ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

A clinical and microbiological study to assess the efficacy of Acmella oleracea and Acacia catechu herbs as local drug delivery in treatment of chronic generalized periodontitis patients.

Aim: A randomized controlled clinical trial was conducted to evaluate the effect of local drug delivery (LDD) of Acmella oleracea (Akarkara) and Acacia catechu (kattha) gels as an adjunct to scaling and root planing (SRP) in generalized chronic periodontitis patients. Materials and Methods: Thirty patients with ninety sites aged 25-65 years with generalized chronic periodontitis having pocket probing depth (PPD) of more than or equal to 5 mm on the basis of inclusion and exclusion criteria were selected. They were treated according to split-mouth design protocol. The placement of gel containing A. oleracea (1%) (Group 1) and A. catechu (1%) (Group 2) as LDD was placed at the two test sites, respectively, and only SRP was done in the control group (Group 3). Periodontal dressing was applied to all the three sites after procedure, and patients were given oral care guidelines. Evaluation of clinical parameters gingival index (GI), plaque index (PI), gingival bleeding index (GBI), PPD, clinical attachment level (CAL), and relative attachment level (RAL) was done at baseline, 1, 3, and 6 months, and microbiological parameter was assessed at baseline and 6 months. N-benzoyl-DL-arginine-2-napthylamide (BANA) test was used for the microbiological analysis. Results: Clinical parameters from baseline to 6 months at different time intervals demonstrated a significant reduction in mean GI, PI, GBI, and PPD and gain in CAL and RAL over a period of 6 months, and results were statistically significant in all the three treatment groups. However, on intergroup comparison, clinically significant difference was observed, but statistically, results were significant at few intervals. The microbiological analysis revealed a statistically nonsignificant reduction at the end of 6 months on intra- and intergroup comparison. Conclusion: The study concluded that the use of A. catechu gel and A. oleracea gel clinically showed improvement in clinical parameters when combined with SRP, attributing to better anti-inflammatory and healing properties.

Coronally Repositioned Flap with Bioresorbable Collagen Membrane for Miller's Class I and II Recession Defects: A Case Series.

OBJECTIVE: Gingival recession is one of the most common esthetic and functional concerns associated with periodontal tissues. Several techniques have been described to cover the exposed root surface. The aim of the present study was to evaluate the efficacy of recession coverage using a coronally repositioned flap in conjunction with a bioresorbable collagen membrane. METHODS: Eight non-smoking healthy subjects with Miller's Class I and II recession defects in the maxillary anterior region were selected. Recession was treated by a coronally repositioned flap along with a bioresorbable type I collagen guided tissue regeneration membrane (Periocol®). Clinical parameters recorded were recession depth, recession width, width of keratinized tissue, and width of the attached gingiva at baseline and 3 months postoperatively. RESULTS: Three-month postoperative measurements demonstrated significant root coverage and a reduction in the recession depth and width. In addition, there was a significant increase in the width of keratinized tissue and of the attached gingiva. CONCLUSION: Recession coverage with a coronally repositioned and bioresorbable collagen membrane demonstrated good results in terms of root coverage as well as increase in the width of keratinized tissue.

Comparative evaluation of C-reactive protein in peripheral blood of patients with healthy gingiva, gingivitis and chronic periodontitis: A clinical and particle-enhanced turbidimetric immuno-analysis.

BACKGROUND: C-reactive protein (CRP), an acute-phase protein monitored as a marker of inflammatory status, has been identified as a major risk factor for various systemic diseases. It is a reliable marker to infectious burdens and/or inflammation. The aim of this study was to compare and evaluate the systemic levels of CRP in the serum sample of the patients with healthy gingiva, gingivitis, and chronic periodontitis. MATERIALS AND METHODS: A total of 60 systemically healthy patients were selected and divided into three groups: Patients with healthy gingiva (Group A), patients with generalized gingivitis (Group B) and patients with chronic periodontitis (Group C). Peripheral blood was collected and high-sensitive (hs)-CRP levels were estimated in the serum samples by using the particle-enhanced turbidimetric immuno-assay technique using a commercially available kit. RESULTS: The mean hs-CRP level in Group A recorded was 0.437 ± 0.216, Group B was 0.771 ± 0.384 and Group C was 2.285 ± 0.381. A significantly elevated hs-CRP level was found in Group C as compared with Group B and A (P < 0.05). However, a moderate, but statistically significant increase in the hs-CRP levels was observed in Group B as compared with Group A (P < 0.05). The percentage of patients with elevated levels of hs-CRP >2 mg/l was significantly higher in Group C. CONCLUSION: The patients with chronic periodontitis demonstrated a mean hs-CRP levels higher than the patients with gingivitis and with healthy gingiva. Furthermore, with the increasing inflammation, the hs-CRP levels increased proportionately.