Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: Randomized double-blind clinical trial.

Objective: Dental handpieces, ultrasonic scalers, air polishers, air abrasion units produce the most visible aerosols. The objective of this study was to assess the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols. Materials and Methods: A total of 60 patients were included in this study, they were randomly assigned into three groups and were subjected to scaling before and after rinsing with 0.2% CHX, 1% PI or irrigation with OZ. Blood agar plates were used to collect the gravitometric settling of aerosols and were sent for aerobic and anaerobic culture. Results: The results demonstrated high percentage reduction of aerobic and anaerobic colony forming units (CFUs) in all three groups. In aerobic CFUs, CHX showed the highest reduction (57%) at mask position whereas at chest position and at 9 ft, PI showed higher CFU reductions (37% and 47%, respectively). In anaerobic CFUs, CHX showed the highest percentage of reduction at chest level (43%) and at 9 ft (44%). Conclusion: CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

Melanin: A scavenger in gingival inflammation.

Background: One of the major direct or indirect targets of ultraviolet exposure of skin is the melanocyte or the melanin -forming cell. Epidermal melanocytes act as a trap for free radicals. Based on the protective role of melanocytes in medical literature, the role of melanin pigmentation in gingiva needs to be elucidated. Periodontal pathogens and their products demonstrate the ability to induce the generation of reactive oxygen species. Hence purpose of this study was to unravel the protective role of melanin (if any) against the gingival inflammation. Materials and Methods: A total of 80 subjects; 20 in each group were selected. The selection of subjects regarding gingival pigmentation was based on Dummett's scoring criteria 0, 3. A complete medical, dental history and an informed consent were obtained from the patients. After evaluation of clinical parameters the GCF was collected using microcapillary pipettes at the selected sites. IL-1β levels were quantitated using ELISA. Results: In non-pigmented healthy and gingivitis groups, there was a positive correlation between plaque index, gingival index and bleeding index versus IL-1β level: indicating an increase in the biochemical mediator of inflammation corresponding to an increase in the clinical parameters of inflammation. Also a positive correlation was found between the gingival index and bleeding index versus the IL-1β levels in the pigmented healthy group. The pigmented gingivitis groups showed a negative correlation between the plaque index, gingival index and bleeding index. Conclusions: The clinical markers of inflammation such as gingival index, bleeding index was of low numerical value in pigmented group than in the non-pigmented group, supposedly due to the protective action of melanin. The negative correlation of clinical markers of inflammation to the IL-1β levels in the pigmented gingivitis group could possibly be attributed to the protective role of melanins.

The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesions.

BACKGROUND: The periodontal lesions with cellular proliferation can be assessed by various methods. One of the most recent methods to determine the proliferative activity is silver-staining nucleolar organizer region (AgNOR) staining. The purpose of the present study was to evaluate, if AgNOR count can act as a proliferative marker and can aid in the diagnosis and prognosis of periodontal lesions. MATERIALS AND METHODS: For this study, subjects with healthy gingival status, non-neoplastic lesions, neoplastic lesions, and plaque-induced gingivitis were included. Following the provisional diagnosis of clinical entity, biopsies were taken from the respective selected sites for histopathological diagnosis. In plaque-induced gingivitis cases, a second biopsy was taken from the selected sites 3 weeks following scaling. After histological confirmation, one more section was prepared, which was subjected to AgNOR staining, and AgNOR numbers were counted by individual and cluster counts and statistically analyzed. RESULTS: Results showed the highest AgNOR count in neoplastic lesions. Non-neoplastic lesions showed a higher AgNOR count as compared to clinically healthy gingiva. Plaque-induced gingivitis showed a considerable reduction in AgNOR count after treatment. CONCLUSION: Results of this study confirmed that AgNOR count reflects the cellular proliferation and has a limited diagnostic value. However, the prognostic value of AgNOR for periodontal lesions is dependable.

Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs.

BACKGROUND: Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socioeconomic status and risk factors including tobacco usage and oral hygiene status. However, there is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. The aim of the study was to investigate the effect of dental fluorosis on the periodontal status using community periodontal index of treatment needs (CPITN), as a clinical study. The purpose of this study is to determine the periodontal status using CPITN index in a population aged between 15 and 74 years residing in the high fluoride areas of Davangere district. The possible reasons for the susceptibility of this population to periodontal disease are discussed. MATERIALS AND METHODS: 1029 subjects, aged between 15 and 74 years suffering from dental fluorosis were assessed for their periodontal status. Clinical parameters recorded were OHI-S to assess the oral hygiene status, Jackson's fluorosis index to assess the degree of fluorosis and CPITN index to assess the periodontal status where treatment need was excluded. RESULTS: Gingivitis and periodontitis were more common in females (65.9% and 32.8%,respectively) than in males (75.1% and 24.2%, respectively). Periodontitis was significantly more common in females. As the age advanced from 15 to 55 years and above, gingivitis reduced from 81.0 to 42.9% and periodontitis increased steadily from 18.0 to 57.1%, which was significant. Periodontitis was high in subjects with poor oral hygiene (81.3%), compared to those with good oral hygiene (14.5%), which was significant. As the degree of fluorosis increased, severity of gingivitis reduced and periodontitis increased, i.e, with A degree fluorosis, gingivitis was 89.4% and periodontitis 8.5%, but with F degree fluorosis the former was 64% and the latter 35.8%, which was statistically significant. CONCLUSION: The results suggest that there is a strong association of occurrence of periodontal disease in high-fluoride areas. The role of plaque is well understood in contrast to the effect of fluorides on periodontal tissues. It goes a long way to reason out fluoride as an important etiological agent in periodontal disease.

The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study.

PURPOSE: Periodontal disease is a commonly prevalent problem faced alike by both the developed and third world countries but showing wide variations in prevalence and severity across different geographical areas. The purpose was to identify Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Ekinella corrodens (Ec), Campylobacter rectus (Cr), Bacteroides forsythus (Bf), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) in Indian adult periodontitis and rapidly progressive periodontitis patients. MATERIALS AND METHODS: Paper points were used to collect the sample from 28 sites in both adult periodontitis and rapidly progressive periodontitis (8 healthy/20 diseased sites) patients and DNA analysis done. The categorical data was analysed by Fishers exact test and difference in the clinical parameters was tested by Mann-Whitney test. RESULTS: In healthy sites of adult and rapidly progressive periodontitis patients, Aa, Ec, Bf and Aa, Pg, Pi, Td, Fn were detected respectively. However, when diseased and healthy sites were compared in both adult periodontitis and rapidly progressive periodontitis patients respectively, only Pg( P =0.004), Cr( P =0.04), Fn( P =0.014) and Pg( P =0.002), Cr( P =0.02), Fn( P =0.008) were statistically significant. CONCLUSION: The prevalence of the microorganisms correlate with the clinical parameters like probing depth and bleeding on probing as seen in the Japanese and Western periodontitis patients' population.

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.

Detection and measurement of oral malodour in periodontitis patients.

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.

Comparative assesment of gingival thickness using transgingival probing and ultrasonographic method.

A decided attitude of expectation among many patients has given a new perspective to regenerative and plastic periodonta surgery. With authors emphasizing on the importance of gingival thickness, attempts are being made to obtain necessary information atraumatically and rapidly. Hence in the present study an attempt has been made to compare the two methods of assessing gingival thickness i.e transgingival probing and ultrasonographic method and also assess the gingival thickness in relation to central incisor lateral incisor and canine in Indian population. The gingival thickness was assessed in patients with healthy gingiva by both the methods. It was observed that transgingival probing method significantly over estimated the thickness of gingiva than the ultrasonographic method and the thickness of gingiva varies with morphology of the crown. It was concluded that compared to transgingival probing ultrasonographic method assesses gingiva thickness more accurately, rapidly and atraumatically.

Treatment of gingival recession by modified Langer and Langer technique.

In recent years, stronger need for esthetics and growing cosmetic demand for a pleasing smile has made many individuals more conscious of the recession on facial aspect of the teeth. Here we report a case illustrating treatment for facial gingival recession using modified Langer and Langer technique. The clinical results showed good soft tissue coverage of the root surfaces and improving esthetics.

FEM in periodontal research.

The changes in the periodontal tissues either due to pathologic processes on external forces have been investigated from histologic, histochemical, biochemical, physiologic, and bioelectrical (bony response) and biochemical viewpoint. However, because of the complexity of stress analysis or experimental techniques, no information is available on the stress induced in the periodontal tissues. The Finite Element Method (FEM), which is introduced as one of the methods for numerical analysis, has become a useful technique for stress analysis in biologic systems. The FEM makes it possible to analytically apply various force systems at any point and in any direction. From the periodontal point of view, FEM would provide different stress levels in periodontal structures based on the biomechanical principle, which in turn may prompt occlusal correction at an earlier date.

A comparative evaluation of an ultrasonic and a manual toothbrush on the oral hygiene status and stain removing efficacy.

The efficacy of ultrasonic toothbrush and a manual toothbrush was compared on the oral hygiene status and on microbial parameters. 26 dental students from the College of Dental Sciences Davangere, Karnataka, were selected for this single blind study of 4 weeks duration. The participants were in the age group of 18-25 years. The brushes were randomly allotted by the co-investigator, who also supervised the brushing technique throughout the study period. The subjects were instructed to refrain from brushing their teeth for 12-14 hours prior to each follow up visit. The main investigator assessed all the clinical parameters at baseline, 14th, 21st and 28th day. Statistical analysis was carried out by an independent statistician who remained blind to the test products. Each of the tooth brushes tested, showed significant reductions in all the clinical parameters between 0 and 28th day. The reductions within the groups were significant although no significant differences between the groups were found. The reductions in stain index, bleeding index and gingival index was higher in ultrasonic toothbrush compared to manual toothbrush. It is concluded that ultrasonic toothbrush is safe and effective in the removal of plaque, stains, reduction of gingival inflammation and gingival bleeding.

DNA probe analysis in smoker and non smoker rapidly progressive periodontitis patients--a pilot study.

Smoking is one of the most significant risk factors in the development and further advancement of inflammatory periodontal disease. The bacteria A. actinomycetemcomitans, P. gingivalis and P. intermedius as indicated as the potential pathogens associated with periodontal disease. Since the bacteria mentioned as well as smoking are factors associated with periodontitis it is of importance to elucidate the interrelationship between these factors. The purpose of this study was to investigate the prevalence of A. actinomycetemcomitans, P. gingivalis and P. intermedius in subgingival plaque samples obtained form healthy and diseased sites of patients with rapidly progressive periodontitis who were smokers and non smokers along with other clinical parameters.

Eosinophilic granuloma with oral manifestations: a case report.

Eosinophilic granuloma is the most benign disorder of the triad commonly known as histocytosis X. In this article a case of a 6 year old female child with multiple eosinophilic granuloma with additional liver dysfunction and its oral manifestation is presented. This case demonstrated that oral findings, may be an early manifestation of the disease, definitive diagnosis needs to be determined by correlation of the clinical findings with histologic features. For the duration of 8 years the case has been followed up, there has been a progressive healing of the lesion, the clinical manifestations of the disease resolved with only chemotherapy and provided a very good prognosis.

A clinical and SEM evaluation of the efficiency of sofscale gel and hand scaling and hand scaling alone.

The purpose of this study is to compose between hand scaling with abd without the calculus solvent gel (sofscale) and ultrasonic instrumentation at clinical and SEM level. 30 patients belonging to the age group of 17-50 year were selected. Patients selected were subjected to three different scaling modalities namely hand scaling (control), hand scaling using sofscale (Experimental quadrant A) and ultrasonic scaling (Experimental quadrant B), in three different quadrants. Case report forms were used to document the tooth sensitivity, soft tissue pain after scaling, patient preference of instrumentation, ease of calculus removal, patient comfort, soft tissue irritation, time taken for scaling, Bleeding while scaling, pre and post operative sulcus bleeding index. In addition to the clinical criteria, the teeth treated were extracted and evaluated using the scanning electron microscope to show potential effects on cemntal surfaces. No difference in tooth sensitivity was appreciated between control and experimental quadrant A. There was a higher degree of tooth sensitivity when treated with ultrasonic. Patients in control group appreciated a higher degree of soft tissue pain. Hand scaling using softscale produced a lesser amount of pain and treatment with ultrasoincs was the least painful. Most of the patients preferred ultrasonic scaling (70%) Calculus removal was easier. Hand scaling using sofscale gel results in more patient comfort when compared to hand scaling alone. There was no significant difference in patient comfort between handscaling using sofscale and ultrasonic scaling. The percentage of reduction of sulcus bleeding index showed no difference between the 3 scaling modalities SEM evaluation revealed that there was no significant difference the 3 scaling modalities in relation to residual calculus, cleaning efficiency and damage to the root surface. This study concluded that treatment with sofscale gel appears to be safe and effective method for removal calculus as this did not damage cemental surfaces, nor did it cause any damage to soft tissue. "Your tratar is your calcified hate. Not only the microflora in your oral cavity but also your muddled thoughts, your obstinate squinting backward, the way you regree when you mean to progress, in other words, the tendency of your diseased gums to form germ catching pockets, all that, the sum of dental picture and psyche, betrays you, it is stored up violence, full of murdero us designs" Gunter Grass.

A comparative assessment of subgingival temperature in bleeding and non-bleeding sites before and after periodontal treatment.

Periodontal disease has affected human kind since times unknown. Various parameters are available to determine whether the tissue has been affected by the disease or not. In this study the reliance of subgingival temperature to be one of the parameters to determine the same has been evaluated.

Intracrevicular application of 0.3% Flurbiprofen gel and 0.3% Triclosan gel as anti inflammatory agent. A comparative clinical study.

This study compared the anti-inflammatory efficacy of Triclosan and Flurbiprofen in a gel form on clinical parameters of moderate gingivitis cases. The study comprised of 100 sites from 16 volunteers and used split mouth technique. 0.3% Triclosan/0.3% Flurbiprofen gels applied intracrevicularly once daily for one week. Clinical parameters like Plaque index, Gingival index and Bleeding index scores were recorded at 0 day, 4th day and 8th day. The obtained results showed significant reductions in clinical parameters from baseline to 8th day. This indicates local delivery of 0.3% Triclosan/0.3% Flurbiprofen gel can be used as an anti-inflammatory agents either alone or as an adjunct to scaling in periodontal therapy.

An appraisal of periodontal bone loss surgically and by radiovisiography. A comparative study.

The objective of the present study was to conduct a comparative evaluation of periodontal bone loss surgically and by radiovisiography. This study included 26 subjects with 23 mesial and 20 distal sites. Majority of RVG measurements were marginally higher than surgical values. On drawing a comparison between surgical and RVG bone loss, the difference value was statistically significant. On mesial sites, the 't' value was 4.55 with p < .001 and on distal sites 't' value was 2.79 with p < .02. In total 60% of sites showed a difference of < 0.5 mm between RVG and surgical values, 28% of sites showed values between 0.6-1.0 mm and 12% showed a1 mm difference.