Anti-Inflammatory Efficacy of Curcumin as an Adjunct to Non-Surgical Periodontal Treatment: A Systematic Review and Meta-Analysis

Abstract

Objective: Curcumin has been used as an adjunct to non-surgical periodontal treatment. However, the efficacy of curcumin in the periodontal therapy remained controversial. This study aimed to evaluate the anti-inflammatory efficacy of curcumin as an adjunct to non-surgical periodontal treatment (NPT) by systematic review.Methods: Databases including Embase, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched to identify relevant RCTs on the use of curcumin as an adjunct to NPT for the treatment of periodontal disease from inception to July 21, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Review Manager 5.3 software.Results: A total of 18 RCTs involving 846 patients/sites were included in this meta-analysis. The results of the meta-analysis revealed that as compared to NPT alone, curcumin as an adjunct to NPT resulted in significant reduction in gingival index (GI) at the 1-week (mean differences (MD) = −0.15, 95% confidence intervals (CI) −0.26 to −0.05, p = 0.005), 2-week (MD = −0.51, 95%CI −0.74 to −0.28, p < 0.0001), 3-week (MD = −0.34, 95%CI −0.66 to −0.02, p = 0.03), 4-week (MD = −0.25, 95%CI −0.48 to −0.02, p = 0.04) or 6-week (MD = −0.33, 95%CI −0.58 to −0.08, p = 0.01) follow-ups. Similar significant reductions were also observed for sulcus bleeding index (SBI) at 1, 2, 4, and 12 weeks. However, there were no statistically significant differences in reducing bleeding on probing (BOP) between curcumin as an adjunct and NPT alone at 4, 12, and 24 weeks.Conclusion: Based on the current evidence, curcumin demonstrates anti-inflammatory efficacies in terms of reducing GI and SBI compared with NPT alone. Moreover, curcumin is a natural herbal medicine with few side effects, and it is a good candidate as an adjunct treatment for periodontal disease.

Pre‐conditioning of gingival epithelial cells with sub‐apoptotic concentrations of curcumin prevents pro‐inflammatory cytokine release

“…Although in many systems, curcumin will be rapidly metabolised to the less active form THC3, in the oral cavity, it may have a role to play in reducing the exaggerated inflammatory burden evident within periodontal diseases, via topical application to gingival tissues. Clinical trials in this area have begun 58 and a meta‐analysis of the use of curcumin as a nonsurgical periodontal treatment has reported that curcumin can decrease gingival index, sulcus bleeding index but not bleeding on probing 59 . In conclusion, we have shown that curcumin can decrease inflammatory markers produced by an oral epithelial cell line in response to challenge by F. nucleatum .…”

“…Clinical trials in this area have begun 58 and a meta-analysis of the use of curcumin as a nonsurgical periodontal treatment has reported that curcumin can decrease gingival index, sulcus bleeding index but not bleeding on probing. 59 In conclusion, we have shown that curcumin can decrease inflammatory markers produced by an oral epithelial cell line in response to challenge by F. nucleatum. The mechanism by which this occurs appears to be driven by the induction of NrF2 responses.…”

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

“…We aimed to include all types of study protocols including SRP, SPD and no treatment in order to accumulate the available evidence in a single publication. A recent study that examined the anti-inflammatory efficacy of curcumin as an adjunct to non-surgical periodontal treatment included 18 randomized clinical trials and demonstrated significant reduction in gingival index and sulcus bleeding index when compared to non-surgical treatment alone [ 74 ]. When curcumin was compared to CHX as adjunct to SRP, it showed similar reductions of PPD, CAL, gingival index and plaque index with CHX [ 75 ].…”

“…This is a result of the strong antimicrobial activity of these herbal products and their synergistic effect again oral biofilm. Herbs may also inhibit the growth of periodontal pathogens, reduce the inflammatory response of the host to the bacteria and finally inhibit innate and adaptive immune responses in periodontal tissues [ 74 ]. For example, the use of Salvadora persica extract has significant anti-streptococcal and anti-lactobacilli effects and is associated with a significant reduction in plaque score and cariogenic bacterial count [ 79 ].…”

Leveraging Bulk Transcriptome and Single-Cell Sequencing reveals the Potential Mechanism of Curcumin in the Treatment of Periodontitis

“…For example, over the past 50 years, Curcumin in an ingredient within multiple natural extracts used in traditional medicine across half of Asia. Curcumin has been recommended as adjunctive treatment to non-surgical periodontal therapy in periodontitis, but its molecular mechanism remains a mystery [9]. Therefore, in the present study, we aimed to integrate singlecell analysis with bulk transcriptome to unravel the secrets behind it.…”