Granulomatosis with polyangiitis in gingiva: A rare case of isolated presentation.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by necrotising granulomatous inflammation of upper and lower respiratory tract, vasculitis and glomerulonephritis. This ailment may present with cough, haemoptysis, sinusitis, nasal deformity, skin lesions, malaise, fever, anorexia, and weight loss. Oral manifestation includes strawberry gingivitis, which is a pathognomonic clinical presentation. Here, we present a case of GPA in gingiva as the first manifestation. Clinical examination of the oral cavity revealed granular, erythematous gingival enlargement in the lower anterior teeth region involving papilla, marginal and attached gingiva with shiny and pebbled surface. Histopathological examination showed pseudoepitheliomatous hyperplasia with vasculitis and inflammation in the connective tissue, neutrophilic infiltration and abscess formation with haemorrhage were noted. Laboratory investigations revealed Proteinase 3 (PR3) antigen and Glomerular basement membrane (GBM) antigen were positive. Clinical, histopathological and laboratory investigations enabled the diagnosis of Granulomatosis with Polyangiitis. We present this rare case report of GPA with primary manifestation in gingiva.

Interdental hygiene index - A proposal of dual-purpose tool for patient assessment and motivation.

BACKGROUND: Interdental areas are more prone to plaque accumulation, thereby increasing the susceptibility for periodontal diseases. Proper method of interdental hygiene assessment and motivation to use interdental aids can potentially reduce the burden of periodontal diseases. MATERIALS AND METHODS: Fifty consecutive volunteer participants who presented with gingival inflammation were recruited based on the set of inclusion criteria. Further, proposed interdental hygiene index (IDHI) and gingival index were recorded by the examiner. Patient-reported outcome measures (PROMs) were recorded on the baseline and 4-week follow-up visits. Descriptive statistics and correlation analysis were performed. RESULTS: The study comprised 50 participants with 22 male and 23 female participants. At baseline, the mean/standard deviation of IDHI was 1.32 ± 0.10 and 0.62 ± 0.21 on follow-up, respectively. For Gingival Index (GI) at baseline, the mean/standard deviation was 1.61 ± 0.15 and 0.70 ± 0.24 on follow-up, respectively. Correlation analysis revealed a significant correlation between IDHI and GI at baseline and follow-up. Majority of the participants scored 0 on the Visual Analogue Scale (VAS) for pain, rated "Good" for acceptability of procedure and perceived efficacy of interdental brush. Participants reported to have acquired "High level of motivation" to use an interdental brush. CONCLUSION: IDHI is a simple and reliable tool to assess the interdental areas of the patient and motivate to use interdental brush for the maintenance of good oral hygiene. PROMs also revealed positive responses from participants.

Low-level Laser Therapy in Combination with Desensitising Agent Reduces Dentin Hypersensitivity in Fluorotic and Non-fluorotic Teeth - A Randomised, Controlled, Double-blind Clinical Trial.

PURPOSE: Dentin hypersensitivity (DH) is a prevalent painful condition of the teeth, the management of which lies in the obliteration of patent dentinal tubules. The purpose of this study was to compare the efficacy of 5% potassium nitrate (PN), low-level laser therapy (LLLT), and combination of low-level laser therapy and 5% potassium nitrate (LLLT+PN) in patients with fluorotic and non-fluorotic hypersensitive teeth. MATERIALS AND METHODS: Ninety self reporting patients with DH completed the randomised, double-blind study. Patients were equally divided into fluorosis group (FG), with moderate to moderately severe fluorosis and the non-fluorosis group (NFG) and subdivided into 3 groups to receive PN, LLLT (810 nm, 1 W) alone and LLLT+PN. Each participant had at least one tooth eliciting a response of ≥ 3 on a visual analog scale (VAS) to evaporative, thermal and electric tactile stimulus (digital scratch-o-meter). The teeth were evaluated at baseline, 30 min post treatment, 1 week, 4 weeks and 12 weeks. The magnitude of pressure applied by the scratch-o-meter was also assessed for all three interventions. RESULTS: Statistically, LLLT+PN was more effective in alleviating DH at all time intervals compared to baseline. However, statistically significant results (p ˂ 0.05) were seen with LLLT+PN at 12 weeks in FG. Magnitude of pressure applied showed statistically significant differences with LLLT+PN at 30 min post treatment. CONCLUSION: LLLT+PN alleviated DH at all time intervals, with a greater effect in the fluorotic group. However, LLLT+PN was more efficacious in reducing DH at 12 weeks post treatment in the fluorotic group.

Analysis of matrix metalloproteinase-8 levels in gingival crevicular fluid and whole mouth fluid among smokers and nonsmokers using enzyme-linked immune-sorbent assay and a novel chair-side test.

AIM: To indigenously prepare a chair-side test kit for investigating and comparing the matrix metalloproteinase (MMP)-8 levels in gingival crevicular fluid (GCF) and saliva in patients with healthy periodontium, gingivitis and chronic periodontitis in smokers and nonsmokers. To validate the diagnostic accuracy of indigenously prepared chair-side test against enzyme-linked immune-sorbent assay (ELISA). Furthermore, to assess the effect of nonsurgical periodontal therapy (NSPT) on the levels of MMP-8 in GCF and saliva among the test groups. MATERIALS AND METHODS: GCF and saliva were collected from 250 subjects. The study population were divided into five groups; health periodontium-nonsmokers (Group 1; n = 50), chronic gingivitis-nonsmokers (Group 2; n = 50), chronic periodontitis-nonsmokers (Group 3; n = 50), chronic gingivitis-smokers (Group 4; n = 50), chronic periodontitis-smokers (Group 5; n = 50). A chair-side test kit was indigenously prepared using polyclonal antibodies (principle of immunochromatography) to detect the MMP-8 levels, and it was validated against ELISA at baseline and 3 months after NSPT. RESULTS: The chair-side test detected MMP-8 levels with a sensitivity and specificity in accordance with ELISA. MMP-8 levels at baseline were higher in Group 2 and Group 3 as compared to controls (P < 0.05), and decreased after therapy (P < 0.05). MMP-8 levels in GCF were greater than in saliva for all the groups, indicating GCF to be a better sample to detect the MMP levels. CONCLUSION: The chair-side test detected MMP-8 levels accurately making it a viable chair side diagnostic tool. It was effective for early diagnosis of the periodontal disease among high-risk population such as smokers.

Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study.

INTRODUCTION: PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched. AIM: The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP). SETTINGS AND DESIGN: The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India. MATERIALS AND METHODS: In a split-mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days. RESULTS: In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups. CONCLUSION: The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.

Furcation Measurements: Realities and Limitations.

Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy. For the efficient clinical management of furcation defects, it is necessary to have a reliable diagnostic tool that can accurately measure and quantify the furcation defect. This article addresses the various diagnostic methods available and assesses their limitations. Further, it also highlights some new frontiers in the field of furcation diagnosis and measurements.

Comparative volumetric and clinical evaluation of peri-implant sulcular fluid and gingival crevicular fluid.

PURPOSE: Peri-implant sulcular fluid (PISF) has a production mechanism similar to gingival crevicular fluid (GCF). However, limited research has been performed comparing their behavior in response to inflammation. Hence, the aim of the present study was to comparatively evaluate PISF and GCF volume with varying degrees of clinical inflammatory parameters. METHODS: Screening of patients was conducted. Based on the perimucosal inflammatory status, 39 loaded implant sites were selected from 24 patients, with equal numbers of sites in healthy, peri-implant mucositis, and peri-implantitis subgroups. GCF collection was done from age- and sex-matched dentate patients, selected with gingival inflammatory status corresponding to the implant sites. Assessment of the inflammatory status for dental/implant sites was performed using probing depth (PD), plaque index/modified plaque index (PI/mPI), gingival index/simplified gingival index (GI/sGI), and modified sulcular bleeding index (BI). Sample collection was done using standardized absorbent paper strips with volumetric evaluation performed via an electronic volume quantification device. RESULTS: Positive correlation of the PISF and GCF volume was seen with increasing PD and clinical inflammatory parameters. A higher correlation of GCF with PD (0.843) was found when compared to PISF (0.771). PISF expressed a higher covariation with increasing grades of sGI (0.885), BI (0.841), and mPI (0.734), while GCF established a moderately positive correlation with GI (0.694), BI (0.696), and PI (0.729). CONCLUSIONS: Within the limitations of this study, except for minor fluctuations, GCF and PISF volumes demonstrated a similar nature and volumetric pattern through increasing grades of inflammation, with PISF showing better correlation with the clinical parameters.