ISSN 0974-3618 (Print) www.rjptonline.org
0974-360X (Online)
REVIEW ARTICLE
Effects
of turmeric on oral submucous fibrosis: A Systematic Review
Nirisha Sriram1,
Gheena. S2, Samrithi Yuvaraj3
11st Year BDS, Reader, Saveetha Dental
College and Hospital, Chennai, India
2Department of Oral Pathalogy, Saveetha Dental College
and Hospital, Chennai, India
31st Year BDS Saveetha Dental College and
Hospital, Chennai, India
*Corresponding Author E-mail: nirishasriram@gmail.com
ABSTRACT:
Oral submucous fibrosis is a chronic, complex
potentially malignant disorder with a high risk of malignant transformation. As the disease progresses, the jaws become rigid to
the point that the sufferers are unable to open their mouth. The major cause of this condition is
arecanut or betel quid chewing. This systematic review explores and discusses
the researches done in the effectiveness of turmeric in oral submucous
fibrosis. The name turmeric is derived from the Latin word terra merita or
turmeryte. The most active component present in turmeric is curcumin. It is a
safe, non-toxic and an effective herb that can act as an alternative for many
conventional drugs due to its enormous therapeutic properties on various
systems of our body. Since age old times turmeric has been used in households
with the belief that it can destroy harmful agents. Now has come the era where
turmeric finds its use out of households and into clinics. Through various
studies it has been found that turmeric has anti oxidants and anti allergic activities.
This makes turmeric a better choice for clinicians to use it to cure
precancerous lesions like oral submucous fibrosis. Researches that are done on
human beings have almost shown positive results in curing oral submucous
fibrosis. However to implement the use of turmeric in oral submucous fibrosis
clinically more trials on a large scale are yet to be conducted.
KEY WORDS: OSMF, Oral submucous fibrosis ,
Turmeric, Curcumin, Precancerous lesions .
INTRODUCTION:
According to Pindborg, oral submucous fibrosis is an
insidious chronic disease affecting the mucosa or any part of the oral cavity
and occasionally extending to the pharynx and esophagus.
Pindborg
classified oral submucous fibrosis into 3 types clinically (1)
·
Stage
I: Stomatitis includes erythematous mucosa, vesicles, mucosal ulcers, melanotic
mucosal pigmentation and mucosal petechiae.
·
Stage
II : Fibrosis occurs in healing vesicles and ulcers, which is the hallmark of
this stage.
o
Early
lesions show blanching of the oral mucosa. Older lesions include vertical and
circular palpable fibrous bands in the buccal mucosa and around the mouth
opening or lips.
o
o
This
results in a mottled marble like appearance of the mucosa because of the
vertical thick, fibrous bands in association with a blanched mucosa.
o
o
Specific
findings include reduction of mouth opening, stiff and small tongue, blanched
and leathery floor of the mouth, fibrotic and de-pigmented gingival, rubbery
soft palate with decreased mobility, blanched and atrophic tonsils, shrunken
bud like uvula and sunken cheeks, not commensurate with age or nutritional
status.
Stage III : Sequelae of oral submucous
fibrosis are as follows :
·
Leukoplakia
is found in more than 25% of individuals with oral submucous fibrosis.
·
Speech
and hearing deficit may occur because of involvement of tongue and the
Eustachian tube.
Histopathalogical
classification of Sirsat and Pindbord include
Pindborg JJ and Sirsat SM (1966) were the first to
divide oral submucous fibrosis depending only on histopathological
features. They are as follows(1)
-
Very
early stage : Finely fibrillar collagen dispersed with marked edema. Plump young fibroblast containing abundant
cytoplasm. Blood vessels are dilated and
congested. Inflammatory cells, mainly
polymorphonuclear leukocytes with occasional eosinophils are found.
-
Early
stage: Juxta-epithelial area shows early hyalinization. Collagen still in separate thick
bundles. Moderate number of plump young
fibroblasts is present. Dilated and
congested bold vessels. Inflammatory
cells are primarily lymphocytes, eosinophils and occasional plasma cells.
-
Moderately
advanced stage: Collagen is moderately hyalinized. Thickened collagen bundles are separated by
slight residual edema. Fibroblastic
response is less marked. Blood vessels
are either normal or compressed.
Inflammatory exudates consists of lymphocytes and plasma cells.
-
Advanced
stage: Collagen is completely hyalinized.
Smooth sheets with no separate bundles of collagen is seen. Edema is absent. Hyalinized area is devoid of
fibroblasts. Blood vessels are
completely obliterated or narrowed.
Inflammatory cells are lymphocytes and plasma cells.
Oral submucous fibrosis condition is preponderant in
India compared to other Asian counties with a reported ubiquitousness ranging
up to 0.4% in Indian rural population.(2) A study conducted in 2002 indicated
that more than 5 million people in India have oral submucous fibrosis. Several experimental, observational,
case-control, animal and tissue culture studies conducted have shown that betel
quid/areca nut is the chief cause for oral submucous fibrosis.
As the accurate cause for oral submucous fibrosis is
yet to be established, synthesizing and formulating a precise drug becomes
difficult. Some of the treatment
methods followed are steroid topical or intralesional injections, placental
extract, anti fibrotic intralesional injection.
Surgery is done if it can no longer be treated with drugs. All of these are curable only to an extent. Hence there comes the need to formulate a
drug that can cure as well as prevent oral submucous fibrosis. Several researches have been going on to
study and understand the effect of turmeric on oral submucous fibrosis.
Turmeric:
Composition
of turmeric(3)
|
SNO
|
CONSTITUENTS
|
QUANTITY
|
|
1
|
Curcumin (curcuminoids)
|
2-4%
|
|
2
|
Volatile(essential) oil
|
3-7%
|
|
3
|
Fiber
|
2-7%
|
|
4
|
Mineral Matter
|
3-7%
|
|
5
|
Protein
|
6-8%
|
|
6
|
Fat
|
5-10%
|
|
7
|
Moisture
|
6-13%
|
|
8
|
Carbohydrates
|
60-70%
|
Therapeutic actions of
turmeric(3)
Therapeutic effects of turmeric in turn depends on the
therapeutic actions of curcumin. It
protects against free radical damage because it is a strong antioxidant. It
lowers the histamine level and stimulates the production of natural cortisone
from adrenal glands. Thus it has a major
role in reducing inflammation. It
protects the liver from a number of toxic compounds such as carbon
tetrachloride, galactosamine, acetaminophen and aspergillus aflatoxin and so
on.
OBJECTIVE:
To do a systematic map on the effect of
turmeric on oral submucous fibrosis.
REVIEW
METHODOLOGY:
Search strategy
Comprehensive searches were done in PubMed, Wiley.com,
Google Scholar and hand search with the key words being “curcumin”, “turmeric”,
“OSMF”, “Oral submucous fibrosis” up to April 2015. Studies from other languages that could be
translated were translated and included for the study. Articles that could not be translated were
left out. Only articles that were
conducted on human beings and had full text were included for the study.
Inclusion Criteria:
Articles were then divided based on their study
type. Out of four articles that fell
into the category of the objective, one was randomized, open-label
interventional study, the other being randomized control study. The other
included studies were pilot, prospective observational study and case control
study. The main criteria evaluated for this review is the burning sensation in
the patients suffering from oral submucous fibrosis.
Data collection and extraction:
For each study the following information were
collected: Study period, publication
language, journal, name of the authors, number of subjects, study type, age, and
outcome measure.
RESULTS AND DISCUSSION:
Discussion of first study:
The study “Comparison of curcumin with intralesional
steroid injection in Oral Submucous Fibrosis – A randomized, open-label interventional
study published in “Journal of oral biology and craniofacial research” in the
year 2014 was conducted for a period of 3 months . It included patients within
the age group 20-40 years(31 males and 9 females) with a histological diagnosis
of oral submucous fibrosis. The patients were randomly divided into three
groups with the first group being treated with intralesional injection of 4mg
dexamethasone and 1500 I.U. Hyaluronidase. The second group were asked to
injest 2 curcumin tablets orally per day. It was found in the study that at the
end of third month that there was a complete resolution of burning sensation
with curcumin when compared to the conventional therapy.(4)
Discussion of second study:
The study “comparative study of the efficacy of
curcumin and turmeric oil as chemopreventive agents in oral submucous
fibrosis:a clinical and histopathological evaluation” - a randomized control
study was conducted for a period of a 3
months. Forty eight patients who were clinically and histopathologically
confirmed as being oral submucous fibrosis were randomly selected for the study
and divided into three groups. Group I
was asked to ingest two curcumin capsules twice a day, making a daily dose of
1g. Group II were asked to topically
apply turmeric oil and swallow it twice a day, making a daily dose of
600mg. Group III patients were the
control group and were given multinal tablets twice a day making a daily dose
of 1g. Author concluded that patients in group I and II found a significant
reduction in burning sensation. (5)
Discussion of third study:
The study “Evaluation of efficacy of turmeric in
management of oral submucous fibrosis” is a case control study conducted for a
month. Thirty patients diagonised with oral submucous fibrosis within the age
group of 18 to 50 years were included for the study. The patients were divided based on Lai’s
stages of oral submucous fibrosis.The patients were administered commercially
available turmeric (curcumin 300 gms and piperine 5 mg) orally three times a
day for a month. The authors concluded that there was reduction in the burning
sensation in all the groups but the significance of the burning sensation varied among the groups.(6)
Discussion of fourth study:
The study “Clinical evaluation of the role of tulsi
and turmeric in the management of oral
submucous fibrosis” is a pilot prospective observational study. Forty one oral submucous fibrosis patients in
the age group of 17 to 56 years were asked to apply 1g of tulsi and 1g of
turmeric mixed in glycerine. They
applied the paste four to five times a day.
The patients reported at an interval of one month for three months. The
authors concluded that there was significant decrease in the burning senstation
after the use of the paste.(7)
|
TOPIC
|
Evaluation of efficacy of turmeric in management of
oral submucous fibrosis
|
|
AUTHOR
|
Nitin Agarwal,
Devika Singh, Abhishek Sinha, Sunita Srivastava Ruchika K Prasad, Govind
Singh
|
|
YEAR
|
July – Sep 2014
|
|
NO. OF PATIENTS
|
30
|
|
DURA TION
|
1 Month
|
|
JOURNAL
|
Journal of Indian
Academy of Oral Medicine and Radiology
|
|
STUDY TYPE
|
21-30 years M-20
F-10
|
|
STUDY TYPE
|
Case control
study
|
|
METHOD AND
MATERIALS
|
Patients divided
into 4 groups
GP1 : >35mm
GP2 : 30-35mm
GP3 : 20-30mm
GP4 : <20 mm
All the 4 groups
were given turmix : (curcumin 300mg and piperini)
|
|
RESULTS
|
GP1:82.50%
improvement in burning sensation.
GP2:83.33%
improvement in burning sensation.
GP3:66.70%
improvement in burning sensation.
GP4:71.67%
improvement in burning sensation.
|
|
TOPIC
|
Comparison of curcumin with intralesional steroid
injections in oral submucous fibrosis
|
|
AUTHOR
|
Monu Yadav, K
Aravinda, Vasu S Saxena, K Srinivas, P Ratnakar, Jyothi Gupta, ArtiSaliya
Sachdev, Payash Shivhare
|
|
YEAR
|
Sep – Dec 2014
|
|
NO. OF PATIENTS
|
40
|
|
DURA TION
|
3 Month
|
|
JOURNAL
|
Journal of oral
biology and craniofacial research
|
|
STUDY TYPE
|
20-40 yrs
M – 31
F - 9
|
|
STUDY TYPE
|
Randomized,
open-lable, interventional study
|
|
METHOD AND
MATERIALS
|
Patients were
divided into 2 groups.
GP1 4mg
Dexamethasone and 1500 I.V. Hyaluronidase
GP2 : oral
administration of turmeric tablets (300mg)
|
|
RESULTS
|
GP1 : 15.6%
improvement in burning sensation
GP2 : complete
reduction in burning sensation
|
|
TOPIC
|
Clinical evaluation of role of tulsi and turmeric in
the management of oral submucous fibrosis
|
|
AUTHOR
|
Adit Srivastava,
Rahul Agarwal, T P chaturvedi, Akhilesh Chandra, O P Singh
|
|
YEAR
|
Jan – Mar 2015
|
|
NO. OF PATIENTS
|
41
|
|
DURA TION
|
3 Month
|
|
JOURNAL
|
Journal of
Ayurveda and integrative medicine
|
|
STUDY TYPE
|
17-56 yrs
|
|
STUDY TYPE
|
Pilot,
prospective observational study
|
|
METHOD AND
MATERIALS
|
Patients applied
a paste of tulsi and turmeric mixed with glycerine
|
|
RESULTS
|
Mean burning
sensation-
Before treatment
24-46+_ 4.0
After treatment
27.85+_3.39
|
|
TOPIC
|
Comparative study of the efficacy of curcumin and
turmeric oil as chemopreventive agents in oral submucous fibrosis : A
clinical and histopathalogical evaluation.
|
|
AUTHOR
|
Deepa Das, Anita
Balan, Sreelatha K T
|
|
YEAR
|
April – June 2010
|
|
NO. OF PATIENTS
|
48
|
|
DURA TION
|
3 Month
|
|
JOURNAL
|
Journal of Indian
Academy of oral medicine and radialogy
|
|
STUDY TYPE
|
Any age
|
|
STUDY TYPE
|
Randomized
control study
|
|
METHOD AND
MATERIALS
|
Patients were
divided into three groups
GP1 : curcumin
capsule 1g
GP2 : Turmeric
oil 600mg
GP3 : Multinial
tablets 1g
|
|
RESULTS
|
GP 1 and GP2
showed significant reduction in burning sensation compared to GP3
|
CONCLUSION:
From all the studies, it can be concluded that
turmeric can be used as an alternative in curing oral submucous fibrosis when
all other treatment methodologies seem to be effective only to an extent. However, before implementing the use of
turmeric in clinical practices, researches should be done on a larger sample
size in order to make sure it does not cause any side effects. Moreover only a
handful of papers /research articles are available with regard to the use of
turmeric with oral submucous fibrosis.
Further, more research can be conducted to identify
which form of turmeric, topical/systemic administration can be used to
ameliorate the symptoms of oral submucous fibrosis better.
REFERENCES:
(1) Rangnathan K, Gauri Mishra. An overview of classification schemes
for oral submucous fibrosis. Journal of Oral and Maxillofacial Pathology, 2006
Jul-Dec;10 (2) : 55-58
(2) Rajendran. R, Raju G.K., Nair S.M., Balasubramanan G. Prevelance
of oral submucous fibrosis in high natural radiation belt of Kerala, South
India. Bulletin of the World Health Organization 1992: 70(6): 783-789
(3) Subasree. S, Karthikeyan Murthykumar, Sripradha. S, Niha Naveed “Effect
of Turmeric on Oral Health: An Overview”. Indian Journal of Pharmaceutical
Science And Health Care.2014 Mar-Apr: 4 (2)
(4) Monu Yadav, Aravinda. K, Vasu S. Saxena, Srinivas. K, Ratnakar. P,
Jyothi Gupta, Arti Saluja Sachdev, Peeyush Shivhare 2014 Sep-Dec; (4)169-173
(5) Deepa Das A, Anita Balan, Sreelatha KT. “Comparative Study of The
Efficacy of curcumin And Turmeric Oil As Chemo preventive Agents In Oral
Submucous Fibrosis: A Clinical And Histopathalogical Evaluation”. Journal of Indian
Academy Of Oral Medicine And Radiology, 2010 Apr-Jun; 22 (2) : 88-92
(6) Nitin Agarwal, Devika Singh, Abhishek Sinha, Sunita Srivastava, Ruchika
K Prasad, Govind Singh” Evaluation of Efficacy Of turmeric In Management of Oral
Submucous Fibrosis”. Journal of Indian Academy of Medicine and Radiology 2014
Jul-Sep
(7) Aditi Srivastava, Rahul Agarwal, Chaturvedi T.P., Akhilesh
Chandra, Singh O.P..Journal of Ayurveda and Integrative Medicine 2015 Jan-Mar