Clinical efficacy of green tea, aloe vera and chlorhexidine mouthwashes in the treatment of dental biofilm induced gingivitis: A multi-arm, double-blinded, randomized controlled clinical trial.

OBJECTIVE: This multi-arm, randomized, double-blinded, controlled clinical trial was designed to evaluate the clinical efficacy of 0.5% green tea (GT), 0.2% chlorhexidine (CHX) and aloe vera (AV) mouthwash as compared to the control (CNT) group (scaling and polishing alone with no mouthwash) in the management of dental biofilm induced gingivitis among 18-40-year-old patients. MATERIAL AND METHODS: Sixty patients with generalized dental biofilm-induced gingivitis were randomly allocated to four study groups (n = 15 each) for treatment, namely Group GT, Group CHX, Group AV and Group CNT after scaling and polishing were administered to all the patients. Plaque index (PI), gingival index (GI) and sulcular bleeding index (SBI) were recorded at baseline, 14th and 21st day. RESULTS: PI, GI and SBI at various time intervals (baseline, 14th and 21st day) showed high statistically significant differences within the group (p < 0.01). Among these, the maximum percentage change was found in the CHX group followed by GT when evaluated from baseline to 21st day. The least percentage change was found in the AV group for PI and GI while the CNT group showed the least percentage change for sulcular index when evaluated from 14th to 21st day. Inter-group results showed high statistically significant differences (p < 0.01) for PI and GI when evaluated between baseline to 14th day and baseline to 21st day. SBI also showed statistically significant differences (p < 0.05) when evaluated between baselines to 14th day and baseline to 21st day. CONCLUSION: Green tea mouthwash displayed a significant reduction in plaque index, gingival index and sulcular bleeding index. 0.5% green tea catechin has equivalent anti-plaque efficacy as 0.2% chlorhexidine gluconate and can be considered a potent alternative to prevent and treat gingival diseases.

Severity of Periodontal Disease in Chronic Kidney Disease Patients: A Hospital-Based Study.

Background Periodontal disease is a chronic inflammatory condition of multifactorial origin. The inflammatory mediators released during the progression of disease may affect all the organs of the body. Renal disease is a chronic systemic disease which may influence the progression of periodontal disease. Therefore, this study was conducted to evaluate and compare the prevalence of periodontal disease among individuals with chronic kidney disease undergoing maintenance hemodialysis with healthy individuals. Methodology In this cross-sectional study including 150 participants, 75 patients with different renal diseases undergoing hemodialysis (Group I) and 75 healthy controls (Group II) were included. The general examination of the patients was done. Blood pressure, pulse, and body mass index were recorded, followed by biochemical investigations, in which serum urea, serum creatinine, and random blood sugar were evaluated for each participant. Plaque Index (PI) and Gingival Index (GI) scores were recorded. Probing pocket depth (PPD) and gingival recession GR were measured, and clinical attachment level (CAL) was calculated based on the obtained values. The subjects were then categorized into three groups, namely, no/mild, moderate, and severe periodontitis. Results Out of the total study participants, 68% were men and 32% were women, with a mean age of 47 years. Serum markers were significantly elevated in Group I compared to Group II. Poor oral hygiene and periodontitis were observed to be much higher in dialysis patients compared to the control group. The two groups also significantly differed in PI, GI, PPD, GR, and CAL, all of which were higher in Group I. Conclusions The results suggest that patients with renal disease must be screened for periodontal disease.

Comparison of clinical outcomes of non-surgical adjunctive use of the 980-nm diode laser to conventional periodontal flap procedure-a randomised controlled split-mouth clinical trial.

Lasers have been found to be effective as an adjunctive in periodontal therapy. The objective of the study was to compare the outcomes of non-surgical adjunctive use of 980-nm diode laser to that of conventional flap surgery in terms of clinical outcome measures and radiographic osseous defect depths. This study was designed as a double-blinded split-mouth randomised controlled clinical trial. A total of fifteen patients (30 quadrants) with generalised periodontitis stage III grade B were randomly assigned test group (diode laser) and control group (conventional flap surgery). Both test and control groups had 15 quadrants each. At 3 months, the probing pocket depth (PPD) was 3.46 ± 0.19 mm (test) and 4.20 ± 0.20 mm (control), with a statistically significant difference between the groups (p = 0.01). Similarly, at 6 months re-evaluation, PPD was 1.46 ± 0.12 mm (test) and 2.33 ± 0.13 mm (control) with a highly significant statistical difference (p = 0.001). Plaque index showed a difference between both test and control groups at baseline, 3 months and 6 months (p = 0.001) while gingival index, modified sulcular bleeding index and radiographic osseous defect depth showed a difference at 3 months and 6 months (p = 0.001). Within the study's limitations, 980-nm diode laser can result in significant improvements in the clinical and radiographic parameters and is very well tolerated by the subjects.

Evaluation of Gingival Crevicular Fluid and Serum Tartrate-resistant Acid Phosphatase Levels in Subjects with Clinically Healthy Periodontium and Chronic Periodontitis - A Clinico-biochemical Study.

BACKGROUND: Periodontitis is a chronic inflammatory disease with conglomerate etiology making it difficult to diagnose at the early stages. Potential biomarkers in gingival crevicular fluid (GCF) would determine the presence of the current disease activity, predict sites vulnerable for future breakdown, and assess the response to periodontal interventions. Merely elevated levels of inflammatory soft-tissue markers do not indicate bone destruction. Since there is no single ideal biomarker established, bone-related biomarkers such as telopeptide of type I collagen, osteocalcin, calprotectin, osteopontin, and tartrate-resistant acid phosphatase (TRAP) seem to hold great promise as predictive markers to determine bone destruction and active phases in the disease progression. The present study is intended to explore the biologic plausibility of the levels of TRAP in health and chronic periodontitis. MATERIALS AND METHODS: The present cross-sectional clinico-biochemical study comprised 30 systemically healthy subjects with 15 periodontally healthy and 15 chronic periodontitis subjects who were age and gender matched. GCF and blood samples were collected from all the patients. TRAP estimation was done in both the samples using an enzyme-linked immunosorbent assay kit. The data were analyzed using independent t-test and Pearson correlation test. RESULTS: Serum and GCF TRAP levels in chronic periodontitis subjects were significantly higher when compared to the periodontally healthy group. There were no significant correlations found among serum and GCF TRAP levels with increasing age and gender in both the groups. An increase in disease severity, i.e., increase in probing pocket depth and clinical attachment level, did not show correlation with the GCF and serum TRAP levels in the chronic periodontitis group. CONCLUSION: Based on the findings of the present study, increased GCF TRAP levels in chronic periodontitis seem to be a potential marker for identifying ongoing periodontal destruction.

Evaluation of the Efficacy of Guava Extract as an Antimicrobial Agent on Periodontal Pathogens.

AIM: The present study was undertaken to assess the inhibitory effect of guava extracts on Porphyromonas gingivalis and Aggregatibacteractinomycetemcomitans, to assess the time-kill curve of P. gingivalis and A. actinomycetemcomitans, and to determine the antiproteolytic activity of guava on P. gingivalis. MATERIALS AND METHODS: Kanamycin blood agar was used to isolate P. gingivalis and A. actinomycetemcomitans. Ethanolic guava extract (EGE) and aqueous guava extract (AGE) were prepared and the inhibitory effects of these extracts for two periodontal pathogens were tested by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) procedures. Antibacterial activity of guava extracts was determined by well diffusion method. Antiproteolytic activity of guava on protease of P. gingivalis was determined by gelatin liquefaction test. RESULTS: The MIC determined for AGE and EGE was at 75 µL/mL concentration for P. gingivalis, whereas EGE exhibited the activity at 75 µL/mL on P. gingivalis. The MIC determined for AGE was at 50 µL/mL for A. actinomycetemcomitans, whereas MIC determined for EGE was at 3.12 µL/mL for A. actinomycetemcomitans. Porphyromonas gingivalis was susceptible to EGE compared with AGE. Aggregatibacter actinomycetemcomitans was more susceptible to guava extracts compared with P. gingivalis. CONCLUSION: Guava extract may be a potential therapeutic agent for periodontitis as it shows significant activity against both P. gingivalis and A. actinomycetemcomitans. CLINICAL SIGNIFICANCE: Guava leaves extract can be used as economical and suitable adjuvant to synthetic drugs and can be a potential therapeutic agent for periodontitis.

A comparative evaluation of topical and intrasulcular application of coenzyme Q10 (Perio Q™) gel in chronic periodontitis patients: A clinical study.

BACKGROUND AND OBJECTIVES: Coenzyme Q10 is a well-studied antioxidant in the medical literature, but studies regarding its efficacy in periodontal diseases are few. coenzymeoenzyme Q10 serves as an endogenous antioxidant and its increased concentration in the diseased gingiva effectively suppresses advanced periodontal inflammation. The aim of this study is to evaluate the efficacy of coenzyme Q10 (Perio Q™) as an adjunct to scaling and root planing in patients with chronic periodontitis. MATERIALS AND METHODS: A total of 18 patients were enrolled for the study. The selected subjects were treated in three different quadrants randomly. The control quadrant was treated by scaling and root planing only, while the other two test quadrants were treated by intra-pocket application of gel combined with scaling or root planing and topical applications combined with scaling and root planning, respectively. Clinical parameters such as plaque index, gingival index, gingival bleeding index and probing pocket depth were assessed at baseline and at the 2(nd) week and 4(th) weeks. The results were subjected to statistical analysis. RESULTS: There was a significant improvement in all clinical parameters in the test sites seen at the end of the 4-week period. Sites with bleeding on probing were reduced more in the test group than in the control group. CONCLUSION: Coenzyme Q10 can be said to have a beneficial effect on periodontitis when used as an adjunct to scaling and root planing.

Effects of a single episode of subgingival irrigation with tetracycline HCl or chlorhexidine: A clinical and microbiological study.

BACKGROUND: The present study was designed to evaluate clinical and antimicrobial effects of a single episode of subgingival tetracycline or chlorhexidine (CHX) irrigation in the absence of scaling and root planing. MATERIALS AND METHODS: Thirty patients diagnosed with chronic periodontitis were recruited for this study, each providing four non-adjacent untreated periodontal pockets with a probing depth equal to or exceeding 6 mm. The four deep periodontal pockets in each patient were assigned to be irrigated with 150 ml each of CHX digluconate 0.2% (group A), tetracycline HCl at concentrations of 10 and 50 mg/ml (groups B and C, respectively), or sterile saline (group D) in a single episode. Recordings of plaque index (PI), gingival index (GI), probing pocket depth (PD), clinical attachment level (CAL), and subgingival bacterial counts from paper point samples were made pre-irrigation (day 0), and at days 7, 28, 56, and 84, post-irrigation. RESULTS: The mean PI and GI scores for all the four groups were reduced post-irrigation, the reduction being significantly higher in group C compared to the other groups. The reduction in the PD and CAL was more significant in group C from day 0 to day 7, whereas the other groups showed minimal changes during this period. The change in the bacterial count was altered towards one of the periodontal health, it being more significant and consistent in the group C. CONCLUSION: The results of this study suggest that subgingival irrigation with high concentrations of tetracycline may play a beneficial role in the management of chronic periodontitis patients.