Blue laser-assisted depigmentation of gingiva using non-ablative technique.

Diode lasers are one of the most widely used modalities in soft tissue dental surgery. Recent advancements have expanded the clinically useful emission spectrum of diode lasers to include the blue light region, corresponding to wavelengths such as 445 and 450 nm. The melanin present in hyperpigmented gingiva acts as a chromophore and absorbs laser energy, thus facilitating the denaturing of melanin-containing cells in the gingiva. This paper presents a case of ethnicity-related gingival hyperpigmentation that was successfully treated using a 445 nm blue wavelength soft tissue diode laser by non-ablative technique. The treated area showed no recurrence of pigmentation up to 9 months postoperatively.

Contextual barriers in effective interpersonal communication with patients: A qualitative analysis.

Purpose: Competence building in interpersonal communication (IPC) between undergraduate students and patients requires deep understanding of the factors influencing their interaction. These factors, contextual to our clinical setup were explored from multisource perspectives to understand the perceived barriers in IPC. Method: Qualitative hermeneutic phenomenological analysis was done for patient's semi-structured interviews (n = 16); interns (n = 15) and faculty (n = 14) unstructured focus group discussions. Three independent authors transcribed the data, derived codes and themes individually, and then collated and reflected on them to draw conclusions. Different collection methods, multisource perspectives, and multilevel analysis provided for triangulation and validation of the study results. Results: This study's multisource feedback identified seven inter-dependent barriers to interpersonal communication between students and patients. They were time constraints, lack of trust and respect, cultural diversity, loco-regional linguistic differences, lack of empathy, illiteracy, and financial constraints. Conclusions: The study concluded by identifying the unique set of barriers preventing interpersonal communication in our clinical microsystem. Addressing these contextual factors by preparing training modules and workshops would prepare undergraduate students for patient-centered care and partnership.

Effect of planning interventions on parent supervised oral health behaviors in primary school-age children: a randomized controlled trial.

OBJECTIVE: To compare the effect of planning interventions on self-reported changes in parents supervised oral health-related behaviors (OHRBs) and associated clinical oral health parameters for primary school-age children. METHOD AND MATERIALS: In total, 110 parent-child pairs (children aged 3 to 8 years) were randomly assigned to either of the two groups. In the "action planning" group, parent participants of the pair were asked to make an "action plan" using the "how, when, where" format for their child OHRBs. In the "implementation intention" group, parents were asked to form an "if-then plan" to improve OHRBs for their child. Self-reported changes on target OHRBs, change in plaque scores, change in plaque stagnation areas, and change in caries status of tooth surfaces were observed at 2, 8, and 12 weeks. RESULTS: Overall OHRBs scores changed significantly from baseline to 12 weeks for both interventions. The scores were significantly better with "if-then" planning than "action planning" (z = 4, P < .001) at 12 weeks. Plaque scores also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning (16.20 ± 5.24) than "action planning" (50.66 ± 11.24) at 12 weeks. The number of plaque stagnation areas also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning at 12 weeks (12.80 ± 5.33) than "action planning" (42.76 ± 10.34) (t = -11.55, P < .001). There was significant change in the caries status of sound tooth surfaces with "action planning" at 12 weeks (z = 116.50, P = .023). There were no new caries lesions reported with "if-then" planning at 12 weeks. CONCLUSION: The study observed significant improvement in OHRBs and associated oral health parameters with planning interventions, preferring "if-then" planning over "action planning." It also elicited significant barriers to behaviors in action.

Periodontal health status in patients with lung cancer: Case-control study.

Objective: The objective of this study was to assess the periodontal health status of individuals with lung cancer in the North Indian population. In addition, the study aimed to determine the levels of human beta-defensin2 (Hbd-2) in the gingival crevicular fluid (GCF) and serum samples collected from the participants. Methods: The study consisted of a total of 90 participants, who were categorized into three groups: Group 1 included 30 healthy individuals, Group 2 comprised 30 patients with chronic periodontitis, and Group 3 involved 30 patients diagnosed with both lung cancer and chronic periodontitis. Various periodontal parameters, including plaque index, gingival index, probing pocket depth, and clinical attachment level (CAL), were assessed in addition to the analysis of human beta defensin2 levels in both the GCF and serum samples of all participants. Results: The study results revealed that all clinical parameters assessed were higher in Group 3 compared to both Group 2 and Group 1. Specifically, the levels of hBD-2 in the GCF were measured as 52.29 ± 46.41 pg/mL in Group 1, 27.15 ± 28.76 pg/mL in Group 2, and 86.01 ± 68.82 pg/mL in Group 3. When comparing the hBD-2 levels in serum, the values were found to be 813.72 ± 269.43 pg/mL in Group 1, 591.50 ± 263.91 pg/mL in Group 2, and 1093.04 ± 674.55 pg/mL in Group 3. These intergroup comparisons indicate variations in hBD-2 levels among the different groups. Conclusions: The study findings demonstrated significantly higher clinical and biochemical markers in patients with both lung cancer and chronic periodontitis, in comparison to individuals with chronic periodontitis alone and healthy participants. These results suggest that Hbd-2 could potentially serve as a valuable diagnostic biomarker for identifying and distinguishing individuals with both lung cancer and chronic periodontitis.

COVID-19 outbreak journey of dental care workers: A systematic review.

The conditions of health-care professionals including dental fraternity have been extremely affected during the COVID-19 pandemic. Dental care workers have suspended all routine dental activities with the fear of transmission of the virus from aerosol-generating dental procedures. They have also stood with medical care professionals as frontline warriors because of the exponentially overburdened of the COVID-19-positive patients worldwide. With the available literature, the aim of this article is to address the trajectories of the life of oral health workers during the outbreak of COVID-19 as well as to analyze what measures shall be taken to improve their overall physical, mental, social, and economic health and precautions while working in dental environment.

Alopecia and Periodontitis: Exploring the connecting dots.

Alopecia areata is a systemic disease with nonscarring hair loss from the scalp, face, or any part of the body. The disease with undetermined etiology and pathogenesis has a considerable impact on the social life of patients which gradually builds up stress and expedites further deterioration of their condition. Interestingly, in such patients, besides stress-relieving exercises and immunomodulators, well-timed dental assessment and prompt treatment have contributed to improving the prognosis of alopecia. This depicts an interrelationship between alopecia and oral foci of infections. Over the past few decades, periodontitis has remained to be one of the predominant forms of oral focus of infection for systemic diseases. The present review throws light on the role of stress and autoimmunity in establishing a possible correlation between alopecia and periodontitis. It is augmented with documented case reports, demanding a complete oral examination in patients with the unexplained origin of alopecia. An interdisciplinary approach is the need of the hour which can prevent the progression of both the diseases as well as other oral infections.

ISP good clinical practice recommendations for gum care.

Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to "Gum Care for All", is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.

A study to evaluate psychological and occlusal parameters in bruxism.

PURPOSE: To evaluate the role of anxiety/depression and occlusal factors in bruxism using Hospital Anxiety and Depression Scale and T-Scan III respectively. METHODS: The present case control study was comprising of a group of thirty patients with bruxism (Group Br) and 30 healthy individuals as control group (Group NBr). Subjects were selected from outdoor patients visiting the dental unit with the chief complaint of wearing off/sensitivity of all the teeth due to habitual grinding. The cases were selected by using the diagnostic criteria as given by the American Academy of Sleep Medicine (AASM). Further based on similarities of age and gender, controls were selected. Tooth wear index was recorded using an index given by Ekfeldt et al. Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to both the groups to evaluate anxiety and depression. Recording of occlusal parameters in both the groups was done digitally by using T-Scan III. Statistical analysis was done by using student's t-test, chi square test and Mann Whitney U test. RESULTS: Group Br had significantly greater mean tooth wear index (22.24 ± 11.5) than group NBr (5.17 ± 3.30). Group Br had significantly higher anxiety (9.03 + 1.87/7.17 + 1.82) and depression scores (8 + 1.93/6.17 + 1.23) as compared to NBr. The disclusion time of group Br was 0.652 ± 0.749 and that of group NBr was 0.247 ± 0.289 (p = 0.008). CONCLUSIONS: Subjects with higher level of anxiety, depression and increased disclusion time may have greater predilection towards suffering from bruxism (p < 0.05).

Localized probiotic-guided pocket recolonization in the treatment of chronic periodontitis: a randomized controlled clinical trial.

PURPOSE: This randomized clinical placebo-controlled trial was conducted to evaluate the effectiveness of Lactobacillus reuteri as a probiotic in guided pocket recolonization (GPR) for the treatment of chronic periodontitis (CP) adjunctive to scaling and root planing (SRP). METHODS: Forty-eight CP patients were randomly assigned to 3 treatment groups: group 1 (SRP+placebo), group 2 (SRP+single application of probiotic), and group 3 (SRP+incremental application of probiotic). Clinical parameters were evaluated at baseline and at 8, 12, and 24 weeks, whereas biochemical parameters were measured at baseline and 12 weeks. RESULTS: At 24 weeks, the probing pocket depth and clinical attachment level improved in all 3 groups from baseline with no significant intergroup differences; however, a statistically significant difference was observed in localized plaque and gingival scores between groups 1 and 3 (P<0.05). At 12 weeks, matrix metalloproteinase-8 (MMP-8), nitric oxide (NO), and gingipains-R (Rgps) levels improved in all 3 groups, with statistically significant differences between groups 1 and 3 for MMP-8 and NO (P<0.05), but no difference for Rgps levels. CONCLUSIONS: Within its limitations, the results of this study show that incremental 3-time application of L. reuteri as a probiotic led to improvements in clinical and biochemical parameters. This protocol can be a useful adjunct to SRP in the non-surgical management of CP. TRIAL REGISTRATION: Clinical Trials Registry - India Identifier: CTRI/2017/03/008231.

Reflective learning for behavioral guidance in pediatric dentistry.

INTRODUCTION: Basic behavioral guidance (BBG) skills help in delivery of quality health care in pediatric dentistry. The complex nature of these skills, warrants analyzing actions performed. An appropriate scientific way to do this is by "reflection." Hence, the present study was designed to introduce "reflection of action" as means for learning BBG skills by undergraduates in pediatric dentistry. METHODS: Participants (dental undergraduate) performed oral prophylaxis (two visits) in pediatric patients (age 3-7 years) with application of BBG skills, under video recording. They were instructed regarding "reflection on action." The learners then reviewed own videos and wrote reflections. Reflections were assessed on Boud's 4R framework and feedback was given by the faculty. Reflective writing was repeated for a second visit. Knowledge of the learners in using reflections for learning was assessed by retrospective pretest posttest questionnaire. Video recordings were scored for BBG skills. Acceptability of the intervention was addressed by satisfaction questionnaire. RESULTS: There was a significant improvement in the knowledge of participants in using reflections for learning these skills. All participants were able to "revisit" (R1 level under Boud's 4R framework) patient encounter in their written reflections. Sixteen participants exhibited shift toward higher levels in the next visit. Video scores of learners also improved significantly over both visits. Students were satisfied with the content, delivery, and relevance of the new educational intervention. CONCLUSION: The strong need of improving BBG skills in pediatric dentistry was met by "reflection on action." There was improvement in the knowledge of students in using reflections for learning and application of behavior guidance skills and was well accepted.

Prevalence of herpesviruses in periodontal disease of the North Indian population: A pilot study.

INTRODUCTION: Periodontitis is a multifactorial disease of diverse microbiome, predominantly bacterial. Bacterial infection alone may not explain complete pathophysiology and clinical variations in disease pattern. Concept of herpesviruses playing a significant role in periodontal pathogenesis has been explored globally. Studies show varied results and difference may be accounted to variations existing in studied populations. The present study explored the prevalence of herpesviruses in periodontal disease of the North Indian population. MATERIALS AND METHODS: In this case-control study, tissue samples were collected from the normal gingiva (control: n = 48) and deepest pocket (cases: n = 48) using a single curette stroke. Periodontal disease status was assessed through the gingival index, pocket depth, and clinical attachment level which were compared to viral marker positivity. RESULTS: Ninety samples from 48 healthy gingiva and 48 periodontitis patients were assessed between the age range of 17-60 years. The prevalence of cytomegalovirus was 2.083% (cases) and 2.083% (controls) and Epstein-Barr virus (EBV) was 18.75% (cases) and 0% (controls). Odd's ratio for EBV in patients with periodontitis is calculated (Haldane-Anscombe correction) to be 21.82%. Herpes simplex virus 1/2 and varicella-zoster virus were absent in both groups. CONCLUSIONS: Within the limitation of this study, EBV was found in cases of periodontitis patients. Its role in disease initiation and progression is not clear. Further studies are required to ascertain EBV as risk factor in periodontal disease.

Relationship between VITAMIN D and chronic periodontitis.

INTRODUCTION: Chronic periodontitis is a multifactorial disease primarily caused by plaque microorganisms, modified from the immune inflammatory response to chronic infection, which leads to the destruction of periodontal tissues in a susceptible host. It is very well known that vitamin D plays a vital role in bone homeostasis and immunity. There can be a biologic rationale to suspect that Vitamin D deficiency could negatively affect the periodontium. Present study was conducted to investigate any relationship between periodontitis and vitamin D. MATERIAL AND METHOD: The clinico-biochemical relationship study was carried out in 168 subjects with Chronic Periodontitis. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) are correlated with serum level of Vitamin D. RESULTS: Statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed.No relationship between 25(OH) D levels and PI was observed.This study also revealed overall low levels of serum Vitamin D in patients with chronic periodontitis but the levels of Vitamin D did not decrease with the increase in the severity of periodontitis. CONCLUSION: A statistically significant relationship between serum 25(OH) D level and periodontal parameters namely GI, PPD and CAL were observed. No relationship between 25(OH) D levels and PI was observed.

A Study to Determine the Prevalence of Temporomandibular Disorders in a Young Adult Population and its Association with Psychological and Functional Occlusal Parameters.

PURPOSE: To determine the prevalence of temporomandibular disorders (TMD) in medical university students and to analyze the relationship of TMD with psychological and functional occlusal parameters. MATERIALS AND METHODS: 200 students (mean age 21.81 ± 1.99) were screened for TMD with the TMD Pain Screener. Clinical examinations identified the participants with TMD. Based on their diagnostic criteria for TMD (DC/TMD) axis I diagnosis, participants were divided into three groups: group 1- non-TMD, group 2- pain related TMD and headaches, and group 3- intra-articular joint disorders. Further study was continued involving patients diagnosed with TMD as the study group, and an equal number of age- and sex-matched participants were selected in control group. Among these, emotional distress was evaluated using the "hospital anxiety and depression scale" (HADS). Occlusal evaluations were done by using the T-Scan computerized occlusal analysis system. Occlusion time, left lateral disclusion time, right lateral disclusion time, and protrusion disclusion time were measured with T-Scan III. These parameters were compared among the groups with ANOVA test at a significance level of 0.05. RESULTS: 17% of the population were affected by TMD. The mean HADSd (depression) and HADSa (anxiety) scores were significantly higher (p < 0.05) in group 2 (7.67 ± 3.68; 10.60 ± 3.33) and group 3 (6.89 ± 3.23; 9.26 ± 4.05) as compared to group 1 (3.18 ± 2.33; 5.29 ± 3.21). The mean values of occlusion time, left lateral disclusion time, right lateral disclusion time, and protrusion-disclusion time were also higher for group 2 and group 3 as compared to group 1. CONCLUSIONS: This study found that the prevalence of TMD in this university student population was 17%. There were significant associations of TMD with psychological parameters and functional occlusal parameters.

Efficacy of Acacia arabica gum as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized controlled clinical trial.

AIM: The aim of the present study was to explore the adjunctive use of Acacia arabica gel in the treatment of chronic periodontitis. METHODS: Single centre, randomised, triple blind, controlled trial on mild to moderate chronic periodontitis patients; Group I (SRP + Acacia arabica, n = 40) and Group II (SRP + placebo, n = 40); were analysed for clinical improvements in periodontal pocket depth (PPD) and clinical attachment levels (CAL) at baseline, 15 and 90 days on application of gels. Gingival index and plaque index were assessed as secondary parameters. RESULTS: Statistically significant PPD reduction (p < .05) and CAL gain (p < .05) was observed with use of Acacia arabica gel. The reduction in sites with moderate PPD was observed more among Group I than Group II and the difference was statistically significant (p = .001). Secondary outcome variables; Plaque Index and Gingival Index showed better resolution with Acacia arabica gel. CONCLUSION: Acacia arabica leads to better clinical outcomes in patients with mild to moderate chronic periodontitis with effective antiplaque and anti-gingivitis action. It may be recommended adjunct to SRP for maintenance in patients with mild to moderate chronic periodontitis.

Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff.

Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Comparative evaluation of periosteum as a barrier membrane with and without an alloplastic bone graft in periodontal osseous defects: A 9 months follow-up study.

BACKGROUND: Regenerative procedures frequently include the use of barrier membranes and bone grafting materials to encourage the growth of key surrounding tissues. The present study aims to evaluate and compare the ability of periosteum in intrabony defect regeneration. MATERIALS AND METHODS: A total of ten intrabony defects were equally divided in two treatment groups. Group I consisted of Periosteum used as a barrier memebrane and Group II of periosteum as barrier membrane alongwith graft material. Nine months post operative evaluation of defect fill was done radiographically. RESULTS: Mean defect fill (CEJ-BBD) was found to be significantly lower in Group II as compared to Group I (P = 0.041). CONCLUSION: Within the limitations of this study, alloplastic graft material supplimentation results in better regeneration with Periosteum used as a barrier membrane.

Periodontal plastic pioneering procedures revisited.

BACKGROUND: Various periodontal plastic procedures are available for treatment of localized gingival recessions. However, in the mirage of newer techniques and materials available, it is difficult for clinicians to decide on the treatment modality. Pioneering techniques provide a cost effective and effective means of maintaining esthetics in recession cases. MATERIALS AND METHODS: Twenty-two subjects with localized gingival recessions were divided in equal groups and treated with lateral pedicle graft (Group A) and Free mucosal graft (Group B). Clinical parameters of length and width of recession and apico coronal length of keratinized gingiva (ACKG) was measured at baseline, 30 and 90 days. Root coverage percentage was calculated. RESULTS: Both groups were effective in recession coverage and gain in ACKG. Root coverage gained in Group A was 65.0 ± 25.2% and for Group B was 61.6 ± 20.5%. CONCLUSION: Lateral pedicle graft and Free mucosal graft provide not only effective means of gaining in root coverage of localized gingival recession cases but also result in gain of ACKG. These techniques remain an important part of periodontal plastic surgery.

Role of space provision in regeneration of localized two-wall intrabony defects using periosteal pedicle graft as an autogenous guided tissue membrane.

BACKGROUND: Marginal pedicle periosteum (MPP) has been used as a rigid membrane in guided tissue regeneration (GTR) for osseous defects. The present study aims to study the effect of space provision by an alloplastic graft material in bone defect area (BDA) reduction of 2-wall defects. METHODS: Twenty interproximal intrabony 2-wall defects in healthy non-smoking patients with chronic periodontitis were randomly divided in control (group 1, periosteum alone) and experimental (group 2, periosteum with alloplastic graft material) groups. Measurements of probing depth (PD), clinical attachment level (CAL), and radiographic BDA were done at the baseline and 6-month postoperative evaluations. RESULTS: The 6-month postoperative assessment showed clinical and radiographic improvements with PD reduction, CAL gain, and changes in BDA in both groups, which was statistically significant compared with baseline (P <0.05). However, BDA reduction was statistically greater in group 2 (48.88% ± 18.61%) compared with group 1 (14.08% ± 12.97%) at the 6-month follow-up (P = 0.009). CONCLUSION: Within the limitations of this study, it can be concluded that space provision by an alloplastic graft material increases the regenerative potential of MPP as a GTR membrane and results in increased defect fill.

Odontogenic myxoma presenting as localized inflammatory gingival enlargement: A diagnostic dilemma.

Odontogenic myxoma (OM) is a rare and locally invasive benign neoplasm found exclusively in the maxillofacial region. The radiographic and clinical features are variable, and the diagnosis is therefore not easy. A case of OM of the maxilla is described in a 19-year-old female, previously diagnosed as inflammatory gingival enlargement. Clinical, histological, radiographic, and computed tomographic (CT) scan assessments were done, which were confirmatory for OM. Surgical excision of the lesion was done. The patient was put on periodic recall, as the recurrence rate of the lesion was high. The biological spectrum of OM was highly variable and diagnosis at an early stage was very difficult. Gingival enlargement presentation might not always be an inflammatory reaction. All possible differential diagnosis should be explored and various diagnostic tools utilized, to screen the enlargement.

Aesthetic management of gingival recession by root biomodification with carbon dioxide laser and subepithelial connective tissue graft with lateral repositioned flap technique.

Localised gingival recessions continue to represent an important aesthetic condition requiring treatment in periodontics. Various techniques have been tried to treat exposed root surfaces to improve aesthetics with high percentage of success and minimal discomfort. Root biomodification is done to improve the predictability of these procedures. This clinical report describes periodontal plastic procedure involving subepithelial connective tissue graft with lateral repositioned flap technique and root biomodification with CO(2) laser for the management of gingival recession.