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.

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.

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.

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.

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.

Quick response code in acrylic denture: will it respond when needed?

Use of acids and other caustic substances in destroying the human body to avoid personal identification is drawing great deal of attention in recent times. With rapid industrial growth, incidence of industrial disasters has increased. In an event of chemical industry disaster, human identification can become a challenge. Embedding bar codes and other electronic means for identification in denture have proved to be a novel innovation in identification of edentulous patients. However, the validity of this method in events of chemical extremes has not been assessed. Hence, the study was undertaken to know the effect of different acids on dentures embedded with quick response codes. Results of this study indicate that simple bar code can be readable up to 33 h after acid treatment. With minimal armamentarium, bar code can be generated incorporating large data into it, providing it to be a cheap and reliable means of denture identification.

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.

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.

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.

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.

Nucleolar organizing regions and alpha-smooth muscle actin expression in a case of ameloblastic carcinoma.

Ameloblastic carcinoma is a rare lesion of odontogenic origin. It is defined as a malignant epithelial odontogenic tumor that histologically has retained the features of ameloblastic differentiation and also exhibits cytologic features of malignancy, like atypia and mitotic activity. Although this lesion represents a separate entity, differentiating it from ameloblastoma has been often challenging to pathologists. In this case study reporting a case of ameloblastic carcinoma, we have attempted to verify the previous findings on the use of Argyrophilic nucleolar organizing regions (AgNORs) and immunohistochemical staining for the alpha-smooth muscle actin (alpha-SMA) in differentiating ameloblastic carcinoma from ameloblastoma. It was observed that AgNORs was found to be almost twice in ameloblastic carcinoma as it was in ameloblastoma. A difference between the two lesions in the pattern of expression of alpha-SMA was also observed, with alpha-SMA being expressed in the odontogenic epithelium and the stroma of ameloblastic carcinoma whereas, in the case of ameloblastoma, it was found only in the stromal part. These findings suggest that AgNORs and alpha-SMA expression may be used as adjuncts to the routine histopathologic examination to differentiate ameloblastic carcinoma and ameloblastoma.