Research Progress on the Mechanism of Action of Traditional Chinese Medicine Extracts in the Prevention and Treatment of Periodontitis
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Keywords

Traditional Chinese medicine extracts
Prevention and treatment of periodontitis
Mechanism of action

DOI

10.26689/par.v9i1.9142

Submitted : 2025-01-14
Accepted : 2025-01-29
Published : 2025-02-13

Abstract

Periodontitis is an inflammatory infectious disease affecting the periodontal supporting tissues and is the primary cause of tooth loosening and tooth loss in adults. Clinically, supragingival scaling, subgingival scaling, root planing, and other basic periodontal treatments, often combined with antibiotic therapy, are commonly employed with moderate efficacy. However, the increasing prevalence of antibiotic resistance and associated adverse reactions has become a growing concern. Recent studies have demonstrated the significant impact of traditional Chinese medicine (TCM) extracts in both the prevention and treatment of periodontitis, exhibiting remarkable effectiveness. This review explores the role and mechanisms of TCM extracts in the prevention and treatment of periodontitis, providing a reference for further elucidation of their mechanisms and a theoretical basis for the development of Chinese herbal medicine-based care products.

牙周炎是一种发生于牙周支持组织的炎症性感染性疾病,是成年人牙齿松动和脱落的主要原因。在临床上,龈上洁治、龈下洁治、根面平整等牙周基础治疗,结合抗生素治疗,通常都有较好的疗效。然而,抗生素耐药性和不良反应越来越普遍。近年来,大量的研究表明,中药提取物在预防和治疗牙周炎方面具有显著的影响,具有特殊的效果。因此,本文就中药提取物在牙周炎防治中的作用及机制进行综述,为深入阐明中药提取物防治牙周炎的作用机制提供参考,并为中草药护理产品的开发提供理论依据。

References

Kwon T, Lamster IB, Levin L, 2021, Current Concepts in the Management of Periodontitis. Int Dent J, 71(6): 462-476. https://doi.org/10.1111/idj.12630

Eke PI, Borgnakke WS, Genco RJ, 2020, Recent Epidemiologic Trends in Periodontitis in the USA. Periodontol 2000, 82(1): 257–267. https://doi.org/10.1111/prd.12323

Makeeva IM, Daurova FY, Byakova SF, et al., 2016, Sensitivity of Microbial Associations of Periodontal Lesions to Antibacterial Agents. Stomatologiia, 95(3): 26–30. https://doi.org/10.17116/stomat201695326-30

Zhou Z, Tang J, 2017, Research Progress of Chinese Herbal Medicine Extracts and Prescriptions in the Treatment of Periodontitis. Medical Recapitulate, 23(11): 2245–2248.

Liu J, Zhao X, Pei D, et al., 2018, The Promotion Function of Berberine for Osteogenic Differentiation of Human Periodontal Ligament Stem Cells via ERK-FOS Pathway Mediated by EGFR. Sci Rep, 8(1): 2848. https://doi.org/10.1038/s41598-018-21116-3

Wang H, Liu X, Kong C, et al., 2020, Effect of Rhodopsin Flavonoid on Expression of IL-6 and IL-18 in Serum of Experimental Periodontitis Rats. Chinese Journal of Laboratory Diagnosis, 24(4): 664–666.

Wang H, 2020, Effect of Hylotelephium Purpureum Gel on Expression of MMP-2, MMP-9 in Periodontal Tissues and Serum of Experimental Periodontitis Rats, dissertation, Jilin University.

Wu Z, 2023, Effect and Mechanism of Naringin Mediating Autophagy to Promote Alveolar Bone Osteogenesis Through Akt/mTOR Pathway, dissertation, Xinjiang Medical University.

Li S, Yao Y, Zhao G, 2023, Naringin Promotes Osteogenic Differentiation of Inflammatory Periodontal Stem Cells by Regulating lncRNA MEG3/Wnt/β-Catenin Signaling Pathway. Cellular & Molecular Immunology, 39(1): 59–64.

Yang H, 2023, Research on EphB4-EphrinB2 Signaling Pathway Regulated by Icariin in Promoting Osteogenic Differentiation of MC3T3-E1 Cells, dissertation, Jinzhou Medical University.

Lv X, 2022, Isoliquiritigenin Alleviates P. gingivalis-LPS/ATP-Induced Pyroptosis by Inhibiting NF-κB/NLRP3/GSDMD Signals in HGFs, dissertation, Qingdao University.

Wang J, Qin H, 2021, Effect of Puerarin on the Improvement of Symptoms and Periodontal Tissue Growth in Mice with Chronic Periodontitis Based on the Pathway of p38 Mitogen-Activated Protein Kinase. Journal of Oral and Maxillofacial Surgery, 31(4): 207–211.

Zhang L, Liu Y, Wu Y, et al., 2020, Effects of Puerarin on Alveolar Bone Resorption and OPG/RANKL/RANK Pathway in Rats with Periodontitis Based on IL-23/Th17 Inflammatory Axis. Journal of Oral Science Research, 36(9): 844–849.

Zhan L, Ma R, Wan N, et al., 2022, Effects of Puerarin on Th17/Treg Cell Immune Homeostasis and the Expression of Related Transcription Factors in Rats with Periodontitis. Journal of Kunming Medical University, 43(11): 36–43.

Liu C, Yan Y, Mo L, et al., 2024, Puerarin Inhibits the Differentiation of Raw264.7 Cells into Osteoclasts Through the Notch Signaling Pathway. Chinese Journal of Tissue Engineering Research, 28(35): 5636–5641.

Zhao Y, Yao N, Geng Q, et al., 2024, The Effect of Eriodictyol on Osteogenic Differentiation of Periodontitis Periodontal Ligament Stem Cells by Regulating the YAP/TAZ Signaling Pathway. Hebei Medicine, 30(7): 1105–1114.

Dai Z, Guo Y, Liu Y, et al., 2024, Impacts of Soy Isoflavones Inhibiting Slit2/MAPK Signaling Pathway on Alveolar Bone Resorption and Inflammatory Response in Periodontitis Rats. Cellular & Molecular Immunology, 40(6): 1131–1136.

Thangavel P, Puga-Olguín A, Rodríguez-Landa JF, et al., 2019, Genistein as Potential Therapeutic Candidate for Menopausal Symptoms and Other Related Diseases. Molecules, 24(21): 3892. https://doi.org/10.3390/molecules24213892

Zhang X, Hou S, Peng Y, et al., 2023, Effect of Genistein on Periodontal Tissues in Mice with Periodontitis. Chinese Journal of Geriatric Dentistry, 21(3): 153–156 + 192.

Zhang J, Jia C, He B, et al., 2023, Hyperoside Inhibits TLR4/MyD88/NF-κB Signaling Pathway to Reduce Periodontal Tissue Damage in Rats with Periodontitis. Shaanxi Medical Journal, 52(11): 1463–1467 + 1472.

Gong Y, Wang C, Wu Z, et al., 2021, Antibacterial Effect of Baicalin and Its Anti-Inflammatory and Osteogenic Ability on Experimental Periodontitis in Rats. Journal of Xinjiang Medical University, 44(4): 415–420.

Zhou Y, Chen Z, Liu Y, et al., 2021, EGCG and Baicalin Inhibit M1 Polarization of Macrophages in Mice Periodontitis Through mTOR Synergistically. Journal of Oral Science Research, 37(7): 622–627.

Wang Q, Feng B, Gao Y, 2023, Effect and Mechanism of Baicalin on the Proliferation and Migration of Human Periodontal Ligament Stem Cells Induced by Lipopolysaccharide. China Pharmacy, 34(10): 1216–1222.

Xia L, Xu D, Zhang B, et al., 2023, Effect of Baicalin Combined with Metronidazole on Periodontal Index and Inflammatory Factors in Patients with Gastric Fire and Kidney Deficiency Type Periodontitis. China Practical Medical, 18(16): 11–16.

Casili G, Ardizzone A, Lanza M, et al., 2020, Treatment with Luteolin Improves Lipopolysaccharide-Induced Periodontal Diseases in Rats. Biomedicines, 8(10): 442. https://doi.org/10.3390/biomedicines8100442

Li Y, Xing H, Wang Y, et al., 2020, Effects of Luteolin on NLRP3/IL-1β Signal Pathway and Bone Remodeling in Periodontitis Rats. Journal of Oral Science Research, 36(12): 1117–1122.

Zhang J, Yang H, 2022, Effect of Gingival Mesenchymal Stem Cells Combined with Total Flavonoids of Astragalus on Periodontitis Rats. The Chinese Journal of Clinical Pharmacology, 38(24): 3020–3024.

Wang D, Liu Y, Shao L, et al., 2023, The Impacts of Astragaloside IV on Periodontal Tissue Remodeling in Orthodontic Rats with Periodontitis by Inhibiting TLR4/MyD88/NF-κB Signaling Pathway. Journal of Practical Stomatology, 39(6): 722–729.

Yu J, 2023, Study on the Role of Quercetin-Regulated Autophagy in the Inhibition of Osteogenic Differentiation of Human Periodontal Ligament Cells by Cigarette Smoke Extract, dissertation, Chongqing Medical University.

Shen Y, Qi X, Feng Y, et al., 2024, A Preliminary Study of Quercetin in the Prevention of Periodontal Lesions in Smokers Through JAK/STAT Signal Pathway. Journal of Modern Stomatology, 38(2): 100–107.

Wei Y, Fu J, Wu W, et al., 2021, Quercetin Prevents Oxidative Stress-Induced Injury of Periodontal Ligament Cells and Alveolar Bone Loss in Periodontitis. Drug Des Devel Ther, 15: 3509–3522. https://doi.org/10.2147/DDDT.S315249

Zhang W, Jia L, Zhao B, et al., 2021, Quercetin Reverses TNF‑α Induced Osteogenic Damage to Human Periodontal Ligament Stem Cells by Suppressing the NF‑κB/NLRP3 Inflammasome Pathway. Int J Mol Med, 47(4): 39. https://doi.org/10.3892/ijmm.2021.4872

Yang SY, Hu Y, Zhao R, et al., 2024, Quercetin-Loaded Mesoporous Nano-Delivery System Remodels Osteoimmune Microenvironment to Regenerate Alveolar Bone in Periodontitis via the miR-21a-5p/PDCD4/NF-κB Pathway. J Nanobiotechnology, 22(1): 94. https://doi.org/10.1186/s12951-024-02352-4

Guo X, Li S, Liang X, et al., 2021, Effect of Quercetin on Periodontal Tissues and Serum AGEs Level in Rats with Diabetic Periodontitis. Journal of Oral Science Research, 37(7): 628–631.

Xiao M, 2023, In Vitro Study on Anti-Inflammatory and Anti-Osteoclastic Effects of Kaempferol on Periodontitis Through MAPK Signaling Pathway, dissertation, Nanchang University.

Hosokawa Y, Hosokawa I, Ozaki K, et al., 2021, Nobiletin Inhibits Inflammatory Reaction in Interleukin-1β-Stimulated Human Periodontal Ligament Cells. Pharmaceutics, 13(5): 667. https://doi.org/10.3390/pharmaceutics13050667

Yu J, Yu M, Li N, 2023, The Impact of Nobiletin on the Inflammatory Injury in Rats with Periodontitis by Regulating the CCL2–CCR2 Signaling Axis. Hebei Medicine, 29(12): 1937–1941.

Cui L, Wu N, Xu J, et al., 2021, Effect of Proanthocyanidins on Related Inflammatory Factors in Diabetic Rats with Periodontitis. Journal of Nongken Medicine, 43(1): 6–10.

Zhu X, 2022, Effect of Grape Seed Proanthocyanidins on Periodontal Tissue of Experimental Diabetic Periodontitis Rats, dissertation, Shihezi University.

Wu Y, Wang X, Zhang Y, et al., 2024, Proanthocyanidins Ameliorate LPS-Inhibited Osteogenesis of PDLSCs by Restoring Lysine Lactylation. Int J Mol Sci, 25(5): 2947. https://doi.org/10.3390/ijms25052947

Ma T, Shi J, Zhang L, et al., 2022, Protective Effect and Mechanism of Protocatechuic Acid on Lipopolysaccharide-Induced Inflammatory Reaction in Human Periodontal Ligament Fibroblasts. Guangxi Medical Journal, 44(2): 172–178 + 197.

Nu E, Ju R, A R, et al., 2023, Antibacterial Effect of Ellagic Acid on Porphyromonas gingivalis and Fusobacterium nucleatum In Vitro. Beijing Journal of Stomatology, 31(6): 400–404.

Yu M, 2024, Experimental Study of Ellagic Acid in the Treatment of Chronic Periodontitis, dissertation, Xinjiang Medical University.

Shi W, Ling D, Zhang F, et al., 2021, Curcumin Promotes Osteogenic Differentiation of Human Periodontal Ligament Stem Cells by Inducting EGR1 Expression. Arch Oral Biol, 121: 104958. https://doi.org/10.1016/j.archoralbio.2020.104958

Lan Q, Cao J, Bi X, et al., 2023, Curcumin-Primed Periodontal Ligament Stem Cells-Derived Extracellular Vesicles Improve Osteogenic Ability Through the Wnt/β-Catenin Pathway. Front Cell Dev Biol, 11: 1225449. https://doi.org/10.3389/fcell.2023.1225449

Wang Y, Lin H, Huang W, et al., 2023, Curcumin Attenuates Periodontal Injury via Inhibiting Ferroptosis of Ligature-Induced Periodontitis in Mice. Int J Mol Sci, 24(12): 9835. https://doi.org/10.3390/ijms24129835

Diomede F, Fonticoli L, Guarnieri S, et al., 2021, The Effect of Liposomal Curcumin as an Anti-Inflammatory Strategy on Lipopolysaccharide e from Porphyromonas gingivalis Treated Endothelial Committed Neural Crest Derived Stem Cells: Morphological and Molecular Mechanisms. Int J Mol Sci, 22(14): 7534. https://doi.org/10.3390/ijms22147534

Tang X, Li Q, Gao Y, et al., 2023, Effects of Farrerol on Periodontal Tissue Injury and mTOR/STAT3 Signaling Pathway in Rats with Ligation Periodontitis. Journal of Chinese Pharmaceutical Sciences, 58(24): 2252–2258.

Sun Y, 2023, 4’-Methoxyresveratrol Inhibits the Inflammatory Response of Human Gingival Fibroblasts Stimulated by LPS with High Concentration Glucose and Its Mechanism, dissertation, Shandong University.

Li Y, Huang Z, Pan S, et al., 2023, Resveratrol Alleviates Diabetic Periodontitis-Induced Alveolar Osteocyte Ferroptosis Possibly via Regulation of SLC7A11/GPX4. Nutrients, 15(9): 2115. https://doi.org/10.3390/nu15092115

Wang Y, Li S, Li J, et al., 2022, Resveratrol Inhibits Human Gingival Fibroblast Inflammation Induced by Lipopolysaccharide Through PI3K/AKT Signaling Pathway. Journal of North Sichuan Medical College, 37(5): 561–566.

Jiang H, Ni J, Hu L, et al., 2023, Resveratrol May Reduce the Degree of Periodontitis by Regulating ERK Pathway in Gingival-Derived MSCs. Int J Mol Sci, 24(14): 11294. https://doi.org/10.3390/ijms241411294

Ma Y, Qian Y, Chen Y, et al., 2024, Resveratrol Modulates the Inflammatory Response in hPDLSCs via the NRF2/HO-1 and NF-κB Pathways and Promotes Osteogenic Differentiation. J Periodontal Res, 59(1): 162–173. https://doi.org/10.1111/jre.13200

Wei X, 2023, Effect of Leucatrol on OPG/RANKL/RANK Signaling Pathway in Rats with Periodontitis. Fujian Journal of Medicine, 45(5): 102–105.

Eltay EG, Gismalla BG, Mukhtar MM, et al., 2021, Punica granatum Peel Extract as Adjunct Irrigation to Nonsurgical Treatment of Chronic Gingivitis. Complement Ther Clin Pract, 43: 101383. https://doi.org/10.1016/j.ctcp.2021.101383

A R, 2023, Effects of Punicalagin on the Growth and Adhesion of Periodontal Pathogens Under Different Conditions, dissertation, Xinjiang Medical University.

Liu C, 2022, Experimental Study on the Treatment of Lycium barbarum Polysaccharide-Glycoprotein in Periodontitis, dissertation, University of Electronic Science and Technology of China.

Cai H, Wang Z, Zhang Z, et al., 2023, Morinda officinalis Polysaccharides Inhibit the Expression and Activity of NOD-like Receptor Thermal Protein Domain Associated Protein 3 in Inflammatory Periodontal Ligament Cells by Upregulating Silent Information Regulator Sirtuin 1. West China Journal of Stomatology, 41(6): 662–670.

Zhang Z, Dai J, Cai H, et al., 2024, Effects of Morinda officinalis Polysaccharides on FN and FN-EDA of Periodontal Ligament Fibroblasts in Inflammatory Microenvironment. Shanghai Journal of Stomatology, 33(2): 123–129.

Zhou S, Ji Y, Yao H, et al., 2022, Application of Ginsenoside Rd in Periodontitis With Inhibitory Effects on Pathogenicity, Inflammation, and Bone Resorption. Front Cell Infect Microbiol, 12: 813953. https://doi.org/10.3389/fcimb.2022.813953

Kim EN, Kaygusuz O, Lee HS, et al., 2021, Simultaneous Quantitative Analysis of Ginsenosides Isolated from the Fruit of Panax ginseng C.A. Meyer and Regulation of HO-1 Expression through EGFR Signaling Has Anti-Inflammatory and Osteogenic Induction Effects in HPDL Cells. Molecules, 26(7): 2092. https://doi.org/10.3390/molecules26072092

Chu K, Zhang Z, Chu Y, et al., 2023, Ginsenoside Rg1 Alleviates Lipopolysaccharide-Induced Pyroptosis in Human Periodontal Ligament Cells via Inhibiting Drp1-Mediated Mitochondrial Fission. Arch Oral Biol, 147: 105632. https://doi.org/10.1016/j.archoralbio.2023.105632

Sun M, Ji Y, Zhou S, et al., 2023, Ginsenoside Rb3 Inhibits Osteoclastogenesis via ERK/NF-κB Signaling Pathway In Vitro and In Vivo. Oral Dis, 29(8): 3460–3471. https://doi.org/10.1111/odi.14352

Sun M, Ji Y, Li Z, et al., 2020, Ginsenoside Rb3 Inhibits Pro-Inflammatory Cytokines via MAPK/AKT/NF-κB Pathways and Attenuates Rat Alveolar Bone Resorption in Response to Porphyromonas gingivalis LPS. Molecules, 25(20): 4815. https://doi.org/10.3390/molecules25204815

Zhang Y, Shi H, 2024, Ginsenoside Rb3 Alleviates the Formation of Osteoclasts Induced by Periodontal Ligament Fibroblasts in the Periodontitis Microenvironment Through the STAT3 Pathway. Cell Biol Int, 48(9): 1343–1353. https://doi.org/10.1002/cbin.12201

Lee WJ, Kim EN, Trang NM, et al., 2023, Ameliorative Effect of Ginsenoside Rg6 in Periodontal Tissue Inflammation and Recovering Damaged Alveolar Bone. Molecules, 29(1): 46. https://doi.org/10.3390/molecules29010046

Shen X, 2023, The Effect of Traditional Chinese Medicine Radix Scrophulariae and Salidroside on Dominant Bacteria of Periodontitis and Peri-Implantitis, dissertation, Hubei University of Medicine.

Wang Y, Li D, Zhao F, et al., 2023, Effects of Ursolic Acid on Alveolar Bone Resorption in Periodontitis Rats by Regulating AMPK/SIRT1 Pathway. Shaanxi Medical Journal, 52(5): 517–522.

Zhou L, Teng N, Gao T, et al., 2024, Protective Effect of Carvacrol Hydrogel on the Alveolar Bone in Rats with Periodontitis. West China Journal of Stomatology, 42(5): 593–608.

Yang L, Feng T, Li S, 2021, Therapeutic Effect of Rabdosia excisa Decoction on Experimental Periodontitis in Rats. Journal of Shanxi College of Traditional Chinese Medicine, 22(5): 332–335 + 340.

Deng Y, 2023, Genipin Regulates Mitochondrial Dysfunction Through Nrf2 to Relieve Oxidative Stress Damage in Periodontitis, dissertation, Jilin University.

Zhang N, Hou X, Zhang W, et al., 2021, Glycyrrhizin Plays a Role in the Treatment of Periodontitis by Regulating the COX-2/NF-κB Signaling Pathway. Journal of Molecular Diagnosis and Therapy, 13(9): 1469–1472.

Zhu Y, Kang J, Zhao J, et al., 2023, Effects of Berberine on Inflammatory Genes and Alveolar Bone Resorption in Mice with Periodontitis. Biological Chemical Engineering, 9(6): 85–88.

Xia S, Jing R, Shi M, et al., 2024, BBR Affects Macrophage Polarization via Inhibition of NF-κB Pathway to Protect Against T2DM-Associated Periodontitis. J Periodontal Res, 59(4): 728–737. https://doi.org/10.1111/jre.13246

Wang C, Liu C, Liang C, et al., 2023, Role of Berberine Thermosensitive Hydrogel in Periodontitis via PI3K/AKT Pathway In Vitro. Int J Mol Sci, 24(7): 6364. https://doi.org/10.3390/ijms24076364. Erratum in Int J Mol Sci, 25(10): 5104. https://doi.org/10.3390/ijms25105104

Gu L, Ke Y, Gan J, et al., 2021, Berberine Suppresses Bone Loss and Inflammation in Ligature-Induced Periodontitis Through Promotion of the G Protein-Coupled Estrogen Receptor-Mediated Inactivation of the p38MAPK/NF-κB Pathway. Arch Oral Biol, 122: 104992. https://doi.org/10.1016/j.archoralbio.2020.104992

Liu S, Huang X, Sun W, 2024, Influences of Emodin on Bone Mineral Density and Inflammatory Response in Rats with Chronic Periodontitis by Up-regulating miR-218 Expression. Current Medicine, 52(4): 594–601.

Chai H, Liang S, Niu Y, et al., 2020, Down-regulation of NF-κB in Periodontal Tissue Cells is One of the Mechanisms of Emodin in the Treatment of Moderate and Severe Chronic Periodontitis. Journal of Practical Stomatology, 36(3): 517–520.

Su J, Zhu Y, Zhang W, 2021, Effects of Phillyrin on p38 MAPK/c-Fos Signal Pathway and Osteoclast Activation in Periodontitis Rats. Journal of Oral Science Research, 37(1): 33–38.

Wang F, Long S, Zhang J, 2021, Moringa oleifera Lam. Leaf Extract Safely Inhibits Periodontitis by Regulating the Expression of p38α/MAPK14-OPG/RANKL. Arch Oral Biol, 132: 105280. https://doi.org/10.1016/j.archoralbio.2021.105280

Yuan H, 2022, Mechanism of Cryptochlorogenic Acid from Moringa oleifera Leaf on Inhibiting Periodontitis and Alveolar Bone Resorption, dissertation, Nanchang University.

Fang H, 2023, Cryptochlorogenic Acid Through NF-κB/JMJD3 Signal Axis Mediated Macrophage Polarization in the Treatment of Periodontitis, dissertation, Nanchang University.

Lan Y, 2023, Mechanism of Orientin on Inhibiting Periodontal Inflammation and Osteoclast Differentiation via Autophagy, dissertation, Nanchang University.

Ren B, Yao H, 2022, Effect of Tripterygium wilfordii Polyglycosides on Experimental Periodontitis in Rats. Journal of Modern Stomatology, 36(1): 10–14.

Chen H, Wang L, Lin Q, et al., 2023, Study on the Antibacterial and Anti-inflammatory Effects of Conyza blinii Lévl. Ethanol Extract on Chronic Periodontitis In Vitro. Chinese Medicine Guide, 29(2): 28–34.

Xie L, Li X, Huang X, et al., 2023, Effects of Allicin on Insulin Resistance and Free Fatty Acid Levels in Obese Rats with Periodontitis. Shanghai Journal of Stomatology, 32(4): 375–379.

Chen H, Liu Y, Yu S, et al., 2023, Cannabidiol Attenuates Periodontal Inflammation Through Inhibiting TLR4/NF-κB Pathway. J Periodontal Res, 58(4): 697–707. https://doi.org/10.1111/jre.13118

Qi M, Qi X, Zhou X, et al., 2023, Therapeutic Effect of Cannabidiol Combined with Minocycline on Periodontitis. International Journal of Stomatology, 51(4): 392–400.