J Periodontol June 2012

Clinical and Microbiologic Effects

of Commercially Available Dentifrice
Containing Aloe Vera: A Randomized
Controlled Clinical Trial
A.R. Pradeep,* Esha Agarwal,* and Savitha B. Naik

Background: Certain plants used in folk medicine serve as

a source of therapeutic agents that have antimicrobial and
other multipotential effects. This prospective, randomized,
placebo, and positively controlled clinical trial was designed
to evaluate the clinical and microbiologic effects of a commercially available dentifrice containing aloe vera on the reduction
of plaque and gingival inflammation in patients with gingivitis.
Methods: Ninety patients diagnosed with chronic generalized gingivitis were selected and randomly divided into three
groups: group 1, placebo toothpaste; group 2, toothpaste containing aloe vera; and group 3, toothpaste with polymer and
fluoride containing triclosan. Clinical evaluation was undertaken using a gingival index, plaque was assessed using a
modification of the Quigley-Hein index, and microbiologic
counts were assessed at baseline, 6 weeks, 12 weeks, and
24 weeks. A subjective evaluation was also undertaken by
questionnaire.
Results: Toothpaste containing aloe vera showed significant improvement in gingival and plaque index scores as
well as microbiologic counts compared with placebo dentifrice.
These improvements were comparable to those achieved with
toothpaste containing triclosan.
Conclusion: Toothpaste containing aloe vera may be a useful
herbal formulation for chemical plaque control agents and improvement in plaque and gingival status. J Periodontol
2012;83:797-804.
KEY WORDS
Aloe; anti-inflammatory agents; clinical trial; dental plaque;
gingivitis; toothpastes.
* Department of Periodontics, Government Dental College and Research Institute, Fort,
Bangalore, Karnataka, India.
Department of Conservative Dentistry and Endodontics, Government Dental College and
Research Institute.

eriodontal diseases are chronic infectious diseases characterized by

a bacterial challenge that can provoke a destructive host response, leading to clinical attachment loss (AL) and
ultimately possible tooth loss.1,2 It is well
established that supragingival plaque is
the cause of gingivitis and plays a primary
role in the initiation of periodontitis.1 The
removal of microbial plaque leads to
resolution of gingival inflammation, and
cessation of plaque control leads to a recurrence of inflammation.
The importance of plaque control in the
maintenance of gingival health has been
well established in the literature.3,4 It has
been shown that rigorous self-performed
plaque control over long periods of time
reduced the levels and altered the composition of subgingival bacteria and reduced the frequency of deep periodontal
pockets.5,6 The inability of the general
adult population to perform adequate
toothbrushing has led to the search for
chemotherapeutic agents to improve plaque control.7 These chemicals, mainly triclosan and chlorhexidine, have been used
as mouthrinses or added to dentifrices to
avoid plaque formation and development
of gingivitis.7-9 Because some of these
substances may have undesirable side
effects, such as tooth staining and taste
alteration, phytotherapeutic agents with
antimicrobial and anti-inflammatory properties have been investigated.10,11
doi: 10.1902/jop.2011.110371

797

Aloe Vera and Gingivitis

The use of natural products in the prevention and

treatment of oral conditions has increased recently
and could be beneficial to urban and rural communities of low socioeconomic levels.12
Aloe vera is a perennial succulent plant belonging
to the Aloeaceae family (subfamily of the Asphodelaceae).13 Among >400 aloe species, aloe vera is the
most accepted species for various medical, cosmetic,
and nutraceutical purposes.14 Aloe vera has anti-inflammatory properties,2-4 antiulcer activity,5,6 and an
astringent effect and may have the ability to reduce
scars and enhance wound healing.7-10
The spectrum of anti-inflammatory activity of aloe
vera against the spectrum of irritants in a number of
models of inflammation in experimental rats has been
evaluated, and it was found that aloe vera was active
in all the models of inflammation.15
The aloe plant contains anthraquinone glycosides
(especially in the latex form, which is different from
the gel), polysaccharides, aloeresins, glucomannans,
and b-sitosterol.16 Antioxidative phenolic compounds
were recently isolated from Aloe barbadensis and identified as aloeresin derivatives.17
The above-mentioned properties, along with the
ease of availability, no known adverse effects, and
cost effectiveness, make aloe vera an ideal candidate
for plaque control, thereby reducing gingivitis and
most likely eventual periodontitis.
The antimicrobial effect of a dentifrice containing
aloe vera has been demonstrated in an in vitro study
in which this phytotherapeutic agent inhibited the
growth of diverse oral microorganisms, such as Streptococcus mutans, Streptococcus sanguis, Actinomyces
viscosus, and Candida albicans.10 The mouthrinse containing aloe vera has showed a significant reduction of
gingivitis and plaque accumulation.18
The dentifrice containing aloe vera has shown a significant reduction of plaque and gingivitis, but it did
not show any additional effect on plaque and gingivitis
control compared with the fluoride dentifrice.19 This
was a 30-day clinical trial, and the effect on microbial
counts were not assessed; therefore, this study has
been conducted to assess the clinical and microbiologic effects of a commercially available dentifrice
containing aloe vera on plaque and gingivitis compared with placebo and a fluoride dentifrice containing triclosan over a period of 6 months.
MATERIALS AND METHODS
Patients
Ethical approval was obtained from the institutional
ethical committee and review board of the Government
Dental College and Research Institute, Bangalore,
India. Ninety dentate patients (45 males and 45 females, aged 25 to 40 years) who reported to the
Department of Periodontics, Government Dental
798

Volume 83 Number 6

College and Research Institute, Bangalore, India, were

recruited for this double-masked, parallel, randomized controlled clinical trial conducted from August
2010 to February 2011. All randomly screened participants were informed about the nature of the study
and signed an informed consent form.
Inclusion/Exclusion Criteria
Inclusion in this study was based on the following criteria: 1) diagnosis of chronic generalized gingivitis; 2)
25 to 40 years old; 3) 20 natural teeth; and 4) no history of periodontal therapy or previous use of antibiotics or anti-inflammatory medication within the
preceding 6 months. Gingivitis was defined in each
patient as bleeding on probing (gentle) at >30% and
a gingival index20 of 1 at >60% of sites examined.
All patients fulfilled the clinical criteria of having a
pocket probing depth (PD) 3 mm, clinical AL = 0,
plaque index (PI) >2 as defined by Turesky et al modification of Quigely Hein PI21,22 with no evidence of radiographic bone loss. Patients with known allergies to
the constituents of the formulation, hematologic disorders, or other systemic illness; pregnant and lactating
females; patients undergoing orthodontic treatment;
and those with smoking habits were excluded (Fig. 1).
Products
The participants were assigned randomly by a computer-generated numbering sequence to one of three
groups (30 patients in each group): group 1, placebo
toothpaste with no anti-inflammatory properties;
group 2, test toothpaste containing aloe vera; and
group 3, fluoride toothpaste containing triclosan
and polymer.i
Clinical Parameters
Patients accepted into the study returned for a baseline examination. Patients were told not to perform
any oral hygiene (including chewing gum) for 8 hours
before the baseline and follow-up examinations. Patients were assessed for plaque using the PI21,22 and
gingival inflammation using the gingival index (GI),20
as well as for oral soft tissue status. After the assessments, all patients received a supragingival prophylaxis and polishing to remove plaque, calculus, and
extrinsic stain. After prophylaxis, patients were instructed on the proper toothbrushing technique and
were given either the dentifrices or the placebo toothpaste along with a diary to record product usage and
daily oral hygiene activities. Instructions for and demonstrations of the modified Bass method of brushing
were provided to the patients.23 The dentifrices were
dispensed to patients by a dental assistant not involved
in the study (Pavan Bajaj, Department of Periodontics,
L.B. Aroma and Health Care, Mumbai, India.
Aloe Plus, L.B. Aroma and Health Care.
i L.B. Aroma and Health Care.

Pradeep, Agarwal, Naik

J Periodontol June 2012

colonies with similar morphology were counted using

a colony counter, their numbers were recorded, and the
total number was taken into
account. Apart from clinical
and microbiologic evaluation, subjective evaluation
was also undertaken at each
visit, using a questionnaire
relating to the taste and flavor of the dentifrices or any
adverse effect experienced
after use. To check for compliance, the participants
were asked to return their
assigned tubes, so that the
investigator could verify
the amount of dentifrice that
was used.
Figure 1.
Consort flow diagram.

Government Dental College and Research Institute,

Bangalore). All tubes had a plain white covering labeled only with lot numbers to ensure proper masking
of the product from the patients and examiner (EA).
Patients were also given a soft-bristled toothbrush to
use during the clinical study. Patients were asked to refrain from all other unassigned forms of oral hygiene,
including non-study toothbrushes or toothpastes, dental floss, chewing gum, or oral rinses during the study.
Patients were assessed in the same dental unit under
identical conditions at baseline, 6 weeks, 12 weeks,
and 24 weeks.
Microbiology
At the baseline and at each visit, the dental plaque
sample was collected from each patient. Each volunteer was asked to gargle with saline to remove any food
debris. Taking all aseptic measures, the plaque was
collected from the buccal groove of the mandibular first
molar tooth using a sterile paper point so that the standardized length of the paper point (colored area)
touched the tooth for 5 seconds. This specimen was
immersed in 1 mL phosphate-buffered saline (PBS).
These plaque specimens were vortexed for 10 seconds, and subcultures were performed immediately
on mitis salivarius agar for Streptococcus species and
glia-conditioned medium for Actinomyces species taking 5 mL plaque in PBS. The colonies of S. sanguis,
Streptococcus mitis, Streptococcus intermedius, Streptococcus oralis, A. viscosus, and Actinomyces naeslundii were identified based on colony morphology. The

Statistical Analyses
Statistical software was used
to analyze the data. The
values of different parameters collected are expressed as means SD. Normality
of continuous data were tested using the KolmogorovSmirnov test. Percentage change from the day 0 value
for each parameter for each subsequent day of the study
was calculated. Among-treatment group comparisons
were performed at each visit. Mean percentage changes
of each parameter were analyzed using mixed-model
repeated measures.
RESULTS
The mean age of the patients was 29.53 years. The
number of males and females in each group and mean
age in each group are given in Table 1. Group sample
sizes were decided by power analysis with 90% power
and a significance level of 0.05. Six patients did not
complete the study and were excluded from the analysis. Two patients did not report after the baseline examination, one patient became pregnant during the study,
and three patients did not come back for the 24-week
examination and recording because they had moved
out of the city. There was no significant difference
among groups 1, 2, and 3 with respect to PI and GI
scores at baseline. There was a gradual decrease in
the PI and GI scores and microbial counts by the 6-,
12-, and 24-week time intervals, respectively, in all
three groups (Table 2).
Percentage reduction (mean SD) for all groups
and all parameters are given in Table 3.
At the end of 24 weeks, a significant difference was
found between groups 1 and 2 and between groups 1
SPSS v.10.5, IBM, Chicago, IL.

799

Aloe Vera and Gingivitis

Volume 83 Number 6

and gingivitis. Despite its free commercial use, this

phytotherapeutic agent does not have sufficient data
to support its antigingivitis and antiplaque claims.24
The purpose of this study is to assess the clinical
and microbiologic effects of a commercially available
dentifrice containing aloe vera on plaque and gingivitis compared to placebo and a triclosan-containing
dentifrice over a period of 6 months. Both the aloe
veracontaining toothpaste and the toothpaste containing triclosan showed significant improvement
over the placebo group. There was no significant difference between the aloe veracontaining toothpaste
and the toothpaste containing triclosan in the reduction of PI and GI as well as in the reduction of microbial
counts.
The predominant Gram-positive species associated with gingivitis include S. sanguis, S. mitis, S. intermedius, S. oralis, A. viscosus, and A. naeslundii.25
Therefore, these organisms were specifically cultured
to assess the microbiology.
The findings of the present study are in agreement
with those of Villalobos et al.,18 who observed a significant reduction in plaque and gingivitis after a 30-day
use of mouthrinses containing aloe vera associated
with toothbrushing. Also, de Oliveira et al.19 found
that both dentifrice containing aloe vera and dentifrice
containing fluoride resulted in significant reduction of
plaque and gingivitis, but no statistical significant difference was observed between them. These results
are similar to those found in the present study.
Although the mechanical control of dental plaque
has been clearly shown to retard the advance of gingivitis and periodontal disease,3,26 Axelsson and Lindhe3

and 3, and also between groups 2 and 3 with respect to

PI score (Table 4).
There was a significant difference between groups 1
and 2 and between groups 1 and 3 at all the time intervals with respect to GI score. However, the difference
between groups 2 and 3 was not statistically significant
with respect to GI score at any time interval (Table 5).
At the end of 24 weeks, a significant difference was
found between groups 1 and 2 and between groups
1 and 3, but there was no significant difference between
groups 2 and 3 with respect to microbial counts (Table 6).
DISCUSSION
Aloe vera is a natural product contained in commercial
herbal dentifrices marketed for the control of plaque
Table 1.

Demographic Characteristics of Patient

Groups
Number of Samples

Mean Age (years)

Group 1 (n = 28)
14 males
14 females

30.40

Group 2 (n = 28)
15 males
13 females

28.80

Group 3 (n = 28)
13 males
15 females

29.39

Table 2.

PI and GI Scores and Microbial Counts (mean SD) at Different Visits

Parameter

Group 2 (n = 28)

Group 3 (n = 28)

P Value

PI scores
Baseline
6 weeks
12 weeks
24 weeks

4.436
3.534
3.250
3.012

0.704
0.779
0.842
0.794

4.478
3.582
2.916
2.348

0.651
0.725
0.716
0.666

4.369
3.634
3.049
2.593

0.595
0.699
0.762
0.690

0.806
0.87
0.25
0.002*

GI scores
Baseline
6 weeks
12 weeks
24 weeks

1.934
1.443
1.260
1.254

0.368
0.350
0.286
0.382

2.035
1.225
0.944
0.802

0.345
0.317
0.286
0.201

1.963
1.263
0.972
0.795

0.400
0.544
0.470
0.350

0.554
0.102
0.001*
<0.001*

31.033
25.853
23.437
22.953

1.917
2.914
3.180
3.337

29.636
19.777
12.745
9.344

3.362
3.319
2.114
2.066

30.067
21.087
14.110
10.069

2.781
2.601
2.375
1.733

0.138
<0.001*
<0.001*
<0.001*

Microbial counts
Baseline
6 weeks
12 weeks
24 weeks
* Statistically significant.

800

Group 1 (n = 28)

Pradeep, Agarwal, Naik

J Periodontol June 2012

Table 3.

Percentage Reduction (mean SD) in PI and GI Scores and Microbial Counts

at Different Visits
Parameter

Group 1 (n = 28)

Group 2 (n = 28)

Group 3 (n = 28)

P Value

PI scores
6 weeks
12 weeks
24 weeks

-20.87 8.949
-27.328 12.595
-32.847 11.452

-20.055 12.442
-35.072 12.849
-47.816 12.161

-17.009 10.346
-30.984 12.688
-41.426 11.557

0.806
0.87
0.25

GI scores
6 weeks
12 weeks
24 weeks

-25.036 13.592
-34.471 9.452
-34.683 14.747

-38.720 16.783
-52.273 16.726
-59.898 10.524

-36.090 24.241
-34.471 9.452
-58.755 17.445

0.554
0.102
0.001*

Microbial counts
6 weeks
12 weeks
24 weeks

-16.767 7.173
-24.532 8.964
-26.063 9.846

-33.439 7.319
-56.897 5.993
-68.357 6.328

-29.950 5.451
-53.113 6.529
-66.408 5.444

0.138
<0.001*
<0.001*

* Statistically significant.

Table 4.

Treatment Differences in Percentage Reduction of PI Score at Different Visits

LS Means
Comparison

Test

Ref.

6 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-20.040
-17.003
-17.003

-20.863
-20.863
-20.040

12 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-35.080
-30.997
-30.997

24 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-47.817
-41.427
-41.427

Mean Difference

95% CI

P Value

0.823
3.860
3.037

(-4.656, 6.303)
(-1.619, 9.339)
(-2.443, 8.516)

0.766
0.165
0.274

-27.327
-27.327
-35.080

-7.750
-3.670
4.083

(-14.28, -1.229)
(-10.19, 2.854)
(-2.441, 10.608)

0.020*
0.267
0.217

-32.857
-32.857
-47.817

-15.0
-8.570
6.390

(-20.98, -8.939)
(-14.59, -2.549)
(0.369, 12.411)

<0.001*
0.006*
0.038*

CI = Confidence interval; LS = least squares; Ref. = reference.

* Statistically significant.

reported that non-compliant patients exhibited signs of

recurrent disease processes. Because of the inconsistency of simple mechanical control of plaque accumulation, a number of chemotherapeutic agents have
been incorporated into home use products to control
plaque and gingivitis. These agents have generally
been incorporated into either mouthrinses or toothpastes. The main action of these agents has been focused on their antimicrobial action. There have been
a number of active ingredients incorporated into various dentifrices. Triclosan/copolymer dentifrices have
been studied extensively for their antiplaque and anti-

gingivitis effectiveness. Triclosan is a phenolic agent

comprising bisphenol and a non-ionic germicide.27
Lindhe et al.28 reported on the results of a 6-month clinical trial comparing a triclosan/copolymer dentifrice
with a dentifrice containing fluoride and found that
the triclosan group had more plaque reduction and resolution of gingivitis than the regular fluoride dentifrice
group. Studies including long-term clinical trials,29
short-term experimental gingivitis models,30 and
short-term randomized clinical studies31 have demonstrated significant reductions in plaque and gingivitis from 20% to as high as 60%. Considering the
801

Aloe Vera and Gingivitis

Volume 83 Number 6

Table 5.

Treatment Differences in Percentage Reduction of GI Score at Different Visits

LS Means
Comparison

Test

Ref.

Mean Difference

95% CI

P Value

6 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-38.713
-36.083
-36.083

-25.030
-25.030
-38.713

-13.70
-11.10
2.63

(-23.30, -4.064)
(-20.67, -1.434)
(-6.989, 12.249)

0.006*
0.025*
0.588

12 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-52.273
-49.997
-49.997

-34.467
-34.467
-52.273

-17.80
-15.50
2.28

(-26.82, -8.795)
(-24.54, -6.518)
(-6.735, 11.288)

<0.001*
<0.001*
0.617

24 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-59.897
-58.760
-58.760

-34.683
-34.683
-59.897

-25.20
-24.10
1.137

(-32.66, -17.76)
(-31.53, -16.63)
(-6.315, 8.588)

<0.001*
<0.001*
0.762

CI = Confidence interval; LS = least squares; Ref. = reference.

* Statistically significant.

Table 6.

Treatment Differences in Percentage Reduction of Microbial Counts at Different Visits

LS Means
Comparison

Test

Ref.

Mean Difference

95% CI

P Value

6 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-33.440
-29.950
-29.950

-16.767
-16.767
-33.440

-16.70
-13.20
3.490

(-20.11, -13.24)
(-16.62, -9.745)
(0.052, 6.928)

<0.001*
<0.001*
0.047*

12 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-56.890
-53.113
-53.113

-24.537
-24.537
-56.890

-32.40
-28.60
3.777

(-36.09, -28.62)
(-32.31, -24.84)
(0.042, 7.511)

<0.001*
<0.001*
0.048*

24 weeks
Group 2 versus group 1
Group 3 versus group 1
Group 3 versus group 2

-68.357
-66.407
-66.407

-26.067
-26.067
-68.357

-42.30
-40.30
1.950

(-46.12, -38.46)
(-44.17, -36.51)
(-1.878, 5.778)

<0.001*
<0.001*
0.314

CI = Confidence interval; LS = least squares; Ref. = reference.

* Statistically significant.

aforementioned data, dentifrice containing triclosan

with copolymer was taken as a positive control in this
study.
The reduction in plaque and gingivitis scores in group
1 (placebo) can be attributed to the Hawthorne effect
(i.e., patients frequently appear to improve merely from
the effects of being placed in a clinical trial).32
The aloe vera gel contains various carbohydrate
polymers, notably either glucomannans or peptic
acid, along with a range of other organic and inorganic
components.14 Treatment of inflammation is still the
key effect for most types of healing, and immunomod802

ulatory properties of the gel polysaccharides, especially the acetylated mannans from aloe vera, seem
to play a key role. Antidiabetic, anticancer, and antibiotic activities of aloe vera have also been reported,
indicating wider use of this gel.16
Saito et al.33 proposed that a glycoprotein, aloctin
A, which was isolated from Aloe arborescens Miller,
markedly inhibits arthritis in rats and carrageenan-induced edema in rats. Hutter et al.34 identified an antiinflammatory agent as C-glucosyl chromone from
Aloe barbadensis. Aloe vera is known to contain several active ingredients, including a carboxypeptidase

J Periodontol June 2012

that inactivates bradykinin in vitro, salicylates, and

a substance that inhibits thromboxane formation.35
The production of reactive oxygen species (ROS) is
an essential protective mechanism against diseases
associated with phagocytic infiltration as the host defense against bacterial pathogens.36 ROS not only
play an important role in cell signaling and metabolic processes but are also thought to be implicated
in the pathogenesis of a variety of inflammatory disorders.37 A defined role for ROS in the tissue destruction that characterizes periodontitis has been
described.38
Okyar et al.39 reported that aloe vera leaf pulp
extract was effective in reducing blood sugar, suggesting that it might be useful in the scavenging of free
radicals. It was reported that treatment with aloe vera
increased antioxidant enzymes and significantly reduced lipid peroxidation products in streptozotocin-induced diabetic rats, showing the relationship between
antioxidant activity and the onset of diabetes.40-42
The aloe vera extract treatment has also resulted in
a significant increase in reduced glutathione, superoxide dismutase, catalase, glutathione peroxidase,
and glutathione S-transferase in the liver and kidney
of diabetic rats, showing the antioxidant property of
aloe vera gel extract.40
Thus, it can be hypothesized that aloe vera extracts
can be useful in the control and treatment of periodontal diseases by virtue of their antioxidant properties as
well. Additional long-term longitudinal trials are required to assess the salivary total antioxidant capacity
after treatment with aloe vera extracts.
CONCLUSIONS
The use of natural herbal preparations in oral health
care continues to be popular, and aloe vera dentifrice
may be a useful addition. Its efficacy is comparable to
toothpaste containing triclosan; therefore, it could be
used for the improvement of plaque and gingival
status. Additional long-term prospective studies
are needed to confirm the results achieved in this
study.
ACKNOWLEDGMENTS
The authors thank L.B. Aroma and Health Care, Mumbai, India, for providing the samples. The authors also
thank Mr. Pandeshwara Suryanarayana Jagannatha,
a statistician, Rajajinagar, Bangalore, India, for performing required statistics. The authors report no conflicts of interest related to this study.
REFERENCES
1. Page RC. The etiology and pathogenesis of periodontitis.
Compend Contin Educ Dent 2002;23(Suppl. 5):11-14.
e H. The role of local factors in the
2. Kornman KS, Lo
etiology of periodontal diseases. Periodontol 2000 1993;
2:83-97.

Pradeep, Agarwal, Naik

3. Axelsson P, Lindhe J. The significance of maintenance

care in the treatment of periodontal disease. J Clin
Periodontol 1981;8:281-294.
4. Cobb CM. Non-surgical pocket therapy: Mechanical.
Ann Periodontol 1996;1:443-490.
5. McNabb H, Mombelli A, Lang NP. Supragingival
cleaning 3 times a week. The microbiological effects
in moderately deep pockets. J Clin Periodontol 1992;
19:348-356.
m MK, Ramberg P, Krok L, Lindhe J. The effect
6. Hellstro
of supragingival plaque control on the subgingival
microflora in human periodontitis. J Clin Periodontol
1996;23:934-940.
7. Nogueira-Filho GR, Toledo S, Cury JA. Effect of 3
dentifrices containing triclosan and various additives.
An experimental gingivitis study. J Clin Periodontol
2000;27:494-498.
8. Palomo F, Wantland L, Sanchez A, Volpe AR, McCool
J, DeVizio W. The effect of three commercially available dentifrices containing triclosan on supragingival
plaque formation and gingivitis: A six month clinical
study. Int Dent J 1994;44(Suppl. 1):75-81.
9. Yates R, Jenkins S, Newcombe RG, Wade WG, Moran
J, Addy M. A 6-month home usage trial of a 1%
chlorhexidine toothpaste (1). Effects on plaque, gingivitis, calculus and toothstaining. J Clin Periodontol
1993;20:130-138.
10. Lee SS, Zhang W, Li Y. The antimicrobial potential of
14 natural herbal dentifrices: Results of an in vitro
diffusion method study. J Am Dent Assoc 2004;135:
1133-1141.
11. Salgado AD, Maia JL, Pereira SL, de Lemos TL, Mota
OM. Antiplaque and antigingivitis effects of a gel
containing Punica granatum Linn extract: A doubleblind clinical study in humans. J Appl Oral Sci 2006;
14:162-166.
12. Botelho MA, Nogueira NA, Bastos GM, et al. Antimicrobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens.
Braz J Med Biol Res 2007;40:349-356.
13. Eggli U. Illustrated Handbook of Succulent Plants: Monocotyledons. Berlin: Springer-Verlag; 2001:102-186.
14. Grindlay D, Reynolds T. The Aloe vera phenomenon:
A review of the properties and modern uses of the
leaf parenchyma gel. J Ethnopharmacol 1986;16:
117-151.
15. Davis RH, Leitner MG, Russo JM, Byrne ME. Wound
healing. Oral and topical activity of Aloe vera. J Am
Podiatr Med Assoc 1989;79:559-562.
16. Reynolds T, Dweck AC. Aloe vera leaf gel: A review
update. J Ethnopharmacol 1999;68:3-37.
17. Yagi A, Kabash A, Okamura N, Haraguchi H, Moustafa
SM, Khalifa TI. Antioxidant, free radical scavenging
and anti-inflammatory effects of aloesin derivatives in
Aloe vera. Planta Med 2002;68:957-960.
18. Villalobos OJ, Salazar CR, Sanchez GR. Effect of
a mouthwash made of Aloe vera on plaque and gingival
inflammation (in Spanish). Acta Odontol Venez 2001;
39:16-24.
19. de Oliveira SM, Torres TC, Pereira SL, Mota OM, Carlos
MX. Effect of a dentifrice containing Aloe vera on
plaque and gingivitis control. A double-blind clinical
study in humans. J Appl Oral Sci 2008;16:293-296.
e H, Silness J. Periodontal diseases in pregnancy. I.
20. Lo
Prevalence and severity. Acta Odontol Scand 1963;
21:533-551.
803

Aloe Vera and Gingivitis

21. Quigley GA, Hein JW. Comparative cleansing efficiency

of manual and power brushing. J Am Dent Assoc 1962;
65:26-29.
22. Turesky S, Gilmore ND, Glickman I. Reduced plaque
formation by the chloromethyl analogue of victamine
C. J Periodontol 1970;41:41-43.
23. Disyam L. A comparison of three methods of toothbrushing: Roll, modified Bass and scrub technique.
J Dent Assoc Thai. 1987;37:1-10.
24. Wu CD, Savitt ED. Evaluation of the safety and
efficacy of over-the-counter oral hygiene products
for the reduction and control of plaque and gingivitis.
Periodontol 2000 2002;28:91-105.
25. Moore WE, Moore LV. The bacteria of periodontal
diseases. Periodontol 2000 1994;5:66-77.
26. Wilson TG Jr, Glover ME, Malik AK, Schoen JA, Dorsett
D. Tooth loss in maintenance patients in a private
periodontal practice. J Periodontol 1987;58:231-235.
27. DeVizio W, Davies R. Rationale for the daily use of
a dentifrice containing triclosan in the maintenance
of oral health. Compend Contin Educ Dent 2004;
25(Suppl. 1):54-57.
28. Lindhe J, Rosling B, Socransky SS, Volpe AR. The
effect of a triclosan-containing dentifrice on established plaque and gingivitis. J Clin Periodontol 1993;
20:327-334.
29. Rosling B, Dahlen G, Volpe A, Furuichi Y, Ramberg P,
Lindhe J. Effect of triclosan on the subgingival microbiota of periodontitis-susceptible subjects. J Clin Periodontol 1997;24:881-887.
30. Nogueira-Filho GR, Toledo S, Cury JA. Effect of 3
dentifrices containing triclosan and various additives.
An experimental gingivitis study. J Clin Periodontol
2000;27:494-498.
31. Volpe AR, Petrone ME, Prencipe M, DeVizio W. The
efficacy of a dentifrice with caries, plaque, gingivitis,
tooth whitening and oral malodor benefits. J Clin Dent
2002;13:55-58.
32. Jeffcoat MK. Principles and pitfalls of clinical trials
design. J Periodontol 1992;63(Suppl. 12):1045-1051.
33. Saito H, Ishiguro T, Imanishi K, Suzuki I. Pharmacological studies on a plant lectin aloctin A. II.

804

Volume 83 Number 6

34.
35.
36.

37.
38.

39.

40.

41.
42.

Inhibitory effect of aloctin A on experimental models

of inflammation in rats. Jpn J Pharmacol 1982;32:
139-142.
Hutter JA, Salman M, Stavinoha WB, et al. Antiinflammatory C-glucosyl chromone from Aloe barbadensis. J Nat Prod 1996;59:541-543.
Klein AD, Penneys NS. Aloe vera. J Am Acad
Dermatol 1988;18:714-720.
Fialkow L, Wang Y, Downey GP. Reactive oxygen and
nitrogen species as signaling molecules regulating
neutrophil function. Free Radic Biol Med 2007;42:
153-164.
McCord JM. The evolution of free radicals and oxidative stress. Am J Med 2000;108:652-659.
Gustafsson A, Asman B. Increased release of free
oxygen radicals from peripheral neutrophils in adult
periodontitis after Fc delta-receptor stimulation. J Clin
Periodontol 1996;23:38-44.
Okyar A, Can A, Akev N, Baktir G, Su
tlu
pinar N.
Effect of Aloe vera leaves on blood glucose level in
type I and type II diabetic rat models. Phytother Res
2001;15:157-161.
Rajasekaran S, Sivagnanam K, Subramanian S. Antioxidant effect of Aloe vera gel extract in streptozotocin-induced diabetes in rats. Pharmacol Rep 2005;57:
90-96.
Nwanjo HU. Antioxidant activity of the exudate from
Aloe barbadensis leaves in diabetic rats. Biokemistri
2006;18:77-81.
Ozsoy NR, Yanardag R, Can A, Akev N, Okyar A.
Effectiveness of Aloe vera versus glibenclamide on
serum lipid parameters, heart and skin lipid peroxidation in type II diabetic rats. Asian J Chem 2008;20:
2679-2689.

Correspondence: A.R. Pradeep, Department of Periodontics, Government Dental College and Research Institute, Fort,
Bangalore 560002, Karnataka, India. E-mail: periodontics_
gdc@rediffmail.com.
Submitted July 22, 2011; accepted for publication September 16, 2011.