Unraveling the cognitive implications among individuals with co-occurring chronic periodontitis and type 2 diabetes mellitus: a cross-sectional study.

OBJECTIVES: Chronic periodontitis and type 2 diabetes mellitus (T2DM) are associated with cognitive decline when examined individually. To gain deeper insight into the combined effects of these conditions on cognitive decline, the present study aimed to examine the cognitive status of individuals with co-occurring T2DM and chronic periodontitis. METHODS: We recruited 220 participants categorized into four groups: Group I, healthy subjects; Group II, individuals with chronic periodontitis; Group III, individuals with T2DM; and Group IV, individuals with both T2DM and chronic periodontitis. Medical histories were recorded for all participants, followed by periodontal examination and evaluation of cognitive status using the Montreal Cognitive Assessment (MoCA) scale. Finger dexterity was assessed using the nine-hole peg test. RESULTS: A statistically significant increase in the proportion of mild cognitive impairment (MCI) was observed between groups I and IV (p<0.001). Logistic regression analysis revealed that, among the parameters assessed in this study, the adjusted odds ratio (OR) was significant for age, finger dexterity scores, and co-occurrence of T2DM and periodontitis. CONCLUSIONS: The findings of this study suggest that the co-occurrence of chronic periodontitis and T2DM can have a detrimental effect on the cognitive abilities of an individual. Subsequent research should include longitudinal monitoring of the cognitive status in patients with concurrent conditions during treatment to gain deeper prognostic insights into the relationship between these co-occurring conditions and cognitive decline.

Effect of a Submucosal Injection of Platelet-Rich Plasma on the Rate of Orthodontic Tooth Movement - A Split-Mouth, Single-Blind Randomized Controlled Trial.

Objective: To investigate the effect of submucosal injection of platelet-rich plasma (PRP) on the rate of mini-implant-supported retraction, using a split-mouth randomized clinical design. Materials and Methods: Twenty subjects of either gender between 16 and 25 years of age with bimaxillary dentoalveolar protrusion and crowding of <4 mm scheduled to undergo fixed mechanotherapy with the extraction of 1st premolars; were recruited for the study. Those with a periodontally compromised dentition, blood dyscrasias, smoking/alcoholism, or with a history of fixed orthodontic treatment were not considered. The intervention side received a submucosal injection of autologous PRP which was prepared using 10 ml of the patient's blood. The rate of extraction space closure on both sides was recorded and compared monthly for 3 months using a digital caliper. Results: Mean overall retraction was faster on the intervention side as compared to the control side by 1.5 times and was statistically significant with a P value of 0.001. There was no influence of gender on the rate of retraction. There was no reported swelling or discomfort associated with the PRP injection. Conclusions: Submucosal injection of PRP significantly accelerates orthodontic tooth movement and can therefore be used as an effective, safe, and minimally invasive method to expedite orthodontic treatment.

Comparison of antiplaque and anti-gingivitis effects of aloe vera mouthwash with chlorhexidine in fixed orthodontic patients-A randomized controlled trial.

BACKGROUND: In daily dental practice, plaque-induced gingivitis is one of the most common periodontal diseases that is frequently encountered. Accumulation of microbial biofilms on surfaces of teeth and poor or inadequate oral hygiene is the chief predisposing factor for this condition. In such a state, antimicrobial mouthwash as an adjunct to mechanical plaque control helps in maintaining good oral hygiene. Among the many conditions, fixed orthodontic treatment is one of the conditions where plaque control becomes challenging to the patient as well as the dentist. In such a situation, antimicrobial mouthwash as an adjunct to mechanical plaque control is highly recommended. Dentistry has recently evidenced a shift of approach for treating many inflammatory oral diseases by using herbal treatment modalities. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research recently. The present study aimed to evaluate efficacy of aloe vera mouth rinse on the dental plaque and gingivitis in patients who were undergoing fixed orthodontic treatment in comparison with 0.2% chlorhexidine mouthwash. MATERIAL AND METHOD: This randomized controlled trial was conducted on 30 subjects with fixed orthodontic treatment. The subjects were grouped in the test group (15 subjects with 10 ml aloe vera mouthwash (99.6% [w/v])) and the control group (15 subjects with 0.2% 10 ml chlorhexidine mouthwash). Plaque index, gingival index and bleeding on probing were recorded for each participant at baseline, 21 days from baseline and 35 days from baseline. The findings were then statistically analysed using student paired and unpaired t-test. RESULTS: Gingival index showed a statistically significant difference from baseline to 21 days and 35 days visit in both the groups. Plaque index and bleeding on probing were statistically significant among both groups when compared baseline to 21 days and 35 days visit, but the difference was not significant between visit 2 and visit 3. CONCLUSIONS: Although chlorhexidine is still the gold standard mouthwash, aloe vera exhibits promising results in reducing plaque and gingivitis scores, without any reported adverse effects. Larger multi-centric trials are needed to prove its effectiveness on dental plaque-induced gingivitis.

Evaluation of Risk Factors of Peri-Implant Disease Using a New Manual Risk Assessment Model: A Clinical study.

Background: Implants are being widely used as a treatment option and are considered the best line of treatment owing to their high level of predictability. However, over 5 years, 0-14.4% of dental implants have demonstrated peri-inflammatory reactions associated with loss of crestal bone and ultimately loss of the implant. Peri-implant diseases are categorized into peri-implant mucositis and peri-implantitis. There are a number of risk factors associated with these conditions, and the early detection of these possible risk factors, change in the treatment protocol whenever required along with a regular follow-up, can ensure a better survival rate of dental implants. In the present study, an attempt has been made to evaluate the risk factors associated with peri-implant diseases and also to correlate these risk factors to the prevalence of peri-implant diseases using the formulated risk assessment model. Methodology. The risk assessment model was prepared based on existing literature explaining the risk factors for peri-implant diseases. This study was conducted as a pilot study, and the method of complete sampling was used wherein all subjects in whom implants have been placed at the Department of Periodontology and Department of Prosthodontics were recalled and assessed. The model was then evaluated on patients in whom dental implants were placed and the implants were loaded for a year. A total of 13 subjects with 21 implants were assessed for the presence or absence of risk factors, and a score was given. Test of proportion and chi-square test was done. Results and Discussion. Of the 21 implants assessed, 15 implants were found to be at low risk and 6 implants with moderate risk of peri-implant disease. The number of implants with low risk was higher in implants with peri-implant mucositis (25%) whereas the implants with moderate risk was higher in implants with peri-implantitis (75%). This comparison was statistically significant with a p value of 0.022. Conclusion: This risk assessment tool can be used in the early detection of peri-implant disease, and identifying the risk factor may help in the success rate of the implant survival.

Teledentistry: a new oral care delivery tool among Indian dental professionals - a questionnaire study.

Background: The sudden massive spread of coronavirus disease 2019 (COVID-19) has led to a major public health emergency and changed the scene of the health care globally. During the COVID-19 pandemic, most dental treatment procedures were considered as major sources of infection transmission. Thus, the current survey aimed at evaluating knowledge, awareness and attitude of dental professional of India towards teledentistry. Methods: A pre structured questionnaire was framed and distributed among 600 dental professionals of India using email, WhatsApp and other social media modes.  SPSS version 17 was used for data analysis. The Chi-Square, student t test and one way ANOVA test were applied to assess the association between qualification, type of practice and participant response.  Logistic regression analysis was also carried out. Results: In total, 431 dental professionals completed the survey. Overall, 94.7% of dental professionals were aware about teledentistry and agreed it is useful in fulfilling needs of the community at great amount. A statistically significant difference was found for questions related to the application of teledentistry for all branches, whether it is a good tool to assess oral hygiene in remote areas and its usefulness in training in primary health care centre when comparison was done among dental professionals and specialist in different branches of dentistry. Conclusions: Within the limits of the study, findings show that study participants exhibited good knowledge and awareness regarding teledentistry. The participants exhibited positive attitude towards teledentistry but at the same time expressed the uncertainty in challenges which they may face in teledentistry. Lack of training, advanced infrastructure, good connectivity and network are main issues they were concerned about. The other important point of concern is many participants felt teledentistry cannot be applied for all branches of dentistry. Future research should focus on this aspect of teledentistry.

Evaluation of Cognitive Impairment in Type 2 Diabetic Patients with Chronic Periodontitis: A Cross-sectional Study.

BACKGROUND: Type 2 diabetes mellitus is an important risk factor for dementia; it also shares a bidirectional relationship with periodontitis. It is hypothesized that the increased severity of periodontitis is associated with cognitive decline in patients having uncontrolled diabetes mellitus. An added risk for future development as well as progression of dementia may be prophesied in such a scenario. Therefore, the present study was conducted to find a correlation between the cognitive impairment (CI) and periodontitis in type 2 diabetes mellitus patients. MATERIALS AND METHODS: A total of 160 older adults aged ≥60 years in Mangalore, Karnataka, India, were included in the present analysis. Known T2DM patients aged ≥60 years and diagnosed with periodontitis with a minimum clinical attachment loss (CAL) of ≥2 mm were considered in the present study. Montreal cognitive assessment test assessed the CI. The analysis was carried out using the χ2 test, an independent t-test. Binary logistic regression analysis (enter method) was performed to derive the odds ratios (95% confidence interval). RESULTS: The study included 160 participants, out of which 120 had CI and 40 did not have CI. A statistically significant association was observed between moderate-to-severe periodontitis, HbA1c levels ≥7%, and CI after excluding the confounding factors like age, gender, diet, lifestyle habits, and education. CONCLUSION: In the present study, cognitive impairment was found to coexist with HbA1c levels ≥7% and moderate-to-severe periodontitis in the elderly diabetics. The clinical implication of these findings adds opportunities to form disease modifiable areas in the elderly diabetic population at a risk for the development of dementia. Additionally, the impact of pre-existing CI on progression of periodontitis and vice versa has been discussed.

Comparative Analysis of Change in pH, Oral Health Status, and the Count of Streptococcus mutans and Lactobacillus Species in the Oral Cavity in Patients with Gastroenteral Diseases Using Saliva: A Pilot Study.

BACKGROUND: Seventy million people are affected by gastroenteral (GI) disturbances throughout the world. Oral cavity possesses various bacteria that remain as healthy commensals or turn pathogenic due to shift of balance with disturbances in health, which is reflected in the oral cavity too. Studies have shown a possible oro-systemic link. This study aimed at assessing the effect of GI disease on oral health comparing levels of pH, microbiological counts, and oral health status between test and control groups. MATERIALS AND METHODS: This pilot study consisted of two groups: test group containing 14 participants (GI disease) and control group (healthy) containing 3 participants. Two saliva samples were collected per patient. One sample was inoculated onto Mitis Salivarius and Rugose agar plates at 37oC in the CO2 incubator for 2 days. The second sample was used for recording pH. Parameters such as decayed, missing, and filled teeth, plaque index, gingival index, probing pocket depth, and clinical loss of attachment were also recorded. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. Regression analysis was applied to predict the three-microbe culture based on the pH and GI disease. RESULTS: The oral health parameters showed a higher number of missing teeth, higher bleeding on probing, higher values of plaque and gingival index, a higher amount of clinical loss of attachment, and acidic pH of saliva in the test group. Microbiological analysis showed more Streptococcus mutans in the control group (7,500-10,000 cfu/mL), with a mean of 8,833.33±1,258.31 cfu/mL; S. salivarius was more in the test group (2,000-25,000 cfu/mL) with a mean of 15,866.67±6,697.76 cfu/mL. Candida was seen only in the test group (2,166.67±2,549.51 cfu/mL) and absent in the control group. Lactobacillus was absent in both the groups. CONCLUSION: The present study suggests the relation between oral health and GI diseases. Hence, saliva could be used as an easy, non-invasive biomarker to analyze the gastroenteric status of the patient.



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Knowledge, attitude and oral care practices for preventing ventilator-associated pneumonia among critical care nurses - A questionnaire study.

BACKGROUND: A cross-sectional study was conducted among intensive care unit (ICU) nurses in private hospitals in India to identify knowledge and practice of ICU nurses in the prevention of ventilator-associated pneumonia (VAP). METHODS: Knowledge of 135 nurses working in ICU was tested using a questionnaire consisting of 18 questions. Fourteen forms were excluded from the statistical analysis due to incomplete data entry by the participants. The data of 121 filled questionnaires were analyzed. The information letters, consent forms, and questionnaires were handed to ICU nurses by Research assistant. Data were coded and entered into SPSS version for descriptive and inferential statistics. RESULTS: A majority of the participants perceived oral care as a necessity in all critically ill patients. Nurses were generally aware of the most likely mechanism of acquiring pneumonia. The type and frequency of oral care varied widely. Many of them stated that they had adequate supplies to provide oral care. Although a majority of nurses had some formal training in oral care, they would appreciate an opportunity to enhance and improve their knowledge and skills. CONCLUSION: The methods of oral care provided vary widely. In summary, randomized controlled trial to date has demonstrated that tooth brushing is associated with a trend toward lower rates of VAP in intubated mechanically ventilated critically ill patients. But it is also to be noted that there was no clear difference between electric and manual tooth brushing. In-house training and workshop can provide required skills needed for the betterment of the treatment provided.

Candidal carriage in saliva and subgingival plaque among smokers and non-smokers with chronic periodontitis-a cross-sectional study.

BACKGROUND AND OBJECTIVES: Studies of gum or periodontal disease have focused mainly on bacterial pathogens. However, information related to fungal species in the saliva and subgingival mileu is particularly lacking in smokers with periodontitis. This cross-sectional study compared the prevalence of various Candida species in saliva and subgingival plaque samples of smokers and non-smokers with periodontal disease. METHODOLOGY: Study subjects were recruited into three group-Group 1: Smokers with chronic periodontitis (N = 30), Group 2: Non-smokers with chronic periodontitis (N = 30) and Group 3: Healthy controls (N = 30). Clinical parameters recorded included plaque index (PI), gingival index (GI), periodontal probing depth (PPD) and clinical attachment loss (CAL). Saliva and subgingival plaque samples were collected from subjects from the above groups. The collected samples were processed for isolation and identification of various Candida species using CHROMagar chromogenic media. Additionally, antifungal susceptibility tests were performed for the isolated Candida species in order to assess antifungal drug resistance to fluconazole and voriconazole. RESULTS: Prevalence of Candida species in saliva samples was quantified as 76.6% in Group 1, 73.3% in Group 2 and 36.6% in Group 3 and statistically significant differences were observed between groups 1 & 3. Prevalence of Candida species in subgingival plaque samples was quantified as 73.3% in Group 1, 66.6% in Group 2 and 60% in Group 3 and no statistically significant differences were observed between groups. Candida albicans was the most frequently isolated species followed by Candida krusei and Candida tropicalis. A positive correlation was observed for smoking exposure, pack years and Candida colonization. A marginally significant positive correlation was observed between Candida colonization and increasing pocket depth and attachment loss. Antifungal drug resistance was mainly observed for Candida krusei in both saliva and subgingival plaque samples. CONCLUSION: Based on the results we can conclude that oral candidal carriage is significantly increased in smokers with periodontal disease. Mechanistic studies are needed to understand the importance of Candida species in periodontal disease.

Recurrent Gingival Cyst of Adult: A Rare Case Report with Review of Literature.

The gingival cyst of adult (GCA) is a rare developmental anomaly of odontogenic origin. It is asymptomatic, slow growing, and commonly seen near the canine and premolar region of mandible. The GCA is usually treated by excisional biopsy. Usually, occurrence is more common in 5th to 6th decade of life. The present case report describes a solitary GCA treated by excisional biopsy in a 76-year-old male patient which had recurred for the fourth time. This article also highlights on diagnostic process and a review of literature describing its histiogenesis, clinical, and histopathologic features of this condition.

Oral Health and Erectile Dysfunction.

Ample evidence strongly supports the fact that periodontal disease is a major risk factor for various systemic diseases namely cardio-vascular disease, diabetes mellitus, etc. Recently, investigators focussed on exploring the link between chronic periodontitis (CP) and erectile dysfunction (ED) by contributing to the endothelial dysfunction. Both the diseases share common risk factors. Various studies conducted in different parts of the world in recent years reported the evidence linking this relationship as well as improvement in ED with periodontal treatment. Systemic exposure to the periodontal pathogen and periodontal infection-induced systemic inflammation was thought to associate with these conditions. The objective of this review was to highlight the evidence of the link between CP and ED and the importance of oral health in preventing the systemic conditions.

Periodontal Health among Non-Hospitalized Chronic Psychiatric Patients in Mangaluru City-India.

INTRODUCTION: A substantial section of society constituting the mentally ill and psychiatric patients deserve special attention. Evidence has suggested that psychological factors have contributed to an increase in the susceptibility to periodontal disease. AIM: The aim of the study was to evaluate the gingival and periodontal health of chronically non-hospitalized psychiatric patients in Mangaluru city, India. MATERIALS AND METHODS: Forty one psychiatric patients having chronic psychiatric illness and on neuroleptic medications for a minimum of 2 years were included in the study. The control group consisted of 41 healthy dental patients who were selected to match the study group by age and gender, and for both groups 20 teeth excluding the third molars should be present. Demographic characteristics, dental examination including gingival index and periodontal health according to the community periodontal index were recorded for each patient in both the groups. RESULTS: In the psychiatric patient group (Group A) 47.1% subjects were suffering from schizophrenia and 17.6% subjects were having mood disorder. Gingivitis varied from mild to severe among the patients of both the groups. Bleeding on probing (CPI 1) was recorded in 23.5% in Group A and 14.6% in Group B. Dental calculus (CPI 2) in 38.2% in Group A and 58.5% in Group B of the subjects, 20.6% with at least one 4mm to 5mm pocket (CPI 3), and 17.6% with at least one 6mm pocket (CPI 4). CONCLUSION: The present study underlines a considerable need for prevention and treatment of periodontal disease among chronic psychiatric patients in Mangaluru city. Every effort should be made to increase the awareness of this cohort regarding the importance of oral hygiene practices and on the early diagnosis of periodontal problems.

Detection, removal and prevention of calculus: Literature Review.

Dental plaque is considered to be a major etiological factor in the development of periodontal disease. Accordingly, the elimination of supra- and sub-gingival plaque and calculus is the cornerstone of periodontal therapy. Dental calculus is mineralized plaque; because it is porous, it can absorb various toxic products that can damage the periodontal tissues. Hence, calculus should be accurately detected and thoroughly removed for adequate periodontal therapy. Many techniques have been used to identify and remove calculus deposits present on the root surface. The purpose of this review was to compile the various methods and their advantages for the detection and removal of calculus.

Evaluation of cortisol levels in gingival crevicular fluid and saliva in anxious and non-anxious patients with chronic periodontitis.

BACKGROUND: To evaluate gingival crevicular fluid (GCF) and salivary cortisol levels in anxious and non-anxious patients with chronic periodontitis. MATERIALS AND METHODS: A total of 45 patients with a mean age 43.4 ± 6.12 years were assigned to three groups: Healthy control group (Group 1), group with chronic periodontitis but no anxiety (Group 2) and group with chronic periodontitis and with anxiety (Group 3). State - Trait anxiety inventory and Hamilton Anxiety rating scale were used to assess the anxiety levels of all the subjects. Clinical measures such as plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded. GCF and unstimulated whole saliva samples were collected, and cortisol levels were determined using ELISA kit. RESULTS: PI, GI, PPD, and CAL were higher in Group 3. Hormone level was significantly higher in Group 3. A positive correlation was found among salivary and GCF cortisol and CAL in Group 3. CONCLUSION: Based on the obtained results individuals with high-levels of anxiety seem to be more prone to have periodontal disease. Salivary and GCF cortisol levels can be used as biomarker for evaluating part of the etiopathogenesis of chronic periodontitis.