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Background: Periodontal surgeries are often followed by post-operative pain and discomfort which is a major concern to both the clinician and the patient. Every effort is being made to reduce the post-operative pain, one amongst them being the pre-operative medication with NSAIDS like ketorolac tromethamine. This type of agent acts peripherally by inhibiting the release of prostaglandins and minimizing the local inflammatory response hence it may be advantageous in reducing post-operative pain and discomfort. Thus, the efficacy of preoperative ketorolac tromethamine administration on periodontal postoperative pain was evaluated. Material & Methods: Two groups of 15 patients each were selected for the study. One group received 20 mg ketorolac immediately before periodontal flap surgery, and the other group doesn’t received any drug. Combination of Diclofenac sodium 50 mg & Paracetamol 325mg tablets was provided as “rescue analgesic. The visual analog scale modified with using numerical rating scales and Wong-Baker Faces Pain Rating Scale was used to estimate pain. Postoperative pain was assessed hourly for the first 12 h on the day of surgery, and 4 times daily on the 1st and 2nd postsurgical days. Timing and dose of rescue analgesic remedication were also recorded. Results: Results indicated that preoperative treatment with ketorolac significantly reduced initial pain intensity and delayed the onset of postoperative pain as compared to no premedication group. Incidence and amount of rescue medication consumption was small in ketorolac groups. No adverse reactions related to preoperative medication were observed. Conclusion: The results of this study showed that 20-mg ketorolac administered immediately before periodontal surgery was effective for alleviating the early postoperative painful sequelae, affected delayed pain levels and postoperative rescue analgesic consumption.
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Background: Periodontitis is a multi-factorial chronic inflammatory disease of attachment apparatus of teeth with microorganisms playing a major role. To address periodontal disease various strategies have been adopted to target these periodonto-pathogens. Various antimicrobial drugs (systemic as well as local) are effectively used to control the disease. However due to various side effects ofsystemic administration of the drugs like gastro intestinal disturbances, development of resistant organisms, high dosage of the drug required, local delivery of the drug is a better option as the drug is directly delivered at the site of infection with minimum dosage and maximum response achieved thus eliminating all the undesired effects of the drug. Aim: To evaluate the efficacy of 10% povidone iodine with 2% metronidazole and 1% ornidazole with 0.25% chlorhexidine gel as local delivery systems for the reduction in the pocket depth, changes in CAL, gingival inflammation. Materials and methods: A total of 20 patients diagnosed with mild- moderate chronic periodontitis were divided into two groups in a split-mouth study design - Group I and Group II with each group containing 20 sites with probing depth of >5 mm, CAL ?3 mm. In Group I, 10% povidine-iodine gel with 2% metronidazole was delivered inside the pocket and Group II, 1% ornidazole with 0.25% chlorhexidine was used as a local delivery system in adjunct to scaling and root planning. In both groups, medications were delivered at weekly interval for a period of 4 weeks. Baseline and 4 weeks measurements were done and compared for probing pocket depth (PPD), clinical attachment levels (CAL) and gingival inflammation. Results: The results obtained were statistically analyzed. Both groups showed statistically significant improvements in terms of clinical parameters. However, there was statistically insignificant difference when compared between the two groups. The results clearly demonstrate that both povidone iodine with metronidazole and ornidazole with chlorhexidine are also useful in controlling the acute phase of the periodontal disease in adjunct to scaling and root planning (SRP). Conclusion: Both drugs when used as an adjunct to scaling and root planning enhances probing pocket depth reduction, change in clinical attachment levels and gingival inflammation in mild- moderate chronic periodontitis cases.
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Background: A working knowledge of the prevalence of hypersensitivity in chronic periodontitis patients, is imperative to adequate prognostication, treatment planning and outcome. The present study, is a primary report of the prevalence of dentinal hypersensitivity, in relation to various patient characteristics (demographic and clinical) in chronic periodontitis patients visiting Government Dental College and Hospital, Srinagar, J&K.Material & Methods:A cross-sectional study design was used to evaluate 100 male and 100 female patients diagnosed with chronic periodontitis both by questionnaire and clinical test for the presence of dentinal hypersensitivity, in relation to various features.Results:An overall prevalence of 34% was found for self-reported and 42 % for actual dentinal hypersensitivity in chronic periodontitis patients. It was highest in females, undergraduates, rural subjects and canine teeth. The most common provoking stimulus was cold, and duration of hypersensitivity was less than 6 months. Clinical attachment loss was found to be more often associated with hypersensitivity than clinical gingival recession.76% of the patients reporting hypersensitivity also reported the use of desensitizing toothpaste.The reported prevalence of hypersensitivity was in concordance with other reports from dental college clinics. The particular geo-social background of the study location could have contributed to the observed difference in precipitating factors, effect of diet, and treatment seeking behaviour. Conclusion: The prevalence of dentine hypersensitivity in chronic periodontitis patients was 34% according to questionnaire and 42% according to the results of clinical test. Periodontal attachment loss was found to be could be an earlier indicator or a possible risk factor of DH, indicating the need for clinical initiative in the management of hypersensitivity in chronic periodontitis patients.
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Background: Management of gingivitis is commonly done by the removal of etiological agents by Periodontist. However, use of topical applications of antibiotic combinations has been shown to improve the treatment outcome. Various drugs alone or in combination have been used. So this study was conducted to determine the effect of different concentrations of combination drugs on gingivitis.Material & Methods:100 patients of gingivitis were divided into two groups of 50 each – Group-A and Group-B. After scaling and root planing, Group-A patients were made to apply Metronidazole 1% and Chlorhexidine 0.25% for period of 12 weeks while as Group-B patients applied Metronidazole 1.5% and Chlorhexidine 0.50% for 12 weeks. Baseline scores of gingival index and bleeding index were recorded followed by readings at 4 and 12 weeks.Results:Results showed that there was a significant improvement in gingivitis and bleeding on probing at 4 and 12 weeks after local application of Metronidazole and Chlorhexidine gel in both the groups. However there were no statistically significant differences between two groups.Conclusions:Topical application of Metronidazole and Chlorhexidine gel as an adjunct to scaling and root planing is an effective treatment modality for the management of gingivitis and the concentrations of the combination do not have any significant effect on the treatment.
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Background: Emergence of Covid-19 pandemic resulted in stressful living conditions throughout the world leading to an alteration of habits and detrimental effects on overall health particularly oral health and hygiene of people throughout the world. The aim was to access perceived stress and its impact on periodontium and oral health in Covid-19 positive patients.Material & Methods:An online health questionnaire was submitted by Covid-19 positive patients over a period of six months with answers regarding their systemic health, perceived stress, existing habits and their alteration, oral hygiene maintenance and symptoms of oral and periodontal diseases during covid positivity.Results:Results showed that there was increase in stress levels of Covid-19 positive patients with alteration of habits and increased incidence of negative effects on oral and periodontal health.Conclusions:Although Covid-19 positive patients experienced more stress and higher incidence of oral and periodontal diseases but no direct relation could be established.
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Background: Periodontal disease is one of the most important oral diseases contributing to the global burden of chronic disease. Motivation in periodontitis patients is thought to play a major role in influencing periodontal health in this patient. This online study focuses on different areas for motivation such as age,cleaning methods, ,frequency of dental visits, knowledge of inter disciplinary relation,frequency of referrals etc.among different health-care professionals. Aim: The main purpose of this study was to assess the medical professional’s knowledge about relation between periodontal and systemic health in health professionals in J&K state.Material & Methods:The study sample consisted of 500 participants ranging between 20 and 60 years old. The questionnaire was prepared and circulated by the mobile application (WhatsApp). A questionnaire consisting of multiple choice questions was used as assessment tool and its content evaluated the patients profile, their knowledge about periodontal disease, the dental professional’s commitment to instruct the patients towards oral hygiene.Results:The result of this study showed that the respondents have moderate awareness regarding the importance of dental, in specific to periodontal health care.Conclusions:Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about the correct oral hygiene practices. There is need for awareness not only in the general population but also in health-care professionals too.
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Background: Periodontal diseases are characterized by the presence of bleeding, inflammation, sensitivity, discomfort, mobility and tooth loss. Plenty of studies supported the assumption that vitamin D deficiency might be a risk factor for periodontal diseases. Our study aimed to investigate the true association between serum vitamin D level and the presence of periodontal disease. Materials and methods: The study evaluated 40 patients (age group 19-35 years) attending the outpatient department, Department of Periodontics and Implantology, Govt. Dental College and Hospital, Srinagar, equally divided into two groups (Group I and Group II) according to the inclusion criteria. Group I included generalized aggressive periodontitis patients while Group II included non periodontitis patients. Clinical parameters and serum 25-hydroxyvitamin D level were assessed. Results: Serum vitamin D levels of periodontitis patients compared to non-periodontitis patients presented non statistically significant differences (p-value = 0.878). Conclusion: Although the serum vitamin D level in aggressive periodontitis patients was lower than the healthy controls but the difference seemed to be statistically insignificant and hence it can be concluded that the serum vitamin D deficiency is not a risk factor for periodontitis.
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Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. A convergent association between polycystic ovary syndrome (PCOS) and periodontal disease, in particular chronic periodontitis (CP), has recently been proposed. The underlying molecular mechanisms of this association are not fully understood, though it is thought that chronic inflammation is responsible. Aim: To assess the awareness of periodontal health status and systemic inflammation of women receiving medical treatment for PCOS and women newly diagnosed with PCOS. Materials and methods: A total of 500 PCOS diagnosed women were recruited based on convenience sampling and completed a survey containing questions related to demography, lifestyle preferences, PCOS awareness and periodontal awareness. Results: Lack of awareness of oral hygiene and its importance on overall treatment of PCOS was observed. Conclusion: There is a dire need of generating oral hygiene awareness via health centres, internet, media etc. and providing full information about the association of PCOS with Oral hygiene, so that many symptoms of PCOS can be overcome after strictly following oral hygiene measures.
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Palatal masticatory mucosa is the main donor site for soft tissue grafts, thus determination of its thickness is of paramount importance as it affects the surgical outcome. Thus in this study we tried to evaluate and compare the mean thickness of palatal masticatory mucosa with the help of direct bone sounding using a periodontal probe and cone beam computerized tomography (CBCT) at different regions. Methods: 30 subjects in the age group of 20-50years were included in this study and had to undergo bone sounding with periodontal probe and subsequently cone beam computerized tomography in relation to canine, 1st premolar, 2nd premolar, 1st molar and 2nd molar at four different points, i.e., 2, 5, 8 and 12 mm from the gingival margin. Results: On comparison between the two techniques nonsignificant difference was found with slightly higher values obtained by CBCT. The tissue at the premolars was thicker than that measured at the molars. There was also increase in tissue thickness as the distance from gingival margin was increased except for canine at the depth of 12mm. Conclusion: It was concluded that CBCT can be used as non-invasive and accurate method to determine the soft tissue thickness of the palatal masticatory mucosa than clinical measurements made via bone-sounding
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Small things have a big impact and so does the field of nanotechnology, because greatness is never determined by its size. Almost every dimension of survival; from security to medicine nowadays is dominated by nanotechnology. The nano-world is blooming rapidly in recent years and like other medical fields it has till date transmuted the sphere of dentistry in a huge way. Periodontitis refers tothe inflammation of the gums and supporting tissues of the tooth. With its progress in various fields, nanotechnology has also evolved as a promising mode of treatment of periodontitis. Nanotechnological methods involve utilization of nano-materials, nano-biotechnology and nano-robots for the treatment and aftercare of periodontal health. This paper focuses on the possible applications of nanotechnology towards periodontics.
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Introduction: The contemporary research interest inautologous platelet concentrates is backed by an emergingevidence of their promising regenerative potential in numberof clinical applications. Periapical inflammatory lesionsrepresent a chronic pathology of the periapical tissuesthat result in considerable bone resorption and worsen theoverall tooth prognosis. With this background, the presentstudy was designed to evaluate the effect of the most recentplatelet concentrate preparation, concentrated growth factors(CGF) on osseous regeneration after surgical management ofperiapical lesions.Material and methods: A prospective study was done intwenty patients where CGF was used to fill the periapicaldefects after periapical curettage. Area of radiolucency andmean gray values were assessed at baseline, 1 month, 3months and 6 months after surgery using Image J software.Paired t-test was used to evaluate changes occurring betweenbaseline and 1 month and baseline and 6 months.Results: And early and enhanced healing was evident formthe substantial decrease in area of radiolucency, and meangrayscale values indicated a progressive increase in bonedensity during the observational period. These changes werehighly significant (P< 0.05).Conclusion: CGF can be used as an efficacious and costeffective alternative to conventional bone substitutes forpromoting healing after the surgical debridement of periapicaldefects.
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The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to evaluate the efficacy of xenogenic bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects. Methods: Twenty intrabony defects were surgically treated. The defects were randomly assigned to treatment with OFD + bone graft (Group B) or OFD alone (Group A). The clinical efficacy of two treatment modalities was evaluated at 9months postoperatively clinically and radiographically. Results: Statistically significant intra group improvements were seen with all the hard tissue and soft tissue parameters in both test and control groups. Statistically significant improvements were seen in group B with clinical parameters and the mean defect fill (AC-BOD) when intergroup comparisons were made. Conclusion: Treatment with bone graft + OFD led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.
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Introduction: Gingival recession is defined as displacement ofmarginal tissue apical to cementoenamel junction (CEJ). Thisprospective clinical study was designed to evaluate clinicallythe effect of lateral pedicle flap (LPF) with platelet‑rich fibrin(PRF) graft for the treatment of denuded root surfaces.Material and Methods: 20 isolated Miller’s Class I and IIgingival recession of single‑rooted teeth were selected for thestudy. Ist we started with caling and root planing, followed byoral hygiene instructions. Plaque index, gingival index, andrecession level (probing depth and clinical attachment level[CAL], were assessed at baseline. Following this, LPF withPRF was done at the recession sites, and parameters wereassessed at 3 and 6 months.Results: The mean level percentage of RC attained was 72.1%at 3 months and 73.4% at 6 months.Conclusion: LPF with PRF produced statistically significantreduction in recession depth and gain in CAL by the end of 6months.
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Background: A number of chlorhexidine mouth rinse preparations have been developed with „antidiscoloration‟ additives, in an attempt to counteract the undesirable tooth discoloration that accompanies the clinical activity of this „gold-standard‟ plaque control agent. However, the efficacy of such formulations for periodontal maintenance remains yet to be elucidated. Aim: To evaluate the feasibility and efficacy of 0.2% chlorhexidine mouthwash with a plasdone (polyvinylpyrrolidone) anti-discoloration system for maintenance after flap surgery, as compared to conventional 0.2% chlorhexidine mouthwash. Methods and Material: The investigation was carried out at the Department of Periodontology, Government Dental College and Hospital, Srinagar, and was designed as a randomized parallel group, triple blind study. Forty patients with chronic periodontal disease, with at least one sextant (with the presence of at least two teeth) scheduled for flap surgery were included and randomly divided into two groups. After preparation, open flap debridement was carried out and the patients were provided pre-calibrated color masked bottles, containing either 0.2% chlorhexidine, or 0.2% chlorhexidine with an anti-discoloration system, which they were instructed to use twice a day (10 ml for 1 minute) for 3 Huda Hussain, Suhail Majid Jan, Roobal Behal. Chlorhexidine mouth rinse with a plasdone based anti-discolouration system for maintenance after periodontal flap surgery: A comparative clinical study. IAIM, 2019; 6(5): 124-131. Page 125 months. Tooth brushing was reinstituted one week after surgery and the patients were recalled every 15 days. Gingival index, Plaque index and Discoloration index were recorded immediately before, 1 month and 3 months after surgery and compared in the two groups. The quantitative data was evaluated as means and standard deviations (SD). Paired t-test was used to evaluate the intragroup differences; intergroup comparisons of post-treatment changes were analyzed by unpaired t-test. Pvalues <0.05 were considered to statistically significant. Results: Post-operative healing and patient compliance were satisfactory with either mouth rinse. After 3 months of use, a statistically non-significant difference (p<0.05) between the two treatments was found for all indices, with the values being marginally higher for the CHX-ADS mouthwash. Over time, plaque index and discoloration were significantly increased over baseline in both the treatments, however, inter-treatment variation was non-significant. Conclusions: The statistical analysis of the present data reveals that PVP neither significantly reduced the efficacy of 0.2% chlorhexidine nor significantly reduced the staining side effect.
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Background: Periodontitis is result of cumulative exposure of dental plaque, thus the main aim of periodontal therapy is the prevention of plaque accumulation and maintain periodontal health. The clinical effect of scaling and root-planning (SRP) are well documented .Antimicrobial agents act as an adjunct to periodontal therapy. One of the most frequently used antimicrobial agents is chlorhexidine gluconate (CHX), it is a broad spectrum antiseptic with a pronounced antimicrobial effect Clinical improvements after SRP are associated with microbiological changes that include a decrease in microbial load and a mean percentage change of certain periodontal pathogens , such as Treponema denticola, Porphyromonas gingivalis and Tarnella forsythus. These species are gram negative anaerobes which possess, an enzyme capable of hydrolyzing synthetic trypsin substrate, BANA. Methods: This study included 30 individuals who were randomly distributed in two groups test (SRP + CHX) and control (SRP) Results: The results of the study stated that the treatment with SRP and CHX improved clinical and microbiological parameters compared to the SRP alone as a monotherapy. Conclusion: CHX rinsing and repeated professional plaque removal could have equivalent therapeutic benefits, the use of CHX offers the great advantage of not requiring the patient’s presence in the dental office
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Background: Patient compliance plays a decisive role in the outcome of periodontal therapy. Although a number of reports have studied patient compliance and its variables during supportive periodontal therapy, there is a paucity of literature on factors affecting compliance to active periodontal therapy. Moreover, as health beliefs largely stem out of social/religious/ethnic convictions, population specific compliance studies are highly relevant. It is foreseeable, that early identification of compliance-affecting variable will enable institution of a timely and personalized patient education/ motivation programme. Aim: To elucidate factors which affect patient compliance during active periodontal therapy in patients visiting Government dental college and hospital, Srinagar. Materials and methods: 150 patients were included in the study for performance of active periodontal therapy (scaling and root planing) over 3-5 visits every 5 days. They were subjected to pre-validated questionnaire to assess their sociodemographic factors, oral health awareness (OHA) and treatment satisfaction (TS). Results: Sociodemographic factors (education, emplyoyment and gender), OHA and most of all TS were found to influence patient compliance in the given population. Conclusion: Certain sociodemographic factors have a bearing on patient compliance and may be assessed as predictors of compliance to therapy. As treatment satisfaction has a profound effect on the patient‟s willingness to return for treatment, it should be an objective of the overall clinical practice. Roobal Behal, Suhail Majid Jan, Huda Hussain. Evaluation of the effect of various factors on patient compliance among patients visiting Govt. Dental College and Hospital, Srinagar. IAIM, 2018; 5(8): 55-63. Page 56 Pertinently, the crucial role of the periodontist in patient education and management should be realized and utilized to achieve predictable compliance.
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Introduction: Smoking is a known risk factor of periodontitis. Cotinine, a metabolic by product of nicotine is involved in the pathogenesis of periodontitis. Changes in gingival microvasculature, gingival epithelium take place which manifest clinically as decreased bleeding on probing and reduced inflammatory response, increased gingival thickness etc. Knowing the importance of gingival thickness in various root coverage procedures and restorative treatments in periodontics and the increased incidence and prevalence of smoking, assessing the relation between these two entities is becoming important. This clinical study is sought to compare the thickness of gingiva in systemically healthy smokers and non-smokers Materials and methods: 40 age matched smokers and non-smokers were considered for the present study. Gingival thickness was measured in the maxillary and mandibular anterior teeth by transgingival probing using UNC-15 probe midbuccally in the attached gingiva and at the base of the interdental papilla. Plaque index and gingival bleeding index were recorded. Student’s independent ttest was employed for comparing various periodontal parameters between smokers and non-smokers. A P-value of less than 0.05 was considered statistically significant. All P-values were two tailed. Results: Both groups had similar gingival bleeding index and plaque index. Smokers had a higher thickness of gingiva both mid bucally and interdentally as compared to non-smokers. Conclusion: Both midbuccal and interdental areas are thicker among smokers when compared to nonsmokers at similar plaque and gingival bleeding levels.
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Introduction: Periodontitis a chronic inflammatory disease results in the destruction of tooth supporting tissues, eventually progresses to tooth loss. Non-surgical periodontal therapy in form of scaling and root planning although considered as a gold standard, does not completely eradicate periodontal pathogens. Limitation of access and bacterial invasion of periodontal tissues being the main reason and hence the demand for an adjunctive measure is necessitated. Sub gingival irrigation interferes with various plaque components predominantly anaerobic bacterial flora which is known to initiate and perpetuate periodontal destruction. The aim of this study is to investigate the effect of sub gingival irrigation with 3% H2O2 compared to normal saline. Material and methods: 20 patients were taken for the study. After scaling and root planing, quadrants in each patient’s mouth were randomly treated two with 20 ml 3% H2O2 sub gingival irrigation and the other two with normal saline. Sub gingival irrigation was performed at baseline and after 1 and 2 weeks. The clinical parameters were recorded at baseline at the end of week 3 and at the end of week 5. Results: Results showed that sub gingival irrigation with 3% H2O2 produced a significant reduction in gingival bleeding, pocket depths and a significant gain in clinical attachment level compared to the control. Tahira Ashraf, Suhail Majid Jan, Roobal Behal, Rafiya Nazir, Abhima Kumar. Effectiveness of Hydrogen Peroxide as a sub gingival irrigant - A clinical study. IAIM, 2017; 4(11): 177-181. Page 178 Conclusion: The results of the present study conclude that that sub gingival irrigation with 3% H2O2 results in inflammation control manifested as decreased gingival bleeding, reduction in pocket depth and gain in relative attachment levels.
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Bisphosphonates, synthetic (Non-biodegradable) analogues of pyrophosphate, were initially used in industry as water softening agents in irrigation systems and lateron discovered as bone loss inhibitors. Bisphosphonates inhibit bone resorption by being selectively taken up and adsorbed to mineral surfaces in bone, where they interfere with the action of the bone-resorbing osteoclasts. Thus, they have been proposed in the management of periodontal diseases by inhibiting the osteoclastic bone resorption and hence are used as a host modulating factor for prevention of bone loss. The other indications being Osteoporosis , Paget’s disease, Malignant hypercalcemia , Bone metastasis, Multiple myeloma etc. Gastro intestinal intolerance, Renal and hepato-toxicity, Hypocalcaemia, Osteonecrosis of jaws seen especially after invasive dental treatment (called as Bisphosphonate related osteonecrosis of jaw, BRONJ) are the main side effects of bisphosphonate therapy. To overcome such effects during dental management of patients, the recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy. The dentist should retain in his/her file the acknowledgment and consent for the treatment.
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Background: Chewing sticks were used throughout the Greek and Roman empires and by many communities till date. Many people do not use modern oral hygiene aids such as toothbrushes due to reasons like cost, customs and religious reasons and accessibility. The miswak, obtained from the twigs of the Salvadora persica tree, may be beneficial due to its mechanical cleaning. The aim of the present study was to assess and compare the oral hygiene status and gingival conditions following the use of conventional tooth brushing and miswak in socially disadvantaged subjects over a period 100 days. Methods: The study was conducted in an orphanage in Srinagar, Jammu and Kashmir. Out of the total 354 subjects, 180 subjects who were within this selected age group were followed and examined After acquiring the permission and the information to the subjects a total of 148 subjects, were voluntarily willing to participate in the study. Out of these subjects 72 subjects were using miswak (Group I), 46 subjects were using tooth brush and tooth paste (Group II) while 30 subjects (Group III) accepted that they were using both miswak as well as tooth paste and tooth brush as an oral hygiene aid. All of these subjects were evaluated for Gingival and Plaque status on 50th and 100th day following oral prophylaxis. The Mean, Standard Deviation, One way ANOVA test and Scheffe test were performed to reveal the statistical significance. Results: Both Group II and Group III showed a significant difference (p≤0.05), at 50th and 100th day in their mean plaque scores. The mean gingival scores recorded for subjects using only miswak and those subjects using both miswak as well as tooth brush and tooth paste increased from 50th day to 100th day and showed a statistical difference between the two means. Conclusion: The results of the present study suggest that miswak can be used as an effective adjunct for oral hygiene maintenance along with toothbrush and tooth paste as it is readily available and inexpensive.