Drug induced gingival enlargement - phenytoin: an overview and case report.

Gingival enlargement is a side effect of several different medication, including immunosuppressants, anticonvulsants, and calcium channel blockers. It is an inflammatory response that starts when plaque and calculus build up on the tooth surface. The most prevalent long-term neurological condition affecting people is epilepsy. In affluent nations, the prevalence of epilepsy is ~ 1%, whereas in less developed countries, it may >2%. The preferred medication for the condition, phenytoin, has major side effects include gingival enlargement. In addition to being visually disfiguring, this enlargement frequently affects speech, chewing and eating. Furthermore, those with poor dental hygiene, causes disabilities with motor coordination and muscular limitations leading to mental disability and physical impairments are more prone to periodontal disease. This article enlightened the mechanism of drug induced gingival enlargement clinically, microbiologically, and surgically.

Antimicrobial efficacy of two commercially available herbal products with and without ultrasonic activation in primary endodontic infections: A randomized clinical trial.

Background: Effective irrigation is crucial for successful endodontic treatment. Traditional irrigants like sodium hypochlorite (NaOCl) have been widely used, but there is a growing interest in exploring natural alternatives for their potential antimicrobial properties. Objective: The study aims to compare the antimicrobial efficacy of Neem, Bitter Gourd, and NaOCl, with and without ultrasonic activation in managing primary endodontic infections. Materials and Methods: Ninety patients were randomly assigned six groups (n = 15) Group 1: NaOCl, Group 2: NaOCl with passive ultrasonic irrigation (PUI), Group 3: Neem juice, Group 4: Neem juice with PUI, Group 5: Bitter gourd juice, and Group 6: Bitter gourd juice with PUI. Bacteriological samples were collected before (S1) and after (S2) shaping, plated on brain heart infusion agar, and colony counting was done after 24 h. Statistical Analysis Used: Shapiro-Wilk test, one-way ANOVA, post hoc Tukey analysis, and paired t-test. Results: All the groups demonstrated a significant reduction in bacterial count. Groups with PUI (2, 4, 6) demonstrated higher mean bacterial reduction than their counterparts without PUI (1, 3, 5). Conclusion: Neem and Bitter gourd juices, particularly when used with PUI, demonstrated antimicrobial efficacy comparable to NaOCl with PUI.

To Evaluate the Clinical Efficacy of 940 nm Diode Laser and Propolis Gel (A Natural Product) in Adjunct to Scaling and Root Planing in Treatment of Chronic Periodontitis.

Background: Recently, various adjunctive treatment options along with Scaling and root planing (SRP) such as local drug delivery, medications, and lasers have been introduced for the treatment Chronic periodontitis (CP) but literature is limited. Aim: To evaluate the clinical efficacy of 940 nm diode laser and propolis gel in adjunct to Scaling and root planing (SRP) in the treatment of CP. Subjects and Methods: Randomized clinical trial was conducted among 30 CP patients with a probing depth of ≥5 mm was allocated randomly into Group 1 (SRP), Group 2 (SRP + diode laser), and Group 3 (SRP + propolis gel). Plaque index, gingival index, pocket probing depth, and clinical attachment level were assessed at baseline, one and three months. Data analysis was performed using SPSS version 17 for windows, and statistical techniques employed were repeated measures by using One-way ANOVA, Tukey's HSD, independent t-test, and paired t-test. Results: Post-treatment sites among all the three groups showed statistically significant reduction in Periodontal index (PI), Probing pocket depth (PPD), and Clinical attachment level (CAL), whereas gingival inflammation was significantly reduced in groups 2 and 3 from baseline to one and three months. On comparison, at baseline, all clinical parameters were statistically insignificant. At one month, the mean difference of PI, Gingival index (GI) was statistically significant between group 1 and 2 whereas the mean difference of CAL and PPD were statistically significant from group 1 to groups 2 and 3. Conclusions: Lasers with SRP were greatly effective in reducing gingival inflammation, PPD, and CAL. Propolis gel also offered encouraging and promising clinical results but still needs further long-term studies to establish its precise role in the treatment of CP.

IgA Levels among Type 2 Diabetic and Non-Diabetic Patients with Periodontitis: A Prospective Clinical Study.

OBJECTIVES: To estimate gingival crevicular immunoglobulin A(IgA) using enzyme-linked immunosorbent assay (ELISA) among type II diabetic patients with periodontitis. MATERIALS AND METHODS: A non-randomized study was done of 40 periodontitis subjects with a mean age of 50 years and were recruited into two groups, Group A (Type II controlled diabetics with HbA1c < 7%) and Group B (non-diabetics with HbA1c between 4 and 6%). Both the groups underwent nonsurgical periodontal therapy (NSPT). The clinical parameters were recorded at baseline, 1, and 3 months. GCF sample was collected for the estimation of crevicular IgA at baseline and at 3 months. STATISTICAL ANALYSIS: Results were analyzed using parametric tests paired t-test and Student's t-test for every assessment point. The level of significance was set at p < 0.05. RESULTS: Difference in IgA levels and clinical parameters was seen between diabetic and non-diabetic groups, which was statistically significant. CONCLUSION: Changes in crevicular IgA levels in patients with diabetic periodontitis can be used as a novel biomarker in assessing the inflammatory status.

Evaluation of Efficacy of Coenzyme Q10 as an Adjunct to Nonsurgical Periodontal Therapy and Its Effect on Crevicular Superoxide Dismutase in Patients with Chronic Periodontitis.

OBJECTIVES: To assess the efficacy of coenzyme Q10 (CoQ10) as an adjunct to nonsurgical periodontal therapy and its effect on superoxide dismutase (SOD) in gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP). MATERIALS AND METHODS: A total of 16 patients aged between 30 and 50 years having mild to moderate CP of both sexes having pocket depth of 5 to 7 mm in four nonadjacent interproximal sites were selected. The sites were randomized and divided into treatment and control groups. CoQ10 and a placebo gel were administered in the treatment and control sites, respectively, at baseline after scaling and root planing (SRP). GCF was collected using microcapillary method at baseline and 3 months and was assessed for SOD using enzyme-linked immunosorbent assay reader at 450 nm wavelength. Probing pocket depth, gingival index, and plaque index were assessed at baseline, 1 month, and 3 months, respectively. STATISTICAL ANALYSIS: For each assessment point, data were statistically analyzed using Student's t-test and paired t-test. Level of significance was set at p < 0.05. RESULTS: On intergroup comparison, there was no statistically significant difference between the clinical parameters of both the groups at all the time intervals (p > 0.05), but there was a significant increase in the level of SOD in the test group (p > 0.05) compared with the control group at 3 months. CONCLUSIONS: Adjunctive use of CoQ10 with SRP can boost the antioxidant concentration, but it is not superior to SRP in the treatment of CP.

The comparative evaluation of 1% alendronate gel as local drug delivery system in chronic periodontitis in smokers and non smokers: Randomized clinical trial.

INTRODUCTION: Periodontitis is a progressive disease of microbial origin involving the loss of supporting tissues of the teeth resulting from host inflammatory and immunologic reactions. The standard approach to the prevention and treatment of periodontal diseases for a number of years has been mechanical therapy and if required surgical intervention Researcher thought of creating a treatment modality where by altering the host response, the destructive host mechanisms could be interfered affecting the final outcome of the disease process. AIM: The present study aims to explore the efficacy of local delivery of a 1% Alendronate (ALN) gel as an adjunct to scaling and root planing (SRP) for the treatment of infrabony periodontal pockets in smokers and non-smoker with Chronic Periodontitis. MATERIALS AND METHOD: 60 infrabony periodontal pockets in patients with chronic periodontitis between the age group of 30-50 years were selected. The study consisted of 2 groups smoker and nonsmoker. A gel based drug delivery system of Alendronate was formulated. 0.1 ml alendronate gel and 0.1 ml placebo gel was placed at the experimental and control sites respectively following root planing. Clinical and radiographic parameters were recorded at baseline, three months and six months. RESULTS: Alendronate was effective in improving clinical and radiographic parameters compared to placebo. Alendronate showed better result in non smoker group when compared with smoker group. CONCLUSION: This Study showed improvements in clinical parameters both at the control and experimental sites. However, the experimental sites (Alendronate) showed greater improvement as compared to the control sites (Placebo). A significant gain in alveolar crest height and defect fill was measured radiographically at non smoker Alendronate group.

Evaluation of non-surgical therapy on glutathione levels in chronic periodontitis.

OBJECTIVE: To compare the levels of glutathione (GSH), both oxidized and reduced forms in patients with and without chronic periodontitis in gingival crevicular fluid (GCF). MATERIALS AND METHODS: Twenty GCF samples from maxillary quadrants were collected using capillary micropipettes from the chronic periodontitis patients (test group) at baseline before treatment, at 1-month, 3 months, and 6 months after scaling and root planing and samples from 20 patients without chronic periodontitis (control group) from maxillary quadrants were also collected. GSH, oxidized glutathione (GSSG) levels and GSH: GSSG ratios were determined using the spectrophotometric method. STATISTICAL ANALYSIS: Results were concluded for the test over control groups using paired Student's t-test. RESULTS: Lower concentrations of GSH (P < 0.001) and GSSG (P < 0.001) were detected in GCF in patients with chronic periodontitis (test group) than patients without chronic periodontitis (control group) at baseline. Treatment had a significant effect in improving the GSH and reducing GSSG levels postscaling and root planing at 1-month and 3 months but not significant effect at 6 months. Scaling and root planing increased the GSH: GSSG ratio (P < 0.001) in the test group as compared to the control group (P < 0.001). CONCLUSIONS: The concentrations of GSH within GCF are reduced in chronic periodontitis patients. Scaling and root planing (nonsurgical therapy) restores GSH concentration in GCF post 1-month and 3 months along with redox balance (GSH: GSSG ratio), but at 6 months the balance is not maintained. Adjunctive use of micronutritional supplements to boost antioxidant concentration in tissues by preserving GSH or by elevating its level at the inflamed sites is recommended, as nonsurgical periodontal therapy alone is not able to maintain redox balance for longer duration.

Prevalence of dentine hypersensitivity: A cross-sectional study in rural Punjabi Indians.

AIMS AND OBJECTIVES: To study the prevalence of dentine hypersensitivity and related risk factors in rural population of Punjab, India. MATERIALS AND METHODS: A total of 650 subjects reporting dentine sensitivity were included in the study comprising of 270 males and 380 females. All the subjects completed an interview and the subjects reporting dentine hypersensitivity were examined further using air syringe to put a blast of air to confirm the diagnosis of dentine hypersensitivity. Periodontal attachment loss and gingival recession of all the sensitive teeth were examined and recorded. RESULTS: The prevalence of dentine hypersensitivity was 25% in the oral test. The subjects receiving the treatment of hypersensitivity were only 15.1%. The older group in the 50-59 years had the highest number (98%) of subjects with dentine hypersensitivity. Most commonly affected teeth were mandibular incisors. The other factors related to dentine hypersensitivity were the socioeconomic status, lower education level, and access to dental care. The periodontal factors related to hypersensitivity were gingival recession and poor oral hygiene. CONCLUSIONS: The prevalence of dentine hypersensitivity was 25% in the rural population of Punjab.

Evaluation of gingival fiber retention technique on the treatment of patients with chronic periodontitis: A comparative study.

UNLABELLED: The destructive action of the chronic periodontitis on the periodontal tissues has provided a continuous challenge to the dental profession to develop better methods to achieve repair of the recession regions and even regeneration of post periodontal tissues. AIMS: To assess the effect of periodontal muco-periostal flap surgery with gingival fiber retention technique on minimizing the post surgical recession. MATERIALS AND METHODS: The sample for the study comprised of 20 patients. The criteria for selection included patients with moderate periodontitis, with minimum recession in the anterior teeth, with adequate width of the attached gingiva, and with no traumatic occlusion. Periodontal muco-periosteal flap surgery with gingival fiber retention technique was done in the experimental site with internal bevel incision, and in control site, muco periosteal flap surgery with crevicular incision was done. Thereafter, observation period was of one week, four weeks, and eight weeks were done for both the sites. STATISTICAL ANALYSIS USED: The results were subjected to statistical analysis using student's t'-test. RESULTS: The result of this study suggests that the periodontal flap surgery with gingival fiber retention technique has a beneficial effect on the anterior teeth, as it maintains the esthetics, recontours the gingiva with minimal recession. The area of recession was more on the control site as compared to experimental site at 4 weeks, 8 weeks and 12 weeks. CONCLUSIONS: Gingival fiber retention technique showed less post-surgical recession and also there was fall in values of plaque index, gingival index, and periodontal index scores, throughout the study.