Exploring the Microbiome Landscape of Dental Plaque: A Cross-Sectional Analysis in Periodontal Health and Disease.

OBJECTIVE: This study aimed to comprehensively analyze the microbiome of dental plaque in individuals with varying periodontal statuses, encompassing both periodontal health and disease. The primary objectives were to identify microbial markers associated with different clinical conditions, explore variations in microbial diversity, and investigate potential correlations between the oral microbiome and clinical parameters. METHODS: A cross-sectional design was employed, involving 164 participants aged 18 to 65 years. Inclusion criteria comprised individuals with good oral and systemic health for the periodontal health group and those diagnosed with various stages of periodontal disease for the periodontal disease group. Dental plaque samples were meticulously collected from diverse tooth surfaces, and clinical examinations were conducted to assess periodontal health status. High-throughput sequencing of the 16S ribosomal RNA (rRNA) gene was utilized for microbiome analysis. RESULTS: Demographic characteristics revealed a balanced distribution between the periodontal health and disease groups. Clinical parameters, including probing depth, clinical attachment loss, and bleeding on probing, exhibited significant differences between the two groups (p < 0.001). Microbial diversity indices indicated a higher diversity in the periodontal health group compared to the disease group (p < 0.001). Analysis of relative abundance of bacterial phyla identified significant variations, with Firmicutes, Bacteroidetes, and Actinobacteria showing differential prevalence between health and disease (p < 0.05). Differentially abundant taxa analysis highlighted specific species associated with each clinical condition, including Prevotella intermedia and Porphyromonas gingivalis. Network analysis revealed complex microbial interactions within the oral microbiome. Functional predictions indicated variations in metabolic capabilities between health and disease, with potential implications for virulence and antibiotic resistance. CONCLUSION: This study provides a comprehensive analysis of the oral microbiome in periodontal health and disease, revealing significant associations between microbial composition and clinical parameters. The identification of microbial markers and functional insights enhances our understanding of the complex interplay within the oral ecosystem. These findings hold promise for advancing diagnostic and therapeutic approaches tailored to individual microbial profiles.

Comparative evaluation of the efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine mouthwashes in the treatment of gingival inflammation: A randomized controlled trial.

BACKGROUND: Chemical plaque control with mouthwashes as an adjunct to mechanical plaque control with a toothbrush and dental floss has been considered an effective method for controlling gingivitis. The anti-inflammatory effects of chemical plaque control benefit the oral tissues by reducing inflammation and bleeding. OBJECTIVES: The aim of the present study was to evaluate and compare the clinical efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine (CHX) mouthwashes in treating gingivitis patients by assessing changes in their clinical parameters. MATERIAL AND METHODS: This prospective study was conducted on 40 patients from our outpatient department, divided into 4 groups of 10 patients each: probiotic mouthwash group (group 1); herbal (Aloe vera) mouthwash group (group 2); povidone-iodine mouthwash group (group 3); and CHX mouthwash group (group 4). All participants were provided with the same type of manual toothbrush, the Pepsodent® toothpaste and a respective mouthwash for twice-daily use until the end of a 28-day observation period. Clinical parameters, such as the marginal plaque index (MPI) and bleeding on interdental brushing (BOIB), were recorded at baseline, and on the 14th and 28th day of the study period. RESULTS: All groups showed a significant decrease in the MPI and BOIB scores. The results were similar in patients who used a probiotic mouthwash and those who used a CHX mouthwash. A comparable change in the mean scores was observed among the herbal and povidone-iodine groups from baseline to day 28. CONCLUSIONS: In the treatment of chronic gingivitis patients,a probiotic mouthwash was nearly as effective as CHX in reducing the plaque and bleeding scores. It showed better results in all clinical parameters than herbal and povidone-iodine mouthwashes. Using a mouthwash along with routine tooth brushing can help in treating gingivitis and slow the progression of the periodontal disease.

Estimation of Serum 1,25-Dihydroxycholecalciferol and Tumor Necrosis Factor-α Levels in Chronic Periodontitis.

BACKGROUND: Major trials in the field of periodontics include a thorough understanding of its pathophysiology and the interplay between host response and periodontal factors. Certain factors such as vitamin D play a crucial role in immune regulation and their depletion is known to contribute to the onset of periodontitis. Research efforts continue to unravel the impact of elevated pro-inflammatory cytokines like TNF-α on osteoclastogenesis in periodontitis. MATERIALS AND METHODS: The study comprised a total of 64 participants, with 33 men and 31 women, including 32 individuals with chronic periodontitis and 32 people without the condition. ELISA was employed to determine the concentrations of TNF-α and 1,25-dihydroxycholecalciferol (1,25(OH)2D) in the participants. Clinical attachment levels, probing pocket depth, gingival bleeding index, and plaque index were meticulously measured. Subsequent to data collection, appropriate statistical tests were conducted. RESULTS: The mean serum levels of 1,25(OH)2D in test and control groups are 173.59 ± 52.60 and 401.47 ± 99.81, respectively. The mean serum levels of TNF-α in the test and control groups are 1078.09 ± 231.51 and 204.75 ± 68.31, respectively. The TNF-α levels exhibited a statistically significant difference between test and control groups (p = 0.0001) at a 5% level of significance. CONCLUSION: Decreased levels of 1,25(OH)2D led to increased values of periodontal parameters. There was also a significant increase in serum levels of pro-inflammatory cytokines such as TNF-α.

Evaluation of soft tissue and crestal bone changes around non-submerged implants with and without a platelet-rich fibrin membrane: A randomized controlled clinical trial.

BACKGROUND: Platelet-rich fibrin (PRF) membranes are known to enhance wound healing after periodontal surgeries and dental implant procedures. OBJECTIVES: The aim of the present study was to examine the effect of PRF on soft tissue healing and the crestal bone level (CBL) around non-submerged dental implants. MATERIAL AND METHODS: A total of 40 patients, aged 20-60 years, with partially edentulous posterior mandibular sites were divided into 2 groups of 20 patients each: group I received non-submerged implants with a PRF membrane; and group II was treated with non-submerged implants alone. The examined parameters included the modified plaque index (mPI), the gingival index (GI), the width of keratinized tissue (WKT), the thickness of keratinized tissue (TKT), and CBL, assessed using digital intraoral periapical radiography (IOPA). All parameters were measured at baseline (immediately post-op), and at 3-month and 6-month follow-ups. RESULTS: In comparison with baseline, statistically significant increases in WKT and TKT were observed in both groups at 3 and 6 months post-op (p < 0.05). Also, significant gains were noted in group I vs. group II (p < 0.05). The CBL increased significantly in both groups at 3 and 6 months post-op (p < 0.05), with no remarkable differences from 3 to 6 months. A decreased CBL was observed in group I vs. group II at the 3- and 6-month intervals (p < 0.05). CONCLUSIONS: The PRF membrane enhances peri-implant tissue wound healing, with gains in soft tissue width and thickness around non-submerged implants.

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.

Evaluation of relationship between stress and periodontal disease in different professional college students.

Background: To evaluate the association between stress and periodontitis in different professional college students. Subjects and Methods: The study was conducted in 360 professional college students which includes Medical, Dental, Pharmacy, Nursing, Engineering, and Chartered Accountancy. From each group, 60 students were included in the study. Self-reported Depression, Anxiety, and Stress Scale questionnaire was given to all the students and clinical examination was conducted in all the participants to assess the Oral hygiene index - simplified (OHI-S), clinical attachment level (CAL), and Gingival Index Simplified (GI-S). Statistical Analysis: Statistics was performed using the ANOVA test, post hoc test, and Pearson correlation test to compare the psychological parameter of stress with periodontal parameters among six groups of students. P <0.05 was considered to be statistically significant. Results: Group I showed higher mean stress scores (10.78 ± 0.76) compared to other groups. The mean OHI-S (1.61 ± 0.15), mean CAL (3.68 ± 0.79), and mean GI-S (1.43 ± 0.15) scores also increased with elevated stress levels among medical students. Followed by Group VI and Group II showed almost similar results. Conclusion: The present study showed strong association between stress and periodontal disease and have an adverse effect over oral hygiene factors among the students.

Perceptions and Preparedness of Dental Professionals toward COVID-19-Related Oral Manifestations in India.

Background: With the reports of oral manifestations observed in coronavirus disease 2019 (COVID-19) patients snowballing day-by-day, it calls for the attention of dental professionals to keep themselves updated regarding these manifestations and how to prevent and manage them in COVID-infected patients. Aims and Objectives: The aim of this study is to assess the perceptions and preparedness of dental professionals in India toward the COVID-19-related oral manifestations. Materials and Methods: A cross-sectional, web-based survey was conducted on dental professionals using a pretested and validated questionnaire. Six hundred and twenty-three responses obtained from January 23, 2021 to February 15, 2021 were included in the study. Results: Mean knowledge scores regarding COVID-19-related oral manifestations were noted to be significantly high among males (13.5 ± 4.9), having a PhD (18.3 ± 5.8), belonging to the specialty of oral medicine and radiology (15.6 ± 4.7), with more than 15 years of clinical experience (15.4 ± 4.7) and practicing in metropolitan areas (13.7 ± 5.03). Tele-consultation and advising palliative care (65.5%) were the most preferred ways of managing COVID-19-related oral manifestations. Ninety-one percentage of the participants felt that inclusion of dentists in the intensive care unit multiprofessional teams, would contribute toward early diagnosis and management of oral manifestations. Conclusion: Study noted lower knowledge scores pertaining to COVID-19-related oral manifestations among BDS graduates with <5 years of clinical experience calling for the implementation of continuing dental education on the oral manifestations occurring in COVID-19 patients.

Accuracy of digital intraoral periapical radiography and cone-beam computed tomography in the measurement of intrabony defects: A comparative study.

BACKGROUND: Periodontal disease is an inflammatory process resulting in clinical attachment loss (CAL), pocket depth (PD), and resulting in the loss of alveolar bone. Diagnostic imaging provides an adjunctive guidelines to assess the alveolar bone height in addition to clinical parameters such as PD and CAL. AIMS AND OBJECTIVES: The objectives of the study are to determine whether the digital intraoral periapical (IOPA) radiographs can be reliably used as an alternative to cone-beam computed tomography (CBCT) in the diagnosis of intrabony defects. MATERIALS AND METHODS: A total of 25 patients with the presence of intrabony defects were included in the study. All the radiographic parameters were recorded using digital IOPA and CBCT. Various intrabony defect morphological characteristics such as height, depth, width, and angle were measured and compared between digital IOPA and CBCT. STATISTICS: The data was subjected to statistical analysis. Mann-Whitney U-test was performed for interexaminer comparison and independent t-test for intergroup comparison. RESULTS: The mean intergroup comparison values between digital IOPA and CBCT in relation to defect width were 3.22 ± 1.10 and 3.20 ± 1.16, respectively (P = 0.970), in relation to defect depth were 7.71 ± 2.3 and 7.91 ± 2.4, respectively (P = 0.769), in relation to defect height were 3.80 ± 1.20 and 3.90 ± 1.2, respectively (P = 0.794), and in relation to defect angle were 34.82 ± 8.4 and 35.28 ± 0.8.6, respectively (P = 0.851). CONCLUSION: With the drawbacks of such as high radiation exposure, unavailability, and high financial cost, digital IOPA with digital software can be used as an alternative to CBCT for measuring intrabony defect morphological characteristics in periodontitis patients.

COVID-19 and oral implications: An updated review.

The emerging (COVID-19) pandemic is a global health disaster, caused by infection with severe acute respiratory syndrome coronavirus-2. The disease spreads at an alarming rate all over the world and presents a range of disease manifestations including asymptomatic, mild, moderate and severe symptoms irrespective of age groups. Most patients with severe symptoms exhibit underlying comorbidities such as diabetes, hypertension and obesity. Alternatively, there is an existing evidence for an association between oral health and nonoral systemic diseases. Since the oral cavity is a significant pool for many respiratory pathogens, patients with oral infections are more likely to develop pneumonia as a complication. Therefore, we emphasize that the oral hygiene status has a great impact on the recession and progression of oropharyngeal and respiratory diseases.

Mapping the link between cardiac biomarkers and chronic periodontitis: A clinico-biochemical study.

BACKGROUND: Various risk factors are coupled with atherosclerotic complications, such as myocardial infarction and stroke. Periodontitis is considered one of them. AIMS AND OBJECTIVES: The objective of the study is to compare and correlate the occurrences of periodontitis with serum levels of cardiac-biomarkers in patients with coronary heart-disorders. MATERIALS AND METHODS: Of 70 individuals diagnosed with coronary artery diseases, 32 patients with chronic periodontitis constituted the test group, 31 without chronic periodontitis constituted the control group. Cardiac-biomarkers analyzed were Troponin T, Troponin I, Myoglobin; low density lipoprotein (LDL), high-density lipoprotein, very LDL (VLDL), total cholesterol (TC), and highly sensitive C-reactive protein (Hs-CRP). Periodontal characteristics were drawn from the plaque index (PI) and gingival index, probing depth (PD), clinical attachment loss, and periodontal inflammatory surface area (PISA). STATISTICAL ANALYSIS: In order to separate any association between cardiac biomarkers and clinical parameters of periodontitis, detailed statistical analysis through independent t-test and Pearson test of correlation was done. RESULTS: Statistically significant differences were seen not only in PI, PD, and PISA between both the groups (P < 0.05), but also between various cardiac parameters of test and control groups (P < 0.001). Positive relations were seen in the test group, between cardiac biomarkers such as TC, VLDL, Hs-CRP, and Troponin T with periodontal parameters such as PD and PISA. CONCLUSION: The study reveals, a strong association between periodontitis and diseases of cardiovascular nature, highlighting the need for awareness and timely medical interventions to prevent periodontitis from scaling up and interfering with the risk of cardiovascular problems.

Association of yoga practice and serum cortisol levels in chronic periodontitis patients with stress-related anxiety and depression.

AIM: Reducing the psychosocial stress by various methods can improve overall health, and yoga is now considered as an easily available alternative method. The present cross-sectional pilot study was conducted mainly to find the association of yoga practice with periodontal disease by measuring serum cortisol levels. MATERIALS AND METHODS: A total of 70 subjects with age range of 35-60 years suffering with chronic periodontitis were divided into group I (with stress), group II (without stress), and group III (practicing yoga). Psychological evaluation was carried out using Hamilton Anxiety Rating Scale (HAM-A) and Zung Self-rating Depression Scale (ZSDS). Periodontal parameters like plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) at 5-8 mm and >8 mm were recorded. Blood samples were collected and serum cortisol levels were measured. RESULTS: Mean age, plaque scores, and number of teeth with PPD and CAL at 5-8 mm and >8 mm were similar in all the groups, except between group I and group III where a multiple comparison with Tukey's post-hoc test showed significant difference in plaque index (P < 0.038) and the number of teeth with CAL 5-8 mm (P < 0.016). Serum cortisol levels and HAM-A scale and ZSDS scores showed highly significant value (P < 0.001) in group I subjects when compared with group II and group III subjects. CONCLUSION: Cross-sectional observation done among three groups showed that individuals practicing yoga regularly had low serum cortisol levels, HAM-A scale and ZSDS scores, and better periodontal health.

Awareness of periodontal disease and its management among medical faculty in Guntur district: A questionnaire-based study.

AIM: The aim of this study was to assess the awareness of periodontal disease, its influence on general health, and attitude toward periodontal disease management among medical faculty in Guntur district. MATERIALS AND METHODS: In this cross-sectional study, 150 medical faculty members from different specialties in Guntur district were included in the study. A self-administered questionnaire was prepared based on knowledge, attitude, and practice surveys to assess the awareness of periodontal disease and its management. RESULTS: Majority of the study participants (82%) had a previous dental visit. Only 31.3% believed that plaque is the major cause for periodontal disease. 56.7% responded that the relation between periodontal disease and systemic diseases is bidirectional. Only 39.3% were aware that periodontal disease is a risk factor for preterm low-birth weight infants. 52.6% of the medical faculty thought that scaling causes loss of enamel. 54.7% were aware that light amplification by stimulated emission of radiation is used in the periodontal treatment. Medical professionals who visited specialist in their previous dental visit obtained mean periodontal score (5.35 ± 1.686) greater than those who had visited general dentist and the difference is statistically significant (0.024). CONCLUSION: This study clearly demonstrates that medical practitioners had fair knowledge about various aspects of periodontal disease. This was particularly evident among those who have had a previous visit to a dentist. It was also found that young professionals with limited experience in the profession had better knowledge.

Evaluation of Periodontal Risk in Adult Patients using Two Different Risk Assessment Models - A Pilot Study.

OBJECTIVE: The aim of the present study was to evaluate the periodontal risk of individuals using periodontal risk assessment (PRA) model and modified PRA model. MATERIALS AND METHODS: A total of 50 patients with chronic periodontitis, age 30-60 years were selected randomly and charting of the periodontal status was performed and those who met the inclusion criteria were enrolled in the study. Parameters recorded were- percentage of sites with bleeding on probing (BOP), number of sites with pocket depths (PD) ≥ 5mm, number of the teeth lost, bone loss (BL)/age ratio, Clinical attachment loss(CAL)/age ratio, diabetic and smoking status, dental status, systemic factors like diabetes were assessed. All the risk factors were plotted on the radar chart in (PRA) and (mPRA) models, using Microsoft excel and periodontal risk were categorized as low, moderate and high risk. RESULTS: Among 50 patients 31 were in low risk, 9 in moderate risk, and 10 in high risk identified by modified (PRA) model, whereas 28 patients were in low risk, 13 in moderate risk and 9 in high risk identified by (PRA). Statistical analysis demonstrated that there was no significant difference between the risk scores (X(2) = 0.932 with degree of freedom = 2, P = 0.627). CONCLUSION: Both the periodontal risk models are effective in evaluating the risk factors and can be useful tool for predicting proper diagnosis, disease progression and therapeutic strategies during the supportive periodontal therapy.

Effect of 3D animation videos over 2D video projections in periodontal health education among dental students.

BACKGROUND: There is limited evidence about the distinguished effect of 3D oral health education videos over conventional 2 dimensional projections in improving oral health knowledge. This randomized controlled trial was done to test the effect of 3 dimensional oral health educational videos among first year dental students. MATERIALS AND METHODS: 80 first year dental students were enrolled and divided into two groups (test and control). In the test group, 3D animation and in the control group, regular 2D video projections pertaining to periodontal anatomy, etiology, presenting conditions, preventive measures and treatment of periodontal problems were shown. Effect of 3D animation was evaluated by using a questionnaire consisting of 10 multiple choice questions given to all participants at baseline, immediately after and 1month after the intervention. Clinical parameters like Plaque Index (PI), Gingival Bleeding Index (GBI), and Oral Hygiene Index Simplified (OHI-S) were measured at baseline and 1 month follow up. RESULTS: A significant difference in the post intervention knowledge scores was found between the groups as assessed by unpaired t-test (p<0.001) at baseline, immediate and after 1 month. At baseline, all the clinical parameters in the both the groups were similar and showed a significant reduction (p<0.001)p after 1 month, whereas no significant difference was noticed post intervention between the groups. CONCLUSION: 3D animation videos are more effective over 2D videos in periodontal disease education and knowledge recall. The application of 3D animation results also demonstrate a better visual comprehension for students and greater health care outcomes.