Effect of nonsurgical periodontal therapy on salivary melatonin levels in patients with periodontal disease.

Context: Periodontitis is an inflammatory disease in which periodontal tissues are damaged as a result of an imbalance in the oxidant/antioxidant systems. Melatonin is one hormone that controls circadian rhythms and is also an antioxidant and immune modulator. Aim: The present study was aimed to evaluate the effect of scaling and root planing (SRP) on salivary melatonin levels (SM) in patients with periodontal disease. Settings and Design: A single-center clinical trial was conducted to evaluate the effect of SRP on SM levels in patients with periodontal disease. Materials and Methods: Forty-five participants of age 30-60 years were equally divided into three groups: 15 healthy participants, 15 participants with gingivitis, and 15 participants with periodontitis. Unstimulated salivary samples were collected from all the participants at baseline and 1 month after SRP from participants of gingivitis and periodontitis group and SM levels were determined by commercially available ELISA kit. Statistical Analysis Used: Group comparisons were made using t-test. The level of significance was set at a P < 0.05 for all tests. Results: SM levels were significantly lower in the chronic periodontitis group. There was a significant improvement in clinical parameters and SM levels in both chronic periodontitis and gingivitis groups after SRP. Conclusion: This study determined that there is a negative correlation between SM levels and the severity of periodontal disease and showed a significant increase in SM levels after SRP, suggesting that melatonin might have a protective role against periodontal disease and can be considered as an effective biomarker.

Effect of diode laser as an adjunct to open flap debridement in treatment of periodontitis - A randomized clinical trial.

Background: The goals of periodontal therapy are to prevent the disease, arrest the disease progression, and regeneration of lost periodontium. Diode laser gained popularity in periodontal practice with a wide range of potential benefits. Aim: This study aims to evaluate and compare the clinical effects of laser-assisted open flap debridement (OFD) versus conventional OFD for the periodontitis treatment. Materials and Methods: A split-mouth, randomized clinical trial was conducted on fifteen participants with periodontitis having probing pocket depths (PPD) ≥5 mm. A total of 30 sites, two sites in each patient, were randomly divided into two groups. Group A received conventional OFD, and Group B received laser-assisted OFD. The assessment of PPD, relative attachment level (RAL), modified sulcular bleeding index (mSBI) was done at baseline, 3 months, and 6 months. Wound healing index (WHI) was assessed at 3rd and 7th day postsurgery, patient response to pain using visual analog scale (VAS) was assessed immediately, 1 day, and 1 week after surgery. Results: The results revealed a significant reduction in PPD, mSBI, and gain in RAL within the groups from baseline to 3 months and 6 months. Intergroup comparison showed a significant difference in PPD, RAL, mSBI, WHI and VAS scores. Conclusions: The use of 980 nm diode laser provided additional benefits over conventional flap therapy.

Comparison of Ozonated Olive Oil and Chlorhexidine Gel as an Adjunct to Nonsurgical Periodontal Therapy for the Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial.

Objectives: Complete elimination of the pathogenic microorganisms from the gingival sulcus area is the ultimate goal of any periodontal therapy. Certain factors such as anatomical variation of teeth, deep periodontal pocket, and tissue-invading ability of some bacteria decrease the effectiveness of conventional nonsurgical periodontal therapy, i.e., scaling and root planing (SRP). Hence, antimicrobial agents could be used as an adjunct to SRP, in order to increase the efficacy of it. Although Chlorhexidine (CHX) is the gold standard as an antiplaque agent, it has several drawbacks. Recently, ozone therapy is being tried for the treatment of several diseases in the field of dentistry. Therefore, the purpose of this study was to evaluate and compare the efficacy of local application of CHX and ozonated olive oil as adjunctive to SRP for the treatment of chronic periodontitis. Materials and Methods: Thirty individuals who fulfilled the eligibility criteria were selected for this split-mouth randomized controlled trial. The treatment sites from each individual were randomly allocated into two groups. Along with SRP, the local application of CHX and ozonated olive oil was done for the control and test sites, respectively. Pocket probing depth, relative attachment loss, and sulcus bleeding index were measured before and 3 months after the treatment. Intragroup and intergroup differences in the clinical parameters were analyzed by Wilcoxon signed-rank test and Mann-Whitney U test, respectively. Results: Three months' posttreatment, all the parameters showed significant improvement in both the groups. However, the intergroup comparison failed to be significant statistically. Conclusion: Ozonated olive oil could enhance the outcomes of SRP for the treatment of periodontal diseases.

Salivary tumor necrosis factor-alpha levels in periodontitis associated with diabetes mellitus after low level laser therapy as an adjunct to scaling and root planning: A randomized clinical trial.

Context: Tumor necrosis factor-alpha (TNF-α) has been shown to play a critical role in the pathogenesis of periodontitis and diabetes. Nonsurgical periodontal therapy was shown to reduce inflammation and improves glycemic status. Recently, adjunctive low level laser therapy (LLLT) has been shown to alter the inflammatory process. Aim: To evaluate and compare the alteration in TNF-α levels before and after treatment in patients with periodontitis with and without type 2 diabetes mellitus (T2DM). Settings and Design: Randomised clinico-biochemical study was carried out for 8 weeks from September 2019 to December 2020. Materials and Methods: Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with T2DM), based on probing depth ≥5 mm, clinical attachment level ≥2 mm, and history of T2DM. Later were subdivided into A1, A2, B1, B2, based on assigned treatments. Clinical periodontal parameters and salivary TNF-α levels were evaluated and compared at baseline to 8 weeks. Statistical Analysis: Multiple group comparisons were done using analysis of variance, intra group comparisons were made using t-tests. Results: Comparison of periodontal parameters and salivary TNF-α levels from baseline to 8 weeks showed statistically significant difference (P < 0.05) in all groups, indicating a positive effect of scaling and root planing (SRP) and adjunctive LLLT. Conclusion: Both SRP and SRP with adjunctive LLLT effectively altered TNF-α levels, correlating reduced periodontal inflammation.

Comparison of salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy as an adjunct to scaling and root planing: A randomized clinical trial.

Context and Aims: Calprotectin is a myeloid protein, exerting pro-inflammatory effects on various cells and are shown to be elevated in inflammatory diseases. Periodontal therapy has been shown to decrease the levels of calprotectin in body fluids. Hence, the present study was aimed at assessing salivary calprotectin levels in periodontitis associated with diabetes mellitus after low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP). Materials and Methods: Sixty-four participants were divided into Groups A (periodontitis) and B (periodontitis associated with type 2 diabetes mellitus [T2DM]) based on probing depth of ≥5 mm, clinical attachment level (CAL) of >2 mm, and history of T2DM. Based on assigned treatments, the groups were subdivided into A1, A2, B1, and B2 where A1 and B1 were subjected to SRP alone and A2 and B2 received LLLT as an adjunct to SRP, respectively. The parameters assessed included probing pocket depth, CAL, bleeding on probing (BOP), plaque index (PI), and salivary calprotectin. All the values were subjected for comparison at baseline and 8 weeks. Statistical Analysis Used: Multiple group comparisons were done using analysis of variance; intragroup comparisons were made using t-test. The level of significance was assessed at P < 0.05 for all tests. Results: All parameters showed a significant difference within the groups from baseline to 8 weeks. Intergroup comparison of PI, BOP, and salivary calprotectin showed a significant difference (P < 0.05). Conclusions: Reduction in calprotectin levels was noticed with LLLT when used as an adjunct to SRP. Calprotectin may be used as a prognostic marker for periodontitis.

Adult multifocal Langerhan's cell histiocytosis involving periodontal tissues.

Langerhans cell histiocytosis (LCH) is a rare inflammatory neoplasia characterized by uncontrolled stimulation and abnormal proliferation of Langerhans cells (LCs). It can present as unifocal or multifocal with local and systemic manifestations which involves various internal organs and mucosal tissues. The clinical course varies among individuals, ranges from spontaneous resolution to life-threatening conditions with multisystem involvement. Prognosis relies on the involvement of risk organs (liver, spleen, and bone marrow) at diagnosis, mainly on organ dysfunction, and response to initial therapy. The diagnosis is based on histological study of tissues samples and shows tissue infiltration with LCs and the tumor cells immunopositive for s100/CD1a/Langerin/CD68 focal). In the oral cavity, LCH affects the alveolar or cortical bone and causes ulcerated lesions involving various mucosal and periodontal tissues. This article reports a case of adult multifocal LCH involving periodontal tissues with 1½ year posttreatment follow-up showing regression of the lesion.

Validating gingival surface temperature as an alternative tool in the diagnosis of periodontal disease activity: An observational clinical trial.

Background. Elevated temperature has been recognized as an inflammatory sign. It is the only indication that can be both objectively and quantitatively evaluated and is considered as a potential indicator of periodontal disease. Assessing gingival surface temperature (GST) could be a diagnostic parameter to determine periodontal health. This pilot clinical study aimed to validate gingival surface temperature (GST) as a clinical diagnostic tool to measure periodontal disease activity by correlating with the periodontal inflamed surface area (PISA). Methods. A cross-sectional mono-center pilot study was conducted with a convenient sample of 50 participants with a mean age of 34.14±13.7 years. Clinical parameters such as probing pocket depth (PPD) clinical attachment loss (CAL) and bleeding on probing (BOP) were measured. GST was recorded with a single lead of the bedside patient monitor and correlated with PISA. Results. The results showed a positive correlation between PISA and GST (P=0.46). Conclusion. This study showed a rise in GST of inflamed sites, but the results did not support the hypothesis that increased GST is an indicator of periodontal disease. As this is a pilot study, further studies with more larger sample sizes need to be undertaken to confirm its use as a diagnostic tool in clinical trials.

Dental management of a patient with incidentally detected hemophilia: Report of a clinical case.

Individuals with hemophilia are at risk for bleeding episodes, which range from mild mucosal/soft-tissue bleeding to life-threatening hemorrhages. This report describes the dental/medical management provided to a 23-year-old patient suffering from uncontrolled bleeding after an electrosurgical procedure (operculectomy) in relation to the mandibular right third molar, in which hemophilia was a true accidental finding. Various safety measures that need to be considered during the dental surgical management of hemophilic patients are discussed.

Association of Stress, Salivary Cortisol, and Chronic Periodontitis: A Clinico-biochemical Study.

BACKGROUND: Periodontitis and stress are among the areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role in successful therapy. Cortisol is a protein which was found to be consistently associated with both. AIM: The present study was aimed to evaluate saliva cortisol levels (SCLs) in chronic periodontitis (CP) patients with and without stress. MATERIALS AND METHODS: In this cross-sectional study, saliva samples were collected and cortisol levels were determined using ELISA method in 92 participants. The participants were divided into four groups based on periodontal condition (number of teeth present, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and clinical attachment level) and stress levels into Group 1 (no periodontitis and no stress), Group 2 (with periodontitis and no stress), Group 3 (without periodontitis and with stress), and Group 4 (with periodontitis and stress). RESULTS: Overall, 92 adult participants (41 males and 51 females) were included in the study. Participants with stress and periodontitis have high mean SCL when compared to other groups (Group 1: 15.01 ± 2.62, Group 2: 31.92 ± 6.80, Group 3: 34.47 ± 13.47, and Group 4: 60.13 ± 6.68). Group I shows a significant negative correlation of cortisol to BOP, stress to PI, and stress to cortisol level, whereas there is a positive correlation of SCL to PD in Group 4 which is not statistically significant. CONCLUSION: SCL showed difference among the groups. SCL were associated with both CP and psychological stress. Increase in inflammation and stress levels enhances the SCL.

Knowledge, attitudes, and practice behaviors of medical specialists for the relationship between diabetes and periodontal disease: A questionnaire survey.

INTRODUCTION: Increased risk of periodontal disease has been associated with diabetes mellitus (DM) and also periodontitis is considered as the sixth complication of DM. Medical physicians may have an advantageous position compared to the dentists to provide early patient counseling about oral health because patients attend medical offices more often than to dental offices and are more likely to be affiliated to medical than to dental insurance. Hence, the medical practitioners should have sufficient knowledge in this regard. The study aimed to assess the knowledge, attitudes, and practice behaviors of endocrinologists, general medicine practitioners, and diabetologists on the relationship between periodontal disease and DM. MATERIALS AND METHODS: Data were collected from sixty participants practicing in Nellore, using a structured questionnaire survey. The obtained data were analyzed through percentages. RESULTS: All the participants (100%) were aware that there existed a relation between oral health and general health. However, only 17.8% (10) of the participants refer their patients to dentists without patients asking for referral. CONCLUSION: The endocrinologists were aware of the didactic relationship, whereas general medicine practitioners and diabetologists are not much well-equipped with the knowledge on relationship between DM and periodontitis. There exists a wide gap between their practice behaviors and current scientific evidence. Therefore, more emphasis must be made by medical practitioners for the diabetic patient toward periodontal health which is most important yet neglected aspect of comprehensive health care.

Primary culprit for tooth loss!!

AIM: In order to facilitate planning for dental health services and to progress strategies to continue the reduction in tooth loss, it is important to identify the factors that result in such loss. therefore the aim of the study is to investigate the major cause for tooth extraction. OBJECTIVE: to examine whether the major reason for tooth extraction is dental caries or periodontal disease. MATERIALS AND METHODS: The study is carried out among the dental practitioners in our district. A questionnaire containing 10 items was distributed to the dental practitioners, which included age, gender, no of teeth indicated for extraction, the reason for extraction, and the periodontal parameters that are involved with the extracted tooth and were requested to complete the form on every extraction they were to undertake. the study form was collected at the end of the study period and data was subjected to statistical analysis. RESULTS: A total of 502 patients were enrolled during the study period, and a total of 1055 teeth were extracted for several reasons. we found that 51.14%extractions are due to dental caries in case of 20-30years age groups, which is more when compared to tooth loss due to periodontal diseases in this age group. whereas in case of >40years of age group periodontal diseases account for 54.11%, and dental caries accounts for only 29.11%. Showing more teeth were lost due to periodontal disease. CONCLUSION: therefore we concluded that, caries is the dominant reason for extraction in patients with 20-30 years of age while periodontal disease accounts for the majority of tooth extraction in patients older than 40 years.

Effect of combination of ethylenediaminetetraacetic acid + tetracycline with coronally positioned flap in the treatment of gingival recession: A clinical study.

CONTEXT: Gingival recession is the apical migration of gingival margin results from destruction of the connective tissue leading to various esthetic problems. Many surgical procedures have been attempted to achieve root coverage that include free gingival grafts, pedicle flaps such as semilunar coronally repositioned flaps (SCRFs) and guided tissue regeneration. The exposed root surface has undergone substantial alterations and may no longer serve as an appropriate substrate for cell attachment and fiber development. When the denuded root surfaces are treated with biomodifiers following mechanical instrumentation, the resulting surface favors both the attachment of fibroblasts and new connective tissue attachment. It was then necessary to evaluate the surface characteristics of the acid demineralized root surface and its effect on periodontal wound healing. AIM: To evaluate the effect of the combination of ethylenediaminetetraacetic acid (EDTA) and tetracycline as root bio-modifiers along with SCRF for root coverage. SETTINGS AND DESIGN: Twenty subjects were randomly assigned into two groups as cases (SCRF + EDTA + tetracycline [TTC]) and controls (SCRF). MATERIALS AND METHODS: Twenty-four percentage EDTA and 100 mg/ml TTC hydrochloride were used along with semilunar coronally positioned flap. The clinical parameters such as recession height, the width of keratinized tissue, recession width, clinical attachment level, probing depth, plaque index, and gingival index were recorded at baseline, 1 and 3 months. STATISTICAL ANALYSES USED: The clinical parameters were compared using post-hoc test and the comparison between cases and controls was done using Mann-Whitney U-test. RESULTS: No statistical significant difference has been observed between the groups. CONCLUSION: It was concluded that no clinical benefit was observed after the application of a combination of 100 mg/ml TTC hydrochloride and 24% EDTA on the root surface.

Diabetes and periodontitis: How well are the patients aware about an established relation?

AIM: The study aimed to assess the levels of awareness about the mutual relationship between diabetes and periodontitis among high-risk age group of the general population and to assess the attitude of general physicians in suggesting diabetic patients to visit a dentist. MATERIALS AND METHODS: A structured, closed-ended questionnaire either in English or in local language (Telugu) was distributed and collected from 203 patients who were willing to participate in the study attending the Department of Periodontics, Narayana Dental College & Hospital, Nellore, AP. Data were statistically analyzed and represented in percentages and number. RESULTS: Only 49.8% of the sample population knew about the mutual relationship between diabetes and periodontitis and only 46% of the diabetic study population was suggested to visit a dentist by the physician. CONCLUSION: There is an insufficient knowledge among the diabetic population regarding the mutual relationship. Only few physicians have suggested their diabetic patients to visit a dentist. As diabetic patients tend to visit a physician earlier than a dentist, it is their responsibility to educate and motivate their patients to seek dental treatment.

Drug-induced gingival overgrowth: A critical insight into case reports from over two decades.

Drug-induced gingival overgrowth (DIGO) is a well-recognized adverse effect of certain systemic medications. Calcium channel blockers, anticonvulsants, and immunosuppressants are frequently implicated drugs in the etiology of DIGO. Drug variables, plaque-induced inflammation, and genetic factors are the three important factors in the expression of gingival changes after systemic medication use. Careful clinical examination and thorough history taking form the basis for diagnosis of DIGO. Histopathological examination is often neglected; however, it is an important aid that helps in differential diagnosis. Cessation or change of drug and meticulous plaque control often leads to regression of the lesion, which however might need surgical correction for optimal maintenance of gingival health. The purpose of the present article is to review case reports and case series published in the last two decades and to assimilate and compile the information for clinical applications such as diagnosis and therapeutic management of DIGO.

Effectiveness of Subgingival Irrigation as an Adjunct to Scaling and Root Planing in the Treatment of Chronic Periodontitis: A Systematic Review.

AIM: Subgingival applications of various chemotherapeutic agents have been used as an adjunct to nonsurgical periodontal treatment and preventive periodontal therapy. Their use in regular clinical practice, however, is less, perhaps due to concerns about clinical success or probably due to a lack of knowledge of their effectiveness or cost. The aim of this systematic review is to obtain overall quantitative estimate of effectiveness of subgingival irrigation (SI) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A literature search of electronic database was performed for articles published through December 31, 2014, followed by manual search of dental journals. Randomized controlled trails (RCTs) assessing the effect of SI as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis evaluated by changes in the clinical and microbiological outcomes were included. RESULTS: This literature search yielded only two randomized, placebo-controlled studies that evaluated the efficacy of SI as an adjunct to SRP in patients with chronic periodontitis. The studies were methodologically not perfect (in terms of mediocre quality) with a risk of bias to come to any final conclusions to be reached. These studies didn't clearly mention about randomization, allocation concealment, blinding, dosage and formulation of irrigants, severity of periodontal disease, patient-centered outcomes and results data. CONCLUSION: Due to insufficient evidence supporting the efficacy of SI as an adjunct to SRP in treating chronic periodontitis, more rigorous scientific research is required to assess the efficacy of SI as an adjunct to SRP in the treatment of periodontal diseases.

Hygiene hypothesis and periodontitis--a possible association.

Hygiene hypothesis has been proposed more than two decades back to explain an increasing prevalence of allergic diseases and atopy. It states that, a lack of early childhood exposure to infectious agents increases susceptibility to allergic diseases and atopy later in life. The evidence in relation to hygiene hypothesis is controversial and inconclusive. Moreover, its underlying mechanisms are elusive and remain to be elucidated. Periodontitis is an inflammatory disease initiated by microorganisms present in the plaque biofilm. Association between periodontitis and various systemic diseases has already been established and is currently an area of interest particularly in periodontal research. Consistent with hygiene hypothesis, some researchers believed that pathogens associated with periodontal diseases might have a protective role in the development of asthma and other allergic diseases. Very few studies attempted to explore the concept of association between periodontitis, asthma and other respiratory allergic diseases which could neither support such a protective role for periodontal diseases nor reject such an association. This suggests a need for additional research to examine the relevance of hygiene hypothesis in periodontics. The purpose of the present article is to review the plausible scientific explanations available for hygiene hypothesis, to review some studies relating periodontitis, asthma and other respiratory allergic diseases and to stress the need for further research.

Effect of Ozonised water on Chronic Periodontitis - A Clinical Study.

BACKGROUND: The aim of the study was to study the clinical effects of ozonated water on periodontal tissues. MATERIALS & METHODS: In the present study 30 subjects were selected with age ranging from 20 to 60 yearsand pocket depth of ≥5mm. Two sites were selected in each patient whichwere divided into two groups. Group 1(control group-irrigation with saline) and Group 2(study group-irrigation with ozonized water) and clinical parameters were recorded at baseline, 15 days and 30 days. RESULTS: When the comparison of mean values of Plaque Index and Gingival Index between the groups and at different time intervals were made, statistically significant difference were observed at 30 days at 5% level. When the mean values of clinical attachment level on mesial and distal site was compared between the groups, statistical significance was observed at 5% level and 1% level respectively.Similarly statistical significance at 5% level was observed at 15 and 30 days on buccal site. CONCLUSION: Subgingival irrigation with ozonized water is beneficial adjunct treatment modality to enhance periodontal health with significant role in periodontal therapy. How to cite this article: Katti SS, Chava VK. Effect of Ozonised water on Chronic Periodontitis - A Clinical Study. J Int Oral Health 2013;5(5):79-84.