxidants and antimicrobials in periodontal therapies has opened a new window for the prevention and treatment of periodontal diseases. There is supporting evidence from multiple studies that an increased intake of antioxidants in the daily diet reduces the risk of several chronic diseases. Oxidative stress is an essential factor in periodontitis and studying the antioxidant defense mechanisms helps in better understanding of underlying tissue damage mechanisms and hence, novel therapeutic interventions. Therefore, the daily intake of natural antioxidants is recommended for the prevention and treatment of periodontitis.


Antimicrobials; antioxidants; gingival diseases; periodontitis; reactive species

Full Text:

Abstract PDF


Eick S, Schäfer G, Kwieciński J, Atrott J, Henle T, Pfister W. Honey-a potential agent against Porphyromonas gingivalis: An in vitro study. BMC Oral Health 2014;14:24.

Talmaç AC, Çalişir M. Antioxidants and Periodontal Diseases: Gingival Disease-a Professional Approach for Treatment and Prevention. London, United Kingdom: IntechOpen; 2019.

Kurita-Ochiai T, Jia R, Cai Y, Yamaguchi Y, Yamamoto M. Periodontal disease-induced atherosclerosis and oxidative stress. Antioxidants 2015;4:577-90.

Loesche W. The antimicrobial treatment of periodontal disease: Changing the treatment paradigm. Crit Rev Oral Biol Med 1999;10:245-75.

Califano JV. Position paper: Periodontal diseases of children and adolescents. J Periodontol 2003;74:1696-704.

Klein B, Tenorio E, Lazinski D, Camilli A, Duncan M, Hu L. Identification of essential genes of the periodontal pathogen Porphyromonas gingivalis. BMC Genomics 2012;13:578.

Najeeb S, Zafar M, Khurshid Z, Zohaib S, Almas K. The role of nutrition in periodontal health: An update. Nutrients 2016;8:530.

Sheets S. Gingipain-dependent interactions with the host are important for survival of Porphyromonas gingivalis. Front Biosci 2008;13:3215.

Herrera D, Alonso B, León R, Roldán S, Sanz M. Antimicrobial therapy in periodontitis: The use of systemic antimicrobials against the subgingival biofilm. J Clin Periodontol 2008;35:45-66.

Müller H, Lange D, Mïller R. A 2-year study of adjunctive minocycline-HCl in Actinobacillus actinomycetemcomitansassociated periodontitis. J Periodontol 1993;64:509-19.

Muller H, Lange D, Muller R. Failure of adjunctive minocycline- HCI to eliminate oral Actinobacillus actinomycetemcomitans. J Clin Periodontol 1993;20:498-504.

Lindhe J, Liljenberg B. Treatment of localized juvenile periodontitis. Results after 5 years. J Clin Periodontol 1984;11:399-410.

Kornman K, Robertson P. Clinical and microbiological evaluation of therapy for juvenile periodontitis. J Periodontol 1985;56:443-6.

Mandell R, Tripodi L, Savitt E, Goodson J, Socransky S. The effect of treatment on Actinobacillus actinomycetemcomitansin localized juvenile periodontitis. J Periodontol 1986;57:94-9.

Jaffin R, Greenstein G, Berman C. Treatment of juvenile periodontitis patients by control of infection and inflammation: Four case reports. J Periodontol 1984;55:261-7.

Mahmood M, Dolby A. The value of systemically administered metronidazole in the modified widman flap procedure. J Periodontol 1987;58:147-52.

Söder B, Nedlich U, Jin L. Longitudinal effect of non-surgical treatment and systemic metronidazole for 1 week in smokers and non-smokers with refractory periodontitis: A 5-year study. J Periodontol 1999;70:761-71.

Haffajee A, Dzink J, Socransky S. Effect of modified widman flap surgery and systemic tetracycline on the subgingival microbiota of periodontal lesions. J Clin Periodontol 1988;15:255-62.

Barça E, Çifçibaşı E, Çintan S. Adjunctive use of antibiotics in periodontal therapy. J Istanb Univ Fac Dent 2015;49:55.

Miremadi S, Cosyn J, Bryun H. Guidelines for the use of antimicrobial agents in the treatment of chronic periodontitis in Belgium. Rev Belge Med Dent (1984) 2008;63:91-6.

Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol 2002;29:136-59.

Lindhe J, Palmer R. Group C summary. J Clin Periodontol 2002;29:160-2.

Walker C. The acquisition of antibiotic resistance in the periodontal microflora. Periodontology 2000 1996;10:79-88. 24. Goodson J. Antimicrobial strategies for treatment of periodontal diseases. Periodontology 2000 1994;5:142-68.

Oteo A, Herrera D, Figuero E, O’Connor A, González I, Sanz M. Azithromycin as an adjunct to scaling and root planing in the treatment of Porphyromonas gingivalis-associated periodontitis: A pilot study. J Clin Periodontol 2010;37:1005-15.

Silva M, Feres M, Sirotto TO, Soares GS, Mendes JV, Faveri M, et al. Clinical and microbiological benefits of metronidazole alone or with amoxicillin as adjuncts in the treatment of chronic periodontitis: A randomized placebo-controlled clinical trial. J Clin Periodontol 2011;38:828-37.

Mestnik M, Feres M, Figueiredo L, Duarte P, Lira E, Faveri M.

Short-term benefits of the adjunctive use of metronidazole plus amoxicillin in the microbial profile and in the clinical parameters of subjects with generalized aggressive periodontitis. J Clin Periodontol 2010;37:353-65.

Yek E, Cintan S, Topcuoglu N, Kulekci G, İssever H, Kantarci A. Efficacy of amoxicillin and metronidazole combination for the management of generalized aggressive periodontitis. J Periodontol 2010;81:964-74.

Giles G, Jacob C. Reactive sulfur species: An emerging concept in oxidative stress. Biol Chem 2002;383:375-88.

Shih P, Yeh C, Yen G. Anthocyanins induce the activation of

Phase II enzymes through the antioxidant response element pathway against oxidative stress-induced apoptosis. J Agric Food Chem 2007;55:9427-35.

Rababah T, Hettiarachchy N, Horax R. Total phenolics and antioxidant activities of fenugreek, green tea, black tea, grape seed, ginger, rosemary, gotu kola, and ginkgo extracts, Vitamin E, and tert-butylhydroquinone. J Agric Food Chem 2004;52:5183-6.

Lotito S, Frei B. Consumption of flavonoid-rich foods and increased plasma antioxidant capacity in humans: Cause, consequence, or epiphenomenon? Free Radic Biol Med 2006;41:1727-46.

Lu J, Yao Q, Chen C. Ginseng compounds: An update on their molecular mechanisms and medical applications. Curr Vasc Pharmacol 2009;7:293-302.

DeFeudis F, Papadopoulos V, Drieu K. Ginkgo biloba extracts and cancer: A research area in its infancy. Fundam Clin Pharmacol 2003;17:405-17.

Lü J, Lin P, Yao Q, Chen C.Chemical and molecular mechanisms of antioxidants: Experimental approaches and model systems. J Cell Mol Med 2009;14:840-60.

Vajragupta O, Boonchoong P, Berliner L. Manganese complexes of curcumin analogues: Evaluation of hydroxyl radical scavenging ability, superoxide dismutase activity and stability towards hydrolysis. Free Radic Res 2004;38:303-14.

Panchatcharam M, Miriyala S, Gayathri V, Suguna L. Curcumin improves wound healing by modulating collagen and decreasing reactive oxygen species. Mol Cell Biochem 2006;290:87-96.

Leke N, Grenier D, Goldner M, Mayrand D. Effects of hydrogen peroxide on growth and selected properties of Porphyromonas gingivalis. FEMS Microbiol Lett 1999;174:347-53.

Chapple I. Role of free radicals and antioxidants in the pathogenesis of the inflammatory periodontal diseases. Mol Pathol 1996;49:M247-55.

Hossai M, Asada K. Monodehydroascorbate reductase from cucumber is a flavin adenine dinucleotide enzyme. J Biol Chem 1985;260:12920-6.

McKenzie R, Johnson N, Aruni W, Dou Y, Masinde G, Fletcher H. Differential response of Porphyromonas gingivalis to varying levels and duration of hydrogen peroxide-induced oxidative stress. Microbiology 2012;158:2465-79.

Rashed H. Evaluation of the effect of hydrogen peroxide as a mouthwash in comparison with chlorhexidine in chronic periodontitis patients: A clinical study. J Int Soc Prev Commun Dent 2016;6:206.

Wolff L, Bandt C, Pihlstrom B, Brayer L. Phase contrast microscopic evaluation of subgingival plaque in combination with either conventional or antimicrobial home treatment of patients with periodontal inflammation. J Period Res 1982;17:537-40.

Jindal M, Tripathi P, Blaggana V, Upadhyay P, Gupta S, Nishat S. Antioxidant therapy (lycopene and green tea extract) in periodontal disease: A promising paradigm. J Indian Soc Periodontol 2019;23:25.

Belludi S, Verma S, Banthia R, Bhusari P, Parwani S, Kedia S, et al. Effect of lycopene in the treatment of periodontal disease: A clinical study. J Contemp Dent Pract 2013;14:1054-9.

Preshaw P. Definitions of periodontal disease in research. J Clin Periodontol 2009;36:1-2.

Ambati M, Koduganti R, Reddy P. Systemic lycopene as an adjunct to scaling and root planing in chronic periodontitis patients with Type 2 diabetes mellitus. J Int Soc Prev Commun Dent 2015;5:25

Kawata A, Murakami Y, Suzuki S, Fujisawa S. Anti inflammatory activity of β-carotene, lycopene and tri-n-butylborane, ascavenger of reactive oxygen species. In Vivo 2018;32:255-64.

Guimarães M, Coimbra L, de Aquino S, Spolidorio L, Kirkwood K, Rossa C. Potent anti-inflammatory effects of systemically administered curcumin modulate periodontal disease in vivo. J Period Res 2011;46:269-79.

Sharma R. Phase I clinical trial of oral curcumin: Biomarkers of systemic activity and compliance. Clin Cancer Res 2004;10:6847-54.

Nugala B, Namasi A, Emmadi P, Krishna P. Role of green tea as an antioxidant in periodontal disease: The Asian paradox. J Indian Soc Periodontol 2012;16:313.

Niki E. Assessment of antioxidant capacity in vitro and in vivo. Free Radic Biol Med 2010;49:503-15.

Singhal R, Siddibhavi M, Sankeshwari R, Patil P, Jalihal S, Ankola A. Effectiveness of three mouthwashes-manuka honey, raw honey, and chlorhexidine on plaque and gingival scores of 12-15-year-old school children: A randomized controlled field trial. J Indian Soc Periodontol 2018;22:34-9.

Dabholkar C. Comparative evaluation of antimicrobial activity of pomegranate-containing mouthwash against oral-biofilm forming organisms: An in vitro microbial study. J Clin Diagn Res 2016;10:ZC65-9.

Charde P. Comparative evaluation between honey and chlorhexidine gluconate on the dental plaque levels and gingival health. Adv Dent Oral Health 2016;1:555571.

Neelam A, Singh DP. Punica granatum: A review on pharmacological and therapeutic properties. J Pharm Sci Res 2012;3:1240-5.

Jurenka JS. Therapeutic applications of pomegranate (Punica granatum L.): A review. Altern Med Rev 2008;13:128‐44.

Sastravaha G, Yotnuengnit P, Booncong P, Sangtherapitikul P. Adjunctive periodontal treatment with Centella asiatica and Punica granatum extracts. A preliminary study. J Int Acad Periodontol 2003;5:106‐15.

Bhadbhade SJ, Acharya AB, Rodrigues SV, Thakur SL. The antiplaque efficacy of pomegranate mouthrinse. Quintessence Int 2011;42:29‐36.

Närhi T, Tenovuo J, Ainamo A, Vilja P. Antimicrobial factors, sialic acid, and protein concentration in whole saliva of the elderly. Eur J Oral Sci 1994;102:120-5.

Somu C, Ravindra S, Ajith S, Ahamed M. Efficacy of a herbal extract gel in the treatment of gingivitis: A clinical study. J Ayurveda Integr Med 2012;3:85.

Kalmar J, Arnold R. Killing of Actinobacillus actinomycetemcomitans by human lactoferrin. Infect Immun 1988;56:2552-7.

Wakabayashi H, Kondo I, Kobayashi T, Yamauchi K, Toida T, Iwatsuki K, et al. Periodontitis, periodontopathic Bacteria and lactoferrin. Biometals 2010;23:419-24.

Berlutti F, Pilloni A, Pietropaoli M, Polimeni A, Valenti P. Lactoferrin and oral diseases: Current status and perspective in periodontitis. Ann Stomatol (Roma) 2011;2:10‐8.

Lee W, Davis K, Rettmer R, Labbe R. Ascorbic acid status: Biochemical and clinical considerations. Am J Clin Nutr 1988;48:286-90.

Rathee D, Bhoria D, Kundu D. Vitamin C and oral health: A review. Indian J Appl Res 2011;3:462-3.

Kurutas E. The importance of antioxidants which play the role in cellular response against oxidative/nitrosative stress: Current state. Nutr J 2015;15:71.

Singh N, Narula SC, Sharma RK, Tewari S, Sehgal PK. Vitamin E supplementation, superoxide dismutase status, and outcome of scaling and root planing in patients with chronic periodontitis: A randomized clinical trial. J Periodontol 2014;85:242-9.

Boyle W, Simonet W, Lacey D. Osteoclast differentiation and activation. Nature 2003;423:337-42.

Masui T, Sakano S, Hasegawa Y, Warashina H, Ishiguro N. Expression of inflammatory cytokines, RANKL and OPG induced by titanium, cobalt-chromium and polyethylene particles. Biomaterials 2005;26:1695-702.

Perayil J. Influence of Vitamin D and calcium supplementation in the management of periodontitis. J Clin Diagn Res 2015;9:ZC35-8.

Miley D, Garcia M, Hildebolt C, Shannon W, Couture R, Spearie CA, et al. Cross-sectional study of Vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 2009;80:1433-9.

Hatipoglu H, Hatipoglu M, Cagirankaya L, Caglayan F. Severe periodontal destruction in a patient with advanced anemia: A case report. Eur J Dent 2012;6:95-100.

Weiss G. Modification of iron regulation by the inflammatory response. Best Pract Res Clin Haematol 2005;18:183-201.

Chakraborty S, Tewari S, Sharma R, Narula S, Ghalaut P, Ghalaut V. Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: A crosssectional study. J Period Implant Sci 2014;44:57.

Valko M, Morris H, Cronin M. Metals, toxicity and oxidative stress. Curr Med Chem 2005;12:1161-208.

Herman M, Golasik M, Piekoszewski W, Walas S, Napierala M, Wyganowska-Swiatkowska M. et al. Essential and toxic metals in oral fluid-a potential role in the diagnosis of periodontal diseases. Biol Trace Elem Res 2016;173:275-82.

Apon A, Kamble P. Role of trace mineral in periodontal health: A review. Clin Trials Degener Dis 2019;4:30.

Frithiof L, Lavstedt S, Eklund G, Söderberg U, Skårberg K, Blomqvist J, et al. The relationship between marginal bone loss and serum zinc levels. Acta Med Scand 2009;207:67-70.


  • There are currently no refbacks.