Correlation of periodontal inflamed surface area with glycated hemoglobin, interleukin-6 and lipoprotein(a) in type 2 diabetes with retinopathy.

BACKGROUND: The two-way relationship between periodontitis and type 2 diabetes mellitus (T2DM) is well established. Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis, accentuating diabetic complications. An inflammatory link exists between diabetic retinopathy (DR) and periodontitis, but the studies regarding this association and the role of lipoprotein(a) [Lp(a)] and interleukin-6 (IL-6) in these conditions are scarce in the literature. AIM: To determine the correlation of periodontal inflamed surface area (PISA) with glycated Hb (HbA1c), serum IL-6 and Lp(a) in T2DM subjects with retinopathy. METHODS: This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR. All subjects were assessed for periodontal parameters [bleeding on probing (BOP), probing pocket depth, clinical attachment loss (CAL), oral hygiene index-simplified, plaque index (PI) and PISA], and systemic parameters [HbA1c, fasting plasma glucose and postprandial plasma glucose, fasting lipid profile, serum IL-6 and serum Lp(a)]. RESULTS: The proportion of periodontitis in T2DM with and without DR was 47.5% and 27.5% respectively. Severity of periodontitis, CAL, PISA, IL-6 and Lp(a) were higher in T2DM with DR group compared to T2DM without DR group. Sig-nificant difference was observed in the mean percentage of sites with BOP between T2DM with DR (69%) and T2DM without DR (41%), but there was no significant difference in PI (P > 0.05). HbA1c was positively correlated with CAL (r = 0.351, P = 0.001), and PISA (r = 0.393, P ≤ 0.001) in study subjects. A positive correlation was found between PISA and IL-6 (r = 0.651, P < 0.0001); PISA and Lp(a) (r = 0.59, P < 0.001); CAL and IL-6 (r = 0.527, P < 0.0001) and CAL and Lp(a) (r = 0.631, P < 0.001) among study subjects. CONCLUSION: Despite both groups having poor glycemic control and comparable plaque scores, the periodontal parameters were higher in DR as compared to T2DM without DR. Since a bidirectional link exists between periodontitis and DM, the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.

Fibrosarcoma of the gingiva: A rare entity.

Fibrosarcoma is a rare malignancy of fibroblasts that seldom occurs in the oral cavity. Although rare, fibrosarcoma is an aggressive lesion associated with a poor survival rate. The occurrence of such a highly aggressive lesion on the gingiva is a diagnostic challenge for the clinician. This is because the gingiva is a common site for various inflammatory and nonspecific enlargements, which are commonly benign and the chances to overlook aggressive lesions are high. This case report describes an atypical case of fibrosarcoma of gingiva in a middle-aged individual that mimicked a nonspecific gingival enlargement.

Proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin level in patients with type 2 diabetes mellitus on insulin therapy and on oral antidiabetic therapy.

BACKGROUND: Treatment of diabetes includes oral antidiabetic drugs (OAD), insulin, or their combinations. Insulin can achieve faster glycemic control and have anabolic action on bone. This study was undertaken to assess the prevalence and severity of periodontitis, and to estimate the proportional relationship between periodontal inflamed surface area, clinical attachment loss, and glycated hemoglobin (HbA1c) level in patients with type 2 diabetes (T2DM) on OAD therapy and on insulin therapy. METHODS: This cross-sectional study comprised 130 patients with T2DM on OAD therapy (OAD group) and 130 patients with T2DM on insulin therapy (INSULIN group). All patients were assessed for sociodemographic, behavioral characteristics, clinical history, periodontal parameters (bleeding on probing, probing depth, clinical attachment loss [Clinical AL], Oral Hygiene Index-simplified, plaque index, and periodontal inflamed surface area [PISA]), and biochemical variables (HbA1c, fasting plasma glucose, postprandial plasma glucose). RESULTS: Prevalence, extent, and severity of periodontitis and PISA were lower in the INSULIN group as compared with the OAD group. A proportional relationship was observed between HbA1c and PISA and between HbA1c and Clinical AL. A unit increase in HbA1c is associated with an increase in PISA of 130.47 mm2 and an increase in Clinical AL of 0.182 mm. CONCLUSION: A proportional relationship was observed between PISA, clinical attachment loss, and HbA1c level in patients with type 2 diabetes mellitus on insulin therapy and OAD therapy. Despite comparable oral hygiene status and glycemic control between the two groups, the periodontal parameters were lesser in the INSULIN group as compared with the OAD group.

Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus.

BACKGROUND: The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications. AIM: To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications. METHODS: This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose). RESULTS: The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients (r = 0.393, P < 0.001). The dose-response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm2 was associated with a 1.0% increase of HbA1c. CONCLUSION: High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.

Prevalence of periodontitis and its correlates among tribal population of Attapady block, Palakkad District, Kerala.

BACKGROUND: Periodontal disease is an immunoinflammatory disease characterized by loss of clinical attachment with subsequent tooth loss. It includes periodontitis and gingivitis. The studies regarding the prevalence of periodontitis among the tribal populations are scarce. The periodontal health status of the tribal population of Attapady has not been reported so far. OBJECTIVE: The present study was conducted to assess the prevalence of periodontitis and its association with oral hygiene habits, tobacco usage, and oral health beliefs among tribal population of Attapady. MATERIALS AND METHODS: This population-based cross-sectional survey of periodontal disease consisting of 360 individuals was conducted among the tribal population of three different panchayats of Attapady. A multistage stratified random sampling was used in the selection of hamlets and cluster sampling for selection of study participants. The sociodemographic characteristics, oral hygiene habits, tobacco usage, and oral health beliefs were assessed using a questionnaire, and clinical examination was based on WHO oral health assessment form 2013. RESULTS: The prevalence of periodontal disease among tribal population of Attapady was 87.5% (95% Confidence interval [CI] 78.48, 96.51).73.3% had gingival bleeding and 13.3% had no/mild periodontitis, The proportion of periodontitis was 84.2% (95% CI 75.5, 92.8). Among chronic perioodntitis subjects 22.8% had moderate periodontitis and 61.4% had severe periodontitis. A significant association was observed between tobacco use (Odds ratio [OR] 5.6, CI 2.99, 10.74), bad oral hygiene habits (OR 4.9, CI 2.64, 9.43), unfavorable oral health beliefs (OR 3.21, CI 1.63, 6.32), and periodontitis. CONCLUSIONS: The prevalence of periodontal disease and periodontitis are high among tribal population of Attapady. Unfavorable oral health belief, bad oral hygiene habits, and detrimental habits like tobacco use were the modifiable risk factors identified in this group.

Comparative evaluation of the effect of curcumin and chlorhexidine on human fibroblast viability and migration: An in vitro study.

BACKGROUND AND OBJECTIVE: Chemical plaque control acts as an adjunct to mechanical periodontal therapy. Chlorhexidine (CHX) is considered as the gold standard in chemical plaque control, but the main concern is about its fibroblast cytotoxicity. Curcumin, a lipophilic polyphenol, may offer as a promising antiplaque agent. This study was conducted to compare the effect of curcumin (0.003%, 0.03%, 0.06%, 0.1%, and 0.12%) and CHX (0.03%, 0.06%, 0.1%, 0.12%, and 0.2%) on gingival fibroblast cell viability and wound healing at different time periods (1, 2, 4, 6, 8, and 10 min). MATERIALS AND METHODS: The minimum inhibitory concentration (MIC50) was determined before the evaluation of cytotoxicity and wound healing property. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and morphological examination by direct invert microscopy were carried out to determine cytotoxicity. Wound healing was evaluated by scratch wound assay. RESULTS AND DISCUSSION: The MIC50 of CHX and curcumin was at 0.1% and 0.003%, respectively. The mean percentage of fibroblast viability at different concentrations of CHX and curcumin at each time period showed a significant difference. Curcumin exhibited less cytotoxicity as compared to CHX at all concentrations and at varying time periods. There was a significant difference between mean percentage of fibroblast viability at MIC50 of CHX (0.1%) and curcumin (0.003%) at different time periods. The difference between percentage wound healing at antibacterial concentrations of CHX and curcumin at varying time periods was significant. CONCLUSION: The antibacterial concentration of curcumin (0.003%) exhibits less fibroblast cytotoxicity and excellent wound healing property as compared to CHX. Curcumin may offer as a promising chemical plaque control agent which is less cytotoxic, cost-effective, safe, easily available, and with a possibly beneficial effect on wound healing.

Does periodontal inflammation affect glycosylated haemoglobin level in otherwise systemically healthy individuals? - A hospital based study.

BACKGROUND AND OBJECTIVES: Microbial biofilm and host susceptibility play an important role in the initiation and progression of periodontitis. Periodontitis is considered the sixth complication of diabetes mellitus and a bidirectional relationship exists between diabetes and periodontitis. This cross-sectional observational study was undertaken to evaluate the glycosylated haemoglobin (HbA1c) level in chronic periodontitis. METHODS: The study involved 100 subjects. The case group consisted of 50 subjects with chronic periodontitis and the control group consisted of 50 periodontally healthy subjects. Periodontal parameters including plaque index, oral hygiene index, modified gingival index, probing pocket depth, and clinical attachment level were measured and recorded. Systemic parameters like Body Mass Index (BMI), Waist Hip Ratio (WHR), C- Reactive Protein (CRP), Glycosylated haemoglobin (HbA1c), lipid profile, fasting blood sugar, post prandial blood sugar and serum albumin were assessed in all subjects. RESULTS: The mean HbA1C for the case group was 6.27±1.5 and for the control was 5.36±0.4 and the difference was statistically significant (p = 0.001). The mean FBS, PPBS, LDL, WHR, CRP was statistically significant between groups (p ≤0.05). Periodontal parameters like PI, OHI, MGI, PD and CAL were significantly higher in the case group than the control group (p value ≤ 0.05). The multivariate linear regression model with the dependent variable HbA1c showed chronic periodontitis was significantly associated with HbA1c level. CONCLUSION: In chronic periodontitis patients (otherwise systemically healthy) the presence of periodontal inflammation affected the glycosylated haemoglobin level and they were in prediabetes stage. Therefore, it is plausible that the prediabetes stage might be reduced via appropriate periodontal therapy.

Effect of non-surgical periodontal therapy on insulin resistance in patients with type II diabetes mellitus and chronic periodontitis, as assessed by C-peptide and the Homeostasis Assessment Index.

AIM: A bidirectional relationship exists between diabetes and periodontitis. In the present clinical trial, we evaluated the effects of non-surgical periodontal therapy (NSPT) on insulin resistance in patients with type II diabetes mellitus (DM) and chronic periodontitis. METHODS: Forty chronic periodontitis patients with type II DM were selected and equally allocated to case and control groups. All patients were assessed for periodontal parameters and systemic parameters. The case group received NSPT, and both groups were re-evaluated after 3 months. RESULTS: All periodontal parameters were found to be significantly improved in the case group compared to the control group 3 months after NSPT. The mean differences in systemic parameters, such as fasting serum C-peptide, Homeostasis Assessment (HOMA) Index-insulin resistance, and HOMA-insulin sensitivity, from baseline to 3 months for the case group were 0.544 ± 0.73, 0.54 ± 0.63, and -25.44 ± 36.81, respectively; for the control group, they were significant at -1.66 ± 1.89, -1.48 ± 1.86, and 31.42 ± 38.82 respectively (P < 0.05). There was a significant decrease in fasting blood glucose and glycosylated hemoglobin A1c from baseline to 3 months in the case group (P < 0.05). CONCLUSION: The present study showed that periodontal inflammation could affect glycemic control and insulin resistance. Effective periodontal therapy reduced insulin resistance and improved periodontal health status and insulin sensitivity in patients with type II DM and chronic periodontitis.

Dental health awareness, attitude, and dental health-care seeking practices as risk indicators for the prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district, Kerala, India.

BACKGROUND: Periodontal disease prevalence in children is an indicator of future disease burden in the adult population. Knowledge about the prevalence and risk status of periodontal disease in children can prove instrumental in the initiation of appropriate preventive and therapeutic measures. AIM: This school-based cross-sectional survey estimated the prevalence and severity of periodontal disease among 15-17-year-old children in Kozhikode district and assessed the risk factors. MATERIALS AND METHODS: Multistage stratified random sampling and randomized cluster sampling were used in the selection of schools and study participants, respectively, in three educational districts of Kozhikode. Periodontal disease was assessed among 2000 school children aged 15-17 years, by community periodontal index. A content validated questionnaire was used to evaluate the sociodemographic characteristics and other risk factors. RESULTS: The prevalence of periodontal disease was estimated as 75% (72% gingivitis and 3% mild periodontitis). The prevalence was higher in urban population (P = 0.049) and males had significantly (P = 0.001) higher prevalence. Lower socioeconomic strata experienced slightly more periodontal disease burden. Satisfactory oral hygiene practices (material and frequency) were observed, but oral hygiene techniques were erroneous. Unhealthy dental treatment-seeking practices and unfavorable attitude toward dental treatment (ATDT) significantly influenced periodontal health status. Overall awareness about dental treatment was poor in this study population. CONCLUSION: The prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district is 75% and is influenced by sociodemographic characteristics. Other risk factors identified were unhealthy dental treatment-seeking practices and unfavorable ATDT. Implementation of well-formulated oral health education programs is thus mandatory.

Treatment of a two wall defect in a mandibular posterior tooth with autogenous bone graft obtained during ledge removal with a hand instrument.

Autogenous bone grafts have been considered the gold standard for bone grafting procedures. This case report describes the management of a two wall defect by utilizing the autogenous bone graft obtained during removal of ledges as a part of osteoplasty procedure. The bone was removed with a sickle scaler, and sufficient amounts of bone graft material were obtained to fill a two wall defect distal to left mandibular first molar.

In vitro evaluation of mechanical properties of platelet-rich fibrin membrane and scanning electron microscopic examination of its surface characteristics.

BACKGROUND: The aim of this study was to evaluate the mechanical properties of the platelet-rich fibrin (PRF) membrane and to compare these properties with that of commercially available collagen membranes used for guided tissue regeneration (GTR) procedures. Scanning electron microscopic (SEM) examination of PRF membrane was also performed to determine the cell distribution pattern within the different regions of the membrane. MATERIALS AND METHODS: Modulus of elasticity and hardness of (i) PRF membrane (ii) bovine collagen membrane and (iii) fish collagen membrane were assessed by performing surface indentation test using T1 950 Triboindenter. The in vitro degradation tests were conducted by placing the (i) PRF membrane (ii) bovine collagen membrane and (iii) fish collagen membrane of equal sizes (10 mm × 5 mm) in 5 ml of pH 7.4 phosphate buffer solution on a shaker set at 40 rpm for 1-week. The degradation profiles were expressed as the accumulated weight losses of the membrane. SEM evaluation of the PRF membrane was done under both low and high magnification. RESULTS: Young's Modulus of elasticity was found to be 0.35 GPa for PRF membrane, 2.74 GPa for bovine collagen membrane and 1.92 GPa for fish collagen. The hardness was 10.67 MPa for PRF membrane, 110.7 MPa for bovine collagen membrane and 90.5 MPa for fish collagen membrane. PRF membrane degraded by about 36% of initial weight after a 1-week in vitro shaking test. Fish collagen membrane degraded by about 8% of initial weight, bovine collagen membrane degraded by about 3% of initial weight. Dense clusters of platelets formed due to extensive aggregation, and few leukocytes were observed in buffy coat area. CONCLUSIONS: The preliminary findings from the assessment of the mechanical properties of PRF membrane showed that it was lacking in several desired properties when compared to commercially available collagen membranes. Lack of rigidity and faster degradation may limit its application in GTR procedures.