Topical Oral Medicaments in Traditional Persian Medicine

Introduction The history of the topical use of medications in the mouth goes back to 5000-3000 BC. Ancient Egyptians used a combination of powdered ashes from oxen hooves, Myrrha, eggshell, and pumice to remove the mass from the tooth. About 1000 BC, ancient Iranians added materials such as the burnt shells of the snails, herbs, gypsums, and oysters to these formulations (1). On the other hand, oral health is significantly important for retaining the general health and quality of life. In addition, maintaining oral hygiene, along with having healthy and beautiful teeth leads to positive psychological effects, which could enhance the self-confidence of the individuals (2). Previous research has focused on the link between oral-dental infections and systemic diseases such as cardiovascular diseases and diabetes (3). Further, oral and dental diseases impose a high cost on global economy systems both as direct and indirect treatment costs (4). Therefore, improving the level of oral health and preventative measures can help maintain the financial resources of the countries by reducing the costs while increasing efficiency. On the other hand, several side effects of oral and parenteral drugs and the great advantages of trans-mucosal drug delivery systems including high vascular bed and permeability, the avoidance of first-pass and enzymatic degradation, and the pre-systematic elimination have increased the tendency to use these drug delivery routes in recent years (5). Among the transmucosal routes, the buccal route has notable importance in designing new drugs due to the ease of use, high acceptability, along with the possibility of easily observing localized complications and having a high level of recovery rate in oral tissues (5). In traditional Persian medicine (TPM) texts, various drug delivery forms are introduced for topical use in the mouth. Notably, the mentioned medicaments are generally comprised of diverse medicinal plants (6). Approximately 50 herbal remedies belonging to 40 plant families are used in the formulation of these drugs. Furthermore, they have antimicrobial (75%), anti-inflammatory (55%), and anti-oxidant (40%) properties. In addition, recent research has confirmed anti-epilepsy, antipyretic, sedative, anti-asthmatic, bronchodilator, and anti-parkinsonism properties for these herbal components (See Supplementary data, Table S1). Moreover, these drug forms are utilized to achieve systemic and topical treatment goals. To the best of our knowledge, no centralized and focused studies are Abstract Objectives: Traditional, topically used oral medicaments are of great importance in the treatment of both oral and systemic diseases. Therefore, the aim of this study was to review the indications of various drug delivery forms and active ingredients of currently used medications in complementary medicine, as well as the results of recent research to find any possible conformity between their traditional and recent pharmaceutical properties. Methods: In this review article, different resources including electronica databases, hand searching, the screening of reference lists and contacting experts were extensively performed, followed by categorizing the extracted data. Results: Based on the results, 6 drug forms were found in gaseous, liquid, and solid states with more than 70 formulations. Liquid and gaseous forms were mainly used to manage systemic conditions and solid forms were mainly applied for local treatments. In addition, the investigation of about 50 herbal components showed that the traditional therapeutic effects of the vast majority of the ingredients were in line with those of the recent studies. However, no clinical studies were found regarding the traditionally mentioned systemic effects after the topical use of this medicament in the form of gargles or mouthrinse. Conclusions: In general, the side effects of oral and injectable drugs, as well as the specific advantages of oral mucosa in achieving the topical and systemic effects and the variety of the plant components of Iranian traditional oral medicament might have high potentials for finding new drugs and improving treatment strategies of some systemic diseases such as central nervous system diseases and depression.