Levels of nitric oxide in smokers and nonsmokers with chronic periodontitis before and after nonsurgical periodontal treatment.

Introduction: The purpose of this study was to determine the level of nitric oxide (NO) in both serum and saliva of smokers and nonsmokers with chronic periodontitis before and after scaling and root planing, as well as to compare the same (NO levels) with the severity of periodontitis. Materials and Methods: Sixty people took part in the study and were divided into three groups. The control group (Group I) involved 20 patients who were nonsmokers with healthy periodontium. The other two groups included 20 patients each, where Group II was nonsmokers with chronic periodontitis and Group III was smokers with chronic periodontitis. In addition, NO generation was quantified indirectly in this study using the Griess reaction to determine the nitrite level in serum and saliva. Results: The mean value of salivary and serum NO was higher in Group III than in Group II, and NO decreased considerably (P < 0.01) in both Groups II and III after treatment compared to before treatment. Conclusion: Serum and salivary NO levels can be used as a good predictor of the inflammatory condition of the periodontium in smokers.

Factors affecting the prevalence of stress, anxiety, and depression in undergraduate Indian dental students.

BACKGROUND: The objective was to assess the prevalence and the associated demographic factors of stress, anxiety, and depression among undergraduate (UG) Indian dental students and determine whether the pattern is different in government-run institutions and those managed by private authorities. MATERIALS AND METHODS: A cross-sectional study was conducted among dental UG students from five dental colleges. Snowball sampling was used to approach 776 potential participants, resulting in a complete response from 507 students. The questionnaire consisted of demographic data; year of study; type of college; accommodation; and Depression, Anxiety, and Stress Scale (DASS)-42. Descriptive data and inferential statistics were obtained. Chi-square test was applied for categorical data to test for significance, and higher analysis was done using multiple linear regression. RESULTS: Females and males comprised 71.8% (n = 364) and 28.2% (n = 143) of the study population, respectively. The prevalence of anxiety was highest (66.86%, n = 339), followed by depression (57.39%, n = 291) and stress (43.99%, n = 223). In terms of severity also, anxiety was the most prevalent condition as more than one-fourth of the students presented with severe and very severe scores in this aspect (25.43%, n = 129) compared to depression (14.39%, n = 73) and stress (10.09%, n = 51). Regression analysis revealed age as a strong positive predictor for all the three conditions, while staying in the hostel was a positive predictor for anxiety and stress. Being female was also an independent predictor for the high prevalence of stress. CONCLUSION: Stress, anxiety, and depression are highly prevalent among Indian dental students. Clinical students and interns have a higher prevalence of stress than preclinical students. Age, being female, and staying in the hostel are positive predictors for the severity of stress. There is no significant difference between government and private colleges, regarding the prevalence of any psychological condition.

Periodontal status associated with dual habits of smoking and smokeless tobacco use: A cross-sectional study in young adults.

Background: Tobacco smoke is an established risk factor for periodontitis. However, few studies have evaluated the periodontal status of smokeless tobacco (SLT) users, while that of individuals with dual habits has largely been unexplored. Therefore, the current study aimed to find if the periodontal status in individuals with dual habits of smoking and SLT use is different from those with any single habit. Methods: Four groups (A: exclusive smokers, B: exclusive tobacco chewers, C: individuals with dual habits, and D: non-users of tobacco), each comprising 75 males in the age group of 20 to 35 years, were selected. Along with the history of tobacco use, a modified oral hygiene index (OHI), gingival index (GI), probing depth (PD), and the number of teeth with gingival recession (GR) were recorded. The data were assessed using the Chi-squared test, one-way ANOVA, and logistic regression. Statistical significance was set at P<0.05. Results: Group C exhibited the highest mean OHI scores, with 94.66% of participants having poor oral hygiene (OHI>3.0). The prevalence of severe gingivitis (GI>2.0) was significantly lower among exclusive smokers (group A) and those with dual habits (group C) compared to the other two groups. As much as 60% of group C participants had average PD in the range of 4-6 mm, while deeper average PD (>6 mm) was most common among smokers. The highest risk of having a tooth with GR was also associated with the dual habit (OR = 4.33, 95% CI = 3.24 - 5.76) compared with the non-users. Conclusion: While both forms of tobacco were associated with poor periodontal status, the additive effect of smoking and SLT use was evident in almost all the parameters, more so with poor oral hygiene and the prevalence of gingival recession. These findings emphasize that individuals with dual habits have an additional risk for periodontal destruction.

Comparative assessment of bone mineral density levels in type 2 diabetic subjects with or without chronic periodontitis: A cross-sectional study.

Background: This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods: A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r). Results: The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479). Conclusion: Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters.

Use of GaAlAs Diode Laser for Excisional Biopsy of Gingival Giant Cell Fibroma: A Case Report of a Rare Lesion.

Giant cell fibroma (GCF) is a relatively rare lesion in the oral cavity. Despite having unique microscopic features, it can be easily misdiagnosed clinically as any common hyperplastic lesion. This report presents a case of a 21-year old male with a lesion involving the papilla between the mandibular central incisors. The lesion was excised completely under topical anesthesia using a 980 nm diode laser. On histopathological examination of the excised tissue, no thermal damage or any other alteration was observed, while the features were suggestive of GCF. Healing of the gingiva was uneventful and without any signs of recurrence. Apart from the widely known advantages of the diode laser, it also appears to maintain the integrity of biopsy specimens, if used with appropriate settings. This advantage may play a vital role in the biopsy of rare lesions where the diagnosis is entirely based on accurate histopathological examination.

Periodontal management of severe periodontitis and generalized gingival enlargement in a patient with chronic renal failure.

Gingival enlargement is a common periodontal pathology seen in medically compromised patients. Although it is not the disease itself, certain medications used to treat these chronic diseases are known to precipitate the gingival enlargement. Periodontitis (PD) and gingival enlargement have been reported increasingly in patients with chronic renal failure. Severe enlargement is detrimental to esthetics and function while having a negative impact on the overall oral health-related quality of life. Treatment of such cases requires comprehensive periodontal management by a specialist, keeping in mind the medically compromised state of the patient. This report presents a case of severe PD with generalized gingival enlargement in a 45-year-old male who was a known case of Stage 4 chronic kidney disease, obstructive uropathy, and hypertension. Gingival enlargement was managed by gingivectomy and gingivoplasty. Six months' follow-up showed no sign of recurrence.

Effect of antidepressants on various periodontal parameters: A case-control study.

BACKGROUND: Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case-control study was conducted to know the effect of two commonly prescribed antidepressants - venlafaxine (serotonin-norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti-inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. MATERIALS AND METHODS: The study sample consisted of 182 depressed patients divided into three study groups: Group I - the control group diagnosed as depressed on the first visit, Group II - depressed patients taking fluoxetine 20 mg/day, and Group III - patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire-based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. RESULTS: The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti-inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants-SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). CONCLUSION: The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti-inflammatory properties.

Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique.

BACKGROUND: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. METHODS: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. RESULTS: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. CONCLUSIONS: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

Hard- and soft-tissue augmentation around dental implant using ridge split and connective tissue graft for esthetic rehabilitation of atrophic anterior maxilla.

Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of the most challenging situations in implant practice. With the increase in popularity of dental implants, augmentation of the alveolar ridge and soft tissue has also become a routine procedure in most of the cases. Although hard-tissue augmentation is performed by other specialists also, a periodontist needs to master the skills of soft-tissue management to deliver esthetic and functional results in implant-supported prostheses. This case report presents a single-staged ridge split approach using piezoelectric surgery with simultaneous implant placement followed by connective tissue grafting at second-stage surgery. Single-staged segmental ridge split technique not only reduces the total treatment duration but also the surgical morbidity for the patient. A subepithelial connective tissue graft is strongly advocated around implants as it is highly predictable while ensuring better esthetic results in terms of tissue color, texture, and long-term stability of the surrounding mucosa.

Impact of nonsurgical periodontal therapy on total antioxidant capacity in chronic periodontitis patients.

AIM: The aim of this study was to determine the utility of plasma total antioxidant capacity (TAC) as marker of periodontal disease by estimating TAC of periodontally healthy and chronic periodontitis patients and the impact of scaling and root planning on total antioxidant status of periodontitis patients. MATERIALS AND METHODS: Blood plasma samples were collected from randomly selected eighty individuals (40 periodontally healthy controls and 40 chronic periodontitis patients), with an age range of 20-45 years and were analyzed for TAC by ferric reducing antioxidant power assay. Scaling and root planing was performed in periodontitis patients, and TAC level was measured again after 3 weeks. Data were analyzed with t-test, using SPSS software (PSAW, Windows version 18.0). RESULTS: The mean plasma TAC was significantly lower (792.33 ± 124.33 µmol/L, P < 0.001) in chronic periodontitis patients compared to healthy control (1076.08 ± 193.82 µmol/L). Plasma TAC level increased significantly (989.75 ± 96.80, P < 0.001) after scaling and root planing. CONCLUSIONS: An inverse relationship exists between plasma TAC and severity of chronic periodontitis suggesting disturbed oxidant-antioxidant balance in chronic periodontitis. Scaling and root planing resulted in the restoration of TAC to normal levels. These results are important from the perspective of including antioxidants in periodontal therapy regime to boost up body's antioxidant defense system and to reduce oxidative stress-mediated periodontal tissue damage. We concluded that TAC can be used as a biomarker to evaluate the health of periodontium.

Necrotizing periodontitis in a heavy smoker and tobacco chewer - A case report.

Necrotizing periodontitis is a distinct and specific disease characterized by rapidly progressing ulceration of the interdental gingiva and then spreading along the gingival margins and leading to acute destruction of periodontal tissues. Necrotizing ulcerative gingival lesions are common in developing countries because of poor nutritional status, poor oral hygiene and debilitating conditions. In the developed world it is mostly seen in patients with the HIV infections and other immune system dysfunctions. The exact etiology of the necrotizing lesions is still unknown; however a fuso-spirochaetal infection along with weakened host immune system seems to play a major role in the pathogenesis of these diseases. Presented is the case of acute necrotizing periodontitis in a 21 year old male patient with no systemic disease but a history of tobacco use (chewing and smoking) since 7 years. The patient was managed by conservative treatment followed by surgery for the correction of gingival defects.

Sclerostin and occlusion: A brief review.

In its pursuit of understanding the wonders of human body, mankind has stumbled upon yet another discovery which not only is a key to chest of unanswered queries but also opens a plethora of new possibilities. Till recently the osteocytes were considered latent cells merely entrapped in the matrix of bone. With the discovery of beta-catenin pathway and sclerostin molecule, these cells are now being recognized to perform a multitude of physiological functions which are important to bone function and turnover. Mechanosensor function of osteocytes via sclerostin molecule offers new possibilities in alveolar bone preservation. Sclerostin and its inhibitors have potential in prosthetic, regenerative and preventive therapy in dentistry. Osteocytic pathway of sclerostin release and mechanism of its interaction with occlusion is discussed in this article.

Endodontic irrigant as a root conditioning agent: An in vitro scanning electron microscopic study evaluating the ability of MTAD to remove smear layer from periodontally affected root surfaces.

BACKGROUND: Instrumentation of the root surface, results in formation of a smear layer of organic and mineralized debris which serves as a physical barrier, inhibiting new connective tissue attachment to the root surface. The present study advocates the use of an endodontic irrigant MTAD (mixture of tetracycline, citric acid and detergent) as a root conditioning agent. The main aim of the study was to compare the root conditioning ability of an endodontic irrigant MTAD (mixture of tetracycline, acid and detergent) with 17% EDTA (ethylenediaminetetraacetic acid). MATERIALS AND METHODS: Sixty freshly extracted human single rooted teeth with confirmed periodontal involvement were selected for this study and decoronated. The apical third of each root was removed and the remaining root was sectioned longitudinally to produce a 6mm to 8mm long tooth section. The root surface was then instrumented by hand using a sharp Gracey 1-2 periodontal curette with 6-8 strokes per area to achieve a smooth glass-like surface. A total of 60 specimens were prepared which were randomly divided into three groups (n=20). Each group received the root conditioning treatments as follows: All specimens were prepared for SEM and scored according to the presence of smear layer. RESULTS AND CONCLUSIONS: MTAD removed the smear layer successfully from the root surfaces. The mean smear score for samples treated with Biopure MTAD was lower than those treated with EDTA, (p=0.04). MTAD can be used as a root conditioning agent with efficient smear layer removal ability and known antimicrobial and anticollagenase activity.

Comparative evaluation of serum C-reactive protein levels in chronic and aggressive periodontitis patients and association with periodontal disease severity.

OBJECTIVE: C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. MATERIALS AND METHODS: A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. RESULTS: Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. CONCLUSION: The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.

Salivary TNF-alpha: A potential marker of periodontal destruction.

AIMS AND OBJECTIVES: (1) To evaluate the effect of type 2 diabetes mellitus on salivary TNF-α level in chronic periodontitis. (2) To evaluate the effect of smoking on salivary TNF-α level in chronic periodontitis. (3) To compare and correlate TNF-α level with the healthy individuals. MATERIALS AND METHODS: Subjects aged 30-35 years were included for the study and divided into four groups as a group of 20 systemically and periodontally healthy individuals (group I), a group of 20 subjects with pocket probing depth (PPD) ≥5 mm and clinical attachment loss (CAL) of ≥2 mm (group II), a group of 20 diabetic subjects (of more than 5 years) with periodontal parameters as of group II as (group III) and a group of 20 subjects smoking (≥10 cigarettes a day) with periodontal parameters of group II as (group IV). Periodontal parameters of PPD, CAL, gingival index (GI), and plaque index (PI) were measured using standard indices and criteria. Three milliliter of unstimulated saliva was taken and salivary TNF-α determined by using ELISA technique (Quantikine Human total TNF-A immunoassay kit). RESULTS: Data revealed highest mean TNF-α in group III followed by group IV, group II, and group I. Mean TNF-α of both group III (76.1%) and group IV (48.8%) was significantly higher as compared to group I (P < 0.001). Mean TNF-α of group III was also found to be significantly different and higher (68.1%) as compared to group II (P < 0.001). Although higher mean TNF-α (31.5%) was found in group IV in comparison to group II, the difference was not statistically significant. Besides above, TNF-α also showed a direct positive correlation with PPD in group II (r = 0.30, P > 0.05) and a significant negative correlation was observed between CAL and TNF-α in group IV. CONCLUSION: Our study clearly underlines a profound impact of diabetes and smoking on salivary TNF-α in chronic periodontitis subjects in comparison to healthy subjects. Moreover, diabetes status increased TNF-α significantly in comparison to smoking in chronic periodontitis patients.

Nonaggressive central giant cell granuloma mimicking chronic inflammatory enlargement: a case report.

This article presents a case of giant cell granuloma in a 24-year-old man. Clinical, histopathological, and radiographic findings are discussed and a differential diagnosis and treatment plan are suggested. Clinical behavior among lesions may vary between nonaggressive and aggressive forms, and even radiographic appearances are not identical. The present case resembled a variety of conditions clinically but was diagnosed histopathologically as giant cell granuloma. This case is presented to emphasize the importance of histopathologic examination to ensure proper diagnosis and treatment.

Dental fluorosis and periodontium: A game of shadows?

Dental fluorosis is a condition which is said to be present when the morphologic features of a tooth are altered clinically, in the form of discoloration or anatomic malformation which is attributed to the developmental changes induced by excess fluoride levels in plasma at the time of tooth formation. In India, an estimated 60 million people are at risk and 6 million people are disabled due to fluorosis. Lack of understanding into the effects of fluorosis on periodontium has left a blind spot in the vision of management of periodontitis in such patient groups. This article suggests the important connection these two conditions can have and emphasize research in this study field.

Determination of levels of nitric oxide in smoker and nonsmoker patients with chronic periodontitis.

PURPOSE: Cigarette smoking is a major risk factor in periodontal diseases. The pathogenesis of periodontal diseases may be affected by alterations of the inflammatory response by smoke. Nitric oxide (NO) is a gaseous, colorless, highly reactive, short-lived free radical with a pivotal role in the regulation of various physiological and pathological mechanisms in the body. It is important in host defense and homeostasis, on the one hand, whereas, on the other hand, it modulates the inflammatory response in periodontitis, leading to harmful effects. The aim of this study was to assess the levels of NO in both the serum and saliva of smokers and nonsmokers having chronic periodontitis and to compare them with periodontally healthy controls. METHODS: SIXTY SUBJECTS PARTICIPATED IN THE STUDY AND WERE DIVIDED INTO THREE GROUPS: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of twenty subjects. The biochemical estimation of NO in the collected serum and in the saliva was performed using the Griess colorimetric reaction. RESULTS: The results showed that the mean value of the salivary and serum NO was greater in group II than in group I, and also greater in group III than in group II. CONCLUSIONS: NO appears to play an important and rather complex role in the immuno-inflammatory process and in the remodeling and maintenance of osseous structures. It is therefore logical that modulation of this mediator has potential for the treatment of a number of inflammatory conditions including periodontal disease.

Dental health attitude in Indian society.

Every society provides a unique soil for a health-care programmer to build upon. Indian society is similarly unique in factors such as social mindset, prevalent beliefs and customs. These factors should not be given a passive glance and should be explored carefully giving an adequate weight to each factor's background and its progress to the present status in contemporary dental practice. Only a careful scientific analysis of society is therefore the need of the hour for oral health-care programmers.