|Year : 2015 | Volume
| Issue : 1 | Page : 53-56
|Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: A clinical and microbiological study
V Anitha1, P Rajesh2, M Shanmugam1, B Meena Priya1, S Prabhu3, V Shivakumar4
1 Department of Periodontics, Chettinad Dental College and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kanchipuram, Tamil Nadu, India
2 Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kanchipuram, Tamil Nadu, India
3 Public Health Dentistry, Chettinad Dental College and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kanchipuram, Tamil Nadu, India
4 Department of Periodontics, Ultra Best Dental College, Madurai, Tamil Nadu, India
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|Date of Submission||30-Jul-2014|
|Date of Decision||17-Oct-2014|
|Date of Acceptance||11-Feb-2015|
|Date of Web Publication||11-May-2015|
| Abstract|| |
Background of the Study: The aim of this study is to evaluate the efficacy of natural curcumin in the management of chronic periodontitis as local drug delivery in comparison to synthetic chlorhexidine, which is the gold standard.
Materials and Methods: Thirty chronic periodontitis patients with an age range of 20-50 years with probing pocket depth (PPD) of 4-6 mm were included. Curcumin and chlorhexidine gel was applied in the contralateral disease sites at baseline and day 15. The clinical parameters like PPD, clinical attachment level (CAL), gingival index (Loe and Silness) and plaque index (Turesky Gillmore modification of Quigley Hein) were recorded and colony forming units (CFU) were assessed microbiologically at baseline, 15 and 30 days.
Results: There was a significant reduction of the clinical parameters (PPD, CAL) and microbiological parameters CFU at 15 and 30 days for both the groups. Curcumin group showed a greater reduction in the clinical parameters when compared with chlorhexidine group. Both groups had a significant reduction in parameters when compared with baseline.
Conclusion: Although curcumin has equivalent benefit to chlorhexidine, curcumin being an ayurvedic herb is an excellent alternative to chlorhexidine due to minimal side-effects.
Keywords: Chlorhexidine, curcumin, local drug delivery, periodontal disease
|How to cite this article:|
Anitha V, Rajesh P, Shanmugam M, Priya B M, Prabhu S, Shivakumar V. Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: A clinical and microbiological study. Indian J Dent Res 2015;26:53-6
Periodontal disease is an inflammatory disease characterized by destruction of the supporting structures of the teeth. The primary etiologic factor of periodontitis is dental plaque and the microorganisms that are present in it.  The biofilm nature of dental plaque provides a specialized environment for the microorganisms thereby ensuring its vitality and pathogenicity. ,
|How to cite this URL:|
Anitha V, Rajesh P, Shanmugam M, Priya B M, Prabhu S, Shivakumar V. Comparative evaluation of natural curcumin and synthetic chlorhexidine in the management of chronic periodontitis as a local drug delivery: A clinical and microbiological study. Indian J Dent Res [serial online] 2015 [cited 2019 Sep 21];26:53-6. Available from: http://www.ijdr.in/text.asp?2015/26/1/53/156806
The aim of periodontal therapy is to remove the bacterial plaque and all the factors that favor its accumulation. The routine therapeutic modality of periodontitis is scaling and root planing (SRP). This involves the removal of supra and subgingival plaque and calculus, thereby returning the tissues to a state of health.  However, the recolonization of the treated sites can occur, and pharmacological agents are nowadays used as adjuncts to mechanical therapy. Locally delivered agents are routinely used to control the re-growth of bacteria following SRP.  The administration of local drug delivery is associated with less systemic side-effects, less drug resistance and enhanced penetration of the drug in the diseased site resulting in the elimination of harmful pathogens.  The common agents used include subgingival chlorhexidine, tetracycline fibers, subgingival minocycline, subgingival doxycycline, and subgingival metronidazole.
Currently, the use of herbal products in dentistry is ever increasing. This can be attributed to their easy availability, low cost and lesser side effects.  One such herbal product is curcumin. Turmeric (haldi) is the rhizome of Curcuma longa belongs to Zingiberaceae family has been traditionally used in Indian medicine for several decades. It has several components, which are collectively known as "curcumin."  The proven properties of curcumin include anti-inflammatory, antioxidant, antimicrobial, antiseptic, antimutagenic.  Anti-inflammatory properties of curcumin is by inhibiting the prostaglandin biosynthesis from arachidonic acid and also by reducing the function of neutrophils during inflammation. Antioxidant property of curcumin is due to its ability to inhibit free radical formation. Antimicrobial effect of curcumin is due to its ability to inhibit the growth of various microorganisms. 
Hence, the aim of this study was to evaluate the efficacy of natural curcumin in the management of chronic periodontitis as local drug delivery in comparison to synthetic chlorhexidine.
| Materials and methods|| |
Sample size calculation
The sample size was selected based on G2 version 3 similar to other studies. 
Subject population and selection
This study was conducted in the Department of Periodontics, Chettinad Dental College and Research Institute between January and February 2014. Ethical approval was obtained from the Institutional Ethical Committee, Chettinad Health City. A written informed consent was obtained from the participants of this study. A total of 30 patients were selected to participate in this study. Inclusion criteria were patients diagnosed with chronic periodontitis with a probing pocket depth (PPD) of >4 mm. Exclusion criteria were the presence of systemic diseases, history of periodontal therapy in the past 6 months, antibiotic use in the past 6 months, and inability to participate in the study for its entire duration.
The study was planned as a split-mouth randomized examiner-blinded clinical trial. The sites to receive either curcumin or chlorhexidine were selected based on a coin toss. All 30 subjects received full mouth SRP. Following SRP, two contra-lateral sites from each patient with PPD between 4 and 6 mm was selected. Each patient contributed two sites with PPD between 4 and 6 mm, which received curcumin and chlorhexidine. Hence, Group - 1 comprised of 30 sites receiving SRP and subgingival curcumin and Group - 2 comprised of 30 sites receiving SRP and subgingival chlorhexidine. It was ensured that the drug was delivered completely into the pocket. A periodontal dressing was placed over the site.
Prior to the start of this study, the following parameters were recorded - Turesky-Gillmore-Glickman modification of Quigley-Hein Plaque index, clinical attachment level (CAL), PPD. Plaque sample was taken from the site, which was selected for local drug delivery with a Gracey curette no 2R/2 L. The plaque sample was transferred into a vial and transported for microbiologic analysis. All the clinical parameters were recorded at baseline, day 15, and day 30.
Preparation of curcumin
Curcumin solution was prepared by mixing 250 gms of the freshly powdered rhizome of curcuma longa in 5 ml of ethanol and kept in hot air oven at 540 degree Celsius for 24 h.A residue obtained was mixed with 95 ml of glycerol, which was used as a natural local drug delivery. 
Commercially available 0.1% of chlorhexidine gel was used as a synthetic local drug delivery. Both curcumin and chlorhexidine gels were placed into the selected site by using a collagen sponge as a vehicle to ensure retention in the site. The collagen sponge was resorbable and hence did not require removal.
The microbiological examination to assess the number of colony forming units (CFU) was carried out using the plaque samples obtained from these patients at baseline, day 15 and day 30.
Briefly, plaque samples were collected from the periodontal pocket using a sterilized Gracey curette parallel to the long axis of the tooth and moved coronally by scraping along the root surface. These plaque samples were placed in an air tight thioglycolate broth transport media supplemented with Hemin and Vitamin K in a 5 ml test tube. The collected plaque samples were immediately sent to the lab for culture.
All the data were compared between Group - 1 and 2, and between the groups and baseline values. The clinical parameters analyzed were PPD and CAL at baseline, 15 days after SRP and Local delivery, and 30 days after SRP and Local delivery. CFU was analyzed microbiologically at baseline, 15 and 30 days.
For statistical analysis, Statistical Package for Social Science (SPSS) version 16 (IBM corporation) was used. The comparison between groups 1 and 2 for PPD, CAL was analyzed using the paired sample statistics. The intra-group comparison was performed using Analysis of Variance.
| Results|| |
Demographics and baseline data
A total of 30 subjects were recruited for this study. The mean age was found to be 47 ± 2.7 years. Of the 30 subjects, 20 were male and 10 were female. The baseline PPD and CAL data are presented in [Table 1]. There was no significant difference between the two groups. This shows the success of the randomization of the sites selected for local drug delivery.
[Table 2] presents the data for 15 days post treatment. There is a reduction in PPD and CAL values in both the groups. A significant difference is seen between group- 1 and 2 in PPD and CAL values at 15 days (P < 0.05).
[Table 3] shows the 30 days post treatment PPD and CAL values for the two groups. There is a significant difference between the two groups (P < 0.05).
[Table 4] presents the intra-group comparison between PPD and CAL at baseline and 30 days. There is a significant reduction in PPD and CAL values within the groups at 30 days. This shows the effectiveness of both curcumin and chlorhexidine in reducing the clinical parameters effectively.
|Table 4: Intra group comparison of the clinical parameters at baseline with 30 day presented as mean±SD |
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[Table 5] shows the data for the microbiologic analysis performed with the plaque samples collected from the sample sites. There was significant difference in the reduction of the CFU between the two groups when seen at day 30.
Microbiological analysis at baseline and at day 30 (ANOVA) reveals a P value of 0.001 for curcumin and 0.022 for chlorhexidine which is statistically significant.
| Discussion|| |
The primary objective of periodontal therapy is to reduce the microbial load thereby leading to an improvement in the clinical parameters. SRP remains the gold standard of periodontal therapy with numerous other agents being currently used as adjunctive therapeutic modalities. This study aimed at evaluating the effectiveness of 1% curcumin when used along with SRP as a local drug delivery by comparing with chlorhexidine. The results of the present study indicated the efficacy of 1% curcumin in reducing both clinical parameters and microbial load in patients with chronic periodontitis. The reduction in PPD and CAL in the curcumin group can be attributed to its anti-inflammatory and wound healing capacity.  The reduction of inflammatory mediators which follows causes shrinkage by reducing inflammatory edema and vascular engorgement of connective tissue. Another mechanism by which curcumin reduces inflammatory changes is by promoting the migration of epithelial cells to aid in re-epithelialization.  The intra-group comparison showed both curcumin and chlorhexidine were able to significantly improve the clinical parameters at 30 days. The study design is in accordance with previously done studies. ,,
The other properties of curcumin such as anti-inflammatory, antioxidant, antimicrobial, hepatoprotective, immunostimulant, antiseptic, antimutagenic properties may also help in the improvement in clinical and microbiologic parameters following use as an adjunct in periodontal therapy.  Sidhu et al. found that curcumin treated wounds had increased TGF-β1 which enhances wound healing which may be responsible in the gain in attachment following its use in periodontal therapy.  It possesses similar mode of action as nonsteroidal anti-inflammatory drugs like aspirin, but also has an advantage that it selectively inhibits the synthesis of prostaglandins and thromboxane while not affecting the synthesis of prostacyclin.  Other studies have also compared the effectiveness of curcumin as a mouthwash and local drug delivery device in periodontal therapy. ,,
The effectiveness of chlorhexidine as an adjunct for periodontal therapy has been proven for many years. It alters the microflora of the periodontal pocket and inhibiting microbial proteases from potent periodontal pathogens. , Its mechanism of action relates to a reduction in pellicle formation, alteration of bacterial adherence to teeth, and an alteration of bacterial cell walls.  The antimicrobial effect can be due to an increase of the cellular membrane permeability, followed by the coagulation of intracellular cytoplasmic macromolecules.  However, the disadvantages of chlorhexidine such as staining of teeth, taste disturbances and an increase in calculus accumulation preclude its long-term use. This is where other agents with similar properties in improving clinical and microbiologic parameters with fewer side effects that chlorhexidine can take its place in long term use in periodontal diseases. Our study showed a significant difference at 30 days for curcumin over chlorhexidine in reducing the microbial and clinical parameters evaluated. This shows that curcumin could be a viable alternative to chlorhexidine in adjunctive use in periodontal therapy.
The limitation of this study includes the duration of evaluation done. This being a pilot study aimed at evaluating the short-term benefit of curcumin in periodontal therapy. Long-term follow-up studies are required in order to derive final conclusions on the effectiveness of curcumin as an adjunct in periodontal therapy and also whether it can replace chlorhexidine.
| Conclusion|| |
In our study, a significant improvement in clinical and microbiological parameters was seen in the curcumin and chlorhexidine group. Although curcumin has equivalent benefit to chlorhexidine, curcumin being an ayurvedic herb is an excellent alternative to chlorhexidine due to minimal side effects. Further studies need to be focused on the substantivity of chlorhexidine.
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Department of Periodontics, Chettinad Dental College and Research Institute, Rajiv Gandhi Salai, Kelambakkam, Kanchipuram, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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