Curcumin (diferuloyl methane), demethoxycurcumin and bisdemethoxycurcumin are the main components of turmeric a member of the ginger family. Curcumin has anti-inflammatory properties and has been used as a remedy for systemic and oral inflammatory diseases. Curcumin chips and mouthwash have been used as an adjunct to scaling and root planing for the management of periodontal disease with some studies reporting effectiveness similar of better than chlorhexidine.
The aim of this review was to evaluate the effectiveness of oral curcumin products in reducing gingival inflammation and probing pocket depth in adults.
Searches were conducted in the Cochrane Library and Medline/PubMed databases. Randomised controlled trials (RCTs) comparing curcumin containing gels, chips, mouthwashes or irrigation against other commercially available products were considered. Studies were selected independently by two reviewers who also extracted data and assessed risk of bias using the Cochrane domains-based tool. Meta-analysis was conducted for plaque reduction, gingival inflammation and pocket depth.
- 27 RCTs involving 963 patients were included.
- 11 studies involved local gel delivery, 3 used topical gel, 6 mouthrinse, 3 subgingival irrigation and 3 chips.
- 24 studies were at unclear risk of bias and 3 at high risk of bias.
- With the exception of reduced pocket probing depth in favour of locally delivered curcumin gel none of the findings were statistically significant (see table below).
|Curcumin agent||No of studies||Mean or Standard mean difference and (95%CI)|
|Gel (local delivery) Plaque index||8||-0.73 (-1.63 to 0.16)|
|Gel (local delivery) Gingival index||4||-0.04 (-0.37 to 0.29)|
|Gel (local delivery) pocket depth||9||-0.87 ( -1.31 to 0.43)|
|Gel (topical) Plaque index||3||-0.05 ( -1.05 to 0.96)|
|Gel (topical) Gingival index||3||0.19 (-0.39 to 0.77)|
|Mouthrinse Plaque index||5||-0.76 (-2.25 to 0.73)|
|Mouthrinse Gingival index||5||-0.09 (-0.29 to 0.10)|
The authors concluded: –
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.
A protocol for the review was registered in PROSPERO and a typical systematic review format employed. The authors have searched two major databases identifying 27 RCTs a majority of these (19) being compared with chlorhexidine products. Studies involving gels (used topically and locally), mouthwashes, subgingival irrigation and chips were included. As well as the range of products used there was variation in the concentration of curcumin used. Meta-analysis showed a significant reduction in probing pocket depth scores with curcumin in the local drug delivery group. All the other parameters showed no significant difference for curcumin a largely against chlorhexidine.
None of the included studies were considered to be at low risk of bias and the majority of studies are small (20-60 participants). Combined with the heterogeneity of the curcumin delivery systems and their dosage the findings should be interpreted cautiously. A previous review of curcumin mouthwashes alone also suggested anti-plaque and anti-gingivitis properties, that included 6 RCTs , five of which are included in this review. High quality well conducted, and well reported trials of curcumin should be undertaken to clarify the effectiveness and dosage of curcumin products as well as any possible adverse effects.
Terby S, Shereef M, Ramanarayanan V, Balakrishnan B. The effect of curcumin as an adjunct in the treatment of chronic periodontitis: A systematic review and meta-analysis. Saudi Dent J. 2021 Nov;33(7):375-385. doi: 10.1016/j.sdentj.2021.07.008. Epub 2021 Jul 14. PMID: 34803277; PMCID: PMC8589622.
Dental Elf – 7th Jun 2021