Herbal alternatives in the management of tooth decay: A comprehensive review of phytotherapeutic agents, mechanisms of action, clinical efficacy, and potential for integrative dental care

Abstract

Abrar Abdullah Alharbi*, Huda Ali Albishi, Haneen Jafar Hawsawi, Samah Omar Alhousah, Afnan Abdulltif M Abdulltif, Khadijah Abdulqader Saad, Khadejah Yousef Al Hosawi, Loolah Mohammed Al Jarshi

Herbal alternatives have garnered significant interest as potential adjuncts or substitutes for conventional treatments of tooth decay, driven by concerns over the side effects of synthetic antimicrobials and fluoride agents. This comprehensive review explores various phytotherapeutic agents including essential oils, polyphenol-rich extracts, and traditional herbal formulations highlighting their mechanisms of antimicrobial action against cariogenic biofilms, anti-inflammatory and antioxidant benefits, and capacity to support enamel remineralization. The discussion synthesizes findings from in vitro studies demonstrating potent inhibition of Streptococcus mutans and other oral pathogens, in vivo evidence of reduced plaque formation and bacterial counts, and preliminary clinical trials that suggest comparable short-term efficacy of herbal dentifrices to fluoride or chlorhexidine products. Despite promising results, challenges persist in standardizing botanical extracts, establishing optimal dosages and delivery methods, assessing long-term safety, and conducting large-scale randomized controlled trials to validate clinical outcomes. The integration of well-characterized herbal formulations into routine dental care may offer a more holistic, natural approach to cariogenic prevention and treatment, but requires further rigorous scientific investigation and regulatory guidance.