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VOLUME 25 , ISSUE 10 ( October, 2024 ) > List of Articles

ORIGINAL RESEARCH

Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial

Nandhini Balasundaram, Aswath Narayanan MB, Leena Selvamary Arul Antony, Ramesh Kumar SG, Sujatha Anandan

Keywords : Adjuvant, Fenugreek, Leukoplakia, Lichen planus, OPMDs, OSMF, Trigonella

Citation Information : Balasundaram N, MB AN, Antony LS, SG RK, Anandan S. Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial. J Contemp Dent Pract 2024; 25 (10):921-929.

DOI: 10.5005/jp-journals-10024-3773

License: CC BY-NC 4.0

Published Online: 13-01-2025

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim: This study aimed to evaluate the effectiveness of fenugreek as an adjuvant in managing oral potentially malignant disorders (OPMDs), specifically leukoplakia, lichen planus, and oral submucous fibrosis (OSMF). Materials and methods: Twenty-one participants prediagnosed with OPMDs were randomly divided into a study group (SG) and a control group (CG), with 10 participants in SG and 11 in CG, respectively. The SG received 2 gm of fenugreek as an adjuvant with standard systemic treatments tailored to the respective lesions: intralesional injection of vitamin A 1,00,000 IU (Aquasol A) and topical application of triamcinolone acetonide 0.1% (Kenacort) for 2 months for leukoplakia. Subjects with oral lichen planus were administered prednisolone 5 mg/day (Wysolone), chlorhexidine mouthwash 0.2% (Peridex), and Zincovit once daily for 8 weeks. For subjects with OSMF, one capsule of SM Fibro once daily for 12 weeks along with dexamethasone 1.5 mL (Decadron) was given, and hyaluronidase 1,500 IU (Hynidase) with 0.5 mL lignocaine HCL (Xylocaine) was injected intralesionally biweekly and mouth exercise was advised for 2 months; control group received only the standard treatment. Sociodemographic data were collected, and clinical assessments, evaluating size and shape for leukoplakia, erythema, and burning sensation for oral lichen planus, and mouth opening, cheek flexibility, and burning sensation for OSMF were assessed from baseline through 2 months. Data collected were organized in Excel and analyzed using Statistical Package for the Social Sciences version 21.0. Results: The SG and CG had 10 and 11 participants, with 4 in each group for leukoplakia, 2 participants in SG and 3 in CG for lichen planus, and 4 participants for OSMF in each group, respectively. Most participants presented with leukoplakia under 2 cm on the buccal mucosa bilaterally, with no significant changes in size or shape postintervention. For lichen planus, mild erythema and burning sensation were noted, but there were no significant differences within or between groups postintervention. A mild burning sensation, a statistically significant improvement in mouth opening was observed in SG (p < 0.051) when compared with CG after 8 weeks postintervention in OSMF. Also, significant improvement in cheek flexibility was noted from baseline to the fourth follow-up in SG post intervention. However, there were no differences between groups during the follow-up period. Conclusion: The findings from this trial suggest that SG showed significant improvement in OSMF than CG, whereas the improvements in leukoplakia and lichen planus remained same in both groups. Clinical significance: Fenugreek, being a cost-effective and affordable agent known for its anticancer, anti-inflammatory, antioxidant, and antiulcerative properties, could be used as an adjuvant for its management in OPMDs.


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  1. Mortazavi H, Baharvand M, Mehdipour M. Oral potentially malignant disorders: An overview of more than 20 entities. J Dent Res Dent Clin Dent Prospects 2014;8(1):6−14. DOI: 10.5681/joddd.2014.002.
  2. Ren ZH, Hu CY, He HR, et al. Global and regional burdens of oral cancer from 1990 to 2017: Results from the global burden of disease study. Cancer Commun 2020;40(2−3):81−92. DOI: 10.1002/cac2.12009.
  3. Yardimci G, Kutlubay Z, Engin B, et al. Precancerous lesions of oral mucosa. World J Clin Cases 2014;2(12):866−872. DOI: 10.12998/wjcc.v2.i12.866.
  4. Warnakulasuriya S, Kujan O, Aguirre-Urizar JM, et al. Oral potentially malignant disorders: A consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Dis 2021;27(8):1862−1880. DOI: 10.1111/odi.13704.
  5. Masthan KM, Babu NA, Sankari SL, et al. Leukoplakia: A short review on malignant potential. J Pharm Bioallied Sci 2015;7(Suppl 1):S165−S166. DOI: 10.4103/0975-7406.155890.
  6. Sridharan G. Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India. Indian J Cancer 2014;51(1):80−85. DOI: 10.4103/0019-509X.134651.
  7. González-Moles MÁ, Warnakulasuriya S, González-Ruiz I, et al. Worldwide prevalence of oral lichen planus: A systematic review and meta-analysis. Oral Dis 2021;27(4):813−828. DOI: 10.1111/odi.13323.
  8. Varghese SS, George GB, Sarojini SB, et al. Epidemiology of oral lichen planus in a cohort of South Indian population: A retrospective study. J Cancer Prev 2016;21(1):55−59. DOI: 10.15430/JCP.2016.21.1.55.
  9. Kerr AR, Warnakulasuriya S, Mighell AJ, et al. A systematic review of medical interventions for oral submucous fibrosis and future research opportunities. Oral Dis 2011;17:42−57. DOI: 10.1111/j.1601-0825.2011.01791.x.
  10. Ganesh D, Sreenivasan P, Öhman J, et al. Potentially malignant oral disorders and cancer transformation. Anticancer Res 2018;38(6):3223−3229. DOI: 10.21873/anticanres.12587.
  11. Lorini L, Bescós Atín C, Thavaraj S, et al. Overview of oral potentially malignant disorders: From risk factors to specific therapies. Cancers 2021;13(15):3696. DOI: 10.3390/cancers13153696.
  12. Lodi G, Franchini R, Warnakulasuriya S, et al. Interventions for treating oral leukoplakia to prevent oral cancer. Cochrane Database Syst Rev 2016;7(7):CD001829. DOI: 10.1002/14651858.CD001829.pub4.
  13. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: A literature review and update. Arch Dermatol Res 2016;308(8):539−551. DOI: 10.1007/s00403-016-1667-2.
  14. Aara A, Satishkumar GP, Vani C, et al. Comparative study of intralesional dexamethasone, hyaluronidase and oral pentoxifylline in patients with oral submucous fibrosis. Glob J Med Res 2012;12(7):1−4. DOI:10.13140/RG.2.2.19209.88162.
  15. Shen YW, Shih YH, Fuh LJ, et al. Oral submucous fibrosis: A review on biomarkers, pathogenic mechanisms, and treatments. Int J Mol Sci 2020;21(19):7231. DOI: 10.3390/ijms21197231.
  16. Danaraddi S, Koneru A, Hunasgi S, et al. Natural ways to prevent and treat oral cancer. J Oral Res Rev 2014;6(1):34−39. DOI: 10.4103/2249-4987.140213.
  17. Chakravarthy PK, Smriti K, Yeturu SK. Role of herbal and natural products in the management of potentially malignant oral disorders. Nat Oral Care Dental Therapy 2020;30:61−79. DOI: 10.1002/9781119618973.ch4.
  18. Salehi B, Lopez-Jornet P, López E, et al. Plant-derived bioactives in oral mucosal lesions: A key emphasis to curcumin, lycopene, chamomile, aloe vera, green tea and coffee properties. Biomolecules 2019;9(3):106. DOI: 10.3390/biom9030106.
  19. Daga D, Singh RK, Pal US, et al. Efficacy of oral colchicine with intralesional hyaluronidase or triamcinolone acetonide in the Grade II oral submucous fibrosis. Natl J Maxillofac Surg 2017;8(1):50−54. DOI: 10.4103/njms.NJMS_5_17.
  20. Desai KM, Hallikermath S, Kale A. Spirulina: An emerging treatment modality for the management of oral submucous fibrosis. Int J Oral Care Res 2011;5:328−331. DOI: 10.5005/jp-journals-10051-0125.
  21. Warner BM, Casto BC, Knobloch TJ, et al. Chemoprevention of oral cancer by topical application of black raspberries on high at-risk mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118(6):674−683. DOI: 10.1016/j.oooo.2014.09.005.
  22. Yadav UC, Baquer NZ. Pharmacological effects of Trigonella foenum-graecum L. in health and disease. Pharm Biol 2014;52(2):243−254. DOI: 10.3109/13880209.2013.826247.
  23. Sundaram G, Ramakrishnan T, Parthasarathy H, et al. Fenugreek, diabetes, and periodontal disease: A cross-link of sorts! J Indian Soc Periodontol 2018;22(2):122−126. DOI: 10.4103/jisp.jisp_322_17.
  24. Van der Waal I, Schepman KP, Van der Meij EH. A modified classification and staging system for oral leukoplakia. Oral Oncol 2000;36(3):264−266. DOI: 10.1016/s1368-8375(99)00092-5.
  25. Chainani-Wu N, Silverman Jr S, Reingold A, et al. Validation of instruments to measure the symptoms and signs of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105(1):51−58. DOI: 10.1016/j.tripleo.2007.06.022.
  26. Mishra G, Ranganathan K. An overview of classification schemes for oral submucous fibrosis. J Oral Maxillofac Pathol 2006;10:55−58.
  27. Patil S, Maheshwari S. Proposed new grading of oral submucous fibrosis based on cheek flexibility. J Clin Exp Dent 2014;6(3):e255−e258. DOI: 10.4317/jced.51378.
  28. World Health Organization. WHO monographs on selected medicinal plants. WHO consultation on selected medicinal plants, WHO consultation on selected medicinal plants (2nd: 1999: Ravello-Salerno, Italy), WHO consultation on selected medicinal plants (3rd: 2001: Ottawa, Ont) & WHO consultation on selected medicinal plants (4th: 2005: Salerno-Paestum, Italy) [Internet]. World Health Organization. 2006. Available from: https://iris.who.int/handle/10665/42052.
  29. Richards D. Prevalence of oral potentially malignant disorders. Evid Based Dent 2018;19(4):120−121. DOI: 10.1038/sj.ebd.6401348.
  30. Mohammed F, Fairozekhan AT. Oral leukoplakia. Treasure Island, FL: StatPearls Publishing; 2020.
  31. Rao NR, Villa A, More CB, et al. Oral submucous fibrosis: A contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J Otolaryngol Head Neck Surg 2020;49(1):3. DOI: 10.1186/s40463-020-0399-7.
  32. El-Naggar AK, Chan JK, Takata T, et al. The fourth edition of the head and neck World Health Organization blue book: Editors’ perspectives. Hum Pathol 2017;66:10−12. DOI: 10.1016/j.humpath. 2017.05.014.
  33. Tewari D, Jóźwik A, Łysek-Gładysińska M, et al. Fenugreek (Trigonella foenum-graecum L.) seeds dietary supplementation regulates liver antioxidant defense systems in aging mice. Nutrients 2020;12(9):2552. DOI: 10.3390/nu12092552.
  34. Raju J, Patlolla JM, Swamy MV, et al. Diosgenin, a steroid saponin of Trigonella foenum-graecum (fenugreek), inhibits azoxymethane-induced aberrant crypt foci formation in F344 rats and induces apoptosis in HT-29 human colon cancer cells. Cancer Epidemiol Biomarkers Prev 2004;13(8):1392−1398. PMID: 15298963.
  35. Verma SK, Singh SK, Mathur A. In vitro cytotoxicity of Calotropis procera and Trigonella foenum-graecum against human cancer cell lines. J Chem Pharm Res 2010;2:861–865.
  36. Khalil MI, Ibrahim MM, El-Gaaly GA, et al. Trigonella foenum (fenugreek) induced apoptosis in hepatocellular carcinoma cell line, HepG2, mediated by upregulation of p53 and proliferating cell nuclear antigen. Biomed Res Int 2015;2015:914645. DOI: 10.1155/2015/914645.
  37. Shabbeer S, Sobolewski M, Anchoori RK, et al. Fenugreek: A naturally occurring edible spice as an anticancer agent. Cancer Biol Ther 2009;8(3):272−278. DOI: 10.4161/cbt.8.3.7443.
  38. Alshatwi AA, Shafi G, Hasan TN, et al. Fenugreek induced apoptosis in breast cancer MCF-7 cells mediated independently by fas receptor change. Asian Pac J Cancer Prev 2013;14(10):5783−5788. DOI: 10.7314/apjcp.2013.14.10.5783.
  39. Alsemari A, Alkhodairy F, Aldakan A, et al. The selective cytotoxic anti-cancer properties and proteomic analysis of Trigonella foenum-graecum. BMC Complement Altern Med 2014;14(1):1−9. DOI: 10.1186/1472-6882-14-114.
  40. Hibasami H, Moteki H, Ishikawa K, et al. Protodioscin isolated from fenugreek (Trigonella foenum-graecum L.) induces cell death and morphological change indicative of apoptosis in leukemic cell line H-60, but not in gastric cancer cell line KATO III. Int J Mol Med 2003;11:23–26. PMID: 12469212.
  41. Al-Daghri NM, Alokail MS, Alkharfy KM, et al. Fenugreek extract as an inducer of cellular death via autophagy in human T lymphoma Jurkat cells. BMC Complement Altern Med 2012;12(1):1−8. DOI: 10.1186/1472-6882-12-202.
  42. Azari O, Kheirandish R, Shojaeepour S. Protective effect of fenugreek seeds (Trigonella foenum-graecum) extract against experimental gastric ulcer in rats. Comp Clin Pathol 2014;23:1743−1748. DOI: 10.1007/s00580-014-1980-0.
  43. Tavakoly R, Maracy MR, Karimifar M, et al. Does fenugreek (Trigonella foenum-graecum) seed improve inflammation, and oxidative stress in patients with Type 2 diabetes mellitus? A parallel group randomized clinical trial. Eur J Integr Med 2018;18:13−17. DOI: 10.1016/j.eujim.2018.01.005.
  44. Emtiazy M, Oveidzadeh L, Habibi M, et al. Investigating the effectiveness of the Trigonella foenum-graecum L. (fenugreek) seeds in mild asthma: A randomized controlled trial. Allergy Asthma Clin Immunol 2018;14:1−8. DOI: 10.1186/s13223-018-0238-9.
  45. Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenum-graecum L.) on blood lipids, blood sugar and platelet aggregation in patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids 1997;56(5):379−384. DOI: 10.1016/s0952-3278(97)90587-1.
  46. Srivastava A, Singh Z, Verma V, Choedon T. Potential health benefits of fenugreek with multiple pharmacological properties. In: Information Resources Management Association, editor. Research Anthology on Recent Advancements in Ethnopharmacology and Nutraceuticals. Hershey (PA): IGI Global; 2022. pp. 672–687.
  47. Setti K, Kachouri F, Hamdi M. Improvement of the antioxidant activity of fenugreek protein isolates by Lactococcus lactis fermentation. Int J Pept Res Ther 2018;24(4):499−509. DOI: 10.1007/s10989-017-9636-y.
  48. Ruwali M. Trigonella foenum-graecum (fenugreek) as a potential cancer chemo-preventive agent. Austin J Biotechnol Bioeng 2014;1(6):2.
  49. Jagadeesan J, Nandakumar N, Rengarajan T, et al. Diosgenin, a steroidal saponin, exhibits anticancer activity by attenuating lipid peroxidation via enhancing antioxidant defense system during NMU-induced breast carcinoma. J Environ Pathol Toxicol Oncol 2012;31(2):121−129. DOI: 10.1615/jenvironpatholtoxicoloncol.v31.i2.40.
  50. Goyal S, Gupta N, Chatterjee S. Investigating therapeutic potential of Trigonella foenum-graecum L. as our defense mechanism against several human diseases. J Toxicol 2016;2016:1250387. DOI: 10.1155/2016/1250387.
  51. Amudhan A, Aishwarya V, Amudhan A. Management of oral submucous fibrosis – An update. Eur J Mol Clin Med 2020;7(5):1380−1392.
  52. Ahmad A, Alghamdi SS, Mahmood K, et al. Fenugreek a multipurpose crop: Potentialities and improvements. Saudi J Biol Sci 2016;23(2):300−310. DOI: 10.1016/j.sjbs.2015.09.015.
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