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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 3  |  Page : 1-4

Comparison of systemic and topical forms of curcumin in oral submucous fibrosis: A clinical and histopathological evaluation in 120 patients


1 Oral Medicine and Radiology, Consultant Dental Practitioner, Ahmedabad, Gujarat, India
2 Orthodontics and Dentofacial Orthopedics, Consultant Orthodontist, Ahmedabad, Gujarat, India
3 Periodontology, Consultant Periodontist, Senior lecturer in College of Dental Science and Research Centre, Ahmedabad, Gujarat, India
4 Oral Pathology, Ahmedabad, Gujarat, India

Date of Web Publication17-Jan-2019

Correspondence Address:
Dr. Nipa Chauhan
A/7 Parth society, Behind partheshwar temple, Isanpur, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_3_18

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  Abstract 

Introduction: Oral submucous fibrosis (OMSF) is a chronic insidious disease of oral mucosa, which is considered as a premalignant condition but has high malignant potential of approximately 7%–30%. Many treatment modalities have been tried since years but none have proved to be curative. Turmeric has been attributed a number of medicinal properties. Turmeric and its active ingredient, “curcumin” are being studied as chemopreventive agents in India and abroad. This study was proposed to evaluate the efficacy of curcumin in patients with OSMF and compare it with conventional treatment such as multivitamin and antioxidant tablets. Materials and Methods: A total of 120 patients who were clinically and histopathologically confirmed as having OSMF were selected and randomly divided into four groups. Group I patients were given tablets, Group II were given capsules, Group III were given oil, and Group IV were given multivitamin tablets. Patients were recalled every 15 days for 8 weeks and results were analyzed using analysis of variance test. Results: After treatment and follow-up, a significant improvement was seen in patients treated with curcumin when compared to those in control group. Conclusion: Curcumin as a treatment modality is efficient, noninvasive, beneficial, and economic for the patients with OSMF.

Keywords: Curcumin, oil of curcumin, oral submucous fibrosis


How to cite this article:
Shah A, Maharaja N, Shah S, Machhi M, Shah V, Chauhan N. Comparison of systemic and topical forms of curcumin in oral submucous fibrosis: A clinical and histopathological evaluation in 120 patients. Int J Oral Care Res 2018;6:1-4

How to cite this URL:
Shah A, Maharaja N, Shah S, Machhi M, Shah V, Chauhan N. Comparison of systemic and topical forms of curcumin in oral submucous fibrosis: A clinical and histopathological evaluation in 120 patients. Int J Oral Care Res [serial online] 2018 [cited 2019 Jun 25];6:1-4. Available from: http://www.ijocr.org/text.asp?2018/6/3/1/250274




  Introduction Top


Oral submucous fibrosis (OSMF) has been mentioned in the Indian medical literature since the time of Sushruta. Pindborg has defined OSMF as “An insidious chronic disease affecting the mucosa or any part of oral cavity and occasionally extending into the pharynx and eosophagus. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with the juxtaepithelial inflammatory reaction followed by a fibroelastic change in the lamina propria with epithelial atrophy leading to the stiffness of oral mucosa and causing trismus and inability to eat.”[1]

OSMF was well established in the Indian medical literature since the time of Sushruta, a renowned physician who lived in the era 600 BC, and was termed as “Vidari.” It was first described in the modern literature by Schwartz, in 1952, who coined the term “atrophia idiopathica mucosa oris” to describe an oral fibrosing disease, he discovered in five Indian women from Kenya.[2] Joshi subsequently coined the term “oral submucous fibrosis (OSMF)” for the condition in 1953.[3] Epidemiological studies show unique prevalence of this premalignant condition in India and Southeast Asia.

The malignant transformation rate for OSMF is 7%–30%.[4]

A wide range of treatment modalities, both medical and surgical, has been proposed but none have been proved, hence search of an effective treatment modality still continues.

Plants have a major source of medicinal use. Turmeric has been attributed a number of medicinal properties. Turmeric and its active ingredient, “curcumin,” are being studied as chemopreventive agents in India and abroad. Curcumin and its oil have been found to inhibit many disease processes through their anti-inflammatory, antioxidant, and anticancer properties.[5]

This study is proposed to evaluate the efficacy of various forms of curcumin in patients with OSMF and to compare it with conventional treatments such as multivitamin and antioxidant tablets.


  Materials and Methods Top


This study was conducted in the Department of Oral Medicine and Radiology, College of Dental Science and Research Center, Ahmedabad, Gujarat, India, for 8 weeks. A total of 120 patients who were clinically and histopathologically confirmed as having OSMF were selected for the study.

Patients clinically having OSMF were selected based on the clinical criteria given by Li et al. (1995)[6], and they were classified on the basis of inter-incisal distance as Group A, B, C, and D. These patients were randomly divided into four groups consisting of 30 patients in each group. Tablets, capsules, and oil were manufactured for the treatment purpose and given to the patients randomly divided into four groups. Group I patients were given tablets, Group II were given capsules, Group III were given oil, and Group IV was control group.

Groups A, B, C, D were divided according to mouth opening criteria by Lai DR

Lai DR classification is

  • Group A: >35 mm


  • Group B: Between 30 to 35mm


  • Group C: Between 20 to 30mm


  • Group D: < 20mm


  • Group I to IV were classified according to treatment modality
    • Group I: Curcumin tablet


    • Group II: Curcumin capsules


    • Group III: Curcumin oil


    • Group IV: Control group (Multivitamin tablets)


    Along with this treatment, all patients were also given general instructions to quit habit, consume green leafy vegetables, avoid spicy food, and perform mouth-opening exercise with ice cream sticks.

    A packet containing 45 tablets each of curcumin (350mg) was given to the patients in Group I and they were instructed to take tablets thrice daily for 15 days. A packet containing 30 capsules each of curcumin (500mg) was given to the patients in Group II and they were instructed to take capsules twice daily for 15 days. Oil of curcumin (10mL) was given to Group III patients and they were instructed to apply topically for 15min twice daily and avoid eating and drinking for half an hour after application. A packet containing 30 Multinal tablets (500mg) each was given to the patients in Group IV and they were instructed to take these tablets twice daily for 15 days. The patients were instructed to report every 15 days during the follow-up of 15, 30, 45, and 60 days, and the difference was noted in the severity of burning sensation, mouth opening, tongue protrusion, and cheek flexibility in all four groups from the beginning till the end of the treatment, and then the results were evaluated using analysis of variance test.


      Results Top


    All the patients in the study tolerated the treatment regimens well. None of the patients reported any allergy or abnormal reaction or any symptoms of toxicity to the treatment modality. When we compared the mean of tongue protrusion of patients of all groups at the beginning and at the end of 8 weeks, we found significant improvement in patients who took curcumin compared to that in control group. The mean difference obtained of capsule and oil was 0.3 and of tablet was 0.2, which is significant as compared to that of control group, which was 0.1 [Table 1].
    Table 1: Mean of comparison of tongue protrusion in 8 weeks (n = 120)

    Click here to view


    A significant improvement in the burning sensation of the patient was reported when treated with curcumin. The patients in Group IV showed minimal improvement when compared to those in the other three groups, whereas better results with burning sensation was observed in Group III patients [Figure 1].
    Figure 1: Mean of comparison of visual analog scale (VAS) scale in 8 weeks (n = 40)

    Click here to view


    A statistically significant increase in the mouth opening of patients was observed in Group I, II, and III as compared to that in Group IV after a follow-up of 8 weeks. The mean increase was 2.6, 3.5, and 2.9 in Group I, II, and III, respectively, compared to that in Group IV, which was 0.8. The patients treated by capsules showed best result in mouth opening [Figure 2].
    Figure 2: Mean of comparison of mouth opening in 8 weeks (n = 120)

    Click here to view


    The clinical scores of OSMF in patients of the four groups were noted before the treatment and at every visit during the treatment and follow-up. A remarkable reduction in the clinical scoring of the patients of Group I, II, and III was observed after first 15 days of the treatment.


      Discussion Top


    After 8 weeks of treatment, the patients in Group I, II, and III showed classic improvement compared to that in Group IV for tongue protrusion, burning sensation, and mouth opening [Figure 3]. Oil showed better results in the reduction of burning sensation, whereas capsules showed good improvement in the score of mouth opening and tongue protrusion. Therefore, it can be stated that turmeric in all forms is a better treatment modality in improving signs and symptoms of OSMF.
    Figure 3: Photograph showing increase in mouth opening before and after the treatment

    Click here to view


    The increase in mouth opening and tongue protrusion brought about by the treatment could be a result of the anti-inflammatory, antioxidant, and fibrinolytic properties of curcumin and turmeric oil. Zhang et al.[7] performed a study on antifibrotic effect of curcumin and concluded that type I and III collagens are the main components of extracellular matrix (ECM). A reduction in the deposition of ECM is of great importance in the treatment of OSMF. By inhibiting the proliferation and inducing apoptosis of myofibroblasts, curcumin effectively decreases the generation of type I and III collagens, confirming its potential therapeutic value in OSMF.[7] Kumar et al.[8] conducted a study on the pathological observations of curcumin in animal model and concluded that it shows profound antitumorigenic and antimutagenic activity.

    Turmeric has been described as a dual inhibitor of arachidonic acid metabolism as it inhibits both cylooxygenase and lipoxygenase pathways of inflammation, thus inhibiting the products of inflammation such as prostaglandins and leukotrienes.[9]

    Biological activities of curcumin are prooxidant, antioxidant, analgesic, anti-inflammatory, antiseptic, antiproliferative, antimutagenic, antimicrobial, neuroprotective, immunomodulatory, and anticarcinogenic.[10],[11],[12],[13]

    Impairment of reactive oxygen species (ROS) by curcumin has been proved, which occurs through its interaction with thioredoxin reductase, thus altering its activity to nicotinamide adenine dinucleotide phosphate oxidase, which could lead to production of ROS.[14] It is known to scavenge superoxide anion radicals and hydroxyl radicals generated by activated macrophages, which play an important role in inflammation. The antioxidant activity of curcumin could be mediated through antioxidant enzymes such as superoxide dismutase, catalases, and glutathione peroxidase. A study by Rai et al.[15] on possible action mechanism for curcumin in precancerous lesions based on serum and salivary markers of oxidative stress concluded that curcumin significantly increases the local and systemic antioxidant status and the levels of vitamins C and E and decreases lipid peroxidation and DNA damage of patients. So the effects brought about by the treatment regimen using curcumin oil and systemic curcumin could be a synergism of their anti-inflammatory and antioxidant properties.[1]


      Summary andConclusion Top


    A statistically significant improvement was observed in the clinical signs and symptoms of the patients treated with systemic curcumin and curcumin oil when compared to those treated with multivitamin tablets after treatment and follow-up evaluation. Those treated with multivitamin tablets hardly showed any improvement in the signs and symptoms. It can be concluded that turmeric is a safe, nontoxic, and an effective alternative for many conventional drugs because of its distinguished therapeutic properties and multiple effects on various systems of the body. Its role in the treatment of oral potentially malignant disorders and oral cancer is very promising. However, not enough information and research is available in this field, and therefore continuous further research is required to determine the efficacy of curcumin and its application in wide range of oral diseases.

    Declaration of patient consent

    The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

    1.
    Samdariya S, Kumar D, Kumar A, Porwal P, Pareek P. Oral submucous fibrosis—A short review. IJMSPH 2014;3:1308-12.  Back to cited text no. 1
        
    2.
    Hebbar PB, Sheshaprasad R, Gurudath S, Pai A, Sujatha D. Oral submucous fibrosis in India: Are we progressing?? Indian J Cancer 2014;51:222-6.  Back to cited text no. 2
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    3.
    Chopra A, Sethi PS, Singh J, Dimple. Oral submucous fibrosis (OSMF). Indian J Dermatol Venereol Leprol 2000;66:255-6.  Back to cited text no. 3
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    Raghunath T, Maheshwaran T, Dineshshankar J, Anusushanth A, Sindhuja P, Sitra G. Pathogenesis and therapeutic intervention of oral submucous fibrosis. J Pharm Bioallied Sci 2013;25:S85-8.  Back to cited text no. 4
        
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    More CB, Gupta S, Joshi J. Classification system for Oral Submucous Fibrosis. Journal of Indian Academy of Oral Medicine and Radiology 2012;24:24-9.  Back to cited text no. 6
        
    7.
    Zhang SS, Gong ZJ, Li WH, Wang X, Ling TY. Antifibrotic effect of curcumin in TGF-β 1-induced myofibroblasts from human oral mucosa. Asian Pac J Cancer Prev 2012;13:289-94.  Back to cited text no. 7
        
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    Kumar NS, Vijaybhasker D, Purushotham Rao K, Pratima S. Pathological observations on the treatment of oral submucous fibrosis of curcumin gels in animal models. Der Pharmacia Lettre 2012;4:919-26.  Back to cited text no. 8
        
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    Michalak M, Paulo M, Pudlo K. Therapeutic significance of curcumin and its role in cancer treatment. J Pre Clin Clin Res 2012;6:73-6.  Back to cited text no. 11
        
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    Mathur V, Tijare M, Desai A, Gupta S, Kallianpur S. Curcumin—Oral cure from the Indian curry. Inter J Pharmacotherapy 2014;4:137-40.  Back to cited text no. 12
        
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    Sharma RA, Gescher AJ, Steward WP. Curcumin: The story so far. Eur J Cancer 2005;41:1955-68.  Back to cited text no. 13
        
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    Swathi R. Oral submucous fibrosis and the role of curcumin in its treatment: A review. Int J Pharm Sci Intervention 2015;4:7-10.  Back to cited text no. 14
        
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        Figures

      [Figure 1], [Figure 2], [Figure 3]
     
     
        Tables

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