Comparative evaluation of efficacy of topical and intra-sulcular application of Co-enzyme Q10 in the non-surgical treatment of periodontal diseases.

Background: Periodontitis is a ubiquitous and irreversible inflammatory condition that affects the supporting structures of teeth, which could lead to tooth loss as well as contribute to systemic inflammation. During the inflammatory phase, there is a release of superoxide ions and reactive oxygen species, which causes an increase in the oxidative stress. To combat this stress, the use of certain antioxidants has been proposed, which will help in maintaining the harmonious equilibrium. Aim: The aim of the present systematic review is to investigate the efficacy of topical and intrasulcular application of coenzyme Q10 in nonsurgical treatment of periodontal disease. Materials and Methods: We conducted a systematic review on the clinical studies which compared the use of coenzyme Q10 as an adjunct to nonsurgical periodontal therapy. The studies mentioned in this review were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and met our inclusion criteria - only randomized control trials in humans and literature published between 2000 and 2020 were included. Results: Therapies with coenzyme Q10 as an adjunct to scaling and root planing (SRP) proved to show superior improvement by reduction in the clinical parameters (plaque index, gingival index, bleeding on probing, and clinical attachment loss) when compared to SRP alone. Conclusions: Adjunctive therapy with coenzyme Q10 provides longer-lasting therapeutic effects and better results when compared with SRP alone. The possibility to use the gel as a sole agent to support standard treatment procedures in periodontitis is also suggested.

A clinico-microbiologic study comparing the efficacy of locally delivered chlorhexidine chip and diode LASER as an adjunct to non-surgical periodontal therapy.

BACKGROUND: Considering the microbial etiology of the periodontal disease, the periodontal therapy aims to control or abolish the pathogenic microbes. The gold standard scaling and root planing procedure has been used since time immemorial but the drawbacks associated with it have led to the development of various adjunctive means. The current study was therefore, performed to comparatively assess the efficacy of local delivery of chlorhexidine and 808-nm diode LASER as an appurtenance to scaling and root planing in patients with chronic periodontitis. METHODS: In a randomized split mouth evaluation, 30 patients having probing depth of ≥5 mm which bled on probing at least at 3 different sites were included. At baseline, the evaluation of plaque index, bleeding index, probing pocket depth and clinical attachment level was done and the microbial samples were collected for the assessment of spirochetes, motile rods and coccoid cells. The 3 selected sites of each subject were allocated to 3 different groups A, B, C viz; Scaling and root planing (SRP) + chlorhexidine chip, SRP + diode LASER and SRP respectively. The patients were recalled after 4 weeks to re-evaluate the clinical and microbiological parameters. RESULTS: All the parameters significantly reduced from baseline to 4 weeks in all the 3 groups. Intergroup comparisons revealed remarkable difference between group A and C and group B and C, respectively; no notably significant difference was found between group A and B. CONCLUSION: The additional use of LASER and chlorhexidine chip assures anti-inflammatory effect and anti-microbial effect that allows reduction in bacterial counts and promotes healing. The use of adjuncts have been found to be efficacious in controlling disease and promoting periodontal health and thereby reducing the need for surgical procedures to be undertaken.

Ceramic soft tissue trimming bur: A new tool for gingival depigmentation.

OBJECTIVE: Pigmentation of the gingiva plays a negative role in an otherwise acceptable "smile window". In the present world, people are more concerned about their aesthetics. Several techniques have been employed such as scalpel surgery, electrosurgery, cryosurgery, chemical agents, abrasion and LASER method for the removal of melanin hyper-pigmentation. The present study is aimed at comparing the efficacy of LASER and soft tissue trimmer for gingival depigmentation. METHODS: A randomized split-mouth study was conducted for twenty patients with gingival pigmentation. Dummet Oral Pigmentation Index (DOPI), Gingival Pigmentation Index (GPI) for pigmentation, bleeding factor, wound healing factor, gingival colour and visual analogue scale (VAS) score for pain were evaluated for both the groups at baseline, 7th day, 1st month and 6th month. RESULTS: Intra-group comparison between baseline and 6th month showed highly significant difference for both LASER and bur groups. There was no statistically significant difference found between both the groups at 6th month using gingival pigmentation index. CONCLUSION: It can be concluded that LASER and soft tissue trimmer both are comparable in achieving aesthetic satisfaction. Hence, the soft tissue trimmer could also be used for depigmentation as it is very cost effective, readily available and acceptable by the patients.

Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy.

The treatment of periodontitis primarily consists of mechanical debridement carried out by means of thorough scaling and root planing that might sometimes be a painful procedure which requires the administration of some form of local anesthesia. The present study comparatively evaluates the anesthetic effect of three such forms, viz; eutectic mixture of 25 mg/g lignocaine plus 25 mg/g prilocaine (EMLA) and needleless jet anesthesia during SRP. 30 patients with probing depth of 5 mm or more and visual analog scale (VAS) score of ≥30 mm on probing were selected and asked to assess the pain by VAS and verbal rating scale (VRS) during SRP after application of the two agents. The difference between the visual analogue values of control, EMLA and Madajet XL is highly significant (p < 0.001). According to the VRS scores, 6.7% of the subjects in the EMLA group reported no pain, 80% mild pain, and 13.3% moderate pain. In the Madajet XL group, 46.7% reported no pain and 53.3% mild pain. In the control group 100% of the patients reported moderate pain when none of the anesthetic was administered. None reported severe pain. Thus, the data suggest that both anesthetics are able to produce anesthesia of the tissues. The needleless anesthesia was relatively superior in performance to EMLA.

Stunted root development: A rare dental complication of Stevens-Johnson syndrome.

Stevens-Johnson syndrome (SJS) is a severe cutaneous reaction seen rarely in clinical practice. Most often, it occurs as an adverse reaction to certain drugs. When it affects children at a very young age, arrested tooth root development may also be seen. We present a case of a 13 year old boy who suffered from SJ syndrome at the age of 7 years. Incomplete root development was observed in all teeth, as demonstrated by panaromic radiography. Clinical features of this condition and its management are further discussed. We aim to emphasise on the need for dental practitioners to be aware of the potential dental complications of SJS and enable them to recognise and manage the condition at the earliest so as to avoid any undesirable sequelae. Key words:Adverse drug reaction, amoxycillin, arrested root development, Stevens-Johnson syndrome.

Morphological study of proximal root grooves and their influence on periodontal attachment loss.

BACKGROUND: The etiology of periodontal diseases is multifactorial including both systemic and local causes. Local factors such as grooves on root surfaces contribute a great deal to the causation of periodontal diseases. MATERIALS AND METHODS: Proximal radicular grooves were studied in 150 extracted maxillary and mandibular anterior teeth. Periodontal attachment loss was measured after staining the root surfaces with 0.1% toluidine blue stain. The relationship of the presence and absence of grooves with periodontal attachment loss was also studied. RESULTS: The prevalence of proximal root grooves was found to be 86.67%. The prevalence of grooves on maxillary teeth was 43.42% and on mandibular teeth was 56.67%. A greater loss of attachment was present on grooved surfaces than on nongrooved surfaces. CONCLUSION: The proximal radicular grooves present as one of the major etiological factors in periodontal diseases.

Comparative evaluation of coenzyme Q10-based gel and 0.8% hyaluronic acid gel in treatment of chronic periodontitis.

BACKGROUND: The anti-inflammatory and immune enhancing effects of coenzyme Q10 (CoQ10) and hyaluronic acid are well established in medical literature. The present study was undertaken to evaluate their role in chronic periodontitis. MATERIALS AND METHODS: One hundred twenty sites in 24 patients with clinically confirmed periodontitis were included in the study. A split-mouth design was used for intrasulcular application of CoQ10 as adjunct to scaling and root planing (SRP), 0.8% hyaluronic acid as adjunct to SRP and SRP alone. Clinical parameters such as plaque index (PI), gingival color change index (GCCI), Eastman interdental bleeding index (EIBI), pocket depth (PD), and clinical attachment level (CAL) were recorded. All the clinical parameters PI, EIBI, GCCI, PD, and CAL were recorded at baseline before SRP. Only PI, EIBI, and GCCI were recorded at 1st and 2nd week. Twenty-one days post 2nd week, i.e., 6th week all the clinical parameters were recorded again. RESULTS: Intragroup analysis of all the clinical parameters showed clinical significant results between baseline and 6th week. However, on intergroup analysis, the results were not significant. CONCLUSION: The local application of CoQ10 and hyaluronic acid gel in conjunction with SRP may have a beneficial effect on periodontal health in patients with chronic periodontitis.

"Hepatitis" - Prevention and management in dental practice.

Today, viral hepatitis has become a silent epidemic worldwide. It is the major cause of liver cirrhosis and liver carcinoma. In a dental office, infections can be expedited through several routes, including direct or indirect contact with blood, oral fluids, droplet splatter, aerosols, etc. The aim of the present review is to increase the awareness among dental practitioners, so as to reduce the burden of hepatitis in their community. Electronic databases like PubMed, Medline, ProQuest, etc. were searched using the keywords hepatitis, dentist, liver disease, and infection control. Manual search of various journals and books was also carried out. Only highly relevant articles from English literature were considered for the present review. The results revealed that the dentists were among the high-risk groups for hepatitis, and they have little information on the factors associated with adherence to hepatitis B vaccination. A dentist can play a major role in the prevention of hepatitis by considering each and every patient as a potential carrier of hepatitis. Proper infection control, sterilization, and prophylactic vaccination protocols should be followed in order to reduce the risk of hepatitis.

Mast cells and oral pathologies: A Review.

Mast cells (MCs) are resident cells of several types of tissues and contain many granules rich in histamine and heparin. They are distributed preferentially about the micro-vascular endothelial cells in the oral mucosa. These cells play a key role in the inflammatory process and thus their number has been found to be altered in various oral pathological conditions such as oral pyogenic granuloma, oral lichen planus, leukoplakia, oral squamous cell carcinoma, periapical cysts etc. The present review article is aimed to describe the alteration in the number of MCs along with their probable roles in these pathological conditions.

Effects of low-intensity laser therapy on the rate of orthodontic tooth movement: A clinical trial.

BACKGROUND: Low-intensity laser therapy (LILT) can be utilized for different treatments in the field of orthodontics and dentofacial orthopedics. The aim of the present study was to evaluate the efficacy of LILT on (1) the rate of canine movement during canine retraction phase and (2) evaluate the radiographic changes occurring during LILT around the irradiated area. MATERIALS AND METHODS: A total of 10 patients of both genders were included for this study. One quadrant of the upper arch was considered control group (CG) and received mechanical activation of the canine teeth with 150 g. The opposite quadrant received the same mechanical activation and was also irradiated with a diode emitting light (gallium-arsenide laser) at 904 nm, for 10 s at 12 mW, at 4.2 J/cm(2). Laser application was done on 1(st) day, 3(rd), 7(th), 14(th), 21(th), 28(th), 35(th), 42(nd), 49(th), 56(th) day respectively during the canine retraction phase. Distance was measured on 1(st) day, 35(th) day and 63(rd) day and appliance activation was done on 1(st) and 35(th) day. Results were analyzed using t-test with the significance level set at P < 0.01. RESULTS: Mean value obtained from 1(st) to 63(rd) day was 3.30 ± 2.36 mm for CG and 3.53 ± 2.30 mm for laser group (LG). CONCLUSION: There was no statistically significant difference in the rate of tooth movement during canine retraction between the LG and the CG. There was no evidence of any pathologic changes in the radiograph following LILT.

Analysis of patient acceptance following treatment of Miller's class II gingival recession with acellular dermal matrix and connective tissue graft.

OBJECTIVE: Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. The search for the appropriate root coverage techniques has resulted in many different approaches. The goal of this study was to evaluate the degree of patient acceptance with acellular dermal matrix (ADM) allograft in the treatment of buccal gingival recession and to compare it with subepithelial connective tissue graft. MATERIALS AND METHODS: Thirty patients with Miller's class II recessions were treated and randomly assigned to the test group (ADM) and control group (subepithelial connective tissue graft). All patients underwent full periodontal evaluation and pre-surgical preparation, including oral hygiene instructions and scaling and root planing. The exposed roots were thoroughly planed and covered by a graft without any further root treatment. Results were evaluated based on the parameters measuring patient satisfaction and clinical outcome after 6 months of the surgical procedure. RESULTS: Postoperatively, significant root coverage, reduction in probing depth, gain in clinical attachment level, and increase in widths of keratinized tissue and attached gingiva were observed on intra-group comparison. There was no significant difference in any of the parameters between test and control groups. CONCLUSION: The subepithelial connective tissue graft and ADM graft were able to successfully treat gingival recession defects; however, the ADM showed better patient acceptance than the connective tissue graft.

Reactive oxygen species in periodontitis.

Recent epidemiological studies reveal that more than two-third of the world's population suffers from one of the chronic forms of periodontal disease. The primary etiological agent of this inflammatory disease is a polymicrobial complex, predominantly Gram negative anaerobic or facultative bacteria within the sub-gingival biofilm. These bacterial species initiate the production of various cytokines such as interleukin-8 and TNF-α, further causing an increase in number and activity of polymorphonucleocytes (PMN) along with these cytokines, PMNs also produce reactive oxygen species (ROS) superoxide via the respiratory burst mechanism as the part of the defence response to infection. ROS just like the interleukins have deleterious effects on tissue cells when produced in excess. To counter the harmful effects of ROS, human body has its own defence mechanisms to eliminate them as soon as they are formed. The aim of this review is to focus on the role of different free radicals, ROS, and antioxidants in the pathophysiology of periodontal tissue destruction.

Hyaluronic Acid: a boon in periodontal therapy.

Hyaluronic acid is a naturally occurring linear polysaccharide of the extracellular matrix of connective tissue, synovial fluid, and other tissues. Its use in the treatment of the inflammatory process is established in medical areas such as orthopedics, dermatology, and ophthalmology. The Pubmed/Medline database was searched for keywords "Hyaluronic acid and periodontal disease" and "Hyaluronic acid and gingivitis" which resulted in 89 and 22 articles respectively. Only highly relevant articles from electronic and manual search in English literature were selected for the present review article. In the field of dentistry, hyaluronic acid has shown anti-inflammatory and anti-bacterial effects in the treatment of periodontal diseases. Due to its tissue healing properties, it could be used as an adjunct to mechanical therapy in the treatment of periodontitis. Further studies are required to determine the clinical efficacy of hyaluronic acid in healing of periodontal lesion. The aim of the present review, article is to discuss the role of hyaluronic acid in periodontal therapy.

Salivary thiocyanate: a biochemical indicator of cigarette smoking in adolescents.

PURPOSE: Saliva is considered to be critical for the maintenance of healthy oral mucosa, and oral fluids provide an easily available, non-invasive medium for the diagnosis of a wide range of diseases and clinical situations. The purpose of this study was to estimate the thiocyanate (SCN) level in saliva of cigarette smokers and compare it with that of nonsmokers. MATERIALS AND METHODS: The present study comprised 100 subjects, of which 50 had a habit of tobacco smoking. The other 50 neither smoked nor chewed tobacco and comprised the healthy control group. The age and sex (all males) of both groups of subjects were matched. All the patients were in the age group of 25 to 40 years. The group of smokers was divided into subgroups according to duration and frequency of smoking. Duration group 1: smoking for a period of 4-7 years; duration group 2: smoking for a period of 8-15 years; duration group 3: chronic smokers, smoking for a period of more than 15 years. Frequency group 1: patients smoked half pack of cigarettes, i.e. 4-6 per day; frequency group 2: patients smoked one pack of cigarettes, i.e. 7-11 per day; frequency group 3: patients smoked more than one pack, i.e. >11, per day. Saliva was collected by the spitting method. Unstimulated whole saliva was refrigerated at 4°C and processed within 24 h. The estimation of thiocyanate in saliva was done according to Densen et al (1967). RESULTS: The present study clearly indicates a significant increase in salivary thiocyanate level in tobacco smokers as compared to nonsmokers (P < 0.0001). Comparing salivary SCN in different duration groups, the salivary SCN level was significantly lower in group 1 vs groups 2 and 3, with P < 0.0001. In terms of smoking frequency, the salivary SCN level was significantly lower in group 1 vs group 3, P < 0.0001. It is also evident that there was an increase in salivary thiocyanate levels with increased duration and frequency, thus showing a positive correlation between them. CONCLUSION: The findings of this study suggest that salivary thiocyanate can be used as a safe and acceptable prevalence measurement for cigarette smoking behaviour.

Ellis-van Creveld syndrome: A rare clinical entity.

Ellis-van Creveld (EVC) syndrome is a genetic disorder with autosomal recessive transmission, which may clinically present as small stature, short limbs, fine sparse hair, hypoplastic fingernails, multiple musculofibrous frenula, conical teeth, hypoplasia of the enamel, hypodontia, and malocclusion. Heart defects, especially abnormalities of atrial septation, have been found in about 60% of cases. The mutation in EVC and EVC2 gene is responsible for this syndrome. The presence of multiple orodental findings makes this syndrome important for dentists. The aim of this article is to present a rare case of EVC syndrome in a 10-year-old girl along with the review of literature.

Recurrent gingival swelling in pregnant women.

The aim of this case report is to present a rare case which has been reported with the history of small nodule like growth on mandibular buccal and lingual area. Thirty year old pregnant women reported a nodule on left mandibular buccal and lingual region. The lesion was surgically excised and sent for biopsy to differentiate from kimura's disease, pyogenic granuloma, epithelioid angiosarcoma (EH). Histologically lesion shows proliferation of endothelial cells along blood vessels suggesting epithelioid hemangioma. The purpose of this report is to discuss and differentiate EH and other vascular rare entities occurring in the oral cavity.

Burning mouth syndrome and menopause.

Menopause is a physiological process typically occurring in the fifth decade of life. One of the most annoying oral symptoms in this age group is the burning mouth syndrome (BMS), which may be defined as an intraoral burning sensation occurring in the absence of identifiable oral lesion or laboratory findings. Pain in burning mouth syndrome may be described as burning, tender, tingling, hot, scalding, and numb sensation in the oral mucosa. Multiple oral sites may be involved, but the anterior two-third part and the tip of tongue are most commonly affected site. There is no definite etiology for BMS other than the precipitating causative factors, and it is still considered idiopathic. Various treatment options like use of benzodiazepine, anti-depressants, analgesics, capsaicin, alpha lipoic acids, and cognitive behavioral therapy are found to be effective, but definite treatment is still unknown. The present article discusses some of the recent concepts of etiopathogenesis of BMS as well as the role of pharmacotherapeutic management in this disorder.

Rotary instruments in the treatment of chronic periodontitis: A randomized clinical trial.

BACKGROUND: The study aimed at comparing the effectiveness of rotary instruments with hand instruments in non-surgical treatment of chronic periodontitis. MATERIALS AND METHODS: Thirty-eight patients with chronic periodontitis, enrolled to this randomized, controlled clinical trial, were divided into two groups. Patients in the control group received scaling and root planing with hand instruments, whereas patients in the test group received treatment with rotary instruments. Clinical assessment by plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level was made prior to and at 6 months after treatment. Differences in the clinical parameters were analyzed using the Wilcoxon signed rank test and Mann-Whitney U test. RESULTS: Both treatments resulted in a significant improvement in all clinical recordings, but no differences in any of the investigated parameters were observed at baseline between the two groups. CONCLUSION: Non-surgical periodontal therapy with the tested rotary instruments may lead to clinical improvements comparable to those obtained with conventional hand instruments.

Peripheral ossifying fibroma.

A case of peripheral ossifying fibroma (POF) in the mandibular gingiva of a 17-year-old male is described. The lesion was asymptomatic, firm, pink, and present on the lingual alveolar mucosa interdentally between 43 and 44. Radiographic investigations revealed no significant findings. Excisional biopsy was performed for the lesion. Microscopic findings confirmed the diagnosis of POF.

Ultra-morphology of root surface subsequent to periodontal instrumentation: A scanning electron microscope study.

BACKGROUND: The aim of this study was to compare root surface characteristic following root planing with various hand and power driven instruments. MATERIALS AND METHODS: A total of 20 single rooted teeth were used in this study, of which two specimens were used as control (no instrumentation done) and remaining 18 specimens were equally divided into three groups. Specimens from each group were then subjected to root planing by one of the following instruments: (1) a Gracey curette (2) Ultrasonic tip and (3) a Rotary bur. In each case, the time required for scaling and root planing was measured. After treatment, the specimens were observed under scanning electron microscope and surface roughness was measured by using Roughness and loss of tooth substance index (RLTSI). RESULTS: The mean RLTSI scores for Gracey curette, ultrasonic and rotary instrument group were 2.5, 2.0 and 0.667 respectively. The mean scores of time spent for scaling and root planing by Gracey curette, ultrasonic and rotary instrument group in seconds were 42.50, 35.83 and 54.50. CONCLUSION: All the three instruments namely Gracey curette, Ultrasonic tip and Rotary bur were effective in mechanical debridement of root surface. The results favoured the use of rotary instruments for root planing to achieve smooth clean root surface; however, the use of rotary instrument was more time consuming which might limit its use in clinical practice.