ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

Influence of Smoking on Gingival Crevicular Fluid Interleukin 1ß and Interleukin-8 in Patients with Severe Chronic Periodontitis among a Rural Population in India.

BACKGROUND AND OBJECTIVE: Smoking is widely prevalent among rural Indian populations. Smoking is considered a significant risk factor for periodontal diseases. The aim of the present study was to evaluate the influence of smoking on the inflammatory cytokines interleukin (IL) IL-1ß and IL-8 in gingival crevicular fluid (GCF) and compare these between smokers and nonsmokers with periodontitis in diseased and healthy sites. MATERIALS AND METHODS: A total of thirty patients with severe chronic periodontitis (15 smokers and 15 nonsmokers) participated in this study. Clinical parameters assessed were gingival index, bleeding on probing, probing depth (PD), and clinical attachment level. One diseased and one healthy site from each of the periodontitis patients were selected for GCF collection and assigned to the following four groups: healthy sites in smoker (SH), diseased sites in smoker (SD), healthy sites in nonsmoker (NH), and diseased sites in nonsmoker (ND) and were analyzed by enzyme-linked immunosorbent assay test (Quantikine®). RESULTS: Intragroup comparisons revealed statistically significant levels of IL-1ß in ND sites compared to NH sites (P < 0.005) and SD sites showed statistically significantly higher levels of IL-1ß compared to SH sites (P < 0.0001). However, there was no significant difference in IL-8 levels between NH and ND sites as well as between SH and SD sites. Intergroup comparisons revealed that SH sites exhibited significantly lower amounts of IL-8 (P < 0.01) compared to NH sites and SD sites showed significantly lower levels of IL-8 compared to ND sites (P < 0.001). However, the comparison of NH and SH sites as well as ND and SD sites showed no significant difference in the levels of IL-1ß. CONCLUSIONS: Cytokine levels were significantly elevated in periodontitis patients. Smokers exhibited a decrease in IL-8 and increase in IL-1ß levels. Hence, this reflects the influence of smoking on immunosuppression and its role in the pathogenesis of periodontal disease.

Treatment Emergent Agranulocytosis with Skin and Gingival Lesions in a Chronic Lymphocytic Leukemia Patient: A Case Report.

Chronic Lymphocytic Leukaemia (CLL) is a monoclonal lymphoid malignancy characterized by progressive accumulation of small, mature but functionally incompetent neoplastic lymphocytes in the peripheral blood, bone marrow and lymphoid organs. Patients present a variable course and may not require early intervention unlike other malignancies. Patients with rapidly deteriorating blood counts, and organomegaly need treatment. Alkylating agent live Bendamustine combined with Rituximab, anti-CD 20 monoclonal antibody have shown promising results in such patients. Anaemia, neutropenia and thrombocytopenia have been reported as treatment emergent events with this combination therapy. Neutrophils are the major innate defense and their depletion can result in a wide range of opportunistic infections. This case report discusess the oral and dermal lesions which emerged with the Rituximab and Bendamustine combination therapy in a patient with CLL and their management.

Interleukin 1ß (+3954, -511 and -31) polymorphism in chronic periodontitis patients from North India.

OBJECTIVE: Several studies have implicated the role of interleukin-1 in various chronic diseases including periodontitis. The present study was carried out with an aim to evaluate the role of interleukin 1ß polymorphisms, namely +3954C/T, -511C/T and -31T/C, in the development of chronic periodontitis. MATERIALS AND METHODS: Twenty-nine chronic periodontitis patients and 31 healthy controls of North Indian origin from Chhattisgarh were recruited for the study. The genotypes for the three variants were determined using the PCR-RFLP technique and the strength of association between genotypes and periodontitis was determined by odds ratio with 95% confidence interval (CI) and chi-square analysis. RESULTS: Analysis for the +3954 allelic and genotypic frequencies of the polymorphism revealed a significant difference in the CT genotype between periodontitits patients and controls (p = 0.03). A significant difference was also observed in the allelic frequencies between the two groups (p = 0.02). For the -511 site, TT genotype revealed a significant association with the disease (p = 0.01). A significant association was also found following the co-dominant model (p = 0.007). However, the -31 polymorphism revealed no significant difference between patients and controls. CONCLUSIONS: In conclusion, the present study suggests a strong association of the TT genotype of -511 and CT genotype of +3954 variant of interleukin 1ß with chronic periodontitis. However, the -31 variant did not show a significant association with the disease.

Effect of simulated microwave disinfection on the mechanical properties of three different types of denture base resins.

STATEMENT OF PROBLEM: Disinfection of prostheses with chemical solutions has deleterious effects on dentures. The appropriate power setting of microwave for disinfection, without affecting denture base properties, is a controversy. PURPOSE: To evaluate and compare the effect of simulated microwave disinfection at a recommended power setting on the mechanical properties of three denture base heat polymerized acrylic resins. MATERIAL AND METHODS: Ninety rectangular specimens of each acrylic resin of 65mm × 10mm × 3 mm dimensions were divided into three groups. Group A (Trevalon), Group B (Trevalon- HI), Group C (Ivocap). In each group, thirty specimens were divided into three subgroups with ten specimens in each and they were submitted to MicroVickers hardness, flexural strength, and impact strength tests. In each subgroup, five specimens were tested before the simulated microwave disinfection and they served as the control group. The remaining five were tested after simulated microwave disinfection and they were considered as the experimental group. Simulated microwave disinfection was done in a domestic microwave oven at 650 W for 5 minutes. RESULTS: The data were analyzed using One-way ANOVA and t-test. The mechanical properties of the three denture base resins were not altered after simulated microwave disinfection, as compared to those of the controls. CONCLUSION: Microwave irradiation at 650 W for 5 min did not affect the mechanical properties of the three denture base resins. Domestic microwave oven, at the prescribed setting, can be used as an alternative method of disinfection for complete dentures without affecting their properties.