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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 118-123

Effects of topical application of Curcuma longa extract in the treatment of early periodontal diseases


Department of Periodontology, B.J.S. Dental College, Hospital and Research Institute, Ludhiana, Punjab, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Dr. Vikrant Sharma
Department of Periodontology, B.J.S. Dental College, Hospital and Research Institute, Sector 40, Chandigarh Road, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.191725

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  Abstract 

Background: Treatment of plaque-induced periodontal disease is largely based on the mechanical debridement of the tooth surface and meticulous maintenance of oral hygiene thereafter. Various chemical plaque control agents are used as adjuncts along with the mechanical plaque control methods for this treatment. Most of these chemical plaque control agents have varied side effects. This has led to the search of natural products which are highly effective in controlling plaque microbes while being biocompatible. Turmeric is one such well-known plant product, known for its varied medicinal value. Aim: The aim of this study is to evaluate the clinical efficacy of Curcuma longa oral formulation in treatment of infective inflammatory early periodontal diseases. Materials and Methods: This clinical study comprised twenty individuals presenting with clinical features of plaque-induced gingivitis and mild periodontitis. Three groups were randomly made in mouth of each patient selected for the study. Group I was treated with scaling and root planing (SCRP) only. Group II was treated with SCRP plus C. longa oral formulation topical application for 2 weeks. Group III was treated only with topical application of C. longa extract oral formulation for 2 weeks. Gingival index, sulcus bleeding index, and plaque index were scored in each group before and after the treatment. Results: The results showed statistically significant improvement with respect to all the clinical parameters in all the three groups. However, Group II showed the maximum improvement (P < 0.001), followed by Group I (P < 0.001) and Group III (P < 0.05). The intergroup difference between the three groups for the improvements in clinical parameters was statistically nonsignificant. Conclusion: The oral formulation containing C. longa extract is effective in treating early infective-inflammatory periodontal diseases not only when used as an adjunct to SCRP but also when used alone.

Keywords: Curcuma longa extract, mild periodontitis, plaque-induced gingivitis


How to cite this article:
Sharma V, Kalsi DS. Effects of topical application of Curcuma longa extract in the treatment of early periodontal diseases. Indian J Dent Sci 2016;8:118-23

How to cite this URL:
Sharma V, Kalsi DS. Effects of topical application of Curcuma longa extract in the treatment of early periodontal diseases. Indian J Dent Sci [serial online] 2016 [cited 2019 Jan 18];8:118-23. Available from: http://www.ijds.in/text.asp?2016/8/3/118/191725


  Introduction Top


Plaque-associated gingivitis is one of the most commonly noted types of periodontal disease. It is prevalent in both children and adult populations and precedes plaque-associated periodontitis. Plaque-induced periodontal diseases, i.e., chronic plaque-induced gingivitis and periodontitis, are inflammation and infection of the tissues that support the teeth, including gingiva, periodontal ligament, and alveolar bone. In the initial stages, plaque-induced periodontal diseases (gingivitis and periodontitis) have been shown to be reversible though they usually lead to irreversible damage to the periodontal tissues in the later stages.[1] The prevention of chronic plaque-induced gingivitis in the individual, therefore, is the first step in preventing periodontitis.[2] Bacterial plaque has been proved to be the single most important factor in the causation and progression of plaque-induced periodontal disease.[3] Treatment of plaque-induced periodontal disease is largely based on mechanical debridement of the tooth surface and meticulous maintenance of oral hygiene thereafter. In addition, many chemical plaque control agents such as chlorhexidine, triclosan, povidone iodine, and phenolic compounds can be used as adjuncts to mechanical plaque control methods.[4],[5],[6] These chemical plaque control agents have been shown to reduce the severity of clinical features of plaque-induced gingivitis such as redness, bleeding, and puffiness of gingiva.[7],[8] Allergy, discoloration of teeth, and unpleasant taste are known side effects of these chemicals plaque control agents, especially when they are used for an extended period.[9]

Herbal products have also been used for hundreds of years for maintenance of oral hygiene and control of gum diseases. It is believed today that more than 80% of Indian population still relies on their use for oral health-care needs. Turmeric, neem, aloe vera, clove, cinnamon, etc. are among the common herbal products used for this purpose. Among these, turmeric has been traditionally used as a remedy for skin, stomach, liver ailments, etc., Since turmeric has antimicrobial, antioxidant, astringent, and other useful properties, it may be useful in dentistry also.[10]

Turmeric (haldi), a rhizome of Curcuma longa, is a flavorful yellow-orange spice. The orange pulp contained inside the rhizome of C. longa yields turmeric powder. The active constituents of turmeric are flavonoid curcumin (diferuloylmethane) and various volatile oils including tumerone, atlantone, and zingiberone. Other constituents include sugars, proteins, and resins. The best-researched active antimicrobial/health-maintaining constituent of turmeric is curcumin.[11] Raw turmeric has 0.3%–5.4% of curcumin by weight. Turmeric has been used extensively in Ayurvedic medicine for centuries, and it is nontoxic and has been shown to have a variety of therapeutic properties including antioxidant, analgesic, anti-inflammatory, antiseptic, and anticarcinogenic activities and has diversified effects in various oral diseases.[10]

For oral use, solution of turmeric has been studied as mouth rinse.[12] So far, very few studies have been done on the use of turmeric in the oral cavity applied topically or in the local drug delivery mode. Recently, a commercial product containing C. longa extract claimed to have curcumin as the active medication (Curenext ®, Abbott Pharmaceuticals) and has become available for topical oral application and is claimed to reduce clinical features of plaque-induced periodontal diseases.

As very little literature is available on curative effects of C. longa extract on plaque-induced periodontal diseases, the present study was designed to evaluate clinical outcomes of application of C. longa extract as an adjunct to scaling and root planing (SCRP) or as a monotherapy in treatment of plaque-induced gingivitis/mild plaque-induced periodontitis.


  Materials and Methods Top


Twenty healthy patients (13 males and 7 females) in the age group of 25–30 years were selected in a randomized, double-blind, split-mouth study. The patients were selected from patients referred to the Department of Periodontology and Oral Implantology for the treatment of mild gingivitis/mild periodontitis. Patients who were smokers, pregnant, had systemic diseases such as diabetes, had taken systemic or topical antibiotic therapy or the over-the-counter antioxidants such as Vitamin C, Vitamin E, or β-carotene-containing products within the last 3 months, or who had undergone periodontal therapy within the last 3 months were excluded from the study. All the selected patients exhibited the clinical signs of chronic plaque-induced gingivitis including bleeding on probing at least at 4 sites per quadrant and had gingival/periodontal pockets measuring <4 mm at least at half of the sites. Any of the patients who took antibiotics or dental treatment, etc., for any reason subsequently during the study were also excluded from the study.

Experimental design

A commercially available product Curenext ® (Abbott Pharmaceuticals) containing 10 mg/g C. longa extract was evaluated for its efficacy in treating plaque-associated gingivitis and mild periodontitis after obtaining informed consent from each patient. Split-mouth design was followed in each patient. Quadrants were randomly allocated in each patient's mouth, and three groups were made. Group I constituted 2 randomly selected quadrants which were treated with only SCRP. Clinical parameters in these selected quadrants were recorded at the 1st day (baseline), 7th day (1 week), and 14th day (2 weeks) from the start of the study. This group showed the effects of SCRP only. The group was named “SCRP group.” Patients were asked to continue all routinely practiced oral hygiene measures by them, and no dietary restrictions were imposed on them during the study.

In the case of Group II and Group III, each group constituted one randomly selected quadrant from the two leftover quadrants. These groups were evaluated on the 14th day after the selection, treatment, and recording of clinical parameters of Group I. Group II was treated with SCRP followed by topical application of C. longa extract oral formulation twice daily for 2 weeks. All the patients were instructed to gently apply a small pea size of C. longa extract oral formulation with a finger over their gingiva 1 h after their routinely practiced oral hygiene measures and were asked not to rinse their mouth with water for at least 10 min after the application. For the last group, i.e., Group III, SCRP was not performed; only topical application of C. longa extract oral formulation twice daily for 2 weeks was prescribed. The selection dates of Group II and Group III (14th day) formed the baseline visit for these groups, and the selected clinical parameters (gingival index, sulcus bleeding index, and plaque index [GI, SBI, and PI]) were recorded in both Groups II and III at the 14th day (baseline visit), 21st day (1 week), and 28th day (2 weeks) from the start of the study. As Group II showed the effects of C. longa extract oral formulation as an adjunct to SCRP treatment, it was named “SCRP + CUR group.” As Group III showed the effects of C. longa extract oral formulation as a monotherapy, it was named “CUR Group.”

The patients of Group II and Group III were also asked to continue all routinely practiced oral hygiene measures by them, and no dietary restrictions were imposed on them during the study.

Patients were asked not to use any of the commercially available chemical plaque control mouthwashes/applications (in any form) in addition to ones already being used before the start of the study.

Measurement parameters

The following clinical parameters were recorded on a case report form and were double entered into a computer: GI by Lobene et al. modification of Loe and Silness,[13] Modified SBI Mombelli et al. and PI modified Quigley Hein and Elliot index.[14]

Data analysis

After completion of the clinical trial, data obtained from the patients were computed and put into statistical analysis. For each treatment group, mean values of GI [Table 1], SBI [Table 2], and PI [Table 3] were calculated at baseline, 1st, 2nd week (for Group I) and 2nd week (baseline), 3rd week, and 4th week (for Group II and Group III). The percentage decrease in gingivitis and gingival bleeding over 2 weeks of treatment in each group was also calculated. The collected data were statistically analyzed using paired t-test for intragroup difference in the groups and ANOVA for intergroup difference between the groups.
Table 1: Gingival index values over 2 weeks

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Table 2: Sulcus bleeding index values over a 2 weeks period

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Table 3: Plaque index values over a 2 weeks period

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  Results Top


All the treatment groups showed significant improvement in gingival conditions with regard to GI, SBI, and PI values.

GI values [Figure 1] for Group I (SCRP), Group II (SCRP + CUR), and Group III (CUR) at baseline were 1.82 ± 0.25, 1.92 ± 0.30, and 1.8 ± 0.42, respectively. SBI values [Figure 2] for Group I (SCRP), Group II (SCRP + CUR), and Group III (CUR) group were 2.04 ± 0.43, 2.18 ± 0.51, and 1.95 ± 0.42, respectively. PI values [Figure 3] at baseline for Group I (SCRP), Group II (SCRP + CUR), and Group III (CUR) were 2.78 ± 0.38, 2.69 ± 0.29, and 2.58 ± 0.23, respectively.
Figure 1: Improvement in gingival index values in the three groups over 2 weeks.

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Figure 2: Improvement in sulcus bleeding index values in the three groups over 2 weeks.

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Figure 3: Plaque index values in the three groups over 2 weeks.

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Intragroup difference

The difference within the groups was analyzed using paired t-test. All the treatment groups showed significant improvements in GI, SBI, and PI values over a period of 2 weeks.

In Group I, there was statistically highly significant improvement in GI, SBI, and PI values (P < 0.001) at 1 and 2 weeks from the baseline. In Group II, also, there was a statistically highly significant improvement in GI, SBI, and PI values (P < 0.001) at 1 and 2 weeks from the baseline. In Group III, there was a statistically significant improvement in GI values (P < 0.05) at 1 week and statistically highly significant (P < 0.001) at 2 weeks from the baseline. Improvement in PI values was also statistically significant (P < 0.05) from 2.58 ± 0.28 at baseline to 2.14 ± 0.47 at 1 week and 1.88 ± 0.32 at 2 weeks from baseline.

Intergroup difference

Treatment with SCRP plus Curenext (Group II) showed greater percentage reductions (31.25%) in GI scores when compared to percentage reductions in Group I (24.17%) and Group III (19.44%) [Figure 4]. As per the reduction in SBI scores, Group II showed more percentage reduction in scores (39.4%) when compared to reductions in Group I (35.8%) and Group III (23.1%); [Figure 5] however, the difference between the reductions of SBI scores was significant only between the Group II and Group III and nonsignificant between Group II and Group I. The difference in reduction in PI was not significant between Group II and Group I with Group II showing 56.8% and Group I showing 52.8% improvements. The reduction in PI values was less in the Group III as compared to other two groups with percentage improvement being 27.13% [Figure 6].
Figure 4: Percentage of reduction (improvements) in gingival index.

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Figure 5: Percentage of reduction (improvements) in sulcus bleeding index values.

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Figure 6: Percentage of reduction (improvements) in plaque index values.

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  Discussion Top


Various chemotherapeutic agents are available for treatment of different plaque-induced periodontal diseases,[6] but a major drawback of these conventional drug therapies is the numerous side effects associated with their use. This has led to renewed interest in the discovery of novel anti-infection/anti-inflammatory natural products derived from plants. Plants have been the major source of medicine since time immemorial. One of the most commonly used anti-infection/anti-inflammatory plant products is turmeric. Turmeric has been attributed a number of medicinal properties in the Ayurvedic system of medicine.[15] Its anti-inflammatory, antioxidant, antimicrobial, hepatoprotective, immunostimulant, antiseptic, and antimutagenic properties are well documented.[16] Due to these properties, turmeric is widely used in Ayurvedic system of medicine to cure inflammatory and infectious diseases. Therefore, turmeric can also be quite useful in chemotherapeutic management of plaque-induced periodontal diseases. Its role in the treatment of plaque-induced periodontal diseases and oral cancers has been evaluated in many studies. In the present study, effects of commercially available preparation containing extract of C. longa in the treatment of mild form of plaque-induced inflammatory periodontal disease (chronic plaque-induced gingivitis/mild periodontitis) were evaluated. The main cause of plaque-induced periodontal disease is microbial oral biofilm. Microbes from plaque infiltrate the periodontal tissues and consequently induce an inflammatory reaction in these resulting in generation of free radicals by the polymorphonuclear leukocytes that are known to result in periodontal tissue damage.[17],[18],[19] The aim of the present study was to evaluate the efficacy of C. longa extract oral formulation as a monotherapy and also as an adjunct to conventional SCRP in alleviation of clinical features of plaque-induced gingivitis and periodontitis. This was done by evaluating the clinical parameters: GI, SBI, and PI over a period of 2 weeks. In all the three groups, there was significant improvement with regard to GI and SBI over a 2 weeks period. SCRP-CUR group showed the maximum amount of improvement when compared to the other two groups. However, the difference between the three groups was statistically insignificant. Application of C. longa extract oral formulation when used as an adjunct to SCRP proved to be the most beneficial treatment. However, when this oral formulation was used as a monotherapy, significant improvement was also seen. This implies that, when used alone, oral formulation containing C. longa extract also has significant beneficial effects as far as alleviation of clinical features of plaque-induced gingivitis is concerned. The commercially available product Curenext ® which contains C. longa extract claims to have curcumin as the active medicinal ingredient. Curcumin is known to have anti-inflammatory properties. It reduces inflammation by lowering histamine levels and possibly by increasing the production of natural cortisone by the adrenal glands.[18] Oral administration of curcumin in cases of acute inflammation was found to be as effective as cortisone or phenylbutazone, and half as effective in cases of chronic inflammation.[20] Its anti-inflammatory properties may be attributed to its ability to inhibit both biosynthesis of inflammatory prostaglandins from arachidonic acid and neutrophil function during inflammatory states.[20] Curcumin also protects against free radical damage because it is a strong antioxidant.[21] Water- and fat-soluble extracts of turmeric and its curcumin component exhibit strong antioxidant activity, comparable to that of Vitamins C and E.[22] An in vitro study measuring the effect of curcumin on endothelial heme oxygenase-1, an inducible stress protein, was conducted utilizing bovine aortic endothelial cells. Incubation (for 18 h) with curcumin resulted in enhanced cellular resistance to oxidative damage.[23] The findings of our study are in accordance with other several studies. Muglikar et al. studied the efficacy of curcumin mouthwash as an adjunct to SCRP in the treatment of chronic gingivitis and compared it to effects of chlorhexidine in terms of its antimicrobial properties. They concluded that curcumin is comparable to chlorhexidine as an anti-infective mouthwash and it is an effective adjunct to mechanical periodontal therapy.[24] Curcumin is also regarded as generally recognized as safe. All these reports make the use of C. longa extract oral formulation very encouraging in cases of chronic plaque-induced periodontal diseases. Although requirement of SCRP for the treatment of chronic plaque-induced periodontal diseases is undisputed, results of our study show that topical application of C. longa extract oral formulation when used alone/before SCRP/along with SCRP can at least make SCRP easy for doctor and patient as it reduces bleeding and inflammation. In some cases, e.g. mild gingivitis, it can even suffice (as suggested by our findings) and act like a monotherapy for curing early plaque-associated periodontal diseases. Topical application of C. longa extract may also be used as monotherapy as a treatment option in cases where oral prophylaxis needs to be postponed to a later date for making patient comfortable till mechanical therapy can be performed.


  Conclusion Top


The results obtained in this study show that topical application of C. longa extract holds a great promise in the treatment of plaque-induced/associated gingivitis/mild periodontitis. Topical application of C. longa extract when used as an adjunct to SCRP can add on to the already available treatment modalities for treatment of plaque-induced periodontal diseases. Further research needs to be conducted to confirm the findings of this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Motterlini R, Foresti R, Bassi R, Green CJ. Curcumin, an antioxidant and anti-inflammatory agent, induces heme oxygenase-1 and protects endothelial cells against oxidative stress. Free Radic Biol Med 2000;28:1303-12.  Back to cited text no. 23
    
24.
Muglikar S, Patil KC, Shivswami S, Hegde R. Efficacy of curcumin in the treatment of chronic gingivitis: A pilot study. Oral Health Prev Dent 2013;11:81-6.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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