Case Reports in Medicine bacteria, liquorice tobacco products discolour teeth and accelerate adjacent gingival breakdown. Quitting the tobacco habit with safe stain removal through scaling and polishing from teeth is feasible. Liquorice sweets are generally health promoting, plea- surable to eat, and in moderation on their own rarely stain teeth. Health care workers, including all in the dental team, discovering new hypertension patients, or noting a history of taking diuretics, should always enquire about consumption or use of any liquorice containing product [14]. Health care workers should update their knowledge about which drugs their patients are using, and follow-up on unwanted or toxic side eﬀects [40, 41]. 6. Conclusion Unduly stained teeth, a stained tongue or other oro- dental signs of intraoral chewing tobacco abuse combined with elevated blood pressures, should alert dentists to the possibility of morbidity arising from liquorice toxicity or abuse. With regular dental maintenance, regular medical history updates are essential and dental practices should measure blood pressure before any surgery. Some patients may even volunteer information about raised blood pressure. Health care professionals should check diets of all hypertensive patients and besides giving advice about eschewing liquorice products could refer aﬀected people for early diagnosis and treatment for hypertension. References [1] D. Brown, in Encyclopaedia of Herbs and Their Uses, vol. 289, pp. 283–284, RD Press, Montreal, Canada, 1995. [2] A. Olukoga and D. Donaldson, “Liquorice and its health implications,” Journal of the Royal Society for the Promotion of Health, vol. 120, no. 2, pp. 83–89, 2000. [3] S. Budavari, Ed., Chemical Formulations. Glycyrrhizin-4515. Cyclamate-2770; Saccharin-8463, Merck & Co, Rahway, NJ, USA, 12th edition, 1996, The Merck Index. [4] M. Quinkler and P. M. Stewart, “Hypertension and the cortisol-cortisone shuttle,” The Journal of Clinical Endocrinol- ogy & Metabolism, vol. 88, no. 6, pp. 2384–2392, 2003. [5] J. Snow, “Glycyrrhiza glabra. Monograph,” Protocol Journal of Botanical Medicine, vol. 1, no. 3, pp. 9–14, 1996. [6] S. K. Acharya, S. Dasarathy, A. Tandon, Y. K. Joshi, and B. N. Tandon, “A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure,” Indian Journal of Medical Research, vol. 98, pp. 69–74, 1993. [7] Y. Arase, K. Ikeda, N. Murashima, et al., “The long term eﬃcacy of glycyrrhizin in chronic hepatitis C patients,” Cancer, vol. 79, no. 8, pp. 1494–1500, 1997. [8] T. G. J. Van Rossum, A. G. Vulto, W. C. J. Hop, J. T. Brouwer, H. G. M. Niesters, and S. W. Schalm, “Intravenous glycyrrhizin for the treatment of chronic hepatitis C: a double-blind, randomized, placebo-controlled phase I/II trial,” Journal of Gastroenterology and Hepatology, vol. 14, no. 11, pp. 1093– 1099, 1999. [9] T. G. J. Van Rossum, A. G. Vulto, W. C. J. Hop, and S. W. Schalm, “Glycyrrhizin-induced reduction of ALT in 5 European patients with chronic hepatitis C,” American Journal of Gastroenterology, vol. 96, no. 8, pp. 2432–2437, 2001. [10] R. V. Farese Jr., E. G. Biglieri, C. H. L. Shackleton, I. Irony, and R. Gomez-Fontes, “Licorice-induced hypermineralocor- ticoidism,” The New England Journal of Medicine, vol. 325, no. 17, pp. 1223–1227, 1991. [11] M. Rotblatt and I. Zimenr, “Liquorice,” in Evidence Based Herbal Medicine, pp. 252–258, Hanley & Belfus, Philadelphia, Pa, USA, 2002. [12] Herbalscienceresearch.com: Risk and safety assessment on the consumption of Locorice root (Glycyrrhiza sp.) its extract and powder as a food ingredient, March 2007. [13] F. Aoki, K. Nakagawa, M. Kitano, et al., “Clinical safety of Licorice Flavonoid Oil (LFO) and pharmacokinetics of glabridin in healthy humans,” Journal of the American College of Nutrition, vol. 26, no. 3, pp. 209–218, 2007. [14] H. A´. Sigurjo´ nsdo´ ttir, L. Franzson, K. Manhem, J. Ragnarsson, G. Sigurdsson, and S. Wallerstedt, “Liquorice-induced rise in blood pressure: a linear dose-response relationship,” Journal of Human Hypertension, vol. 15, no. 8, pp. 549–552, 2001. [15] W. B. Kannel, “Fifty years of Framingham Study contributions to understanding hypertension,” Journal of Human Hyperten- sion, vol. 14, no. 2, pp. 83–90, 2000. [16] L. Adam, “In vitro antiviral activity of indigenous glycyrrhizin, liquorice and glycyrrhizic acid (Sigma) on Japanese encephali- tis virus,” Journal of Communication Disorders, vol. 29, no. 2, pp. 91–99, 1997. [17] J. Cinatl, B. Morgenstern, G. Bauer, P. Chandra, H. Rabenau, and H. W. Doerr, “Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coron- avirus,” The Lancet, vol. 361, no. 9374, pp. 2045–2046, 2003. [18] T. Hattori, S. Ikematsu, A. Koito, et al., “Preliminary evidence for inhibitory eﬀect of glycyrrhizin on HIV replication in patients with AIDS,” Antiviral Research, vol. 11, no. 5-6, pp. 255–262, 1989. [19] J. G. Chung, “Inhibitory actions of glycyrrhizic acid on arylamine N-acetyl transferase of Helicobacter pylori from peptic ulcer patients,” Drug and Chemical Toxicology, vol. 21, no. 3, pp. 355–370, 1998. [20] W. D. W. Rees, J. Rhodes, and J. E. Wright, “Eﬀect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin,” Scandinavian Journal of Gastroenterology, vol. 14, no. 5, pp. 605–607, 1979. [21] F. Borrelli and A. A. Izzo, “The plant kingdom as a source of anti-ulcer remedies,” Phytotherapy Research, vol. 14, no. 8, pp. 581–591, 2000. [22] S. Shintani, H. Murase, H. Tsukagoshi, and T. Shiigai, “Gly- cyrrhizin (licorice)-induced hypokalemic myopathy: report of 2 cases and review of the literature,” European Neurology, vol. 32, no. 1, pp. 44–51, 1992. [23] V. E. Tyler, Herbs of Choice: The Therapeutic Use of Phytomedic- inals, Pharmaceutical Press, Binghamton, NY, USA, 1994. [24] S. Shibata, “A drug over the millennia: pharmacognosy, chemistry, and pharmacology of licorice,” Yakugaku Zasshi, vol. 120, no. 10, pp. 849–862, 2000. [25] M. Abdollahi, R. Rahimi, and M. Radfar, “Current opinion on drug-induced oral reactions: a comprehensive review,” Journal of Contemporary Dental Practice, vol. 9, no. 3, pp. 1–15, 2008. [26] K. Atilla and R. S. Vasan, “Prehypertension and risk of car- diovascular disease,” Expert Review of Cardiovascular Therapy, vol. 4, no. 1, pp. 111–117, 2006. [27] S. Saydah, M. Eberhardt, N. Rios-Burrows, D. Williams, L. Geiss, and R. Dorsey, “Prevalence of chronic kidney disease