Blood Root by Eclectic Herb

POSSIBLY EFFECTIVE

• Dental plaque. Some preliminary clinical research shows that bloodroot extract may reduce plaque. Using a toothpaste containing bloodroot and zinc chloride (Viadent Original, Vipont Pharmaceuticals, Fort Collins, CO) or a similar toothpaste containing bloodroot, zinc chloride, and fluoride (Viadent Fluoride toothpaste, Vipont Pharmaceuticals, Fort Collins, CO) along with a mouth rinse containing bloodroot and zinc (Viadent Oral Rinse, Vipont Pharmaceuticals, Fort Collins, CO) daily for 6 months appears to reduces plaque index scores compared with control paste and rinse formulations in adults with moderate plaque and gingival inflammation (36672,36675). Bloodroot extract also appears to reduce the regrowth of plaque following dental cleaning when used with no other oral hygiene. Manual rinsing with a particular product containing bloodroot extract 300 mcg/mL (Viadent Oral Rinse) or supragingival irrigation with a solution containing bloodroot extract 22.5 mcg/mL for 14 days after a professional tooth cleaning appears to inhibit plaque growth compared with a placebo rinse (36697,36701). Other clinical evidence suggests that bloodroot extract prevents plaque development during orthodontic treatment. Using a specific toothpaste (Viadent toothpaste, Viadent Inc., Fort Collins, CO) containing bloodroot extract 750 mcg/gram along with a specific mouth rinse (Viadent Oral Rinse, Viadent Inc., Fort Collins, CO) containing bloodroot extract 300 mcg/mL three times daily for 6 months appears to reduce the development of plaque compared with placebo in adolescent orthodontic patients (36687).
• Gingivitis. Some preliminary clinical research shows that bloodroot may reduce gingivitis. Using a toothpaste containing bloodroot and zinc chloride (Viadent Original, Vipont Pharmaceuticals, Fort Collins, CO) or a similar toothpaste containing bloodroot, zinc chloride, and fluoride (Viadent Fluoride toothpaste, Vipont Pharmaceuticals, Fort Collins, CO) along with a mouth rinse containing bloodroot and zinc (Viadent Oral Rinse, Vipont Pharmaceuticals, Fort Collins, CO) daily for 6 months appears to reduces gingival index scores and bleeding upon probing compared with control paste and rinse formulations in adults with moderate plaque and gingival inflammation (36672,36675). However, some recent clinical evidence suggests that using toothpaste containing bloodroot extract 750 mcg/mL plus 2% zinc chloride along with a mouth rinse containing 300 mcg/mL plus 0.2% zinc chloride does not improve plaque index scores, gingival index scores, or probing depths in patients with gingivitis (36707). Bloodroot extract also appears to reduce the gingivitis development following dental cleaning when used with no other oral hygiene. Manual rinsing with a particular product containing bloodroot extract 300 mcg/mL (Viadent Oral Rinse) or supragingival irrigation with a solution containing bloodroot extract 22.5 mcg/mL for 14 days following professional tooth cleaning appears to inhibit gingivitis development compared with a placebo rinse (36697,36701). Other clinical evidence suggests that bloodroot extract may prevent gingivitis development during orthodontic treatment. Using a specific toothpaste (Viadent toothpaste, Viadent Inc., Fort Collins, CO) containing bloodroot extract 750 mcg/gram along with a specific mouth rinse (Viadent Oral Rinse, Viadent Inc., Fort Collins, CO) containing bloodroot extract 300 mcg/mL three times daily for 6 months appears to reduce the development of gingival inflammation and sulcular bleeding compared with placebo in adolescent orthodontic patients (36687).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Periodontitis. Preliminary clinical evidence suggests that using a toothpaste containing 0.075% bloodroot extract plus 2.0% zinc chloride along with a mouth rinse containing 0.03% bloodroot extract plus 0.2% zinc chloride twice daily for 2 weeks following debridement and treatment with chlorhexidine 0.2% oral rinse for 2 weeks significantly lowers gingival index scores and number of bleeding sites, but not plaque index scores, compared to treatment with fluoride-containing toothpaste/mouth rinse in patients with periodontitis (36665). More evidence is needed to rate bloodroot for these uses.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Rotaviral diarrhea. It is unclear if oral tormentil root extract is beneficial in children with rotaviral diarrhea. Details: A small clinical study in children 3 months to 7 years of age with rotaviral diarrhea living in Russia shows that taking an undeclared, age-based dose of tormentil root extract three times daily for up to 5 days reduces the duration of diarrhea by approximately 2 days when compared with placebo. Taking tormentil root extract also reduced intravenous fluid requirements when compared with placebo (10667).
• Ulcerative colitis. It is unclear if oral tormentil extract is beneficial in patients with ulcerative colitis. Details: A small, open-label clinical study in patients with active ulcerative colitis shows that taking tormentil extract 1.2-3 grams daily for 3 weeks modestly reduces symptoms of ulcerative colitis and improves markers of inflammation when compared to baseline (78590). The validity of these findings is limited by a lack of placebo control. More information is needed to rate tormentil for these uses.

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POSSIBLY SAFE ...when used orally and appropriately short-term (4).

POSSIBLY UNSAFE ...when excessive doses are used orally. The bloodroot constituent sanguinarine, although thought to be poorly absorbed, is a toxic alkaloid (6,12). ...when applied topically. Use of toothpaste or mouthwash containing bloodroot has been associated with an increased risk of developing oral leukoplakia (36666,36668). When applied to the skin, bloodroot paste causes pain, skin erosion, and a thick scab called an eschar which falls off leaving an indented scar. The U.S. Food and Drug Administration recommends that patients avoid bloodroot containing topical products such as "black salve" (53499,95442,95444,95445,95446).

PREGNANCY: LIKELY UNSAFE
when used orally (12); avoid using.

LACTATION: POSSIBLY UNSAFE
when used orally (4); avoid using.

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POSSIBLY SAFE ...when used orally and appropriately. Tormentil extract has been used with apparent safety in doses of up to 3 grams daily for up to 3 weeks (12,78590). ...when used topically and appropriately (12).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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General ...Orally, bloodroot is generally well tolerated when used in appropriate doses, short term (4). Nausea, vomiting, and central nervous system depression have been reported. Higher oral doses can result in glaucoma, hypotension, shock, and coma (6,12). Long term use of bloodroot toothpaste or mouthwash has been associated with leukoplakia, keratoses of the mouth, impaired taste, and staining of the tongue, teeth, and fillings (36666,36668,36707). Topically, skin contact with fresh bloodroot can cause irritation or contact dermatitis (19). Avoid contact with the eyes and mucous membranes because of its irritant properties.

Cardiovascular ...Orally, high doses of bloodroot may cause hypotension (6).

Dermatologic ...Topically, skin contact with fresh bloodroot can cause irritation or contact dermatitis (19). Topical application of bloodroot can corrode skin and produce a thick dry scab called an eschar which falls off and results in a depressed scar. There are numerous cases of patients applying bloodroot salves topically for 3-4 hours daily for 3-12 days to skin cancers, moles and blemishes. These patients report experiencing severe pain, burning, skin erosion, and scarring (53499,95442,95444,95445,95446).

Gastrointestinal ...Orally, bloodroot may cause nausea and vomiting (12). Some research shows that bloodroot-containing toothpastes and mouth rinses can be used for up to six months without evidence of adverse effects (36679). However observational research has found an association between chronic use of bloodroot toothpaste or mouthwash and leukoplakia or keratoses of the mouth and lip. Discontinuing these products did not always result in a resolution of leukoplakia (36666,36668). Prolonged use of bloodroot oral rinse causes impaired sensation of taste, as well as staining of the tongue, teeth, and fillings. The impaired taste and staining do seem to resolve after discontinuation of the bloodroot rinse (36707).

Neurologic/CNS ...Orally, bloodroot may cause CNS depression. High oral doses may cause shock and coma (6).

Ocular/Otic ...There are reports of worsening vision after small oral doses of bloodroot (36680). Glaucoma has been reported after high oral doses of bloodroot (6). However, some experts disagree that oral use of bloodroot causes ocular toxicity (36680). Direct contact of bloodroot with the eyes and mucous membranes should be avoided because of its irritant properties.

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General ...Orally, tormentil seems to be well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, heartburn, and a feeling of fullness.

Gastrointestinal ...Orally, tormentil has been reported to cause mild abdominal pain, heartburn, and feelings of fullness in one clinical trial. These adverse effects occurred at the same frequency for doses ranging from 1.2 grams daily to 3 grams daily (78590).

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