Comparative Study of Azithromycin Versus Doxycycline Effect on the Resistin Level in Periodontitis Patients With Type 2 Diabetes: A Randomized Controlled Clinical Trial.

AIM: The present study aimed to determine if azithromycin (AZM) and doxycycline therapy, as an adjunct to scaling and root planning (SRP), modulate host response and improve clinical outcomes in periodontitis patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: Forty-five periodontal sites in 15 periodontitis patients with T2DM received nonsurgical periodontal therapy (NSPT). In Group I, patients were placebo (not receiving any medication), Group II patients received systemic AZM therapy (AZM 250 mg/day for five days), and Group III patients received doxycycline (20 mg twice per day for three months. The resistin level was collected and measured by enzyme-linked immunosorbent assay (ELISA). Gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were recorded at baseline, one-month, and three-month intervals. RESULTS: All groups showed improvement in clinical parameters and resistin levels throughout the study. The mean resistin level at three months was the highest in Group I and the lowest in Group III. Patients in Group II showed a larger decrease in mean PD than those in Group I and III. Group III had the highest gain in mean CAL, with an increase of 1.78 mm in attachment. CONCLUSION: Resistin might be a useful indicator of current disease status. In addition, benefits from adjunctive systemic use of AZM and doxycycline have been administered with non-surgical periodontal therapy.

Perception of tobacco hazards on general and periodontal health and tobacco cessation counseling among dental students.

INTRODUCTION: Tobacco use is one of the leading worldwide health risk factors and a primary cause of premature death and disability. Tobacco cessation programs might work well if provided by all healthcare providers. This study aimed to evaluate dental students' knowledge, attitudes, beliefs, and practices towards tobacco hazards on general and periodontal health and tobacco cessation councling. METHODS: A descriptive cross-sectional study was conducted among dental students who were in their clinical years (the fourth, fifth and sixth year of study), in Saudia Arabia in 2022. A self-administered questionnaire derived from the TCC questionnaire survey was carried out among 315 dental students. Knowledge was considered poor if correct answers were below the median value. Attitude was on a five-point Likert scale. Adjusted logistic regression analyses were performed. RESULTS: The study revealed that about 52% have poor knowledge, 64% have negative attitudes, 69% have negative beliefs, and 44% poor practice. All these ratings were below median values. It also showed that younger dental students were 2 times more likely to have poor knowledge (AOR=1.97; 95% CI: 1.1-3.53) and smokers were less likely to have poor knowledge (AOR=0.34; 95% CI: 0.12-0.95). One third of students perceived patient resistance as a barrier to TCC while 50% reported lack of knowledge, 32% lack of time, and 24% lack of materials. CONCLUSIONS: The study findings urge the inclusion of programs to encourage dental students to help patients quit tobacco use and to make educational material available to them.

Development and Optimization of a Novel Lozenge Containing a Metronidazole-Peppermint Oil-Tranexamic Acid Self-Nanoemulsified Delivery System to Be Used after Dental Extraction: In Vitro Evaluation and In Vivo Appraisal.

In-depth studies on essential oil-based nanoemulsions (NEs) have centered on a variety of oral health issues. NEs improve the delivery of nonpolar active agents to sites and thereby boost the dissolution and distribution of the agents. Metronidazole-peppermint oil-tranexamic acid self-nanoemulsifying drug delivery systems (MZ-PO-TX-SNEDDS) were created and loaded into novel lozenges to act as antifungal, hemostatic, antimicrobial, and analgesic dosage forms after dental extractions. The design-of-experiments approach was used in creating them. To generate the NEs, different concentrations of MZ-PO (240, 180, and 120 mg), 2% TX (600, 450, and 300 mg), and Smix1:1 (600, 400, and 200 mg) were used. The ideal formulation had serum levels of 1530 U/mL of interleukin-6, a minimal inhibitory concentration against bacteria of 1.5 µg/mL, a droplet size of 96 nm, and a blood coagulation time of 16.5 min. Moreover, the produced NE offered better MZ release. The adopted design was used to produce the ideal formulation; it contained 240 mg of MZ-PO, 600 mg of 2% TX, and 600 mg of Smix1:1. It was incorporated into lozenges with acceptable characteristics and an improved capability for drug release. These lozenges had reasonable coagulation times, IL-6 serum levels, and MIC values. All of these characteristics are desirable for managing symptoms following tooth extractions. Therefore, these lozenges loaded with MZ-PO-TX-SNEDDs might be considered a beneficial paradigm for relieving complications encountered after tooth extractions.

Utilization of a nanostructured lipid carrier encapsulating pitavastatin-Pinus densiflora oil for enhancing cytotoxicity against the gingival carcinoma HGF-1 cell line.

Oral squamous cell carcinoma (OSCC) is the most common epithelial tumor of the oral cavity. Gingival tumors, a unique type of OSCC, account for 10% of these malignant tumors. The antineoplastic properties of statins, including pitavastatin (PV), and the essential oil of the Pinus densiflora leaf (Pd oil) have been adequately reported. The goal of this investigation was to develop nanostructured lipid carriers (NLCs) containing PV combined with Pd oil and to determine their cytotoxicity against the cell line of human gingival fibroblasts (HGF-1). A central composite quadratic design was adopted to optimize the nanocarriers. The particle size and stability index of the nano-formulations were measured to evaluate various characteristics. TEM analysis, the entrapment efficiency, dissolution efficiency, and the cytotoxic efficiency of the optimized PV-loaded nanostructured lipid carrier drug delivery system (PV-Pd-NLCs) were evaluated. Then, the optimal PV-Pd-NLCs was incorporated into a Carbopol 940® gel base and tested for its rheological features and its properties of release and cell viability. The optimized NLCs had a particle size of 98 nm and a stability index of 89%. The gel containing optimum PV-Pd-NLCs had reasonable dissolution efficiency and acceptable rheological behavior and acquired the best cytotoxic activity against HGF-1 cell line among all the formulations developed for the study. The in vitro cell viability studies revealed a synergistic effect between PV and Pd oil in the treatment of gingival cancer. These findings illustrated that the gel containing PV-Pd-NLCs could be beneficial in the local treatment of gingival cancer.

Perception of Tobacco Counseling and Cessation among Dental Practitioners.

OBJECTIVE: To investigate the knowledge and practice of tobacco cessation and counseling (TCC) among dental practitioners and their attitude and perceived barriers. METHODS: A cross-sectional study targeted licensed dental practitioners in Jeddah, Saudi Arabia. Participants answered a pretested and validated self-administered questionnaire consisted of demographic data; smoking status; knowledge of tobacco hazards, attitude, and practice; and perceived barriers of tobacco cessation counseling. RESULT: Among the total sample of 529, response rate was 72.2% (mean age (34.20 ± 9.38 years), males (42.4%), and current smokers (23.8%)). Only 13.2% received formal training on TCC. Around (57.1%) reported smoking of dental team as an obstacle for TCC. Half of the participants (49.9%) reported patient's resistance as barrier to TCC. Others (45%-48%) reported insufficient time, knowledge, or training for TCC. Professional responsibility and willingness to provide cessation services constituted the highest median. CONCLUSION: The majority showed willingness to participate in TCC. Lack of training, smoking status of providers, females, inadequate materials, and patients' resistance were the most common barriers. Education and training on TCC are recommended and should be allowed as a routine practice in dentistry.

Effect of Subantimicrobial Dose Doxycycline Treatment on Gingival Crevicular Fluid Levels of MMP-9 and MMP-13 in Periodontitis Stage 2, Grade B in Subjects with Type 2 Diabetes Mellitus.

The aim of this study was to investigate the effect of using subantimicrobial dose doxycycline as an adjunct in periodontitis stage 2, grade B in subjects with type 2 diabetes mellitus. A total of thirty patients were divided into the following two groups with reference to periodontitis, type 2 diabetes mellitus, and administration of the doxycycline drug: Group I: patients with periodontitis stage 2, grade B and type 2 diabetes mellitus who received SRP only. Group II: patients with periodontitis stage 2, grade B and type 2 diabetes mellitus who received SRP and doxycycline 20 mg. The following clinical measurements were recorded at baseline (prior to scaling and root planning) and after one and three months postoperatively: GI, PI, and PD with a periodontal calibrated probe. The levels of both MMP-9 and MMP-13, from 60 GCF samples, were analyzed by ELISA. Patients treated with SRP and doxycycline 20 mg showed a significant reduction of PD, PI, GI, MMP-9, and MMP-13 than patients who received SRP only. Improvements in parameters clinically and biochemically were observed following the adjunctive use of doxycycline subantimicrobial dose therapy for the management of stage 2, grade B periodontitis patients with type 2 diabetes mellitus.

Prevalence and policy of occupational violence against oral healthcare workers: systematic review and meta-analysis.

BACKGROUND: Occupational violence is considered unlawful in professional environments worldwide. In the healthcare industry, including dentistry, the safety of workers is essential, and it is of the utmost importance to ensure patient and employee safety and provide quality care. This study aimed to evaluate the prevalence of violence and associated workplace policies among oral healthcare professionals. Additionally, it aimed to identify the factors associated with violence and their impact on oral healthcare workers. METHODS: A systematic review and analysis of the literature was conducted using PubMed, ScienceDirect, Scopus, Web of Science, Cochrane Library and ProQuest. Original articles written in English and published between January 1992 and August 2019 were included in the analysis. RESULTS: A total of 980 articles were found, and eight were selected for analysis. The violence experienced by healthcare workers included both physical and non-physical forms, such as shouting, bullying, and threatening; it also included sexual harassment. The impact of violence on workers manifested as impaired quality of work, psychological problems, and, although rare, quitting the job. With regard to dental healthcare, awareness of occupational violence policies among dental professionals has not been previously reported in the literature. CONCLUSIONS: The increasing incidence of occupational violence against oral healthcare workers indicates the need for the implementation of better protective measures to create a safe working environment for dental professionals. There is a current need for increasing awareness of workplace violence policies and for the detection and reporting of aggression and violence at dental facilities.

Periodontal services rendered by general dental practitioners in Saudi Arabia.

PURPOSE: The study aimed to determine the types of periodontal services rendered by general dental practitioners (GDPs) in Saudi Arabia. SUBJECTS AND METHODS: A cross-sectional survey was performed on a convenience sample of 340 licensed GDPs practicing within Saudi Arabia. GDPs were asked several questions regarding the types of periodontal services offered, the level of training and education received in periodontics and the periodontal referral processes. RESULTS: Two hundred and ninety GDPs responded to the survey. The most commonly rendered periodontal services by the GDPs were oral hygiene instructions (84.1%; 244/290), mouthwash prescribing (82.7%; 240/290) and scaling and root planing (72.4%; 210/290). Only 21% (59/282) of the GDPs surveyed reported providing periodontal surgical services. The most frequently rendered surgical procedures included gingivectomy, functional crown lengthening and single posterior implant. Also, 76% (220/290) of the GDPs had no continuing education (CE) credit relating to periodontics. The level of training received in the dental school seemed to be an important factor that influenced a GDP's decision to provide periodontal services. Also, 64% (184/286) of the GDPs were not routinely performing periodontal screening exams. The most common reason for not referring patients to a periodontist was practice setting's policy. CONCLUSION: Periodontal services commonly rendered by the GDPs of this survey were mostly nonsurgical in nature. The results indicate a need for formal advanced training in periodontics. GDPs should be encouraged to take periodontic CE courses.

Histopathologic analysis of gingival lesions: A 20-year retrospective study at one academic dental center.

BACKGROUND: The gingiva is part of the periodontium supporting structures surrounding the teeth and commonly involved in gingival and periodontal conditions. Assessing the distribution of gingival lesions is important for evaluating the prevalence of periodontal disease in the population to optimize the oral health care services. The purpose of this study is to report the frequency and distribution of gingival lesions biopsied from 1996-2016. MATERIAL AND METHODS: This cross-sectional retrospective study retrieved data from all gingival lesions biopsied from 1996-2016 and sent to the King Abdulaziz University Dental Hospital oral pathology laboratory. Histologic sections were reviewed in a blinded manner by a certified oral pathologist to confirm the initial histologic diagnosis. RESULTS: Of the 1,248 oral-maxillofacial lesions, 119 (9.5%) gingival lesions were diagnosed. The mean age was 41.58 years. Gingival lesions were more prevalent in female patients than male patients (53.8%). The most common diagnoses were reactive lesions (41.2%). Pyogenic granuloma was the predominant lesion in the category (n=26, 21.8%), and followed by inflammatory conditions (24.4%), benign neoplasm (9.2%), malignant neoplasm (7.6%), epithelial lesions (7.6%), miscellaneous (5%), and immune-mediated diseases (5%). Squamous cell carcinoma was the only malignant neoplasm reported (7.6%; mean age, 57.44 years) and more common in male than female patients (2:1). Most biopsies were sent from oral and maxillofacial surgeons (55.6%) followed by general dentists (22.2%) and periodontists (12.8%). CONCLUSIONS: Pyogenic granuloma was the most common gingival lesion. Squamous cell carcinoma was the only malignant lesion in which histologic examination was the definitive diagnostic measure. This study provides information about the frequencies and distributions of gingival lesions over 20 years. Key words:Gingival biopsies, retrospective, reactive lesions, oral pathology.