supplements in mainstream, natural, and direct sales channels as defined by the Nutrition Business Journal and the Chicago area-based market research firms SPINS LLC and Information Resources, Inc. (American Botanical Council, 2021). Each of these herbal medications is represented by a common name and the accompanying Latin name. Elderberry is the most common herbal medication OHCPs are likely to encounter (Smith, T., Majid, F., Eckl, V., & Morton Reynolds, C., 2021); consumers spent an estimated $275,544,691 on elder berry supplements in 2020, with annual sales doubling each year since our first edition of this module (where elderberry didn’t even make the top 10 list). Elderberry is commonly used to support immune health and as a remedy to help alleviate cold and flu symptoms, often reducing the severity and duration of colds, and the duration of the flu. No doubt that the COVID pandemic played heavily in the rise of consumer spend on this product also. Elderberry displaced horehound which was the top-selling herbal ingredient 2013 to 2019. Horehound is the primary ingredient in many throat lozenges that may contain other herbal and nonherbal ingredients. Cranberry is a type of evergreen shrub that grows in wet habitats (such as bogs or wetlands) in northeastern and northcentral parts of the United States. Orally, cranberry is used for prevention and treatment of urinary tract infections, kidney stones, neurogenic bladder, as a urinary deodorizer for people with incontinence, prevention of urinary catheter blockage, and to heal skin around urostomy stomas. Beyond these first three, Table 1 lists the complete top 20 herbal medications OHCPs are most likely to encounter, and additional high-risk herbal-drug interactions are discussed, despite their lower prevalence in the general population. Medications that are commonly used in dentistry typically fall into five drug classes: analgesics and anti-inflammatories, antibiotics, local anesthetics, sedatives, and emergency medications (Donaldson & Goodchild, 2012). There may be some additional miscellaneous medications such as antiseptics (e.g., chlorhexidine), fluoride supplements, or drugs to treat xerostomia (e.g., pilocarpine); however, it is unlikely that these drugs are part of every OHCP’s armamentarium. The drug component of the herbal-drug interactions to be reviewed, then, will focus on the drugs commonly used in dentistry (Table 2). This approach will help to concentrate the discussion on the most common dental-related herbal-drug interactions, with a goal of defining strategies to help avoid these interactions.
Table 1: Top-Selling Herbal Medications that OHCPs are Most Likely to Encounter Rank Common Name Latin Name 1 Elderberry Sambucus nigra 2 Horehound Marrubium vulgare 3 Cranberry Vaccinium macrocarpon 4 Turmeric* Curcuma longa 5 Apple cider vinegar Malus spp.** 6 Ginger Zingiber officinalis 7 Echinacea Echinacea spp. 8 Garlic Allium sativum 9 Fenugreek Trigonella foeneum-graecum 10 Wheat grass / Barley grass Triticum aestivum / Hordeum vulgare 11 Saw palmetto Serenoa repens 12 Ashwagandha Withania somnifera 13 Green Tea Camellia sinensis 14 Ivy Leaf Hedera helix 15 Ginkgo Ginkgo biloba 16 Cannabidiol (CBD) Cannabis sativa 17 Black cohosh Actaea racemosa 18 Beta-sitosterol*** -- 19 Red rice yeast Oryza sativa 20 Aloe Aloe vera * Includes standardized turmeric extracts with high levels of curcumin. ** spp. = species pluralis (more than one species). *** Beta-sitosterol is a common plant sterol that can be derived from various plants. Note. Adapted from Smith, T., Majid, F., Eckl, V., & Morton Reynolds, C. (2021). Herbal Supplement Sales in US Increase by Record- Breaking 17.3% in 2020. HerbalGram 131:52-65. Retrieved from https://www. herbalgram.org/resources/herbalgram/issues/131/table- of-contents/ hg131-mkrpt/
Table 2: The Drugs Commonly Used in Dentistry Antibiotics/Antifungals Anti-inflammatory Agents and Analgesics Local Anesthetics
Emergency Medications
Sedatives
• Amoxicillin. • Azithromycin. • Cephalexin. • Chlorhexidine
• Acetaminophen. • Aspirin. • Codeine. • Glucocorticoids
• Articaine. • Benzocaine (topical). • Bupivacaine. • Dyclonine (topical). • Lidocaine (with or without epinephrine). • Lidocaine (topical). • Mepivacaine (with or without levonordefrin). • Prilocaine. • Tetracaine (topical).
• Benzodiazepines (alprazolam,
• Albuterol. • Aspirin. • Diphenhydramine. • Epinephrine. • Flumazenil. • Glucose. • Naloxone. • Nitroglycerine. • Oxygen.
diazepam, lorazepam, midazolam, and triazolam).
(topical; antiseptic).
(dexamethasone and prednisone).
• Zaleplon. • Zolpidem.
• Clarithromycin. • Clindamycin. • Clotrimazole (topical).
• Hydrocodone. • Ibuprofen. • Oxycodone.
• Doxycycline. • Erythromycin. • Fluconazole. • Metronidazole. • Nystatin. • Penicillin. • Tetracycline.
Note. Adapted from “Pregnancy, Breast-Feeding and Drugs Used in Dentistry,” by M. Donaldson and J. H. Goodchild, 2012, Journal of the American Dental Association, 143 (11), 858-871.
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