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Pomegranate Flavonoids for Oral Health

Gingivitis is an inflammation of the gums caused by bacteria, which results in irritation and bleeding. Pomegranates (Punica granatum) contain polyphenolic flavonoids that exert activities that could be considered beneficial to oral health, i.e., may prevent the development of gingivitis. These activities that have previously been demonstrated include direct antioxidative effects (e.g., radical scavenging), indirect antioxidant effects (e.g., induction of endogenous antioxidant enzymes), anti-inflammatory effects, antibacterial effects, the ability to remove dental plaque from teeth, and the inhibition of bacterial sucrose digesting enzyme, which is responsible for the initiation of oral problems, including gingivitis. However, the inhibition of enzymatic breakdown of sucrose was done using an extract of pomegranate flowers, not fruit. A pilot study in which a pomegranate extract was used as adjunct therapy for periodontal treatment showed bioactive effects. Thus, the present study was conducted to determine whether daily mouth rinsing with a pomegranate extract alters salivary measures reflective of biological activity relevant to gingivitis.


Thirty-two healthy, nonsmoking young men (n = 16) and non-pregnant women (n = 16) aged 19-25 years with good oral hygiene habits were enrolled in this randomized, single-blinded, controlled study, which was conducted at The Ohio State University. The subjects were randomly assigned by gender to treatment with pomegranate extract (POMELLA® Extract; standardized to contain 30% punicalagins; Verdure Sciences; Noblesville, Indiana) or with placebo (corn muffin mix in water) for 4 weeks. The daily dose of pomegranate extract was 100 mg. The pomegranate group was instructed to rinse their mouths 3 times daily (1 minute per rinse) with 35 ml of a pomegranate extract-containing aqueous solution, whereas the placebo group rinsed with a similar appearing formulation that contained no pomegranate. Following mouth rinsing with sterile water, saliva samples were collected, after subjects chewed paraffin wax to stimulate saliva flow. The subjects abstained from eating for at least 3 hours before providing saliva samples. Levels of total protein, a-glucosidase, aspartate aminotransferase, and ceruloplasmin and total antioxidant status were measured in the saliva samples before and after the 4 weeks of 3 times per day mouth rinsing with placebo or pomegranate extract.


No trends for individual sexes were noted; therefore, data for both sexes were pooled. Salivary concentrations of total protein (P < 0.01), a-glucosidase (P < 0.05), and aspartate aminotransferase (P < 0.005) were significantly lower after than before mouth rinsing with pomegranate extract. Ceruloplasmin activity and total antioxidant status were significantly greater after (P < 0.05 for each) than before mouth rinsing with pomegranate extract. No significant differences in ceruloplasmin activity, total antioxidant status, or concentrations of total protein, a-glucosidase, and aspartate aminotransferase were observed between before and after values in the placebo group. No adverse effects were reported in either group.


Mouth rinsing with a flavonoid-rich pomegranate extract had a positive effect on salivary measures reflective of biological activity relevant to gingivitis: increased activity of ceruloplasmin and measured antioxidant status (higher activities correlate with better protection against oral oxidant stress) and reductions in total protein (higher levels correlate with increases of plaque-forming bacteria), aspartate aminotransferase (increases correlate with higher levels of cell injury), and a-glucosidase (higher activity correlate with greater sucrose degradation). A 2006 study showed positive effects of pomegranate on oral health as well. Menezes et al1 showed an 84% decrease in dental plaque microorganisms after a single 1-minute mouth rinse with hydroalcoholic extract (HAE) from pomegranate in 20 subjects and concluded that the HAE from pomegranate was "very effective against dental plaque microorganisms." The authors of the present study conclude that "oral cavity exposure to pomegranate flavonoids' components could promote oral health, including affecting processes related to gingivitis."


—Brenda Milot, ELS



DiSilvestro RA, DiSilvestro DJ, DiSilvestro DJ. Pomegranate extract mouth rinsing effects on saliva measures relevant to gingivitis risk. Phytother Res. 2009;23: 1123-1127.



1Menezes SM, Cordeiro LN, Viana GS. Punica granatum (pomegranate) extract is active against dental plaque. J Herb Pharmacother. 2006;6:79-92.

This article was published on Thursday February 11, 2010.
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