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Integrative approach for Oral Precancerous Lesions

I was having a conversation with some dentists working in an organization which has lots of healthcare related outreach programs. One of the programs is early detection of cancer or precancerous conditions in rural areas where quid consumption habit is very rampant. precancerous conditions are the lesions that have potential to become cancer. After an early diagnosis, the patients are given standard treatment procedures, but without much success. Their argument was: “what was the benefit of diagnosing the condition early, if the treatment if not effective?” Most of the scientific evidence also points to the fact that treatments for precancerous lesions are not always effective.

The conversion from precancerous to cancer is an unpredictable phenomenon and once the patient knows that he has a precancerous condition in the mouth, he is under constant fear, stress and anxiety about when will it get converted to cancer. This feeling of insecurity and helplessness is more killing than the condition itself.

Most of the time Precancerous oral lesions occur because of habits like smoking, tobacco chewing, gutka consumption etc. Sometimes they also occur due to autoimmune conditions, stress and other lifestyle related conditions. Some of these conditions are Leucoplakia, Oral submucous fibrosis and Oral lichen planus.

In India 10-12% people suffer from oral precancerous conditions. Almost 5 to 7% of these conditions convert themselves into cancer. Oral cancer is one of the top three cancers the Indian population suffer from.
The precancerous conditions do not always resolve, even after the patients quit the habit. Even if they do not convert into cancer, they are a huge morbidity problem in which there is progression in restricted mouth opening in Oral submucous fibrosis and continuous burning and pain in mouth in lichen planus and so on. Inability to eat the food, negatively affect quality of life of the patients.

Can Integration with Ayurveda help?

We may not get exact matching disease name in Ayurveda for various oral lesions but they are explained in detail depending on signs and symptoms that can be roughly correlated with Allopathy nomenclatures. These are Mukhapaka, Mukha arbuda, Sannipataja oshta vyadhi, Vrna, Gandalaji, Dantaveshtaka, Jihva kantaka, Talupaka and many more…

All these diseases have treatment protocols described in Chikitsa sutra in Ayurveda texts. These are again directed towards Dosha imbalance and its restoration.

My own clinical experience says that Ayurveda treatments are very effective. There is scientific evidence for it too. But we need more clinical and research-based data to conclusively talk about efficacy of integrative treatments for precancerous lesions.

If integrative approach can be applied in this matter by combining advanced diagnostic technics to detect cancer/precancerous conditions with combination of Allopathy and Ayurveda treatment protocols, it may be possible to get better results for reversing the premalignant conditions and also prevent its conversion to cancer.

Scientific Evidence

1. Kundan R. Patel, Manjusha Rajagopala, Dharmendrasinh B. Vaghela, and Ashok Shah A pilot study on Ayurvedic management of oral submucous fibrosis Ayu. 2015 Jan-Mar; 36(1): 34–40.

2. Deshpande A, Tandon S, Deshpande N. Low resource screening method of pre-cancerous lesions and its reversal by Triphala in teen-age Indian population. Ayu 2014;35: 160–167.

3. Kaur S, Arora S, Kaur K, Kumar S. The in vitro antimutagenic activity of Triphala—An Indian herbal drug. Food Chem Toxicol 2002;40:527–534.

4. Baliga MS. Triphala, Ayurvedic formulation for treating and preventing cancer: A review. J Altern Complement Med 2010;16:1301–1308.

5. Kaur S, Michael H, Arora S, et al. The in vitro cytotoxic and apoptotic activity of Triphala—An Indian herbal drug. J Ethnopharmacol 2005;97:15–20.

6. Sudarshan R1, Annigeri RG, Sree Vijayabala G. Aloe vera in the treatment for oral submucous fibrosis - a preliminary study.J Oral Pathol Med. 2012 Nov;41(10):755-61. doi: 10.1111/j.1600-0714.2012.01168.x. Epub 2012 May 31.

7. Vasconcelos LC, Sampaio MC, Sampaio FC, Higino JS. Use of Punica granatum as an antifungal agent against candidosis associated with denture stomatitis. Mycoses. 2003;46:192–6. [PubMed]

8. Furletti VF, Teixeira IP, Obando-Pereda G, Mardegan RC, Sartoratto A, Figueira GM, et al. Action of Coriandrum sativum L. essential oil upon oral Candida albicans biofilm formation. Evid Based Complement Alternat Med 2011;2011:985832.

9. Messier C, Epifano F, Genovese S, Grenier D. Licorice and its potential beneficial effects in common oro-dental diseases. Oral Dis 2012;18:32-9.

10. Sumit B, Geetika A. Therapeutic benefits of holy basil (Tulsi) in general and oral medicine: A review. Int J Res Ayurveda Pharm 2012;3(6):761-4.

11. Stuart RW, Lefkowitz DL, Lincoln JA, Howard K, Gelderman MP, Lefkowitz SS. Upregulation of phagocytosis and candicidal activity of macrophages exposed to the immunostimulant, acemannan. Int J Immunopharmacol 1997; 19:75-82.

12. Pipalia, Annigeri , Mehta R. Clinicobiochemical evaluation of turmeric with black pepper and nigella sativa in management of oral submucous fibrosis—a double-blind, randomized preliminary study Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Dec;122(6):705-712

13. Krishna, Makadia et al. ayurvedic management of leukoplakia - a case study. Journal of Ayurveda and Integrated Medical Sciences (ISSN 2456-3110), http://www.jaims.in/index.php/jaims/pages/view/Citation, v. 2, n. 3, p. 296 298, july 2017.

14. Prabhu RV, Prabhu V, Chatra L, Shenai P, Suvarna N, Dandekeri S. Areca nut and its role in oral submucous fibrosis. J Clin Exp Dent. 2014;6(5):e569-75. http://www.medicinaoral.com/odo/volumenes/v6i5/jcedv6i5p569.pdf

15. Srivastava A, Agarwal R, Chaturvedi TP, Chandra A, Singh OP. Clinical evaluation of the role of tulsi and turmeric in the management of oral submucous fibrosis: A pilot, prospective observational study. J Ayurveda Integr Med 2015;6:45‑9.

16. Pawar Parashuram Sahadu, Pawar Sucheta Parashuram. effect of ayurvedic treatment in lichen planus; iamj: Volume 3; Issue 9; September-2015

17. Ratha KK, Barik L, Panda AK, Hazra J. A single case study of treating hypertrophic lichen planus with Ayurvedic medicine. AYU 2016;37:56‑61.

18. Abhijeet AloK1, inDrA Deo Singh2, ShivAni Singh3, MAlliKA KiShore4, PrAKASh ChAnDrA jhA5 Curcumin – Pharmacological Actions And its Role in Oral Submucous Fibrosis: A Review Journal of Clinical and Diagnostic Research. 2015 Oct, Vol-9(10): ZE01-ZE03

19. Vibha Singh, Mahesh Pal,1 Shalini Gupta,2 S. K. Tiwari,1 Laxman Malkunje, and Somdipto Das. Turmeric - A new treatment option for lichen planus: A pilot study Natl J Maxillofac Surg. 2013 Jul-Dec; 4(2): 198–201.

20. Vinay K Hazarey, Aditee R Sakrikar, and Sindhu M Ganvir. Efficacy of curcumin in the treatment for oral submucous fibrosis - A randomized clinical trial; J Oral Maxillofac Pathol. 2015 May-Aug; 19(2): 145–152.

21. Rawson K, Prasad RK, Nair AK, Josephine J. Oral Submucous Fibrosis – The Indian Scenario: Review and Report of Three Treated Cases. J Indian Acad Oral Med Radiol 2017;29:354-7

Dr. Vaibhavi Joshipura

Periodontist (Gum Specialist) MDS, Periodontics/Periodontology, PhD. Periodontics/Periodontology