Efficacy of aloe vera mouthwash versus chlorhexidine on plaque and gingivitis: A systematic review.

OBJECTIVES: The present systematic review assessed the efficacy of aloe vera mouthrinse on plaque and gingival inflammation. METHODS: A comprehensive search of PubMed, EMBASE, Scopus and Web of Science was conducted in February 2018 to identify all relevant studies using the following keywords: aloe vera, gingivitis, gingival inflammation, plaque-induced gingivitis, periodontal health and plaque control. The eligibility criteria were all randomized clinical trials that assessed the efficacy of aloe vera mouthrinse in comparison to chlorhexidine on plaque and gingivitis. The risk of bias of the included studies was assessed using the Cochrane risk of bias assessment tool. RESULTS: Six randomized clinical trials comprising 1358 subjects were included in this systematic review. All included studies showed that aloe vera was effective in reducing plaque and gingival inflammation. Four studies found aloe vera as effective as chlorhexidine in reducing plaque scores, while two studies found chlorhexidine significantly more effective than aloe vera. With regard to gingival inflammation, three studies showed comparable results between aloe vera and chlorhexidine, while one study showed better results with chlorhexidine. Moreover, the results showed that aloe vera had no or very minimal side effects compared to chlorhexidine, which showed significant side effects including stains and altered taste sensation. CONCLUSION: The available evidence remains inconclusive but suggests that aloe vera mouthwash is comparable to chlorhexidine in reducing gingival inflammation but inferior to chlorhexidine in reducing plaque. These findings are preliminary and further high-quality studies with adequate sample sizes are highly recommended.

Coronally Advanced Flap with Amniotic Membrane in the Treatment of Gingival Recession: Three Case Reports.

Gingival recession is defined as an apical displacement of soft tissues to the cementoenamel junction. Various treatment options for the management of gingival recessions include laterally positioned flap, double papillae flap, coronally advanced flap (CAF) with or without guided tissue regeneration, free gingival autografts, and autogenous subepithelial connective tissue grafts. Three patients with multiple adjacent gingival recessions in the upper jaw were treated utilizing amniotic membrane (Tata memorial) with CAF. The results of this procedure show that amniotic membrane can be used in the treatment of gingival recession defects with significant root coverage and to increase the thickness of keratinized gingiva. There was an increase in height and thickness of keratinized gingiva from 3 to 3.5 mm and 1.5 to 2 mm, respectively. The present results suggest that the combined approach of CAF and amniotic membrane can be considered as a treatment option for multiple adjacent gingival recessions.

Comparative evaluation of hemodynamic, vasoconstrictive, and SpO2 variability during different stages of periodontal surgery performed using 0.5% ropivacaine or 2% lignocaine HCl (1:80,000 adrenaline) local anesthesia: A randomized, double-blind, split-mouth pilot study.

AIM: The aim of this study is to compare anesthetic, hemodynamic, vasoconstrictive, and SpO2 variability of 0.5% ropivacaine to the "gold standard" lignocaine (2%) with epinephrine (1:80,000) during periodontal surgery. MATERIALS AND METHODS: A total of 20 systemically healthy controls meeting the inclusion criteria were selected from the Outpatient Department of Sri Sai College of Dental Surgery. Preoperatively, all participants were infiltrated with 0.5 ml of 0.5% ropivacaine intradermally as test solution to record any allergic reaction. Open flap debridement was performed using local anesthesia containing 2% lignocaine hydrochloride with 1:80,000 epinephrine or 0.5% ropivacaine. Recordings were made of the time of onset, duration of action, the intensity, and depth of anesthesia and various hemodynamic changes throughout the surgical procedure. In addition, blood loss volume and postoperative pain were also assessed. RESULTS: Ropivacaine showed statistically longer duration of action (mean±SD =5.3±0.71 hrs) than lignocaine with epinephrine (mean=2.14±0.98 hrs). Blood loss during flap surgery was comparatively less when performed under ropivacaine. No statistical differences were observed in systolic BP, diastolic BP, SpO2 and heart rate during different stages of periodontal surgery between either of the local anesthetic agents. CONCLUSION: Ropivacaine demonstrates comparable efficacy as lignocaine with added advantage of longer duration of action and superior postoperative pain control. No adverse events from this newer anesthetic were noted, and hence, it can be used safely as a viable local anesthetic for periodontal surgical procedures.

Efficacy of low-level laser therapy in management of recurrent herpes labialis: a systematic review.

Recurrent herpes labialis (RHL) is a highly prevalent viral infection that affects the oro-facial region. Current treatment options have limited efficacy in reducing healing time and recurrence rate of the disease. Recently, low-level laser therapy has been proposed as a potential treatment alternative for the management of RHL with no side effects. This systematic review aims to evaluate the effectiveness of laser therapy in the management and prevention of RHL. A comprehensive search of Medline/PubMed, Scopus, and Web of Science was carried out to identify published clinical trials comparing laser intervention to active and/or non-active controls for the treatment of RHL. Due to marked heterogeneity of available data, studies were assessed qualitatively, and no statistical analysis was performed. Of the retrieved 227 articles, six clinical trials met the eligibility criteria. The wavelengths, the power output, and energy density ranged between 632.5-870 nm, 5-80 W, and 2.04-48 J/cm2, respectively. All included studies found laser to be effective in the management and prevention of RHL, without any side effects. The findings of this review suggest that laser is potentially a safe and effective treatment alternative for the management of RHL. However, due to high variability in study designs and inconsistency in laser parameters among the included studies, more well-designed randomized clinical trials with standardized laser parameters are highly warranted.

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

BACKGROUND: The aim of this study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus (OLP). MATERIALS AND METHODS: PubMed/MEDLINE, Scopus, and ISI Web of knowledge were searched until July 2017, using the following keywords: OLP, erosive lichen planus, lichen planus, and PDT. RESULTS: Five clinical studies were included. The risk of bias was considered high in 4 studies and moderate in 1 study. The efficacy of PDT was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation, and power density ranged between 420-660 nm, 30 seconds to 10 minutes, and 10-500 mW/cm2 , respectively. All studies reported PDT to be effective in the management of symptomatic OLP. Two studies reported PDT to be as effective as corticosteroids, 1 study reported a better efficacy of PDT compared to corticosteroids, whereas 2 studies found PDT to be inferior to corticosteroids. CONCLUSIONS: The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted.

Influence of Smoking on Gingival Crevicular Fluid Interleukin 1ß and Interleukin-8 in Patients with Severe Chronic Periodontitis among a Rural Population in India.

BACKGROUND AND OBJECTIVE: Smoking is widely prevalent among rural Indian populations. Smoking is considered a significant risk factor for periodontal diseases. The aim of the present study was to evaluate the influence of smoking on the inflammatory cytokines interleukin (IL) IL-1ß and IL-8 in gingival crevicular fluid (GCF) and compare these between smokers and nonsmokers with periodontitis in diseased and healthy sites. MATERIALS AND METHODS: A total of thirty patients with severe chronic periodontitis (15 smokers and 15 nonsmokers) participated in this study. Clinical parameters assessed were gingival index, bleeding on probing, probing depth (PD), and clinical attachment level. One diseased and one healthy site from each of the periodontitis patients were selected for GCF collection and assigned to the following four groups: healthy sites in smoker (SH), diseased sites in smoker (SD), healthy sites in nonsmoker (NH), and diseased sites in nonsmoker (ND) and were analyzed by enzyme-linked immunosorbent assay test (Quantikine®). RESULTS: Intragroup comparisons revealed statistically significant levels of IL-1ß in ND sites compared to NH sites (P < 0.005) and SD sites showed statistically significantly higher levels of IL-1ß compared to SH sites (P < 0.0001). However, there was no significant difference in IL-8 levels between NH and ND sites as well as between SH and SD sites. Intergroup comparisons revealed that SH sites exhibited significantly lower amounts of IL-8 (P < 0.01) compared to NH sites and SD sites showed significantly lower levels of IL-8 compared to ND sites (P < 0.001). However, the comparison of NH and SH sites as well as ND and SD sites showed no significant difference in the levels of IL-1ß. CONCLUSIONS: Cytokine levels were significantly elevated in periodontitis patients. Smokers exhibited a decrease in IL-8 and increase in IL-1ß levels. Hence, this reflects the influence of smoking on immunosuppression and its role in the pathogenesis of periodontal disease.

Effect of adjunctive use of systemic antioxidant therapy (N-acetylcysteine) on soluble receptor activator nuclear factor κB ligand levels in gingival crevicular fluid following surgical periodontal treatment for chronic periodontitis.

N-acetylcysteine (NAC) is an anti-oxidant drug that has been used as a mucolytic agent and a paracetamol antidote for many years. This study was designed to determine the efficacy of the adjunctive use of NAC for periodontal treatment. Thirty subjects with moderate-to-severe chronic periodontitis were randomized to surgery with NAC (600 mg; S-NAC), surgery only (S-nonNAC), and healthy control groups. Gingival crevicular fluid (GCF) samples were obtained from all patients and sRANKL levels were determined by enzyme-linked immunosorbent assay at baseline, and 1, 3, and 7 months post-surgery. Plaque and gingival indices, probing depths, and clinical attachment levels were recorded at the same time. There was a significant reduction in probing depth at 3 months in the S-NAC group when compared to the S-nonNAC group (P < 0.05). However, no statistically significant differences in plaque and gingival indices, probing depths, clinical attachment levels, and sRANKL levels in GCF were noted between the surgical treatment groups at the end of 7 months. Hence, the use of adjunctive NAC resulted in a significant reduction in probing depths in the S-NAC group when compared to the S-nonNAC group at 3 months, but no statistically significant differences in GCF sRANKL levels were observed in the sites that underwent surgical treatment with or without NAC at different time intervals.

Is Khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review.

BACKGROUND: Khat (Catha edulis) chewing is a highly prevalent habit in the Arabian Peninsula and East Africa, and has recently spread to Western countries. The association between khat chewing and oral mucosal lesions is well documented in the literature. However, there is no concrete evidence on the association between khat chewing and periodontal disease. The purpose of this systematic review was to analyze the influence of khat chewing on periodontal health. MATERIAL AND METHODS: A literature search of PubMed, Scopus and Web of Sciences databases was carried out to identify relevant articles published from 1990 to May 2017. The inclusion criteria were all clinical studies that assessed the relationship between khat chewing and periodontal disease. RESULTS: The search yielded 122 articles, of which 10 were included in this systematic review. Most of the studies exhibited a positive correlation between khat chewing and periodontal disease. CONCLUSIONS: Altogether, the analysis of the current evidence reveals that khat chewing is destructive to the periodontium and enhances the risk of periodontal disease progression. However, due to variability of studies, more longitudinal case-controlled studies are highly warranted to establish a causal relation between khat chewing and periodontal disease. Key words:Khat chewing, periodontal health, periodontal disease, risk factor.

Combination of hydroxyapatite, platelet rich fibrin and amnion membrane as a novel therapeutic option in regenerative periapical endodontic surgery: Case series.

INTRODUCTION: Periapical surgery is the last resort in the arsenal of an endodontist to effectively deal with periapical lesions that result from necrosis of the pulp. Bone grafts, growth factors and membranes form an array of regenerative materials that influence the healing outcome of periapical surgery. PRESENTATION OF CASE: The main purpose of the two cases reported here was to assess the potential benefits of a combination of bone graft, platelet-rich fibrin (PRF) and amnion membrane in terms of reduced post-operative discomfort, radiographic evidence of accelerated periapical bone healing and present a novel therapeutic option in the management of large periapical lesions. Two cases of radicular cysts were treated through a combined regenerative approachof Bio-Gen mix®, PRF and amnion membrane. The patients were assessed for discomfort immediate post-operatively and after a week. The patients were recalled every month for the next 6 months for radiographic assessment of the periapical healing. DISCUSSION: Literature is replete with articles that have substantiated the role of demineralized bone matrix comprising a mixture of cancellous and cortical bone graft particles in enhancing regeneration. To the best of our knowledge, there has been no evidence related to the application of a human placental membrane in periapical surgery. Hence, the rationale of using a combined approach of Bio-Gen mix®, PRF and amnion membrane was to combine the individual advantages of these materials to enhance clinical and radiographic healing outcomes. Our present case reports provide an insight into this novel therapeutic option. CONCLUSION: The results of this case seriessubstantiatesthe credibility of using a combination ofamnion membrane with a bone graft and PRF to enhance radiographic healing outcome with decreased post-operative discomfort and present a viable regenerative treatment modality in periapical surgery.

Efficacy of low-level laser therapy in management of symptomatic oral lichen planus: a systematic review.

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology and indefinite cure. This systematic review assessed the efficacy of low-level laser therapy in the treatment of symptomatic OLP. Electronic databases (PubMed, Scopus, and Web of Science) were searched from date of inception till and including December 2016, using various combinations of the following keywords: oral lichen planus, laser therapy, low-level laser therapy, and phototherapy. Owing to heterogeneity of data, no statistical analyses were conducted. Initially, 227 publications were identified. After selection, only six studies were included in this systematic review. In these studies, the laser wavelengths, power output, and duration of irradiation ranged between 630-980 nm, 20-300 mW, and 10 s-15 min, respectively. All of the included studies found laser to be effective in management of OLP, without any reported adverse effects. The results of the included studies confirm that low-level laser therapy is effective in management of symptomatic OLP and can be used as an alternative to corticosteroids. However, due to variety of methods and substantial variations in laser parameters among these studies, more randomized clinical trials with large sample sizes are highly warranted.

Evaluation of Cyclosporine A with ß-TCP in the Treatment of Human Infra bony Defects - A Randomized Controlled Pilot Study.

INTRODUCTION: Cyclosporine A (CsA), an immunosuppressant, is considered a life saver drug in organ transplant cases. It has also been tested in animal and human studies for periodontal applications as it selectively inhibits T lymphocyte proliferation, Interleukin-2 (IL-2) and other cytokine production, without any effect on T suppressor cells, thereby suppressing the cell mediated immunity and suppressing the inflammation. Inflammatory and immunological responses have been found to be decreased and bone formation is found to be increased in immunosuppressed animals. CsA is also supposed to potentiate osseous regeneration due to increase in the bone alkaline phosphatase levels and a direct activating effect on osteoblasts. AIM: The present study was aimed at evaluating locally administered low dose of CsA which is potent immunosuppressant along with ß-Tricalcium phosphate (ß-TCP) in comparison with ß TCP alone, in the treatment of human infrabony defects, over a period of six months. MATERIALS AND METHODS: Thirty two systemically healthy chronic periodontitis patients with infrabony defects were included in the randomized, controlled, parallel arm study and were allocated into either Group A (n =16), patients treated with ß-TCP + CsA (2 mg) or Group B (n =16), patients treated with ß-TCP. Clinical parameters [Relative Attachment Level (RAL), Probing Depth (PD), Gingival Recession (GR)] and radiographic parameters were measured at baseline and six months postoperatively. Statistical analysis was done using SPSS version 16 software. Student's paired and independent t-test were used for intra and inter-group analysis. RESULTS: Both Group A and Group B showed statistically significant improvements in clinical and radiographic parameters from base line to six months post-operatively. The Clinical Attachment Level (CAL) gain, Linear Bone Growth (LBG) and Percentage Bone Fill (% BF) were 2.38±1.12 mm, 1.90±1.48 mm and 49.83±29.23 mm in Group A and 2.57±1.22 mm, 2.03±1.16 mm and 62.84±29.70 mm in Group B respectively, inter group comparison showed no statistically significant difference. CONCLUSION: Both the groups revealed statistically significant improvement in clinical and radiographic parameters and adjunctive use of CsA did not prove beneficial.

Treatment of dentinal hypersensitivity using low-level laser therapy and 5% potassium nitrate: A randomized, controlled, three arm parallel clinical study.

AIM: The present randomized study was aimed to compare the efficacy 5% potassium nitrate (KNO3) toothpaste, low-level laser therapy (LLLT), and LLLT with 5% KNO3 toothpaste in the treatment of dentinal hypersensitivity (DH). MATERIALS AND METHODS: Total of 45 patients complaining of DH with visual analog scale (VAS) score being ≥2 were recruited and were divided into three groups. Group A was treated with 5% KNO3 toothpaste, Group B using LLLT along with the application of 5% KNO3 toothpaste, and Group C using LLLT alone. VAS scores were recorded at the baseline, 1st, 2nd, and 3rd weeks by the examiner who is blinded toward the treatment. The sensitivity response was evaluated using air spray and tactile sensation (explorer). RESULTS: A greater reduction of DH was recorded at the end of 3 weeks in Group C and Group B when compared to Group A. Better results were noted in Group C at the end of the 1st week when compared to Group B. According to this study, there was no additional benefit of using toothpaste along with LLLT. CONCLUSION: A greater reduction of DH was recorded at the end of 3 weeks in Group C and Group B when compared to Group A. Better results were noted in Group C at the end of the 1st week when compared to Group B. According to this study, there was no additional benefit of using toothpaste along with LLLT.

Laser-assisted lip repositioning surgery: Novel approach to treat gummy smile.

Excessive gingival display (EGD) resulting in a "gummy smile" is a major esthetic concern with ramifications in an individual's personal and social life. Numerous treatment modalities have been used for the correction of EGD. The present case report describes the successful treatment of a young woman with an excess gingival display caused by a hyperactive upper lip and a mild vertical maxillary excess that was treated with a laser-assisted lip repositioning surgical technique accompanied by gingival recontouring. The procedure was accomplished by laser-assisted removal, through scraping a strip of mucosa from the maxillary buccal vestibule and suturing the mucosa of the lip to the mucogingival junction. This technique resulted in shortened vestibule and restricted the muscle pull of the elevator muscles of the lip, thereby reducing gingival display when the patient smiles. Laser-assisted lip repositioning surgery can be a viable, minimally invasive alternative to orthognathic surgery.

Efficacy of low level laser therapy in the treatment of burning mouth syndrome: A systematic review.

BACKGROUND: Burning mouth syndrome (BMS) is a chronic pain condition with indefinite cure, predominantly affecting post-menopausal women. The aim of this study was to systematically review the efficacy of low level laser therapy in the treatment of burning mouth syndrome (BMS). METHODS: PubMed, Embase and Scopus were searched from date of inception till and including October 2016 using various combinations of the following keywords: burning mouth syndrome, BMS, stomatodynia, laser therapy, laser treatment and phototherapy. The inclusion criteria were: Prospective, retrospective and case series studies. Letter to editors, reviews, experimental studies, studies that were not published in English, theses, monographs, and abstracts presented in scientific events were excluded. Due to heterogeneity of data no statistical analyses were performed. RESULTS: Ten clinical studies fulfilled the eligibility criteria, five of which were randomized clinical trials. In these studies, the laser wavelengths, power output and duration of irradiation ranged between 630-980nm, 20-300mW, 10s-15min, respectively. Most of studies reported laser to be an effective therapy strategy for management of BMS. CONCLUSION: Majority of the studies showed that laser therapy seemed to be effective in reducing pain in BMS patients. However, due to the varied methodologies and substantial variations in laser parameters among these studies, more clinical trials are required to ascertain the efficacy of laser for treating BMS.

Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques.

INTRODUCTION: Inadequate vestibular depth results in poor plaque control owing to an insufficient width of keratinized gingiva. Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers. AIM: To evaluate the patient perceptions related to pain and discomfort on the 1(st), 3(rd) and the 7(th) day post vestibuloplasty and also assess the healing outcomes related to the treatment of inadequate vestibular depth either with the diode laser or the scalpel. MATERIALS AND METHODS: Twenty patients who had inadequate vestibular depth and required vestibuloplasty were assigned randomly to undergo the procedure either with the scalpel or the laser. The data obtained was analysed for intergroup comparison with an independent paired t-test and intragroup comparison was determined by a paired t-test. RESULTS: Intragroup comparison within the laser group for VAS scores of pain and discomfort within all the reported days exhibited a significant difference (p<0.05). Inter group comparison revealed that the patients in the laser group had lower VAS cores for pain and discomfort compared to the scalpel group (p<0.05). Analysis of the three pointer scale for healing revealed that the patients in the laser group exhibited better healing outcomes on the 1(st), 3(rd) and the 7(th) day compared to the scalpel group. CONCLUSION: Observations from the study highlight the opinion that laser can be a safe and effective alternative to traditional vestibuloplasty performed with the scalpel.

Comparing Laser and Scalpel for Soft Tissue Crown Lengthening: A Clinical Study.

Crown lengthening procedure is aimed at exposure of sufficient crown structure accomplished by a gingivectomy, an apically positioned flap with osseous resection or the use of lasers. Our present clinical study is aimed to assess the clinical effectiveness of a diode laser for functional crown lengthening procedure and to compare it with the conventional procedure using the scalpel. Fourteen patients including males and females, aged 20- 40 years were recruited and divided into two groups to undergo crown lengthening either with the scalpel or the laser. The data obtained was analyzed for intergroup comparison with an Unpaired t-test and intragroup comparison was determined by ANOVA.Analysis of the intergroup results for pain showcased that there was a significant difference (P<0.002) in VAS scores of pain on the 3rd day as well as on the 7th day (P<0.044), with patients in the laser group displaying significantly lower VAS scores compared to the scalpel group, but when both the groups were compared on the 10th day, there was no significance (P<0.14).Intergroup comparison of the mean VAS scores for discomfort observed on the 3rd, 7th and the 10th day of the study suggested that there was a significant difference of the VAS scores of discomfort on the 3rd and the7thdays, with the patients in the laser group displaying significantly lower VAS scores for discomfort compared with the scalpel.Observations from the study emphasize that laser can be a safe and effective alternative to traditional crown lengthening performed with the scalpel.

Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial.

OBJECTIVE: Periodontitis is known to have multifactorial etiology, involving interplay between environmental, host and microbial factors. The current treatment approaches are aimed at reducing the pathogenic microorganisms. Administration of beneficial bacteria (probiotics) has emerged as a promising concept in the prevention and treatment of periodontitis. Thus, the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing (SRP) in the treatment of patients with chronic periodontitis and halitosis. METHODS: This is a randomized, placebo-controlled, double-blinded trial involving 32 systemically healthy chronic periodontitis patients. After SRP, the subjects were randomly assigned into the test and control groups. Test group (SRP + probiotics) received subgingival delivery of probiotics and probiotic mouthwash, and control group (SRP + placebo) received subgingival delivery of placebo and placebo mouthwash for 15 days. Plaque index (PI), modified gingival index (MGI), and bleeding index (BI) were assessed at baseline, 1 and 3 months thereafter, whereas probing depth (PD) and clinical attachment level were assessed at baseline and after 3 months. Microbial assessment using N-benzoyl-DL-arginine-naphthylamide (BANA) and halitosis assessment using organoleptic scores (ORG) was done at baseline, 1 and 3 months. FINDINGS: All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study. Inter-group comparison of PD reduction (PDR) and clinical attachment gain (CAG) revealed no statistical significance except for PDR in moderate pockets for the test group. Test group has shown statistically significant improvement in PI, MGI, and BI at 3 months compared to control group. Inter-group comparison revealed a significant reduction in BANA in test group at 1 month. ORG were significantly reduced in test group when compared to control group. CONCLUSION: Within the limitations of the study, the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters.

Periodontal Systemic Connections-Novel Associations-A Review of the Evidence with Implications for Medical Practitioners.

Periodontal diseases, considered as inflammatory diseases have proved to have a spectrum of systemic implications. Earliest research has associated periodontal disease with common systemic aliments such as hypertension, diabetes, osteoporosis, rheumatoid arthritis to name a few. The evolution of advanced diagnostic aids let researchers make vast inroads in linking periodontal diseases to systemic diseases like Alzheimer's disease (AD) and even Schizophrenia. Our aim was to review and critically evaluate comprehensive literature and provide knowledge to medical practitioners on these associations so as to pave way for closer interactions between medical and dental practitioners in implementing better health care. Electronic databases such as PubMed, Google Scholar and Cochrane databases were used as source of the data for relevant studies published from 2005 up to 2015 with the following keywords, "'Periodontal disease", "systemic conditions", "periodontal disease and Alzheimer's", "Periodontal disease and Schizophrenia", "Periodontal disease and Psoriasis" and "Periodontal disease and erectile dysfunction". The evidence presented ascertains that a reasonable and modest association does exist between Periodontal disease and Alzheimer's, Schizophrenia, Erectile dysfunction, as well as Psoriasis and thus establishes periodontal disease as a potential risk factor.

Laser-Assisted Periodontal Management of Drug-Induced Gingival Overgrowth under General Anesthesia: A Viable Option.

Gingival overgrowth/hyperplasia can be attributed to several causes, but drug-induced gingival overgrowth/hyperplasia arises secondarily to prolonged use of antihypertensive drugs, anticonvulsants and immunosuppressants. The management is complex in nature considering the multitude of factors involved such as substitution of drug strict plaque control along with excision of the tissue to be performed under local anesthesia as outpatient. In the recent times, the patient's psychological fear of the treatment with the use of surgical blade and multiple visits has developed the concept of single visit treatment under general anesthesia incorporating a laser as viable option. The present case highlights the new method of management of gingival overgrowth.

Periodontal management of sturge-weber syndrome.

Sturge-Weber syndrome (SWS) is a sporadic disorder and is frequent among the neurocutaneous syndromes specifically with vascular predominance. This syndrome consists of constellation of clinical features like facial nevus, seizures, hemiparesis, intracranial calcifications, and mental retardation. It is characterized by focal port-wine stain, ocular abnormalities (glaucoma), and choroidal hemangioma and leptomeningeal angioma most often involving occipital and parietal lobes. The present paper reports three cases of SWS with oral manifestations and periodontal management, which included thorough scaling and root planing followed by gingivectomy with scalpel and laser in cases 1 and 3 consecutively to treat the gingival enlargement. However, the treatment in case 2 was deferred as the patient was not a candidate for periodontal surgery.