al, 2017). Theoretically, taking a combination of turmeric and antidiabetes drugs might have an additive effect and increase the risk of hypoglycemia. From a dental perspective, be aware of patients with diabetes who may routinely consume turmeric and request that they do not suddenly start or stop taking this supplement before the dental procedure; OHCPs will want patients to be as stable as possible when they are seen in the office. As with all patients with diabetes, routine blood glucose monitoring is paramount, dental appointments should be kept relatively short, and patients should maintain their normal nutritional routine. In patients with controlled diabetes, this potential herbal-drug interaction can be easily managed. Turmeric can inhibit CYP3A4 causing increased blood levels of concomitant medications such as clarithromycin, clindamycin, erythromycin, dexamethasone, hydrocodone, lidocaine, alprazolam, diazepam, midazolam, and triazolam. If any of these medications are to be used during the dental appointment, patients should stop taking turmeric at least 24 hours before the procedure to avoid a potential herbal-drug interaction. Alternatively, medications that are not listed as having an interaction with turmeric could be substituted (e.g., azithromycin Apple cider vinegar Apple cider vinegar was the only other herbal supplement ingredient besides Ashwagandha with a sales increase of more than 100% from 2019. Apple cider vinegar is the fermented juice from crushed apples. It contains pectin, vitamins, minerals, and acid in the form of acetic acid or citric acid (Hill, Woodruff, Foote, & Barreto-Alcoba, 2005). The crushed apples are soaked in water, and yeast converts the natural sugars in the apples to alcohol. The alcohol is then converted to acetic acid, the main component of vinegar, in the presence of bacteria. Over time, the liquid will turn murky, and this cloud of yeast and bacteria is known as the “mother.” Some people credit the mother, which is considered a probiotic, with the potential health benefits of apple cider vinegar (McDonald, 2021; Fahey, 2017). While it is most popularly used in salad dressings and cooking, apple cider vinegar has been traditionally used for a variety of medical reasons, including wound disinfection (Beheshti, et al., 2012). Despite these health claims, however, human clinical research on apple cider vinegar is limited. A number of small studies have reported positive findings, particularly related to glycemic control and lipid profiles. In a 2019 meta- analysis and systematic review of the health effects of vinegar, the authors reported that consumption of apple cider vinegar was associated with better glycemic control in patients with type 2 diabetes compared to other vinegars (Cheng, Jiang, Wu, & Wang, 2019; Martini, 2021). Another systematic review and meta-analysis Ginger Ginger has been shown in the medical literature as being possibly effective to treat nausea and vomiting (Chaiyakunapruk, Kitikannakorn, Nathisuwan, Leeprakobboon, & Leelasettagool, 2006; Dabaghzadeh, Khalili, Dashti-Khavidaki, Abbasian, & Moeinifard, 2014; Matthews, Haas, O’Mathúna, & Dowswell, 2015), dysmenorrhea (Ozgoli, Goli, & Moattar, 2009; Pattanittum et al., 2016), morning sickness (Fischer-Rasmussen, Kjaer, Dahl, & Asping, 1991; Jewell & Young, 2003; Matthews et al., 2015; Thomson, Corbin, & Leung, 2014), osteoarthritis (Amorndoljai, Taneepanichskul, Niempoog, & Nimmannit, 2015; Bartels et al., 2015; Leach & Kumar, 2008; Terry, Posadzki, Watson, & Ernst, 2011), and vertigo (Grøntved & Hentzer, 1986). People have also reported taking this herbal supplement for motion sickness, colic, diarrhea, dyspepsia, flatulence, irritable bowel syndrome, loss of appetite, migraine headache, and for discontinuing selective serotonin reuptake inhibitor drug therapy – despite the lack of evidence in support of these uses. Topically, the fresh juice of ginger has been used for treating thermal burns, and the essential oil of ginger is used topically as an analgesic.
as an antibiotic, articaine as a local anesthetic, or lorazepam as a sedative agent). In vitro, turmeric has been shown to have antiplatelet effects, however, results from human research are inconsistent (Shivalingu, B. R., Vivek, H. K., Nafeesa, Z., Priya, B. S., & Swamy, S. N., 2015). Until more is known, turmeric should be used cautiously in combination with anticoagulant and antiplatelet drugs as concomitant use might increase the risk of bleeding due to decreased platelet aggregation. Some of these drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others. On a dental note, a recent clinical trial evaluated the efficacy of turmeric gel as an anti-plaque and anti-gingivitis agent compared to chlorhexidine gel (Kandwal, A., Mamgain, R. K., & Mamgain, P., 2015). Both study groups reported a comparable reduction in plaque and gingival index. Turmeric gel reported better acceptance due to pleasant odor and no staining of teeth in comparison to chlorhexidine gel that reported a bitter taste and staining of teeth. published in 2021 examined the effects of apple cider vinegar on lipid profiles and glycemic parameters and concluded that apple cider vinegar had significant, positive effects on blood sugar and blood lipid levels (Hadi, Pourmasoumi, Najafgholizadeh, Clark, & Esmaillzadeh, 2021). High-quality research on apple cider vinegar’s effects on metabolism and weight loss is lacking, however, according to a separate systematic review published in 2020 (Launhold, Kristiansen & Hjorth, 2020). From a dental perspective, a recent study evaluating the effects of newly proposed irrigants; the pomegranate, apple cider, and grape vinegars in comparison with contemporary irrigants; sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX), and octenidine-hydrochloride (OCT) on microhardness and surface roughness of human root canal dentin, found that he use of vinegar for endodontic irrigation may have a softening effect on root canal dentin with time and may increase dentin roughness (Akbulut, Guneser, & Eldeniz, 2019). One other study evaluated the in vitro antifungal activity of apple cider vinegar on Candida spp. involved in denture stomatitis (Mota, de Castro, de Araújo Oliveira, & de Oliveira Lima, 2015). The authors concluded that apple cider vinegar showed antifungal properties against Candida spp., thus representing a possible therapeutic alternative for patients with denture stomatitis. Ginger is thought to inhibit thromboxane synthetase and decrease platelet aggregation (Abebe, 2002; Argento, Tiraferri, & Marzaloni, 2000; Backon, 1991; Stanger, Thompson, Young, & Lieberman, 2012; Thomson et al., 2002; Srivastava, 1989). Excessive amounts of ginger might increase the risk of bleeding when used with anticoagulant/antiplatelet drugs such as aspirin or any of the nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Patients should stop taking ginger at least 24 hours before the dental procedure to avoid this potential herbal- drug interaction, and they should continue to avoid taking ginger concurrently with any NSAID that may be prescribed for postoperative dental pain. OHCPs should exercise caution with patients who regularly consume ginger and any antiplatelet agent as they may be at higher risk for bleeding postoperatively, which could interfere with wound healing. In patients who refuse to interrupt their usual doses of ginger, dentists may elect to use a cyclooxygenase-2 (COX-2) inhibitor such as celecoxib to manage postoperative dental pain with or without acetaminophen or a glucocorticoid (e.g., dexamethasone) because these agents do not interact with ginger.
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