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      Comparative Study of Punica granatum Gel and Triadent Oral Paste Effect on Recurrent Aphthous Stomatitis, a Double Blind Clinical Trial

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          Abstract

          Statement of the Problem:

          Recurrent aphthous stomatitis is a common oral lesion, and the use of herbal remedies containing tannin and flavonoid has been reported to be effective in treating aphthous stomatitis.

          Purpose:

          This study was aimed to evaluate the effect of Punica granatum muco-adhesive gel on controlling the oral recurrent aphthous stomatitis and its comparison with Triadent oral paste.

          Materials and Method:

          In this double-blind clinical trial, 60 patients with minor aphthous stomatitis were enrolled. These patients had no systemic diseases and were not on any medications. The patients were randomly treated with Punica granatum formulated gel, Triadent oral paste and placebo. The time of pain elimination and the time of complete healing were recorded and the pain degree was assessed and recorded by each patient. The data were analyzed using survival analysis and ANOVA test.

          Results:

          The Kaplan-Meier survival analysis demonstrated that pain relief time in Punica granatum group was lower than placebo group ( p= 0.002), even so, it caused no significant difference with the Triadent group in comparison with the placebo group ( p= 0.08). The survival analysis also indicated that the wound healing time in Punica granatum group was significantly lower than the other two groups ( p< 0.05).

          Conclusion:

          Punica granatum gel has a successful effect in controlling and treating recurrent aphthous stomatitis. It can be considered as an affordable and inexpensive treatment.

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          Most cited references25

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          The effects of plant flavonoids on mammalian cells: implications for inflammation, heart disease, and cancer.

          Flavonoids are nearly ubiquitous in plants and are recognized as the pigments responsible for the colors of leaves, especially in autumn. They are rich in seeds, citrus fruits, olive oil, tea, and red wine. They are low molecular weight compounds composed of a three-ring structure with various substitutions. This basic structure is shared by tocopherols (vitamin E). Flavonoids can be subdivided according to the presence of an oxy group at position 4, a double bond between carbon atoms 2 and 3, or a hydroxyl group in position 3 of the C (middle) ring. These characteristics appear to also be required for best activity, especially antioxidant and antiproliferative, in the systems studied. The particular hydroxylation pattern of the B ring of the flavonoles increases their activities, especially in inhibition of mast cell secretion. Certain plants and spices containing flavonoids have been used for thousands of years in traditional Eastern medicine. In spite of the voluminous literature available, however, Western medicine has not yet used flavonoids therapeutically, even though their safety record is exceptional. Suggestions are made where such possibilities may be worth pursuing.
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            Antioxidant, antimalarial and antimicrobial activities of tannin-rich fractions, ellagitannins and phenolic acids from Punica granatum L.

            The Punica granatum L. (pomegranate) by-product POMx was partitioned between water, EtOAc and n-BuOH, and the EtOAc and n-BuOH extracts were purified by XAD-16 and Sephadex LH-20 column chromatography to afford ellagic acid (1), gallagic acid (2), punicalins (3), and punicalagins (4). Compounds 1 - 4 and the mixture of tannin fractions (XAD-16 eluates) were evaluated for antioxidant, antiplasmodial, and antimicrobial activities in cell-based assays. The mixture of tannins (TPT), XAD-EtOAc, XAD-H2O, XAD-PJ and XAD-BuOH, exhibited IC50 values against reactive oxygen species (ROS) generation at 0.8 - 19 microg/mL. Compounds 1 - 4 showed IC50 values of 1.1, 3.2, 2.3 and 1.4 microM, respectively, against ROS generation and no toxicity up to 31.25 microg/mL against HL-60 cells. Gallagic acid (2) and punicalagins (4) exhibited antiplasmodial activity against Plasmodium falciparum D6 and W2 clones with IC50 values of 10.9, 10.6, 7.5 and 8.8 microM, respectively. Fractions XAD-EtOAc, XAD-BuOH, XAD-H2O and XAD-PJ compounds 1 - 4 revealed antimicrobial activity when assayed against Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Cryptococcus neoformans, methicillin-resistant Staphylococcus aureus (MRSA), Aspergillus fumigatus and Mycobacterium intracellulare. Compounds 2 and 4 showed activity against P. aeruginosa, C. neoformans, and MRSA. This is the first report on the antioxidant, antiplasmodial and antimicrobial activities of POMx isolates, including structure-activity relationships (SAR) of the free radical inhibition activity of compounds 1 - 4. Our results suggest a beneficial effect from the daily intake of POMx and pomegranate juice (PJ) as dietary supplements to augment the human immune system's antioxidant, antimalarial and antimicrobial capacities.
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              Pomegranate as a cosmeceutical source: pomegranate fractions promote proliferation and procollagen synthesis and inhibit matrix metalloproteinase-1 production in human skin cells.

              Pomegranate (Punica granatum) is an ancient fruit with exceptionally rich ethnomedical applications. The peel (pericarp) is well regarded for its astringent properties; the seeds for conferring invulnerability in combat and stimulating beauty and fertility. Here, aqueous fractions prepared from the fruit's peel and fermented juice and lipophilic fractions prepared from pomegranate seeds were examined for effects on human epidermal keratinocyte and human dermal fibroblast function. Pomegranate seed oil, but not aqueous extracts of fermented juice, peel or seed cake, was shown to stimulate keratinocyte proliferation in monolayer culture. In parallel, a mild thickening of the epidermis (without the loss of ordered differentiation) was observed in skin organ culture. The same pomegranate seed oil that stimulated keratinocyte proliferation was without effect on fibroblast function. In contrast, pomegranate peel extract (and to a lesser extent, both the fermented juice and seed cake extracts) stimulated type I procollagen synthesis and inhibited matrix metalloproteinase-1 (MMP-1; interstitial collagenase) production by dermal fibroblasts, but had no growth-supporting effect on keratinocytes. These results suggest heuristic potential of pomegranate fractions for facilitating skin repair in a polar manner, namely aqueous extracts (especially of pomegranate peel) promoting regeneration of dermis, and pomegranate seed oil promoting regeneration of epidermis.
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                Author and article information

                Journal
                J Dent (Shiraz)
                J Dent (Shiraz)
                Journal of Dentistry
                Journal of Dentistry Shiraz University of Medical Sciences (Iran )
                2345-6485
                2345-6418
                September 2019
                : 20
                : 3
                : 184-189
                Affiliations
                [1 ]Dental Material Research Center, Dept. of Oral and Maxillofacial Medicine, Dental Research Institute,Isfahan University of Medical Sciences, Isfahan,Iran.
                [2 ]Dept. of Pharmaceutics, School of Pharmacy and Novel Drug Delivery Systems Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
                [3 ]Dentis, Isfahan, Iran.
                Author notes
                Correspondence: Tavangar A. Dental Material Research Center, Dept. of Oral and Maxillofacial Medicine, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Tel:+98-9132265606
                Article
                JDS-20-3
                10.30476/DENTJODS.2019.44913
                6732176
                31579693
                0e5267a0-825d-40a6-b2c4-1c4c37e6188c
                Copyright: © Journal of Dentistry Shiraz University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : September 2018
                : October 2018
                : August 2018
                Categories
                Original Article

                aphthous , triadentent , pain , punicagranatum , stomatitis , management

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