Association between preterm birth and low birth weight and maternal chronic periodontitis: A hospital-based case-control study.

BACKGROUND: Periodontal diseases (PDs) are one of the most common chronic diseases affecting overall oral functions, and their association with adverse pregnancy outcomes (APOs) has been an area of interest since the late 90s. OBJECTIVES: The present hospital-based case-control study aimed to find any association between maternal chronic periodontitis (CP) and preterm birth (PTB) and low birth weight (LBW) by comparing the periodontal parameters in patients with normal birth, PTB and LBW. MATERIAL AND METHODS: The participants of the study were females that had delivered a live baby (n = 1,200). They were classified as either cases or controls. The cases were defined as PTB if the delivery was before 37 weeks of gestation, and as LBW if the infant weighed <2,500 g. The others were controls. The intraoral examination, which included recording the periodontal status, was conducted within 3 days of delivery. Detailed medical history and demographic data were recorded for the determination of the confounding factors. The multivariable dependence of PTB and LBW on both the categorical and continuous data was analyzed using a multivariate logistic regression analysis. Adjusted odds ratios (AORs) with a 95% confidence interval (CI) for the risk of PTB and LBW were calculated. RESULTS: A strong association with PTB was found for a high plaque index (PI) score (AOR = 1.61; p < 0.001; 95% CI: 1.26-2.07) and a mean pocket probing depth (PPD) ≥4 mm (AOR: 4.32; p < 0.001; 95% CI: 3.09-6.02). A strong association with LBW was found for a high PI score (AOR = 2.02; p < 0.001; 95% CI: 1.43-2.83) and a mean PPD ≥4 mm (AOR: 8.70; p < 0.001; 95% CI: 6.01-12.59). A high PI score and a mean PPD ≥4 mm were independent risk factors for PTB and LBW. CONCLUSIONS: The presence of deep pockets and inadequate plaque control in pregnant females increased the risk of APOs.

Assessing the effect of piezoelectric ultrasonic scaler tip wear on root surface roughness under influence of various working parameters: A profilometric and atomic force microscopic study.

Background: Assessing the effect of scaler tip wear on the root surface roughness using piezoelectric ultrasonic scaling device under influence of various working parameters, i.e. power setting, lateral force, and instrumentation time. Materials and Methods: An experimental study was conducted using 160 single-rooted tooth samples divided into two groups of new (n = 80) and worn tips (n = 80). Samples were prepared to examine the root surface roughness after being instrumented by new and worn piezoelectric ultrasonic tips (8 new/8 worn) at different parameters. The erosion ratio (ER) of the new/worn tip was examined under an atomic force microscope and roughness over root surface was measured by a contact surface profilometer. One-way analysis of variance test, post hoc Tukey's test, and independent t-test were used for intragroup, pair-wise multiple comparisons and intergroup comparison of average roughness (Ra) value. Results: A statistically significant difference was found between the ER of new and worn scaler tips (P < 0.001). Intragroup comparison between subgroups 1 and 8 showed a higher Ra value in both the groups (P < 0.005). There was a significantly higher Ra value of worn tips compared to new tips (P < 0.05). Significantly higher mean Ra value was shown when lateral force changed from 50 g to 100 g (P < 0.005). Conclusions: Increasing value of power setting, lateral force, and instrumentation time caused more surface roughness in worn-out scaler tips compared to new scaler tips. Lateral force and instrumentation time proved to be a major factor influencing surface roughness.

Effects of non-surgical periodontal therapy on serum inflammatory factor high-sensitive C-reactive protein, periodontal parameters and renal biomarkers in patients with chronic periodontitis and chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is associated with significant morbidity and mortality, and there are various risk factors for this disease. Although the association between CKD and periodontal disease (PD) has been reported in various cross-sectional studies, longitudinal intervention studies are scarce. OBJECTIVES: This study aimed to evaluate the effects of non-surgical periodontal therapy (NSPT) on periodontal clinical parameters, serum inflammatory factor high-sensitivity C-reactive protein (hs-CRP) and renal biomarkers in patients with CKD and chronic periodontitis (CP). MATERIAL AND METHODS: A total of 80 patients with confirmed CKD aged 22-65 years, attending the Institute of Kidney Diseases Research Centre (IKDRC) in Ahmedabad, India, and referred to the Government Dental College and Hospital, Ahmedabad (GDCHA), were enrolled in this study. The patients were divided into 2 groups: group 1 received NSPT, including scaling and root planing (SRP), as well as oral hygiene instructions; and group 2 received oral hygiene instructions without NSPT. Periodontal clinical parameters, such as probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BoP), the periodontal inflamed surface area (PISA) score, and the Simplified Oral Hygiene Index (OHI-S), were recorded. Biomarkers, including hs-CRP, the estimated glomerular filtration rate (eGFR) and the urine albumin-to-creatinine ratio (UACR), were obtained from medical records. The comparisons of periodontal parameters, hs­CRP and renal biomarkers within and between the groups were performed at baseline, and 3 and 6 months after treatment. RESULTS: The periodontal parameter scores as well as the serum levels of hs­CRP and UACR significantly decreased while eGFR significantly increased in group 1 after treatment as compared to baseline (p < 0.001). Six months after treatment, group 1 showed significantly lower values than group 2 for periodontal parameters, the serum levels of hs­CRP and renal biomarkers except for eGFR, which improved and increased (p < 0.001). CONCLUSIONS: Periodontitis is an important source of chronic inflammation and the treatment of periodontitis can hinder systemic inflammation in CKD patients. Non-surgical periodontal therapy resulted in improved periodontal health, with significant decreases in hs­CRP and UACR, and an increase in eGFR in CKD patients with CP in comparison with CKD patients not receiving NSPT.

Estimation of gingival crevicular blood glucose level for the screening of diabetes mellitus: A simple yet reliable method.

AIM: This study was designed to assess the reliability of blood glucose level estimation in gingival crevicular blood(GCB) for screening diabetes mellitus. MATERIALS AND METHOD: 70 patients were included in study. A randomized, double-blind clinical trial was performed. Among these, 39 patients were diabetic (including 4 patients who were diagnosed during the study) and rest 31 patients were non-diabetic. GCB obtained during routine periodontal examination was analyzed by glucometer to know blood glucose level. The same patient underwent for finger stick blood (FSB) glucose level estimation with glucometer and venous blood (VB) glucose level with standardized laboratory method as per American Diabetes Association Guidelines.1 All the three blood glucose levels were compared. Periodontal parameters were also recorded including gingival index (GI) and probing pocket depth (PPD). RESULTS: A strong positive correlation (r) was observed between glucose levels of GCB with FSB and VB with the values of 0.986 and 0.972 in diabetic group and 0.820 and 0.721 in non-diabetic group. As well, the mean values of GI and PPD were more in diabetic group than non-diabetic group with the statistically significant difference (p < 0.005). CONCLUSION: GCB can be reliably used to measure the blood glucose level as the values were closest to glucose levels estimated by VB. The technique is safe, easy to perform and non-invasive to the patient and can increase the frequency of diagnosing diabetes during routine periodontal therapy.

Periodontal status and oral health behavior in hospitalized patients with chronic obstructive pulmonary disease.

AIM: We evaluated the periodontal health status and oral health behavior among hospitalized patients with chronic obstructive pulmonary disease (COPD) to assess the association of COPD with dental health. MATERIALS AND METHODS: A group of 100 hospitalized patients with COPD and a group of 100 age, sex, and race-matched control patients were included in this study. Detailed case histories along with standardized measures of oral health including gingival index, plaque index (PI), and simplified oral hygiene index (OHI) were estimated and compared. Probing depths and clinical attachment levels (CALs) were recorded at four sites per tooth. C-reactive protein (CRP) levels in saliva and serum were also measured. RESULTS: The study subjects had similar demographics and distribution in either group. Patients with COPD had significantly lower brushing frequency, poor periodontal health (OHI and PI), greater gingival inflammation, and deeper pockets/CALs compared to controls. Further COPD patients had significantly higher serum and salivary CRP levels compared to control groups. CONCLUSIONS: Lower brushing frequency, poor oral health, and presence of destructive periodontal disease were observed among patients with COPD, which warrants promoting dental care and oral health knowledge as an integrated approach to treating COPD patients.

Comparative clinical evaluation of laterally positioned pedicle graft and subepithelial connective tissue graft in the treatment of Miller's Class I and II gingival recession: A 6 months study.

AIM: The purpose of the study was to compare clinical outcomes of laterally positioned pedicle graft (LPPG) and subepithelial connective tissue graft (SCTG) for treatment of Miller's Class I and II gingival recession defects, at the end of 6 months. MATERIALS AND METHODS: Sixty Miller's Class I or II gingival recession defects (≥3 mm) (n = 30 each) on the labial aspect of anterior teeth were treated by either of the above techniques. Clinical parameters including recession depth (RD), width of keratinized gingiva (WKG), percentage of root coverage (%RC), and complete RC were recorded at baseline and 6 months postoperatively. Data were recorded and statistical analysis was done for both intergroup and intragroup. STATISTICAL ANALYSIS USED: Paired t-test intragroup and Student's t-test intergroup. RESULTS: In LPPG, RD decreased from 4.9 ± 0.99 mm to 1.1 ± 0.3 mm and WKG increased from 0.7 ± 0.87 to 4.5 ± 0.86 mm at 6 months, while in SCTG, RD decreased from 4.67 ± 1.12 mm to 0.46 ± 0.68 mm and WKG increased from 1.1 ± 0.99 to 5.33 ± 0.72 mm at 6 months postoperatively. The values of the soft tissue coverage remained stable for 6 months. CONCLUSIONS: Highly significant and effective soft tissue coverage was obtained by both techniques. LPPG resulted in effective soft tissue coverage for isolated deep narrow defects while SCTG in isolated and multiple, deep narrow and wide defects.

Gingival crevicular fluid levels of Matrix Metalloproteinase-1 (MMP-1) and Tissue Inhibitor of Metalloproteinase-1 (TIMP-1) in periodontal health and disease.

BACKGROUND: Matrix Metalloproteinases (MMPs) are directly responsible for pathogenesis of periodontal diseases and their activity is regulated by Tissue Inhibitor of Metalloproteinases (TIMPs). This study was aimed to evaluate changes in gingival crevicular fluid (GCF) levels of MMP-1 and TIMP-1 in periodontal health and disease. MATERIALS AND METHOD: Clinical parameters were recorded and GCF samples were collected from 30 subjects with chronic generalised periodontitis and 20 periodontally healthy subjects. Subjects with periodontitis underwent scaling and root planing (SRP). GCF samples were collected and clinical parameters were recorded again after 1 month of SRP. GCF levels of MMP-1 and TIMP-1 were detected by ELISA. RESULTS: GCF levels of MMP-1 were significantly increased in subjects with periodontitis at baseline (P0) as compared to periodontally healthy subjects (C). GCF levels of MMP-1 reduced significantly in subjects with periodontitis after treatment (P1) as compared to P0. GCF levels of TIMP-1 were significantly reduced in P0 as compared to C. GCF levels of TIMP-1 increased significantly in P1 as compared to P0. CONCLUSION: Substantial elevation in GCF levels of MMP-1 and reduction in TIMP-1 were found in periodontitis as compared to healthy subjects. GCF levels of MMP-1 and TIMP-1 improved significantly after treatment.

An evaluation of 0.2% hyaluronic acid gel (Gengigel ®) in the treatment of gingivitis: a clinical & microbiological study.

AIM: Hyaluronic acid is a glycosaminoglycan with anti-inflammatory & anti edematous properties. This study is seeking to ascertain whether Hyaluronic acid gel formulation is clinically and microscopically effective in treatment of gingivitis. METHODS: In longitudinal, randomized, and placebo-controlled clinical trial, 105 patients with chronic plaque induce gingivitis were randomly divided into three groups; negative control group, placebo control group and test group. Patients were instructed to apply gel on inflamed gingiva twice daily in addition with routine oral hygiene maintenance. The clinical parameters Plaque Index (PI), Gingival Index(GI) and Papilla Bleeding Index (PBI) were determined at intervals of 1 week, 2 weeks and 4 weeks from baseline, microbiological parameters were monitored at the interval of 4 weeks from baseline. RESULTS: An improvement of all clinical variables was observed (p<0.05) for all treatment modalities. Clinically, There is significant difference (p<0.05) for GI & PBI in test group as compared to other groups, but reduction in PI was non-significant. In negative control and placebo control groups, the difference between clinical parameters was non-significant. Statistically significant (p<0.05) reduction in percentage of anaerobic gram negative bacilli and relative increase of gram positive coccoid cells was seen in all treatment groups at 4 weeks as compared to baseline. However, results were not statistically significant (p>0.05) in pair wise comparison in between groups. CONCLUSION: Local application of 0.2 % HA gel adjunct to non surgical periodontal treatment provided a significant improvement in clinical parameters than placebo control and negative control groups. Microbiologically experimental group does not showed any spastically significant results.

Clinical evaluation of subepithelial connective tissue graft and guided tissue regeneration for treatment of Miller's class 1 gingival recession (comparative, split mouth, six months study).

OBJECTIVES: The present study aims to clinically compare and evaluate subepithelial connective tissue graft and the GTR based root coverage in treatment of Miller's Class I gingival recession. STUDY DESIGN: 30 patients with at least one pair of Miller's Class I gingival recession were treated either with Subepithelial connective tissue graft (Group A) or Guided tissue regeneration (Group B). Clinical parameters monitored included recession RD, width of keratinized gingiva (KG), probing depth (PD), clinical attachment level (CAL), attached gingiva (AG), residual probing depth (RPD) and % of Root coverage(%RC). Measurements were taken at baseline, three months and six months. A standard surgical procedure was used for both Group A and Group B. Data were recorded and statistical analysis was done for both intergroup and intragroup. RESULTS: At end of six months % RC obtained were 84.47% (Group A) and 81.67% (Group B). Both treatments resulted in statistically significant improvement in clinical parameters. When compared, no statistically significant difference was found between both groups except in RPD, where it was significantly greater in Group A. CONCLUSIONS: GTR technique has advantages over subepithelial connective tissue graft for shallow Miller's Class I defects and this procedure can be used to avoid patient discomfort and reduce treatment time. Key words:Collagen membrane, comparative split mouth study, gingival recession, subepithelial connective tissue graft, guided tissue regeneration (GTR).

Coronally Positioned Flap for Root Coverage: Comparison between Smokers and Nonsmokers.

BACKGROUND: Gingival recession is significantly more common among smokers, while cigarette smoking has been shown to negatively influence healing following periodontal therapeutic procedures as compared to non-smokers. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects. MATERIALS AND METHODS: Ten current smokers (≥10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 3 to 4-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), recession width (RW) and apico-coronal width of keratinized tissue (KT) were determined. RESULTS: Intra-group analysis showed that CPF was able to reduce RD and improve CAL in both groups (P < 0.001). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (60.09% versus 76.05%; P < 0.05). No smokers obtained complete root coverage compared to 30% of non-smokers (P < 0.05). CONCLUSION: Within the limits of present study, it can be concluded that cigarette smoking may present negative impact on root coverage outcome by CPF as compared to non-smokers and therefore represent one more challenge to periodontal plastic therapy. Key words: Gingival recession/therapy; flap; smoking/adverse effects. How to cite this article:Nanavati B, Bhavsar N V, Mali J. Coronally Positioned Flap for Root Coverage: Comparison between Smokers and Nonsmokers. J Int Oral Health 2013; 5(2):21-27.

Orthodontic-periodontic intervention of pathological migration of maxillary anterior teeth in advanced periodontal disease.

This case report presents a female patient whose chief complaint was of mobile and palatally drifted upper left central incisor which led to malalignment of upper anterior teeth. Orthodontic treatment of upper left central incisor was done with the help of 'Z' spring for the alignment of the upper anterior teeth. It was followed by splinting of upper anterior teeth to improve the stability and masticatory comfort. Regenerative periodontal surgery with Decalcified freeze dried bone allograft was done in relation to upper left central incisor.

Papillon-lefevre syndrome: Case series and review of literature.

Papillon-lefevre syndrome (PLS) belongs to a heterogeneous group of skin diseases that are characterized by hyperkeratosis of palms and soles. It is a type IV palmoplantar keratosis (PPK) while the palmoplantar keratodermas share some features of PPK, they are etiologically heterogeneous. PLS differs from other types of PPK by the presence of severe and early onset periodontitis. Genetic studies have shown that mutation in the major gene locus of chromosome 11q14 with the loss of function of cathepsin-C (CTSC) gene is responsible for PLS. CTSC gene mutations are causative for PLS. The resultant loss of CTSC function is responsible for the severe periodontal destruction seen clinically. This report represents two siblings with classical signs and symptoms of PLS.

A double blind controlled trial comparing three treatment modalities for dentin hypersensitivity

Aim: This randomized, double blind, split mouth study was aimed to compare three dentin desensitizing treatment modalities. Methods: Two hundred sixty teeth of 25 patients; each having at least 2 hypersensitive teeth in each quadrant, were included. Teeth were randomized to 4 groups: Group A treated with 2% NaF solution, Group B received GLUMA®; an aqueous solution of Hydroxy-Ethyl-Methacrylate and Glutarldehyde, (HEMA-G), Group C received iontophoresis with distilled water (placebo) and Group D was treated with NaF-iontophoresis. Pain response was evaluated on a visual analogue scale (VAS), by using tactile, air blast and cold-water stimuli at 0-day, 15-day, 1-month and 3-months interval. Results: All treatments were effective in reducing dentinal hypersensitivity significantly, Group D and Group B were more effective than Group A and Group C at all time intervals. Group D and Group B were equally effective in reducing dentinal hypersensitivity at 15-day and 1-month interval but Group D was more effective at 3-months. Conclusion: All treatment modalities were more effective in reducing hypersensitivity than placebo. 2% NaF-iontophoresis and HEMA-G were more effective than 2% NaF local application at all time intervals. But at 3-months, 2% NaF-iontophoresis was more effective than HEMA-G, while placebo produced no significant effect in reduction of hypersensitivity (AU)

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Evaluation of calcium sulphate barrier to collagen membrane in intrabony defects.

PURPOSE: The aim of this study was to clinically and radiographically evaluate and compare treatment of intrabony defects with the use of decalcified freeze-dried bone allograft in combination with a calcium sulphate barrier to collagen membrane. METHODS: Twelve patients having chronic periodontal disease aged 20 to 50 years and with a probing depth >6 mm were selected. Classification of patient defects into experimental and control groups was made randomly. In the test group, a calcium sulphate barrier membrane, and in control group, a collagen membrane, was used in conjunction with decalcified freeze-dried bone graft in both sides. Ancillary parameters as well as soft tissue parameters along with radiographs were taken at baseline and after 6 months of surgery. Parameters assessed were plaque index, modified gingival index, probing depth, relative attachment level, and location of the gingival margin. A Student's t-test was done for intragroup and a paired t-test for intergroup analysis. RESULTS: Intragroup analysis revealed statistically significant improvement in all the ancillary parameters and soft tissue parameters with no statistically significant difference in intergroup analysis. CONCLUSIONS: The study concluded that a calcium sulphate barrier was comparable to collagen membrane in achieving clinical benefits and hence it can be used as an economical alternative to collagen membrane.

A double blind controlled trial comparing three treatment modalities for dentin hypersensitivity.

AIM: This randomized, double blind, split mouth study was aimed to compare three dentin desensitizing treatment modalities. METHODS: Two hundred sixty teeth of 25 patients; each having at least 2 hypersensitive teeth in each quadrant, were included. Teeth were randomized to 4 groups: Group A treated with 2% NaF solution, Group B received GLUMA®; an aqueous solution of Hydroxy-Ethyl-Methacrylate and Glutarldehyde, (HEMA-G), Group C received iontophoresis with distilled water (placebo) and Group D was treated with NaF-iontophoresis. Pain response was evaluated on a visual analogue scale (VAS), by using tactile, air blast and cold-water stimuli at 0-day, 15-day, 1-month and 3-months interval. RESULTS: All treatments were effective in reducing dentinal hypersensitivity significantly, Group D and Group B were more effective than Group A and Group C at all time intervals. Group D and Group B were equally effective in reducing dentinal hypersensitivity at 15-day and 1-month interval but Group D was more effective at 3-months. CONCLUSION: All treatment modalities were more effective in reducing hypersensitivity than placebo. 2% NaF-iontophoresis and HEMA-G were more effective than 2% NaF local application at all time intervals. But at 3-months, 2% NaF-iontophoresis was more effective than HEMA-G, while placebo produced no significant effect in reduction of hypersensitivity.

Cardioprotective effect of periodontal therapy in metabolic syndrome: a pilot study in Indian subjects.

BACKGROUND: Obesity, metabolic syndrome, and atherosclerosis are linked with an increased acute-phase response. Severe periodontal disease is associated with cardiovascular disease as sequelae of a systemic inflammatory response. OBJECTIVE: The aim of this study was to assess changes in measures of systemic inflammation induced by periodontal therapy in periodontally diseased individuals with metabolic syndrome, compared to those induced in a systemically healthy group. METHODS: A total of 31 subjects with chronic generalized periodontitis, including 16 subjects with metabolic syndrome (group A) and 15 systemically healthy subjects (group B), underwent nonsurgical periodontal therapy. Serum high-sensitivity C-reactive protein (hsCRP), total leukocyte count, and measures of lipid metabolism were measured at baseline and at 2 months after periodontal therapy. Baseline data for comparison was also obtained from 15 systemically and periodontally healthy individuals (group C). RESULTS: Baseline periodontal parameters and serum CRP were significantly higher in group A than in group B. In group A, following periodontal therapy, a significant decrease was noted in mean serum CRP (3.28 +/- 1.4 mg/L to 2.6 +/- 1.5 mg/L), total leukocyte counts (8,322 +/- 1,888 cells/mm(3) to 6,361 +/- 1,426 cells/mm(3)), serum triglycerides (153.3 +/- 38 mg/dL to 121.0 +/- 28.57 mg/dL), along with a significant rise in serum high-density lipoprotein (HDL) (41.1 +/- 5.2 mg/dL to 44.37 +/- 6.7 mg/dL). In group B, changes in these parameters were not statistically significant. Mean serum low-density lipoprotein (LDL) and mean cholesterol levels did not change significantly in either group. CONCLUSIONS: Periodontal therapy produced significant modulation of serum hsCRP, total leukocytes, serum triglycerides, and HDL, and thus may benefit individuals affected with both metabolic syndrome and advanced periodontal disease.

Use of fibrin glue in periodontal flap surgery.

In the changing era of perio surgeries one innovative remedy has ended the inconvenience of suturing and has allowed the clinician to meet growing expectations and demands of today's dental patient, and the remedy is fibrin glue. When periodontal plastic surgical procedures done or implants placed in esthetic zone, fibrin sealants may be variable alternative to closing flaps with sutures and with histologic benefits and has potential uses in field of medicine. Fibrin sealant is an excellent beginner in the era of sutureless periodontal flap surgery, and this article is a humble effort to prove it.