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Dental Materials

Comparative evaluation of the


antimicrobial efficacy of aloe vera
tooth gel and two popular commercial
toothpastes: An in vitro study
Dilip George, MDS   n  Sham S. Bhat, MDS   n  Beena Antony, PhD

Aloe vera (Aloe barbadensis Miller) has been suggested for a Streptococcus mutans, Lactobacillus acidophilus, Enterococcus
wide variety of ailments but its use in dentistry is limited. This faecalis, Prevotella intermedia, and Peptostreptococcus anaerobius.
article reviews the uses of the plant and describes an in vitro Aloe vera tooth gel demonstrated enhanced antibacterial effect
investigation that compared the antimicrobial effectiveness of aloe against S. mitis.
vera tooth gel with two popular, commercially available dentifrices. Received: November 29, 2007
The preliminary results showed that aloe vera tooth gel and the Accepted: February 8, 2008
toothpastes were equally effective against Candida albicans,

T
he success of any toothpaste, growth but its nutritive potency Materials and methods
in part, lies on its ability to decreases after 12 years of growth.7 To demonstrate antimicrobial
eliminate pathogenic oral Aloe gel will lose its complete activity, this study utilized an aloe
microflora. Fluoride dentifrices potency if it is exposed to sunlight vera tooth gel (Forever Bright,
have been widely used all over the for more than two hours, as it is Forever Living Products, Scottsdale,
world and extensive research has easily oxidized; consequently, it AZ; 888.440.2563), known as
established their abilities in terms of is necessary to stabilize it under Toothpaste A, and two commercial,
caries resistance.1 pharmaceutical standards for ready locally available toothpastes: Pepso-
The gel or mucilage from Aloe use and longer shelf life. Non-profit dent (Unilever, Englewood Cliffs,
barbadensis Miller (otherwise organizations like the International NJ; 201.894.7660) and Colgate
known as aloe vera) is a convenient Aloe Science Council have set (Colgate-Palmolive, Canton, MA;
homegrown remedy that can be standards for aloe vera approval and 800.821.2880), known as Tooth-
used both as a moisturizing agent give their seal of quality for aloe pastes B and C, respectively.
and for treating minor burns and products. Such products are more This study used freeze-dried stock
skin abrasions. Aloe vera is a cactus- beneficial, since the seal is given culture of the reference strains of
like plant that actually is part of the to only those products with estab- Streptococcus mutans, Candida
lily family. There are more than 300 lished therapeutic benefits.7 albicans, Lactobacillus acidophilus,
varieties of the aloe plant but the This in vitro evaluation compared S. mitis, Enterococcus faecalis, Pre-
Aloe barbadensis variety exhibits the the antimicrobial activity of an votella intermedia, and Peptostrep-
best medicinal properties. aloe vera tooth gel and two com- tococcus anaerobius. The organisms
Modern use of aloe vera was first mercially popular, locally available were cultured in trypticase soy broth
documented in the 1930s to heal toothpastes. These toothpastes were and transferred to the selective
radiation burns.2 Aloe vera juice tested against seven pathogenic media to revive from the stock.
taken internally has been shown to microorganisms that frequently The organisms employed in the
have various beneficial effects on dominate the oral microbiota. The study were cultured in their respec-
the body.3-6 results are intended to show the tive selective media. For example, S.
The efficacy of Aloe barbadensis relative antimicrobial effectiveness mutans was cultured in Mitis Salivar-
Miller increases when the plant of each dentifrice against each ius Bacitracin Agar (Gold’s Media),
is harvested after three years of particular species. C. albicans in Sabouraud’s Dextrose

238 May/June 2009 General Dentistry www.agd.org


Agar, L. acidophilus in Rogosa SL
Agar, S. mitis in Mitis-Salivaris Agar,
E. faecalis in Mac Conkey’s Agar, C
and both Prevotella intermedia and
Peptostreptococcus anaerobius in
Neomycin Blood Agar.8
The purity of each test strain was
checked during each trial by using
subculture, Gram’s stain, and colony A
morphology. Antimicrobial suscep- B
tibility was checked by using the
ditch method.9 The Muller Hinton
Agar was used to demonstrate the
antibacterial effect on aerobes, while
Wilkins Chalgren Blood Agar was
used for anaerobes and Sabouraud’s
Dextrose Agar for Candida.
Three wells (4 mm in diameter
and 3 mm deep) were made using Fig. 1. Zone of inhibition as observed in Candida albicans for toothpastes A, B, and C, using
a sterile metallic template, with a Sabouraud’s Dextrose Agar.
rubber teat in each plate. The inocu-
lums were prepared and adjusted to
0.5 McFarland turbidity standards,
according to National Committee
on Clinical Laboratory Standards
(NCCLS) guidelines.10 The agar C
plates were streaked with the respec-
tive stock culture microorganisms.
Using a sterile spoon excavator, the
toothpastes were dispersed into the
wells. At that point, the plates were
incubated at 37°C for 48 hours in
the respective environments—that A
is, E. faecalis and C. albicans in the B
incubator, S. mutans and S. mitis in
the candle jar, and L. acidophilus,
Prevotella intermedia, and Pepto-
streptococcus anaerobius in an anaer-
obic jar (Hi Anaerobic System-Mark
II with Anaerobic Hi Gas Pack, Hi
Media Laboratories, Mumbai, India; Fig. 2. Zone of inhibition observed in Prevotella intermedia for toothpastes A, B, and C, using Wilkins
91.022.2500.0970), which works Chalgren Blood Agar.
on the principle of gas generated
from chemicals.
After incubation, zones of inhibi-
tion (that is, locations where no
growth of bacteria was present) of the zones were measured with inhibition value of the tested
were examined around the wells a Hi Antibiotic Zone Scale (Hi product. No attempt was made
that contained the dentifrice. These Media Laboratories). The mean to obscure the identity of the test
appeared as a clear, circular halo diameter of the well’s measure- agents. The test was repeated six
surrounding the wells. Diameters ments (in mm) represented the times in triplicate to overcome any

www.agd.org General Dentistry May/June 2009 239


Dental Materials  Antimicrobial efficacy of aloe vera tooth gel and commercial toothpastes

vera for oral hygiene had not been


Table. Mean diameter of the zone of inhibition obtained after 48 hours of evaluated prior to this study. The
incubation. antibacterial, antifungal, and anti-
viral properties of aloe vera have
N Mean SD H p been established; in addition, it
S. mutans 4.18 0.124 (not significant) reduces inflammation and pain and
A 6 15.8333 0.75277 aids in healing.
B 6 15.5000 1.04881 The antimicrobial effects of aloe
C 6 16.8333 1.16905 vera have been attributed to the
C. albicans 5.48 0.058 (not significant) plant’s natural anthraquinones:
A 6 24.0000 0.823666 aloe emodin, aloetic acid, aloin,
B 6 25.0000 0.89443 anthracine, anthranol, barbaloin,
C 6 23.6667 1.03280 chrysophanic acid, ethereal oil,
L. acidophilus 0.87 0.647 (not significant)
ester of cinnamonic acid, isobarba-
loin, and resistannol.11 In relatively
A 6 23.1667 3.54495
small concentrations together with
B 6 23.8333 3.37145
the gel fraction, these anthraquino-
C 6 22.8333 3.06050 nes provide analgesic, antibacterial,
S. mitis 6.76 0.034 (significant) antifungal, and antiviral activity;
A 6 17.0000 3.16228 in high concentrations, they can
B 6 14.6667 1.50555 be toxic.12 Saponins, which contain
C 6 14.3333 1.75119 glycosides, are soapy substances
E. faecalis 0.84 0.659 (not significant) that have both cleansing and anti-
A 6 22.3333 2.06559 septic properties.13-15
B 6 23.0000 2.19089 Acemannan, a complex mannose
C 6 23.3333 2.06559 carbohydrate derived from the
aloe vera plant, has an inherent
Prevotella intermedia 4.83 0.09 (not significant)
stickiness/viscosity, which makes it
A 6 21.3333 1.03280
ideal for denture adhesive formula-
B 6 22.1667 0.98319
tions. A 1998 study reported that
C 6 20.8333 0.75277 acemannan formulations of 150:1
Peptostreptococcus anaerobius 0.07 0.968 (not significant) (containing 0.05% benzalkonium
A 6 21.6667 0.81650 chloride, 0.1% methylparaben, and
B 6 21.5000 1.37840 0.01% hyamine 1622) exhibited
C 6 21.6667 1.36626 ideal adhesive strength and pH and
minimal cytotoxicity.16
The organisms employed in the
present study include both the
technical errors that might have maximum antimicrobial activity normal flora and pathogens of the
occurred during a single attempt. against C. albicans and all anaer- oral cavity. S. mutans has been
The Kruskall Wallis Test was obes in vitro. strongly associated with the initiation
utilized, with SPSS Version 14 soft- Compared to the Toothpastes B of caries, while there is a correlation
ware used to analyze the results. and C, Toothpaste A demonstrated between Lactobacilli and the further
an increased antibacterial effect development of carious lesions.17
Results against S. mitis (p = 0.034). The table A 1995 study by Bai et al demon-
Results of this preliminary in vitro lists the zone of inhibition obtained strated a high Candida count in chil-
study demonstrated that aloe vera from each toothpaste after 48 hours. dren with insulin-dependent diabetes
tooth gel was equally effective as mellitus, a condition associated with
Toothpastes B and C for control- Discussion symptoms like dry mouth, burning
ling all of the organisms in the A review of the literature suggested sensations, and painful fissures.18
study. All three toothpastes showed that the potential of using aloe E. faecalis has been associated with

240 May/June 2009 General Dentistry www.agd.org


re-infection and subsequent failure of care products, additional long-term New York: Pharmaceutical Products Press;1993:
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