REVIEW OF RELATED LITERATURE

LOCAL

Aloe barbadensis Mill also known as Aloe Vera or in Tagalog Sabila is a small plant growing about a foot
tall. Aloe barbadensis is rare in the Philippines and is a very versatile plant but with proper management,
this plant can grow and give wonderful benefits. Its bioactivities include burn healing, wound healing,
anti-inflammatory, antibacterial (Garde, 2015) Aloe Vera plant is not just for house decoration. Today,
Aloe Vera is included as the main ingredient in many processed skin products such as lotions, gel,
creams, and sunblock that everyone can purchase in drugstores, boutiques, and supermarkets. Aloe Vera
is an effective moisturizer. Aloe Vera can keep one's skin clear and prevent it from dehydration or drying
because the plant's leaves store water. The leaves of Aloe Vera plant are water-dense that contains a
combined special plant compounds called complex carbohydrates, making it an effective moisturizer.
Aloe Vera is limited only for external application to the skin and is very harmful to take Aloe Vera gel
orally (Villafuerte, 2019).Glycerine is a popular natural humectant because many people are using
skincare to make their skin became smooth and protect from the sun. The glycerine has a benefit to
keeping your skin healthy has been found that glycerine has a vital role which is to travel in our skin to
change the old skin cells and replace another new skin cell. The last one is helping to fight the dry skin
because it attracted and retained moisture in the skin and maintained the balance of water and resulting it
has become softer and smoother and glycerine has found that help your skin barrier or wall strengthen
(Human Nature, 2015).

Local Studies

Hand sanitizers replaced the traditional soap and water in many places in today’s generation to become a
germ-free world especially this time of the pandemic. A good soap cleans our dirty hands every day. It is
also inconveniencing a good small soap when traveling but water spills and soap that are not rinsed
properly might attract more germs. The discovery of a thing called hand sanitizer might remove all these
factors as it is very convenient and did not require soap and water (Lidres, 2017).There is a general
reminder that rubbing alcohol containing 70% and alcohol-based hand sanitizer has an effective substance
that can kill viruses and germs. Hand sanitizer can extinguish 99.9% of bacteria as fast as 15 seconds after
application. It can also prevent the spreading of bacteria and certain viruses. For hand sanitizer to achieve
its disinfecting capability, it should not be rub once it was applied on the particular surface of the skin, it
should let stay for about 15-30 seconds enable it to sanitize the area efficiently (Department of Science
and Technology - Industrial Technology Development Institute, 2020).

FOREIGN

New infections, bacterial or viral, have often raised significant threats to public health across the globe.
One of these hazardous pathogens is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),
which is renowned to cause coronavirus disease 2019 (COVID19) that was declared a global pandemic by
the World Health Organization (WHO) at the beginning of 2020. After its discovery in Wuhan in
December 2019, more than 150 million confirmed cases have occurred worldwide by April 2021. The
preventive protocols to cope with COVID-19 are just supportive in order to minimize the spread of this
disease as the best approach. Frequent and reliable handwashing is one of the many approaches adopted
to prevent the transmission of the virus.
Secondary bacterial or fungal infection can be considered as one of the most common and serious
complications related to viral infections, especially in the elderly. Secondary infections could lead to the
escalation of the clinical complications, increase the need for intensive care, and raise the rate of
mortality. A recent report on COVID-19 related co-infections showed that the mortality rate of 15.2%
was observed for patients with pneumonia caused by antibiotic-resistant strains of Staphylococcus aureus
(S. aureus) and Klebsiella pneumoniae (K. pneumoniae). Moreover, a study by Plantefèvere et al.
reported that 28% of intensive care unit (ICU) patients with severe SARS-CoV-2 pneumonia are co-
infected with bacteria. The use of an effective hand sanitizer is considered as an essential alternative to
handwashing, and is one of the current protocols to prevent the spread of viral infections and related
secondary infections, hence decreasing the need for intensive care administration and antibiotics use.

Following the outbreak of COVID-19, alcohol-based hand sanitizers (ABHS) have become a common
alternative to conventional handwashing in healthcare and neighborhood settings as a preventative tool,
causing an increased alcohol demand. Several hand sanitizers with different variations are available. It is
essential to consider the types of hand sanitizers that function effectively against pathogens. ABHS
recommended by the WHO are mostly composed of ethanol, isopropyl alcohols, or hydrogen peroxides in
varying combinations, in which the ethanol or isopropyl alcohol concentration is mainly at a range of 60–
95% [6]. This concentration range can be considered as the active bactericidal concentration range for
most ABHS. The demand for alcohol has increased due to the manufacturing of ABHS, which reduced
the global alcohol supply chain massively. The WHO proposed two formulations for lower volume
production of ABHS due to the COVID19 pandemic demands for alcohol. The first formulation consists
of 80% (v/v) ethanol, 0.125% (v/v) hydrogen peroxide, and 1.45% (v/v) glycerol, while the second
formulation contains 75% (v/v) isopropyl alcohol, 0.125% (v/v) hydrogen peroxide, and 1.45% (v/v)
glycerol. This urged the need to find an alternative alcohol-free hand sanitizer (AFHS) with a comparable
antimicrobial activity to overcome the risk in the alcohol supply chain.

In this study, AFHS formulations prepared from natural ingredients that include aloe vera, vitamin E,
glycerin, and different essential oils (EOs) were evaluated. These ingredients are also widely available in
the market, which make them easily accessible. The use of aloe vera gel as the hand sanitizer vehicle was
due to its natural moisturizing and germ-retarding abilities, as well as the competence of inhibiting some
bacterial strains. Vitamin E and glycerin were used for their ability to slow down rancidity (i.e., oxidation
or hydrolysis of fats and oils) and to moisturize the skin, respectively. The primary active compounds of
the AFHS gels are EOs, which have a wide range of antimicrobial activities. The antimicrobial activity of
EOs is reported to be due to their hydrophobic nature that facilitates the partition of active components in
the lipid of the bacterial cell membrane and mitochondria, hence reducing cytoplasmic membrane
integrity. For instance, it was demonstrated that a mixture of clove oil and cinnamon is effective against
several fungal, yeast, and bacterial species, such as Aspergillus flavus, Debaryomyces hanseni, and S.
aureus. The natural compounds used to prepare the AFHS are commonly used ingredients in cosmetic
applications owing to the variety of their properties. However, an optimized concentration of these
compounds should be used in the preparation of AFHS, as the increased proportion could lead to dermal
sensitivity and skin irritation, according to previously reported studies.

In addition, the preparation of hand sanitizer in the form of gel has several advantages over other forms of
hand sanitizers, such as liquid (spray) or foam. The key desirable properties of gel formulation are the
ability to create a protective layer on the site of application and the longer protection time on the skin in
comparison to the other hand sanitizer forms. The retention time of the hand gel is higher than the liquid
and foam hand sanitizers, and it has a preferable moisturizing feeling and adherence property on the
applied skin . Therefore, hand gel was considered as a suitable hand sanitizer form for the preparation of
AFHS in this study.

These formulated AFHS gels are aimed to control the spread of co-infections during pandemics.
Following the preparation of hand sanitizer gels, the characterization and the evaluation of all prepared
formulations were carried out in terms of organoleptic properties, pH measurement, rheological behavior,
and gel spreadability. A microbiological test zone of inhibition was performed against different bacterial
strains and Candida albicans (C. albicans) yeast to examine the antimicrobial activity of AFHS gels.
Finally, an acceptability test was conducted to assess the safety of the prepared hand gels by determining
any side effects, such as skin irritation and skin redness, which may arise from their application on human
skin.

FOREIGN

The wonderful plant “Aloe Vera”, with a scientific name of aloe barbadensis, is the oldest known herbal
medicine dating back to ancient time. Aside from the health benefits of Aloe Vera, it also known by its
outstanding characteristics reported in history. There are over 250 species of Aloe Vera in the world. It is
part of the Liliaceous family which is a succulent plant that means it has water-storing tissues. Aloe
usually grows in arid climates and no chance of surviving in a freezing environment. It is widely
distributed in Africa, Philippines, and India. Aloe Vera has no stem. Its green leaves resemble to a
sword’s blade which holds the translucent healing gel that provides medicinal usages of the plant. The gel
is consists of 96% water, it contains 18 of 20 amino acids that can be found within the body and vitamins
A, B, C, and E. One of the most vital components found in aloe is a compound carbohydrate identified as
acemannan permits nutrients to reach the cell, nurture them and also defend them from toxins.

As stated by (Paul Kwak, 2009), the height of a Barbados Aloe, a plant with a shrubby and long body
form, can grow up to eighty centimetre or four feet. Its leaves have two main portions of epidermis which
are the leaf gel and the rind. The protective layer which is the outermost part is rubbery and smooth is the
rind. Below the rind are composed of three types of tubular structures known as the vascular bundles.
Like most plants, it has a xylem, the transporter of minerals and water that comes from the roots to the
leaves, and the phloem the part which transports starches mixed with other materials to the roots. The
anthraquinones, third sticky layer, where the connection of the inner surface of the rind and the vascular
stacks is located, has the greatest beneficial elements composing aloe. The major and the fourth portion of
the leaves is the gel maker which are the lacunar mesophyll and the spongy parenchyma. This serves as
the compartment of water of the Barbados aloe.

In addition, using Aloe Vera has two options. One is using it internally for boosting the immune system,
improve body defences, and for cleansing and detoxifying intestines. The second one is the external use
for healing and moisturizing of the wounds because of its ability to accelerate the regeneration of skin
cells. Smith “Qualities of Aloe Vera”. L Aloe Vera Fresca.
Irreversible hydrocolloid or alginate is the most commonly used impression material in dentistry since it
is easy to manipulate, does not imply specialized equipment, and is low-priced. Alginate is based on
natural substances extracted from brown seaweed. As irreversible hydrocolloids are composed of 80%
water, they are subject to the phenomena of imbibition and syneresis.

Henceforth, we emphasize the importance of immediate disinfection of dental materials as a standard

cross-infection protocol to control the transfer of infectious diseases from saliva and blood of the patient
to dentists and technicians.
Disinfectants in routine use (sodium hypochlorite, glutaraldehyde) can have several deleterious effects
like burning sensation of mouth and throat, irritation of eyes and skin, watering of eyes, and others.
Hence, they are harmful to both health personnel and the environment. Therefore, the need is to find a
more natural biocompatible alternative with comparable disinfection efficacy. Aloe barbadensis Mill is a
small succulent herb and has potent antibacterial, antifungal, and antiviral properties.
The disinfection only removes microorganisms from the surface of the impression, but an unwanted side-
effect of this process is the potential for a change in the dimensions of the impression due to interaction
between the set material and the disinfecting solution. Alginate is a hydrophilic material that can absorb
water present in the disinfecting solution and may result in the distortion of the impression. Disinfection
of alginate impressions by both spray and immersion methods have been evaluated in the past with
widely varying results. A general conclusion was that dimensional changes observed with disinfection
were not clinically significant for most uses of irreversible hydrocolloid. However, the most accurate
casts were retrieved from impressions disinfected by spray rather than immersion. Aloe vera has been
used for ages for medicinal purposes and can be used fruitfully in the field of dentistry as well. The main
advantage of the use of aloe vera as a disinfectant is that it is a natural product that has no or minimal side
effects, readily available, less expensive, and, most importantly, is 100 percent biodegradable and does
not cause any harm to the environment. As no study has been done yet to evaluate the efficacy of aloe
vera as a disinfectant by immersion and spray method on an alginate impression material and its effect on
the dimensional accuracy of the resultant gypsum cast, this study had been planned.