Periodontitis and Diabetes: Complication or Predictor.

Recent studies indicate that periodontal health influences systemic health and that this has also been considered as a bidirectional relationship for several systemic conditions. This is particularly evident for the inter-relationship between periodontal disease and diabetes mellitus (DM). This relationship between the health of periodontium and DM provides an example of a viz. association. Whereby, there is always possibility that a systemic disease predisposes the individual to oral infections, and, once the oral infection is established, it exacerbates the systemic disease through its pathogenesis and its disease cycle incorporating other organs as oral cavity is also a part of a human body. There are also associations between periodontal disease and systemic conditions such as cardiovascular problems, osteoporosis, obesity, and pancreatic disease. Hence, emphasis should now be placed on treating chronic periodontal diseases as a means of deteriorating systemic diseases. Now-a-day periodontitis has been considered as the sixth complication of DM.

Photodynamic Therapy: A Shining Light in Periodontics.

Photodynamic therapy (PDT) uses a photoactive dye (photosensitizer [PS])that activates by exposure to light of a specific wavelength in the presence of oxygen. The energy transfer from the activated PS to available oxygen leads to the formation of reactive oxygen species, such as singlet oxygen and free radicals. These chemical species are extremely reactive and can damage proteins, lipids, nucleic acids, and other components of the bacterial cell wall. Bacterial biofilms are widely implicated in their role in the causation of gingivitis and periodontitis. Prophylactic and therapeutic regimens for dental plaque related diseases include the usage of various chemotherapeutic agents. Since it is difficult to maintain therapeutic concentrations of these agents in the oral cavity and they run the risk of being rendered ineffective by bacterial resistance mechanisms, the need for an alternative antimicrobial approach in the treatment and prevention of dental plaque related diseases was felt. Many studies have reported the killing of bacteria via lethal photosensitization including both Gram-positive and Gram-negative bacteria. Photosensitization leads to bacterial elimination, with minimal chances of microbial resistance and with no adverse effects on host tissues and resident microflora. In dentistry, PDT has found use in the treatment of oral cancers, bacterial and fungal infections, and also in the detection of malignancies. PDT is free from genotoxic and mutagenic effects; another important factor for long-term safety. The ease of accessibility of the oral cavity to illumination makes it a suitable target for PDT.

Classifying Periodontal Diseases: An Unending Controversy.

In order to obtain more knowledge about the causation of periodontal diseases the various forms of the disease have to be classified. In the past 130 years, various classification systems for periodontal diseases based on the understanding of the nature of these diseases at the time the classifications were proposed. Revisions to existing systems have been largely influenced by three dominant paradigms that reflect thinking at the time the classifications were proposed: the clinical characteristics paradigm (1870-1920), the classical pathology paradigm (1920-1970), and the infection/host response paradigm (1970-present). The changes in the paradigm have always been followed by the conceptual changes in the classification of periodontal disease. Although classification systems for periodontal diseases currently in use are firmly based on, and dominated by, the infection/host response paradigm, some features of the older paradigms are still valid and have been retained.

Low level laser therapy in the treatment of aphthous ulcer.

Recurrent aphthous stomatitis (RAS) is one of the most common and painful ulcerative lesions of the oral cavity, but until now no cure has been recognized for it. Two patients diagnosed with minor RAS were treated in a single sitting with low level laser therapy using 940-nm diode laser. The lesions healed completely within 3-4 days and a follow-up for 1 showed no recurrence in these patients. According to the results of this study, low level laser therapy can decrease the healing time, pain intensity, size, and recurrence of the lesion in patients with minor RAS, and hence can be considered the most appropriate treatment modality for minor RAS, with greatest clinical effectiveness.