Somatic Variants and Exon-Level Copy Number Changes in Five Hyperplastic Oral Leukoplakias.

Oral leukoplakia (OL), an oral potentially malignant disorder, begins with a hyperplastic/hyperkeratotic stage at which no genome-scale somatic single nucleotide variant profiles have been described so far. We performed exome sequencing of five cases at this stage with no evidence of dysplasia to identify genetic alterations (exon-level copy number alterations, indels, and single nucleotide variants), their association with transcript levels, and relationship with oral cancer susceptibility. Pathway enrichment analysis of genes associated with tobacco chewing and age-related mutation signatures, transcripts with variants predicted to be functionally damaging and those with significantly altered levels all indicated the involvement of focal adhesion, ECM-receptor interactions, regulation of cytoskeleton, and DNA repair. Two novel mutations identified in FAT1 tumor suppressor gene were associated with decreased transcript levels. In addition, 16 expressed cancer driver genes contained functionally damaging variants. Many of the affected genes were also reported in dysplastic OL lesions. The presence of variants in cancer driver genes and those shared with oral dysplasias possibly provides a basis for further progression and increased susceptibility to oral cancer.

Width and thickness of the gingiva in periodontally healthy individuals in a central Indian population: a cross-sectional study.

OBJECTIVES: The present study was performed to determine the gingival dimensions (width and thickness) among young individuals in a central Indian population. MATERIALS AND METHODS: Periodontal probing depth, width of the keratinized and attached gingiva, and gingival thickness were recorded on maxillary and mandibular teeth from central incisor to first molar unilaterally in 75 systemically healthy individuals (32 males and 43 females; 19-30 years of age). Comparisons were made gender-wise, arch-wise, tooth-wise, and site-wise using either the Student's t test or the ANOVA. RESULTS: Keratinized and attached gingiva were wider in the maxilla than in the mandible both at proximal and at mid-buccal aspects (p < 0.001). At the tooth level also, gingiva was wider at the maxillary teeth than the corresponding mandibular teeth and at proximal aspects than at the mid-buccal aspect (p < 0.001). Regarding the thickness, gingiva was thicker among males, in the mandible, and at inter-proximal sites (p < 0.001). In either arch, maximum thickness was observed at the incisor region and least at the canine region. CONCLUSIONS: Dimensions of the gingival tissues vary between different populations and between different areas of the dentition within the same subject. These variations need to be better understood because these aspects may have an important bearing on periodontal treatment planning as width and thickness of gingiva are important in terms of maintenance of periodontal health. CLINICAL RELEVANCE: The dimensions of the clinically healthy gingiva are important in clinical practice as they can influence the progression of periodontal disease as well as impact the outcome of periodontal and restorative and orthodontic therapy.

Total and Differential Leukocyte Counts in the Peripheral Blood of Patients with Generalised Aggressive Periodontitis.

PURPOSE: To compare the total and differential leukocyte counts in the peripheral blood of generalised aggressive periodontitis patients with that of periodontally healthy subjects in a central Indian population. MATERIALS AND METHODS: Seventy-five patients with generalised aggressive periodontitis and 63 periodontally healthy subjects were enrolled for the purpose of the study. All participants received a full-mouth periodontal examination in which probing depth and clinical attachment level were recorded. The haematological variables analysed included total leukocyte count, neutrophil count, lymphocyte count, monocyte count, neutrophil percentage, lymphocyte percentage, monocyte percentage and platelet count. RESULTS: The patient group showed a significantly higher total leukocyte count (7.62 ± 1.70 x 109 cells/l, p = 0.008), neutrophil count (5.06 ± 1.47x109 cells/l, p < 0.001) and neutrophil percentage (70.61 ± 8.73, p < 0.001), as well as a significantly lower lymphocyte count (1.82 ± 0.65 x 109 cells/l, p = 0.002) and lymphocyte percentage (26.55 ± 8.05, p < 0.001) compared to the control group. Logistic regression analyses showed significant associations between aggressive periodontitis and elevated total leukocyte (p = 0.012) and neutrophil counts (p = 0.001). CONCLUSION: The findings of the present study suggest that patients with generalised aggressive periodontitis might also demonstrate a systemic inflammatory response, as evidenced by increased leukocyte counts. This systemic inflammatory response observed in patients with generalised aggressive periodontitis may be associated with an increased risk for cardiovascular diseases.

Biopsied lesions of the gingiva in a southern Indian population - a retrospective study.

PURPOSE: To retrospectively analyse the frequency and distribution of various biopsied lesions of the gingiva among patients attending a dental teaching institution in Karnataka state in India. MATERIALS AND METHODS: Data collected from 153 gingival biopsies referred to the Department of Oral Pathology, Yenepoya Dental College in Mangalore, Karnataka state, India during a 5-year period from 2004-2008 were utilised for the purpose of this study. Lesions were categorised by their type and analysed for age, sex and location. RESULTS: Non-neoplastic lesions accounted for 51% while neoplastic and potentially malignant lesions accounted for 49% of the lesions. The most common non-neoplastic lesion was pyogenic granuloma (42.3%), the most common benign neoplasm was fibroma (34.5%) and the most common malignant lesion was squamous cell carcinoma (82.6%). Among all the lesions, the most common was squamous cell carcinoma (24.8% of all the lesions). CONCLUSIONS: Unlike in previous studies, squamous cell carcinoma was the most common gingival lesion. The proportion of malignant and potentially malignant lesions was also higher among subjects in the present study than in other populations. Hence, public oral health programmes need to be formulated to better tackle the burden of these diseases.

Surgical exposure and crown lengthening for management of complicated fractures of maxillary anterior teeth. A case report.

When a tooth fracture occurs, the fracture line can extend in a variety of directions, and the direction of the fracture line often dictates the treatment plan. In cases where fracture lines extend apical to the gingival margin, exposure of fractured margins becomes necessary. And management of such tooth fractures often requires an interdisciplinary approach involving endodontic, periodontic and restorative procedures. This article describes a case in which severely traumatized maxillary anterior teeth were managed by a combined approach involving surgical exposure and crown lengthening, endodontic and restorative procedures.

Relationship of smoking and smokeless tobacco use to tooth loss in a central Indian population.

PURPOSE: The present study was conducted to determine the patterns of tooth loss among subjects with different tobacco- related habits and compare it with non-users of tobacco. MATERIALS AND METHODS: A total of 1075 patients over the age of 14 years attending the Department of Periodontics, People's College of Dental Sciences and Research Centre, Bhopal, India from May to September 2009 were included in the study. Besides name, age and gender, information regarding tobacco habits was recorded through interviews. Based on the tobacco habits, the patients were grouped into 4 categories: group 1 (non-users of tobacco), group 2 (smokers only), group 3 (smokeless tobacco users only) and group 4 (users of both smoking and smokeless tobacco). Tooth loss was determined by clinical examination of all permanent teeth excluding the third molars. Tooth loss included missing or extracted teeth as well as teeth indicated for extraction due to periodontal disease, dental caries or wasting diseases. Prevalence and mean tooth loss for whole dentition, maxillary and mandibular arches were compared between the 4 groups. The chi-square test and one-way ANOVA were used for comparing the prevalence and mean tooth loss, respectively, between different groups. RESULTS: The overall prevalence and mean tooth loss, respectively, for different groups were as follows: group 1: 28.3% and 0.85; group 2: 56.1% and 1.97; group 3: 58.7% and 2.38; group 4: 56.7% and 2.48 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the maxillary arch for the different groups were: group 1: 15.3% and 0.32; group 2: 43% and 1.24; group 3: 34.3% and 0.91; group 4: 45.4% and 1.26 (P < 0.001 for both prevalence and mean tooth loss). The prevalence and mean tooth loss, respectively, for the mandibular arch for the different groups were: group 1: 22.3% and 0.52; group 2: 33.6% and 0.73; group 3: 50.9% and 1.48; group 4: 48.5% and 1.23 (P < 0.001 for both prevalence and mean tooth loss). CONCLUSION: When compared to non-users of tobacco, tooth loss was greater among subjects who consumed tobacco. In India, where consumption of tobacco in different forms is very common, public health programmes need to be implemented to increase public awareness regarding the adverse effects of tobacco on oral health.

A case-control study on the association between periodontitis and coronavirus disease (COVID-19).

BACKGROUND: Coronavirus disease (COVID-19) and periodontitis share common characteristics, such as an exaggerated inflammatory response. As periodontal diseases were shown to be associated with respiratory diseases, such as pneumonia, it is quite possible that a relationship may exist between periodontitis and COVID-19. Hence, the aim of the present study was to determine whether periodontitis and poor oral hygiene are associated with COVID-19. METHODS: A case-control study was conducted. Patients who had positive real-time reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were included in the case group (n = 79), and patients with negative results were included in the control group (n = 71). The periodontal examination involved recording the plaque scores, calculus scores, tooth mobility, gingival bleeding, probing depth, recession, and clinical attachment level (CAL). RESULTS: Logistic regression analysis showed significant associations of mean plaque scores ≥ 1 (odds ratio (OR), 7.01; 95% confidence interval (CI), 1.83 to 26.94), gingivitis (OR, 17.65; 95% CI, 5.95 to 52.37), mean CAL ≥ 2 mm (OR, 8.46; 95% CI, 3.47 to 20.63), and severe periodontitis (OR, 11.75; 95% CI, 3.89 to 35.49) with COVID-19; these findings were more prevalent in the case group. CONCLUSION: Based on the above mentioned observations, it can be concluded that there is an association between periodontitis severity and COVID-19. Gingival bleeding and dental plaque accumulation are also more frequent among COVID-19 patients. Hence, it is essential to maintain periodontal health and good oral hygiene as an important measure for COVID-19 prevention and management.

Undersized implant site preparation to enhance primary implant stability in poor bone density: a prospective clinical study.

PURPOSE: Achieving primary implant stability in areas with poor bone density is often challenging to the clinician. Previous research has suggested that modified surgical protocols might be beneficial in such situations. The objective of the present clinical study was to evaluate the survival rate of implants placed using undersized implant site preparation in areas with poor bone density. MATERIALS AND METHODS: A total of 52 implants were placed in 29 patients. Of the 52 implants, 26 were surgically placed according to the standard drilling protocol (control group) and 26 were placed in low-density bone using an adapted bone drilling method (test group). The maximum insertion torque values and resonance frequency analysis measurements were also recorded. All implants were examined clinically and radiographically at follow-up visits during the study period. Oral hygiene status, bleeding on probing, peri-implant probing depth, and implant survival rate were assessed. RESULTS: According to the survival criteria used in the present study, no failure was recorded, and the overall survival rate was 100% for both groups after 12 months. The mean probing depth was 2.75 ± 0.75 mm in the test group and 2.87 ± 0.79 mm in the control group. The mean insertion torque value was 35.19 ± 4.79 Ncm in the test group and 34.62 ± 5.82 Ncm in the control group. The resonance frequency analysis value was 68.58 ± 4.81 implant stability quotient and 66.69 ± 5.41 implant stability quotient in the test and control groups, respectively. The observed differences were not statistically significant (P > .05). CONCLUSIONS: The results of the present study suggest that placement of implants by an adapted drilling technique in sites with poor bone density is beneficial in enhancing primary implant stability and improving the implant survival rate.

Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population.

BACKGROUND: Findings of studies testing the association between smokeless tobacco (SLT) use and periodontal health have shown varying results in different populations. Considering the high prevalence of SLT use in India, the present study was conducted to understand the pattern of periodontal destruction within different areas of the dentition among SLT users. METHODS: Age, gender, oral hygiene habits, the frequency and duration of SLT consumption, the type of SLT product used, and the site of retention of the SLT product in the oral cavity were recorded among 90 SLT users. Probing depth (PD), recession (REC), and clinical attachment loss (CAL) at SLT-associated and non SLT-associated teeth of the mandibular arch were compared based on the site of retention of the SLT product, the type of product used, and the duration of the habit. RESULTS: REC and CAL were significantly higher at the SLT-associated zones compared to non SLT-associated zones and at both interproximal and mid-buccal sites of SLT-associated teeth. Among individuals who had the habit for more than 5 years and also among those who had the habit for 5-10 years, PD, REC, and CAL were significantly higher at SLT-associated teeth than at non SLT-associated teeth. Significantly greater periodontal destruction was observed at SLT-associated teeth among khaini users and gutkha users. CONCLUSIONS: Smokeless tobacco consumption resulted in greater destruction of periodontal tissues. The severity of periodontal destruction at SLT-associated sites differed depending on the type of smokeless tobacco used, the site of retention of the SLT, and the duration of the habit.

Trends in extraction of permanent teeth in private dental practices in Kerala state, India.

AIM: The aim of the present study was to identify the trends in tooth loss among patients attending four general dental practices in the south Indian State of Kerala. METHODS AND MATERIALS: The reasons for extraction of permanent teeth among patients who had attended the four clinics during a one-month period were categorized as follows: (1) dental caries and their sequelae, (2) periodontal disease, (3) orthodontic, (4) impactions, (5) prosthodontic, and (6) other reasons. RESULTS: A total of 997 permanent teeth were extracted, of which 445 (44.6 percent) teeth were extracted due to dental caries and their sequelae, 331 (33.2 percent) teeth due to periodontal disease, 111 (11.1 percent) teeth for orthodontic purposes, 25 (2.5 percent) teeth due to impactions, 25 (2.5 percent) teeth for prosthodontic purposes, and 60 (6 percent) teeth for other reasons. CONCLUSION: The results of the present study suggest that dental caries and periodontal disease were the two major causes of tooth mortality in this particular patient population. CLINICAL SIGNIFICANCE: This is probably the first study to report on the trends in tooth loss in general practice in India. Similar studies should be conducted in other regions of the country to generate valuable data regarding the oral health patterns of the nation's population.

Causes and patterns of loss of permanent teeth among patients attending a dental teaching institution in south India.

AIM: The aims of the present study are to determine the causes and pattern of loss of permanent teeth among patients attending a dental teaching institution in southern India. METHODS AND MATERIALS: Data collected from patients attending the outpatient wing of the Sri Sankara Dental College, Kerala, during a three month period was used for the study. The cause for extraction was classified as follows: (1) caries and its sequelae, (2) periodontal disease, (3) orthodontic purposes, (4) impactions, (5) prosthodontic purposes, and (6) other reasons. RESULTS: A total of 1791 permanent teeth were extracted of which 708 (39.5%) teeth were extracted due to caries and its sequelae, 508 (28.4%) due to periodontal disease, 347 (19.4%) for orthodontic purposes, 29 (1.6%) due to impactions, 155 (8.7%) for prosthodontic purposes, and 44 (2.5%) for other reasons. CONCLUSION: The results of the present study suggest caries and periodontal disease are the major causes of tooth mortality in the study population. CLINICAL SIGNIFICANCE: Data regarding the causes of tooth loss indirectly provides invaluable information on the pattern of oral health in a population which can be utilized for planning public health policies designed to address the burden of oral diseases.

Early Childhood Caries: Prevalence, Risk Factors, and Prevention.

Early childhood caries (ECC) is major oral health problem, mainly in socially disadvantaged populations. ECC affects infants and preschool children worldwide. The prevalence of ECC differs according to the group examined, and a prevalence of up to 85% has been reported for disadvantaged groups. ECC is the presence of one or more decayed, missing, or filled primary teeth in children aged 71 months (5 years) or younger. It begins with white-spot lesions in the upper primary incisors along the margin of the gingiva. If the disease continues, caries can progress, leading to complete destruction of the crown. The main risk factors in the development of ECC can be categorized as microbiological, dietary, and environmental risk factors. Even though it is largely a preventable condition, ECC remains one of the most common childhood diseases. The major contributing factors for the for the high prevalence of ECC are improper feeding practices, familial socioeconomic background, lack of parental education, and lack of access to dental care. Oral health plays an important role in children to maintain the oral functions and is required for eating, speech development, and a positive self-image. The review will focus on the prevalence, risk factors, and preventive strategies and the management of ECC.

Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection?

BACKGROUND: The microorganism Helicobacter pylori has been closely linked to chronic gastritis, peptic ulcer, gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma. Despite the current treatment regimens that lead to successful management of H. pylori-positive chronic gastritis, the reinfection rate is high. It has been suggested that one of the possible mechanisms of reinfection is the recolonization from dental plaque. The purpose of this study was to determine whether dental plaque, poor oral hygiene, and periodontal disease were risk factors for H. pylori infection. METHODS: Among the 134 patients, 65 patients who had a positive H. pylori serology or positive rapid urease test or histologic evidence for the presence of H. pylori in antral biopsy specimens were categorized as cases. The remaining 69 patients who were negative for H. pylori serology, the rapid urease test, and histology were controls. RESULTS: It was found that the association of periodontal disease and poor oral hygiene with H. pylori infection was not significant. There was a higher prevalence of H. pylori in the dental plaque of patients with gastric H. pylori infection than in controls, but both groups had a surprisingly high positive urease test for H. pylori in plaque (89% and 71%, respectively). CONCLUSIONS: H. pylori in dental plaque is seldom eliminated by H. pylori-eradication therapy, and this may act as a source for future reinfection. Hence, eradication of H. pylori from the dental plaque should be made an important part of comprehensive management of H. pylori-associated gastric diseases.

Rare instance of gingival enlargement in Klippel-Trenaunay syndrome: a case report.

Klippel-Trenaunay Syndrome is a rare congenital malformation that may include port-wine stain, soft tissue and bony hypertrophy, and venous malformations and lymphatic abnormalities. Although it usually involves the limbs, it may also rarely involve the head, neck, and orofacial regions. Despite its rarity, Klippel-Trenaunay Syndrome should be considered in the differential diagnosis of gingival enlargement. The condition can be easily recognized clinically, but further investigations including imaging studies have to be carried out in order to better understand the nature of the lesion. This report describes a case of gingival enlargement in Klippel-Trenaunay Syndrome in a 16-year-old female patient. The diagnosis of the condition was made based on the patient history, clinical and radiographic examination, computed tomography (CT), and angiogram.

Management of periodontitis associated with endodontically involved teeth: a case series.

The pulp and the periodontal attachment are the two components that enable a tooth to function in the oral cavity. Lesions of the periodontal ligament and adjacent alveolar bone may originate from infections of the periodontium or tissues of the dental pulp. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. The function of the tooth is severely compromised when either one of these is involved in the disease process. Treatment of disease conditions involving both of these structures can be challenging and frequently requires combining both endodontic and periodontal treatment procedures. This article presents cases of periodontitis associated with endodontic lesions managed by both endodontic and periodontal therapy.

Role of dental plaque, saliva and periodontal disease in Helicobacter pylori infection.

Helicobacter pylori (H. pylori) infection is one of the most common bacterial infections in humans. Although H. pylori may be detected in the stomach of approximately half of the world's population, the mechanisms of transmission of the microorganism from individual to individual are not yet clear. Transmission of H. pylori could occur through iatrogenic, fecal-oral, and oral-oral routes, and through food and water. The microorganism may be transmitted orally and has been detected in dental plaque and saliva. However, the role of the oral cavity in the transmission and recurrence of H. pylori infection has been the subject of debate. A large number of studies investigating the role of oral hygiene and periodontal disease in H. pylori infection have varied significantly in terms of their methodology and sample population, resulting in a wide variation in the reported results. Nevertheless, recent studies have not only shown that the microorganism can be detected fairly consistently from the oral cavity but also demonstrated that the chances of recurrence of H. pylori infection is more likely among patients who harbor the organism in the oral cavity. Furthermore, initial results from clinical trials have shown that H. pylori-positive dyspeptic patients may benefit from periodontal therapy. This paper attempts to review the current body of evidence regarding the role of dental plaque, saliva, and periodontal disease in H. pylori infection.

Oral Cavity as an Extragastric Reservoir of Helicobacter pylori.

Background. Several studies were reported on the prevalence, and relationship between the existence of Helicobacter pylori (H. pylori) in oral cavity and in stomach of patients. The purpose of this study was to systematically review the existing literature on the presence of H. pylori in the oral cavity and its link to gastric infection, the existence of coinfection, and the impact of anti-H. pylori therapy on the dental plaque and vice versa. Method. Two authors independently searched the Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The articles were analyzed critically and all qualified studies were included. The search was carried out by using a combined text and the MeSH search strategies: using the key words Helicobacter, Helicobacter pylori, and H. pylori in combination with dental plaque, periodontitis, and oral hygiene. Results. The data was presented in 8 tables and each topic separately discussed. Conclusion. Based on the systematic review of the available literature on H. pylori infection and its presence in the oral cavity, it can be concluded that dental plaque can act as a reservoir, and proper oral hygiene maintenance is essential to prevent reinfection. Due to the diversified methods and population groups involved in the available literature, no concrete evidence can be laid down. Further studies are necessary to establish the role of H. pylori in the oral cavity and its eradication on preventing the gastroduodenal infection.

Increased levels of serum and gingival crevicular fluid monocyte chemoattractant protein-1 in smokers with periodontitis.

BACKGROUND: Smoking alters the host response, including vascular function, neutrophil/monocyte activities, adhesion molecule expression, antibody production, and cytokine and inflammatory mediator release. Monocyte chemoattractant protein-1 (MCP-1) is involved in the activation and recruitment of inflammatory and immune cells to infected sites, thereby mediating a variety of pathophysiologic conditions. Estimation of serum and gingival crevicular fluid (GCF) MCP levels could be a reliable indicator of periodontal disease activity. Hence, the objective of this study is to analyze the serum and GCF MCP-1 levels of smokers and never-smokers with periodontitis and compare them with those in periodontally healthy individuals. METHODS: A total of 90 participants (30 periodontally healthy individuals, 30 non-smoking individuals with periodontitis, and 30 smokers with periodontitis) formed the study group. Serum and GCF samples were collected, and MCP-1 levels were estimated using enzyme-linked immunosorbent assay. RESULTS: Mean MCP-1 levels in serum and GCF were found to be highest in smokers with periodontitis, followed by the periodontitis group, and then by the healthy controls. The values were statistically significant (P <0.001). CONCLUSIONS: It can be concluded that the high levels of both serum and GCF MCP-1 found in smokers could explain the severity of periodontitis in smokers. More longitudinal, prospective studies will help to verify the observations of the present study. Further research in this direction could reveal reliable markers to forecast the progression of periodontitis in high-risk groups.

Impact of osteoporosis and its treatment on oral health.

Osteoporosis has emerged as a major health problem affecting middle-aged and older individuals. It is characterized by a reduced bone mass and strength, resulting in increased susceptibility to fractures. The disease is associated with several risk factors, and increasing evidence suggests that it may be associated with oral health conditions such as periodontal disease, reduced jaw bone density and tooth loss. Besides the effects of osteoporosis on oral health, bisphosphonate-related osteonecrosis of the jaws is a major concern to the dentist. Bisphosphonate-related osteonecrosis of the jaws is a recently described adverse effect of bisphosphonate therapy. The exact mechanisms by which these drugs cause necrosis of the jaws remain unclear, and a true cause-and-effect relationship between osteonecrosis of the jaw and bisphosphonate use has not yet been established. Hence, any form of invasive dentoalveolar treatment should be performed with caution in patients taking bisphosphonates. This review discusses current evidence on osteoporosis and its treatment implications as a risk factor in the development of various oral diseases.