Influence of mechanical debridement with adjunct probiotic therapy on clinical status and salivary cortisol levels in patients with periodontal inflammation.

OBJECTIVE: The null hypothesis is that there is no difference in periodontal parameters and salivary cortisol levels (CL) among patients with periodontal inflammatory conditions (PIC) who receive non-surgical mechanical debridement (NSMD) with or without adjunct probiotic therapy (PT). The aim of this study was to assess the influence of NSMD with and without adjunct PT on clinical status and whole salivary CL in patients with PIC. PATIENTS AND METHODS: Participants were randomly divided into four groups: Group-1: NSMD alone (n=19); Group-2: NSMD + PT (n=18); Group-3: PT + oral hygiene instructions (OHI) (n=17); and Group-4: PT alone (n=18). Lactobacillus rhamnosus SP1 (2×107 colony-forming units/day) was used for PT. Plaque and gingival indices (PI and GI), probing depth (PD) and clinical attachment loss (AL) were assessed, and whole salivary CL was assessed at baseline and at 6-week follow-up. Marginal bone levels were assessed at baseline and demographic data was collected using a questionnaire. Sample-size estimation was performed, and statistical significance was determined at p<0.05. RESULTS: At follow-up, PI (p<0.01), GI (p<0.01), and PD (p<0.01) were significantly higher in PT + OHI and PT alone groups compared with individuals who underwent NSMD + PT and NSMD alone. At baseline and follow-up, there was no significant difference in CL in all groups. There was no statistically significant correlation between age, gender, PI, PD, GI, clinical AL, salivary flow rate, education status and salivary CL in all groups at baseline and follow-up. CONCLUSIONS: NSMD continues to be the "gold standard" and most reliable treatment strategy for managing PIC. It is imperative to reach a consensus regarding the duration, dosage, and frequency of PT that would yield optimal results for managing PIC.

The Pattern of Expression of Human Placental Lactogen Across Normal, Lactational, and Malignant Mammary Epithelium.

The immunoexpression of human placental lactogen (hPL) in mammary epithelium is not well studied in the literature. Our overall objective was to delineate the distribution pattern of hPL across mammary epithelia of varying levels of differentiation. This is the first research to study the level of expression of hPL in human lactational change epithelium. Immunohistochemistry (IHC) for hPL was performed on archival formalin-fixed paraffin-embedded tissue blocks of 97 cases. These consisted of 53 invasive ductal carcinomas, 21 lactational change cases, and 23 cases of normal mammary tissue. The results of this study show underexpression of hPL in malignant epithelium compared to normal and lactational groups individually and combined as a non-malignant group. However, a higher expression of hPL was noted in mammary carcinoma of axillary lymph node (ALN)-positive patients compared to ALN-negative cases. There was no statistically significant difference between hPL expression and tumor grade, estrogen receptors (ER), progesterone receptors (PR), or human epidermal growth factor receptor 2 (HER2) status. The comparison of the immunoexpression of hPL in malignant epithelium versus lactational change epithelium may provide the basis for future studies on the possible role of hPL in the protective mechanism of lactation tissue from carcinogenesis. Our results could be explained by the proposed mechanism in the literature, which is that breast cancer cells have a potential inhibitory effect on the translation of human chorionic somatotropin hormone (CSH) mRNA into hPL protein. Our results support the literature findings of a poorer prognostic outcome for breast malignancies when hPL is expressed but require further studies using a more comprehensive range of clinical parameters.

Efficacy of adjunct subgingival minocycline delivery for treatment of peri-implantitis in moderate cigarette smokers.

OBJECTIVE: Localized subgingival minocycline hydrochloride (MH) delivery as an adjuvant to with non-surgical mechanical debridement (NSMD) is useful for the treatment of periodontitis; however, there are no trials that have assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers and non-smokers. This randomized controlled trial assessed the efficacy of subgingival MH delivery with NSMD for the treatment of peri-implantitis in cigarette-smokers. PATIENTS AND METHODS: Self-reported current cigarette-smokers and non-smokers with peri-implantitis were encompassed. These individuals were subdivided into 2-subgroups. Patients in test- and control groups received NSMD with and without a single delivery of subgingival MH. Modified-gingival-index (mGI), modified-plaque-index (mPI), probing-depth (PD) and crestal-bone-loss (CBL) were measured at baseline and at 6-months' follow-up. Demographic-data was also collected. Level of significance was set at p<0.01. RESULTS: Twenty-four cigarette-smokers and 24 non-smokers with peri-implantitis were included. There was a significant reduction in mPI (p<0.01), mGI (p<0.01), PD (p<0.01) at 6-months among patients with and without type-2 DM in test- and control-groups. There was no significant difference in peri-implant mPI, PD and mGI, patients with and without type-2 diabetes in test- and control-groups at 6-months of follow-up. There was no significant difference in CBL in all patients at 6-months of follow-up. CONCLUSIONS: A single application of subgingival MH delivery is as effective as NSMD alone for the treatment of peri-implantitis in cigarette-smokers and non-smokers.

Frequency, distribution and determinants of Helicobacter pylori infection in adults and adolescents with gastric symptoms: cross-sectional epidemiological inquiry in district Haripur, Pakistan.

Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups.

Anti-nociceptive efficacy of essential oil-based extracts for the management of orofacial pain: a systematic review of available evidence.

OBJECTIVE: Experimental studies have shown that essential oil (EO)-based extracts derived from medicinal plants exhibit antinociceptive activity. The aim of the present systematic review was to assess the anti-nociceptive efficacy of EO-based extracts for the management of orofacial pain (OFP). MATERIALS AND METHODS: To address the focused question "Are EO-based formulations effective for the management of OFP disorders?", indexed databases were searched without time and language restrictions using the preferred reporting items for systematic reviews and meta-analysis guidelines. Risk of bias (ROB) was assessed. RESULTS: Eight studies were included and processed for data extraction. Two studies were clinical (one in adults and one in children) and 6 were performed in rodents. Results from one clinical study showed that inhalation of EO-extracts does not affect subjective toothache scores; and results from the study on children reported that inhalation of lavender oil reduces anxiety and pain during and after tooth extraction. Results from all experimental studies showed that administration of EO-extracts reduces orofacial nociceptive behavior. The ROB was high in 50% and 83.3% of the clinical and experimental studies, respectively. CONCLUSIONS: The anti-nociceptive efficacy of EO-extracts for the management of OFP remains debatable. Further well-designed and power-adjusted randomized clinical trials are needed in this regard.

Influence of mini-screw implant-assisted intrusion on orthodontically induced inflammatory root resorption: a systematic review.

AIM: To systematically review indexed literature related to the influence of mini-screw implant (MSI)-assisted intrusion on orthodontically induced inflammatory root resorption (OIIRR). METHODS: Indexed databases were searched without time and language restrictions using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (a) original studies; (b) patients/subjects undergoing MSI-assisted intrusion; and (c) tomographic and/or histological assessment of OIIRR. Letters to the Editor, commentaries, case reports/series, reviews, and studies based on two-dimensional radiographic assessment of OIIRR were excluded. For experimental and clinical studies, the risk of bias assessment was performed using the Systematic Review Centre for Laboratory animal Experimentation risk of bias tool and the Risk of Bias in Non-randomized Studies of Interventions guidelines, respectively. RESULTS: The initial search yielded 453 studies, out of which 6 (3 clinical and 3 on animal-models) were included. The clinical studies were performed on males and females with a mean age ranging between 16.07 and 25.5 years. Duration of the clinical studies ranged from 3.8 to 9 months. The animal studies were performed on mini-pigs, rats, and dogs. The mean age in the studies on rats and mini-pigs was 2.76 and 18 months, respectively. In the study on canine models, mean age was not reported. In all studies, MSI-assisted intrusion was shown to cause OIIRR. Power analysis was performed in one study. All studies had a moderate risk of bias. CONCLUSIONS: MSI-assisted intrusion is a risk factor for OIIRR; however, from a clinical perspective, further well-designed and power-adjusted studies are needed.

Mini-screw implant-supported pontics for the transitional management of missing permanent maxillary lateral incisors in children and adolescents: a review of currently available evidence.

AIM: To review currently available evidence regarding the use of mini-screw implant (MSI)-supported pontics for the transitional management of missing permanent maxillary lateral incisors in children and adolescents. METHODS: Indexed databases were searched until October 2019. The following inclusion criteria were imposed: (a) children and adolescents with missing permanent maxillary lateral incisor/s; (b) temporary replacement of missing permanent maxillary lateral incisors with MSI-supported pontics; (c) clinical and radiographic assessment of the outcome [MSI stability and/or alveolar bone (ALB) development]; and (d) follow-up after pontic placement. Commentaries, letters to the Editor, reviews, and studies in adult patients and/or patients with systemic/genetic diseases, with no follow-up, and without clinical and radiographic assessment of the outcome were excluded. RESULTS: Six out of 225 initially-identified studies were included. All studies were case-reports/series. A variability was observed among studies-assessed regarding the treatment protocol such as in the MSI dimensions, loading time and pontic retention protocol. Results from the included studies indicate that the MSI-supported pontics remained stable, with no infraocclusion and angular bony defect formation, ALB levels and bone density were maintained, and there was vertical ALB development during the follow-up period which ranged up to 99 months. Reported complications included MSI loss due to mobility, crown repair/replacement due to discoloration, and gingival impingement. CONCLUSIONS: The limited evidence shows that MSI-supported pontics are useful transitional restorations for missing permanent maxillary lateral incisors in children and adolescents; however, further well-designed clinical trials are needed in this regard.

Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta-analysis.

This study aimed to evaluate the efficacy of metformin as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Electronic searches were conducted in databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to August 2017. Randomized clinical trials with data in comparison between adjunctive locally delivered metformin use to SRP and placebo in each group and a follow-up period of at least 6 months, were included. Primary outcomes included clinical attachment level, while secondary outcomes were bone defect (BD) fill and reduction in probing depth. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using the random effects model. Five clinical studies were included in the qualitative synthesis and 3 studies were included for meta-analysis. All the included studies showed significant BD fill, probing depth reduction and clinical attachment level gain with adjunctive locally delivered metformin compared to SRP alone. Considering the effects of adjunctive metformin as compared to SRP, a high degree of heterogeneity for BD fill (Q value = 7.03, P = .02, I2  = 71.55%) was noticed among both the groups. Meta-analysis showed a statistically significant clinical attachment level gain (WMD = -2.83, 95% CI = -3.32 to -2.34, P < .001), BD fill (WMD = -2.96, 95% CI = -3.99 to -1.93, P < .001) and probing depth reduction (WMD = -3.11, 95% CI = -3.63 to -2.59, P < .001) for SRP + metformin treatment vs SRP. Adjunctive use of metformin delivery in periodontal treatment appears to be effective in BD fill, reducing probing depth and gain in clinical attachment level. Further multicentered randomized clinical trials are warranted in future to prove additional benefits of metformin as an adjunct to SRP in the treatment of chronic periodontitis.

Association between obstructive sleep apnea and erectile dysfunction: a systematic review and meta-analysis.

The purpose of the present systematic review and meta-analysis was to assess the association between obstructive sleep apnea (OSA) and erectile dysfunction (ED). To address the focused question, "Is there an association between OSA and ED?" indexed databases were searched up to May 2017 without time or language restrictions using various key words including: obstructive sleep apnea, sleep apnea syndromes, erectile dysfunction, sleep-disordered breathing, snoring, sexual function, and impotence. Review articles, case-reports and case-series, commentaries, letters to the editor, interviews and updates, studies assessing the efficacy of OSA treatment in the improvement of ED, or studies evaluating the efficacy of ED treatment in the improvement of OSA were excluded. Twenty-eight observational studies were included for qualitative synthesis. Overall, 19 studies had a cross-sectional design, 7 studies were case-control, and 2 were cohort studies. The odds ratios (OR) with a 95% confidence interval were calculated from 10 studies. The combined OR was 0.45, with a 95% confidence interval of 0.18-0.71, indicating that in patients without OSA, the risk of ED is significantly lower compared with patients with OSA. The available evidence shows that OSA is associated with a higher risk of ED; however, further well-designed controlled clinical trials and longitudinal prospective studies are needed in this regard.

Outcome of orthodontic palatal plate therapy for orofacial dysfunction in children with Down syndrome: A systematic review.

To evaluate the effects of orthodontic palatal plate therapy (OPPT) in the treatment of orofacial dysfunction in children with Down syndrome (DS). Indexed databases were searched. Clinical trials in DS allocated to test (treatment with palatal plates) versus control group (without palatal plates/special physiotherapy for orofacial stimulation) with follow-up of any time duration and assessing mouth closure, tongue position, active and inactive muscle function as outcomes. Study designs, subject demographics, frequency and duration of palatal plate therapy, method for assessment, follow-up period and outcomes were reported according to the PRISMA guidelines. Eight clinical studies were included. The risk of bias was considered high in three studies and moderate in 5 studies. The number of children with DS ranged between 9 and 42. The mean age of children with DS at the start of the study ranged between 2 months and 12 years. The duration of palatal plate therapy ranged between 4 months and 48 months. The follow-up period in all studies ranged from 12 to 58 months. All studies reported OPPT to be effective in improving orofacial disorders in children with DS. Most of the included studies suggest that palatal plate therapy in combination with physiotherapy/orofacial regulation therapy according to Castillo Morales/speech and language intervention seems to be effective in improving orofacial disorders in children with DS. However, the risk of bias of the included studies was high to moderate. Longitudinal trials with standardized evaluation methods, age of children at treatment initiation, treatment duration and standard orofacial outcomes are recommended.

Influence of involuntary cigarette smoke inhalation on osseointegration: a systematic review and meta-analysis of preclinical studies.

There are no studies that have systematically reviewed the influence of involuntary cigarette smoke inhalation (ICSI) on the stability of implants. The aim of the present study was to perform a systematic review and meta-analysis of preclinical studies that assessed the influence of involuntary cigarette smoke inhalation ICSI on osseointegration. Indexed databases (PubMed, Google-Scholar, Scopus, EMBASE, and Web of Knowledge) were searched till September 2017. Titles and abstracts of studies identified using the above-described protocol were independently screened by 2 authors. Full-texts of studies judged by title and abstract to be relevant were independently evaluated for the stated eligibility criteria. Nine studies were included. Six studies showed that ICSI compromised bone area contact around implants. In 4 studies, peri-implant bone mineral density was significantly higher in the control group than among subjects exposed to ICSI. For the effects of ICSI on the osseointegration of dental implants, significant differences could be observed for bone-to-implant contact for test subjects in cancellous (Z=-4.08, p<0.001) and cortical bone (Z=-4.31, p<0.001) respectively. ICSI may negatively influence osseointegration of dental implants. It is imperative to educate patients about the negative effects of passive smoking on dental and systemic health.

Does incorporating collagen and chondroitin sulfate matrix in implant surfaces enhance osseointegration? A systematic review and meta-analysis.

Implant surface modification has been used to improve osseointegration. However, evidence regarding improved new bone formation (NBF) and osseointegration with the use of collagen-chondroitin sulfate (CS) matrix coated implants remains unclear. The aim of this study was to assess the efficacy of collagen-CS matrix coating on the osseointegration of implants. The focused question was "Does the incorporation of collagen-CS matrix in implant surfaces influence osseointegration?" To answer the question, indexed databases were searched up to July 2017 using various combinations of the key words "collagen", "chondroitin sulfate", "osseointegration", and "implants". The initial literature search identified 497 articles, of which 18 reporting experimental studies fulfilled the inclusion criteria. Thirteen of the studies included (72%) reported that implants coated with a collagen-CS matrix presented higher NBF, bone-to-implant contact, and/or bone volume density. The strength of this observation was supported by meta-analysis results. Nevertheless, the results should be interpreted with caution due to the lack of standardization regarding the dosage formulation of collagen-CS, short-term follow-up, and lack of assessment of confounders. On experimental grounds, the incorporation of collagen-CS matrix into implant surfaces appears to promote osseointegration. From a clinical perspective, the results from animal models support phase I studies in healthy humans.

Oral Candida carriage and species prevalence in denture stomatitis patients with and without diabetes.

The objective of this study was to assess the oral Candida carriage and species prevalence in denture stomatitis (DS) patients with and without diabetes mellitus (DM). To address the focused question "In patients receiving dentures, how does having diabetes compared to no diabetes influences the carriage and species prevalence of oral Candida?" Indexed databases were explored without time or language restrictions up to and including February 2017. Nine studies were included. In these studies, the number of diabetics ranged between 14 patients and 405 individuals with mean ages ranging between 33 years and 66.4 years. In five studies, the percentage of hyperglycemic patients in the diabetic group ranged from 14.3% to 100%. In one study, all diabetic patients were normoglycemic. Seven studies reported Candida-associated DS to be significantly higher among diabetics than non-diabetics. Candida albicans was the most prevalent species isolated among diabetics and non-diabetics with DS. Denture-wearers with DM are more susceptible to Candida-associated DS as compared to non-diabetics.

Influence of implant location in patients with and without type 2 diabetes mellitus: 2-year follow-up.

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars. Peri-implant bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were measured. P-values less than 0.05 were considered statistically significant. The mean age of patients with T2DM was 42.5 years and that of non-diabetic controls was 40.6 years. The mean fasting blood glucose levels of patients with and without T2DM were 74.5mg/dl (66-80mg/dl) and 82.5mg/dl (79-88.1mg/dl), respectively. The mean duration of T2DM was 4.3 years. There was no significant difference in BOP, PD, or CBL around implants placed in any of the zones in the jaws of patients with and without T2DM. There is no influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without T2DM.

Role of local alendronate delivery on the osseointegration of implants: a systematic review and meta-analysis.

There is controversy regarding whether locally delivered alendronate enhances osseointegration. The aim of this systematic review was to assess the role of local alendronate delivery (topical, or as a coating on implant surfaces) in the osseointegration of implants. The focused question was, "Does the local delivery of alendronate affect osseointegration around implants?". To address this question, indexed databases were searched, without time or language restriction, up to and including January 2017. Various combinations of the following key words were used: "alendronate", "bisphosphonates", "osseointegration", and "topical administration". letters to the editor, historic reviews, commentaries, case series, and case reports were excluded. In total, 18 experimental studies were included: alendronate-coated implants were used in 13 of these studies and local delivery in five studies. The results of 11 of the studies showed that alendronate coating increased new bone formation, the bone volume fraction, or bone-to-implant contact (BIC) and biomechanical properties. Results from two studies in which alendronate was administered topically indicated impaired BIC and/or biomechanical fixation around implants. On experimental grounds, local alendronate delivery seems to promote osseointegration. From a clinical perspective, the results in animal models support phase 1 studies in healthy humans (without co-morbidities other than edentulism).

Association between periodontal disease and polycystic ovary syndrome: a systematic review.

The purpose of the present study was to review systematically the association between periodontal diseases (PDs) and polycystic ovary syndrome (PCOS). To address the focused question, 'Is there a relationship between PD and PCOS?' indexed databases were searched up to October 2016 without time or language restrictions using different combinations of the following key words: PCOS, ovarian cysts, PD, periodontitis, gingival diseases and gingivitis. Letters to the Editor, commentaries, historic reviews, case-report, unpublished articles and animal/experimental studies were excluded. Seven case-control studies were included. The number of study participants ranged between 52 and 196 females aged between 15 and 45 years. In three and three studies, proinflammatory cytokines were assessed in gingival crevicular fluid and saliva samples, respectively. In one study, salivary microbes were investigated. All studies reported that a positive association exists between PD and PCOS. In conclusion, there is a positive association between PD and PCOS; however, further well-designed longitudinal controlled clinical trials are needed in this regard. It is recommended that physicians should refer patients with PCOS to oral health-care providers for comprehensive oral evaluation and treatment.

Role of diode lasers in oro-facial pain management.

With the increasing use of low level laser therapy (LLLT) in clinical dentistry, the aim of the present study was to assess the effectiveness of diode lasers in the management of orofacial pain. Indexed databases were searched without language and time restrictions up to and including July 2016 using different combinations of the following key words: oral, low level laser therapy, dental, pain, diode lasers, discomfort and analgesia. From the literature reviewed it is evident that LLLT is effective compared to traditional procedures in the management of oro-facial pain associated to soft tissue and hard tissue conditions such as premalignant lesions, gingival conditions and dental extractions. However, it remains to be determined which particular wavelength will produce the more favorable and predictable outcome in terms of pain reduction. It is highly recommended that further randomized control trials with well-defined control groups should be performed to determine the precise wavelengths of the diode lasers for the management of oro-facial pain. Within the limits of the present review, it is concluded that diode lasers therapy is more effective in the management of oro-facial pain compared to traditional procedures.

A systematic review and meta-analysis of pre-clinical studies assessing the effect of nicotine on osseointegration.

Nicotine has been associated with vasoconstriction and an impaired cellular healing response. It is therefore likely that nicotine jeopardizes osseointegration. This systematic review and meta-analysis was performed to assess pre-clinical studies on the effect of nicotine on implant osseointegration. Databases were searched up to and including March 2016 for animal/non-human studies using the following Keywords: bone to implant contact; implant; nicotine; osseointegration; bone healing; and new bone formation. In total eight in vivo design studies were included and processed for data extraction. Five studies reported no significant influence of nicotine on healing around implants. Quantitative analysis of the effects of nicotine on the osseointegration of dental implants showed a significant difference in bone-to-implant contact between test and control subjects (Z=-2.49; P=0.014). From the studies included in the present review; it appears that nicotine has an effect on implant osseointegration.