Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review.

This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.

Variations of Serum CRP Levels in Periodontal Health and Diseases: A Clinico-Biochemical Study.

This study aimed to quantify serum C-reactive protein (CRP) values in periodontally healthy people and explore the relationship between serum CRP levels and chronic periodontitis, and the influence of scaling as well as root planing (SRP) on serum CRP levels. The study included 100 systemically healthy adults (n = 100; 50 males and 50 females) who were separated into two groups: Group A (control) n = 50; periodontally healthy subjects and Group B (test) n = 50; subjects with chronic periodontitis. The test group (group B) was further separated randomly into two groups: B1 (n = 25) and B2 (n = 25). The clinical parameters and serum CRP levels were measured only once in Group A and before SRP in Group B1 subjects. In Group B2 subjects the clinical parameters and serum CRP levels were measured only after two months following SRP. For group A, B1, and B2 (the readings recorded after SRP) the mean gingival index scores were 0.146, 2.437, and 1.052, respectively, while the plaque index was 0.414, 2.499, and 0.954, respectively. Probing pocket depth (PPD) and clinical attachment loss (CAL) showed statistically significant differences between three groups, with higher values in patients with periodontitis before intervention (2.196 ± 0.49; 1.490 ± 0.23), respectively. Healthy controls (Group A) had a C-reactive protein level of 0.04820 mg/dL, while group B1 (test) had 1.678 mg/dL and 0.8892 mg/dL (group B2). C-reactive protein levels were observed to be greater in the test group (groups B1 and B2), and these differences were statistically significant (p < 0.001). Chronic periodontitis enhances blood levels of systemic inflammatory markers like CRP, which has been reduced by periodontal treatment with SRP.

Oral health knowledge, attitude, and practice of pregnant women in Deccan, South India: a cross-sectional prenatal survey.

Pregnancy is a unique condition for women, associated with physiological and emotional changes in the body. Various research showed an association between periodontal disease and adverse pregnancy outcomes. Importance to hygiene maintenance should be given during pregnancy and improve the wellbeing of the mother and child. This study assessed oral health knowledge, attitude, and practices among pregnant women in Hyderabad. The study design was cross-sectional and included 445 women who responded and completed the survey. Subjects were selected using a random sampling technique in gynecology clinics. The questionnaire form consisted of four sections: demographic data, knowledge, attitude, and oral hygiene practice. Out of the 482 pregnant females invited to participate in the study, 445 women completed the survey, giving a response rate of 92%. The majority of women showed good knowledge and attitude regarding oral hygiene and its relation to pregnancy. However, the participants showed poor compliance with the recommended protocol. There are certain myths and barriers to dental treatment that need to be considered in the prenatal education of women. If explained by the gynecologist, the importance of oral health and its correlation with systemic health will play a crucial role in improving oral hygiene practice and regular dental visits.

Inhibitory Effect of Nepeta deflersiana on Climax Bacterial Community Isolated from the Oral Plaque of Patients with Periodontal Disease.

BACKGROUND: The red-complex bacteria are one of the most significant complexes found simultaneously in subgingival plaque next to the periodontal pocket. The current antibacterial treatment is not adequate, and multidrug resistance to it is developing. Henceforth, the antibacterial effect of the ethanolic extract of Nepeta deflersiana was put to test against red-complex bacteria in patients with chronic periodontitis. METHODS: Well diffusion and micro broth dilution procedure by Alamar blue were applied to assess the zone of inhibition (ZOI), the minimum inhibitory concentration (MIC), and the minimum bactericidal concentration (MBC). Anti-virulence efficacies of the plant extract that comprise of adherence and formation of biofilms were examined by the process of adherence and biofilm production assay. RESULTS: The crude extract of Nepeta deflersiana exhibited significant inhibitory outcome against periodontopathic bacteria with noteworthy MIC (0.78-3.12 mg/mL), inhibitory zone (12-20 mm), as well as MBC (3.12-12.50 mg/mL). The N. deflersiana extract inhibited bacterial adhesion ranging from 41% to 52%, 53% to 66%, and 60% to 79% at the given MIC × 0.5, MIC × 1, and MIC × 2 in succession. Substantial suppression was also developed in the biofilm production of the investigated periodontopathic strains following exposure to numerous concentrations of N. deflersianan extract for a period of 24 and 48 h. CONCLUSION: These outcomes divulge a new concept that N. deflersiana extract can be utilized to manufacture valuable antibacterial compounds to treat chronic and acute periodontitis. This identifies N. deflersiana as an essential natural source for future drug development.

Relationship between Malocclusion and Periodontal Disease in Patients Seeking Orthodontic Treatment in Southwestern Saudi Arabia.

BACKGROUND: Malocclusion is known to cause plaque accumulation and periodontal breakdown. However, no previous study from Saudi Arabia has assessed this relationship in patients seeking orthodontic treatment for esthetics. OBJECTIVE: The objective of this study was to investigate the relationship between malocclusion and periodontal disease in terms of gingival inflammation, probing pocket depth (PPD) and recession in patients seeking orthodontic treatment for esthetic improvement. MATERIALS AND METHODS: This prospective cross-sectional study was conducted at the Outpatient Division of Periodontics, College of Dentistry, King Khalid University, Saudi Arabia, among consecutive new patients seeking orthodontic treatment for esthetic improvement between June and August 2018. Angle's class of malocclusion, various malalignments, plaque index (PI), gingival index (GI), adequacy of width of attached gingiva (WAG), response to fremitus test, PPD and gingival recession (GR) were recorded. P < 0.05 was considered statistically significant. RESULTS: A total of 410 consecutive patients were included. Of these, 314 patients had Class I, 57 had Class II (division I), 25 had Class II (division II) and 14 had Class III malocclusions. In patients with all types of malocclusion, the majority had a PI and GI of score 2 (74.1% and 83.7%, respectively). Most of the patients (85.9%) had adequate WAG; similarly, 94.9% had a negative fremitus test, which shows the absence of trauma from occlusion. Mean PPD and GR in the maxillary and mandibular arches showed varying results. CONCLUSION: This study demonstrates a relationship between malocclusion and presence of periodontal disease in patients seeking orthodontic treatment for esthetic improvement in the southwestern region of Saudi Arabia. Therefore, in patients seeking orthodontic treatment, careful evaluation of gingival and oral hygiene along with adequacy of attached gingiva should be considered.

Spectrophotometric Analysis of Dental Enamel Staining to Antiseptic and Dietary Agents: In Vitro Study.

RESULTS: The mouthwash containing titanium dioxide (TiO2) nanoparticles produced the greater enamel discoloration compared to that of chlorhexidine. Brushing had little effect on removal of stains induced by all mouthwashes except for dietary solutions (lemon with sodium bicarbonate and olive with laurel) and distilled water (control). CONCLUSION: The results from this study show that mouthwashes containing TiO2 nanoparticles and other antiseptic mouthwashes cause change in color of the teeth and lead to poor esthetic appearance when compared to dietary and control solutions. Thus, future in vivo studies have to be conducted to confirm these findings as in vitro studies may not provide a reliable simulation of the clinical situations.

Salivary Osteocalcin as Potential Diagnostic Marker of Periodontal Bone Destruction among Smokers.

: The objective of the study was to assess the levels and diagnostic accuracy of salivary osteocalcin (OC), osteonectin (ON), and deoxypyridinoline-containing degradation fragment of the C-terminal telopeptide region of type I collagen (CTX) in adult smokers with periodontal bone destruction. Towards this, ninety systemically healthy patients (groups I: healthy, II: periodontitis with non-smokers, and III: periodontitis with current smokers) were included in the study. The results showed a positive correlation (weak to moderate) was observed for OC, ON, and CTX with probing pocket depth (PPD; r = 0.40, 0.32, and 0.36) and alveolar bone loss (BL; r = 0.58, 0.38, and 0.51) (p < 0.01). Smoker periodontitis was best discriminated from healthy controls using 15.25 ng/mL of OC (AUC: 0.870; 95% CI: 0.757-0.943; YI (Youden Index): 0.693; p < 0.0001). However, with a cut-off of BL at 33.33%, 19.24 ng/mL of salivary OC gave the best discrimination (AUC: 0.809; 95% CI: 0.686-0.900; Se: 80.0%; Sp: 73.47%, and YI: 0.534). A 16.45 ng/mL amount of OC gave excellent discrimination (AUC: 0.811; 95% CI: 0.688-0.901; Se: 92.31%; Sp: 65.22%, and YI: 0.575) among healthy and smoker periodontitis when PD at 6mm was considered as cut-off. Conclusion: The best discrimination between healthy controls and smoker periodontitis was obtained at 15.25 ng/mL of salivary OC.

Pemphigus vulgaris presenting as gingival involvement.

Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the mucous membrane and skin. Typically, oral lesions appear before skin lesions, and in a majority of the cases only oral lesions are present. The dentist may then be the first to recognize and diagnose this disease. It is unusual for PV to present over the gingiva as a primary site of involvement. Diagnosis is based on clinical presentation and confirmed by histopathological study. Early diagnosis and management can prevent the uneven life- threatening effects of this potentially chronic mucocutaneous disorder. The case serves to enhance our awareness of the gingiva as a site at which systemic disease can manifest itself.

A comparative evaluation of atrigel delivery system (10% doxycycline hyclate) Atridox with scaling and root planing and combination therapy in treatment of periodontitis: A clinical study.

BACKGROUND: Local delivery of antimicrobial has resulted in good clinical outcome along with scaling and root planing. The present study is carried out to evaluate and compare the efficacy of local delivery of 10% doxycycline hyclate in adjunct to scaling and root planing in the treatment of periodontitis. MATERIALS AND METHODS: A randomized crossover split mouth design was performed, a total number of 130 sites from 4 patients, 63 sites from patients with aggressive periodontitis and 67 sites from chronic periodontitis patients were selected and divided into scaling and root planing (SRP) group, SRP and doxycycline group and doxycycline alone group. Clinical parameters viz. plaque index, modified gingival index, bleeding index, clinical attachment level (CAL), and sub gingival temperature were evaluated on day 0, 15(th), 45(th), and 90(th) day. CAL recording was performed only on day 0 and 90(th) day. RESULTS: In 90 days study, all the three groups showed significant reduction in clinical parameters. But on comparison, SRP and doxycycline group showed better results than doxycycline alone group and SRP alone group. CONCLUSION: The results of this study demonstrated that doxycycline hyclate 10% gel (Atridox) is as effective as SRP in reducing the clinical signs of periodontitis.

Periodontal disease as the initial oral manifestation of abdominal tuberculosis.

Tuberculosis is a chronic, specific granulomatous disease and a major cause of death in developing countries. We report a case of tuberculosis presenting first as periodontal loss of tooth support leading to loose teeth and gingival enlargement affecting a 17-year-old female patient without any pulmonary lesion. Diagnosis was based on histopathological examination and positive adenosine deaminase activity Mycobacterium tuberculosis test. The clinical presentation of tuberculosis may take many forms. However, with the decline in numbers, tuberculosis lesions of the oral cavity have become so rare that they are frequently overlooked in the differential diagnosis of oral lesions. Also, this case report emphasizes the need for dental clinicians to be aware of the possibility of tuberculosis presenting first in the oral cavity, and contribute in control of tuberculosis through early detection and referring the patients to physicians for proper treatment.