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Eectiveness of natural lip balm cinnamon (Cinnamomum burmannii) in accelerating (Damayanti. et al)
(Cinnamomum burmannii
rattus norvegicus
1*22
1
Cinnamomum burmannii is commonly used in the treatment and is thought to be an anti-
inammation medicinal herb that may hasten recovery. Lip wound healing is a critical need for aesthetic
performance. The purpose of this study is to evaluate the ecacy of natural lip balm C. Burmannii
has been shown to speed up the healing of incision wounds in rats (Rattus norvegicus). This
research was carried out in the laboratory biomedical Faculty of Medicine, Universitas Islam Bandung.
In twenty-seven male rats weighing 200-300 g, a lip mucous incision of 10 mm length and 4 mm depth
was surgically created. Simple random sampling was used to divide the animals into three treatment
groups based on wound treatment after lip incision (The control group applied distillation water, the rst
group applied a lip balm placebo/base, and the second group applied natural lip balm C. burmannii) and
then divided into three observation times (days 3rd, 7th, and14th). A lip biopsy was performed during each
observation time to determine the success of the therapy. The macroscopic examination was carried out
by counting the number of lip wounds that were closed around, while the microscopic examination was
carried out by counting epithelialization with a Leica microscope and image raster software. The
length of the lip wound has greatly decreased in the C. Burmannii group with a p-value of 0,048 (p<0.05,
and epithelialization was comparable across the board. The use of Cinnamomum burmannii
natural lip balm is eective in accelerating lip wound healing by bringing the lip wound closer together.
Eectiveness of Natural lip balm Cinnamon (Cinnamomum burmannii) in accelerating the incision wound
healing process in Rattus norvegicus.
lip balm; cinnamomum burmannii; wound; epithelialization; healing process
p-ISSN: 1979-0201; e-ISSN: 2549-6212; Available from: http://jurnal.unpad.ac.id/pjd/article/view/9593
DOI: 10.24198/pjd.vol34no3.9593
Submission: May 28, 2022; Accepted: Nov 31, 2022; Published online: Nov 31, 2022
*Corresponding author: Meta Maulida Damayanti, Department of Pathology Anatomy, Faculty of Medicine, Universitas Islam
Bandung, Indonesia. Jalan Taman Sari 20, West Java, Indonesia, 40116. Phone: +6281395014778; Email: meta_md@unisba.
ac.id. Email: meta_md@unisba.ac.id
Wound healing is an essential survival mechanism
that is sometimes disregarded. The research on
interrupted wound healing is limited, and there is
no standard categorization for wound healing in the
oral region. Wound healing is made up of a series
of intricate biological processes. To complete the
224
Padjadjaran Journal of Dentistry 2022; 34(3): 223-231.
healing process with the fewest possible scars, all
tissues follow an almost identical pattern.
The outcome of wound healing in the
oral cavity might dier from that of a clinically
healed wound. Wound healing occurs in the mouth
cavity, which is a unique environment hosting
millions of microorganisms. In the oral cavity,
lesion healing can range from a clinically healed
wound with minimal scarring and histologically
normal connective tissue beneath epithelial
cells to severe trismus induced by brosis. Oral
wound healing is inuenced by a variety of local
and general variables, and a better knowledge
of these aspects can aid in addressing diculties
that contribute to poor oral wound healing.1
There are slight dierences in wound
healing in the skin and oral mucosal areas. Oral
and cutaneous wound closure and inammatory
responses can be stimulated by human saliva. As a
result, saliva might be a promising new treatment
option for open skin wounds.2 Wound healing is a
multi-step mechanism that improves the structure
and function of injured tissues. Multiple growth
factors and cytokines produced at the wound site
regulate the process precisely. Any modications
that impede the healing process might accelerate
tissue injury and prolong the repair process.
Infections, underlying disorders, and drugs can all
lead to poor wound healing.3 Bioactive chemicals
present in foods and medicinal plants are appealing
molecules for the creation of novel medications to
treat various degrees of diseases, including those
connected with inammatory processes, which
are frequently linked to oxidative stress.4
Natural compounds having anti-
inammatory, antioxidant, antibacterial, and pro-
collagen synthesis capabilities have been studied
extensively as wound healing agents. In developing
countries, traditional medicine is used by 80% of
the population to manage fundamental medical
concerns. As a result, research has lately been done
to identify novel eective, and safe therapeutic
compounds derived from natural sources for the
management of a range of ailments. For many
years, indigenous plants have been employed for
this purpose by many tribes all over the world.5
Cinnamon (Cinnamomum spp., Lauraceae family)
refers to a group of about 250 evergreen trees
native to Asia, China, and Australia. Burmannii
Cinnamon (also called Korintje, Java, or Indonesian
cinnamon). Cinnamon extracts and essential oils
have been obtained from several sections of the
plant, including the leaves, bark, fruits, root
bark, owers, and buds. There are more than 80
compounds known, and their compositions change
owing to a variety of variables.
Cinnamomum spp. Main Constituents and
Antibacterial Properties Against Oral Pathogens.
The primary ingredient of cinnamon EO and
extracts was reported to be trans-Cinnamaldehyde
(t-Cinnamaldehyde or (E)-Cinnamaldehyde).
Cinnamon’s organoleptic and antibacterial
characteristics are mostly due to this molecule.
Although it is generally associated with clove,
eugenol is another potent component found in
cinnamon essential oil. Its powerful antibacterial
qualities may have a key impact on dental
health because it is one of the most prevalent
components in cinnamon EO and extracts. Linalool,
β-Caryophyllene.6 Cinnamon is widely used in
medicine and is proven as an antihyperlipidemic,
immunomodulatory, antihypercholesterolemic,
and analgesic.7,8 ,9,10
Lip balm is a type of wax that is applied
to the lips as a moisturizer to keep them from
drying out and cracking. Lip moisturizers are
widely used in situations when protection is
required, such as when the air humidity is low
or the temperature is too low to prevent water
evaporation and mucosal epithelial cells on lips.
Because of the weak protective function, the lips
are particularly vulnerable to external impacts,
such as excessive heat, which can cause the lips to
become dry, chapped, and dull-colored Lip salve
is a cosmetic preparation manufactured with the
same foundation as lipstick, although there are
signicant variations between the lipstick and a
lip moisturizer that are mostly functional.
Lip balm creation employing the most natural
materials possible and formulation assessment
These natural ingredients and safer alternatives
to synthetic excipients were used to eectively
construct a lip balm formulation.11,12 Natural
materials are now strongly suggested for medical
therapy since they are safer and less expensive.
Cinnamon has previously been used as a medicine
to reduce urea levels, repair chronic inammation,
antidepressant, and treat liver damage.13,14,15
Cinnamon is used as a treatment because it
contains active chemicals. Cinnamaldehyde and
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Eectiveness of natural lip balm cinnamon (Cinnamomum burmannii) in accelerating (Damayanti. et al)
coumarin were important chemicals with anti-
inammatory and antibacterial eects.16 Other
research has not employed cinnamon as a wound
healing material in the face area, which demands
not just rapid but also aesthetically good healing
materials. Therefore, we conducted this study to
analyze the eectiveness of natural lip balm C.
Burmannii to accelerate the lip wound healing
process in rats (Rattus norvegicus).
27 adults male Wistar rats, weighing between
200 and 300g. The animals were kept in regular
animal laboratory housing with free access to
standard food and unlimited access to water in
this environment, and they were given a week to
get acclimated to the environment. Animals were
divided into three treatment groups based on
the method used to treat lip wounds (the control
group was given distilled water, group 1 was
given placebo lip balm, and group 2 was given C.
burmannii); and nally, each treatment group was
divided into three observation time groups (Day 3,
7, and 14). Ketamine (50 mg/kg BW) was injected
intramuscularly to induce anesthesia in the rats.
A scalpel that measured 10mm in length and 4mm
in depth was used to make an incision on the
animal’s lower lip. The lower lip of the animal was
incision with a scalpel of 10mm in length and 4mm
in depth. Each group received dierent materials
for treatment. The control group used distilled
water, the rst group used a placebo (basic) lip
balm, and the second group used C. burmannii
natural lip balm. All of the wound incisions were
to be covered by the daily therapy material given
to the lip incision area. Using a digital camera
and a ruler as a scale, the lip incision sites were
photographed on the intervention day and at the
end of each observation period. At the end of the
research, image raster software examined the
images from each day.
All animals were sacriced the day of each
observation period, and the lip tissues around the
incision were collected. Each sample was cut into
pieces and preserved in 10% formalin to assess
histological changes.
Cinnamon plants were obtained from the
Surakarta plantation which had been tested for
plant determination at the ITB School of Life
Science and Technology with registration number
1282/IT1.C11.2/TA.00/2022. Nature lip balm C.
Burmannii was made with the composition of 45g
olive oil, 24g candelilla wax, and 45g cupuaçu
butter, then put in a water bath at 100 °C to
form a homogeneous mixture called the base.
Furthermore, up to 18 grams of cinnamon leaf
powder are added. Once homogenous, pour into a
lip balm molds tube and use a universal indicator
to determine the pH of the liquid. To stabilize the
lip balm, let the liquid at room temperature for 48
hours until completely solidied.
Ulcer length was measured with a ruler and
photo analyses by image raster software. All
measurements were performed by the same
operator. Ulcer length was evaluated on day 3,
day 7, and day 14 by camera handphone with
specication 50MP, 10x optical zoom (Samsung S22
ultra).
The animals were put to sacrice on days 3, 7,
and 14 so that lower lip samples could be taken
for histological analysis. The specimens were
rapidly xed in 10% neutral buered formalin for
at least 24 hours. Using the standard method,
the xed specimens were embedded in paran.
The prepared paran blocks were divided into
pieces that were 5 m thick. These sections were
stained with hematoxylin and eosin. Using a
Leica microscope and image raster software,
the microscopic study was evaluated by counting
epithelialization and the macroscopic analysis
by counting lip wounds closer. At 100 and 400
times magnication, tissue images were taken. In
addition to that, pathologists do analysis in ve
dierent elds of view.
The relationship between the ulcer length and
epithelialization variation from 9 experimental
groups was analyzed using Kruskal Wallis
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Padjadjaran Journal of Dentistry 2022; 34(3): 223-231.
C
Day-3 0.9 1 0.9
Day-7 0.9 0.9 0.9 0.368
Day-14 0.9 0.9 0.9
G1
Day-3 1 0.9 0.9
Day-7 0.9 0.8 0.8 0.056
Day-14 0.8 0.8 0.8
G2
Day-3 0.7 0.6 0.7
Day-7 0.7 0.6 0.6 0.048
Day-14 0.5 0.4 0.4
correlation analysis (SPSS 26 software) and p<0.05
showed statistical signicance.The Faculty of
Medicine Unisba’s ethics committee granted
approval for all animal research in accordance with
the Laboratory Animal Ethics ARRIVE guidelines
2.0 (001/KEPK-Unisba/II/2022).
In this study, the healing process of the rat’s lip in
each group was evaluated, and the results showed
a considerable accelerating activity related to
Cinnammomun burmannii lip balm compared to
the placebo lip balm and control group. The lip
healing area was signicantly reduced in natural
lip balm C. Burmanii treated (P<0.05) (Table 1).
There was a signicant lip wound closer
(p<0.05) in a group with natural lip balm C.
Burmannii application. The length of the ulcer
decreased by observation time among a group
(Figure 1).There was no signicant change in
epithelial length in all groups. Signicant changes
E
G
Eectiveness of natural lip balm cinnamon (Cinnamomum burmannii) in accelerating (Damayanti. et al)
were seen on the third and seventh days of
observation. Table 2 shows the results of measuring
the thickness of epithelialization. Based on the
treatment group, the average thickness in group
2 was better than the control group and placebo,
but not statistically signicant. Based on the time
E
G
E
G
228
Padjadjaran Journal of Dentistry 2022; 34(3): 223-231.
of observation on the 3rd and 7th day, there were
signicant dierences between the groups.
This present study showed natural lip balm
C. Burmannii signicantly accelerates lip
wound healing by decreasing the length of lip
wounds. Direct apposition of the epithelium to
underlying collagen-dense connective tissue.
Despite substantial structural and physiological
similarities, skin and mouth mucosa recover in
radically dierent ways in response to damage.
The oral mucosa has a proclivity for quick
restoration of barrier function with minimal
underlying brosis, whereas skin heals slowly and
scars accumulate. Matricellular proteins, which
modulate cell activity, have been found to play
important roles in cutaneous healing, although
their involvement in oral mucosa repair is unclear.
Wounds in the oral mucosa have been proven to heal
substantially quicker and with less scar formation
than skin wounds. This nding is accompanied
by a decreased inammatory response, which
can be attributable to a decrease in neutrophil
recruitment, and pro-inammatory cytokines. The
G1 G2
Day-3
0.04 0.11 0.18
0.0270.06 0.08 0.15
0.07 0.11 0.3
Day-7
0.06 0.07 0.23
0.0380.09 0.14 0.15
0.05 0.14 0.25
Day-14
0.13 0.19 0.13
0.1480.07 0.19 0.4
0.16 0.3 0.24
P value 0.807 0.663 0.397
E
G
229
Eectiveness of natural lip balm cinnamon (Cinnamomum burmannii) in accelerating (Damayanti. et al)
pathology of inammation is initiated by complex
processes triggered by wound lip incision. The
ulcer can directly activate macrophages, which
trigger the production of inammatory mediators.
The pharmacological reduction of herbal medicine
inammatory mediators is regarded as one of
the necessary conditions to alleviate various
disorders caused by macrophage activation. C.
Burmannii is used as an anti-inammatory drug.
Cinnamaldehyde, the principal constituent of leaf
C. Burmannii.
Cinnamaldehyde has been demonstrated to
exhibit antibacterial activities. However, many
of the molecular pathways that contribute to
lip healing being quicker than skin healing are
still unknown. In recent years, several research
has revealed that the extracellular matrix (ECM)
composition is an important element in soft tissue
healing. Matricellular proteins, in particular,
have received a lot of attention recently due to
their role in direct cell behavior modication by
periostin as a possible treatment to promote soft
tissue repair or decrease brosis.17,18
In the current investigation, we discovered
that cinnamaldehyde signicantly enhanced the
epithelialization of lip incisions in rats while
lowering pro-inammatory markers. Wound healing
necessitates a well-coordinated combination of
numerous biological and molecular activities.
Angiogenesis is a vital phase in wound healing
because it regenerates blood vessels and allows
for the oxygen supply required to encourage repair
and vessel development. Angiogenesis is a series
of processes that results in the development of
new blood vessels from the pre-existing vascular
network and is critical in wound healing.
For treatment, traditional medicinal herbs
and pure chemicals extracted from plants have
been employed. C. Burmannii contains the active
chemicals cinnamaldehyde and coumarin, which
serve as angiogenesis promoters. The possible
method involves increasing VEGF secretion and
activating both the PI3K/AKT and MAPK signaling
pathways.19,20,21
These ndings are similar to those of
Khadeeja M Ali et al, who show that administration
inhibited proinammation production, enhanced
anti-inammatory markers IL-1β and TNF-α, and
oxidative stress minimized the increase in the
level in experimental animal models.22 Clinical
studies performed by several researchers have
demonstrated the application of medicinal plants
to accelerate the healing process with anti-
inammatory eects by their bioactivity abilities
to promote wound healing and prevent infection
without grave side eects.23,24,25,26 According
to another study, cinnamaldehyde eectively
inhibited ox-LDL-induced vascular smooth muscle
cells (VSMCs) proliferation, migration, and
inammatory cytokine overproduction, as well as
foam cell formation in VSMCs and macrophages.27
It has been demonstrated in several research
with other animals that epithelialization
increases. Amin Daemi et al. in 2019 used topical
Cinnamomum verum increased wound healing and
may be used to treat diabetes patients’ wounds.28
On the other hand, the present study showed, the
length of epithelialization was not signicantly
dierent among a group. It should be noted that
this research used an animal model. However,
there are inherent limitations in any animal model
of human illness; in comparison to human lip
inammation, the experimental inammation’s
duration of the disease is brief and follows an
acute phase.
Our nding indicates that the application of
the natural lip balm Cinnamomum burmannii is
eective to accelerate lip wound healing by faster
lip wound closer.
This study was funded by the Faculty of Medicine
Universitas Islam Bandung and many thanks to
the laboratory biomedical and the sta for their
assistance in animal handling. Moreover, the
authors would like to extend gratitude to the
department of pathology anatomy for histological
analyses.
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