# Healthy Effects of Pomegranate (_Punica granatum_ L.) in Internal Medicine and Dentistry
## 6 Pomegranate and Oral Health
While its anti-viral properties may contribute to treating periodontitis triggered by viral infections [161; 162]. For chronic periodontitis, pomegranate-based compounds have also proven effective. In fact, clinical studies have demonstrated the effectiveness of pomegranate extract in reducing inflammation in this chronic condition and inhibiting periodontitis. Moreover, it has shown its action against microbial growth, including the growth inhibition of _S. aureus_ and of MRSA strains [155; 163; 164; 165]. Pomegranate's applications extend even further. It has demonstrated its ability in treating recurrent aphthous stomatitis, promoting wound healing, and acting as a storage medium for avulsed teeth [166; 167; 168]. An optimal therapeutic agent for plaque control must fulfill selected criteria, including specificity for plaque bacteria, substantivity, stability, lack of adverse reactions, toxic safety,ecological safety, and user-friendly features [169]. Pomegranate seems to align well with these criteria [12]. Research supporting pomegranate's role in oral health is primarily limited to in vitro studies, although promising in vivo studies exist. Pomegranate rinsing reduces \(\alpha\)-glucosidase activity and increases ceruloplasmin activity in saliva [12]. Pomegranate extract effectively treats denture stomatitis, associated with candidiasis [170]. Pomegranate tannins inhibit human salivary \(\alpha\)-amylase, a substrate for cariogenic microbes [171; 172]. Studies on periodontal therapy support the efficacy of a gel containing extracts of _Centella asatica_ and _Punica granatum_ L. [159]. Pomegranate chewing seems to enhance antibacterial and antioxidant effects and boost the salivary flow rate. Pomegranate flower extract inhibits the bacterial sucrose-digesting enzyme linked to dental caries and gingivitis [173]. Antioxidant agents from pomegranate are hypothesized to have preventive effects against oral cavity diseases [174]. Pomegranate extracts reduce aspartate aminotransferase activities, suggesting benefits in periodontal pathology [175]. Hydroalcoholic extracts from pomegranate fruit significantly decrease dental plaque CFUs, offering an alternative for reducing plaque bacteria [150]. Pomegranate contributes to the maintenance of oral hygiene and reduces microorganisms cultured from dental plaque in one-minute rinses with a mouthwash containing pomegranate extract [157]. Punicic acid in PSO acts as an anti-inflammatory agent by down-regulating neutrophil activation and LPO [176; 177]. Tooth decay, initiated by _Streptococcus mutans_ in the oral cavity, is a prevalent chronic condition affecting children and young adults. Conventional mouthwashes, such as CHX, possess antimicrobial properties but are also associated with drawbacks, such as staining and taste alterations. A recent study explored the antibacterial potentiality of pomegranate peel and guava leaf extracts, comparing them with CHX in a group of children. The results indicate a significant reduction (\(p<0.01\)) in \(S\). _mutans_ count after using pomegranate and guava leaf extracts. The beneficial effects seem to be directly correlated with the concentration of these extracts. However, the efficacy of CHX outperformed both extracts, emphasizing the need for further research on a combined antimicrobial approach [178]. In fact, CHX is the gold standard for its potent antibacterial and antiplaque properties, but its use is associated with certain side effects. Among these are xerostomia (dry mouth), hypogeusia (reduced sense of taste), and discoloration of the tongue. In particular, long-term use of CHX may lead to the development of calculus on teeth and extrinsic tooth staining. In this context, it is important to explore alternative oral care solutions with fewer associated side effects [179; 180]. Among these, herbal products have been investigated, and pomegranate seems to represent one of the most effective herbal remedies. In this regard, a study aimed to evaluate the effectiveness of pomegranate mouthrinse compared to 0.12% CHX mouthrinse.