Periodontitis increases the risk of gastrointestinal dysfunction: an update on the plausible pathogenic molecular mechanisms.

Periodontitis is an immuno-inflammatory disease of the soft tissues surrounding the teeth. Periodontitis is linked to many communicable and non-communicable diseases such as diabetes, cardiovascular disease, rheumatoid arthritis, and cancers. The oral-systemic link between periodontal disease and systemic diseases is attributed to the spread of inflammation, microbial products and microbes to distant organ systems. Oral bacteria reach the gut via swallowed saliva, whereby they induce gut dysbiosis and gastrointestinal dysfunctions. Some periodontal pathogens like Porphyromonas. gingivalis, Klebsiella, Helicobacter. Pylori, Streptococcus, Veillonella, Parvimonas micra, Fusobacterium nucleatum, Peptostreptococcus, Haemophilus, Aggregatibacter actinomycetomcommitans and Streptococcus mutans can withstand the unfavorable acidic, survive in the gut and result in gut dysbiosis. Gut dysbiosis increases gut inflammation, and induce dysplastic changes that lead to gut dysfunction. Various studies have linked oral bacteria, and oral-gut axis to various GIT disorders like inflammatory bowel disease, liver diseases, hepatocellular and pancreatic ductal carcinoma, ulcerative colitis, and Crohn's disease. Although the correlation between periodontitis and GIT disorders is well established, the intricate molecular mechanisms by which oral microflora induce these changes have not been discussed extensively. This review comprehensively discusses the intricate and unique molecular and immunological mechanisms by which periodontal pathogens can induce gut dysbiosis and dysfunction.

"United Pedicle Flap" for management of multiple gingival recessions.

Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.

Ascorbic acid: new role of an age-old micronutrient in the management of periodontal disease in older adults.

To review the new role of an age-old micronutrient - ascorbic acid - in the management of periodontal disease. Articles pertaining to the topic were searched in PubMed and other search engines from year 1974 to April 2014 with the following key words: "ascorbic acid," "ascorbate," "vitamin C," "periodontal disease," "gingivitis," "periodontitis," "anti-oxidants" and "elderly." Balanced nutrition is an essential factor in the elderly. Modification of nutritional requirement is important to overcome the effect of an unbalanced diet in older individuals as a result of several external and internal host-associated factors. Micronutrient requirements as aging advances could change, and require due attention. Ascorbic acid and its relationship with periodontal disease are very well known. However, recent changes in the concept of understanding the pathogenicity has led to a new path of therapeutic intervention with ascorbic acid in many chronic diseases. Oxidative stress with its associated burden might alter the disease process. In the era of "periodontal medicine," the impact of remote tissue changes on systemic disease has to be taken into serious consideration. Deficiency of nutritional impact on the host, with micronutrient vitamin C detailed in this review with sources, absorption, interaction and its relationship with systemic disease, and thereby the impact on periodontal disease. Ascorbic acid plays an important role in the aging process, and in the maintenance of periodontal health in the elderly.