Dental Fluorosis and Periodontium: an Original Research Report of In Vitro and In Vivo Institutional Studies.

Fluorosis is one of the global problems that have persisted for a very long time now without any specific treatment and cure. Fluoride is known for its influence on the tooth structures like enamel and dentin, but little information exists on its effect on the surrounding periodontal structures and bone. With this background, we conducted multiple studies assessing etiological, diagnostic, therapeutic and clinical criteria in subjects with and without dental fluorosis in a single group of the population residing in high fluoride water areas (1.5-3.0 ppm) of Davangere District, Karnataka, India. These preliminary studies conducted are hereby elaborately presented and discussed in this comprehensive review article along with their important conclusions.

Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the effectiveness of Azadirachta indica (neem)-based herbal mouthrinse in improving plaque control and gingival health. METHODS: Literature search was accomplished using electronic databases (PubMed, Cochrane Central Register of Controlled Trials and EMBASE) and manual searching, up to February 2015, for randomized controlled trials (RCTs) presenting clinical data for efficacy of neem mouthrinses when used alone or as an adjunct to mechanical oral hygiene as compared to chlorhexidine mouthrinses for controlling plaque and gingival inflammation in patients with gingivitis. RESULTS: Of the total 206 articles searched, three randomized controlled trials evaluating neem-based herbal mouthrinses were included. Due to marked heterogeneity observed in study characteristics, meta-analysis was not performed. These studies reported that neem mouthrinse was as effective as chlorhexidine mouthrinse when used as an adjunct to toothbrushing in reducing plaque and gingival inflammation in gingivitis patients. However, the quality of reporting and evidence along with methods of studies was generally flawed with unclear risk of bias. CONCLUSION: Despite the promising results shown in existing randomized controlled trials, the evidence concerning the clinical use of neem mouthrinses is lacking and needs further reinforcement with high-quality randomized controlled trials based on the reporting guidelines of herbal CONSORT statement.

Effects of Tetracycline, EDTA and Citric Acid Application on Nonfluorosed and Fluorosed Dentin: An In Vitro Study.

UNLABELLED: Fluorosis is one of the factors that may bring about mineralization changes in teeth. Routine treatment of root biomodification is commonly followed during Periodontal therapy. BACKGROUND: The Purpose of the present study was to compare and evaluate the morphological changes in fluorosed and nonfluorosed root dentin subsequent to the application of Tetracycline, EDTA and Citric acid. Both fluorosed and nonfluorosed teeth comprising of periodontally healthy and diseased were included in this study. METHOD: Each of them was grouped into Tetracycline Hydrochloride, EDTA and Citric acid treatment groupes. Using scanning electron microscope (SEM), the photomicrographs of dentin specimens were obtained. RESULTS: Showed that there was no significant difference in exposure of number of tubules in different groups, while significant increase in the tubular width and tubular surface area was seen in fluorosed healthy, followed by fluorosed diseased groups, nonfluorosed healthy and nonfluorosed diseased groups after root biomodification procedure using various root conditioning agents. The root biomodification procedure brings in definite difference between fluorosed and nonfluorosed dentin specimens.

Azithromycin buccal patch in treatment of chronic periodontitis.

AIM: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. MATERIALS AND METHODS: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90(th) day, and clinical parameter was assessed at the end of 90(th) day. RESULTS: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90(th) day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. CONCLUSION: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.

Autologous Stem Cell Application in Periodontal Regeneration Technique (SAI-PRT) Using PDLSCs Directly From an Extracted Tooth···An Insight.

Periodontal regeneration represents the ultimate goal of periodontal therapy. The current regenerative techniques have limited success rates especially in advanced periodontal defects. Currently the research is focused on novel cell-based approaches for periodontal regeneration to overcome the limitations of existing treatment. The human clinical trial on stem cells based periodontal regeneration is promising. The plethora of animal studies provide sound evidence to support the belief that periodontal ligament stem cells (PDLSCs) can be used for periodontal regeneration. The direct application of autologous periodontal stem cells in treatment of intrabony defects is attempted for the first time in periodontal literature. Stem cell Application in Periodontal Regeneration Technique (SAI-PRT) using direct PDLSCs has overcome the limitations and concerns of ex- vivo stem cell culture methods like high cost, technique sensitivity, loss of stemness during cell passage, genetic manipulation and tumorigenic potential. Clinical feasibility, success and cost effectiveness over currently available techniques are encouraging. The clinical utility of this novel idea is recommended.

Effect of chlorhexidine, povidone iodine, and ozone on microorganisms in dental aerosols: randomized double-blind clinical trial.

OBJECTIVE: Dental handpieces, ultrasonic scalers, air polishers, air abrasion units produce the most visible aerosols. The objective of this study was to assess the effect of chlorhexidine (CHX), povidone iodine (PI), and ozone (OZ) on the microorganisms in dental aerosols. MATERIALS AND METHODS: A total of 60 patients were included in this study, they were randomly assigned into three groups and were subjected to scaling before and after rinsing with 0.2% CHX, 1% PI or irrigation with OZ. Blood agar plates were used to collect the gravitometric settling of aerosols and were sent for aerobic and anaerobic culture. RESULTS: The results demonstrated high percentage reduction of aerobic and anaerobic colony forming units (CFUs) in all three groups. In aerobic CFUs, CHX showed the highest reduction (57%) at mask position whereas at chest position and at 9 ft, PI showed higher CFU reductions (37% and 47%, respectively). In anaerobic CFUs, CHX showed the highest percentage of reduction at chest level (43%) and at 9 ft (44%). CONCLUSION: CHX, PI and OZ showed similar effects in reducing aerobic and anaerobic CFU's at the chest mask and at 9 ft. OZ can be used as a preprocedural agent, considering its beneficial effects.

Fluorosed fibroblast attachment on fluorosed and nonfluorosed teeth after SRP and EDTA root biomodification.

BACKGROUND: Fluorosis causes mineralization changes in the tooth and can lead to morphologic alterations of fibroblasts. To understand the effect of fluorosis on periodontal healing, the initial step during healing, such as fibroblast attachment to the root surface, needs to be evaluated. Hence, the objective of the present study was to study the attachment of fluorosed fibroblasts on the fluorosed and nonfluorosed root fragments. MATERIALS AND METHODS: A total of 56 fluorosed and nonfluorosed, periodontally healthy and diseased tooth roots were obtained and allotted to eight groups: Fluorosed and nonfluorosed healthy controls (FH and NFH, respectively), fluorosed and nonfluorosed diseased controls (FD and NFD, respectively), fluorosed and nonfluorosed roots treated with scaling and root planing (FD + S and NFD + S, respectively), and similar groups treated with scaling and root planing and 24% ethylenediaminetetraacetic acid (EDTA) gel application for 2 min (FD + SE and NFD + SE, respectively). After the respective treatment, the root fragments were incubated in the human periodontal ligament fibroblast cells obtained and cultured from freshly extracted healthy human fluorosed premolar tooth root. RESULTS: In the nonfluorosed roots category, greater attachment was found in the untreated nonfluorosed diseased (P = 0.036) and SRP-treated nonfluorosed diseased groups (P = 0.008) as compared to the nonfluorosed healthy group. While in the fluorosed roots category, no significant difference was observed in FL-FA (P > 0.05) within the group. However, no attachment was observed in EDTA-treated fluorosed root fragments. When fluorosed groups were compared to nonfluorosed groups, no significant changes were noted between the groups. CONCLUSION: SRP proves to be a standard requirement for fibroblast attachment to occur both in fluorosed and nonfluorosed roots. Although there was no significant difference in attachment between SRP and SRP + EDTA among fluorosed roots, EDTA does not seem to be a promising agent for root biomodification in fluorosed roots in a given concentration and time of treatment.

Evaluation of hydroxyapatite (Periobone-G) as a bone graft material and calcium sulfate barrier (Capset) in treatment of interproximal vertical defects: A clinical and radiologic study.

BACKGROUND: This study has been undertaken to assess treatment response of interproximal vertical defects using an alloplast (Periobone-G) and calcium sulfate (Capset) as a barrier both clinically and radiographically. MATERIALS AND METHODS: Eight patients were selected with 16 sites that were divided into control and experimental sites based on split mouth study design. Plaque index, gingival index, probing depth, clinical attachment level, gingival margin position were recorded at baseline and 9 months and radiographic assessment was done at baseline and 9 months after recording clinical parameters, the sites were randomly treated either with hydroxyapatite granules Periobone-G or hydroxyapatite granules (control group) was used to fill the osseous defect and calcium sulfate (Capset) (experiment group) barrier was placed. RESULT: The plaque score reduction was statistically highly significant within control and experimental groups. The gingival score reduction was significant within control and experimental groups, although there were no significant difference between the 2 groups. The pocket depth reduction was significant within control and experimental group, however, the hydroxyapatite + capset group showed significant reduction as compared with hydroxyapatite alone group. The clinical attachment gain and gingival margin position was significant within control and experimental groups, although there was no significant difference between the 2 groups. The amount of defect fill was significant in both control and experimental groups but the difference between the 2 groups was not significant. The mean change in alveolar crest level between control and experimental groups was significant (P=0.02). The percentage of original defect resolved was not significant. CONCLUSION: The use of calcium sulfate as a barrier proved its role in the treatment of interproximal defects. The application of calcium sulfate (Capset) barrier is easy and simple. The multifaceted properties of calcium sulfate demonstrate its usefulness in periodontal practice.

Peri-implant and periodontal tissues: a review of differences and similarities.

The health and vitality of an osseointegrated implant depends on the surrounding supporting tissues, which not only anchor the implant to the bone but also have the important function of providing a protective seal. The aim of this article is to provide a basic understanding of differences and similarities between the periodontal and peri-implant tissues at the histologic, clinical, and immunologic levels; it is essential to know these differences and similarities during the clinical handling of these similar-looking tissues. The comparative features are of clinical relevance because it is critical to understand the behavior of the soft tissue found around the tooth and implant. This knowledge is vital from the preliminary stage of treatment planning through prosthetic rehabilitation.

The effectiveness of manual versus powered toothbrushes for plaque removal and gingival health: A meta-analysis.

BACKGROUND: The aim of this systematic review and associated meta-analysis was to compare manual and powered brushes in relation to the removal of plaque and gingival health. Stain removal, adverse effects and microbiological evaluation cost were also considered. MATERIALS AND METHODS: To be included in the review, a trial had to be a randomized-controlled trial (RCT) comparing manual and powered brushes. Trials confined to comparing different types of powered or different types of manual brushes were excluded. Split mouth designs were eligible. Trials with subjects of specific age group (18-25 years) were included. The primary outcomes were plaque and gingival health with data defined as short-term (0-28 days) duration were analyzed. Powered brushes were categorized into three groups depending on mode of action. Numerical data extracted were checked by a fourth reviewer for accuracy. RESULTS: Three trials with full articles were identified. These include trials published between 2002 and 2005. The trials involved 56 subjects at baseline, without loss of subject for follow up. Powered brushes reduced plaque and gingivitis at least as effectively as manual brushing. Ionic brushes statistically significantly reduced plaque and gingivitis. CONCLUSION: In general there was no evidence of a statistically significant difference between powered and manual brushes. However, ionic brushes significantly reduce plaque and gingivitis in both the short-term evaluations. The clinical significance of this reduction is not known. Observation of methodological guidelines and greater standardization of design would benefit both future trials and meta-analyses.

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

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

Epidemiology of gingival recession and risk indicators in dental hospital population of Bhimavaram.

OBJECTIVE: Gingival recession (GR) is a common manifestation in most populations, and is considered as an early sign of periodontal disease. GR is an intriguing condition where various factors play an important role in its etiology. Only few studies have been undertaken to assess the prevalence and risk factors for GR in patients visiting dental hospitals. The aim of this study is not only to estimate prevalence, severity, and extent of GR in hospital population, of Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, but also to assess the potential risk factors for the same. MATERIALS AND METHODS: In this study, 2837 patients were examined of which 627 were included into the study. The age range was 16-80 years. Subjects were interviewed using a structural questionnaire, and full mouth clinical examination was done to assess recession. RESULTS: Of all subjects examined 45.6%, 16.2% of individuals and 13%, 4.8% of teeth per individual showed GR >3 mm. Prevalence and severity of recession was correlated with age. Recession was present but recession threshold ≥3 and ≥5 mm affected only small percentage of teeth in subjects younger than 45 years. Mandibular incisors showed the highest prevalence of GR ≥1 mm with 61% of teeth being affected. Smoking and presence of supragingival calculus were most significantly associated localized and generalized recession. CONCLUSION: Prevalence of periodontal disease is high among this population based on the presence of gingival recession in most the individuals. High prevalence of GR is significantly associated with supragingival calculus and smoking habits. This suggests a need to improve their periodontal condition through education, motivation, and improving their periodontal health.

Clinical and radiographic evaluation of human periodontal osseous defect (mandibular grade II furcation) treated with PepGen P-15 and a bioresorbable membrane (Atrisorb).

BACKGROUND: The various treatment modalities available to treat furcation involvement either maintain the existing furcation or increases access to furcation or leads to elimination of furcation (root resection, bicuspidization etc). Newer treatment modalities include regenerative procedures like placement of bone graft and organic or synthetic membranes. In this study we have evaluated the use of a new xenograft based tissue engineered bone material which provides both the inorganic and organic component; individually and in conjunction with a synthetic bioresorbable material. MATERIALS AND METHODS: 6 patients with 18 mandibular grade 2 furcations were selected after the completion of initial phase in all the patients. Selected sites were divided into control and experimental groups randomly and were treated by split mouth design. The control sites were treated with flap debridement and placement of ABM graft, whereas the experimental site received flap debridement, ABM graft and a synthetic bioresorbable membrane. RESULTS: All the parameters recorded showed significant reduction from baseline to 9 months in both the experimental and control group. When compared in between the control and experimental group, all the parameters showed marginally better results in the control group, although none of them were clinically significant. CONCLUSION: The results of this study suggest that the use of ABM along with a bioresorbable membrane and without membrane is both beneficial for the treatment of grade 2 furcation. On the cost benefit basis, the bone graft alone seems to be a better choice for regenerative treatment of furcation involvement.

The comparative evaluation of xanthan gel with chlorhexidine (Chlosite) in smokers and non-smokers: A clinical and microbiological assessment.

BACKGROUND AND OBJECTIVES: Prevention of the periodontal disease progression is the primary goal of periodontal therapy. When conventional therapy is found inadequate to attain periodontal health in chronic periodontitis, local antimicrobial agents have been used as an adjunct with scaling and root planning (SRP) which has reproduced encouraging results. Hence, this study was undertaken to evaluate the new sustained released local drug Chlosite clinically and microbiologically in smokers and non-smokers. MATERIALS AND METHODS: The patients were grouped into experimental group A treated with SRP plus Chlosite (SRP + CHL), experimental group B treated with Chlosite alone (CHL), and control group C treated only with SRP alone. A total number of 141 sites from six patients (67 sites from three non-smoker patients and 74 sites from three smoker patients) participated in this study. The clinical parameters, Plaque index (PI), Gingival index (GI), Bleeding index (BI), and Relative attachment level (RAL), were recorded and subgingival plaque samples were collected and subjected to microbiological analysis. RESULTS: On comparison of smokers and non-smokers, in SRP group, non-smokers showed a higher reduction in BI and GI and smokers showed a higher reduction in PI. There was no significant gain in RAL of both smokers and non-smokers. In SRP + CHL group, non-smokers showed a higher reduction in relation to BI and GI and smokers showed a higher reduction in relation to PI. There was no significant gain in RAL of both smokers and non-smokers. In CHL group, both smokers and non-smokers showed a nonsignificant reduction in BI, GI, and RAL, but smokers showed a significant reduction in PI as compared with non-smokers. All the groups showed reduction in the microbial count of Fusobacterium nucleatum, Porphyromonas gingivalis, and Tannerella forsythia which were found to be statistically not significant when it was compared between non-smokers and smokers. INTERPRETATION AND CONCLUSION: In this study, all treatment groups were found to be efficacious in the treatment of periodontal disease as demonstrated by improvement in PI, GI, BI, and RAL. Combination of SRP and Chlosite resulted in added benefits compared with the two treatment groups.

Melanin: a scavenger in gingival inflammation.

BACKGROUND: One of the major direct or indirect targets of ultraviolet exposure of skin is the melanocyte or the melanin -forming cell. Epidermal melanocytes act as a trap for free radicals. Based on the protective role of melanocytes in medical literature, the role of melanin pigmentation in gingiva needs to be elucidated. Periodontal pathogens and their products demonstrate the ability to induce the generation of reactive oxygen species. Hence purpose of this study was to unravel the protective role of melanin (if any) against the gingival inflammation. MATERIALS AND METHODS: A total of 80 subjects; 20 in each group were selected. The selection of subjects regarding gingival pigmentation was based on Dummett's scoring criteria 0, 3. A complete medical, dental history and an informed consent were obtained from the patients. After evaluation of clinical parameters the GCF was collected using microcapillary pipettes at the selected sites. IL-1ß levels were quantitated using ELISA. RESULTS: In non-pigmented healthy and gingivitis groups, there was a positive correlation between plaque index, gingival index and bleeding index versus IL-1ß level: indicating an increase in the biochemical mediator of inflammation corresponding to an increase in the clinical parameters of inflammation. Also a positive correlation was found between the gingival index and bleeding index versus the IL-1ß levels in the pigmented healthy group. The pigmented gingivitis groups showed a negative correlation between the plaque index, gingival index and bleeding index. CONCLUSIONS: The clinical markers of inflammation such as gingival index, bleeding index was of low numerical value in pigmented group than in the non-pigmented group, supposedly due to the protective action of melanin. The negative correlation of clinical markers of inflammation to the IL-1ß levels in the pigmented gingivitis group could possibly be attributed to the protective role of melanins.

Management of gingival inflammation in orthodontic patients with ozonated water irrigation--a pilot study.

OBJECTIVE: Ozonated water irrigation has recently been tried for its antimicrobial and anti-inflammatory effects in treatment of periodontitis. During orthodontic treatment, gingival inflammation occurs along with increased lactate dehydrogenase (LDH) enzyme levels in gingival crevicular fluid (GCF). Thus, the aim of this pilot study was to evaluate the clinical effects of a single subgingival irrigation with ozonated water on gingival inflammation in orthodontic patients and also to correlate the clinical effects with LDH enzyme activity in GCF. METHODS: Fifteen systemically healthy orthodontic patients (seven men and eight women, mean age 17.3 years) with full-mouth brackets were included in this prospective, cross-sectional, clinical and laboratory investigation. Clinical parameters, LDH enzyme activity and GCF volume were measured at baseline (0 day) followed by subgingival irrigation with 0.01 mg l(-1) ozonated water. These parameters were again assessed on 14th and 28th day. RESULTS: There was significant (P < 0.05) reduction in values of clinical parameters, GCF LDH activity and GCF volume after subgingival irrigation with ozonated water. Also, a significant correlation (r = 0.50, P = 0.01) was observed only between the post-treatment changes of plaque index and LDH values, among the clinical parameters assessed. CONCLUSIONS: A single subgingival irrigation of 0.01 mg l(-1) ozonated water can effectively reduce the gingival inflammation in orthodontic patients, which is also reflected in the reduction of LDH enzyme levels. However, further randomized controlled trials are required to validate the use of ozone irrigation in orthodontic patients for plaque control measures.

Effect of local drug delivery in chronic periodontitis patients: A meta-analysis.

Periodontal diseases are multi-factorial in etiology, and bacteria are one among these etiologic agents. Thus, an essential component of therapy is to eliminate or control these pathogens. This has been traditionally accomplished through mechanical means (scaling and root planing (SRP)), which is time-consuming, difficult, and, sometimes, ineffective. From about the past 30 years, locally delivered, anti-infective pharmacological agents, most recently employing sustained-release vehicles, have been introduced to achieve this goal. This systematic review is an effort to determine the efficacy of the currently available anti-infective agents, with and without concurrent SRP, in controlling chronic periodontitis. Four studies were included, which were all randomized controlled trials, incorporating a total patient population of 80, with 97 control sites and 111 test sites. A meta-analysis completed on these four studies including SRP and local sustained-release agents compared with SRP alone indicated significant adjunctive probing depth (PD) reduction for 10% Doxycycline hycylate (ATRIDOX), minocycline hydrochloride (ARESTIN), tetracycline hydrochloride (PERIODONTAL PLUS AB), and chlorhexidine gluconate (PERIOCHIP). Essentially, all studies reported substantial reductions in gingival inflammation, plaque scores, and bleeding indices, which were similar in both the control and the experimental groups. Use of antimicrobial sustained-release systems as an adjunct to SRP does not result in significant patient-centered adverse events. Local drug delivery combined with SRP appears to provide additional benefits in PD reduction compared with SRP alone.

Prophylactic vaccination against periodontal disease: a systematic review of preclinical studies.

BACKGROUND: Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is to systematically review all preclinical (i.e., animal) studies that present supporting evidence for the feasibility of formulating a prophylactic human periodontal vaccine. METHODS: A manual and electronic literature search was made for animal studies up to February 2010 that presented clinical, morphologic (alveolar bone level), and immunologic data for the efficacy of a prophylactic periodontal vaccine. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, quality assessment, determination of outcome measures, screening method, data extraction, data synthesis, and drawing of conclusions. RESULTS: Only two randomized controlled animal trials qualified, and they reported exactly opposite effects of vaccine administration in Macaca fascicularis experimental periodontitis models by administration of two different agents (i.e., a negative effect with combined whole-cell antigens of Porphyromonas gingivalis and Prevotella intermedia in contrast to a positive effect with cysteine proteases of P. gingivalis). However, no statistical process could be applied to their results (data inadequately reported) in order to pool and evaluate the changes in outcome measures after vaccine administration, which, highlighted their mediocre study quality. CONCLUSIONS: Because of the insufficient quantity and quality of animal trials, no adequate evidence could be gathered to use the beneficial effects of these animal experiments to formulate a prophylactic human periodontal vaccine. Thus, good-quality animal trials are needed in this field of vaccine testing.

Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate the effects of Lactobacilli reuteri (Prodentis) alone and in combination with scaling and root planing (SRP) in a double blind, randomized, placebo-controlled clinical trial of volunteers with chronic periodontitis. METHODS: Thirty, otherwise systemically healthy, chronic periodontitis patients (19 males and 11 females, aged between 34 and 50 years) were included. The study period was 42 days. 'Split-mouth' design was used for the SRP, which was performed on day 0; two quadrants (either right or left) were treated with SRP whereas the remaining two quadrants were left untreated. The participants received a toothbrush, toothpaste, and brushing instructions. L. reuteri Prodentis lozenges (1×10(8) CFU DSM17938+1×10(8) CFU ATCC PTA 5289) or the corresponding placebo lozenges were taken twice daily from day 21 to day 42. Statistical analysis was done for comparisons of clinical parameters (Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), probing pocket depth (PPD), clinical attachment level (CAL)) and microbiological levels of the pathogens Aggregibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Prevotella intermedia (Pi). All p-values less than 0.05 were considered significant. Assessments were made on day 0 before SRP treatment, on day 21 before administration of the lozenges, and on day 42. RESULTS: At day 42, the PI, GI, and GBI were significantly reduced by all treatment modalities. When ranked, the amount of PI, GI and GBI reduction by the different treatments was SRP + Prodentis Prodentis SRP + placebo placebo; all differences were statistically significant. For PPD and CAL, the best result was obtained with the SRP+Prodentis treatment. PPD was reduced from 5.08±0.75 to 3.78±0.61 mm (p<0.001) and CAL from 3.93±0.93 to 2.85±0.74 mm (p<0.001). Prodentis, either alone or following SRP, reduced Aa, Pi, and Pg by 1 log(10) unit (p<0.01). The SRP+placebo combination did not significantly affect the levels of the pathogens. CONCLUSION: The present randomized controlled trial confirms the plaque inhibition, anti-inflammatory, and antimicrobial effects of L. reuteri Prodentis. L. reuteri Prodentis probiotic can be recommended during non-surgical therapy and the maintenance phase of periodontal treatment. Considering the beneficial effects of probiotics, this therapy could serve as a useful adjunct or alternative to periodontal treatment when SRP might be contraindicated. Further studies are required in this direction.

Idiopathic linear leukoplakia of gingiva: A rare case report.

White lesions of the oral cavity are not uncommon though majority of them are benign. This case report documents a rare case of idiopathic linear leukoplakia of gingiva with no apparent etiology. Initial examination revealed a non-scrapable linear white lesion on the marginal and papillary gingiva of upper right teeth region. Incisional biopsy was taken for pathologic evaluation. Patient was treated with routine oral hygiene procedures and excision of the lesions. The histopathological results demonstrated hyperparakeratinized/orthokeratinized hyperplastic oral epithelium with orthokeratin-filled clefts and with no dysplasia. Clinical results demonstrated no recurrence after electrosurgical intervention. This paper reports a rare case of idiopathic linear leukoplakia of gingiva which was non-dysplastic in nature. Electrosurgical treatment proved to be successful compared to surgical technique as there was no recurrence even after two years of follow-up.