Natural Products in Dental Care (2010-2026): A Narrative Review of Efficacy, Clinical Utility, and Research Gaps

INTRODUCTION

Natural products are increasingly used to supplement treatments in holistic medicine (Taheri et al., 2011; Chauhan et al., 2020). Plants and their byproducts have been used in medicine, including dentistry, for antimicrobial, antioxidative, and anti-inflammatory purposes (Lugo-Flores et al., 2021). Furthermore, they have regenerative properties. They help treat and prevent dental caries, periodontal disease, gingivitis, halitosis, oral mucositis, and support endodontic and orthodontic treatments (Chen et al., 2020; Moghadam et al., 2020; Kumar et al., 2021; Anwar et al., 2025; Hashim et al., 2025; Janakiram et al., 2020; Flemming et al., 2021; Budala et al., 2023; Refaey et al., 2024; Gloria-Garza et al., 2025; Ibrahim and Khalel, 2025). Neem oil, Aloe, propolis, curcumin, and clove oil (Syzygium aromaticum) are used for medicinal purposes. These compounds are derived from nature, including green tea (Camellia sinensis) extracts and other essential oils, which act cumulatively (Anwar et al., 2025; Janakiram et al., 2020; Malcangi et al., 2025; Laleman and Teughels, 2020; Inchingolo et al., 2025). However, more challenging issues remain, such as the need for standards for the formulation of products, regulatory practices, bioavailability of herbal agents, and long-term clinical studies (Freires and Rosalen, 2016; Song et al., 2025; Kumar et al., 2022). This review aimed to present evidence from 2010 to 2026 regarding natural products that are most clinically useful in dental care from Q1 to Q4 journals.

METHODOLOGY

This narrative review was constructed based on a literature survey using sources such as Google Scholar and PubMed from 2010 to 2026. The search terms used to identify relevant literature were ‘natural product’, ‘herbal medicine’, ‘plant extract’, ‘oral health’, ‘dental caries’, ‘periodontal disease’, ‘gingivitis’, ‘endodontics’, and related keywords. A narrative perspective was synthesized on recent advances, product-specific efficacy, and comparisons with conventional care using a purposeful sampling approach rather than systematic extraction. Studies were screened for inclusion based on their relevance to clinical and preclinical applications in oral health, journal ranking (Q1-Q4), recency, and citation impacts. Finally, 29 key studies were selected to provide a comprehensive overview of the topic (Figure 1). The study was approved by the Institutional Review Board (IRB) of Riyadh Elm University (REU) (IRB approval number FRP/2026/605/1423/1298).

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DISCUSSION / REVIEW OF LITERATURE

The landscape of dental research between 2010 and 2026 witnessed a significant shift in the investigation of plant-derived agents. As illustrated in the chronological distribution of thematic clusters (Figure 1), this evolution represents a transition from an "Early Phase" of preliminary identification to a "Growth Phase" and a "Recent Phase" characterized by high-density research in specific therapeutic applications. This progression reflects the increasing global emphasis on validating natural products as viable, evidence-based alternatives or adjuncts to conventional therapies.

Major Classes of Natural Products Used in Dental Care

Building on the research trends identified in Figure 1, the following sections categorize these agents based on their clinical utility. The variety of phytochemicals occurring in many natural products offers great promise in the field of dentistry, particularly because of their synergistic activities. Natural products may be divided into four general therapeutic classes:

Plant Extracts and Herbal Medicines

Neem (Azadirachta indica): The Presence of Azadirachtin and Nimbin is responsible for anti-inflammatory and plaque reduction (Janakiram et al., 2020; Anwar et al., 2025).

Aloe Vera (Aloe barbadensis): Contains acemannan and other glycoproteins that promote wound healing and immune response modulation of the gingiva (Figueiredo et al., 2022; Niculescu et al., 2024).

Clove (Syzygium aromaticum): Eugenol is the primary component and is well known for its analgesic and antimicrobial properties in endodontics (Jain et al., 2024; Anwar et al., 2025).

Miswak (Salvadora persica): Contains Benzyl isothiocyanate and silica, and the combination of both is responsible for plaque disruption and enamel remineralization (Wassel and Khattab, 2017).

Bee Propolis: Complex mixture of Caffeic Acid Phenethyl Ester (CAPE) and pinocembrin, which exerts broad antimicrobial activity against periodontopathogens and resinous bee products (Wassel and Khattab, 2017; Figueiredo et al., 2022).

Turmeric (Curcuma longa): Contains curcumin, a polyphenol with strong anti-inflammatory properties, and is used in endodontics for disinfection (Jain et al., 2024).

Cranberries (Vaccinium macrocarpon): Contain A-type proanthocyanidins that form a barrier limiting adherence and biofilm formation on teeth (Chen et al., 2020; Figueiredo et al., 2022).

Calendula (Calendula officinalis): Saponins and flavonoids of triterpenes that promote the health and repair of tissues and mucosa (Figueiredo et al., 2022).

Chamomile (Matricaria recutita): Bisabolol and chamazulene are soothing and anti-inflammatory compounds present in chamomile. Their effects on gingival tissues have been discussed (Figueiredo et al., 2022; Anwar et al., 2025).

Essential Oils

Thymol, eucalyptol, and menthol are active compounds in many mouth rinses. These volatile compounds create disruptions to the bacterial membrane, coupled with the ability to modulate quorum sensing, to inhibit biofilm maturation (Anwar et al., 2025).

Polyphenols and Flavonoids

Camellia sinensis (green tea) contains the bioactive compound epigallocatechin gallate (EGCG). EGCG inhibits Glucosyltransferase (GTF), an enzyme vital for biofilm formation (Flemming et al., 2021; Budala et al., 2023).

Natural Polymers and Bioactive Compounds

Advanced applications utilize chitin-derived chitosan nanoparticles and Arabic gum. In addition to being superior scaffolding materials, these natural polymers are also carriers of bioactive compounds with the potential to shift the scope of dentistry from palliative to regenerative (Paradowska-Stolarz et al., 2021; Song et al., 2025).

Although heterogeneous formulations and inadequate standards have limited the clinical application of natural products (Freires and Rosalen, 2016; Song et al., 2025), promising clinical evidence has been reported based on Randomized Controlled Trials (RCTs) and systematic reviews. The need for comprehensive and prolonged studies to establish the safety and effectiveness of long-term use is crucial (Table 1).

Efficacy Against Dental Caries

Certain plant compounds and polyphenols exhibit remarkable antibacterial activity against S. mutans and other acidogenic pathogens. These compounds can be extracted from green tea (Camellia sinensis) and cranberries (Vaccinium macrocarpon) (Chen et al., 2020; Flemming et al., 2021; Gloria-Garza et al., 2025; Tzimas et al., 2024). The application of varnishes that include propolis, Salvadora persica (miswak), and chitosan-based polymers shows better S. mutans activity than varnishes that only include fluoride in both in vitro and ex vivo models (Wassel and Khattab, 2017). Furthermore, xylitol and similar non-cariogenic polyols do not induce caries. They affect bacterial metabolic activity and subsequently lessen the acidic response of these pathogens to tooth enamel (Angarita-Díaz et al., 2025; Philip et al., 2019).

In addition to non-cariogenic polyols, other herbal agents have shown tremendous clinical applications in treating gingival and periodontal inflammatory conditions. Neem (Azadirachta indica)-based dentifrices have shown similar efficacy in plaque and gingivitis as chlorhexidine, while being better tolerated, as they have fewer side effects such as staining or dysgeusia (Janakiram et al., 2020; Malcangi et al., 2025). Furthermore, polyphenols in Camellia sinensis can inhibit bacterial adhesion and provide antioxidative defense at the oral level (Flemming et al., 2021). Aloe vera (Aloe barbadensis) gel can help control the inflammatory response of the gingiva in both periodontal and orthodontic therapy (Niculescu et al., 2024), and propolis has an impressive deep antimicrobial action against all oral periodontopathogens (Wassel and Khattab, 2017; Figueiredo et al., 2022).

Periodontal Disease and Gingivitis Management

Herbal dentifrices and mouth rinses containing Azadirachta indica (neem) or Camellia sinensis (green tea) extracts have been shown to be clinically non-inferior to traditional chlorhexidine or fluoride-based controls in reducing Plaque Index (PI) and Gingival Index (GI) scores and in reducing the incidence of treatment-related adverse effects (Janakiram et al., 2020; Malcangi et al., 2025; Laleman and Teughels, 2020; Inchingolo et al., 2025). Similarly, Aloe vera (Aloe barbadensis) gel and rinses are effective in reducing gingival inflammation. Propolis offers potent, broad-spectrum antimicrobial protection against various periodontal pathogens (Figueiredo et al., 2022).

In addition, polyherbal formulations containing sage, Matricaria recutita (chamomile), thyme, and Syzygium aromaticum (clove) use synergistic biological pathways to improve therapeutic outcomes (Anwar et al., 2025; Pytko-Polończyk et al., 2021). Ultimately, these natural formulations have better tolerability profiles with less mucosal irritation and extrinsic staining rates than synthetic agents, resulting in better patient compliance in long-term periodontal maintenance regimens (Inchingolo et al., 2025).

Adjunctive Uses: Endodontics and Orthodontics

Beyond routine plaque and gingivitis management, natural products serve as essential therapeutic adjuncts in specialized dental disciplines, such as endodontics and orthodontics, where traditional synthetic agents may be limited by their toxicity or tissue irritation.

Achieving complete disinfection of the root canal system remains a significant challenge in endodontic therapy. Herbal irrigants, including propolis, triphala, Azadirachta indica (neem), Curcuma longa (turmeric), and Camellia sinensis (green tea), have demonstrated significant antibacterial efficacy, particularly against resilient pathogens such as Enterococcus faecalis (Jain et al., 2024).

Similarly, in orthodontics, the focus often shifts to managing iatrogenic gingival inflammation associated with fixed-appliance therapy. The application of Aloe vera (Aloe barbadensis), resveratrol, and honey has been shown to be effective in modulating gingival inflammatory responses and enhancing patient comfort during orthodontic interventions (Niculescu et al., 2024). These findings underscore the potential of natural agents to act as active, biocompatible contributors to the clinical success of complex restorative and corrective procedures.

RESEARCH GAPS

Despite the extensive literature supporting the efficacy of natural products in cariology and periodontology, significant research gaps remain across specialized dental disciplines and their methodological approaches. As illustrated in the research coverage matrix (Figure 2), there is a notable scarcity of studies investigating the adjunctive use of neem (Azadirachta indica), propolis, and chitosan nanoparticles in orthodontics. Similarly, the clinical application of Aloe vera (Aloe barbadensis) as an endodontic adjunct requires further exploration. Beyond these discipline-specific deficits, a broader methodological void exists regarding the execution of long-term, large-scale Randomized Controlled Trials (RCTs) that compare head-to-head outcomes with the gold standard synthetic agents. The current literature frequently lacks standardized protocols for formulation, precise dosing guidelines, and optimized delivery systems, which limits the translation of these natural agents into widespread clinical practice. Consequently, future investigations must prioritize resolving these regulatory and standardization barriers while exploring the synergistic effects of polyherbal combinations and integrating nanotechnology to enhance the bioavailability of plant-derived compounds.

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Future research should focus on large-scale RCTs with standardized formulations, dosages, and delivery systems to confirm their long-term safety and effectiveness. Table 2 summarizes future research directions and open questions regarding the use of natural products in dental care.

CONCLUSION

Natural products-including neem (Azadirachta indica) extract toothpaste and mouthwash, green tea (Camellia sinensis) polyphenols, catechins, ECCG rinses, gels, toothpastes, lollipops, gums, chewing sticks, mouthwashes, aloe vera (Aloe barbadensis) gel, propolis, triphala, chitosan nanoparticles, and clove oil (Syzygium aromaticum) /turmeric (Curcuma longa) -are among the most effective agents used from 2010 to 2026 for the prevention or treatment of caries, gingivitis, periodontal disease, oral infections, and endodontic adjuncts in Q1-Q4 journals. They offer comparable efficacy to conventional agents with improved safety and tolerability; however, they require further standardization and regulatory harmonization.

In summary, natural products offer promising alternatives or adjuncts to conventional dental therapies, with neem extract toothpaste, mouthwash, green tea (Camellia sinensis), aloe vera (Aloe barbadensis), and propolis being among the most effective products. However, further high-quality research is required before widespread adoption in clinical practice.

ACKNOWLEDGEMENT

I would like to express my sincere gratitude to Riyadh Elm University (REU) for providing institutional support and resources necessary to conduct this review. I wish to extend my utmost appreciation to the Research and Innovation Center (RIC) for the remarkable advice, support, and help provided in an inspiring way, along with the technical assistance provided during the writing and research sections. This study was approved by the Institutional Review Board of REU (IRB approval number: FRP/2026/605/1423/1298). I declare that this narrative review was written without the support of any sponsors or profits.

ABBREVIATIONS

CHX

Chlorhexidine

EGCG

Epigallocatechin Gallate

GI

Gingival Index

IRB

Institutional Review Board

PI

Plaque Index

Q1-Q4

Journal Quality Quartiles

RCTs

Randomized Controlled Trials

REU

Riyadh Elm University

RIC

Research and Innovation Center.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

FINANCIAL SUPPORT AND SPONSORSHIP

The author declares that this narrative review was written without the support of any sponsors or profits. Institutional resources were provided by Riyadh Elm University.

AUTHOR CONTRIBUTIONS

As the sole author, Hanan Khojah is designated as the 'guarantor' and takes full responsibility for the integrity of the work as a whole, from inception to the published article. The contributions to this manuscript, categorized as requested, are as follows:

Concept: Hanan Khojah, Design: Hanan Khojah, Definition of intellectual content: Not applicable, Literature search: Hanan Khojah, Data acquisition: Hanan Khojah, Data analysis: Hanan Khojah, Manuscript preparation: Hanan Khojah, Manuscript editing: Hanan Khojah, Manuscript review: Hanan Khojah.

CLINICAL STUDIES

Not applicable.

EXPERIMENTAL STUDIES

Not applicable.

STATISTICAL ANALYSIS

Not applicable.

SUMMARY

This narrative review evaluated 29 high-impact studies from 2010 to 2026 that investigated the efficacy of natural products in dentistry. Key findings indicate that agents such as neem, green tea, aloe vera, and propolis are non-inferior to conventional treatments such as chlorhexidine and fluoride in managing plaque, gingivitis, and caries. Although these products offer superior safety profiles and high patient compliance, the field faces significant hurdles in standardizing formulations and establishing long-term clinical protocols.