Oral hygiene is the basic routine one must follow to keep the mouth and teeth free from disorders.
The mouth is the gateway to the alimentary canal which receives food and saliva. Mouth is lined with a mucosal membrane and consists of the oral cavity.
The oral cavity includes the teeth and the gums. The roof of the mouth consists of the hard and soft palate while the base is covered by the tongue.
Salivary glands present near the mouth help to keep it moist and free from infections.
Peridontum comprises the tissues that support the teeth and gums are also referred to as gingiva. Both maxillary (upper) and mandibular(lower) teeth are innervated thus enabling sensations of pain or cold and heat.
The tongue helps to sense taste as well as to chew and swallow food.
Dentists recommend a number of procedures to maintain oral hygiene:
- Professional teeth cleaning
- Oral irrigation
- Plaque removal
- Tongue cleaning and gum care
Certain types of food such as green tea, onions, dairy products help balance pH of the mouth, preserve tooth enamel and kill bacteria; whereas food rich in carbohydrates can damage the teeth.
Smoking damages the oral cavity. Certain medications can also reduce the flow of saliva which can lead to an increase in bacterial growth in the mouth.
Cardiovascular diseases, low birth weight, endocarditis, osteoporosis are a few of the diseases linked with poor oral health.
However, the body’s natural defences and good oral hygiene habits can protect an individual from disorders related to the oral cavity.
Table of Contents
- Benefits of Turmeric in Oral health
- How to use Turmeric for Dental Problems
- Research Studies
- Study 1: Turmeric Gel Aids In Treatment of Gingivitis
- Study 2: Turmeric More Effective than Commonly Used Germicidal Mouthwash for Plaque and Gingivitis
- Study 3: Curcumin Fares Better Than Steroids In Treatment Of Oral Submucous Fibrosis
- Study 4: Curcumin Fares Better Than Steroids In Treating Oral Ulcers
Benefits of Turmeric in Oral health
Turmeric is a famous curry spice that is used generously by Asians in their food as well as a medicine.
Turmeric belongs to the ginger family and turmeric powder is obtained from its rhizome. Curcuminoids is a class of compounds found in turmeric powder that are strong antioxidants and they are responsible for the bright yellow color of the spice.
Curcumin is the principal curcuminoid that demonstrates the pharmacological properties of turmeric.
The volatile oil fraction of turmeric gives the spice its flavourful aroma and also contributes to the therapeutic properties.
Research studies suggest that these properties can be of use in dental problems and diseases related to the mouth.
1. Turmeric and Gingivitis
Gingivitis is the mild inflammation of the gums characterized by swelling and irritation.
Plaque is a film of bacteria that grows on the teeth and another surface of the mouth.
A study was performed to compare the effect of turmeric mouthwash to that of standard treatment-chlorhexidine gluconate mouthwash in treating gingivitis and plaque.
Subjects of the age group 25-35 years participated in this study. Their plaque and gingivitis index score was measured at 0, 14 and 21 days. Significant reduction in plaque index and a microbial count was observed in both groups. No difference in the gingival index was seen in either group.
However, chlorhexidine gluconate mouthwash was more effective when the antiplaque property was considered.
What it means: Nevertheless it is important to note that turmeric mouthwash is as effective as chlorhexidine mouthwash and can be used as an adjunct and low cost measure to control plaque.
2. Turmeric for Periodontitis
Periodontitis is inflammation of tissues supporting the teeth. If left untreated, it can lead to loosening and loss of teeth.
It is primarily caused by the accumulation of bacteria at the gum line. The line of treatment followed includes the following procedures:
- Scaling: removal of tartar and bacteria from the teeth and gum line
- Root planning: smoothening of roots surfaces to prevent the future build-up of plaque.
However, the treatment is invasive and requires multiple visits, use of local anesthesia and antibiotics.
A study was conducted to compare the effect of turmeric gel along with Scaling and Root planning (SRP) and the effect of SRP alone on the plaque, gingivitis and other factors pertaining to periodontitis.
30 patients participated in this study wherein certain parts of the affected sites of their mouth were treated with SRP alone and some with turmeric gel and SRP.
Significant reduction in recorded parameters was seen in both groups but turmeric gel combination brought about greater reduction than SRP alone. This effect can be due to turmeric’s anti-inflammatory and anti-microbial property.
3. Turmeric for Oral Cancer
Oral cancer is the cancerous growth of cells in the mouth.
Use of tobacco, excessive alcohol consumption, lack of oral hygiene, etc. are some of the factors that can lead to oral cancer.
Curcumin possesses anti-cancer property and it is effective in controlling and terminating cancerous growth. China Medical University investigated the effect of curcumin on drug-resistant oral cancer cell lines.
Considering the limitation of poor bioavailability, a special formulation of curcumin was prepared.
Curcumin brought about cell death in oral cancer cells; however, it was not toxic normal human gum cells and other cell types found in the normal human cavity.
Curcumin modulated the activity of multiple drug resistance protein-1 (protein that confers resistance to routine treatment and enhances survival potential of cells) and stimulated the production of reactive oxygen studies in cancerous cells leading to cell death.
Nanoparticle formulation of curcumin can thus serve to be therapeutic in drug-resistant oral cancer.
Turmeric’s role as an anti-cancer is well known. It is no surprise it can help in oral cancer too.
4. Turmeric for Oral Submucosal Fibrosis
Oral submucosal fibrosis (OSMF) is a disease in which tissue comprising the lining of the mouth hardens and changes in the composition of the muscle connecting the mouth increase difficulty in opening the mouth and affect activities like eating and swallowing.
Patients suffering from this condition are at increased risk of developing oral cancer. The anti-inflammatory and antioxidant activity of curcumin is responsible for its chemopreventive action.
A research study was conducted to evaluate the efficacy of turmeric treatment for oral submucosal fibrosis.
30 patients participated in this study and they were split into four groups based upon the extent to which they could open their mouth.
Each patient was administered curcumin tablet containing 300mg curcumin and 5mg piperine thrice daily for 1 month.
Patient’s mouth opening and burning sensation were recorded.
Results from the four groups indicated that mouth opening improved in the range of 0.7-5.1% whereas burning sensation reduced by 66-83%.
If overall improvement is considered turmeric did not affect mouth opening but significantly reduced burning sensation.
It was concluded that turmeric has a therapeutic effect on individuals suffering from oral submucosal fibrosis but further research is required.
A similar study was performed at Government Dental College, Trivandrum, India wherein forty-eight patients were split into 3 groups.
Each group was administered only one of the following drugs: curcumin(daily dose of 1 gram), turmeric oil(daily dose of 600mg) and standard treatment tablets (daily dose of 1 gram).
Patients were evaluated every 15 days for 9 months. Groups receiving turmeric showed the significant reduction in burning sensation and intolerance to spicy food within 3 months of treatment.
These groups also reported complete relief from pain and demonstrated a significant increase in mouth opening. None of these effects were observed in the control group.
Curcumin brought about quick changes whereas turmeric oil had a slow but long term effect and it even reduced the lesions.
Results of this study indicate that both anti-inflammatory and antioxidant activities of turmeric make it a potential candidate to treat OSMF.
5. Turmeric for radiation-induced mucositis
As mentioned previously, oral mucositis or inflammation of the mucosal layer lining the oral cavity occurs as a side effect to radiation therapy for head and neck cancer.
80 patients who were receiving chemoradiotherapy for head and neck cancer participated in a study which was designed to investigate turmeric’s effect on radiation induced mucositis.
40 patients were given turmeric mouthwash and the other 40 were administered povidone-iodine treatment for comparison.
Based on results recorded over 7 weeks, it was observed that turmeric mouthwash prevented and reduced radiation-induced oral mucositis.
Turmeric mouthwash also reduced the incidence of intolerable mucositis, reduced changes in body weight and prevented breaks in treatment.
It was concluded that gargling with turmeric during treatment of head and neck cancer can prevent and reduce radiation induced mucositis.
6. Turmeric for toothaches, swelling, etc.
Apart from serving as a herbal remedy, turmeric finds its use in different forms in dental problems. Dental plaques are not visible to the naked eye.
They are generally stained with dyes so as to spot their location for removal. A dental plaque detection system has been designed wherein the staining agent contains turmeric extracts and curcumin and light emitting apparatus is used.
The apparatus emits light at a particular wavelength which helps to identify the plaque.
Sealants are an artificial coating applied to the teeth to protect them from decay. They are applied to pits- hollow regions and fissures- grooves of the back teeth.
Turmeric extract is one of the colorants used in preparing a sealant which is generally composed of plastic and one colorant.
Turmeric, due to its anti-inflammatory property, can be applied locally or taken as an alternative to nonsteroidal anti-inflammatory drugs to treat aching gums or teeth.
How to use Turmeric for Dental Problems
Here are some easy to follow ways to use turmeric for dental health:
1. Massaging aching teeth with roasted, ground turmeric can help reduce pain and swelling.
2. Prepare turmeric water by boiling 5g of turmeric powder, two cloves and two ground leaves of guava in 200g water. Let it cool. Rinsing the mouth with this water can provide instant relief from dental problems.
3. Prepare a paste by mixing 1 tsp of turmeric with ½ tsp of salt and ½ tsp of mustard oil. Rub this paste twice daily on gums and teeth for relief from gingivitis and periodontitis.
4. To prepare a gum pack wet a pinch of turmeric powder in water or in Vitamin E oil and apply it at night to the affected areas. One can also roll this paste in gauze and tuck it in the mouth.
5. Applying the powder of burnt turmeric pieces and bishop’s weed seed (also known as ajwain ) on teeth and cleaning them helps strengthen gums and teeth.
Former sufferers of dental and gum problems recommend brushing teeth with turmeric powder as it has cured their problems of bleeding gums, periodontitis and bad breath.
However turmeric stains the teeth yellow, so it is advisable to follow this routine with regular toothpaste.
This dosage section is for oral use of turmeric.
Turmeric incorporated in the diet is the safest way of consuming it.
Turmeric supplements are available in the form of capsules containing powder, tincture or fluid extracts.
The recommended dosage is as follows:
- Cut roots: 1.5-3 g per day
- Powdered roots: 1-3g per day
- Standardized powder of curcumin: 400-600mg 3 times a day.
- Fluid extract with 1:1 concentration: 30-90 drops per day
- Tincture of 1:2 ratio : 15-30 drops 4 times a day
Read my detailed article on dosage here
Study 1: Turmeric Gel Aids In Treatment of Gingivitis
This study was conducted to assess the efficacy of Curcuma gel in gingivitis. This study was conducted on 10 patients suffering from severe gingivitis.
It was primarily done on those patients who did not receive any kind of periodontal therapy in the last six months.
The 10 selected patients with a papillary index score of 3 (higher bleeding) were asked to apply Curcuma gel after brushing twice a day regularly for three weeks. They were also asked to leave the gel in the mouth for 10 minutes before rinsing with water.
The results were recorded in the form of tables in a proforma sheet at different time intervals like 0, 7, 14, 21 days.
The aim of the study was to analyze the parameters like papillary bleeding index and gingival index with the help of a visual analog scale.
The papillary bleeding index is used to assess the overall health of gingiva mainly the bleeding tendency of gingiva while Gingival index is used to analyze the gingival condition along with the qualitative changes like change in color of gingiva or swelling of gingiva.
What were the results of the study?
Initially (day 0) the bleeding was very high. On day 7 the bleeding was considerably less and with time the bleeding got significantly reduced. On day 21 the papillary bleeding score was reduced to as low as 1.25.
The application of Curcuma gel didn’t show any adverse allergic reaction or ulceration.
There was a drastic decrease in inflammation when Curcuma gel was applied thrice daily for three weeks continuously. The color of the gingiva also improved significantly from reddish pink to pale pink.
At last, the study shows that the Curcuma gel is a potent herb in treating gingivitis due to its anti-inflammatory and anti-microbial properties.
How does this occur?
Curcumin is a hydrophobic polyphenol and an active constituent of Curcuma longa (turmeric). It posses many properties of which anti-inflammatory and anti-bacterial activity is of paramount importance in gingivitis.
Curcumin exerts its effect as an anti-inflammatory agent by inhibiting the activation of nuclear factor kappa-B (a transcription factor) as well as by inhibiting the activity of pro-inflammatory enzyme cyclooxygenase-2 which in turn reduces the inflammatory mediators involved in arachidonic acid metabolism.
It is also better than other anti-inflammatory drugs like aspirin as it does not affect the synthesis of prostacyclin which is responsible for inhibiting the platelet aggregation that leads to the formation of dental plaque but selectively inhibits thromboxane which facilitates platelet aggregation thus forming dental plaque.
Another potent mechanism of curcumin in gingivitis is its antimicrobial activity. The major microorganism which plays a key role in the progression of gingivitis is P.gingivalis.
It possesses a spectrum of proteases including trypsin-like enzymes. These enzymes enhance the ability of P.gingivalis to destruct the periodontal ligaments and tissues.
The possible mechanism by which curcumin exhibits its antibacterial activity against P.gingivalis and other pathogenic microorganisms is by blocking the assembly dynamics of FtsZ in the Z-ring .
You might be wondering what this FtsZ is and what is its role here? FtsZ is an essential bacterial protein which assembles by itself at a particular site called “Z-ring”.
This ring plays an important role in bacterial proliferation as it provides energy for it.
Curcumin is also a powerful anti-oxidant. It reduces oxidative stress which occurs due to the imbalance between body’s own antioxidant defense system and reactive oxygen species (ROS).
This ROS plays a major role in periodontal tissue destruction.
What does this mean?
As we can see from the above study and its results that a daily application of Curcumin gel for three weeks continuously can significantly improve the symptoms of gingivitis like inflammation, bleeding and reddening of gums.
This proves that Curcuma (Turmeric) is an effective adjunct that can be used in the treatment of gingivitis and plaque removal.
The turmeric gel showed no visible side-effects and was biocompatible in nature.
Study 2: Turmeric More Effective than Commonly Used Germicidal Mouthwash for Plaque and Gingivitis
A research published in 2012 in the Journal of Indian Society of Periodontology aimed at comparing the ability of turmeric and chlorhexidine gluconate mouthwashes in intercepting the development of bacterial infections like gingivitis and plaque.
The study comprised of 60 patients suffering from gingivitis.
Half of them were asked to use 0.1% turmeric mouthwash and the other half was given 0.2% chlorhexidine gluconate mouthwash for 21 days.
Changes in the severity of plaque and gingivitis after 0, 14 and 21 days were analyzed.
After 21 days, the researchers deduced that the severity of plaque and gingivitis reduced significantly in both groups.
Both turmeric and chlorhexidine were nearly equally efficient.
Turmeric reduced plaque by 69.072% and gingivitis by 62.545%. Chlorhexidine, on the other hand, reduced plaque by 64.207% and gingivitis by 61.150%.
Turmeric was found to be more effective on both counts if we consider the exact percentages!
From these facts, we can infer that both turmeric mouthwash and chlorhexidine mouthwash are efficient in preventing and reducing the severity of oral infections like plaque and gingivitis owing to their anti-inflammatory and anti-bacterial characteristics.
But considering the facts that concentration of chlorhexidine mouthwash was twice that of turmeric mouthwash;, and that continuous chlorhexidine usage can produce various adverse effects, it would not be wrong to say that turmeric, in the end ,may be better than chlorhexidine in maintaining good oral health.
Study 3: Curcumin Fares Better Than Steroids In Treatment Of Oral Submucous Fibrosis
This study elucidates the extent of effectiveness of curcumin in case of Oral Submucous Fibrosis (OSF).
This was a clinical trial conducted on 30 OSF patients. They were assigned into 2 groups, with 15 people in each group. One group was tested group and another one was the control group.
The test group was put on a regime of commercially available Curcuminoids named Longvida(400mg lozenges, daily intake of 2gm lozenges).
The control group was under the steroid tenovate (0.05% of clobetasol propionate)ointment regime. This ointment had to be applied thrice a day.
Both these regimes lasted for 3 months and follow-up analysis was done at the end of 6months. Both groups were advised to regularly perform some physiotherapy exercises involving the movement of the mouth and the jaws.
This mouth exercise device (MED) based had to be done for 20 min, 10 min for each side. This is done thrice a day.
OSF is diagnosed based on the reduction of the interincisal distance (distance between your 2 jaws at mouth opening) in mouth opening and fibrous bands found in the oral mucosa.
Patients were asked to forego the use of tobacco 1 month prior to the start of the drug regime.
The baseline for mouth opening and the fibrous bands were noted for each group at the start of the experiment. This was then compared with the results after the 3months trial and the 6-month follow-up.
Visual Analogue Scale (VAS) measurements were also monitored.
This is to check the burning sensation caused by the intake of hot & spicy food. This is another parameter to monitor OSF and common tooth sensitivity.
Keeping all these parameters in mind the results were analyzed.
What were the results?
The results showed some drastic changes. There was a 5.93mm increase in mouth opening in the test group. This is 2.37mm deviation from the baseline. In case of the control group, the increase in the mouth opening is of 2.66mm. A meagre 1.76mm deviation from the baseline.
Burning sensation on an intake of spicy food reduced in the treatment group but this was not observed in the control group.
The results of the test group showcased a sustained outcome, even 6months after withdrawal of the treatment. On the other hand, the control group had a relapse of disease parameters 6 months after treatment withdrawal.
Thus, it is clearly illustrated in this study that curcumin had a far more sustained effect than conventionally applied steroids used in OSF.
How did this occur?
The anti-inflammatory and anti-oxidant effects of curcumin are the chief mechanism of action against Oral Submucous Fibrosis.
The inhibition of COX-2,lipoxygenase and inducible nitric oxide synthase (iNOS) enzymes by curcumin plays a major role in this.
Also, the blocking of certain pro-inflammatory cytokines like IL-12, IL- 8, IL-6, TNFα reduces inflammation in the mouth. Thus affecting OSF patients by relieving the pain and burning sensation.
The anti-oxidant property of curcumin causes a scavenging effect on superoxide and hydroxyl radicals. This results in a reduction of oxidative stress (imbalance between prooxidant and antioxidant agents).
It reduces lipid peroxidation (degradation of lipids which damages tissue).
All these factors are responsible for the reduction in the burning sensation caused due to intake of spicy foods.
What does this mean?
Overall, this study reveals the efficacy of curcumin as an alternative cure for Oral Submucous Fibrosis. The lack of any side effects and the relative sustained effect of curcumin makes it a far better cure than conventional steroids.
Read the full study at http://www.ncbi.nlm.nih.gov/pubmed/26604488
Study 4: Curcumin Fares Better Than Steroids In Treating Oral Ulcers
The study was a randomized, double blind, clinical trial and was carried out for a period of 6 months.Detailed case history was made.
60 patients diagnosed with recurrent aphthous stomatitis were selected for the clinical trial based on various inclusion and exclusion criteria. Group I had 30 participants. They were given curcumin gel for the treatment of RAS. The other group was given a standard treatment of Triamcinolone Acetonide gel.
The size of ulcer was measured by a sterile Vernier Caliper. The number of ulcers was also noted down. The pain score was measured for each participant in the study and noted down.
A strict uniform protocol for administration of gel was followed. Patients were asked to apply the gels thrice a day on each of the ulcer post their meal.
They were asked to not consume food or water for at least half an hour.
The same type of applicator was provided to everyone and the quantity of application was also fixed.
Patients were examined on alternate days and the following parameters were noted down.
• Size of the ulcers
• Number of ulcers
• Pain score
The curcumin gel used was Curenext oral gel that contained 10mg of Curcuma longa extract per gram of gel. Triamcinolone Acetonide gel used for the study was Kenacort oral paste that contained 0.1% triamcinolone acetonide.
What were the results of the study?
60 patients were involved in the study. They were randomly assigned in groups of 30.
There was no significant variation in the demographic data of the patients in the two groups.
The pain scores were compared. The pain score of group I from day 0 to day 7 was calculated to be 4.7±1.53. The means that the average level of pain on a scale of 10 was found to be 4.7.
The pain score for group II patients was found to be 4.5±1.43. Group II patients on an average rated their pain from day 0 to day 7 as 4.5.
The result implies that there was a notable reduction in pain in 7 days in both groups.
Statistically, there was no significant difference in pain scores between the groups.
Another parameter that was recorded was the number and size of ulcers. The results show that over the period of 7 days the size and number reduced remarkably for both groups of people.
There was no considerable difference in the parameter result between Group I and Group II.
This study showed that curcumin is effective in reducing pain and healing the ulcer. It effectively reduces the size and number of ulcers.
How does this occur?
Treatment of oral ulcer aims at relieving pain, reduce inflammation and promote healing.
Curcumin downregulates the expression of interleukin (IL)-6 protein, TNF, and various other chemokines. This leads to suppression of inflammation.
One such mechanism is by decreasing the rate of release and metabolism of arachidonic acid.
Arachidonic acid is a polyunsaturated fatty acid present in the cell membrane. It is an intermediate in the inflammation pathway.
Also, it is a vasodilator that is responsible for the redness of the affected site.
Oxygenation of arachidonic acid produces prostaglandins by cyclooxygenase pathway and leukotrienes from lipoxygenase pathway.
A decrease in arachidonic acid metabolism reduces the activity of cyclooxygenase and lipoxygenase, which are inflammatory enzymes.
This, therefore, reduces inflammation.
Curcumin possesses anti-oxidant properties.
It prevents oxidative damage of the cells. Curcumin decreases the level of lipid peroxides. This prevents Oxidative degradation of lipids which in turn reduces tissue damage.
Curcumin elevates the level of superoxide dismutase (SOD) that breaks down potentially harmful oxygen molecules. Catalase (CAT), glutathione peroxidase (GPx) levels also increase due to curcumin.
This prevents the cells against oxidative stress. Oxidative stress is the imbalance between the production of free radicals and the ability of the body to neutralize the harmful effect of free radicals by antioxidants. This leads to aggressive cellular damage.
The wound is covered by a new layer after it is filled with well vascularised healthy tissues.
Curcumin increases the activity of transforming growth factor-beta1 and fibronectin which is responsible for the enhancement of wound healing.
What does this mean?
This implies that curcumin can heal oral ulcer and relieve the pain as effectively as a steroid.
Steroids have unwanted and non-reversible side effects.
Turmeric has a pharmacological activity that is similar to steroids.
Turmeric, if taken in required dosage, can be a safer, economical and effective alternative to steroids.
Read the full study at: http://www.ncbi.nlm.nih.gov/pubmed/25126527[/su_expand]
Turmeric as a spice is very safe to use.
However one must be careful with turmeric supplements as it is a concentrated form of curcumin and may contain other components which are included to enhance its availability in the body.
Inappropriate dose or allergic reactions from supplements can affect one’s health; so it is advisable to take turmeric supplements as per a health practitioner’s recommendation.
Few of the conditions under which one should avoid turmeric supplements are:
- Pregnancy & Lactation
- Diabetes (if one is consuming blood thinning medications)
- Prior to surgery
- Gall bladder disorders
- Bile passage obstructions
- Gastrointestinal disorders
If consuming medications that reduce stomach acid and/or blood thinning agents.