Multiple periodontal abscesses with atypical segmental teeth mobility in a nonperiodontitis case: A periodontal alarm of postcoronavirus disease-2019 mucormycosis.

The coronavirus pandemic, constantly mutating virus, and newer complications arising with each passing day have put health workers in jeopardy. One such serious complication being reported is mucormycosis. It is a deadly and rapidly spreading infection resulting in angioinvasion and tissue necrosis. In precoronavirus disease (COVID) era mucormycosis was observed mainly in patients having comorbidities such as diabetes, neutropenia, or previous history of organ transplant. In the present case report, a systemically healthy patient presented with mucormycosis postcoronavirus disease-2019 infection. The patient presented with atypical periodontal findings such as multiple periodontal abscesses, segmental teeth mobility, and deep periodontal pockets confined to the maxillary right quadrant. This form of presentation should be a wake-up call for all dental professionals to be in the constant lookout for any signs and symptoms of mucormycosis even in seemingly nonhigh-risk patients.

Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome.

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.

Subgingivally delivered 1.2% atorvastatin in the treatment of chronic periodontitis among smokers: a randomized, controlled clinical trial.

AIM: Statins are known to have a beneficial effect in the treatment of chronic periodontitis (CP). The current study was designed to investigate the effectiveness of a 1.2% atorvastatin (ATV) local drug delivery system as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBD) in CP among smokers. METHODS: Seventy-one smokers with CP were categorized into two treatment groups: SRP + 1.2% ATV gel and SRP + placebo gel. Clinical parameters, modified sulcus bleeding index, probing depth, and clinical attachment level were recorded at baseline before SRP and at 3, 6, and 9 months. At baseline, 6 months, and 9 months, the percentage of radiographic defect depth reduction was determined using computer-aided software. RESULTS: The mean probing depth reduction and mean clinical attachment level gain were found to be greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic defect depth reduction was found in the ATV group compared to the placebo group after 9 months. CONCLUSION: The ATV local drug delivery as an adjunct to SRP can be used in the treatment of IBD in CP among smokers.

Efficacy of Subgingivally Delivered 1.2% Atorvastatin in the Treatment of Chronic Periodontitis in Patients With Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial.

BACKGROUND: The present study was designed to evaluate effectiveness of 1.2% atorvastatin (ATV) gel, as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects in chronic periodontitis (CP) in patients with type 2 diabetes mellitus (t2DM). METHODS: Seventy-five patients were categorized into two treatment groups: 1) SRP plus 1.2% ATV and 2) SRP plus placebo. Clinical parameters including modified sulcus bleeding index, probing depth (PD), and relative attachment level (RAL) were recorded at baseline and 3, 6, and 9 months. Percentage radiographic defect depth reduction was evaluated using computer-aided software at baseline and 6 and 9 months. RESULTS: Mean PD reduction and mean RAL gain was greater in the ATV group than the placebo group at 3, 6, and 9 months. Furthermore, ATV group sites presented with a significantly greater percentage of radiographic defect depth reduction at 6 and 9 months. CONCLUSION: Locally delivered ATV was found to be effective in treatment of intrabony defects in CP in patients with t2DM.

Triphala, a New Herbal Mouthwash for the Treatment of Gingivitis: A Randomized Controlled Clinical Trial.

BACKGROUND: An antiplaque agent with minimal side effects that can be used as an effective adjunct to mechanical plaque control is needed. The current study is designed to evaluate efficacy of triphala (TRP) mouthwash in reduction of plaque and gingivitis. METHODS: Ninety individuals with chronic generalized gingivitis were randomly assigned to three groups: 1) group I, placebo mouthwash; 2) group II, TRP mouthwash; and 3) group III, chlorhexidine (CHX) mouthwash. All individuals were instructed to rinse with their respective mouthwash twice daily. 1) Plaque index (PI); 2) gingival index (GI); 3) oral hygiene index-simplified (OHI-S); and 4) microbiologic colony counts were recorded at baseline and at 7, 30, and 60 days. RESULTS: All three groups showed gradual reduction in PI, GI, and OHI-S levels from baseline to 7, 30, and 60 days. There was also significant reduction in microbial counts in all groups at all time intervals except in group I. A significant difference was noticed with respect to reduction in PI, GI, OHI-S, and microbiologic counts in group I compared with groups II and III. However, no significant differences were found between groups II and III for any parameters at any time intervals. CONCLUSIONS: TRP mouthwash was found to decrease inflammatory parameters from baseline to follow-up intervals. Because improvement in gingivitis was comparable with that of CHX mouthwash, TRP mouthwash can be considered a potential therapeutic agent in the treatment of gingivitis.

Platelet-Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Platelet-rich fibrin (PRF), a second-generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP). METHODS: Ninety-six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site-specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months. RESULTS: PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months. CONCLUSIONS: PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.

Comparative efficacy of a herbal and a non-herbal dentifrice on dentinal hypersensitivity: a randomized, controlled clinical trial.

AIM: Dentinal hypersensitivity (DH) is a common painful condition of the teeth of adults. The present study was conducted to assess and compare the efficacy of a commercially-available novel herbal dentifrice with a non-herbal potassium nitrate in the reduction of DH. METHODS: A total of 145 individuals (73 males and 72 females; aged 25-60 years) were divided into three groups randomly: (a) group 1: a placebo dentifrice; (b) group 2: a commercially-available herbal dentifrice; and (c) group 3: 5% non-herbal potassium nitrate. The sensitivity scores for controlled air stimulus and cold water were recorded at baseline, 6 weeks, and 12 weeks. RESULTS: Both groups 2 and 3 were found to be significantly better, as compared to the placebo group at the end of 6 and 12 weeks in the reduction of DH. Group 2 also showed comparable results in the reduction of DH when compared to group 3. CONCLUSION: The herbal dentifrice showed comparable results to the non-herbal dentifrice and can be recommended for the treatment of DH.

Clinical and microbiological effects of systemic azithromycin in adjunct to nonsurgical periodontal therapy in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis: a randomized placebo-controlled clinical trial.

OBJECTIVE: This study aimed to evaluate clinical and microbiological effects of systemic azithromycin (AZM) in adjunct to nonsurgical periodontal therapy (NSPT; or scaling root planing - SRP) in treatment of Aggregatibacter actinomycetemcomitans associated periodontitis (AAAP). METHODS AND MATERIALS: Seventy individuals with moderate to severe periodontitis and subgingival detection of A. actinomycetemcomitans were randomly allocated to two groups. Thirty-five individuals were allocated to full mouth SRP+AZM (500 mg oral delivery (OD) × 3 days) while 35 individuals were allocated to SRP+Placebo (OD × 3 days) group. The clinical variables evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI), and percent bleeding on probing sites (%BOP), while microbiologic variables included percentage of subjects positive for A. actinomycetemcomitans at baseline, 3, 6, and 12 months. RESULTS: The AZM group showed statistically significant reduction in mean PD (2.91 ± 0.88 mm) as compared to placebo (1.51 ± 0.98 mm) (P < 0.001), while CAL gain was significant in the AZM group (2.71 ± 1.15 mm) as compared to the placebo group (1.71 ± 1.29 mm) (P < 0.001). There was also a statistically significant reduction in the number of subjects positive for A. actinomycetemcomitans in the AZM group (P < 0.0001). CONCLUSION: Azithromycin was found to significantly improve the clinical and microbiological parameters in AAAP individuals.

Clinical and microbiological efficacy of systemic roxithromycin as an adjunct to non-surgical periodontal therapy in treatment of chronic periodontitis. A randomized, double-blinded, placebo-controlled clinical trial.

PURPOSE: The objective of this randomized clinical trial was to evaluate the clinical and microbiological effects of systemic administration of roxithromycin (RXM) as an adjunct to non-surgical periodontal therapy (NSPT) in the treatment of individuals with moderate to severe chronic periodontitis (CP). METHODS: 70 individuals (38 males and 32 females, aged 25 to 60 years) with moderate to severe CP were randomly allocated into two groups. 35 individuals were allocated to full mouth SRP+RXM while 35 individuals were allocated to SRP+ Placebo group. The clinical parameters evaluated were probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and % bleeding on probing sites (%BOP) at baseline (B/L), 1-, 3- and 6-month intervals while microbiologic parameters included percentage of sites positive for periodontopathic bacteria A. actinomycetemcomitans, P. gingivalis and T. forsythia at B/L, 3 and 6 months using polymerase chain reaction. RESULTs: Both groups showed improved clinical and microbiologic parameters over 6 months. RXM group showed a statistically significant reduction in mean PD and CAL gain as compared to the placebo group (P < 0.0001). There was reduction in percentage of sites positive for periodontopathic bacteria over the duration of the study in both groups and a statistically significant reduction in the number of sites positive for A. actinomycetemcomitans in RXM group (P < 0.001).

Clinical evaluation of the periodontal health condition and oral health awareness in Parkinson's disease patients.

OBJECTIVE AND BACKGROUND: The objectives were to compare periodontal status between subjects with and without Parkinson's disease (PKD) to determine the influence of PKD on periodontal disease. This study was conducted to evaluate the relationship of periodontal status with severity of PKD. MATERIALS AND METHODS: This study was conducted on 45 subjects with PKD (subjects with PKD were divided into 5 groups from group 2 to group 6 according to Hoehn and Yahr stages) and 46 control subjects (group 1). Probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and percentage of bleeding sites (%BoP) were evaluated. All subjects were interviewed regarding their practice of oral hygiene and access to professional dental care. RESULTS: There were statistically significant differences in PD, CAL, GI, PI and %BoP in subjects with PKD and controls (p < 0.001). All the evaluated periodontal clinical parameters and indices deteriorate with increase in severity of PKD. The mean PD value increased from 2.75 mm for group 1 to 6.17 mm for group 6, and mean CAL value increased from 3.14 mm for group 1 to 6.74 mm for group 6. The mean GI, PI and %BoP values increased from 0.55, 1.35 and 20.37 to 2.66, 3.80 and 70.86, respectively with increasing severity of PKD. CONCLUSION: There is a need for dental care and encouragement to use plaque control methods for subjects with PKD as periodontal pathology presented a high prevalence even in the early stages of PKD.

Clinical and microbiological effects of levofloxacin in the treatment of chronic periodontitis: a randomized, placebo-controlled clinical trial.

AIM: The aim of the present study was to evaluate the clinical and microbiological effect of systemic levofloxacin (LFX) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis (CP). METHODS: Sixty-five patients with CP were randomly divided into a test (n = 33, SRP and LFX 500 mg, once daily [o.d.]) and a control group (n = 32, SRP and placebo, o.d.). Plaque index (PI), gingival index (GI), percentage of sites with bleeding on probing (%BoP), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, 10 days, and 1-, 3-, and 6-month intervals. The percentage of sites positive for Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis, and Tannerella forsythia were recorded at baseline and at 3 and 6 months. RESULTS: Patients receiving LFX showed statistically-significant improvements in mean PD and CAL. The intergroup difference in PI, GI, and%BoP was not significant at any interval. There was a reduction in the percentage of sites positive for periodontopathic bacteria over the duration of the study in both groups, and a statistically-significant reduction in the number of sites positive for A. actinomycetemcomitans in the LFX group (P < 0.001). CONCLUSION: Levofloxacin was found to significantly improve the clinical and microbiological parameters in CP individuals.

Periodontal health condition in patients with Alzheimer's disease.

OBJECTIVE: To compare periodontal health status in individuals with and without Alzheimer's disease (AD). METHODS: A total of 58 individuals with AD and 60 cognitively normal (ND) adult individuals, ranging in age from 50 to 80 years, were assessed for periodontal health status. Individuals with AD were further divided as mild, moderate, and severe, based on degree of cognitive impairment as evaluated using Mini-Mental State Examination. Gingival index (GI), plaque index (PI), probing depth (PD), clinical attachment level (CAL), and percentage of bleeding sites (%BOP) were evaluated. RESULTS: All the evaluated periodontal parameters were higher in individuals with AD than that in ND individuals, and the periodontal status deteriorated with the progression of AD. There were significant differences in mean GI, PI, PD, CAL, and %BOP between all the groups. CONCLUSION: The periodontal health status of individuals with AD deteriorates with disease progression and was closely related to their cognitive function.

Correlation of human S100A12 (EN-RAGE) and high-sensitivity C-reactive protein as gingival crevicular fluid and serum markers of inflammation in chronic periodontitis and type 2 diabetes.

OBJECTIVE: The aim of the present study was to evaluate the levels and correlation of human S100A12 and high-sensitivity C-reactive protein (hs-CRP) in gingival crevicular fluid (GCF) and serum in chronic periodontitis (CP) subjects with and without type 2 diabetes mellitus (DM). MATERIALS AND METHODS: A total of 44 subjects were divided into three groups: group 1 had 10 periodontally healthy subjects, group 2 consisted of 17 CP subjects and group 3 had 17 type 2 DM subjects with CP. GCF and serum levels of human S100A12 and hs-CRP were quantified using enzyme-linked immunosorbent assay and immunoturbidimetric analysis, respectively. The clinical outcomes evaluated were gingival index, probing depth and clinical attachment level and the correlations of the two inflammatory mediators with clinical parameters were evaluated. RESULTS: Both human S100A12 and hs-CRP levels increased from group 1 to group 2 to group 3. The GCF and serum values of both these inflammatory mediators correlated positively with each other and with the periodontal parameters evaluated (p < 0.05). CONCLUSION: Human S100A12 and hs-CRP can be considered as possible GCF and serum markers of inflammatory activity in CP and DM.

Clinical and microbiological effects of levofloxacin in the treatment of Aggregatibacter actinomycetemcomitans-associated periodontitis: a randomized placebo-controlled clinical trial.

AIM: To evaluate the clinical and microbiological effects of systemic levofloxacin (LFX) in subjects with Aggregatibacter actinomycetemcomitans-associated chronic periodontitis (AA-ACP). MATERIALS AND METHODS: Subjects with severe periodontitis with subgingival detection of A. actinomycetemcomitans were randomly divided into two treatment groups; a test group (n = 35) that received scaling and root planing (SRP) and LFX (500 mg o.d.) and a control group (n = 34) that received SRP and placebo (o.d.) for 10 days. Plaque index (PI), gingival index (GI), percent of sites with bleeding on probing (% BoP), probing depth (PD) and clinical attachment level (CAL) were recorded and subgingival plaque samples were cultivated for detection of A. actinomycetemcomitans at baseline to 6 months at various intervals. RESULTS: Subjects receiving LFX showed the greatest improvements in mean PD and CAL. The difference in the reduction of PD and CAL in the two groups was significant at 1, 3 and 6 months for PD and 3 and 6 months for CAL (p < 0.05). The inter-group difference in PI, GI and % BoP was not significant at any interval. Detectable levels of A. actinomycetemcomitans were significantly less in the test group 3 and 6 months post-therapy. CONCLUSION: Systemic LFX as an adjunct to SRP improves clinical outcomes and suppresses A. actinomycetemcomitans below detectable levels.

Association of metabolic syndrome and periodontal disease in an Indian population.

BACKGROUND: Metabolic syndrome, the whole of interconnected factors, presents with local manifestation, such as periodontitis, related by a common factor known as oxidative stress. The aim of the present study was to assess the association between metabolic syndrome and periodontal disease in an Indian population. METHODS: Clinical criteria for metabolic syndrome included 1) abdominal obesity; 2) increased triglycerides; 3) decreased high-density lipoprotein cholesterol; 4) hypertension or current use of hypertension medication; and 5) high fasting plasma glucose. Serum C-reactive protein (CRP) levels were also measured. Periodontal parameters including gingival index (GI) average and deepest probing depth (PD) and clinical attachment level (CAL) were recorded on randomly selected quadrants, one maxillary and one mandibular. Based on the presence or absence of metabolic syndrome, individuals were divided into two groups. RESULTS: The periodontal parameters PD, CAL and GI differed significantly between the two groups. The GI values in Group 1 (2.06 ± 0.57) were greater than in Group 2 (1.79 ± 0.66; p = 0.0025). Similarly PD and CAL values in Group 1 (4.58 ± 1.69 and 2.63 ± 1.61 mm) were significantly greater (p < 0.001) than in Group 2 (3.59 ± 1.61 and 1.61 ± 1.40 mm, respectively). Also, three metabolic components and serum CRP correlated with average PD, and the strength of the correlation was medium in Group 1 as compared to Group 2, in which it was weak. CONCLUSION: The association between metabolic syndrome and periodontal disease was significant, and abdominal obesity appeared to be the most important contributing metabolic factor to periodontal disease.

Clinical efficacy of subgingivally delivered 1.2% atorvastatin in chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: Atorvastatin (ATV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Recently, statins have shown pleiotropic effects such as anti-inflammation and bone stimulation. The aim of the present study is to investigate the effectiveness of 1.2% ATV as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBDs). METHODS: Sixty individuals were randomized into two treatment groups: SRP plus 1.2% ATV and SRP plus placebo gel. At baseline and 3, 6, and 9 months, clinical parameters, which included modified sulcus bleeding index, plaque index, probing depth (PD), and clinical attachment level (CAL), were recorded at baseline. Radiologic assessment of IBD fill was done using computer-aided software at baseline and 6 and 9 months. RESULTS: Mean PD reduction and mean CAL gain were greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic bone fill was found in the ATV group (35.49% ± 5.50%) compared to the placebo group (1.82% ± 1.32%) after 9 months. CONCLUSION: ATV as an adjunct to SRP can provide a new direction in the management of IBDs.