# Healthy Effects of Pomegranate (_Punica granatum_ L.) in Internal Medicine and Dentistry
## 6 Pomegranate and Oral Health  
Pomegranate has garnered significant attention in the field of dentistry for its potential therapeutic properties, particularly in the treatment of dental plaque, gingivitis, and periodontitis. The literature data about this fruit have revealed a multitude of benefits, making it a valuable candidate for promoting oral health. Dental plaque, a biofilm of bacteria that forms on tooth surfaces, is a primary contributor to oral health problems. Pomegranate has been extensively studied for its ability to counteract dental plaque formation. The flavonoids present in pomegranate demonstrated a robust antibacterial action against key contributors to plaque formation, including _Streptococcus sanguis_ and _Eikenella corrodens_ (Table 2) [143; 144]. Its antibacterial effect is attributed to tannins, compounds that enhance bacteriolysis and impair bacterial adherence to tooth surfaces. Comparative studies have highlighted the pomegranate's superior inhibition capacity towards specific bacteria compared to chlorhexiidine (CHX), a commonly used oral antiseptic [145]. Despite limited research about pomegranate's impact on plaque and salivary proteins, a study conducted on adolescents revealed that pomegranate mouthrinse significantly reduced plaque accumulation and gingivitis compared to a placebo. This finding aligns with existing literature, suggesting pomegranate extract's potential as an adjunct therapy for treating gingivitis with minimal side effects [146]. Moreover, pomegranate mouthwash has proven to be effective against periodontal pathogens, such as _Aggregatibacter actinomycetemcomitants_, _Porphyomonas gingivalis_, and _Prerotella intermedia_[147]. Notably, pomegranate plays a role in inhibiting quorum sensing in bacteria, which is a process vital for gene expression related to antibiotic resistance and biofilm development. This pomegranate function adds an intriguing dimension to its antibacterial properties [148; 149]. Orthodontic patients, who often face challenges in maintaining oral hygiene, have benefited from a hydro-alcoholic extract of pomegranate, demonstrating a substantial reduction in dental plaque bacteria compared to CHX [150]. Punicalagin has been identified as a key contributor to pomegranate's antibacterial activity [21]. Beyond its antibacterial prowess, pomegranate exhibits a positive synergistic effect with antibiotics against methicillin-resistant _Staphylococcus aureus_ (MRSA) and methicillin-sensitive _S. aureus_, showcasing its potential as a complementary agent in the battle against antibiotic-resistant strains [151]. Gingivitis is characterized by chronic inflammation and early clinical manifestations such as gum bleeding [152; 153; 154; 155]. This oral ailment leads to increased salivary albumin, cystatin C, and amylase. The enhancement of the latter is due to plasma protein leakage into the gingival creicular fluid, thus offering a non-invasive diagnostic tool. Clinical studies affirm pomegranate efficacy in reducing gingival bleeding and in diminishing colony-forming units (CFUs) of dental plaque organisms [155; 156]. Mouthrinse containing pomegranate extract has also demonstrated effectiveness in reducing bacterial protein levels and activities related to cell injury, increasing antioxidant enzyme activity, thus highlighting its potential role in oral health maintenance [136; 157]. For acute periodontitis, studies emphasize pomegranate's anti-inflammatory effects and its potential as an adjuvant treatment to conventional periodontal therapy [158]. Biochemical investigations reveal significant decreases in inflammatory markers (IL-1B and IL-6), indicating pomegranate potentiality in managing periodontal disease [159]. Pomegranate also enhances the growth of enteric probiotic bacteria, suggesting potential benefits in decreasing the periodontal pathogen load [160]. Its antibacterial activity extends to _Helicobacter pylori_, associated with deep periodontal pockets.