Sir, I read with great interest the letter to editor entitled Herbal interactions (BDJ 2010; 209: 57). There has been an increase in the use of herbal medicines around the world in recent years in the general belief amongst the public that they are safe because they are obtained from natural sources. However, some of these products have associated adverse effects. Ginger contains gingerols and shogaols that prevent blood cells from clotting and acts as a natural blood thinner. Similarly, garlic is extremely beneficial to the entire cardiovascular system. Chemicals named alliin, allinase, and allicin present in garlic improve blood circulation by thinning the blood.

Ginkgo and Ginseng herbal supplements are widely used in Europe and the United States to treat circulatory disorders. Ginkgo leaves contain two types of chemicals (flavonoids and terpenoids). Flavonoids protect the blood vessels from damage and terpenoids improve blood flow by dilating blood vessels and reducing the stickiness of platelets. Though all these herbal medicines have a beneficial blood thinning action, especially in heart diseases, they can be risky to consume in large quantities. The blood thinning effect of these natural products may lead to bleeding from the gums, nose, in urine, stools and bruises. Hence, patients should never start self medication and combine artificial and natural blood thinners without consulting a physician. These herbal supplements should be stopped by the patients at least 36 hours prior to surgery or dental procedures due to the risk of bleeding complications. The medical history taken by the dentist should include questions regarding the taking of herbal and over-the-counter medications.