Efficacy of curcumin as an adjunct to scaling and root planning in chronic periodontitis patients: A clinical and microbiological study

A study on the impact of gargling with compound Scutellaria baicalensis Georgi on oral health and microflora changes in fixed orthodontic patients: An experimental study

PURPOSE

To investigate the effect of Scutellaria baicalensis Georgi gargle on oral health and changes in oral bacteria among orthodontic patients.

METHODS

About 110 cases of oral fixed orthodontic patients were screened from January 2020 to June 2022 at Taizhou Hospital in Zhejiang Province. They were randomly divided into the experimental group (receiving compound S. baicalensis Georgi gargle once a day) and the control group (receiving 0.9% NS gargle once a day), with 55 cases in each group. Gingival samples were collected from both groups before and 3 months after the orthodontic surgery for bacterial culture, and the differences between the 2 groups of patients in Plaque Index (PLI), gingival bleeding index (sBl), and periodontal depth (PD) before and after the operation were compared. Results: The detection levels of PLI, PD, and sBI in the experimental group were lower than those in the control group (P < .05) 3 months after orthodontic surgery (P < .05); after orthodontic correction for 3 months, there was a significant difference in coccus, bacillus, Campylobacter, Clostridium, Helicobacter, and filamentous bacteria between the experimental group and the control group (P < .05); and Porphyromonas gingivalis, Fusobacterium nucleatum, Bacteroides forsythus (B.f), and Agglomerata actinomycetes in the 2 groups were statistically significant after 3 months of orthodontic treatment (P < .05).

CONCLUSION SUBSECTIONS

In fixed orthodontic treatment, S. baicalensis Georgi gargle can effectively inhibit oral pathogens and maintain periodontal health.

Clinical and microbiologic effect of local application of curcumin as an adjunct to scaling and root planing in periodontitis: Systematic review

BACKGROUND

The main aim of periodontal therapy is to halt the progression of periodontitis. Curcumin, one of the main components of Curcumin longa, has been well known to possess antimicrobial, anti-inflammatory, and even anticarcinogenic properties. This systematic review assessed the impact of local application of curcumin in the pocket on the clinical and microbiologic parameters as an adjunct to scaling and root planing in periodontitis patients.

METHODS

The electronic literature search retrieved 61 studies from PubMed, MEDLINE, and ScienceDirect. After screening titles, abstracts, and keywords and reading through these articles, we identified 9 articles meeting all inclusion criteria, which were included for systematic review.

RESULTS

There was a significant difference in both clinical parameters in a short duration of a month after curcumin chips were placed as an adjunct to scaling and root planing as compared to the control. Local application of curcumin also results in slight to significant reduction in the red complex microorganisms.

CONCLUSION

This review suggested that local application of curcumin can be considered as a viable adjunct to mechanical debridement in periodontitis. However, further studies need to be conducted to establish its optimum dose, delivery method, and frequency in achieving the best clinical outcomes.

Phytotherapy in periodontics as an effective and sustainable supplemental treatment: a narrative review

PURPOSE

Periodontal disease is a chronic condition caused by microbial infection and mediated by the host's immune response. Phytotherapy is a therapeutic approach that utilizes a renewable resource capable of supplying less expensive medicines for the world's growing population. This review aimed to present clinical evidence on the use of complementary medicinal herbs in the treatment of periodontal diseases.

METHODS

Different databases were searched using the terms "herbal" and "periodontitis." All included studies were examined with a focus on herbal indications, type, and prescription length. Dentists' therapeutic and prophylactic herbal prescribing habits were also assessed.

RESULTS

Various herbs such as turmeric, neem, aloe-vera, pomegranate, catechu, tulsi, cloves, lemon grass, green tea, tea tree oil, peppermint, garlic, pineapple, oak bark, babul, bakul, sage, coriander, moringa, amla, guava, and grape seed extract have been used in the treatment of periodontitis. These herbs have been reported to exhibit a range of therapeutic effects, including anti-inflammatory, antiplaque, antihalitosis, antiresorptive, antioxidant, antibacterial, antifungal, antiviral, and antimicrobial properties. These components can be utilized in various forms such as mouth rinse, gel, oil, toothpaste, aqueous extract, mouthwash, or tooth powder.

CONCLUSIONS

Several readily available herbal formulations are now available on the market and have been shown to be effective as supplemental periodontal phytotherapy. However, these should be used under the supervision of a dental professional to ensure optimal benefits and effectiveness. Therefore, it is necessary to improve the understanding of suggested herbal prescription practices among dental professionals.

Fabrication and Characterization of Electrospun Ocimum sanctum and Curcumin-Loaded Nanofiber Membrane for the Management of Periodontal Disease: An In Vitro Study

Background Periodontal disease is a chronic inflammatory condition that gradually deteriorates the supportive tissues of teeth, eventually leading to tooth loss. Mechanical debridement stands as the gold standard method for treating periodontitis. However, antimicrobial therapy is recommended for optimal results when used alongside mechanical debridement. Numerous studies have investigated local drug delivery as an adjunct to mechanical debridement of affected tooth surfaces. Ocimum sanctum exhibits anti-inflammatory, antioxidant, and antimicrobial properties. Similarly, curcumin, as documented in the literature, demonstrates a broad spectrum of anti-inflammatory and antimicrobial effects. Electrospinning has demonstrated itself to be a highly effective method for fabricating drug-loaded fibers. Electrospun nanofibers containing Ocimum sanctum and curcumin are expected to exhibit greater efficacy due to their increased surface area, facilitating the dispersion of larger quantities of drugs, and their ability to control drug release when employed as a local drug delivery system. This study aims to fabricate and characterize the properties of nanofiber membranes loaded with Ocimum sanctum and curcumin using the electrospinning technique. Methods About 50 mg each of Ocimum sanctum and curcumin were blended with 15% polyvinyl alcohol and 2% chitosan polymer in a 4:1 ratio and left to stir overnight. A 10 mL syringe was filled with this solution, and an 18 G blunt-end needle charged at 15.9 kV was used for extrusion. Continuous fibers were collected onto a collector plate positioned 12 cm from the center of the needle tip, at a flow rate of 0.005 mL/min. The morphology of the fabricated membrane was assessed through scanning electron microscopy (SEM), the strength of the material was assessed through tensile strength analysis using INSTRON, an Electropuls E3000 Universal Testing Machine (INSTRON, Norwood, MA), and the drug release pattern was analyzed using Jasco V-730 UV-visible spectrophotometer (Jasco, Easton, MD). Results The morphology of this nanofiber showed a random distribution of fibers with no bead formation. The average diameter of the membrane was 383±102 nm, and the tensile strength of this material was 1.87 MPa. The drug release pattern showed an initial burst release of Ocimum sanctum, followed by a controlled release in subsequent hours. However, curcumin showed very little drug release because of its solubility. Conclusion In summary, the Ocimum sanctum and curcumin-loaded nanofibers exhibited robust tensile strength, a controlled drug release profile, and uniform drug distribution within the nanofiber membrane. Consequently, it can be concluded that curcumin nanofibers and electrospun Ocimum sanctum serve as valuable agents for local drug delivery in the treatment of periodontitis.

Herbal and nano-based herbal medicine: New insights into their therapeutic aspects against periodontitis

Objective

Periodontitis is a type of prevalent chronic inflammatory disorder resulting in a failure in the function of tissues supporting the tooth, like gingiva, alveolar bone, and periodontal ligament. Although antibiotic therapy is a common therapy for periodontitis cases, this approach can cause some adverse effects in these patients. Thus, finding an effective curative option with low side effects is still a puzzle.

Materials and Methods

This narrative review was conducted on the effects of herbal and nano-based herbal medicine against periodontitis by searching different databases such as Google Scholar, PubMed, Scopus, Web of Science, Science Direct, and Scientific Information Databases.

Results

According to published studies, some popular herbal formulations, such as Aloe vera, curcumin, Melaleuca alternifolia, and Scutellaria baicalensis Georgi, can be effective in periodontitis treatment. However, these herbal products may be accompanied by some pharmacological limitations, such as poor bioavailability, instability, and weak water solubility. On the other hand, harnessing nano-based herbal formulations can elevate the bioavailability, diminish toxicity, and omit repeated administration of drugs.

Conclusion

Herbal and nano-based herbal products can create a good chance to treat periodontitis efficiently.

Addressing Antimicrobial Properties in Guided Tissue/Bone Regeneration Membrane: Enhancing Effectiveness in Periodontitis Treatment

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are the two surgical techniques generally used for periodontitis disease treatment. These techniques are based on a barrier membrane to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics, or prosthetic restoration. Numerous studies have highlighted biocompatibility, space-creation, cell-blocking, bioactivity, and proper handling as essential characteristics of a membrane's performance. Given that bacterial infection is the primary cause of periodontitis, we strongly believe that addressing the antimicrobial properties of these membranes is of utmost importance. Indeed, the absence of effective inhibition of periodontal pathogens has been recognized as a primary factor contributing to the failure of GTR/GBR membranes. Therefore, we suggest considering antimicrobial properties as one of the key factors in the design of GTR/GBR membranes. Antibiotics are potent medications frequently administered systemically to combat microbes and mitigate bacterial infections. Nevertheless, the excessive use of antibiotics has resulted in a surge in bacterial resistance. To overcome this challenge, alternative antibacterial substances have been developed. In this review, we explore the utilization of alternative substances with antimicrobial properties for topical application in membranes. The use of antibacterial nanoparticles, phytochemical compounds, and antimicrobial peptides in this context was investigated. By carefully selecting and integrating antimicrobial agents into GTR/GBR membranes, we can significantly enhance their effectiveness in combating periodontitis. These antibacterial substances not only act as barriers against pathogenic bacteria but also promote the process of periodontal healing.

Susceptibility of periodontal pathogens to a novel target-specific drug delivery system containing self-nanoemulsifying curcumin: An in vitro study

Background

Long-term use of many classic chemotherapeutic agents as adjuncts in the management of periodontitis has adverse complications, leading to seeking out naturopathic remedies. Although curcumin has been investigated in managing periodontitis, its therapeutic benefits have not been fully explored due to its limited solubility in an aqueous medium. This study aimed to develop a novel target-specific drug delivery system containing 1% self-nanoemulsifying curcumin (SNEC) in a hydroxypropylmethylcellulose (HPMC) matrix and evaluate the susceptibility of periodontal pathogens to this system in vitro.

Methods

Its antibacterial activity against Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans was evaluated and compared to pure nano-curcumin and SNEC alone by estimating their minimum inhibitory concentrations (MIC).

Results

The antibacterial activity of pure nano-curcumin, SNEC, and SNEC in HPMC against the four periodontal pathogens evaluated in terms of MIC was recorded in the range of 0.2‒0.4, 0.4‒0.8, and 0.2‒0.8 µg/mL, respectively. However, the MIC of all three curcumin formulations against the periodontal pathogens tested was higher than that of the standard moxifloxacin. While both pure nano-curcumin and SNEC showed increasing values of inhibition zones with increasing concentrations on disk diffusion assay, lower concentrations of SNEC in HPMC did not show a zone of inhibition against the tested pathogens.

Conclusion

The novel delivery system containing SNEC in HPMC may be a potential adjunct in managing periodontitis due to its probable sustained antimicrobial activity against the tested periodontal pathogens.

Efficacy of curcumin gel as an adjunct to scaling and root planing on salivary procalcitonin level in the treatment of patients with chronic periodontitis: a randomized controlled clinical trial

THE AIM OF THE STUDY

To evaluate the effect of curcumin gel combined with scaling and root planing (SRP) on salivary procalcitonin in periodontitis treatment.

MATERIALS AND METHODS

seventy patients were selected from the Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, and sixteen patients were excluded. Patients in groups II and III included stage II grade A periodontitis. The participants were classified into three groups: group I as a negative control group (individuals with healthy gingiva), group II (SRP) were treated with SRP, and group III (curcumin gel) which was applied weekly for four weeks after SRP. Clinical indices (plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD)) and saliva samples for procalcitonin (PCT) assessment using an enzyme-linked immunosorbent assay (ELISA) test were collected and measured at both baselines and after six weeks.

RESULTS

This randomized controlled clinical trial registered on ClinicalTrials.gov (NCT05667376) and first posted at 28/12/2022 included Fifty-four patients (20 male; 34 female). Regarding the age and sex distribution, there was no statistically significant difference between the three studied groups (p > 0.05). There was no significant statistical difference regarding PI, GI, PPD, and CAL between group II and group III at baseline p (> 0.05). However, there was a significant statistical difference regarding the clinical parameters at baseline of both group II and group III as compared to group I (p ≤ 0.05). At six weeks after treatment, group III showed greater improvement in the PI, PD, and CAL as opposed to group II (p ≤ 0.05). Regarding PCT values, at baseline, there wasn't a statistically significant difference between group II and group III (p > 0.05). However, there was a significant statistical difference between group II, group III, and group I (p ≤ 0.05). At six weeks after treatment, there was a statistically significant decrease in PCT levels of both group II and III (p ≤ 0.05).

CONCLUSION

The application of curcumin gel was found to have a significant effect on all clinical indices as opposed to SRP.

Efficacy of topical curcuma longa in the healing of extraction sockets: A split-mouth clinical trial

Background

The healing process after dental extraction is influenced by various factors, and finding effective strategies for promoting wound healing and reducing postoperative discomfort remains a challenge. This study aimed to evaluate the effectiveness of topical Curcuma longa gel in reducing pain and promoting wound healing after dental extraction, with the secondary objective of assessing the occurrence of dry sockets. The study was a split-mouth randomized controlled trial conducted at the oral and maxillofacial surgery department over 3 months.

Materials and Methods

This split-mouth randomized controlled trial consisted of a total of 21 patients undergoing bilateral extractions. One extraction socket was randomly assigned to the test group, where Curcuma. longa gel was applied, while the contralateral socket served as the control group, receiving a placebo. Pain and wound healing were evaluated using standardized scales on the 3rd and 7th days postextraction. Descriptive statistics, paired t-tests, and unpaired t-tests were performed using the SPSS software version 19. The statistical significance was fixed at P ≤ 0.05.

Results

The test group showed significantly higher mean healing scores on the 3rd and 7th days compared to the control group. On the 7th day, the test group had significantly lower mean pain scores than the control group. No cases of dry sockets were observed in either group.

Conclusion

Topical Curcuma longa gel demonstrated positive effects in promoting wound healing and reducing pain after dental extraction. Clinicians should consider the use of Curcuma longa gel as a post-extraction medicament, particularly in cases involving multiple or traumatic extractions.

Brief literature review and comprehensive bioinformatics analytics unravel the potential mechanism of curcumin in the treatment of periodontitis

OBJECTIVE

Periodontitis is a chronic oral disease prevalent worldwide, and natural products are recommended as adjunctive therapy due to their minor side effects. Curcumin, a widely used ancient compound, has been reported to possess therapeutic effects in periodontitis. However, the exact mechanism underlying its activity remains unclear. In this context, the present study aimed to conduct computational simulations to uncover the potential mechanism of action of Curcumin in the treatment of periodontitis.

MATERIALS AND METHODS

Single-cell analysis was conducted using a dataset (i.e., GSE164241) curated from the Gene Expression Omnibus (GEO) database through an R package "Seurat package." Bulk RNA sequencing data were curated from GSE10334 and GSE16134 and processed by R package "Limma." Then, the marker genes in the single-cell transcriptome and differentially expressed genes (DEGs) in the bulk transcriptome were integrated. Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) analyses were also carried out to reveal their functionalities. Key targets were mined from their protein-protein interaction (PPI) network topologically. Afterward, molecular docking was performed. The top-ranked pose was subjected to molecular dynamics simulations to investigate the stability of the docking result.

RESULTS

FOS, CXCL1, CXCL8, and IL1B, were filtered after a series of selected processes. The results of molecular modeling suggested that except for IL1B, the Vena Scores of the rest exceeded -5 kcal/mol. Furthermore, the molecular dynamic simulation indicated that the binding of the CXCL8-Curcumin complex was stable over the entire 100 ns simulation.

CONCLUSION

The present study unlocked the binding modes of CXCL1, FOS, and CXCL8 with the Curcumin molecule, which were relatively stable, especially for CXCL8, hindering its promising potential to serve as the critical targets of Curcumin in periodontitis treatment.

Green Alternatives as Antimicrobial Agents in Mitigating Periodontal Diseases: A Narrative Review

Periodontal diseases and dental caries are the most common infectious oral diseases impacting oral health globally. Oral cavity health is crucial for enhancing life quality since it serves as the entranceway to general health. The oral microbiome and oral infectious diseases are strongly correlated. Gram-negative anaerobic bacteria have been associated with periodontal diseases. Due to the shortcomings of several antimicrobial medications frequently applied in dentistry, the lack of resources in developing countries, the prevalence of oral inflammatory conditions, and the rise in bacterial antibiotic resistance, there is a need for reliable, efficient, and affordable alternative solutions for the prevention and treatment of periodontal diseases. Several accessible chemical agents can alter the oral microbiota, although these substances also have unfavorable symptoms such as vomiting, diarrhea, and tooth discoloration. Natural phytochemicals generated from plants that have historically been used as medicines are categorized as prospective alternatives due to the ongoing quest for substitute products. This review concentrated on phytochemicals or herbal extracts that impact periodontal diseases by decreasing the formation of dental biofilms and plaques, preventing the proliferation of oral pathogens, and inhibiting bacterial adhesion to surfaces. Investigations examining the effectiveness and safety of plant-based medicines have also been presented, including those conducted over the past decade.

Evaluation of healing in mandibular molar extraction sockets with and without turmeric gel

Context

In the present era of allopathic medication usage, there is always a risk of toxicity. Turmeric is a wonderful natural herb with excellent healing properties and a plethora of many clinical trials in dentistry. Hence, this study aims to evaluate the efficacy of healing in mandibular molar extraction sockets with and without turmeric gel.

Aim

This study aimed to evaluate the efficacy of turmeric gel with the objective of analyzing the soft tissue healing in mandibular molar extraction sockets with and without turmeric gel.

Settings and Design

The split-mouth study design with randomization of the sites was done using the sequentially numbered opaque sealed envelope (SNOSE) in the same patient indicated for bilateral lower molar extraction. A total of 50 patients were included in the study, who were divided into group A, 25 patients in the experimental site using turmeric gel, and group B, 25 patients in the control site without turmeric gel.

Materials and Methods

Turmeric in the form of gel was used in the experimental site to evaluate its efficacy in soft tissue healing of the mandibular molar extraction socket. The extraction sites of the same patient were evaluated for soft tissue healing on postoperative day 1, day 7, and day 21 using Landry, Turn Bell, and Howley scale.

Statistical Analysis

A comparison of soft tissue healing between group A and group B, which showed a consequential difference in group A on day 7 with P = 0.001 and day 21 with P = 0.001, was significant.

Results

Results revealed postoperative day 1 showed a significant beginning of healthy granulation tissue formation in both the groups. There was a consequential difference in soft tissue healing in group A on postoperative day 7 and day 21 as compared to group B. The turmeric in the form of gel proved to enhance the soft tissue healing in the mandibular molar extraction socket.

Conclusions

The present study revealed that enhanced soft tissue healing of the extraction socket of the mandibular molar was present in the turmeric gel group on postoperative day 7 and day 21 than in without the turmeric gel group.

A Systematic Review and Meta-Analysis on the Efficacy of Locally Delivered Adjunctive Curcumin (Curcuma longa L.) in the Treatment of Periodontitis

This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; p = 0.03; 95% CI -0.54 to -0.11; I² = 62.3%), and for PPD (-0.47 mm; p = 0.024; 95% CI -0.88 to -0.06; I² = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.

Clinical Effectiveness of Herbal Oral Care Products in Periodontitis Patients: A Systematic Review

BACKGROUND

The use of herbal products in oral cavity has shown an increased popularity and potential benefits due to their additional anti-inflammatory and antioxidant properties as well as the lack of side effects related to their use.

OBJECTIVE

To assess the clinical effectiveness of herbal dental products (mouthwash, dentifrice, gel) when compared to conventional products or placebo in periodontitis patients.

MATERIAL AND METHODS

A systematic review with 22 studies was carried out using MEDLINE/Pubmed, EMBASE and Web of Science databases in addition to hand searches. Randomized and non-randomized clinical trials that evaluated the effect of any herbal dental product and compared it with conventional products or placebo in periodontitis patients and published up to March 2022, were screened.

RESULTS

Herbal products used as adjuncts to scaling and root planing (SRP) or supragingival debridement (SPD) led to superior clinical outcomes than placebo or no adjuncts (8 studies). In conjunction with SRP, these products showed comparable outcomes with chlorhexidine (6 studies) or better (4 studies). When used as adjuncts to SPD, herbal oral care products demonstrated comparable outcomes with chlorhexidine and conventional products (4 studies).

CONCLUSIONS

Within the limitations of this systematic review, herbal oral care products may play a key role in the management of periodontal disease. Further well-designed studies are needed to establish their efficacy.

Curcumin as a Natural Approach of Periodontal Adjunctive Treatment and Its Immunological Implications: A Narrative Review

Scaling and root planing represent the gold standard in the treatment of periodontal disease, but these therapeutic methods cannot eliminate the remaining periodontopathogenic bacteria in cement, tubules, and periodontal soft tissue. Thus, a number of additional therapeutic means have been adopted, including local and systemic antibiotic therapy, as well as the use of photodynamic therapy techniques. Recently, special attention has been paid to potential phytotherapeutic means in the treatment of periodontal disease. In this review, we aim to present the effects generated by the extract of Curcuma longa, the various forms of application of turmeric as an additional therapeutic means, as well as the aspects related to its biotolerance.

Curcumin as a Natural Approach of Periodontal Adjunctive Treatment and Its Immunological Implications: A Narrative Review

Scaling and root planing represent the gold standard in the treatment of periodontal disease, but these therapeutic methods cannot eliminate the remaining periodontopathogenic bacteria in cement, tubules, and periodontal soft tissue. Thus, a number of additional therapeutic means have been adopted, including local and systemic antibiotic therapy, as well as the use of photodynamic therapy techniques. Recently, special attention has been paid to potential phytotherapeutic means in the treatment of periodontal disease. In this review, we aim to present the effects generated by the extract of Curcuma longa, the various forms of application of turmeric as an additional therapeutic means, as well as the aspects related to its biotolerance.

The Effects of Nutraceuticals and Bioactive Natural Compounds on Chronic Periodontitis: A Clinical Review

The paper aims to review the current clinical evidence of various herbal agents as an adjunct treatment in the management of chronic periodontitis patients. Gingivitis and periodontitis are two common infectious inflammatory diseases of the supporting tissues of the teeth and have a multifactorial etiology. An important concern about chronic periodontitis is its association with certain systemic disease. New treatment strategies for controlling the adverse effects of chronic periodontitis have been extensively assessed and practiced in sub-clinical and clinical studies. It has been shown that the phytochemical agents have various therapeutic properties such as anti-inflammatory and antibacterial effects which can be beneficial for the treatment of periodontitis. The findings of this review support the adjunctive use of herbal agents in the management of chronic periodontitis. Heterogeneity and limited data may reduce the impact of these conclusions. Future long-term randomized controlled trials evaluating the clinical efficacy of adjunctive herbal therapy to scaling and root planing are needed.

The effect of curcumin as an adjunct in the treatment of chronic periodontitis: A systematic review and meta-analysis

Background

A large number of trials has been conducted using curcumin as the main ingredient in mouth rinses, topical oral gel, subgingival irrigant, locally delivered gel and locally delivered chips to reduce gingival inflammation and probing pocket depth. However, the results of these trials vary and are debatable.

Objective

To evaluate the effectiveness of oral curcumin products as compared to the routinely used ones in reducing gingival inflammation and probing pocket depth in adults.

Methods

Electronic databases such as Pubmed/Medline and Cochrane Library and hand searching was done for randomised controlled trials (RCTs), which yielded 148 results, of which 27 RCTs compared curcumin products with routinely used ones. Meta-analysis was conducted to check for plaque reduction, gingival inflammation and pocket depth.

Results

963 participants in the 27 RCT studies were considered for a systematic review. We found that for a long-term evaluation of probing pocket depth in nine studies each with 400 participants, there was a statistically significant difference in the reduction when curcumin topical gel was used as compared with the control [SMD −0.87, 95% CI: −1.31 to −0.43]. However, in the evaluation of short-term plaque and gingival scores, we found no statistically significant differences in the reduction when curcumin mouth rinse was used [SMD −0.76, 95% CI: −2.25 to 0.73] and [MD: −0.09, 95% CI: −0.29 to 0.10].

Conclusion

Curcumin topical and local delivery gel, mouth rinses and sub-gingival irrigants were found to be equally effective compared to the routinely used agents for reduction of plaque and gingival inflammation. Curcumin local delivery gel had greater reduction in probing pocket depth.

Effects of Curcuma as an adjunct therapy on periodontal disease: A systematic review and meta-analysis

BACKGROUND

Periodontal disease (PD) is the second most prevalent buccal infectious condition in adults. Owing to its multifactorial etiology, treatment and maintenance are challenging. Scaling and root planing, associated with adequate plaque control, are considered the gold standard treatments for this disease. However, the instrumentation techniques can fail to completely eliminate calculus, particularly in higher grade and progression rated PD cases, and the continuing efficient removal of the biofilm by the patient can limit the long-term response of this treatment. Anti-infective herbal products, such as Curcuma, have been added as adjuvant therapy to prolong periodontal treatment outcomes.

OBJECTIVE

This systematic review aimed to summarize and evaluate whether Curcuma can contribute to PD treatment when applied as an adjunct to the standard scaling and root planing therapy.

DATA SOURCES

We searched databases using specific keywords and Boolean operators and systematically conducted the extraction and analysis according to the PROSPERO (CRD42019145691) database. The main eligibility criteria were randomized clinical trials in humans published in the English language.

RESULTS

Twelve studies were included in the review and 11 in the meta-analysis. Quantitative analysis of different clinical parameters was described. In comparison with the control group, Curcuma was associated with a reduction in pocket depth after 90 days of treatment (mean deviation: 0.48; 95% confidence interval: 0.89-0.08).

CONCLUSION

This systematic review and meta-analysis indicated that Curcuma is an effective product when applied as adjunct therapy for PD treatment. This improved the clinical and microbiological parameters.

A review of therapeutic potentials of turmeric (Curcuma longa) and its active constituent, curcumin, on inflammatory disorders, pain, and their related patents

Turmeric (Curcuma longa) and its constituent, curcumin, have been used for their therapeutic properties for a long time. Most of the medicinal impacts of turmeric and curcumin might be attributed to their anti-inflammatory, antinociceptive, and antioxidant effects. In the present review, the preventive and therapeutic potentials of turmeric and its active constituent, curcumin, on inflammatory disorders and pain as well as patents related to their analgesic and anti-inflammatory effects, have been summarized to highlight their value on human health. A literature review was accomplished in Google Scholar, PubMed, Scopus, Google Patent, Patentscope, and US Patent. Several documents and patents disclosed the significance of turmeric and curcumin to apply in several therapeutic, medicinal, and pharmaceutical fields. These phytocompounds could be applied as a supplementary therapy in phytotherapy, inflammatory disorders such as arthritis, inflammatory bowel diseases, osteoarthritis, psoriasis, dermatitis, and different types of pain including neuropathic pain. However, because of inadequate clinical trials, further high-quality studies are needed to firmly establish the clinical efficacy of the plant. Consistent with the human tendency to the usage of phytocompounds rather than synthetic drugs, particular consideration must be dedicated to bond the worth of turmeric and curcumin from basic sciences to clinical applications.

Clinical efficacy of curcumin versus chlorhexidine as an adjunct to scaling and root planing for the treatment of periodontitis: A systematic review and meta-analysis

This study aims to evaluate the clinical efficacy of curcumin versus chlorhexidine as adjuncts to scaling and root planing (SRP) for periodontitis treatment. We searched PubMed, EMbase, Cochrane Library, and ClinicalTrials.gov from inception to February 18, 2021 and identified studies with relevant randomized controlled trials (RCTs) using curcumin or chlorhexidine as an adjunct to SRP. Nine RCTs involving 420 patients/sites were included. A meta-analysis with a random-effects model revealed that curcumin and chlorhexidine, as an adjunct to SRP, reduced probing pocket depth (PPD) at similar levels during a 3-, 4-, 6-, and 12-week follow-up. No significant differences were observed in reducing clinical attachment loss (CAL) between curcumin and chlorhexidine as an adjunct to SRP at 4 weeks and 6 weeks. Furthermore, gingival index (GI) and plaque index (PI) were similar using curcumin versus chlorhexidine as an adjunct to SRP at the 4-week-, 6-week-, and 12-week follow-up. Based on the available evidence in RCTs, compared with chlorhexidine as an adjunct to SRP, curcumin has a similar effect on reducing PPD, CAL, GI, and PI. The quality of evidence is low, limited by the number of studies and their limitations. Further studies are needed to firmly establish the clinical efficacy of curcumin.

From Simple Mouth Cavities to Complex Oral Mucosal Disorders-Curcuminoids as a Promising Therapeutic Approach

Oral diseases are among the most common encountered health issues worldwide, which are usually associated with anomalies of the oral cavity, jaws, and salivary glands. Despite the availability of numerous treatment modalities for oral disorders, a limited clinical response has been observed because of the inefficacy of the drugs and countless adverse side effects. Therefore, the development of safe, efficacious, and wide-spectrum therapeutics is imperative in the battle against oral diseases. Curcumin, extracted from the golden spice turmeric, is a well-known natural polyphenol that has been extensively studied for its broad pleiotropic attributes and its ability to modulate multiple biological processes. It is well-documented to target pro-inflammatory mediators like NF-κB, ROS, COX-2, IL-1, IL-2, TGF-β, growth factors, apoptotic proteins, receptors, and various kinases. These properties make curcumin a promising nutraceutical in the treatment of many oral diseases like oral submucous fibrosis, oral mucositis, oral leukoplakia, oral erythroplakia, oral candidiasis, aphthous stomatitis, oral lichen planus, dental caries, periodontitis, and gingivitis. Numerous in vitro and in vivo studies have shown that curcumin alleviates the symptoms of most of the oral complications, including the inhibition of the progression of oral cancer. In this regard, many clinical trials have been completed, and many are ongoing to investigate the "curcumin effect" in oral maladies. Therefore, the current review delineates the mechanistic framework of curcumin's propensity in curbing oral diseases and present outcomes of the clinical trials of curcumin-based therapeutics that can provide a breakthrough in the clinical management of these diseases.

Evaluation of Anti-plaque and Anti-inflammatory Effects of Oral Curcumin Gel as Adjunct to Scaling and Root Planing: A Clinical Study

Context:

The adverse effects associated with traditional adjunctive chemical agents in the management of gingivitis has stimulated research into search for alternate molecules including herbal products. Aims-To compare the effects of oral curcumin gel as an adjunct to scaling and root planing (SRP) with the effects achieved by SRP alone by assessing their effects on plaque, gingival inflammation and gingival bleeding.

Materials and Methods:

Sixty patients in the age group of 20–60 years were recruited employing inclusion and exclusion criteria. Study population was randomly divided into two groups. Group A-test group was instructed to use twice daily the experimental curcumin gel after initial SRP. Group B-control group received only SRP. Parameters recorded were plaque index (PI), gingival index (GI) and sulcus bleeding index (SBI) on day 0 (baseline), days 7, 14, and 21 along with subjective assessment of any reported untoward side effect. Data was analyzed statistically.

Results:

The PI, GI and SBI decreased in both the test group and control group from day 0 to day 21 consecutively. Intergroup comparison shows that all the parameters were statistically significant in Group A (P < 0.001) as compared to Group B.

Conclusion:

Curcumin gel has significant antiplaque and anti-inflammatory effect in the treatment of gingivitis and can be effectively employed as an adjunct to SRP.

Adjuvant effects of curcumin as a photoantimicrobial or irrigant in the non-surgical treatment of periodontitis: Systematic review and meta-analysis

AIM

Curcumin (CUR) has been used clinically in several studies as a subgingival irrigant or as a photoantimicrobial in combination with a blue light-emitting diode (LED) in antimicrobial photodynamic therapy (aPDT) adjuvant to scaling and root planing (SRP). The aim of this study was to assess the effectiveness of CUR as an irrigant or as a photoantimicrobial in conjunction with the blue LED in aPDT adjuvant to SRP, compared to SRP as conventional mechanical treatment.

MATERIALS AND METHODS

Fifteen randomized controlled trials (RCT) were included in a qualitative analysis after researching the databases: PubMed / MEDLINE, SCOPUS, EMBASE, Cochrane Central, Web of Science and Scielo. Manual searches were also performed. Five studies were submitted to quantitative analysis, evaluating periodontal clinical parameters such as probing depth (PD) and clinical attachment level (CAL).

RESULTS

The obtained results have shown clinical benefits in PD reduction and CAL gains at 3 months with the use of CUR as adjuvant therapy to SRP, both as an irrigant or photoantimicrobial, in comparison with SRP monotherapy.

CONCLUSION

Currently, there is evidence that treatment with CUR applied as irrigant or in conjunction with the blue LED as aPDT presents superior clinical results in the short term, for clinical periodontics parameters like as PD reduction and CAL gain, when compared to SRP monotherapy in the non-surgical treatment of periodontitis. However, these results cannot be proven in the long term.

Local delivery natural products to treat periodontitis: a systematic review and meta-analysis

OBJECTIVES

This study aimed to answer the PICO question: in adults with periodontitis, does subgingival delivery of natural products (NP) after scaling and root planing (SRP) results in a better reduction of probing pocket depth (PPD) when compared with SRP alone or SRP plus placebo?

MATERIAL AND METHODS

A search for trials was carried out in eight databases. Two independent investigators performed all steps of this review. PPD reduction, clinical attachment level (CAL) gain, gingival inflammation, and biofilm accumulation reduction were investigated. We conducted meta-analyses where data could be pooled.

RESULTS

Searches yielded 4771 records, in which 27 trials fulfilled the eligibility. There was a large heterogeneity among trials (I² > 0.69, χ² < 0.000). Only four studies were at low risk of bias. The evidence quality was very low. The effectiveness of NP was demonstrated in a follow-up of 3-6 months considering PPD reduction (8 trials: 0.72 mm [95%CI: 0.23, 1.22]) and CAL gain (5 trials: 1.07 mm [95%CI: 0.36, 1.78]). A significant reduction in periodontal inflammation favors the use of NP. The biofilm accumulation reduction effect of NP was very weak or non-significant.

CONCLUSION

Although the high risk of bias and large heterogeneity of trials impose some restrictions on the validity of effect estimate, this review indicates that adjunctive NP better reduced the PPD when compared to SRP alone or SRP plus placebo in a follow-up of 3-6 months.

CLINICAL RELEVANCE

The evidence of non-responsive patients to conventional periodontal therapy highlights the need for therapeutic alternatives to treat periodontitis.

Antibacterial Activity of Curcumin Against Periodontal Pathogens: A Systematic Review

Periodontitis is a chronic inflammatory disease characterized by destruction of the supporting structures of teeth caused by development of dental plaques and accumulation of microorganism around the gingival tissue. Curcumin has been shown to improve clinical parameters in periodontal diseases. However, the efficacy of curcumin in the elimination of periodontal pathogens is not clearly defined. The purpose of this study was to carry out a systematic review of the antibacterial activity of curcumin against periodontal pathogens. An electronic literature search in Medline, Scopus, Science Direct, Web of Science, Cochrane library, and Google scholar was performed up to February 29, 2020, to identify studies assessing the antibacterial activity of curcumin against periodontal pathogens. From 1238 publications, three clinical trials and five in vitro studies met the eligibility criteria. All three clinical studies reported improvement in restoring gingival health in clinical and microbiological parameters, following adjunctive use of curcumin for treatment of periodontitis. All five in vitro studies showed that curcumin could inhibit the growth of bacterial strains. Three of the five in vitro studies evaluated the effect of curcumin on mixed biofilm of periopathogens, which showed a significant inhibitory effect of curcumin on periodontal biofilms. This systematic review found that curcumin has antibacterial activity against periopathogens. The anti-biofilm activity of curcumin is reported as one of the mechanisms for this phenomenon. Curcumin could improve the clinical parameters of periodontal tissue not only by inhibition of the pathogens but also by modulating the host response.

Efficacy and Safety of Tetrahydrocurcuminoids for the Treatment of Canker Sore and Gingivitis

Background

Tetrahydrocurcuminoids (THCs) are among the major metabolites of curcuminoids with a higher bioavailability and physiological stability and exhibit a broad spectrum of therapeutic activities. The objective of this study was to evaluate the efficacy of THCs in patients suffering from canker sore and gingivitis designed as an exploratory clinical trial.

Methods

This is an open label prospective pilot clinical trial carried out at two clinical centers: Noble Hospital, Pune, Maharashtra, and Sri Venkateshwara Hospital, Bangalore, Karnataka in India. Participants were assigned to 21 days of treatment with chewable oral THCs supplement. Patients were instructed to self-administer one chewable tablet containing 100 mg of THCs twice daily for up to 21 days. This clinical trial was registered at a public Clinical Trial Registry in India (http://www.ctri.nic.in). Thirty-one canker sore and twenty-nine gingivitis patients participated in this study. Body mass index, throat numbness/relief, Visual Analog Scale (VAS) pain score, canker sore lesions, gingival appearance, inflammation and bleeding were assessed before and after treatment, at 14 and 21 days. Vital signs and laboratory parameters were assessed for safety.

Results

THCs treatment significantly reduced the reddening at the site, difficulty in chewing, swallowing, and VAS pain score in the canker sore patients. Further, both single and multiple lesions were completely healed. In gingivitis patients, gingival appearance, bleeding, and inflammation were significantly reduced. No adverse effects were observed during the study.

Conclusion

Overall, the findings of this study show that supplementation of THCs for 21 days reduced the pain and prevented the progression of the disease in patients suffering from canker sore and gingivitis without adverse side effects.

Comparison of Effects of Curcumin and Nano-curcumin on the Survival of Human-Derived Mesenchymal Stem Cells: An Experimental Study

Aim:

To evaluate and compare the effect of curcumin (CUR) and Nano-curcumin (N-CUR) on human-derived mesenchymal stem cells (MSCs) in a dose-dependent manner.

Materials and Methods:

An experimental study performed with putative MSCs from a total of five systemically healthy subjects with chronic periodontitis. These putative MSCs were isolated by cell culture and were further characterized and identified by colony-forming unit assay and immunocytochemical analysis using cell surface markers CD105, CD146, CD45 and CD73. The identified MSCs were treated with different doses of CUR and N-CUR, and compared with α-minimum essential medium (α -MEM) for its cell viability by performing MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay for 48 and 72 hr. The statistically analysis was performed using one-way analysis of variance (ANOVA) followed by Tukey’s post hoc test and Bonferroni’s post hoc test.

Results:

Compared to the α-MEM group, both CUR and N-CUR treated cells have shown significantly ( P = .029) higher survival rate at lower concentration (0.1 and 0.5 µM/L), at 48 hr incubation. However, there was no statistically significant difference between the CUR and N-CUR groups on cell survival rate at both 48 and 72 hr incubation. When compared between the concentrations of the same group, significantly higher cell viability ( P = .001) was observed at lower concentrations (0.1, 0.5 µM/L) in both test groups after incubation for 48 and 72 hr.

Conclusion:

Both CUR and N-CUR have a dose-dependent effect on human derived MSCs survival when incubated for 48 hr, whereas N-CUR shows increased cell survival rate even at 72 hr of incubation. Although, the cautious use of CUR and N-CUR at higher concentrations is recommended.

Local application of curcumin-loaded nanoparticles as an adjunct to scaling and root planing in periodontitis: Randomized, placebo-controlled, double-blind split-mouth clinical trial

OBJECTIVE

Assess a single local application of curcumin-loaded nanoparticles as an adjunct to scaling and root planing (SRP) in nonsurgical periodontal treatment (NPT).

MATERIALS AND METHODS

Twenty healthy subjects with periodontitis received SRP+PLGA/PLA nanoparticles loaded with 50 μg of curcumin (N-Curc) or SRP+empty nanoparticles. Probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were monitored at baseline, 30, 90, and 180 days. IL-1α, IL-6, TNFα, and IL-10 in the gingival crevicular fluid (GCF) were assessed by ELISA, and counts of 40 bacterial species were determined by DNA hybridization at baseline, 3, 7, and 15 days post-therapy.

RESULTS

PPD, CAL, and BOP were similarly and significantly improved in both experimental groups. There was no difference in GCF cytokine levels between experimental groups, although IL-6 was decreased at 3 days only in the N-Curc group. NPT reduced counts of red complex bacterial species in both groups. Veillonella Parvula counts increased significantly only in N-Curc group at 7 days, whereas Aggregatibacter actinomycetemcomitans counts increased significantly only in the control group from day 3 to day 15.

CONCLUSION

We conclude that a single local administration of nanoencapsulated curcumin in periodontally diseased sites had no additive benefits to NPT.

CLINICAL RELEVANCE

Our results showed that a single local application of curcumin-loaded nanoparticles associated with nonsurgical periodontal therapy did not improve clinical outcomes. Hence, our findings do not support the use of curcumin as an adjunct to nonsurgical periodontal therapy.

Vitamin D3 and Dental Mesenchymal Stromal Cells

Vitamin D3 is a hormone involved in the regulation of bone metabolism, mineral homeostasis, and immune response. Almost all dental tissues contain resident mesenchymal stromal cells (MSCs), which are largely similar to bone marrow-derived MSCs. In this narrative review, we summarized the current findings concerning the physiological effects of vitamin D3 on dental MSCs. The existing literature suggests that dental MSCs possess the ability to convert vitamin D3 into 25(OH)D3 and subsequently to the biologically active 1,25(OH)2D3. The vitamin D3 metabolites 25(OH)D3 and 1,25(OH)2D3 stimulate osteogenic differentiation and diminish the inflammatory response of dental MSCs. In addition, 1,25(OH)2D3 influences the immunomodulatory properties of MSCs in different dental tissues. Thus, dental MSCs are both producers and targets of 1,25(OH)2D3 and might regulate the local vitamin D3-dependent processes in an autocrine/paracrine manner. The local vitamin D3 metabolism is assumed to play an essential role in the local physiological processes, but the mechanisms of its regulation in dental MSCs are mostly unknown. The alteration of the local vitamin D3 metabolism may unravel novel therapeutic modalities for the treatment of periodontitis as well as new strategies for dental tissue regeneration.

Comparison of effect of curcumin gel and noneugenol periodontal dressing in tissue response, early wound healing, and pain assessment following periodontal flap surgery in chronic periodontitis patients

Background

The study was designed taking into consideration the drawbacks of periodontal dressing and healing properties of curcumin. The aim was to assess and compare the effect of Curcumin gel (Curenext) and noneugenol periodontal dressing (Coe pak) on tissue response, wound healing in the early stages, and pain post periodontal flap surgery in patients diagnosed with chronic periodontitis.

Materials and Methods

Twenty patients requiring periodontal flap surgery were allotted to two groups at random, one receiving periodontal dressing and the other receiving curcumin for this cross over split-mouth study. Flap surgeries were performed on 2 quadrants with 3 weeks' interval. After suture removal, postoperative sites were assessed for tissue response (tissue color [TC] and tissue edema [TE]) and early wound healing as primary outcomes of the study. The secondary outcome was pain assessment and the number of analgesics taken by the individuals.

Results

The two groups showed no significant differences with respect to tissue response, early wound healing, and pain perception. Curcumin group consumed lesser number of analgesics as compared to the one with periodontal dressing.

Conclusion

It was confirmed that periodontal dressing and curcumin are effective in reducing the TE, normalizing the TC, enhancing the wound healing and reducing the pain perception. Curcumin can thus be used as an alternative to periodontal dressing.

Modulatory effect of curcumin analogs on the activation of metalloproteinases in human periodontal stem cells

Periodontitis progresses due to increased levels of active metalloproteinases (MMPs) and the imbalance between MMPs and their tissue inhibitors (TIMPs). Natural curcumin limits the lytic activity of MMPs but has low cellular uptake. Use of synthetic curcumin analogs could be a means of overcoming this limitation of treatment efficiency. Human periodontal stem cells were isolated from gingival tissue, gingival ligament fibers, periodontal ligament, and alveolar bone. The effect of five synthetic curcumin analogs was compared with that of natural curcumin by assessing cytotoxicity [by 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay], the cellular uptake (by fluorometry), the proteolytic activities of MMP-2 and -9 (by zymography), and the levels of TIMP-1 (by ELISA). Our results indicated increased cytotoxicity of synthetic curcumins for doses between 100 and 250 μM. At a concentration of 10 μM, cellular uptake of synthetic curcumins varied depending on their chemical structure. The curcumin compounds modulated pro-MMP-2 levels and increased TIMP-1 production. There was no detectable synthesis of pro-MMP-9 and no activation of MMPs 2 and 9. Gingival tissue and gingival ligament fiber stem cells were most responsive to treatment, showing inverse correlations between pro-MMP-2 and TIMP-1 levels. In conclusion, synthetic curcumins influenced the balance between pro-MMP-2 and TIMP-1 in human periodontal stem cells in vitro, and this could open perspectives for their application as adjuvants in periodontal therapy.

An in vitro evaluation of cytotoxicity of curcumin against human periodontal ligament fibroblasts

Introduction:

Curcumin, a component of turmeric (Curcumalonga L.), is a molecule of multitude of medicinal properties. Although curcumin has found a place in the treatment of gingival and periodontal diseases, there are no reported cytotoxicity studies on the cells of clinical significance (i.e., periodontal ligament [PDL] fibroblasts).

Aims:

The objective of this research was to assess the in vitro cytotoxicity of curcumin against human PDL fibroblasts.

Materials and Methods:

Human PDL fibroblasts from premolar teeth were cultured and used for cytotoxicity tests from healthy children presented for orthodontic extractions. Test concentrations of curcumin (100%, 50%, and 25%) were prepared by diluting 95% curcumin with di‑methyl‑sulfoxide and added to 96‑well microtiter plate (in triplicate) containing the fibroblast culture (approximately 2 × 104 cells/well). Fibroblast cells without treatment (without curcumin) acted as a control group. The viability of cells after 48 h of incubation at 37°C in a humidified atmosphere of 5% CO₂ and 95% air was ascertained by the 3‑(4, 5‑dimethyl‑thiazol‑2‑yl)‑2, 5‑diphenyl‑tetrazolium bromide (MTT) assay. The viability of PDL fibroblast cells of experimental wells was expressed relative to that of control, in terms of change in the color intensity. Absorbencies were recorded at 450 nm on a microplate reader with background subtraction at 620 nm. The cell viability at various concentrations of curcumin against the PDL fibroblasts was calculated as mean absorbance (optical density) and percentage values.

Results:

Cell viability of PDL fibroblasts to 100%, 50%, and 25% curcumin concentration was 111.75%, 112.50%, and 114.40%, respectively.

Conclusions:

No in vitro cytotoxicity was detected for curcumin against human PDL fibroblasts, at any of the concentrations used (100%, 50%, and 25%) by MTT assay at the end of 48 h.

Herbal medicine as adjunct in periodontal therapies- A review of clinical trials in past decade

The aim of this paper was to analyze the literature published in the research related to herbal medicine as adjunct in periodontal therapies. An internet search using search engines- Google, Researchgate and PubMed was carried out. The keywords used for search were-periodontal therapy, adjunct, herbal, and periodontitis. Full text articles of the articles were collected from the year 2007-2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.

Antimicrobial Activity of Curcuma longa L. Extract on Periodontal Pathogens

AIM

The aim of this study was to evaluate the antimicrobial activity of Curcuma longa L. extract (CLE) on periodontal pathogens.

MATERIALS AND METHODS

Sixty patients were divided into three groups: Group I (n = 20) patients treated with scaling and root planning (SRP) only, Group II (n = 20) patients treated with SRP followed by subgingival irrigation with 1% CLE solution, and Group III (n = 20) patients treated with SRP followed by subgingival irrigation with 0.2% chlorhexidine (CHX) solution. The clinical parameters (plaque index [PI], gingival index [GI] scores, probing pocket depths) were recorded at baseline, 4 weeks, and 8 weeks. The antimicrobial efficacy of 1% CLE and 0.2% CHX solutions against Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans were evaluated by disk diffusion method.

RESULTS

There was no significant difference in the mean values of zone of inhibition exhibited by both CLE and CHX solutions. All the groups showed significant improvement in the clinical parameters when compared to baseline values. The improvement in the PI and GI scores in the CLE group was lesser than that in CHX group by the end of the study period.

CONCLUSION

CLE possess antimicrobial efficacy against the common periodontopathic bacteria. However, further large-scale studies evaluating the substantivity of C. longa are required to support its beneficial use in the treatment of periodontal diseases.

Curcumin for the Management of Periodontitis and Early ACPA-Positive Rheumatoid Arthritis: Killing Two Birds with One Stone

We propose curcumin as a preventive measure to avoid/manage periodontitis (PD), and as a natural immunosuppressant for rheumatoid arthritis (RA). PD, mainly caused by Porphyromonas gingivalis forming biofilm and leading to tooth decay, is a major public health issue and a risk factor for the development of RA in humans. P. gingivalis is able to trigger experimental autoimmune arthritis in animal models and in humans can induce citrullinated peptides, which not only are a source of anti-citrullinated antibodies (ACPAs), but also participate in autoreactive responses and disease development. Curcumin appears to have efficient anti-bacterial activity against P. gingivalis infection and biofilm formation. In addition to antibacterial, anti-oxidant, and anti-inflammatory action, curcumin exerts unique immunosuppressant properties via the inhibition of Th17 pro-inflammatory responses and promotion of regulatory T cells, thus suppressing autoimmunity. We introduce curcumin as a natural product for the management of both PD and RA-related autoreactivity, possibly also as a preventive measure in early RA or individuals at high risk to develop RA.

Effects of curcumin and melatonin on bone formation in orthopedically expanded suture in rats: A biochemical, histological and immunohistochemical study

OBJECTS

To investigate the effects of curcumin (CUR) and melatonin (MEL) on new bone formation following rapid maxillary expansion (RME) in rats.

SETTING AND SAMPLE POPULATION

For this study, 24 12-week-old adult male Wistar albino rats from the Animal Laboratory at Adnan Menderes University, Faculty of Medicine, were used.

MATERIALS AND METHODS

The rats were randomly divided into the following 3 groups (n = 8 each): only expansion (OE), expansion plus MEL (MEL) and expansion plus CUR (CUR). CUR and MEL were given to the rats during the study period. After the sacrifice of the animals, biochemical, histological and immunohistochemical examinations were performed.

RESULTS

Serum bone alkaline phosphatase levels in the MEL group were statistically (P = .007) higher than in the OE group. Serum glutathione peroxidase and catalase activities in the CUR and MEL groups were significantly higher than in the OE group (P = .007 and P = .021, respectively). Inflammatory cell infiltration, new bone formation and capillary intensity parameters did not demonstrate statistically significant differences between the groups (P = .865, P = .067 and P = .055, respectively). The immunohistochemical findings revealed that IL-1, IL-6 and TNF-α H scores showed considerable differences between the groups (all P < .001). The highest IL-1, IL-6 and TNF-α H scores were found in the OE groups rather than in the other groups (P < .001).

CONCLUSION

CUR and MEL treatments may be effective in accelerating new bone formation and beneficial in preventing relapse following the RME procedures.

Treponema denticola increases MMP-2 expression and activation in the periodontium via reversible DNA and histone modifications

Host-derived matrix metalloproteinases (MMPs) and bacterial proteases mediate destruction of extracellular matrices and supporting alveolar bone in periodontitis. The Treponema denticola dentilisin protease induces MMP-2 expression and activation in periodontal ligament (PDL) cells, and dentilisin-mediated activation of pro-MMP-2 is required for cellular fibronectin degradation. Here, we report that T. denticola regulates MMP-2 expression through epigenetic modifications in the periodontium. PDL cells were treated with epigenetic enzyme inhibitors before or after T. denticola challenge. Fibronectin fragmentation, MMP-2 expression, and activation were assessed by immunoblot, zymography, and qRT-PCR, respectively. Chromatin modification enzyme expression in T. denticola-challenged PDL cells and periodontal tissues were evaluated using gene arrays. Several classes of epigenetic enzymes showed significant alterations in transcription in diseased tissue and T. denticola-challenged PDL cells. T. denticola-mediated MMP-2 expression and activation were significantly reduced in PDL cells treated with inhibitors of aurora kinases and histone deacetylases. In contrast, DNA methyltransferase inhibitors had little effect, and inhibitors of histone acetyltransferases, methyltransferases, and demethylases exacerbated T. denticola-mediated MMP-2 expression and activation. Chronic epigenetic changes in periodontal tissues mediated by T. denticola or other oral microbes may contribute to the limited success of conventional treatment of chronic periodontitis and may be amenable to therapeutic reversal.