Herbal nutriceuticals: a primer for dentists and dental hygienists

Herbs have been in use for centuries to prevent and control disease. In recent history demand by the public for herbal supplements has created a multimillion-dollar industry. Herbal extracts are effective because they interact with specific chemical receptors within the body and are in a pharmacodynamic sense, drugs themselves. A matter for public concern is that herbal supplements are currently independent of regulation by the Federal Drug Administration (FDA). The FDA considers herbal products to be dietary supplements, not drugs. The National Toxicology Program has recently started to examine the composition and standardization of commercial preparations to identify potential health hazards from contaminants or product over use. Many herbal preparations have significant pharmacological effects. The problem that arises for the dental professional is the effect these products have in concert with prescription medications as well as effects on the patient's general response to medication and dental treatment. Drug interactions with the large number of commercially available herbal products can be grouped by the mechanism of most common interactions. These major types of reactions are: (1) alteration of drug metabolizing enzyme activity, (2) interactions with the blood clotting process, and (3) alteration of the inflammatory and immune response. The widespread use of herbal supplements makes it essential that healthcare providers become informed about this aspect of a patient's personal health practices.