Introduction

Self-care is one-way individuals without access to professional care can actively manage oral health issues [1]. In addition to oral pain, bleeding gums, bad breath, and aesthetic demands, all increase self-care behaviors. The demand for an aesthetic smile has grown during the last few years.  Dental bleaching is considered the most conservative and biologically safe treatment for discolored teeth. Tooth discoloration is a frequent dental finding associated with clinical and esthetic problems [2]. A study conducted in 2017 in Saudi Arabia investigated patients' perception of the dental aesthetic, dissatisfaction with dental appearance, and tooth color, a common finding. More than half of the participants believed some remedies could be used successfully at home to provide a teeth-bleaching effect (57.69%). When asked to name what they know of these remedies, sodium bicarbonate, followed by charcoal, was the most frequently mentioned material [3]. Moreover, statistically significant differences were observed in the tooth-whitening ability of homemade herbal and commercially available agents [4]. In addition, Yiming Li found that using baking soda dentifrice with a manual brush has a positive effect on stain reduction and increasing teeth whiteness without any clinical adverse effects compared to silica-based dentifrice [5]. 

Dar-Odeh et al. investigated natural remedies used for oral diseases among female patients in Madinah, Saudi Arabia. The results showed that almost 43% of the participants had used natural remedies to treat oral diseases. The most commonly cited reasons were financial. Most of the natural remedies used were herbal, with cloves and miswak being the most frequently reported [6].

Chamomile mouthwash has an excellent short-lasting analgesic effect on aphthous stomatitis [7]. When used as a mouthwash, chamomile can effectively prevent gingivitis and periodontal disease of its anti-inflammatory properties; however, allergic reactions have been reported. The use of herbal anti-inflammatory formulations for a more extended period was found to be safer than that of chemical anti-inflammatory drugs [8].

Honey is a low-cost natural product manufactured by honeybees from plant nectar and sweet deposits. Honey treats oral ulcers, candidiasis, stomatitis, dental caries, plaque, gingivitis, and periodontal disease. Pure, natural honey may heal tooth disorders. Honey's antibacterial, anti-inflammatory, anti-ulcer, and antioxidant qualities help prevent dental and oral illnesses. In a controlled clinical investigation, researchers examined the effects of eating honey on orthodontic patients' plaque production and honey's antibacterial properties on plaque microorganisms. Honey may reduce tooth cavities and gingivitis after orthodontic treatment [9-14].

Garlic is a valuable herbal medicine used for centuries to treat various ailments. Along with its benefits come some adverse effects. It has been reported that crushed garlic can cause a chemical burn of oral mucosa when placed overnight to treat toothache [15]. In a study by Kanth et al. to determine the antimicrobial properties of 10 naturally available plant products against oral microorganisms causing caries, clove oil was the most effective of all products against microorganisms [16].

Frequent use and abuse of presently accessible treatment drugs have resulted in a rise in undesirable effects and the emergence of resistant strains. Traditional remedies are seldom utilized but must be reinstated since they are practical and have few adverse effects. Awareness of traditionally accessible herbal treatments can prevent and treat oral disorders at an affordable cost without waiting for appointments. How far home remedies are used to resolve dental problems of tooth pain, gingival bleeding, teeth discoloration, and halitosis has not been thoroughly investigated in Saudi Arabia. Hence, this study aimed to assess the local community's attitude, awareness, and oral health knowledge of the use of different remedies in treating oral problems.

Materials and Methods

Study design

It was a descriptive cross-sectional study based on the questionnaire.

Study sample

The study sample comprised residents and citizens aged above 15 years residing in Saudi Arabia were considered in this study.

Sample size

A minimum sample of 377 subjects was calculated based on the 5% margin of error, and 95% confidence level, assuming a response distribution of 50%. This sample size was estimated using the Raosoft online sample size calculator. However, to improve the power of the study, a final sample size of 434 subjects was calculated.

Data collection tool

An electronic structured close-ended questionnaire containing fifteen questions was utilized as a data collection tool. The link to this online questionnaire was distributed through social media, inviting participants to fill it out online. In addition to the demographic data and level of education, the questionnaire is designed to investigate the participant's use and their knowledge and awareness of home remedies for treating some dental problems before seeking professional help. Two experts validated the questionnaire. The reliability of the questionnaire was established by pilot testing, and Cronbach's alfa was found to be 0.85.

Ethical considerations

This proposal was registered in the REU research center web portal, and Ethical Committee approval was obtained (#SRS/2020/19/190/188). The purpose of the study was explained to each subject, and completing the questionnaire was considered consent for participation. All collected data were confidential and for research and publication purposes only.

Statistical analysis

Nominal data were described as absolute numbers and percentages. The Chi-squared or Fisher exact tests were used to compare the frequency between the two groups. Fisher exact test was used if the expected frequency was below five. Multivariable logistic regression analysis was used to study the factors associated with herbal and home remedies used by the participants. A univariable logistic regression analysis was performed for baseline data and questions related to awareness and effectiveness of herbal and home remedies. Factors with a P-value of 0.1 or less in the univariable analysis were included in a stepwise multivariable logistic regression with a backward elimination and a stay P-value of 0.05. Model discrimination was tested with C-statistics, and the area under the receiver operator curve was reported. We reported the odds ratio and the 95% confidence interval. There were no missing data. All analyses were performed using Stata 17 (Stata Corp- College Station, TX, USA). A P-value of less than 0.05 was considered statistically significant.

Results and Discussion

The survey was distributed to 434 participants; 251 responded "Yes" to the question, "Have you ever used any home or herbal products to treat one of your oral and dental problems?". The most common purposes for using herbal medications were toothache (n= 202, 80.5%), teeth whitening (n= 70, 27.9%), mouth malodor (n= 60, 23.9%), and gum bleeding (n= 67, 26.7%). Other rare indications were cold symptoms, increased immunity and overcoming insomnia (n= 1), ulcers (n= 4), oral fungal infection (n= 2), sore throat relief (n= 1), orthodontic treatment (n= 3), teething in children (n= 2), oral infections (n= 2), and tongue fungal infection (n= 1) (Figure 1). Moreover, the most common herbal and home remedies used were cloves (n= 194, 77.3%), salt and water (n= 180, 71.7%), Myrrh (n= 125, 49.8%), activated charcoal (n= 50, 19.9%), sodium bicarbonate (n= 23, 9.2%), turmeric (n= 20, 8%), lemon (n= 12, 4.8%), chamomile (n= 12, 4.8%) and vinegar (n= 10, 4%). Most of the participants who used herbal or home remedies thought they were practical or moderately effective and did not suffer problems related to their use (Table 1).

Table 1. The response of the herbal and home remedies users to the questions related to the effectiveness and safety of these remedies

The herbal non-users group had significantly more males and were younger than herbal users. On the other hand, there was no difference in education between groups (Table 2). Most participants answered the question "What would you do if you are unsatisfied with your teeth' color?" by "Go to the dentist for bleaching in the clinic" (n= 226, 51.1%), "Use an at-home-bleaching product from the pharmacy" (n= 118, 27.2%), "Use alternative methods and home or herbal preparations" (n= 39, 9%) and 104 (24%) stated that "No action is necessary." The survey allowed multiple answers to this question, and there was no difference in response between herbal users and non-users (P= 0.114). Furthermore, most participants replied to the question "What would you do when you feel toothache?" by "Go to the doctor" (n= 259, 59.7%), "Take painkillers" (n= 165, 38%), and "Use herbal/home remedies such as cloves or others" (n= 42, 9.7%). Multiple answers were allowed to this question, and herbal users responded more with "Use herbal/home remedies such as cloves or others" than herbal non-users (P˂ 0.001). Herbal users received more information about herbal remedies from others (P˂ 0.001) or the Internet (P˂ 0.001) than herbal non-users. Herbal users significantly thought compared to herbal non-users that the use of these remedies had fewer side effects than medications (P= 0.024) and that the herbal remedies are safe and effective (P˂ 0.001) (Table 2).

Table 2. Comparison of the baseline characteristics and responses between herbal users and non-users

The perception about the effectiveness of turmeric in treating oral malodor (P= 0.044), sodium bicarbonate in teeth whitening (P˂ 0.001), cloves in alleviating pain (P˂ 0.001), and turmeric in teeth whitening (= 0.037) was higher in herbal users compared to non-users (Table 3).

Table 3. The perception of participants about the efficacy of herbal and home remedies in treating dental problems

Herbal and home remedies use was lower in males (OR: 0.28; P˂ 0.001) and higher if the participants had previous information from people about the herbal remedies (OR: 3.31; P˂0.001), if they believed that herbal remedies are safe and effective (OR: 1.74; P˂ 0.001), if the cause of use was the effectiveness of the remedies rather than the cost (OR: 3.23; P˂0.001) and if they believe that Clove is effective in alleviating pain (OR: 1.43; P˂0.001) (Table 4, Figure 2).

Table 4. Multivariable analysis of factors associated with herbal and home remedies use

NB: The area under the curve (AUC)= 0.83

We compared herbal users for teeth whitening (n= 70) and other purposes (n= 181). Participants who used herbal and home remedies for teeth whitening were mostly females (P= 0.018); however, there was no significant difference in age group and education level between groups (P= 0.192 and 0.108, respectively) (Table 5).

Table 5. Characteristics of participants who use herbal and home remedies for teeth whitening