Phytomedicine refers to the use of naturally derived products to cure and mitigate human conditions. Natural products have the advantages of causing minimum side effects, being biocompatible, available, and economical, with a wide array of biological activities. Reports have described the use of natural products with antimicrobial and anti-inflammatory properties to treat oral conditions and promote wound healing. Moringa oleifera, known as the drumstick or horseradish tree, is believed to have medicinal properties regarding a range of medical conditions, though there is limited information on its use in oral medicine. This narrative review focuses on the use of Moringa extracts in the management of oral conditions, including oral infections, inflammatory conditions, the remineralization of hard tissues, oral wound healing, and tissue regeneration, drawing from both in vitro and in vivo studies which indicate that the potential of Moringa extracts in supporting dentin-pulp regeneration after caries or trauma is worthy of more careful consideration.

The use of medicinal plant preparations to clean and disinfect root canal infection is gaining popularity. The aim of this study was to evaluate the bioactive composition of leaf extracts of Moringa oleifera plants cultivated in Iraq (specifically Baghdad) and their antimicrobial activity against selected root canal pathogens for potential application in endodontic treatment. Materials and Methods. Moringa leaf extracts were prepared either through cold maceration or warm digestion techniques to perform an ethanolic or aqueous extraction, respectively. Phytochemical detection was performed before thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) to measure flavonoids and phenolic compounds within both extracts. Then, their antimicrobial activities were investigated against Streptococcus mutans, Enterococcus faecalis, and Candida albicans through minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), and agar well diffusion assay in comparison to NaOCl and Ca(OH)₂. Results. Phytochemical screening showed several active ingredients but with higher expression of flavonoids and phenolic compounds. Also, different types of these compounds were detected through TLC and quantified by HPLC. MIC values for ethanolic extract against Streptococcus mutans, Enterococcus faecalis, and Candida albicans were 60, 65, and 55, respectively, while for aqueous extract, MIC values were 70, 80, and 50, respectively. Aqueous extract showed a higher inhibition zone than ethanolic extract for both Streptococcus mutans and Enterococcus faecalis with a statistically significant difference ( ) for all tested materials except with NaOCl and Ca(OH)₂ in Streptococcus mutans and Enterococcus faecalis, respectively. The ethanolic extract showed a higher inhibition zone against Candida albicans, with a statistically significant difference ( ) for all tested materials. Conclusion. Ethanolic and aqueous extracts of Moringa oleifera leaves cultivated in Baghdad contain considerable quantities of phytochemicals, especially flavonoid and phenolic compounds, and demonstrated antimicrobial activities against selected endodontic pathogens. Therefore, Moringa leaf extracts could be suggested as an alternative antimicrobial material in endodontic treatment.

Objectives: The primary objective of vital pulp therapy (VPT) is to induce the formation of tertiary dentin bridge through the application of bioactive materials to maintain pulp vitality. This study aimed to evaluate the odontogenic potential of Moringa oleifera ethanolic and aqueous extracts as sustainable herbal pulp capping materials in comparison to mineral trioxide aggregate (MTA) and a bioceramic putty. The evaluation was conducted in vitro on human dental pulp stem cells (DPSCs) and in vivo using a rat model of direct pulp capping. Methods: Moringa leaf extracts were prepared and the cytotoxicity assessed using MTT assay to measure the IC50, and their odontogenic potential was further evaluated in vitro by measuring alkaline phosphatase (ALP) activity and performing Alizarin Red staining for mineralization in comparison to MTA. For the in vivo study, the exposed rat pulps were capped with the extracts, MTA, the bioceramic putty, or a plain collagen sponge (control). Histological analysis was performed to evaluate inflammation and tertiary dentin bridge formation. Results: The ethanolic, aqueous extracts and MTA showed low cytotoxicity, though the ethanolic extract had significantly enhanced ALP expression (p < 0.05) and mineralized nodule formation (p < 0.05) compared to the other groups. In the in vivo study, the plain collagen sponges failed, resulting in necrosis. Conversely, MTA and the ethanolic extract exhibited the best outcomes, inducing the lowest inflammatory response (mainly score 1 and 2) and the successful formation of an irregular dentin bridge by odontoblast-like cells, whereas the aqueous extract and bioceramic putty showed intermediate results, with higher inflammation levels. Conclusions: Ethanolic Moringa oleifera extract is a highly biocompatible material with potent odontogenic induction capabilities, primarily driven by its flavonoid content. It is a promising, novel, and cost-effective material for use in the VPT as an effective alternative to MTA.