Origanum majorana L. as an Herbal Medicine for the Treatment of Apical Abscess: A Case Report and Literature Review

Maryam Mosaffa-Jahromi1, Maryam Firouzmandi2, Mehdi Pasalar1 

1Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

2Department of Operative Dentistry, Dental School, Shiraz University of Medical Science, Shiraz, Iran

Introduction

One of the most common forms of dental abscesses is apical ones which may present different signs and symptoms. Various microbial species have been suggested as its etiology, although anaerobic bacteria were predominant [1, 2]. Two common disorders causing dental pain are apical periodontitis and acute apical abscess. In a study performed in 2009 in UK, the prevalence of dental pain was 9% [3]. Of these individuals experiencing dental pain, approximately 30% had symptomatic apical periodontitis and further 13% developed an acute apical abscess [4, 5].

Common therapeutic approaches include drainage and debridement, antibiotics and surgical procedures whenever possible. There are numerous antibiotics for the treatment of periodontal abscesses based on dental biofilm responsible [2]. Diffusion of irritants such as bacteria and their toxins from an inflamed or necrotic pulp to the periapical tissues causes apical periodontitis [6]. Exacerbation of this condition may lead to symptomatic apical periodontitis or an acute apical abscess. In clinical examination of a tooth with apical periodontitis, the tooth is often very sensitive to precision and has negative or delayed response to vitality tests. Acute apical abscess presents a continuum of apical periodontitis. Long-term presence of infection leads to liquefaction of the periapical tissues and pus formation [3]. Complementary and alternative medicine modalities like traditional Persian medicine (TPM) have proposed some therapeutic options in this regard.

Case Presentation

A 28-year-old woman visited in our TPM clinic with pain of both upper incisors for 3 days. On examination, the teeth were sensitive to percussion and revealed scabs on the buccal side of gingiva without any discharge or sinus tract. There was a red bulging on the mouth roof adjacent to painful teeth. It was sensitive to pressure without any purulent release. The patient had pain on these teeth aggravating during mastication for one week. She met a dentist and underwent endodontic repair, but pain increased gradually and returned to dentist three days later. According to new physical examination, the dentist planed for pus drainage through surgical action. She refused because of fear and came for an alternative herbal treatment. After signing an informed consent, oregano (Origanum majorana L.) administered as follows; 30g in 250ml of boiled water as decoction (Jooshandeh) three times per day and 50g in 2 L of boiled water every two hours as smog (Bakhoor). After 2 days, a fistula appeared on buccal surface of the upper gum, secreting purulent exudates for an hour (Figure-1). Then, the patient’s complaints removed and she felt better. Physical examination showed redness on the site of fistula without any remaining symptoms. Post-treatment radiography revealed no sign of abscess (Figure-2).

Discussion

Clinical manifestations of acute apical abscess are spontaneous pain, tenderness in percussion, pus formation and swelling of the surrounding tissues [7]. The recommended interventions in patients with apical periodontitis and acute apical abscess are extraction or root canal therapy of affected tooth, possibly in conjunction with drainage. There are few complications such as swelling, pain, bleeding and dry socket following the routine treatment plan. These can urge patients to avoid timely dental treatment and subsequent consequences [3]. However, patients’ fear of dental procedures should be kept in mind.

On the other hand, there are some herbal medicines in TPM textbooks described as attractive (Jazeb) able to extract pus into skin surface through a fistula. Oregano or Marzanjoosh (O. majorana), a commonly used herbal plant in Asia, Europe, and northern Africa, is a well-known herbal medication in this regard with aforementioned property. It has an aromatic scent and the ovate leaves are the medicinal part consumed in different forms like decoction or infusion. Based on TPM books, oregano could be used for a series of diseases including headache, dyspnea or dysmenorrhea. Its temperament is hot and dry in TPM texts recommended to use for the treatment of different inflammatory processes. TPM sages believed that controlling an abcess had an algorithmic course – one the most important step is the maturity phase (Nozdj)- which could be undoubtedly completed by an external agent with hot temperament [8].

Although the mechanism of action is not clear-cut, there are some reports to confirm the efficacy in TPM masterpieces [9]. Main components include volatile oil, flavonoids and caffeic acid derivatives while more than 50% of volatile oil fraction is carvacrol. Various unproven effects such as diaphoretic, cough suppressor or anti-inflammatory have been attributed to oregano in folk medicine. In traditional Chinese medicine or homeopathy, it is used for febrile conditions, gastrointestinal disorders like dysentery, upper respiratory infections, and sexual tonic. There is also weak evidence supporting the antibacterial effect of oregano essential oil, carvacrol in the current literature [10], albeit the attractive quality denoted in TPM literature does not seem attributable to this outcome. It is of great concern that no life-threatening side effects have been reported in the case of appropriate use of designated therapeutic dose. Other benefits including availability and low cost should be considered as other advantages of using herbal medicine.

Conclusion

We do not have any reports on chemical products with this unique effect, therefore introducing a new noninvasive therapeutic method for abscess drainage might be a fundamental innovation.

Acknowledgments

The authors would like to thank the patient for her cooperation.

Conflicts of Interest

There was no conflict of interest to be declared.