Curcumin, a polyphenolic compound derived from the spice turmeric, has attracted substantial attention due to its potential therapeutic applications in periodontitis. Its capacity to regulate glucose metabolism, mitigate oxidative stress, and induce anti-inflammatory effects has been demonstrated in a multitude of in vitro studies. Additionally, curcumin has been demonstrated to possess potent antimicrobial and anti-inflammatory properties, both of which are essential for the treatment of periodontitis [1]. Curcumin may exert its beneficial effects in the treatment of periodontitis through the following mechanisms: i) Downregulation of inflammatory mediators, such as tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), which are essential in the pathogenesis of the disease; ii) Inhibition of matrix metalloproteinases (MMPs) and iii) Modulation of the host immune response, thereby restoring the equilibrium between pro- and anti-inflammatory cytokines [2]. In the field of pharmacology, DMC has gained interest due to its potential antimicrobial and anti-inflammatory properties [3]. Periodontal disease is a sustainable inflammatory condition that impacts the tissues supporting the teeth, mostly due to pathogenic microbes in plaque biofilm [4]. The potential therapeutic applications and effects of DMC on periodontal pathogens have been the subject of a limited number of studies. It has been observed that it can inhibit the growth and reduce the viability of bacteria frequently linked to periodontal disease, such as P.gingivalis, Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum [5]. These bacteria are proven to be essential in the advancement and progression of periodontal disease. Evidence indicates that it may inhibit the generation of inflammatory cytokines, such interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6), which play a role in the development of periodontitis [6]. Dental plaque biofilms are complex microbial communities that contribute to periodontal disease. DMC has demonstrated the ability to disrupt and inhibit the formation of biofilms by periodontal pathogens [7]. By inhibiting biofilm formation, DMC may help prevent the establishment and persistence of pathogenic bacteria in the oral cavity. The majority of studies on the role of DMC in periodontal microbiology have been conducted in vitro, employing cell cultures or laboratory models [8].
Multiple clinical trials have examined the effectiveness of curcumin in treating periodontitis, either alone or in conjunction with conventional treatment methods such scaling and root planing (SRP). Curcumin has shown encouraging outcomes by significantly reducing clinical measures, including as probing depth, gingival index, and plaque index, when compared to placebo or conventional treatments [9–11].
In a clinicomicrobiologic randomized trial involving 30 patients, local application of curcumin led to improvement of periodontal parameters within one month [12]. Curcumin inhibited the LPS-induced decrease in OPG/sRANKL ratio and NF-κB activation, and attenuated the production of IL-1β and TNF-α in rat gingival fibroblasts stimulated by Lipopolysaccharide (LPS). In vivo, curcumin substantially reduced gingival inflammation and modulated collagen fibre and alveolar bone loss. Curcumin inhibits NF-κB activation and reduces the OPG/sRANKL ratio induced by LPS, thereby modulating inflammatory activity in rat periodontitis [13]. The injection of curcumin-loaded nanoparticles in Wistar rat models led to a complete inhibition of inflammatory bone resorption, a significant reduction in both osteoclast counts and the inflammatory infiltrate, and a significant attenuation of p38 MAPK and NF-kB activation [14]. A 2% turmeric gel as local delivery agent as an adjunct to SRP was found to be effective in pocket reduction [15]. This 2% formulation was more effective than 1% chlorhexidine gel [16]. A controlled release form of curcumin produced similar clinicomicrobiological results to chlorhexidine [17]. Similar results were obtained in various studies [18–21].
In a systematic review which evaluated different formulations of curcumin showed that in nine studies there was a statistically significant difference in the pocket reduction when curcumin topical gel was used as compared with the control [22]. In contrast, in a meta-analysis, the use of curcumin/turmeric along with SRP showed a statistically significant difference compared to SRP alone. However, this change was deemed clinically insignificant [23].
Although these findings offer useful insights, additional studies are required to assess the effectiveness and safety of DMC in clinical settings and its potential as an adjunct therapy for periodontal disease. Additionally, it is worth considering that DMC bioavailability and stability in the oral cavity need to be carefully addressed to ensure effective delivery and penetration into periodontal tissues [24]. Clinical studies are required to determine optimal dosages, formulations, and modes of administration for DMC in the context of periodontal microbiology. DMC has been studied for its potential effects against P.gingivalis, a bacterium commonly associated with periodontal diseases such as gingivitis and periodontitis [25]. It has been shown to inhibit the growth and viability of this bacterium in laboratory studies. The exact mechanisms of its antibacterial effects are not fully understood, but they are believed to involve the disruption of bacterial cell membranes and interference with bacterial enzyme activity. P.gingivalis produces various virulence factors that contribute to its ability to colonize and penetrate the gingival epithelium. DMC has been shown to hinder the synthesis and function of various virulence factors, such as proteases and fimbriae [26]. By inhibiting these factors, DMC may help attenuate the pathogenicity of P.gingivalis and reduce its ability to cause tissue damage. It demonstrates anti-inflammatory effects by decreasing the production of pro-inflammatory cytokines including interleukin-1 beta (IL-1β) and interleukin-6 (IL-6), that have a role in the inflammatory process linked to P.g-induced periodontal destruction [27].
Further research, including well-designed clinical trials, is needed to validate these findings and determine the optimal dosage, formulation, and mode of administration for DMC in the context of P.gingivalis-associated periodontal destruction. DMC has demonstrated potential as a local drug delivery agent for the treatment of periodontitis, a persistent immuno-inflammatory condition. Local drug delivery involves the delivery of therapeutic agents directly to the site of infection or inflammation to enhance their effectiveness. DMC demonstrates anti-inflammatory properties that can help in controlling the inflammation linked to periodontitis [28]. By delivering DMC directly to the affected periodontal tissues, it may help reduce inflammation and prevent further tissue damage. DMC has been shown to possess antibacterial properties against periodontal pathogens, including P.gingivalis, which is a key bacterium associated with periodontitis. The local drug delivery of DMC may help inhibit the growth and activity of these pathogenic bacteria, aiding in the control of the infection [29]. Periodontitis involves an immune response that can contribute to tissue destruction. DMC modifies the host immune response by diminishing the generation of pro-inflammatory cytokines while promoting anti-inflammatory responses. Local delivery of DMC may help regulate the immune response in the periodontal tissues, promoting healing and reducing tissue damage [30]. Utilizing DMC as a local drug delivery agent allows for controlled release of the compound at the site of infection or inflammation. This sustained release can help maintain the therapeutic levels of DMC over an extended period, maximizing its effectiveness in treating periodontitis [31]. The administration technique for DMC in periodontal therapy can vary depending on the chosen formulation. For example, if a gel formulation is used, it may be applied topically to the affected periodontal tissues using a syringe or an applicator. The dental professional will provide specific instructions on the proper administration technique to ensure the optimal delivery and distribution of DMC. The treatment duration and frequency of DMC usage should be determined by the dental professional based on the individual's condition and response to treatment [32]. The optimal usage of DMC in periodontal therapy also relies on patient compliance [33]. Patients should follow the instructions provided by the dental professional, including proper application techniques, adherence to the recommended treatment schedule, and maintenance of good oral hygiene practices. It is important to note that the specific recommendations for DMC usage in periodontal therapy may vary based on the latest research findings and individual patient needs. Therefore, it is crucial to consult with a dental professional for personalized advice and guidance.
It is important to note that while DMC shows promise as an antimicrobial agent in laboratory studies, its efficacy and safety in clinical settings are still being investigated [34]. Further research, including in vivo and clinical trials, is necessary to determine its potential therapeutic applications against microbial infections. Additionally, the formulation, concentration, and delivery methods of DMC need to be optimized to enhance its antimicrobial activity and bioavailability [35]. It is important to note that while DMC shows promise as a local drug delivery drug in periodontitis, further research is needed to establish its efficacy, safety, and optimal delivery methods [36]. Clinical studies are necessary to evaluate the appropriate dosages, formulations, and techniques for local administration of DMC in periodontal therapy [37]. DMC can be formulated into various delivery systems, including gels, nanoparticles, liposomes, or microspheres. The choice of formulation depends on factors such as the desired release profile, ease of application, and stability of DMC [38]. The selection of an appropriate delivery system should be based on scientific evidence and expertise of the dental professional [39]. In conclusion, the current body of evidence indicates that curcumin has the potential to be a promising adjunctive therapy for the treatment of diabetes-associated periodontitis. Curcumin is an attractive candidate for the treatment of this severely debilitating condition due to its antioxidant, antimicrobial, and anti-inflammatory properties, as well as its capacity to regulate the host immune response. In order to optimize the delivery and administration of curcumin in the clinical setting and to elucidate the precise mechanisms of action, additional research is necessary. This study hypothesized that DMC could be an effective local drug delivery method specifically for periodontitis through its action against P.gingivalis and by modulating inflammatory responses in oral fibroblasts. Nevertheless, while this study focuses on molecular docking, it is important to acknowledge the limits in the in-vivo environment that impact the drug circulation, sustainability, release kinetics and elimination. These limitations can be better understood through conducting appropriate animal trials.