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Original Article

Effect of Curcumin in Reducing Burning Sensation in Potentially

Malignant Disorders of Oral Cavity
Nitin Nigam, Siva Prasad Reddy Enja, Shruti Chandra, Neelakshi Pandey
Department of Oral Medicine and Radiology, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India

Abstract
Introduction: Curcumin, chemically named as diferuloylmethane is a yellow coloured pigment which shows anti‑inflammatory, antioxidant,
pro‑apoptotic, antibacterial, antiviral and antifungal activities. It suppresses cyclooxygenase, lipooxygenase and other inflammatory mediators
and destroys free radicals. Aim: To evaluate the efficacy of curcumin in reducing the burning sensation in potentially malignant disorders of
oral cavity. Materials and Methods: 100 subjects diagnosed clinically with potentially malignant disorders of oral cavity were included in
this study. The patients were administered commercially available turmeric systemically and topical application of turmeric and honey was
advised. Their burning sensation on VAS scale was evaluated after 15 days, and the data was then statistically analysed by Wilcoxon sign rank
test. Results: After the treatment there was a significant decrease in VAS scale. The median showed decrease from 7 to 4. The mean value also
showed decrease from 6.91 to 3.98. Conclusion: Hence, it is concluded that turmeric and honey showed positive results in reducing burning
sensation in potentially malignant disorders of oral cavity.

Keywords: Burning sensation, curcumin, potentially malignant disorders

 Introduction anti‑inflammatory, analgesic, antiseptic, and proapoptotic

The application of antioxidants in several industrial procedures
have been studied in the 19th and 20th century. In recent years,
with new advancements, there is an upsurge in the field of
prevention and treatment of disorders by utilizing the chief
property of antioxidants, i.e., scavenging free radicals.
Therefore, it is very important to determine the role of free
radicals in the progression of disease as well as the preventive
effects of antioxidants. Antioxidants prevent cellular
damage which is a common pathway for cancer. The reversal or
control of potentially malignant disorders is a prime approach
against carcinogenesis for the prevention of cancer. Research
needs to be done on whether antioxidants can protect humans
from disorders such as leukoplakia, lichen planus, carcinoma
in situ, and oral cancer.[1]
Curcumin, a yellow pigment in curry powder is derived
from Curcuma longa plant, which is commonly known as
turmeric. It belongs to ginger family (Zingiberaceae).[2] The
components are known as curcuminoids, which include
mainly curcumin (diferuloyl methane), demethoxycurcumin,
and bisdemethoxy‑curcumin. Curcumin exhibits antioxidant,
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activities, and hence, are used in ayurvedic medicines. It
can be used in various forms for oromucosal disorders
in topical manner such as turmeric extract, turmeric oil,
turmeric water, turmeric powder, burnt turmeric pieces,
and roasted ground turmeric, and in systemic manner in the
form of tablet.[3] Turmeric exhibits its anti‑inflammatory
properties by increasing the production of natural cortisone
and lowering the levels of histamine. The DNA protecting
and antioxidant property of curcumin are responsible for
anti‑precancer activities.[4] Curcumin has been shown to
suppress transformation, proliferation, and spread of tumor
to distant sites. The mechanism of action is that it regulates
transcription factors, growth factors, inflammatory cytokines,
protein kinases, and various enzymes. The proliferation of
cancer cells is inhibited by inducing apoptosis and arresting
Address for correspondence: Dr. Shruti Chandra,
Department of Oral Medicine and Radiology, Saraswati Dental College
and Hospital, Faizabad Road, Tiwari Ganj, Lucknow, Uttar Pradesh, India.
E‑mail: shruti.chandra42@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Nigam N, Reddy Enja SP, Chandra S, Pandey N.
Effect of curcumin in reducing burning sensation in potentially malignant
DOI:
10.4103/jiaomr.JIAOMR_37_16
disorders of oral cavity. J Indian Acad Oral Med Radiol 2017;29:7-11.
Received: 29‑03‑2016  Accepted: 21‑06‑2017  Published: 04‑08‑2017

© 2017 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer - Medknow 7
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Nigam, et al.: Effect of curcumin in potentially malignant disorders

cells in different stages of cell cycle.[5,6] Curcumin also shows taken twice daily for 15 days along with the topical application
antiviral property by inhibition of HIV‑1 and HIV‑2 proteases, of turmeric and honey in a paste form by cotton applicator
reduction of HSV‑1 replication, and suppressing transcription 2–3 times daily. After 15 days, patients were recalled and the
of HPV‑18.[7‑10] VAS score was recorded. Patient was asked to get empty tablet
In‑vitro studies have proven that curcumin is an effective blister packs to ensure that tablet was taken on a regular basis.
destroyer of reactive oxygen species and reactive nitrogen No other parameter was taken into account. The data was then
species. The inhibition of lipo‑oxygenase and cyclo‑oxygenase statistically analyzed by Wilcoxon sign rank test.
activities has also been observed. It has been seen that
curcumin lowers the activity of smokeless tobacco extract Results
or nicotine‑derived nitrosamine ketone‑induced nuclear The results showed significant decrease in VAS value after the
factor kappa‑light‑chain‑enhancer of activated B cells and treatment [ Graph 1]. An example of how to interpret the box
cyclooxygenase‑2 in oral premalignant and cancer cells. plot is shown in Graph 2. In comparison of the medians, median
Turmeric also acts by increasing the number of micronuclei value of VAS after treatment is significantly lower i.e., from a
in the circulating lymphocytes.[4,5,11] value of 7 pre‑treatment to 4 post treatment. The mean value
Honey exhibits antibacterial, antifungal, and anti‑inflammatory also showed reduction from 6.91 to 3.98 [Table 1]. The Z value
property. It decreases prostaglandin synthesis at site, increases and P value were −8.642b and <0.001, respectively [Table 2].
nitric oxide in lesion, and inhibits leukotriene B4, which is
mediator of inflammation.[12] Discussion
In 1952 Schwartz named an oral fibrosing disorder as
Materials and Methods atrophica idiopathica mucosa oris based on the findings in
This study was conducted in relation to the effect of curcumin to 5 Indian women from Kenya. Joshi named the condition as
reduce the burning sensation in potentially malignant disorders oral submucous fibrosis  (OSMF) in 1953. As the etiology
and was conducted in the Department of Oral Medicine and pathogenesis of this disorder is not specific, it is believed
and Radiology in Saraswati Dental College, Lucknow after that the cause is multifactorial.[5] Pindborg in 1968 and Caniff
receiving approval of the ethical committee. et al. in 1986 described the disease as a reaction to capsaicin,
an irritant in chillies, however, this was not completely
One hundred patients (both male and female) were included
proved in the experimental work.[13] Oral lichen planus is
as participants in the study where they were clinically
a chronic inflammatory disorder which affects 0.5–2% of
confirmed as suffering from potentially malignant disorders,
the general population. It is caused by an immune response
i.e., oral submucous fibrosis (60 patients), speckled
which is mediated by abnormal T cell. There is a change in
leukoplakia (10 patients), and oral lichen planus (30 patients).
the antigenicity of the basal epithelial cell surface.[14] Oral
They gave a positive history of smoked/smokeless tobacco
leukoplakia which is derived from the Greek words “leukos”
and burning sensation. Although no documented reports
meaning white, and “plax” meaning plaque is mainly caused
could be found in literature which gives the prevalence of
burning sensation in leukoplakia, in this study only patients by tobacco intake. Because of chronic irritation of the mucosa
who had speckled leukoplakia with burning sensation were by tobacco, there are inflammatory changes and increased
taken into account. Other variables can be taken into account permeability of mucosa to carcinogens and nitroson or
to assess the response to treatment in leukoplakia, however,
in this study only burning sensation i.e., subjective symptom
was considered. It can be considered reliable as the subject
and investigator are the same while assessing the response to
medication. Patients were evaluated on clinical basis alone as
this study does not proves changes at the histopathological
level by the treatment and is only based on the subjective
symptoms of the patients pre and post treatment. A written
consent of the participants was taken on an ethical format
regarding their participation in the study.
The study involved the use of visual analog scale (VAS), which
is one of the key method for the study to record the severity of
burning sensation in the individual patients.[1] The 2nd material
holds an equal importance as it is the drug of choice prescribed
to patients to reduce the burning sensation, i.e., tablet Turmix.
The burning sensation was noted on VAS scale on the first visit. Graph 1: Graph depicting median value of VAS Scale before and after
The patients were given tablet Turmix by the investigators to be treatment

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Nigam, et al.: Effect of curcumin in potentially malignant disorders

Table 1: Statistical analysis of burning sensation on VAS scale before and after administration of Turmix tablet and
local application of turmeric and honey
Mean Maximum Median Minimum Percentile Percentile
25 75
VAS Before 6.91 10 7 2 5 9
VAS After 3.98 8 4 1 2 5

Table 2: Z value and P value of VAS Scale

VAS After ‑ VAS
Before
Z ‑8.642b
P Value <0.001

nicotine. There is moderate‑to‑severe grade of dysplasia in

nonhomogenous leukoplakia, and hence, there is a greater
risk of developing into malignancy because of the presence of
erythematous component. Burning sensation can be attributed
to chronic irritation and erythematous surface.[15,16]
Deepa et al. in 2010 conducted a comparative study on
the efficacy of curcumin capsules and turmeric oil as
chemopreventive agents in oral submucous fibrosis, in which
they divided 48 patients into three groups on the basis of
different types of medications administered. Group I was
given curcumin capsules, group II was given turmeric oil, and
group III was taken as the control group and were provided with
multinal tablets. In this study tablet Turmix twice daily and
topical application of turmeric and honey was the medication
and 100  patients suffering from oral sub mucous fibrosis,
lichen planus, and leukoplakia were included. Their study
concluded that participants in group I and group II presented
with statistically significant reduction in burning sensation and
reduced difficulty in consuming spicy food after the treatment
period of 3 months and follow‑up in comparison to those of
Group III. Because curcumin had comparatively more effect
than the other medications provided during the treatment, it
can be used for the treatment of oral submucous fibrosis.[17]
The results of this study are in concordance with their study
with the decrease in burning sensation on VAS scale after
treatment period of 15 days.
Nagpal and Sood in 2013 presented a review article on
the role of curcumin in oral and systemic diseases. In the
treatment of various potentially malignant disorders such as
oral submucous fibrosis, leukoplakia, and lichen planus, the
role of curcumin has been studied. In‑vitro and in‑vivo animal
experiments with turmeric extract and turmeric oil have shown
oncopreventive property. The local symptoms of burning
sensation and pain were reduced and mouth opening was also
increased.[13] The results of this study are in accordance with
the anti‑inflammatory effect mentioned in the article.
Agarwal et al. conducted a study to check the effect of turmeric
on mouth opening and burning sensation on VAS. The study
was conducted among 30 patients who were diagnosed with
oral submucous fibrosis. The patients were administered
Graph 2: Key to interpret plot in graph 1
commercially available turmeric thrice daily and after every
month for 3 months, burning sensation on VAS scale and mouth
opening were noted. However, in our study 100 patients with
oral submucous fibrosis, lichen planus, and leukoplakia were
taken and tablet Turmix was given twice daily for 15 days,
and only change in burning sensation on VAS scale was noted.
Their study showed that the improvement in mouth opening
was not significant; however, the change in burning sensation
on VAS was significant with a P value <0.001, which is in
accordance with the results of our study.[18]
Jurenka conducted a study in 2009 in which phase 1 trial was
done among 25 patients to assess the efficacy of curcumin in
preventing the progression of different potentially malignant
disorders. The initial dose given was 500 mg daily which was
later increased to 8 g daily for a duration of 3 months. In our
study, the dose of tablet Turmix given was fixed for 15 days
for 100 patients. On histopathological analysis, decrease in
hyperkeratosis, parakeratosis, dysplasia, and inflammation
was seen. Two out of 7 patients with leukoplakia and 2 out
of 6 patients with Bowen’s disease showed improvement
in condition.[19] In this study, histopathological examination
was not done. The results of their study supports the
anti‑inflammatory action of curcumin, which is proved by
this study as well because the burning sensation is reduced.
In a study done by Hazarey et al. in 2015, 30 patients suffering
from oral submucous fibrosis were equally divided into
two groups, i.e., the test and control groups. The test group
was administered longvida lozenges (curcumin) and the
control group was treated with tenovate ointment (clobetasol
propionate 0.05%) for a period of 3 months and follow‑up was

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Nigam, et al.: Effect of curcumin in potentially malignant disorders
done for 6 months. In our study the sample size was 100 which
comprised patients suffering from oral submucous fibrosis,
leukoplakia, and lichen planus, and turmeric in both topical
and systemic form along with honey was prescribed twice
daily for 15 days. In their study burning sensation on VAS and
interincisal distance was noted. The test group showed more
increase in mouth opening and reduction in burning score on
VAS compared to the control group. Control group showed
significant relapse in condition.[20] The results match with this
study as the burning sensation is reduced, although a  control
group was not taken in our study.
Yadav et al. conducted a study in 2014 to compare curcumin
with intralesional steroid injections in treatment of oral
submucous fibrosis. Forty patients were divided into two
groups. In group 1, weekly intralesional injection of
dexamethasone and hyaluronidase was given. In group 2,
curcumin tablet (Turmix 300 mg per day) was given.
Treatment time was 3 months. Weekly burning sensation,
interincisal distance, and tongue protrusion was evaluated.
There was complete resolution in burning sensation in group 2
treated with Turmix. Mean of interincisal distance was more
in group 2.[21] The results are similar to those obtained in
the present study as the burning sensation was reduced in
100 patients with oral submucous fibrosis, lichen planus, and
leukoplakia on taking Turmix tablet and topical application of
turmeric and honey for 15 days.
Singh in 2013 conducted a pilot study among 10 patients
suffering from oral lichen planus. Turmeric extract was applied
twice daily for 3 months. After 15 days, significant improvement
in burning sensation, ulceration, and striae was noted. There was
no adverse effect.[14] In the present study, 30 patients suffering
from lichen planus reported relief in burning sensation after
systemic administration of tablet Turmix and local application
of turmeric and honey 2–3 times daily. However, other clinical
features were not taken into account.
In another study conducted by Srivastava et al. in 2015, effect
of topical application of tulsi and turmeric in treatment of
41 patients of oral submucous fibrosis was noted. Significant
improvement in burning sensation and mouth opening was
seen after monthly visits for 3 months.[22] In this study local
application of turmeric and honey was prescribed twice daily for
15 days in 60 patients of oral submucous fibrosis. The burning
sensation reduced and the P value was significant (<0.001),
which is similar to this study results.
In a study reported by Keshari in 2015, 27 patients suffering
from oral lichen planus were treated with topical curcumin
ointment which was applied thrice daily for 2 weeks. Significant
improvement in erythema, pain and ulceration was noted.[23] In
this study topical application of turmeric and honey was done
twice daily for 15 days by 30 patients suffering from oral lichen
planus. Significant improvement in burning sensation was noted.
In a study done by El Haddad in 2013, significant improvement
was noted in oral lesions. Out of the 19 patients suffering from
10 Journal of Indian Academy of Oral Medicine & Radiology  ¦  Volume 29  ¦  Issue 1  ¦  January‑March 2017
recurrent apthous stomatitis, 92% reported relief in pain in one
day after application of honey. Two patients suffering from
recurrent intraoral herpes reported immediate relief of pain and
complete resolution by 5th day of start of the lesion. Eighteen
patients suffering from atrophic oral lichen planus showed
mild reticulation and resolution in 1–2 months. Four patients
suffering from candidiasis showed no strains of Candida after
histopathological examination which was done after 1 month
of start of treatment. In 2 patients who had oral psoriasis,
complete resolution of erythema was seen after 2 months.[12] In
this study, 60 patients suffering from oral submucous fibrosis,
30 from oral lichen planus, and 10 from speckled leukoplakia
were prescribed topical application of honey 2–3 times daily
for 15 days along with turmeric. Significant improvement in
burning sensation was noted with the median of VAS value
reducing to 4 after treatment which was 7 before treatment.
Limitations of our study
Tablet Turmix and paste of turmeric and honey were used in
combination for this study, and hence, the efficacy of individual
medication could not be determined. Second, out of the many
other signs and symptoms of potentially malignant disorders
only burning sensation was taken into account for determining
the effect of turmeric and honey.
Strengths of our study
Tablet Turmix, turmeric, and honey are easily available
medications and are cost effective too. Hence, a larger section
of patients can avail the benefits. This being a prospective
study with adequate sample size, the results are more reliable.
Conclusion
Curcumin in the form of commercially available tablet Turmix,
turmeric, and honey in combination can be successfully used
in the treatment of burning sensation in potentially malignant
disorders of the oral cavity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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