Evaluation of Glycosylated Hemoglobin Levels and Effect of Tobacco Smoking in Periodontally Diseased Non-Diabetic Patients.

Background and Objective: Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers. Methods: The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups. Results: The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant. Conclusion and Global Health Implications: This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.

Assessment of clinical efficacy of locally delivered 0.2% Thymoquinone gel in the treatment of periodontitis.

OBJECTIVES: To evaluate the potential benefits of local application of Thymoquinone gel as an adjunctive to scaling and root planing (SRP) in subjects with chronic periodontitis. MATERIAL AND METHODS: Twenty subjects with 40 test sites were selected according to inclusion and exclusion criteria. They were further divided into 2 groups. Group I comprised of study subjects (Thymoquinone in addition to SRP) and Group II comprised of control subjects (only SRP). Clinical parameters such as Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Relative Attachment Level (RAL), were monitored at baseline and 6 weeks post operatively. Alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF) were evaluated at baseline and 6 weeks post operatively using microcapillaries. In addition antimicrobial efficacy of Thymoquinone was evaluated against 3 bacteria using antimicrobial strains. RESULTS: Statistically highly significant reduction was observed in PI, GI and PPD, rise in RAL and GCF ALP level in both the groups at 6 weeks from baseline. On comparison between Group I and Group II, former demonstrated statistically significant reduction in PPD, GCF-ALP levels and rise in RAL but statistically no significant differences were observed in PI and GI at 6 weeks. On microbiological assessment of 0.2% Thymoquinone gel, it was observed to be sensitive against P. gingivalis, A. actinomycetemcomitans and P. intermedia. CONCLUSION: Significant changes in clinical and biochemical parameters were achieved in the current study. Hence, it is concluded that intracrevicular application of 0.2% Thymoquinone gel could be a beneficial adjunct to SRP in treating chronic periodontitis.

Trefoils: An unexplored natural protective shield of oral cavity.

The new mammalian growth factor peptide family consists of three peptides, TFF1, TFF2, and TFF3, which are secreted mainly from mucous epithelia with mucus gel. The predominant secretion of trefoil factor (TFF) occurs from gastric mucosal lining, small and large intestine, oral mucosal cells, and salivary glands. Research regarding trefoil factors is an immerging aspect in the dental field. The mucosal healing and restitution function describes about its novel role in case of chronic inflammatory conditions, but its expression from different tissue at different pathological condition shows its importance in immune response. At present, TFF expression has been detected from the severe periodontal diseased tissue samples. Future research from mild to moderate chronic periodontal diseased condition should be carried out to assess the protective response of TFF in gingival tissues. In future, assessment of TFF levels and its expression in oral mucosal tissues and oral secretions, such as saliva and gingival crevicular fluid, will provide a negative biomarker for chronic periodontal diseases and a novel therapeutic agent in oral mucosal healing.

Safety of lacosamide in children with refractory partial epilepsy.

OBJECTIVES: The study was carried out to investigate the safety of lacosamide on children with refractory partial epilepsy. MATERIALS & METHODS: The study was carried out at a tertiary care hospital after obtaining approval from the institutional ethics committee. Patients aged between 5 and 15 years taking oral lacosamide (LCM) tablets that were given orally as an adjunctive anti-epileptic drug were enrolled for assessing safety, tolerability and its effect on the behavioural life at every visit of titration, during the treatment period (3 months) and at 2 follow up visits that were done at monthly intervals. Adverse events reported by caregiver or by investigator were recorded. Patients/caregivers also completed a 25 items on Connor's behavioural rating clinical scale at every visit. RESULTS: Out of 531 screened patients, 79 patients with refractory partial epilepsy were enrolled after they fulfilled the inclusion and exclusion criteria. Mean age of the children was 8.84 ± 3.09 years (5-15 years), of which 53 were males and 26 females. The mean age at onset of seizures in males was 6.46 ± 3.57 and in females, 6.38 ± 3.39 years. Seventy-six children of 79, completed 3 months of treatment period showed significant (p < 0.001) decrease in the frequency of seizures, significant improvement in behaviour and showed good tolerability. Three (3.79%) patients dropped out of the study due to hyperactive behaviour, vomiting and lack of seizure control respectively. CONCLUSIONS: Lacosamide is a well-tolerated newer antiepileptic drug that is effective in refractory partial epilepsy paediatric patients and concurrently improved patient's behaviour.

Initial bone preparation followed by a 2-week delay before implant placement enhances the clinical and radiographic outcome: a randomized controlled trial.

Initial bone preparation followed by a 2-week delay before implant placement enhances the biological activity at the osteotomy site, which may improve the treatment outcome. The aim of this study was to compare the clinical and radiographic outcomes of initial bone preparation and a 2-week delay in implant placement with the conventional method. Subjects were outpatients selected from a department of periodontology and oral implantology. The implant sites were randomly allocated to a test group and a control group (n=7 each). Test sites were treated with initial bone preparation followed by implant placement after a 2-week delay; control sites were treated with the conventional protocol. All sites were assessed over 12 months for the keratinized mucosa index, probing depth, implant mobility, and radiographic peri-implant crestal bone levels. A total of 14 implants were placed in 12 subjects (five males and seven females, mean age 31.5 years, range 18-45 years). The results showed a statistically significant reduction in peri-implant probing depth and crestal bone levels in the test group (P<0.01). This randomized controlled trial demonstrated better clinical and radiographic outcomes for initial bone preparation followed by a 2-week delay in implant placement; this may be an alternative to the conventional protocol.

Clinical evaluation of GEM 21S(®) and a collagen membrane with a coronally advanced flap as a root coverage procedure in the treatment of gingival recession defects: A comparative study.

AIM: Clinical evaluation of efficacy of rhPDGF-BB plus beta tricalcium phosphate (GEM 21S(®)) along with a collagen membrane in root coverage using a coronally advanced flap. MATERIALS AND METHODS: This human case series evaluated the clinical outcome of rhPDGF-BB with beta-tricalcium phosphate (GEM 21S®) and a collagen membrane in the treatment of recession defects using a coronally advanced flap. Patients were followed postoperatively, and healing was evaluated at 1, 3, and 6 months, with recession depth as the primary outcome measure. RESULTS: This pioneer case series revealed a favorable tissue response to GEM 21S® and collagen membrane from both clinical and esthetic point of view in regenerative periodontal surgery.

Photodynamic therapy--a strategic review.

Mechanical removal of the biofilm and adjunctive use of antibacterial disinfectants or various antibiotics have been conventional methods of the periodontitis therapy. There has been an upsurge of bacterial strains becoming resistant due to the injudicious use of antibiotics, recently. As a result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. As the scientific community seeks alternatives to antibiotic treatment, periodontal researchers have found that photodynamic therapy (PDT) is advantageous to suppress anaerobic bacteria. Hence, PDT could be an alternative to conventional periodontal therapeutic methods. This review elucidates the evolution and use of photo dynamic therapy. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Even though PDT is still in the experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap operations may be reduced, patient comfort may increase and treatment time decrease. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

Success or failure of a dental implant: its relationship to bone density: a case report of a failed implant.

AIM: The purpose of this article is to illustrate the relationship of bone quality and the prognosis of dental implant. BACKGROUND: Reported success rates for dental implants are high. Thus, an implant-supported restoration offers a predictable treatment for tooth replacement. Nevertheless, failures that mandate immediate implant removal do occur. CASE DESCRIPTION: A case involving a 40-year-old male patient who had a missing mandibular left first molar is reported. A mucoperiosteal flap was made using interdental and crevicular incisions. The osteotomy was performed starting with the pilot drill, then the depth of the osteotomy was assessed using the shoulder depth gauge. The site was gradually enlarged using reamers with progressively increasing diameters. The implant (Bicon's Nano Tite™) was then placed. However, three months later at the second stage surgery, the implant was found to be clinically mobile. The surgical site selected in this case had fine trabeculated bone with thin cortical plates (D4 bone) that apparently contributed to the failure of dental implant. SUMMARY: Implant therapy has become common practice and will continue to increase in popularity. This also implies that dental professionals will have to learn more how to deal with implant failure and related complications. Why an implant does not integrate could have a multifactorial etiology. CLINICAL SIGNIFICANCE: The type and quality of bone available to support a dental implant are very important, so attention should be directed to all the factors responsible for the success or failure of a dental implant. In cases involving D4 bone, one must consider other treatment modalities for replacement of a missing tooth or use caution in the placement of the implants, especially in the high-load-bearing molar areas.

Intracrevicular application of 0.3% Flurbiprofen gel and 0.3% Triclosan gel as anti inflammatory agent. A comparative clinical study.

This study compared the anti-inflammatory efficacy of Triclosan and Flurbiprofen in a gel form on clinical parameters of moderate gingivitis cases. The study comprised of 100 sites from 16 volunteers and used split mouth technique. 0.3% Triclosan/0.3% Flurbiprofen gels applied intracrevicularly once daily for one week. Clinical parameters like Plaque index, Gingival index and Bleeding index scores were recorded at 0 day, 4th day and 8th day. The obtained results showed significant reductions in clinical parameters from baseline to 8th day. This indicates local delivery of 0.3% Triclosan/0.3% Flurbiprofen gel can be used as an anti-inflammatory agents either alone or as an adjunct to scaling in periodontal therapy.