Development and in vitro characterization of a mucoadhesive gel with Moringa oleifera extract for periodontal drug delivery.

Background: Extensive in vitro and in vivo research has been conducted in the previous decades to analyze the effectiveness of medicinal plants in the treatment of periodontal diseases. Moringa oleifera is a highly potent medicinal plant that has anti-inflammatory and immuno-modulatory properties. In our study, we aim to design, formulate, and evaluate the antibacterial efficacy of M. oleifera extract for local drug delivery (LDD) as periodontal treatment. Materials and Methods: This study was an in vitro experimental model. M. oleifera extract was prepared using a maceration process with powdered dried leaves of M. oleifera and 70% ethanol. The minimum inhibitory concentration (MIC) of Moringa extract against Porphyromonas gingivalis was assessed using the broth dilution method. The gel was prepared with the obtained MIC of Moringa extract and a combination of polymers- Polyethylene glycol 6000, Carbopol 940, and Chitosan. Further, the formulated gel was subjected to in vitro characterization by thermodynamic stability tests, pH determination, and syringeability test. Viscosity was determined using Brookfield DV-II + Viscometer. Mucoadhesive strength was determined using a fabricated mucoadhesive strength test apparatus. Results: M. oleifera leaves extract possesses a bactericidal effect against P. gingivalis even at a low amounts of 25 µg/ml and so is a potent botanical extract for the formulation of LDD agents for periodontal diseases. The formulation shows adequate stability, good mucoadhesiveness, and controlled drug release, on incorporating the herbal extract into the blank gel. Conclusion: The M. oleifera leaves extract possesses a bactericidal effect against P. gingivalis which has been suggested to be the keystone pathogen in the etiopathogenesis of periodontitis. Hence, M. oleifera leaves extract can be used to treat periodontal diseases as a LDD agent.

Comparison of simvastatin 1.2% gel and alendronate 1% gel in chronic periodontitis as local drug delivery: A randomized clinical trial.

Introduction: Simvastatin (SMV) is used for the treatment of hypercholesterolemia. Long-term systemic administration of SMV has been shown to result in increased bone mineral density. Alendronate (ALN) is known to inhibit osteoclastic bone resorption and has osteostimulative properties. Aim: To compare percentile changes in gain in clinical attachment level and reduction of pocket depth, and to radiographically evaluate osseous defect fill with subgingival local drug delivery of 1.2% SMV gel and 1% ALN gel. Materials and Methods: A split-mouth study was conducted with 40 infrabony defects from 20 patients diagnosed with chronic periodontitis. The sites were assigned as test site 1 (SMV gel) or test site 2 (ALN gel). After phase I therapy, a single application of SMV gel or ALN gel was done into periodontal pockets. Clinical periodontal parameters and percentage of bone fill were evaluated at baseline, 3 and 6 months. Results: There was a statistically significant reduction in pocket depth, plaque index, and bleeding index scores, gain in Clinical attachment level (CAL) and bone defect fill from baseline to 6 months at both sites. On comparison between the groups, test site 2 showed significant improvement in clinical attachment level than in test site 1 at 6-month follow-up. Test site 2 showed more percentage bone fill than test site 1. Conclusion: Usage of both SMV and ALN gels in periodontal intra bony defects can lead to significant improvements in clinical and radiographic parameters; however, ALN showed better osseous defect fill.

Calcium Channel Blockers Induced Gingival Overgrowth: A Comprehensive Review from a Dental Perspective.

Background: Gingival overgrowth (GO) as a manifestation of calcium channel blockers (CCBs) was first introduced in the literature by Ramon et al. in 1984. Since then, the use of CCBs as a treatment modality for hypertension has been recorded extensively in the literature for its association with GO. Aim: The aim of our study is to evaluate histopathology, treatment, and follow-up for the cases detailed in various studies and also to highlight the protocol mentioned to identify these presentations. Materials and Methods: A broad search was conducted from the period 1980 to 2021 using electronic databases PubMed Central, Scopus, Cochrane, and SciELO databases. About 293 articles were initially chosen. The articles further excluded did not fit the criteria for the study and eventually 50 articles which met the inclusion criteria were chosen as part of this literature review. Results: A comparative analysis was carried out regarding histopathology, treatment modalities, drug dosage, and duration to evaluate the differences in cases between 1980 and 2021. From the available studies, it was found that the histopathological and clinical findings were varied. Treatment strategies employed were different, though follow-ups in most cases were uniform. Conclusion: CCBs and their relationship with GO have been widely reported in the literature. Dentists should approach this condition by taking appropriate medical and dental history and follow evidence-based treatment guidelines to provide more relevant and judicious management of this condition. Inter-disciplinary treatment approaches would provide better outcomes.

Antiplaque Efficacy of a Novel Moringa oleifera Dentifrice: A Randomized Clinical Crossover Study.

OBJECTIVES: The use of herbal dentifrices has grown exponentially over the years. They are categorically referred to as ethnomedicines. Various agents have been tried with contradicting findings based on phytopharmacological analysis. Miswak is one agent which has been used over the years. A novel Moringa oleifera-based dentifrice has shown promising results in terms of its cytotoxicity, biocompatibility, and as a potent anti-inflammatory agent. Therefore, the present study aims to compare the efficacy of two commercially available miswak- and moringa-based herbal dentifrices on the reduction of plaque and gingivitis scores. MATERIALS AND METHODS: This randomized clinical crossover study included 20 subjects with mild to moderate gingivitis. The study was conducted over a total examination period of 20 days with a wash-out period of 2 weeks between the use of both the toothpastes. The plaque index and gingival index of the study subjects were recorded at the designated time intervals throughout the study period. STATISTICAL ANALYSIS: The data collected were entered on Microsoft Excel, and statistical analysis using SPSS software (SPSS version 28, IBM Corp, Armonk, New York, United States) was done. The statistical test used was the Wilcoxon signed-rank test. Moreover, p ≤0.05 was considered significant. RESULTS: The results showed that the reduction in mean gingival index scores from baseline to day 3 was more statistically significant in the moringa-based dentifrice. Similarly, the plaque index scores showed statistically significant reduction following the use of the moringa-based dentifrice when compared with the miswak dentifrice. This study reveals that the moringa dentifrice is a safe and effective agent in reducing plaque accumulation and treating gingival inflammation. CONCLUSION: The current study aims to provide an insight into the possible role of moringa dentifrice as a possible adjunctive oral hygiene aid.

Necrotizing Ulcerative Gingivitis, a Rare Manifestation as a Sequel of Drug-Induced Gingival Overgrowth: A Case Report.

PURPOSE: The purpose of this case report is to present a rare case of amlodipine-induced gingival overgrowth with a secondary formation of necrotizing ulcerative gingivitis involving the upper and lower arches of a 68-year-old female patient with a chief complaint of "swollen gums and pain on mastication which has been recurring for the past 5 years." MATERIALS AND METHODS: The treatment plan of this case was divided according to quadrants of the mouth. Each week, one quadrant was surgically excised, and the remaining quadrants were observed for any changes. The gingival overgrowths were excised using a 15 blade, and debris/plaque was removed with Gracey curettes. RESULTS: Although full-mouth exodontia was performed, the patient unfortunately suffered with recurrences in GO. These results are suggestive of idiopathic causes of GO. CONCLUSION: Careful examination, physician referrals, and biopsy to rule out any specific anomalies and to assist in proper diagnosis are followed by sequential management of the case results in productive outcomes.

Mycotic infections - mucormycosis and oral candidiasis associated with Covid-19: a significant and challenging association.

INTRODUCTION: Bacterial and fungal secondary infections following COVID-19 disease are widely being reported and are an area that should receive careful attention. Mucormycosis is a fatal fungal condition affecting immunocompromised patients caused by a group of mold mucoromycetes. Candida albicans (C. albicans) is an oral commensal present in almost 40-65% of healthy oral cavities in adults. Several cases of mucormycosis and oral candidiasis have been reported lately in COVID-19 patients, and it may elevate the associated risks of morbidity and mortality. MATERIALS AND METHODS: Articles were taken from a period of 2020 to April 2021 using search sources such as Cochrane, PubMed, Fungiscope and Mycobank using keywords mucormycosis, Black fungus, oral candidiasis, white fungus, COVID-19, Sars-Cov-2. DISCUSSION: The development of oral mucocutaneous lesions, such as mucormycosis and candidiasis in COVID-19 patients could be due to inhaling spores resulting in pulmonary and/or sinus congestion and prolonged mechanical ventilation in the ICU settings and the long-term use of broad-spectrum antibiotics respectively. The onset of candidiasis after the emergence of COVID-19 clinical signs and symptoms varied considerably and is reported within 1-30 days in most of the cases reported in the literature. Biofilms present on the denture surfaces are predisposing factors to oral candidiasis. We aim to summarize the limited data available regarding diagnosis, clinical presentation, and therapeutic approaches for the management of Mucormycosis and oral candidiasis in COVID-19 patients. CONCLUSION: Careful monitoring of oral lesions should be instituted through interdisciplinary telemedicine and teleconsultation to aid in primary diagnosis, thereby avoiding personal attendance during the pandemic. Dental practitioners should be included among the interdisciplinary teams for exhaustive intraoral examination and reduce the risk of morbidity and mortality.

Post-Covid alliance-mucormycosis, a fatal sequel to the pandemic in India.

As the battle against the deadly Covid-19 pandemic is still continuing worldwide, several complications are being reported in patients who have recovered post-covid. One such lethal complication being reported in patients in India in recent times, who have tested positive for Covid-19 and are gradually recovering, is a fungal disease called Mucormycosis or the black fungus. With several hundreds of cases being reported all over the country, it has triggered an additional wave of panic among the general public. Post-Covid-19 patients who are more vulnerable to Mucormycosis are those with a history of poorly controlled diabetes mellitus and also those who are immuno-compromised and have been treated with steroids and other drugs for Covid-19. The aim of this short review is to briefly cover the epidemiology of mucormycosis, its possible pathophysiology in Post Covid scenario, the clinical presentation and its diagnosis and management.

Evaluation of Aloe vera as matrix metalloproteinase inhibitor in human dentin with and without dentin-bonding agent: An in vitro study.

Background: Proper hybrid layer formation lays the foundation of resin-dentin bonding. The resin infiltration in demineralized dentin collagen couples with the adhesive/resin composites in the mineralized dentin surface. However, the activation of enzymatic activity in the collagen matrix can degrade the hybrid layer. Over the time, it leads to reduced bond strength. Mainly, the enzymes involved are matrix metalloproteinases (MMPs) which are involved in degrading most of the extracellular matrix components. Aloe vera is an herb with an anti-inflammatory effect, but its role in human dentin as an enzyme inhibitor has not been verified yet. Aims: The purpose of the study was designed for evaluating the inhibitory action of Aloe vera on MMP in human dentin with and without dentin bonding agents. Materials and Methods: A total of 15 freshly extracted healthy human teeth were collected and stored at 4°C until use. The roots were separated. The enamel and remnant pulp tissue were removed, and collected teeth were pulverized with liquid nitrogen in the minimum volume of 50-mM phosphate buffer to obtain dentin powder extract. The dentin powder extract is the source of MMPs, and therefore, the extract was treated with A. vera solution and incubated to assess the enzyme inhibition by the plate assay method and zymographic analysis. Results: A. vera treated sample with and without dentin bonding agent showed inhibition of dentin MMP's activity by plate assay method and confirmed by zymogram analysis. Conclusions: A. vera has the potential for inhibiting the MMPs enzyme activity of human dentin collagen with and without dentin bonding agents.