Comparative Evaluation of Gingival Depigmentation using Tetrafluoroethane Cryosurgery and Gingival Abrasion Technique: Two Years Follow Up.

OBJECTIVE: A comparative evaluation of the gingival depigmentation by using Tetrafluoroethane cryosurgery and the gingival abrasion technique - 2 years of follow up. MATERIAL AND METHODS: Ten systemically healthy patients who were aged 18 to 36 years were selected for the study. Tetrafluoroethane was used for the cryosurgical depigmentation and the gingival abrasion technique used a coarse flame shaped bur. The presence or absence of pigmentation was tabulated, based on the GPI (Gingival Pigmentation Index). For the statistical analysis, Freidman's test was used. RESULTS: The keratinization was completed within a week after the application of the cryogen and about 10 days after the gingival abrasion technique was done. The statistical analysis which was done after 90th, 180th days and 2 years. The p-value which was obtained (p<.001) showed the superiority of cryosurgery over the gingival abrasion. During the follow up period, no side effects were seen for both the techniques and the improved aesthetics was maintained upto 2 years. CONCLUSION: The use of cryogen Tetrafluoroethane is easy, practical and inexpensive as compared to gingival abrasion, due to its high rate of recurrence. Hence, it is more acceptable to the patients and the operator. Further studies are needed to assess the long term effectiveness of the cryosurgical method of depigmentation.

Chronic inflammatory gingival enlargement associated with orthodontic therapy--a case report.

PURPOSE: Gingival enlargement, also synonymous with the terms gingival hyperplasia or hypertrophy, is defined as an abnormal overgrowth of gingival tissues. A case of a 19-year-old male presenting with maxillary and mandibular chronic inflammatory gingival enlargement associated with prolonged orthodontic therapy is reported here. Surgical therapy was carried out to provide a good aesthetic outcome. No recurrence was reported at the end of 1 year. The importance of patient motivation and compliance during and after therapy as a critical factor in the success of treatment has also been highlighted through this case report.

Effectiveness of cryogen tetrfluoroethane on elimination of gingival epithelium and its clinical application in gingival depigmentation-histological findings and case series.

OBJECTIVE: To histologically assess and clinically co-relate the effectiveness of cryogen Tetrafluoroethane (TFE) for gingival depigmentation procedure. MATERIAL AND METHODS: Twelve patients having unaesthetic gingival melanin pigmentation were included in the study. Gingival tissues of eight patients having gingival melanin pigmentation undergoing gingivoplasty or gingivectomy for crownlengthening were exposed to the cryogen and this was used for the histological examination. Gingivectomies were done after 8, 24, 96 hours and after a week of application of tetrafluoroethane. Four fair skinned patients complaining of unaesthetic gingival hyperpigmentation underwent gingival depigmentation using Tetrafluoroethane cryogen. RESULTS: Histologically after 96 hours of application of cryogen there was complete loss of retepegs and epithelial detachment from the corium was evident. Complete re - epithelialisation was noted after a week and was clinically correlated. CONCLUSION: We therefore, concluded that histologically tetrafluoroethane can effectively destroy gingival epithelium without causing damage to the connective tissue and clinically the color of the gingiva had more pleasing appearance 6 months postoperatively. Hence the cryogen can be used safely for depigmentation procedure.

Superoxide dismutase enzyme and thiol antioxidants in gingival crevicular fluid and saliva.

BACKGROUND: The possibility of impaired antioxidant status and so increased oxidative damage in periodontal disease is being conjectured. The present randomized controlled study was carried out with the objective of analyzing the activity of superoxide dismutase enzyme and thiol antioxidants in gingival crevicular fluid (GCF) and saliva as indicators of response to periodontal therapy. MATERIALS AND METHODS: SUBJECTS WERE SCREENED AND RANDOMLY DIVIDED INTO THREE GROUPS: 23 periodontally healthy controls, 24 with gingivitis, and 23 with periodontitis. Based on the clinical attachment levels, the periodontitis group was further divided into subgroups, including mild, moderate, and severe periodontitis. GCF and saliva samples were collected for estimation of superoxide dismutase and thiol antioxidant concentrations at baseline and 15 days after nonsurgical treatment. Intragroup comparisons were statistically analyzed using repeated measures analysis of covariance (P value <0.05). RESULTS: Superoxide dismutase was present in greater quantities in the GCF compartment (100.32±3.67 U/0.5 mL) than in saliva (39.99±3.52 U/0.5 mL), with elevated levels in mild and moderate subgroups as compared with severe periodontitis. Thiol concentrations were comparable in these media, 14.43±1.57 micromol /L in GCF and 15.09±2.26 micromol/L in saliva. Following treatment, superoxide dismutase and thiol antioxidant concentrations significantly improved in all the patient groups. CONCLUSION: The reduction of the inflammatory response following therapy resulted in improved antioxidant profiles in both the GCF and salivary compartments.

Recurrent periodontal abscess associated with "teeth as a tool".

We report an unusual case of recurrent periodontal abscess in a 31-year-old male electrician due to his habit of using his teeth as a tool for stripping electrical wires. The patient was not aware of the consequences of this habit. Clinically, there was presence of moderate depth of periodontal pocket around the tooth and, radiographically, there was a vertical defect mesial to the involved teeth. The patient was educated about the consequences of his habit and surgical treatment was undertaken. A papilla preservation flap with regenerative periodontal surgical procedure was done, orthodontic and restorative treatment was planned at the follow-up. This case highlights the importance of eliciting a proper and complete personal history, including occupational details. In our patient these details helped us correlate the destruction of the periodontium to the unusual etiology.

Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital.

OBJECTIVES: To determine the prevalence of amlodipine-induced gingival overgrowth (GO) among elderly subjects attending an Indian teaching hospital and find any association with demographic factors, drug variables, oral hygiene status and gingival inflammation. METHODS: A cross-sectional pilot study included 157 dentate patients aged 60 years or more, taking Amlodipine for at least 3 months. Data were collected from past medical records and oral examination. Clinical assessment of GO was correlated with patient's age, gender, drug dosage (2.5, 5 or 10 mg/day), duration of drug therapy (3-4, 4-6, 6-12, 12-24 and >24 months) and also with subjects' plaque index and gingival index scores. RESULTS: Eight patients (5.09%) had GO. No statistically significant relation was observed between age (p = 0.79), gender (p = 0.56), drug dosage (p = 0.25) and duration of drug intake (p = 0.62) and prevalence of GO. GO prevalence related highly significantly (p < 0.001) with plaque and gingival index scores. CONCLUSIONS: Prevalence of amlodipine-associated GO in the sample of elderly Indian patients was noted higher than that previously reported. Plaque and gingival inflammation were highly correlated with this condition, while demographic characteristics and drug dosage did not relate significantly.

Allele, genotype, and composite genotype effects of IL-1A +4845 and IL-1B +3954 polymorphisms for chronic periodontitis in an Indian population.

INTRODUCTION: The pro-inflammatory cytokine interleukin-1 (IL-1) is a key modulator of host responses to microbial infection and a major modulator of extracellular matrix catabolism and bone resorption, and polymorphisms in the IL-1 gene cluster have been associated with an increased risk of developing severe adult periodontitis. A case control study was performed to determine the role of IL-1A+4845 and IL-1B+3954 polymorphisms in the predisposition to chronic periodontitis. MATERIALS AND METHODS: The study was conducted with 103 unrelated participants recruited from Manipal College of Dental Sciences, Manipal, which included 51 chronic periodontitis patients and 52 normal periodontally healthy individuals. Extensive clinical data were collected, bone loss was the major outcome variable and smokers and diabetics were excluded from the study to eliminate the influence of these risk factors. Genomic DNA was isolated from the blood samples of participants for genotyping IL-1A+4845 and IL-1B+3954 polymorphisms by polymerase chain reaction-restriction fragment length polymorphism and the data statistically analyzed. RESULTS: Allele 2 of the IL-1A+4845 polymorphism was carried by 38% of all participants; of these only 6 were homozygous for the allele. Allele 2 of the IL-1B+3954 was carried by 21% of the subjects; only 1 was homozygous for allele 2. The composite genotype was carried by 31% of the cases and by 38% of the controls. Overall, 35% participants carried the composite IL-1 genotype. No statistically significant association was found for the distributions. CONCLUSIONS: The distribution of the IL-1 positive composite genotype is in concordance with the frequencies reported in the Caucasians. Association was not found for the effect of allele, genotype, composite genotype, and haplotypes of IL-1A+4845 and IL-1B+3954 polymorphisms with periodontitis. Its utility as a risk marker in this population was not borne out by the study.

A rare case of unusual gingival enlargement post radiotherapy.

Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function, radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement of the gingiva of 6 months' duration and lower lip swelling of 7 months' duration. She was a known case of carcinoma of nasopharynx and had received radiotherapy and chemotherapy. Based on the history, the clinical appearance of the gingiva, and the other oral changes we considered both post-radiotherapy gingival enlargement and secondary metastasis to gingiva as possibilities. An incisional biopsy was performed (internal bevel gingivectomy). The histopathological report did not reveal any metastatic changes. Thus, we diagnosed post-radiotherapy gingival enlargement. For the multiple carious teeth, extraction and root canal treatment was carried out as necessary. The patient was referred to the department of Oral and Maxillofacial Surgery for management of swelling of the lips, which was diagnosed as lymphedema of the lip. Gingival enlargement is rare post radiotherapy. Such nonplaque-associated gingival enlargement in a patient who has undergone radiotherapy should be subjected to biopsy and histopathological examination to distinguish between secondary metastasis and post-radiation changes.

An adventurous habit of bottle-cap opening resulting in an endodontic-periodontal lesion: a case report.

An unusual case of an endodontic-periodontal lesion in a 29-year-old man resulting from a habit of opening beer bottle (metal) caps using his mandibular left molar is reported. The patient had been a chronic alcoholic with several emotional problems and was unaware of the injurious nature of his habit. Thus, the importance of a detailed case history and assessment of psychosocial aspects for an accurate diagnosis of such conditions is highlighted.

Association of cigarette smoking with superoxide dismutase enzyme levels in subjects with chronic periodontitis.

BACKGROUND: Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). In the present study, the influence of smoking on the periodontium was determined by estimating the levels of SOD in light and heavy smokers with periodontitis. METHODS: Seventy subjects in the age range of 20 to 55 years, including 60 smokers and 10 non-smokers (controls), were selected. Clinical parameters recorded were plaque index (PI), probing depth (PD), and attachment loss (AL). Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (> or = 10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. Gingival crevicular fluid (GCF) and saliva samples were collected. SOD levels were analyzed using spectrophotometric assay. RESULTS: The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and intergroup analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. CONCLUSIONS: There was a progressive reduction in SOD levels from healthy non-smokers to light smokers to heavy smokers. These findings highlight the need to augment the efforts of smoking-cessation programs. The benefits of reduced smoking and improved antioxidant levels may motivate smoking cessation.

A rare case of malignant fibrous histiocytoma of the gingiva.

BACKGROUND: Malignant fibrous histiocytoma (MFH) is an aggressive, high-grade tumor with poor prognosis. It is the most common soft tissue sarcoma in adults, usually occurring retroperitoneally in extremities. MFH of the head and neck is rare. Cases with primary involvement of only the oral soft tissues have been reported; a few occurred in the gingiva. Its clinical features include a painless enlarging mass, which may or may not be ulcerated. METHODS: A 20-year-old female patient presented with a non-healing necrotic ulceration of 4 months' duration on the maxillary anterior labial gingiva. Based on her history and agricultural background, a provisional diagnosis of chronic fungal and chronic bacterial infection was given. The patient was placed on a topical antifungal in combination with antibiotic therapy for 10 days. Because the lesion failed to respond to the initial therapy, an incisional biopsy was performed. The lesion was diagnosed as MFH based on clinical, histopathologic, and immunohistochemical findings. RESULTS: The patient was referred to the Department of Oncology and Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, for further evaluation and treatment; the lesion was treated by resection of the premaxilla, and a splint was placed. She was followed up for 3 months with improvement in her condition. CONCLUSIONS: Because MFH is rare in the oral cavity, misdiagnosis may not be unusual based on the initial clinical examination. Any suspicious lesion that is unresponsive to treatment must be subjected to histopathologic evaluation to arrive at a final diagnosis.

Clinical management of an unusual case of gingival enlargement.

AIM: The purpose of this article is to report a case of conditioned gingival enlargement managed by non-surgical periodontal therapy. BACKGROUND: Hormones are specific regulatory molecules that modulate a host of body functions. Hormonal effects reflect physiologic and pathologic changes in almost all tissues of the body with the periodontium being no exception. Physiologic changes like puberty, the menstrual cycle, and pregnancy cause hormonal variations that may cause inflammation of the gingiva. Oral contraceptives that contain estrogen and/or progesterone are associated with gingival enlargement. REPORT: A 28-year-old female presented with a complaint of swelling of the gingiva with spontaneous bleeding in the maxillary anterior region for a period of one year. The health history documented the use of contraceptives for one year, and a clinical examination revealed the existence of poor oral hygiene and enlarged painful gingival tissues that bled when touched. SUMMARY: This case reaffirms the fact plaque control is the most important procedure in any periodontal therapy. Another factor contributing to the excellent response to therapy is patient compliance. The patient followed home care instructions well and was effective in personal oral hygiene measures.

Esthetic management of the upper labial frenum: a novel frenectomy technique.

An abnormal upper labial frenum is capable of retracting the gingival margin, creating a diastema, limiting lip movement, and in cases of a high smile line, affecting esthetics also. When an abnormal frenum is present, frenectomy is advised. This technique has been modified in many ways. But in most of the techniques the zone of attached gingiva and esthetics are not considered. This case report highlights a new technique of frenectomy that results in good esthetics, excellent color match, gain in attached gingiva, and healing by primary intention at the site of the thick, extensive abnormal frenum.

Twenty-year follow-up of an unconventional intentional replantation.

For many years, intentional replantation has been a treatment option for pulpless teeth and an effective strategy for teeth that would be difficult, if not impossible, to treat using traditional root canal therapy. The preservation of cell vitality in the periodontal ligament, the removal of all tissue debris and irritating substances from the root surface, achievement of a good apical seal and reinforcement of the crown structure are critical in ensuring normal function of the reimplanted tooth. In this article, we report on an unconventional intentional replantation of a mandibular second molar to relieve continuing symptoms. Retrograde fillings were placed in the second molar and the coronal pulp chamber was sealed with amalgam. No endodontic therapy was carried out either during or after the procedure. After 20 years, the patient was asymptomatic, the tooth was still functional and a recall intraoral periapical radiograph showed an intact periodontal ligament space and lamina dura with no evidence of gross root resorption or ankylosis.

The attachment of V79 and human periodontal ligament fibroblasts on periodontally involved root surfaces following treatment with EDTA, citric acid, or tetracycline HCL: an SEM in vitro study.

OBJECTIVE: The present in vitro study has been designed to establish and compare the effects of citric acid, EDTA, and tetracycline HCl on human periodontally diseased roots on the structure, attachment, and orientation of V79 (primary Chinese hamster lung fibroblasts) cells and human periodontal ligament fibroblasts (HPDL). MATERIALS AND METHODS: Commercially available V79 cells and HPDL derived from healthy human third molars were used in this study. These fibroblasts were left in solution for seven days in order to attain confluence. Forty single-rooted teeth were obtained from patients diagnosed with periodontitis. The crown part was removed under constant irrigation and the root was split vertically into two equal halves, thus, yielding 80 specimens. Following scaling and root planing, the specimens were washed with phosphate buffered saline (PBS) and kept in 50 microg/ml gentamycin sulphate solution for 24 hours. The root pieces were then treated as follows: citric acid at pH 1, 24% EDTA, or with a 10% solution of tetracycline HCl and were then placed in V79 fibroblast cultures and HPDL cultures. The specimens were harvested after four weeks and were fixed in 2.5% glutaraldehyde in PBS before preparation for scanning electron microscopy (SEM). RESULTS: The behavior of V79 cells was similar to that of human periodontal ligament cells on root conditioned surfaces. V79 and HPDL showed a healthy morphology on root surfaces treated with citric acid and EDTA and a relatively unhealthy appearance on root surfaces treated with tetracycline HCl and distilled water (control group). CONCLUSION: The results suggest the use of citric acid and EDTA as root conditioning agents favorably affects the migration, attachment, and morphology of fibroblasts on human root surfaces, which may play a significant role in periodontal healing and regeneration.

Acceptability of powered toothbrushes for elderly individuals.

OBJECTIVES: This study evaluated the usefulness of powered toothbrushes in elderly individuals for removing supragingival plaque and improving gingival health and comparing this to the use of regular manual toothbrushes. METHODS: Fourteen persons aged 68-85 years having moderate gingivitis were included in the study. A crossover clinical trial consisting of two phases of three months' duration each was carried out. All the participants were given an oral prophylaxis, following which they were instructed to use the manual toothbrush for three months. Again, for the same subjects, an oral prophylaxis was given and they were asked to use the powered toothbrush for the next three months. Plaque Index and Gingival Index scores were recorded one, two, and three months after the use of each toothbrush. Oral hygiene instruction was reinforced only at baseline. RESULTS: The powered toothbrush was more effective than a regular manual toothbrush in removing plaque and controlling gingivitis. CONCLUSION: The powered toothbrush may prove to be a good alternative to the manual toothbrush for this segment of the population, as it does not require any special dexterity to use.

Diabetes mellitus--a modifier of periodontal disease expression.

The understanding of causes and progression of periodontal disease has increased considerably in recent years making it all the more important to gain knowledge about diabetes and its interrelationship with periodontal disease so as to be able to assess their impact on one another more accurately. Strong evidence exists to support the fact that diabetic patients are at an increased risk for periodontitis. A number of underlying factors are known to contribute to enhanced periodontal destruction in diabetics. There has been intensive research to characterise the mechanisms responsible for the pathogenesis of both microvascular and macrovascular complications. It is also known that there is variability in the rate of development and severity of these complications with some diabetics experiencing none of them. Many of the host response traits that confer susceptibility to periodontitis in otherwise healthy individuals are exaggerated in diabetics. These diabetes associated susceptibility traits include neutrophil dysfunction, abnormal cross-linking and glycosylation of collagen, defective secretion of growth factors and subsequent impaired healing. However it is uncertain which of the hypothesised mechanisms or combinations of mechanisms is directly responsible for the pathogenesis of the complications or whether different mechanisms are operative in different tissues.