|Year : 2017 | Volume
| Issue : 1 | Page : 7-11
Effect of curcumin in reducing burning sensation in potentially malignant disorders of oral cavity
Nitin Nigam, Siva Prasad Reddy Enja, Shruti Chandra, Neelakshi Pandey
Department of Oral Medicine and Radiology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
|Date of Submission||29-Mar-2016|
|Date of Acceptance||21-Jun-2017|
|Date of Web Publication||04-Aug-2017|
Department of Oral Medicine and Radiology, Saraswati Dental College and Hospital, Faizabad Road, Tiwari Ganj, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: Curcumin, chemically named as diferuloylmethane is a yellow coloured pigment which shows anti inflammatory, antioxidant, pro apoptotic, antibacterial, antiviral and antifungal activities. It suppresses cyclooxygenase, lipooxygenase and other inflammatory mediators and destroys free radicals. Aim: To evaluate the efficacy of curcumin in reducing the burning sensation in potentially malignant disorders of oral cavity. Materials and Methods: 100 subjects diagnosed clinically with potentially malignant disorders of oral cavity were included in this study. The patients were administered commercially available turmeric systemically and topical application of turmeric and honey was advised. Their burning sensation on VAS scale was evaluated after 15 days, and the data was then statistically analysed by Wilcoxon sign rank test. Results: After the treatment there was a significant decrease in VAS scale. The median showed decrease from 7 to 4. The mean value also showed decrease from 6.91 to 3.98. Conclusion: Hence, it is concluded that turmeric and honey showed positive results in reducing burning sensation in potentially malignant disorders of oral cavity.
Keywords: Burning sensation, curcumin, potentially malignant disorders
|How to cite this article:|
Nigam N, Reddy Enja SP, Chandra S, Pandey N. Effect of curcumin in reducing burning sensation in potentially malignant disorders of oral cavity. J Indian Acad Oral Med Radiol 2017;29:7-11
|How to cite this URL:|
Nigam N, Reddy Enja SP, Chandra S, Pandey N. Effect of curcumin in reducing burning sensation in potentially malignant disorders of oral cavity. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2017 Dec 17];29:7-11. Available from: http://www.jiaomr.in/text.asp?2017/29/1/7/212088
| Introduction|| |
The application of antioxidants in several industrial procedures have been studied in the 19th and 20th century. In recent years, with new advancements, there is an upsurge in the field of prevention and treatment of disorders by utilizing the chief property of antioxidants, i.e., scavenging free radicals. Therefore, it is very important to determine the role of free radicals in the progression of disease as well as the preventive effects of antioxidants. Antioxidants prevent cellular damage which is a common pathway for cancer. The reversal or control of potentially malignant disorders is a prime approach against carcinogenesis for the prevention of cancer. Research needs to be done on whether antioxidants can protect humans from disorders such as leukoplakia, lichen planus, carcinoma in situ, and oral cancer.
Curcumin, a yellow pigment in curry powder is derived from Curcuma longa plant, which is commonly known as turmeric. It belongs to ginger family (Zingiberaceae). The components are known as curcuminoids, which include mainly curcumin (diferuloyl methane), demethoxycurcumin, and bisdemethoxy-curcumin. Curcumin exhibits antioxidant, anti-inflammatory, analgesic, antiseptic, and proapoptotic activities, and hence, are used in ayurvedic medicines. It can be used in various forms for oromucosal disorders in topical manner such as turmeric extract, turmeric oil, turmeric water, turmeric powder, burnt turmeric pieces, and roasted ground turmeric, and in systemic manner in the form of tablet. Turmeric exhibits its anti-inflammatory properties by increasing the production of natural cortisone and lowering the levels of histamine. The DNA protecting and antioxidant property of curcumin are responsible for anti-precancer activities. Curcumin has been shown to suppress transformation, proliferation, and spread of tumor to distant sites. The mechanism of action is that it regulates transcription factors, growth factors, inflammatory cytokines, protein kinases, and various enzymes. The proliferation of cancer cells is inhibited by inducing apoptosis and arresting cells in different stages of cell cycle., Curcumin also shows antiviral property by inhibition of HIV-1 and HIV-2 proteases, reduction of HSV-1 replication, and suppressing transcription of HPV-18.,,,
In-vitro studies have proven that curcumin is an effective destroyer of reactive oxygen species and reactive nitrogen species. The inhibition of lipo-oxygenase and cyclo-oxygenase activities has also been observed. It has been seen that curcumin lowers the activity of smokeless tobacco extract or nicotine-derived nitrosamine ketone-induced nuclear factor kappa-light-chain-enhancer of activated B cells and cyclooxygenase-2 in oral premalignant and cancer cells. Turmeric also acts by increasing the number of micronuclei in the circulating lymphocytes.,,
Honey exhibits antibacterial, antifungal, and anti-inflammatory property. It decreases prostaglandin synthesis at site, increases nitric oxide in lesion, and inhibits leukotriene B4, which is mediator of inflammation.
| Materials and Methods|| |
This study was conducted in relation to the effect of curcumin to reduce the burning sensation in potentially malignant disorders and was conducted in the Department of Oral Medicine and Radiology in Saraswati Dental College, Lucknow after receiving approval of the ethical committee.
One hundred patients (both male and female) were included as participants in the study where they were clinically confirmed as suffering from potentially malignant disorders, i.e., oral submucous fibrosis (60 patients), speckled leukoplakia (10 patients), and oral lichen planus (30 patients). They gave a positive history of smoked/smokeless tobacco and burning sensation. Although no documented reports could be found in literature which gives the prevalence of burning sensation in leukoplakia, in this study only patients who had speckled leukoplakia with burning sensation were taken into account. Other variables can be taken into account to assess the response to treatment in leukoplakia, however, in this study only burning sensation i.e., subjective symptom was considered. It can be considered reliable as the subject and investigator are the same while assessing the response to medication. Patients were evaluated on clinical basis alone as this study does not proves changes at the histopathological level by the treatment and is only based on the subjective symptoms of the patients pre and post treatment. A written consent of the participants was taken on an ethical format regarding their participation in the study.
The study involved the use of visual analog scale (VAS), which is one of the key method for the study to record the severity of burning sensation in the individual patients. The 2nd material holds an equal importance as it is the drug of choice prescribed to patients to reduce the burning sensation, i.e., tablet Turmix. The burning sensation was noted on VAS scale on the first visit. The patients were given tablet Turmix by the investigators to be taken twice daily for 15 days along with the topical application of turmeric and honey in a paste form by cotton applicator 2–3 times daily. After 15 days, patients were recalled and the VAS score was recorded. Patient was asked to get empty tablet blister packs to ensure that tablet was taken on a regular basis. No other parameter was taken into account. The data was then statistically analyzed by Wilcoxon sign rank test.
| Results|| |
The results showed significant decrease in VAS value after the treatment [Graph 1]. An example of how to interpret the box plot is shown in [Graph 2]. In comparison of the medians, median value of VAS after treatment is significantly lower i.e., from a value of 7 pre-treatment to 4 post treatment. The mean value also showed reduction from 6.91 to 3.98 [Table 1]. The Z value and P value were −8.642b and <0.001, respectively [Table 2].
|Table 1: Statistical analysis of burning sensation on VAS scale before and after administration of Turmix tablet and local application of turmeric and honey |
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| Discussion|| |
In 1952 Schwartz named an oral fibrosing disorder as atrophica idiopathica mucosa oris based on the findings in 5 Indian women from Kenya. Joshi named the condition as oral submucous fibrosis (OSMF) in 1953. As the etiology and pathogenesis of this disorder is not specific, it is believed that the cause is multifactorial. Pindborg in 1968 and Caniff et al. in 1986 described the disease as a reaction to capsaicin, an irritant in chillies, however, this was not completely proved in the experimental work. Oral lichen planus is a chronic inflammatory disorder which affects 0.5–2% of the general population. It is caused by an immune response which is mediated by abnormal T cell. There is a change in the antigenicity of the basal epithelial cell surface. Oral leukoplakia which is derived from the Greek words “leukos” meaning white, and “plax” meaning plaque is mainly caused by tobacco intake. Because of chronic irritation of the mucosa by tobacco, there are inflammatory changes and increased permeability of mucosa to carcinogens and nitroson or nicotine. There is moderate-to-severe grade of dysplasia in nonhomogenous leukoplakia, and hence, there is a greater risk of developing into malignancy because of the presence of erythematous component. Burning sensation can be attributed to chronic irritation and erythematous surface.,
Deepa et al. in 2010 conducted a comparative study on the efficacy of curcumin capsules and turmeric oil as chemopreventive agents in oral submucous fibrosis, in which they divided 48 patients into three groups on the basis of different types of medications administered. Group I was given curcumin capsules, group II was given turmeric oil, and group III was taken as the control group and were provided with multinal tablets. In this study tablet Turmix twice daily and topical application of turmeric and honey was the medication and 100 patients suffering from oral sub mucous fibrosis, lichen planus, and leukoplakia were included. Their study concluded that participants in group I and group II presented with statistically significant reduction in burning sensation and reduced difficulty in consuming spicy food after the treatment period of 3 months and follow-up in comparison to those of Group III. Because curcumin had comparatively more effect than the other medications provided during the treatment, it can be used for the treatment of oral submucous fibrosis. The results of this study are in concordance with their study with the decrease in burning sensation on VAS scale after treatment period of 15 days.
Nagpal and Sood in 2013 presented a review article on the role of curcumin in oral and systemic diseases. In the treatment of various potentially malignant disorders such as oral submucous fibrosis, leukoplakia, and lichen planus, the role of curcumin has been studied. In-vitro and in-vivo animal experiments with turmeric extract and turmeric oil have shown oncopreventive property. The local symptoms of burning sensation and pain were reduced and mouth opening was also increased. The results of this study are in accordance with the anti-inflammatory effect mentioned in the article.
Agarwal et al. conducted a study to check the effect of turmeric on mouth opening and burning sensation on VAS. The study was conducted among 30 patients who were diagnosed with oral submucous fibrosis. The patients were administered commercially available turmeric thrice daily and after every month for 3 months, burning sensation on VAS scale and mouth opening were noted. However, in our study 100 patients with oral submucous fibrosis, lichen planus, and leukoplakia were taken and tablet Turmix was given twice daily for 15 days, and only change in burning sensation on VAS scale was noted. Their study showed that the improvement in mouth opening was not significant; however, the change in burning sensation on VAS was significant with a P value <0.001, which is in accordance with the results of our study.
Jurenka conducted a study in 2009 in which phase 1 trial was done among 25 patients to assess the efficacy of curcumin in preventing the progression of different potentially malignant disorders. The initial dose given was 500 mg daily which was later increased to 8 g daily for a duration of 3 months. In our study, the dose of tablet Turmix given was fixed for 15 days for 100 patients. On histopathological analysis, decrease in hyperkeratosis, parakeratosis, dysplasia, and inflammation was seen. Two out of 7 patients with leukoplakia and 2 out of 6 patients with Bowen’s disease showed improvement in condition. In this study, histopathological examination was not done. The results of their study supports the anti-inflammatory action of curcumin, which is proved by this study as well because the burning sensation is reduced.
In a study done by Hazarey et al. in 2015, 30 patients suffering from oral submucous fibrosis were equally divided into two groups, i.e., the test and control groups. The test group was administered longvida lozenges (curcumin) and the control group was treated with tenovate ointment (clobetasol propionate 0.05%) for a period of 3 months and follow-up was done for 6 months. In our study the sample size was 100 which comprised patients suffering from oral submucous fibrosis, leukoplakia, and lichen planus, and turmeric in both topical and systemic form along with honey was prescribed twice daily for 15 days. In their study burning sensation on VAS and interincisal distance was noted. The test group showed more increase in mouth opening and reduction in burning score on VAS compared to the control group. Control group showed significant relapse in condition. The results match with this study as the burning sensation is reduced, although a control group was not taken in our study.
Yadav et al. conducted a study in 2014 to compare curcumin with intralesional steroid injections in treatment of oral submucous fibrosis. Forty patients were divided into two groups. In group 1, weekly intralesional injection of dexamethasone and hyaluronidase was given. In group 2, curcumin tablet (Turmix 300 mg per day) was given. Treatment time was 3 months. Weekly burning sensation, interincisal distance, and tongue protrusion was evaluated. There was complete resolution in burning sensation in group 2 treated with Turmix. Mean of interincisal distance was more in group 2. The results are similar to those obtained in the present study as the burning sensation was reduced in 100 patients with oral submucous fibrosis, lichen planus, and leukoplakia on taking Turmix tablet and topical application of turmeric and honey for 15 days.
Singh in 2013 conducted a pilot study among 10 patients suffering from oral lichen planus. Turmeric extract was applied twice daily for 3 months. After 15 days, significant improvement in burning sensation, ulceration, and striae was noted. There was no adverse effect. In the present study, 30 patients suffering from lichen planus reported relief in burning sensation after systemic administration of tablet Turmix and local application of turmeric and honey 2–3 times daily. However, other clinical features were not taken into account.
In another study conducted by Srivastava et al. in 2015, effect of topical application of tulsi and turmeric in treatment of 41 patients of oral submucous fibrosis was noted. Significant improvement in burning sensation and mouth opening was seen after monthly visits for 3 months. In this study local application of turmeric and honey was prescribed twice daily for 15 days in 60 patients of oral submucous fibrosis. The burning sensation reduced and the P value was significant (<0.001), which is similar to this study results.
In a study reported by Keshari in 2015, 27 patients suffering from oral lichen planus were treated with topical curcumin ointment which was applied thrice daily for 2 weeks. Significant improvement in erythema, pain and ulceration was noted. In this study topical application of turmeric and honey was done twice daily for 15 days by 30 patients suffering from oral lichen planus. Significant improvement in burning sensation was noted.
In a study done by El Haddad in 2013, significant improvement was noted in oral lesions. Out of the 19 patients suffering from recurrent apthous stomatitis, 92% reported relief in pain in one day after application of honey. Two patients suffering from recurrent intraoral herpes reported immediate relief of pain and complete resolution by 5th day of start of the lesion. Eighteen patients suffering from atrophic oral lichen planus showed mild reticulation and resolution in 1–2 months. Four patients suffering from candidiasis showed no strains of Candida after histopathological examination which was done after 1 month of start of treatment. In 2 patients who had oral psoriasis, complete resolution of erythema was seen after 2 months. In this study, 60 patients suffering from oral submucous fibrosis, 30 from oral lichen planus, and 10 from speckled leukoplakia were prescribed topical application of honey 2–3 times daily for 15 days along with turmeric. Significant improvement in burning sensation was noted with the median of VAS value reducing to 4 after treatment which was 7 before treatment.
Limitations of our study
Tablet Turmix and paste of turmeric and honey were used in combination for this study, and hence, the efficacy of individual medication could not be determined. Second, out of the many other signs and symptoms of potentially malignant disorders only burning sensation was taken into account for determining the effect of turmeric and honey.
Strengths of our study
Tablet Turmix, turmeric, and honey are easily available medications and are cost effective too. Hence, a larger section of patients can avail the benefits. This being a prospective study with adequate sample size, the results are more reliable.
| Conclusion|| |
Curcumin in the form of commercially available tablet Turmix, turmeric, and honey in combination can be successfully used in the treatment of burning sensation in potentially malignant disorders of the oral cavity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]