Effectiveness of ginger on pain following periodontal surgery - A randomized cross-over clinical trial.

BACKGROUND: Ibuprofen is one of the generally prescribed Non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain after periodontal surgery, but are contraindicated in certain patients. Ginger, which is the rhizome of Zingiber officinale, being a common herbal drug having anti-inflammatory as well as analgesic activities can be an efficient substitute for synthetic agents like Ibuprofen. OBJECTIVES: To compare the effectiveness of ibuprofen and dried ginger powder on pain and gingival inflammation following open flap debridement. MATERIALS AND METHODS: Ten systemically healthy individuals with chronic generalized periodontitis were selected for this single-blinded randomized cross-over clinical trial and underwent open flap debridement in at least two quadrants. Each quadrant was randomly allocated to receive either Ibuprofen (400 mg) or Ginger powder capsules (400 mg) thrice daily for three days. Subjects were requested to note down the pain score on the Visual Analogue Scale (VAS) provided in a printed format, for the first eight hours after surgery and on the following two days, and gingival inflammation was assessed after one week, using Modified Gingival Index (MGI). RESULT: The difference in the VAS score and MGI between the two groups was not of statistical significance. CONCLUSION: Effectiveness of ginger powder for the management of pain and gingival inflammation following open flap debridement is comparable to that of ibuprofen.

Effect of Non-Surgical Periodontal Therapy on the Serum Sialic Acid Levels in Diabetic Patients with Periodontitis.

Sialic acid (SA), a family of acetylated derivatives of neuraminic acid, an acute phase reactant by itself. It usually occurs as a terminal component at the non-reducing end of carbohydrate chains of glycoproteins and glycolipids. SA participates in multiple physiological functions, such as cell-to-cell interactions, cell migration and proliferation. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by rise in blood glucose level. Periodontitis is a chronic inflammatory disease of the periodontal tissue, leading to destruction of bone surrounding the tooth and ultimately tooth loss. There is a two way relationship between diabetes mellitus and periodontitis. Periodontitis is the sixth complication of diabetes along with retinopathy, nephropathy, neuropathy, macrovascular disease, and altered wound healing. Inflammatory mediators like interleukin-6 and tumor necrosis factor-alpha produced during periodontal inflammation can interfere with the actions of insulin receptors and worsen the glycemic control of diabetic patients. Periodontitis is a major cause of tooth loss, affecting over 300 million people and bacteria associated with periodontitis are also linked with systemic problems like endocarditis, atherosclerosis. Recent work has highlighted a major role for the host sugar sialic acid in the biofilm physiology and host-pathogen interactions of T. forsithya, a key periodontal pathogen. There exists a need for a biomarker, for early detection of disease evolution and more robust therapy efficacy measurements. Serum sialic acids were estimated in Indian population by diphenylamine method and Thiobarbituric acid method. The average values were 68 ± 2.6 mg percent by DPA method and 56 ± 5 mg percent by TBA (thiobarbituric acid assay) method. Age and sex showed no influence on serum sialic acid level. Objectives of the present study was to compare (TSSA) level in healthy subjects, subjects with (CMP) with and without (NIDDM) and its effect on non-surgical periodontal therapy. In the present study, the participants were divided into three groups: Group A, B and C. Group A consists of systemically healthy subjects, Group B consists of subjects with (CMP) while Group C consists of subjects with (CMP) with (NIDDM) and results of this study indicated that, at baseline, there were significant differences between Group A, B and Group C with respect to all the clinical parameters, including (GI), (OHI-S), (PPD), (CAL), (TSSA) and (HbA1c) levels. Thus (TSSA) level could be considered as novel biomarker in the progression of periodontal disease and diabetic status. Periodontitis could be considered as a potential, modifiable, and independent risk factor for the development of diabetes. Early detection of elevated (TSSA) level may help in interpreting the progression of periodontitis, risk of development of diabetes mellitus in future and also to prevent complications.

Assessment of membrane-organizing extension spike protein as a biomarker for periodontal disease by comparing its level in gingival crevicular fluid in individuals with and without chronic severe periodontitis - A pilot study.

BACKGROUND: Membrane-organizing extension spike protein (Moesin) is a cytoskeletal protein expressed in the gingival crevicular fluid (GCF) which may play a role in the immune response in periodontal disease. The objective of this study was to evaluate whether Moesin can be used as a biomarker for periodontal disease. MATERIALS AND METHODS: Thirty patients satisfying the required inclusion criteria were selected from those reporting to the out patient (OP) of the department of periodontics and divided into two groups: Group A - systemically healthy controls with no periodontitis and Group B - systemically healthy controls with chronic severe periodontitis. Periodontal parameters were recorded. GCF was collected, and Moesin levels in the two groups were assessed using enzyme-linked immunosorbent assay. Scaling and root planing (SRP) was done in Group B patients who were reviewed, and samples were collected again after 4 weeks and analyzed. RESULTS: At baseline, the mean GCF Moesin level in Group A was 666.95 ± 471.872 pg/ml, while in Group B, it was found to be 27435.35 ± 14179.77 pg/ml, which showed a high statistically significant difference on comparison. The mean GCF Moesin level in patients with chronic severe periodontitis was 27435.35 ± 14179.77 pg/ml at baseline, and on review 1 month after SRP, it was found to have undergone a statistically significant reduction to 27161.23 ± 14161.57 pg/ml (P = 0.001). CONCLUSION: Within the limits of this study, it can be concluded that Moesin can serve as a potential biomarker for periodontal disease.

A Qualitative Analysis of Periodontal Pathogens in Chronic Periodontitis Patients after Nonsurgical Periodontal Therapy with and without Diode Laser Disinfection Using Benzoyl-DL Arginine-2-Naphthylamide Test: A Randomized Clinical Trial.

INTRODUCTION: Periodontal diseases are caused by pathogenic bacteria locally colonized in the dental biofilm creating infection; the main etiological factor is represented by dental plaque and in particular by anaerobic Gram-negative bacilli. For that reason, the first phase of periodontal treatment is always represented by the initial preparation which primarily aims at the elimination or reduction of bacterial infection and the control of periodontal plaque-associated inflammation. Yet, another innovative causal therapy is represented by the irradiation of periodontal pockets with LASER. The aim of this randomized clinical study is to compare and to detect the presence of periodontal pathogens in chronic periodontitis patients after nonsurgical periodontal therapy with and without diode LASER disinfection using BANA test. MATERIALS AND METHODS: This randomized clinical trial includes 20 patients having chronic periodontitis. From each patient, one test site and one control site were selected and assessed for gingival index (GI), oral hygiene index (OHI), pocket probing depth and clinical attachment level (CAL), and presence of BANA pathogens. The test site underwent scaling and root planning along with diode LASER therapy as an adjuvant while the control site received scaling and root planning alone. Patients were recalled for review after 2 weeks and 2 months where periodontal parameters were assessed and plaque samples were collected and analyzed for BANA pathogens. RESULTS: The test site where LASER was used as an adjuvant showed significant reduction in pocket probing depth, CAL, OHI, GI, and periodontal pathogens which shows that the amount of recolonization of microbes is less when LASER is used as an adjuvant to conventional therapy. CONCLUSION: Diode LASER as an adjuvant to SRP has shown additional benefits over conventional therapy in all the clinical parameters evaluated and this can be associated in the treatment of periodontal therapy. BANA-enzymatic kit is a simple chair side kit which can be reliable indicator of BANA positive species in dental plaque.

Association of stress, salivary cortisol level, and periodontitis among the inmates of a central prison in Kerala.

BACKGROUND: The aim of this cross-sectional study was to evaluate the association between stress, salivary cortisol, and periodontitis among the inmates of the central prison. MATERIALS AND METHODS: Seventy inmates were grouped depending on their pocket depth into Group A (pocket depth >4 mm and <6 mm), Group B (at least four sites with pocket depth ≥6 mm), and Group C (pocket depth ≤3 mm). The clinical parameters such as the oral hygiene index-simplified, gingival index, pocket depth, and the clinical attachment levels (CALs) were recorded. Stress was measured using the Depression, Anxiety, and Stress Scale along with prison time served. Saliva samples were collected, and cortisol levels were determined using electrochemiluminescence assay. Chi-square test was used for finding the association between the clinical parameters. The correlation between clinical parameters, stress, salivary cortisol levels, and time served was done using Pearson's rank correlation coefficient. RESULTS: The CALs, the stress score and the salivary cortisol levels were significantly higher in Group B (P < 0.001). Pearson's correlation showed a positive correlation between stress, cortisol level, and pocket depth. A positive correlation which was statistically significant was obtained between salivary cortisol level and prison time served by the inmates. CONCLUSION: Within the limits of this study, it can be concluded that there is a positive relation between stress and periodontal disease. The study suggests that salivary cortisol level can be used as a marker to assess stress.

Comparison of the efficacy of subgingival irrigation with 2% povidone-iodine and tetracycline HCl in subjects with chronic moderate periodontitis: A clinico microbiological study.

BACKGROUND: This study was performed to evaluate and compare the clinical and antimicrobial efficacy of subgingival irrigation with tetracycline and povidone-iodine as an adjunct to nonsurgical periodontal therapy. MATERIALS AND METHODS: Twenty subjects with chronic moderate periodontitis were recruited in this split-mouth study with probing pocket depth of >3 and ≤5 mm and clinical attachment loss of 3-4 mm in relation to 16, 36, and 46. In each subject, three selected periodontal pockets were assigned to receive one out of three irrigants (1) sterile water (control) in 16; (2) tetracycline at 10 mg/ml in 36; (3) 2% povidone-iodine in 46, and these sites were designated as Group A, Group B, and Group C, respectively. Plaque score, gingival score, pocket probing depth, and clinical attachment level were evaluated before treatment and at 1 and 3 months posttreatment. Multiplex polymerase chain reaction was used to detect Porphyromonas gingivalis and Tannerella forsythensis which have been implicated as the major risk factors for periodontal disease. Subgingival plaque collected before treatment and at 1 and 3 months posttreatment. Data were analysed using ANOVA and repeated measure ANOVA. Results were considered significant if P < 0.05. RESULTS: Clinical and microbiological parameters were reduced posttreatment, the reduction being significantly higher in Group B compared to Group C. CONCLUSION: It can be concluded that chemical and mechanical therapies were of slight benefit in the treatment of chronic moderate periodontitis, and there was an adjunctive effect of significance when scaling and root planing was combined with a single subgingival irrigation with tetracycline or povidone-iodine in lower concentration.

Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis.

INTRODUCTION: It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. AIM: To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation, using clinical parameters like gingival index (GI), oral hygiene index-simplified (OHIS), probing pocket depth (PPD), clinical attachment level (CAL) and bone density (BD). Also, to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density (BD). DESIGN AND SETTINGS: A nonrandomised clinical trial done in Amrita School of dentistry, Kochi, India. MATERIALS AND METHODS: Group A taking vitamin D (250IU/day) and calcium (500 mg/day) supplementation, and Group B were not taking oral supplementation. All subjects had at least one or more teeth with chronic moderate periodontitis. Digital Orthopantomogram images were taken to assess bone density. Data were collected at baseline and three months. STATISTICAL ANALYSIS USED: OHI-S, GI, PPD, CAL, and Bone Densities (BD) were calculated per group. Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test. Intragroup comparison of parameters at recall interval was done using Paired sample t-test. The results were considered statistically significant when p-value was <0.05. RESULTS: Both Groups showed significant change in the periodontal parameters and bone density after three months and intragroup comparison showed highly significant results for vitamin D group in relation to GI, OHI S and bone density. CONCLUSION: Calcium and vitamin D supplementation has got a positive effect on periodontal health and it can be used as an adjunct to non surgical periodontal therapy.

Comparison of glycated hemoglobin levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy.

BACKGROUND: Only a few studies have examined the association between periodontitis and glycated hemoglobin (HbA1c) levels in individuals without diabetes. The aim of this study is to compare HbA1c levels in individuals without diabetes and with and without periodontitis before and after non-surgical periodontal therapy. METHODS: This comparative study was done on individuals without diabetes who were 35 to 65 years old. Group A consisted of 30 individuals without periodontitis, and group B consisted of 30 individuals with periodontitis. Body mass indices and clinical parameters, including oral hygiene index-simplified (OHI-S) score, gingival index (GI), probing depth (PD), clinical attachment level (CAL), and HbA1c level, of all participants were recorded. All participants received non-surgical periodontal therapy (scaling and root planing). After 3 months, all participants were reexamined, and clinical parameters and HbA1c levels were evaluated and compared to baseline values. RESULTS: There were significant differences between group A and group B in regard to baseline OHI-S, GI, PD, and HbA1c (P <0.05). There was no clinical attachment loss in group A, either at baseline or after 3 months. At the end of 3 months, group B showed improvement in all clinical parameters (P <0.05) and their HbA1c levels also significantly decreased (P <0.05), although the values never reached those of group A. CONCLUSION: The HbA1c levels of individuals without diabetes and with periodontitis (group B) were significantly reduced 3 months after non-surgical periodontal therapy, although they never reached the same levels as those of the individuals without diabetes or periodontitis (group A).

Comparison of Salivary TIMP-1 Levels in Periodontally Involved and Healthy Controls and the Response to Nonsurgical Periodontal Therapy.

Background. Periodontal disease is a chronic inflammatory condition affecting the supporting structures of the dentition. Periodontal destruction is an outcome of the imbalance between matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases (TIMPs). We wanted to prove the hypothesis that salivary TIPM-1 level will vary in different people. A decrease in TIMP-1 level could make them more susceptible to periodontitis whereas a normal level could prevent increased tissue destruction thereby inhibiting the progression from gingivitis to periodontitis. This could probably pave the way for TIPM-1 to be a specific salivary biomarker and serve as a useful diagnostic and therapeutic tool in periodontitis. Methods. Whole unstimulated saliva of 2 ml was collected from twenty-five periodontally healthy and twenty-seven systemically healthy subjects with periodontitis. Clinical parameters recorded at baseline and reevaluated after four weeks in subjects with periodontitis following nonsurgical periodontal therapy were gingival index (GI), oral hygiene index-Simplified (OHI-S), probing pocket depth, and clinical attachment level (CAL). Salivary TIMP-1 levels in both were analyzed using a commercially available ELISA kit.

Compliance to recall visits by patients with periodontitis - Is the practitioner responsible?

CONTEXT: Compliance to recall visit is directly related to the medium and long-term success of active periodontal therapy. AIMS: To determine the percentage of patients who were compliant to recall visits by the practitioner and to find out the reasons for noncompliance by noncompliant patients. SETTINGS AND DESIGN: Cross-sectional study was carried out in the Department of Periodontology, Amrita School of Dentistry. The study participants were former patients of the Department of Periodontology. PATIENTS AND METHODS: A total of 216 patients were selected for the study - 116 males and 100 females. They were divided according to their socioeconomic status - professionals and nonprofessionals. Nonprofessionals were divided into those who had completed high school education and those who had not. They were followed up to find out how many were compliant to recall visits and the reasons for noncompliance by noncompliant patients. STATISTICAL ANALYSIS: The data was entered into SPSS version 11.5. Descriptive statistics were used. The frequencies of responses were calculated. RESULT: Of the total study population, 48.1% was compliant, of which 58.6% and 37.6% of males and females were compliant, respectively. In terms of percentage, 60.6% of professionals, 52.4% of those who had completed high school education and 31.3% of those who had not completed high school education were compliant. CONCLUSION: Compliance to recall visits by the periodontitis patients depends largely on the practitioner. Inadequate motivation by the practitioner and inadequate education in general are responsible for noncompliance to periodontal treatment.