[Comparing the effect of chlorhexidine and persica mouthrinses on periodontal status of fixed orthodontic patients]

Since maintaining good oral hygiene in fixed orthodontic patients is more difficult compared to normal individuals more serious methods for plaque control is needed. One way to improve oral hygiene and gingival health is chemical plaque elimination by means of mouthrinses. The aim of this study was to compare the effects chlorhexidine and Persica mouthrinses on periodontal status of patients undergoing fixed orthodontic treatment. 38 cases with the mean age of 14.2 years were selected among the patients who were refered to Mashhad Dental School for orthodontic treatment. 14 patients were eliminated for different reasons. In all patients before and three months after bonding orthodontic attachments gingival index, gingival bleeding index and mean pocket depth were measured. Then the patients were divided into three groups: for the first group chlorhexidine and for the second group Persica was prescribed. The third group did not receive any mouthrinse and was mentioned as control group. 30 days after using mouthrinses all of the indices were measured for the third time. SPSS software was used for data analysis and after confirming normal distribution of these data, paired t-test and ANOVA with 95% confidence interval were used. Gingival index, plaque index and mean pocket depth showed significant increase after beginning orthodontic treatment. Gingival index had a significant reduction in all groups after prescribing mouthrinses but this reduction was not significant between three groups. Mean pocket depth in chlorhexidine group and gingival bleeding index in Persica group had significant reduction. Plaque index did not show significant reduction in any of three groups. Most of the indices show significant increase after bonding of fixed orthodontic appliances. This emphasizes the need for more serious methods of oral hygiene control during orthodontic treatment. Since plaque index and gingival index did not show significant decrease in patients using chlorhexidine or Persica mouthrinses in comparison to control group it is concluded that correct tooth brushing and flossing are the main factors in plaque elimination and gingival health and mouthrinses could be used as an adjuctive

Cross-sectional study of periodontal status in healthy persons and those with coronary artery disease

Infections and among them extravascular infection may cause atherosclerosis and provoke their complication. Some evidence suggests that dental infections and periodontal disease are involved in pathogenesis of coronary artery disease. Patients were chosen from private cardiology clinic. In this double blind controlled cross-sectional study, patients were in two groups. Those who had CAD* by given criteria, and those in non-CAD group. Periodontal examinations were performed by periodontologist in a blind manner. Of 250 subjects screened and examined by cardiologist, 39 agreed and presented for dental examinations, of whom 10 were edentulous, and 29 were dentate. Of dentate subjects 11 had CAD and 18 were free of CAD. For all periodontal parameters, greater values were recorded for CAD group, indicating a more severe periodontal disease among CAD subjects as compared to non-CAD group. CAD subjects showed a significantly greater level of dental plaque accumulation as compared to non-CAD group [P=0.004]. Percentage of edentulous subjects was greater among CAD subjects than non-CAD subjects. All periodontal parameters were not significantly greater, among CAD patients than non-CAD control subjects, suggesting no association between poor periodontal status and coronary artery disease. Further studies are needed

[Clinical evaluation of immediate implantation with biologic membrane after tooth extraction]

The replacement of missing teeth with late dental implants has become an acceptable and standard treatment modality. However, there have been only a few studies evaluating the immediate dental implants. The aims of this study were: 1] To evaluate the possibility of inserting dental implants into extraction sockets immediately after extraction. 2] To assess osseointegration after immediate implant insertion clinically. 3] To evaluate the changes in depth and width of defects surrounding implants as well as change in distance from cover screw to alveolar crest after insertion of fixtures following immediate implantation and assess the efficacy of this method in preserving height and width of the alveolar ridge. In this clinical trial which had a before-after design, five implants were inserted in 3 patients immediately following extraction of the teeth number 44, 47, 11, 14 and 23. HA coated Dyna implant systems were used in this study. At the initial stage as well as the second stage of surgery the following parameters were measured at 6 sites around each implant: width and depth of remaining defect around the neck of fixtures and the distance from the covers crew to crest. The role of baseline defect parameters on the final configuration of defects were analyzed statistically, by paired t-test and multiple regression. Defect depth and defect width showed improvements of 3.4mm [90%] and 1.8mm [94.5%] respectively which were statistically significant. Improvement in the width and depth of defects had negative correlation with baseline defect width and depth. Furthermore, the distance from alveolar crest to the cover screw at baseline had a significant influence on the reduction of the defect width at the re-entry visit. Primary stability at the insertion visit had a significant and positive effect on the remaining defect depth at the re-entry, although its effect on the defect width was positive but insignificant. Sites with primary stability showed a 10 times smaller distance from cover screw to the crest, which was statistically significant. Insertion of immediate implants into extraction sockets using Dyna HA coated implants are clinically possible, with a predictable and successful outcome. In addition, primary stability of implants in such sites, although is not essential for clinical osseointegration, it may facilitate the bone fill in the defects around immediately inserted implants

[Effects of combined use of Hydrogen peroxide and chlorhexidine mouthrinses on gingivitis, plaque and tooth staining]

Bacterial plaque is the most important factor in periodontal diseases and plaque control is effective in the prevention of periodontitis. Mechanical plaque control is the most reliable method in plaque reduction but because insufficient mechanical plaque control is usually performed by most patients, chemical plaque control beside mechanical plaque control is more desirable. Several chemical agents for chemical plaque control are used and chlorhexidine is the most effective agent in chemical plaque control and it causes plaque and gingival inflammation reduction. However, chlorhexidine side effects, the most common of which being tooth staining and dorsal tongue staining, are the main factors in inadequate compliance among patients. Scientists suggest the use of oxidating mouthrinses such as hydrogen peroxide and carbamide peroxide for reduction of chlorhexidine staining. The purpose in this study was to compare the induced stain and plaque and gingivitis reduction between chlorhexidine alone and hydrogen peroxide as adjunct to chlorhexidine. In this interventional Study, 30 patients with mild to moderate gingivitis referred to periodontic clinic of Mashhad Dental School [26 males, 4 females], were randomly assigned in a double-blind, 2 group parallel design study. At the beginning of the study, all subjects received scaling and root planing and polishing. After two weeks, PI, GI, and GBI were examined. Gluconate chlorhexidine 0.2% mouhrinse was prescribed for control group to be used for 30 seconds twice a day for 14 days. Subjects in the test group rinsed their mouth with hydrogen peroxide 1.5% for 30 seconds prior to chlorhexidine use twice a day for 14 days. During the study, the patients refrained from brushing. After 14 days, PI, GI, GBI and stain index were recorded again for both groups.The data were statistically analysed by t-test using SPSS 10 software. PI scores for both groups were approximately equal at the end of study. GI and GBI scores were also approximately equal at the end of the study however, reduction in these scores was slightly greater for the control group. The residual inflammation in the test group might be attributed to the used of hydrogen peroxide. The considerable reduction in both severity and extend of staining score in body region in test group was significantly lower than control group but there was no significant difference between two groups in stain severity scores in gingival region. We conclude that use of hydrogen peroxide prior to chlorhexidine may cause significant reduction in tooth staining. Moreover, hydrogen peroxide does not have negative effects on plaque and gingivitis reduction ability of chlorhexidine

[Peripheral blood monocytes responsiveness in aggressive periodontitis patients by comparison of Interleukin-6 production before and after stimulation by E. Coli lipopolysacharide]

Results of other studies suggests that hyper-responsiveness of monocytes to the products of dental plaque especially the endotoxin of Gram negative bacteria and secretion of high levels of pro-inflammatory cytokines may have a role in the pathogenesis of AP. To investigate this possibility, we evaluated the IL-6 production by cultured peripheral blood monocytes before and after stimulation by E.coli lipopolysacharide [LPS] in AP patients and healthy controls. Fifteen patients with AP were compared to 15 periodontal healthy controls in a case control study. Mononuclear layer was obtained from peripheral blood samples and monocytes were isolated and cultured. The reaction of monocytes was studied by IL-6 production before and 6 hours after stimulation by 0.1 micro g/ml E.coli. LPS. The IL-6 concentration in the culture supernatant was measured with ELISA [Enzyme linked Immunosorbent Assay]. Wilcoxon and Mann-Whitney U-tests were used to compare the groups. There was no significant difference in IL-6 production levels before LPS stimulation between patients and controls [P = 0.5]. The IL-6 production after LPS stimulation in the patients was higher than controls, and the difference approached the significance threshold [P = 0.07]. However, the increase in the IL-6 production as a result of LPS stimulation was significantly higher in patients compared to controls [P = 0.029]. Our results suggest that increase in monocyte responsiveness may play a potential role in the pathogenesis of AP. Elevation in cytokines elicited at the site of infection in response to a minimal bacterial challenge can exert significant effects locally and systemically. An over aggressive immune response can provide the basis of explanation for the observed severe tissue damage. and bone loss in periodontium, familial nature of aggressive periodontitis and other immunological findings associated with the pathogenesis of this disease. Future investigations through longitudinal monitoring of monocyte responsiveness over time and following successful treatment are required to elucidate the role of this phenomenon in the pathogenesis of periodontitis

Review of Microbiologic Similarities of Refractory periodontitis and refractory Periapical Periodontitis

Treatment resistance cases in both endodontal and periodontal diseases are sometimes encountered in spite of a good treatment. These cases may be caused by microbial agents and / or inefficient host responses. The microbial factors need further investigation and host response in discussed in this section. Thirty two articles and two text were reviewed for this discussion. The main cause of innate and specific immune system involvement in refractory periapical periodontitis are microbial factors, where as in refractory periodontitis the bacterial factor is less prominent and cigarette smoking is considered the main factor with emotional stressors micronutient deficiency and herpesviruses being contributing factors

[Determination of periodontal treatment needs of Mashhad I dental students using the CPITN index]

Introduction: the aim of this study was to evaluate periodontal status and treatment needs among Mashhad dental students

Materials and Methods: 301 students [204male and 97 female] with age range of 19-37 were selected from 3rd 4th 5th and 6th grade dental students and were studied for 5 months using CPITN index

Results: mean CPTIN was 0.447 for females and 0.912 from males. In female, it was 0.22 for maxilla and 0.674 for mandible. In males, it was 0.672 for maxilla and 1.152 for mandible. Mean CPITN among different age groups was 0.546 for the 19-25 year group, 0.970 for the 26-30 year group and 1.213 for the <30 year respectively. Mean CPTIN was 0.715, 0.696, and 0.784 for the 3rd, 4th, 5th and 6th grade dental students respectively

Conclusion: periodontal status was more satisfactory among females, and among the 4th grade students followed by 3rd grade students. Treatment needs were generally low. Maxilla was less affected than mandible. Gingivitis was the most prevalent involvement

[ study of phagocytosis defects of polymorphonuclear cells in diabetic patients affected with periodontitis]

Introduction: diabetes mellitus is one of the most common metabolic diseases in which elevated blood glucose level interferes with activity of Polymorphonuclear [PMN] cells. Prevalence and severity of periodontal diseases in diabetic patients are also reported to be higher than nondiabetics. Considering different opinions regarding the interrelationships of PMN cell dysfunction and destruction of periodontal tissues in diabetics, this study was performed

Materials and Methods: this study was a case-control one. 53 cases [22 with IDDM, 21 with NIDDM and 10 non diabetics] were selected for this study. Diabetic patients [equal males and females] were referred from Mashhad Diabetic Center. The examined parameters were PMN cell function [using NBT test], fasting blood sugar, plaque index, pocket depth, bleeding index and bone loss [using panoramic x- ray]. The data were analyzed using One - Way ANOVA, multivariable analysis, Tukey test and correlation coefficient

Results: the fasting blood sugar level of both diabetic groups were significantly higher than that of nondiabetic groups [P<0.001]. The plaque index was significantly higher in NIDDM group compared with control group [P=0.002]. Bone loss was more severe in NIDDM group than IDDM and control groups. The difference was statistically significant. PMN cell function in IDDM group was significantly lower than NIDDM and control groups [P=0.011]

Conclusion: observing the result, it is tempting to claim that with aging and in the presence of suitable condition for the plaque bacteria, the periodontal disease in the diabetic patients become more server. Prevention of the periodontal diseases will be possible provided that the blood sugar level and the bacterial plaque are controlled