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Alternative Medicine
Herbal Medicine

It is important that your dentist has all the information,
including your medical history, herbal medication 
and conventional drugs you are taking. 

Cautions                                                 Recommendations Before Surgery
Remedies                                                Tell your Dentist
     Alternative medicine or "natural remedies" for dental care have been around for centuries only now there is research to prove if they are effective or just old wives tales.

Always tell your dentist about all medications and supplements you are taking and how much you take.

     We do caution you when using any alternative "natural" treatments including herbal supplements.  Remember that even the most common herbs such as St. John's Wort and Ginko Biloba can cause serious health problems if taken in combination with other drugs or in extreme dosages.  

These medication are not just ground up herbs, but are actually derived from the potent oils of the plants.  These natural medication are capable of dangerous drug interactions that can  put a person at an increased risk for a complication during and after dental treatment.

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  1. Blood thinners, such as the popular ginkgo biloba and even vitamin E can be dangerous when taken with aspirin, which also acts as a blood thinner. Because this may cause a situation in which some patients' blood will have difficulty clotting.  
    bulletGinkgo may also increase gum disease. Gingko affects the platelets in the blood stream that cause the clotting
    mechanism to occur after an injury. Patients taking gingko may bleed through their gums, and the product may cause uncontrollable bleeding or speed up existing gum disease.  Bleeding time is prolonged when ginkgo is used with aspirin
    bulletIf you take aspirin frequently, you may want to pass on ginkgo biloba.
    bulletGingko biloba has anti-platelet properties that may reduce blood clotting.  Aspirin is an anticoagulant, or blood thinner,
     that also may increase the time it  takes for blood to clot. Thus, combining gingko use with daily or frequent 
    aspirin use could increase the risk of bleeding complications. Ask your doctor before taking both regularly.
    bulletThe following herbal medications can also cause an increase in  bleeding when combined with prescription or over the counter drugs...garlic, Melilot, Sweetwoodruff, Horse Chestnut, Cinnabar root, Alfalfa, Dong quai, Barberry,
    Goldenseal, Oregon grape,  Feverfew and Bromelains. These herbs increase the action of blood thinners Coumadin,
    Warfarin and other coumadin anticoagulants.
    Feverfew, garlic, ginger, ginkgo-
  2. Vitamin C, when taken in the thousands of grams can cause problems and weaken the efficiency of anesthesia.
  3. Calming supplement, such as Kava Kava or St. John's Wort and Valerian**** can enhance the effects of the anesthesia to cause problems.  It is recommended to gradually discontinue the use of valerian and kava 7 days prior to anesthesia because of its potential to enhance the sedative effects of agents used in general anesthesia. ^
  4. Garlic can cause bleeding though platelet aggregation and it can increase the action of coumadin and warfarin in anticoagulant therapy.  It is recommended that you discontinue the use of garlic at least seven days prior to surgery. ^
  5. Dandelion and bearberry are both herbal supplements that are said to work as a diuretic. These can interact with and over-enhance the effects of prescription diuretics, which can lead to dehydration, loss of potassium in the body, and even disrupt heart-rhythm.
  6. Ephedra Warning: Enforcement of LB 113**

    This is a resolution to protect the public from illegal ephedrine containing food/herbal supplements that can cause:

    bulletcardiovascular instability through increased heart rate
    bulletrisk of heart attacks
    bulletblood pressure
    bulletrisk of heart ischemia,  stroke and death. 

    Dosage unit is not to exceed 25 mg of ephedrine.  Maximum recommended dosage in 24 hours is 100mg or less. The label must contain a warning statement. It is recommended that you discontinue this herb at least 24 hours prior to surgery.  

    Avoid mixing Ephedra with:

    bulletHeart drugs
    Combined with these drugs, it becomes even more risky. Ephedra is a potent herb that is present in many products, especially those designed to give pep or lose weight. It goes by many names, such as ma huang, herbal ecstasy, mahuang, mahuanggen and ma huang root. Suspect any "natural" product that claims to cause weight loss or increase energy to have ephedra in it, and review the product's contents with your doctor or pharmacist before assuming it doesn't.
    HHS Acts to Reduce Potential Risks with Ephedra
  7. Echinacea-possible problems with allergic reactions ,decreased effectiveness of immunosuppressants and possible immune suppressant with long-term use (more than 8 weeks).  Long term use increases the risk of poor wound healing and opportunistic infections. Echinacea increases your immune response but should be taken  for two weeks or less.  Taken long term, it may actually decrease your body’s ability to fight disease.
     You should discontinue taking Echinacea as far in advance as possible of medical surgery.^ Avoid mixing with:
    bulletAnabolic steroids
    bulletAmiodarone (Cordarone, Pacerone), used to treat arrhythmia
    bulletMethotrexate (Methotrexate), used to treat rheumatoid arthritis
    bulletKetoconazole (Nizoral), an antifungal drug
    bulletCyclosporine (Neoral, Sandimmune, SangCya), an immunosuppressant
    Echinacea can be toxic to the liver and shouldn't be combined with other drugs
     that can cause liver damage
  8. Feverfew-can increase bleeding and it can increase the action of coumadin and warfarin in anticoagulant therapy.
  9. Ginseng can cause bleeding and hypoglycemia by lowering blood sugar.  It is recommended to discontinue ginseng use at least seven day prior to surgery.^ Avoid mixing with:
    bulletWarfarin (Coumadin), an anticoagulant-this combination could cause bleeding 
    bulletPhenelzine sulfate (Nardil), an antidepressant-could caue headache, trembling,
    manic behavior.
    bulletDigoxin (Lanoxicaps, Lanoxin)-could interfere with its pharmacologic action
  10. Sanguinarine is not recommended due to its links to predisposing gum tissue to oral cancer.
  11. The herb ma huang,  known as ephedra, has been associated with stroke, heart attack, and sudden death. Ma huang is an herbal source of ephedrine, a powerful stimulant found in weight-loss and energy supplements. People with heart conditions should be especially careful to avoid stimulants.
  12. Melilot, sweet woodruff, horse chestnut, cinnabar root, alfalfa, dong qui, barberry, goldenseal, Oregon grape, bromelains can increase the action of blood thinners like coumadin and warfarin.
  13. Garlic, Gingko and Feverfew can increase the effectiveness of aspirin and can greatly increase bleeding.
  14. Cassia cinnamon can decrease the effectiveness of tetracycline by up to 80%.  Tetracycline can be used to help treat gum disease.
  15. Agrimonia eupatoria, agropyrum repens, alchemilla arvensis, alisma plantago, anacyculus purethrum, bearberry, black cohosh, hawthorn, sassafras, dandelion and viola tricolor can cause hypotension when taken with medications prescribed for hypertension.  Caution needs to be used when getting out of the dental chair after being in a laid back position.
  16. St John's Wort can cause drowsiness and sensitivity to light.  It interferes with the effectiveness of other drugs such as Versed, Valium and Halcion, Coumadin and digoxin and Tylenol.  Due to its ability to diminish the actions of other drugs it is recommended you discontinue its used five days prior to surgery. ^
    Avoid mixing St John's Wort with any prescription medications. In particular, avoid taking St. John's Wort with:
    bulletAntidepressants-combination of SJW with some antidepressants, such as 
    selective serotonin reuptake inhibitor, may cause excess of serotonin.  Typical
    symptoms include headache, stomach upset and restlessness.
    bulletIndinavir sulfate (Crixivan), a protease inhibitor used to treat HIV
    bulletDigoxin (Lanoxicaps, Lanoxin), a drug used to increase the force of contraction
    of heart muscle and to regulate heartbeats
    bulletTheophylline (Slo-bid, Theo-Dur), an asthma medication
    bulletCyclosporin (Neoral, Sandimmune, SangCya) an immunosuppressant
    SJW has been shown to affect your body's metabolism of all of these drugs. Many other drugs are likely to be affected too. Until more is known about SJW's ability
    to alter the metabolism of pharmaceutical medications, it is probably best not to combine such medications with SJW.
  17. Kava alert: Avoid mixing with:
    bulletSleeping pills
    bulletDrugs used to treat anxiety or Parkinson's disease
    The FDA Center for Food Safety and Applied Nutrition notified of the potential risk of severe liver injury associated with the use of kava-containing dietary supplements. Supplements containing the herbal ingredient kava are promoted 
    for relaxation (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal symptoms and other uses. Kava-containing products have been associated with liver-related injuries, including hepatitis, cirrhosis, and liver 
    failure. Kava can be listed under different names...Piper Methysticum, ava 
    pepper, sakau and Tonga. Given these reports, persons who have liver disease 
    or liver problems or persons who are taking drug products that can affect  
    the liver, should  consult a physician before using kava-containing supplements.****
  18. Valerian-The medical concern is that is has the potential to enhance the sedative effects of agents used in general anesthesia.  It is recommended to discontinue use of valerian prior to anesthesia.  If you are  taking large doses of this medication it is recommended you not abruptly discontinue this medication but slowly decrease taking this herb in order to prevent withdrawal symptoms. 
  19. Cayenne-Avoid mixing with:
    bulletAngiotensin-converting enzyme (ACE) inhibitors, drugs used for diabetic kidney
    disease, heart failure, high blood pressure.
    bulletTheophylline (Slo-bid, Theo-Dur), an asthma medication.
    bulletCayenne may increase the absorption and impact of these drugs.  It may also increase the likelihood of developing a
    cough when used with ACE inhibitor.

20.  Herbal tea may be harmful to teeth -Dentists have warned herbal tea lovers that their favorite drink may be harming their teeth. According to a report published in the Journal of Dentistry, herbal tea can erode the protective layers of enamel that surround every tooth. It may be a healthier alternative to the more traditional cup of tea. Many of the teas they tested were acidic enough to erode tooth enamel. They also found that some were up to three times more acidic than fruit juice. It was suggested to avoid herbal and fruit teas. MG Worldwide Ltd 2003

21.  Methotrexate-Sudden death..Bill-Internet health comment 10/05

The greatest risk for a complication from dental procedures like having a tooth removed, root planing and scaling, gum surgery, biopsies.  Excessive bleeding can hamper routine dental treatment such as dental cleaning, fillings and crowns.

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Recommendations Before Having Dental Surgery, if you use any of these herbal medications stop taking them: 

bulletEphedra at least 24 hours before surgery
bulletGarlic 7 days before surgery
bulletGinkgo 36 hours before
bulletGinseng 7 days before surgery
bulletKava 24 hours before
bulletSt. John's Wort 5 days before surgery****

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bulletFluoride-naturally occurring mineral has been proven to protect teeth from decay.
bulletNon-alcohol mouthwash-alcohol dries out the mouth which can cause discomfort and create an environment for more plaque to thrive.
bulletTea-wet tea bags can give relief from canker sores, swollen gums, toothaches and stop bleeding after extraction.
bulletNatural preventive treatment for cold sores-A diet that is high in lysine and low in arginine has been found to be helpful. In vitro studies indicate that the amino acid arginine is required by the herpes virus to replicate. Since lysine competes with arginine for intestinal transport, a diet rich in lysine (brewers yeast, legumes, dairy, wheat germ, fish and meat) and low in arginine may have an antiviral effect. Chocolate, peanuts and almonds are high in arginine and should be avoided. In addition to dietary changes, lysine supplements are recommended. A dose of 1,000 mg taken three times a day has been shown to be effective. This approach is not curative but can help prevent recurrences
bulletGreen tea halts growth of oral cancer cells and breaks down and kills existing oral cancer.  Ingesting or swishing with green tea introduces the tea polyphenols to the oral cancer cells which may be present in the mouth.  The polyphenols are antioxidants, which work to remove the free radicals (oxidants) that cause mutation of genes, which may lead to cancerous growth to prevent gene mutations from the actions of the oxidants and cause cell death in cancerous cells without harming the normal cells.  They can also inhibit the growth and spread of cancerous cells.  The mouth's mucous lining must be exposed to four to six cups of green tea a day^^.  This study suggest  the use of green tea as a beverage or in oral health and skin care products is likely to be beneficial in helping to prevent oral cancer. +++
bulletZinc- available in lozenges to relieve pain of sore throat. Topical applications of zinc can reduce symptoms and prevent cold sores recurrences. It is applied directly to the skin at the site of the flare-up. Zinc can also be used to help alleviate cold and flu symptoms.
bulletLemon Balm-lemon balm cream promoted the healing of cold sore blisters in 5 days . Used on regularly, lemon balm cream can decrease the frequency of recurrences.
bulletHoney-has enzymes that contain antibacterial quality...phytochemicals which act as antioxidants to prevent the erosion of tissue surrounding teeth as a result of an infection*.  Caution, honey can vary widely in the potency of its antibacterial agents and should not be given to children under 2.
bulletPlant Aloe Vera: 
bulletRelieve a Cold Sore-anti-viral and anti-inflammatory properties, aloe vera provides additional benefits to the skin, such as amino acids, B1,B2,B6 and C vitamins 
bulletDentists are recommending patients to consume aloe vera juice to treat various internal ulcerations of the mouth, including apthous ulcer, lichen planus and oral mucus membranes. Recent findings show that aloe vera cleared up oral lesions associated with lichen planus better than any other traditional treatments.

Oral Health Problems Aloe vera: Natural, home remedy treats canker and cold sores

 New reports prove that the aloe vera plant, which has been used to heal skin for more than 2,000 years, can also treat many oral health problems including canker sores, cold sores, herpes simplex viruses, lichen planus and gingivitis. There is good evidence to support using aloe vera for oral health problems because it is alsoan  inexpensive alternative.

Aloe vera accelerates healing and reduces pain associated with canker sores, which are blisters on the lips or mouth. Aloe vera does not have a bad taste or sting when applied. Patients can drank 2.0 ounces of aloe vera juice daily and apply topical aloe vera lip balm. The oral lesions may clear up in four weeks and complete success can be achieved. Thus Aloe vera can be taken both as the aloe vera juice and aloe vera gel. Those interested in using aloe vera for oral health problems are encouraged to speak with a dentist for proper treatment techniques.

Treatment and use of aloe vera plants
  • Aloe vera plants are available at most plant stores and nurseries.
  • Place near a window.
  • Water when the soil is dry.
  • Do not over water.
  • To get the gel out of the plant, use scissors to snip off an inch of the leaf.
  • Squeeze the leaf that was snipped off. The gel will squeeze out.

    January/February issue of General Dentistry, Richard L. Wynn, PhD, the Academy of General Dentistry's (AGD) 2005

  • bulletOil of calendula - For mouth wounds like cold sores.
    bulletPlant-derived amica - Can be useful to patients after a tooth extraction or after oral surgery. It responds to minor trauma
    bulletValerian - To calm nervous or anxious patients who are interested in an alternative to nitrous oxide***
    bulletBarberry Bark- To treat bad breath+
    bulletHorehound-To treat acute or chronic sore throats and coughs+
    bulletMyrrh Gum- Removes bad breath+
    bulletSpeedwell-Used as a gargle for mouth and throat sores+
    bulletGinger Root-Remedy for a sore throat+
    bulletEchinacea Root-To treat strep throat+
    bulletMore Tea, Less Cavities  --  drinking black tea can help prevent gum disease and fight cavities by rinsing your month with black tea. Rinsing for 1 minute, 10 times a day resulted in a decrease in plaque build-up. The chemicals in black tea, called polyphenols, suppress the growth of cavity-causing bacteria in plaque and reduce acid production levels. So drinking black tea could reduce the number of cavities and prevent periodontal disease. American Society for Microbiology 101st General Meeting, Orlando, Fla.Ivanhoe Newswire (August 29, 2002) ORLANDO, Fla. (Ivanhoe Newswire) May 23, 2001
    bulletNatural Whitening: Brush with your normal toothpaste and rinse as usual. Dip the brush into baking soda and brush again with that for one full minute.. Rinse with mouthwash. Once Weekly: Substitute the following regimen for one brushing each  week:Mix two teaspoons baking soda with enough hydrogen peroxide to make a thick paste. ... Brush and allow the mixture to remain on your teeth for at least two minutes. Do not swallow this mixture. Rinse. Brush again with your regular.
    bulletHibicleans OTC and dilute a 4oz bottle with a gallon of water has the same effects as chlorhexdine

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    Always tell your dentist about all medications and supplements you are taking and how much you take from vitamins to Echinacea, everything you put in your body causes a certain reaction, and some alternative medicines are very potent. They can react and interfere with medications your dentist gives you or enhance them to cause a much stronger reaction.

     If your dentist doesn't know what drugs or supplements you have taken, he or she will not know how to protect you from possible substance interactions

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    To learn more about herbs:
    Herbal Task Force
    National Center for Complementary and Alternative Medicine
    Alternative Medicine Foundation
    Food and Drug Administration

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    ** Dentalnotes pg 3, Fall 2001
    ***AGD Alternative Medicine  Sept 23,01.
    +Only limited scientific investigation supports these claims AGD.
    ****JADA News Vol 132, October 2001 pg 1378.
    ^^The research was supported by a grant from the American Cancer
    ^^Dentalnotes, Winter 2001 pg 1
    ++FDA Probes Anti-Anxiety Herb, MedlinePlus 02/02
    JAMA Vol 286, #2 pg 208, 2001.
    ****FDA Medwatch.3/02
    +++Chemoprevention of Oral Cancer by Green Tea; Biochemistry 11/01; Dr. Hsu, Dr Singh, Fr Lewis, Dr Borke, Dr. Dickinson, Ms Drake, Dr. Caughman, Dr Schuster.
    ^Herbal Remedies, General Dentistry; Dr. Wynn, pg 14-20 Jan-Feb 2002.

    **Check to see if the supplement you are considering is registered with the state by calling 402-471-2118 or check at; go to Department of Regulation & Licensure.  To report ephedrine products not meeting the above labeling statues, call HHS Investigations Division 402-471-0175 and provide: Name & distributor of product; location of store where found; date product found; copy of advertisement materials or verbiage from label and any conversion you had with salesperson or owner.

    1998-2002 Mayo Foundation for Medical Education and Research. 

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    February 06, 2008

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