Investigating the diagnostic potential of IL-1ß, IL-10, and IL-36γ in gingival crevicular fluid in patients with different periodontal conditions.

BACKGROUND: The study aimed to analyze cytokine levels, including interleukin (IL)-1ß, IL-10, and IL-36γ, to investigate the link between pro- and anti-inflammatory responses in periodontal conditions and assess their potential as diagnostic biomarkers for distinguishing between different types of periodontal conditions. METHODS: 80 systemically healthy non-smokers (25 periodontally healthy, 25 with gingivitis, 30 with periodontitis) were included. Clinical periodontal parameters were recorded, and gingival crevicular fluid (GCF) samples were obtained. Receiver operating characteristic (ROC) curve analysis was applied to determine the diagnostic value of cytokines. RESULTS: IL-36γ had the highest sensitivity for diagnosing periodontitis, although its specificity for identifying those without periodontitis was relatively low. The combination of IL-1ß and IL-36γ was the most effective in differentiating periodontitis from periodontal health. IL-10 was found to be an acceptable discriminator for distinguishing gingivitis from healthy conditions. However, its sensitivity and specificity for identifying gingivitis were lower. The combination of the three cytokines showed the highest ability to distinguish between periodontitis and gingivitis. CONCLUSION: The levels of IL-1ß, IL-10, and IL-36γ in GCF may provide insights into periodontal health and disease status. Further studies are needed to validate these results and explore the potential of these cytokines in periodontal disease management.

All three of these cytokines exhibit exceptional diagnostic accuracy, particularly in distinguishing between chronic periodontitis and periodontal health.Moreover, the combination of IL-1ß and IL-36γ stands out as the most accurate diagnostic indicator for periodontitis. This combination could serve as a robust biomarker panel for the early detection and monitoring of periodontal disease, potentially allowing for timely interventions to prevent disease progression.

Evaluation of the relationship between dental anxiety and oral health status of mothers and their children.

BACKGROUND: Mothers usually have the primary role in raising children and developing health-related behaviors. This study aims to evaluate the relationship between dental anxiety and oral hygiene status of mothers and children's dental anxiety and gingival health. METHODS: The study included 305 children, aged 4-12 years, who came to the dentist for the first time and their mothers. All the demographic and oral hygiene information were collected through a questionnaire. The dental anxiety of the mothers and children was assessed using the Modified Dental Anxiety Scale (MDAS) and Venham Picture Test (VPT), respectively. The oral examination of the mother and children was performed, and their PI, GI, and DMFT scores were recorded. RESULTS: While the correlation between MDAS and VPT was positive and strong in children aged 8-12, it was positive but weak in the 4-7 age group. A significant relationship was detected between the mother's PI, GI, DMFT, and the child's VPT score. According to the mothers' dental anxiety, there were no statistically significant differences in PI, GI, and dmft values in children aged between 4 to 7. A moderately positive and statistically significant relationship between maternal dental anxiety and children's DMFT was identified in children aged 8-12. CONCLUSIONS: Children's dental anxiety was significantly influenced by maternal dental anxiety, post-treatment complications experienced by the mother, and the oral health status of the mother. TRIAL REGISTRATION: Clinical Trials-ID: NCT05563532; Registration Date: 17.09.2022.

Gingival Manifestations in Oral Chronic Autoimmune Bullous Diseases: A Retrospective Study.

Background and Objectives: Desquamative gingivitis (DG) is a clinical term indicating "peeling gums" and is associated with different oral manifestations. In this study, we aimed to assess the association between DG and autoimmune blistering mucocutaneous diseases (ABMD) with oral manifestations. Materials and Methods: A retrospective study including 88 patients diagnosed between 1998 and 2019 with ABMD (intraepithelial and subepithelial autoimmune blistering diseases) was performed at the Oral Medicine Department, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy in Bucharest. For each patient, the sociodemographic and anamnestic data, as well as clinical features of oral lesions (location), histological evaluation, and direct immunofluorescence data were collected. Results: Most of the patients involved in the study were female (78.4%). In total, 34 patients (38.63%) were diagnosed with subepithelial autoimmune diseases (SAD) and 54 (61.36%) had intraepithelial autoimmune diseases (IAD). Differences in the anatomic distribution of oral involvement were found between SAD and IAD. The presence of DG was significantly more common in patients with SAD compared to those with a diagnosis of IAD. Conclusions: Specific anatomical locations of the oral lesions are significantly associated with different subtypes of ABMD, with gingiva and hard palate mucosa being more involved in SAD and the soft palate and buccal mucosa in IAD. Desquamative gingivitis is a clinical sign that raises diagnostic challenges for several conditions in oral medicine.

BP180NC16a autoantibody positivity may predict low-risk mucous membrane pemphigoid.

OBJECTIVE: The objective of the present study was to explore the clinical characteristics of BP180NC16a autoantibody-positive mucous membrane pemphigoid. SUBJECTS AND METHODS: Data from 22 patients were collected by retrospective chart review. For the detection of BP180NC16a autoantibody, a commercially available enzyme-linked immunosorbent assay or chemiluminescent enzyme immunoassay kit was used. The patients were classified into the following clinical phenotypes: low-risk patients who had lesions only in the oral mucosa or in the oral mucosa and skin and high-risk patients who had lesions in the oral mucosa and any of the following sites: the eyes, upper respiratory tract, or esophagus. RESULTS: Eleven of the 22 patients (50%) were BP180NC16a-positive at the time of diagnosis. All the positive patients were in the low-risk group. There was a significant difference in the incidence of low-risk mucous membrane pemphigoid between BP180NC16a autoantibody-positive and BP180NC16a autoantibody-negative patients (p = 0.004). Patients' age, disease duration, and oral disease activity scores were not significantly different between the two groups. CONCLUSION: BP180NC16a reactivity was associated with the clinical phenotype characterized by only oral mucosal lesions or combined oral mucosal and skin lesions. BP180NC16a autoantibody might be useful as a serum marker to predict low-risk mucous membrane pemphigoid.

Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis.

OBJECTIVE: To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. MATERIAL AND METHODS: In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10-16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. RESULTS: 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 - 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 - 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. CONCLUSIONS: Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

High frequency of upper aerodigestive tract manifestations in mucous membrane pemphigoid.

OBJECTIVE: The objective of this study was to evaluate the frequency of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid associated with desquamative gingivitis. SUBJECTS AND METHODS: Data from 25 patients were collected by retrospective chart review. Their upper aerodigestive had been evaluated using a conventional flexible fiberscope. Oral disease activity was quantified on the basis of the Mucous Membrane Pemphigoid Disease Area Index activity score. RESULTS: Lesions of the upper aerodigestive tract were confirmed in nine symptomatic patients (9/25, 36%), of which five (5/25, 20%) had laryngeal involvement. No lesions were seen in the asymptomatic patients on fiberscope examination. There was a statistically significant difference in the symptoms, high oral disease activity score, and linear IgA deposition on direct immunofluorescence between patients with and without upper aerodigestive tract lesions (p = .001, .001, .002, respectively). CONCLUSION: The high frequency of considerable complications highlights the importance of confirming the presence of upper aerodigestive tract involvement in patients with mucous membrane pemphigoid having desquamative gingivitis. Signs including the presence of symptoms, high oral disease activity score, or linear IgA deposition on direct immunofluorescence might indicate a higher risk of upper aerodigestive tract involvement.

Effectiveness of interdental cleaning devices with active substances: a systematic review.

OBJECTIVES: To systematically review the literature on the efficacy of interdental cleaning devices (ICDs) used with active substances, as adjuncts to toothbrushing, in comparison with toothbrushing alone or with ICDs without active substances. MATERIALS AND METHODS: Searches for randomized clinical trials were performed in PubMed, Embase, Scopus, Cochrane (CENTRAL), and Web of Science. Two independent researchers performed study selection, data extraction, and risk-of-bias assessment; a third one resolved any disagreement. Meta-analysis was not feasible, and a narrative approach was used to synthesize the evidence. RESULTS: Seven studies were included. Dental floss with chlorhexidine was used in five studies, whereas interdental brushes with chlorhexidine and cetylpyridinium chloride were used in one study each. ICDs with active substances resulted in significantly higher antiplaque and antigingivitis efficacies than without ICDs (n = 3). ICDs with and without active substances demonstrated contrasting results. For this comparison, six studies were included for each outcome. Significantly higher antigingivitis efficacy of ICDs with active substances was noted in four studies, whereas significantly higher antiplaque efficacy of ICDs with active substances was reported in three studies. All comparisons demonstrated a very low certainty of evidence. CONCLUSIONS: There is no robust evidence for the additional clinical efficacy of ICDs with active substances regarding their antiplaque and antigingivitis efficacies. These devices may have additional clinical efficacy when compared with the absence of interproximal hygiene. CLINICAL RELEVANCE: The use of ICDs helps maintain or achieve periodontal health. However, the adjunct use of active substances may not provide additional benefits.

THERE IS NO DIFFERENCE BETWEEN CURCUMIN MOUTHWASHES AND CHLORHEXIDINE MOUTHWASHES IN DECREASING DENTAL PLAQUE AND GINGIVAL INFLAMMATION.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Sadeq A. Al-Maweri, Mohammed Nasser Alhajj, Esraa A. Deshisha, Ameera K. Alshafei, Azza I. Ahmed, Nada O. Almudayfi, Sara A. Alshammari, Alla Alsharif, Saba Kassim (2021). Curcumin mouthwashes versus chlorhexidine in controlling plaque and gingivitis: A systematic review and meta-analysis. International Journal of Dental Hygiene. Pages 1-9. SOURCE OF FUNDING: Government? Industry? Non-profit, Foundations, etc? Other? Information not available? TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Biopsied non-dental plaque-induced gingival diseases in a Chinese population: a single-institute retrospective study.

BACKGROUND: While inflammatory diseases such as gingivitis and periodontitis induced by dental plaque biofilms constitute the majority of gingival lesions, gingiva can also be affected by a variety of diseases with aetiologies different from bacterial biofilms. The aim of this study was to retrospectively analyze the frequency and distribution of non-dental plaque-induced gingival diseases (NDPIGDs) in the Chinese population in a single institute. METHODS: A total of 6859 samples of biopsied gingival diseases during the period 2000-2019 were obtained from the Department of Pathology, Peking University Hospital of Stomatology. Lesions were categorized by histopathological diagnosis, pathological characteristics and the new classification of gingival health and gingival diseases/conditions. Demographic information, such as gender, location, and age, were also analyzed. RESULTS: Among 6859 biopsied NDPIGD samples, the five most frequent diagnoses included oral squamous cell carcinoma (OSCC, n = 2094), fibrous hyperplasia (n = 2026), pyogenic granuloma (n = 478), epithelial dysplasia (n = 477), and epithelial hyperplasia/hyperkeratosis (n = 436). All types could be grouped into nine categories according to their pathological characteristics. The most common biopsied NDPIGDs category was "hyperplastic lesions" (n = 2648, 38.61%), followed by "malignant neoplasms" (n = 2275, 33.17%). The most common diagnosis types in each category were fibrous hyperplasia and OSCC. Of all NDPIGDs, most lesions could be categorized into the new classification of gingival health and gingival diseases/conditions; only 7.07% did not fit the current classification system. CONCLUSIONS: The present study is the first report on the frequency and distribution of biopsied NDPIGDs in a Chinese population. Unlike previous studies, the most prevalent categories were "hyperplastic lesions" and "malignant neoplasms". The proportion of "malignant neoplasms" and "oral potentially malignant disorders" was remarkably higher than in previous researches. Nevertheless, the study provided epidemiological information on many NDPIGDs, which could be useful for future health policies as well as screening programs.

The Role of DNA Methylation and Histone Modification in Periodontal Disease: A Systematic Review.

Despite a number of reports in the literature on the role of epigenetic mechanisms in periodontal disease, a thorough assessment of the published studies is warranted to better comprehend the evidence on the relationship between epigenetic changes and periodontal disease and its treatment. Therefore, the aim of this systematic review is to identify and synthesize the evidence for an association between DNA methylation/histone modification and periodontal disease and its treatment in human adults. A systematic search was independently conducted to identify articles meeting the inclusion criteria. DNA methylation and histone modifications associated with periodontal diseases, gene expression, epigenetic changes after periodontal therapy, and the association between epigenetics and clinical parameters were evaluated. Sixteen studies were identified. All included studies examined DNA modifications in relation to periodontitis, and none of the studies examined histone modifications. Substantial variation regarding the reporting of sample sizes and patient characteristics, statistical analyses, and methodology, was found. There was some evidence, albeit inconsistent, for an association between DNA methylation and periodontal disease. IL6, IL6R, IFNG, PTGS2, SOCS1, and TNF were identified as candidate genes that have been assessed for DNA methylation in periodontitis. While several included studies found associations between methylation levels and periodontal disease risk, there is insufficient evidence to support or refute an association between DNA methylation and periodontal disease/therapy in human adults. Further research must be conducted to identify reproducible epigenetic markers and determine the extent to which DNA methylation can be applied as a clinical biomarker.

Effect of sonic versus manual supervised toothbrushing on both clinical and biochemical profiles of patients with desquamative gingivitis associated with oral lichen planus: A randomized controlled trial.

OBJECTIVES: The aim of this randomized, parallel-design, clinical trial was to investigate the effectiveness of an intensive plaque control programme with sonic versus manual toothbrushing on clinical outcomes and gingival crevicular fluid (GCF) levels of matrix metalloproteinases (MMP) in desquamative gingivitis (DG) patients. METHODS: A total of 32 patients affected by DG secondary to oral lichen planus (OLP) were consecutively recruited and randomly assigned to a test (n = 16) and control (n = 16) group. Both groups were enrolled in an intensive control programme comprising supragingival scaling and polishing, and brush-specific instructions for a period of 8 weeks. The treatment of interest (test) was the use of a sonic-powered toothbrush, and the standard treatment (control) was the utilization of a soft-bristle manual toothbrush for twice-daily home oral hygiene procedures. Periodontal parameters, patient-centred outcomes, MMP-1 and MMP-9 GCF levels were evaluated at baseline and 8 weeks after starting the programme. RESULTS: The plaque control programme resulted in statistically significant reduction in periodontal parameters with consequent improvement in the clinical features, painful symptoms and severity of DG lesions in both groups (all P < 0.001). When a sonic toothbrush was used, there was a more significant decrease in clinical indices, mucosal disease scores and GCF levels of MMP-1 and MMP-9. CONCLUSIONS: This clinical trial reported the effectiveness of a combined protocol based on professional oral hygiene and supervised toothbrushing in OLP patients with DG. The daily use of a sonic toothbrush would seem to perform better in the short term.

Influence of 3 calcium channel blockers on gingival overgrowth in a population of severe refractory hypertensive patients.

OBJECTIVE: The aim of the current study was to assess the association between 3 different calcium channel blockers (CCBs) (nifedipine, amlodipine and felodipine) and gingival overgrowth in patients with a diagnosis of severe refractory hypertension. METHODS: One hundred and sixty-two patients with severe refractory hypertension, taking CCBs, were selected. Gingival overgrowth was graded and periodontal measurements were recorded (probing pocket depth, clinical attachment level, plaque index and bleeding on probing). Unconditional multivariable binary logistic regression analyses were performed to assess the association between CCB intake and gingival overgrowth after adjusting for potential confounders. RESULTS: Of the 162 patients, 26 (16.0%) were current smokers and 101 (62.3%) were females. The mean age (SD) was 54.1 (8.5) years and the median age (range) 52.5 (39-78) years. Gingival overgrowth was observed in 55 patients (34.0%). Nifedipine was the most common medication (35.2%; 57 of 162). The results of multiple binary logistic regression showed statistically significant associations between CCB intake (exposure) and gingival overgrowth (outcome) after adjusting for the variables treatment time with antihypertensive and plaque index. Patients with gingival overgrowth were 2.5 (odds ratio = 2.46; 95% confidence interval: 1.04-5.82) and 4.0 (odds ratio = 3.90; 95% confidence interval: 1.47-10.35) times more likely to be taking nifedipine and amlodipine, respectively, than patients without gingival overgrowth. On the other hand, this significant association was not observed for felodipine. CONCLUSION: Nifedipine and amlodipine, but not felodipine, were associated with gingival overgrowth in patients with severe refractory hypertension.

Healing of toothbrush-induced abrasions to keratinized mucosa of the palate in humans: A pilot study.

BACKGROUND AND OBJECTIVE: To the best of our knowledge, the healing time for toothbrush-induced gingival abrasions in humans has not yet been explored. The aim of this study was to evaluate the time needed to heal for toothbrush-induced abrasions of the keratinized mucosa of the palate. MATERIAL AND METHODS: In patients without, with mild periodontitis or with periodontitis, gingival abrasion lesions were induced at the keratinized mucosa of the palate by brushing up to 2 minutes. Healing as observed clinically was followed via calibrated digital photographs of the lesion after staining, every 24 hours until the lesion had resolved. In patients without or with only mild periodontitis, the healing time of lesions caused by 30 seconds and 1 minute of brushing was also recorded. RESULTS: Thirty-one participants (11 without or with mild periodontitis, 20 with periodontitis) met the inclusion criteria. In patients without or with mild periodontitis, the lesions induced by brushing for 2 minutes diminished by 48.7% of their original surface area within 24 hours. In patients with periodontitis the respective outcome was 45.4% (P = .87). Abrasions caused by 2 minutes of brushing needed more than 24 hours to heal completely. When decreasing the time exposed to trauma, fewer lesions were visible at baseline and the time needed to heal decreased. The subgroup of smokers was too small to evaluate any effect. CONCLUSION: The longer the exposure time of the keratinized mucosa of the palate to trauma, the more lesions were visible, the larger the abrasions were and the more time they needed to heal completely. More studies are needed to investigate the role of smoking, gingival biotype and to link these findings with gingival recessions.

Plaque-induced gingivitis: Case definition and diagnostic considerations.

OBJECTIVE: Clinical gingival inflammation is a well-defined site-specific condition for which several measurement systems have been proposed and validated, and epidemiological studies consistently indicate its high prevalence globally. However, it is clear that defining and grading a gingival inflammatory condition at a site level (i.e. a "gingivitis site") is completely different from defining and grading a "gingivitis case" (GC) (i.e. a patient affected by gingivitis), and that a "gingivitis site" does not necessarily mean a "GC". The purpose of the present review is to summarize the evidence on clinical, biochemical, microbiologic, genetic markers as well as symptoms associated with plaque-induced gingivitis and to propose a set of criteria to define GC. IMPORTANCE: A universally accepted case definition for gingivitis would provide the necessary information to enable oral health professionals to assess the effectiveness of their prevention strategies and treatment regimens; help set priorities for therapeutic actions/programs by health care providers; and undertake surveillance. FINDINGS: Based on available methods to assess gingival inflammation, GC could be simply, objectively and accurately identified and graded using bleeding on probing score (BOP%) CONCLUSIONS: A patient with intact periodontium would be diagnosed as a GC according to a BOP score ≥ 10%, further classified as localized (BOP score ≥ 10% and ≤30%) or generalized (BOP score > 30%). The proposed classification may also apply to patients with a reduced periodontium, where a GC would characterize a patient with attachment loss and BOP score ≥ 10%, but without BOP in any site probing ≥4 mm in depth.

Periodontal condition in relation to the adherence to nutrient recommendations in daily smokers.

AIM: To examine whether a healthy diet based on nutrient recommendations is associated with periodontal condition in smokers. MATERIAL AND METHODS: Daily smokers from the cross-sectional Health 2000 Survey (BRIF 8901) in Finland were analysed in two age groups (30-49 and 50-79 years, n = 704 and 267) and according to the level of oral hygiene. Periodontal condition was measured as the number of sextants with gingival bleeding and teeth with ≥4 mm deepened periodontal pockets. Information on nutrition was collected by a validated food frequency questionnaire and measured using the Baltic Sea Diet Score (BSDS) and the Recommended Finnish Diet Score (RFDS). RESULTS: In the total study population, no association between the scores and periodontal condition was observed. Among 30- to 49-year-old participants with good oral hygiene, diet scores associated inversely with the number of teeth with deepened periodontal pockets (p = .078 (BSDS) and p = .027 (RFDS)). CONCLUSIONS: In a representative sample of Finnish adults who smoke, a healthy diet was not associated with periodontal condition. Among a younger age group with good oral hygiene, a healthy diet associated with better periodontal condition. Age and oral hygiene appeared to modify the association between diet and periodontal condition.

Non-plaque-induced gingival diseases.

While plaque-induced gingivitis is one of the most common human inflammatory diseases, several non-plaque-induced gingival diseases are less common but often of major significance for patients. The non-plaque-induced gingival lesions are often manifestations of systemic conditions, but they may also represent pathologic changes limited to gingival tissues. A classification is proposed, based on the etiology of the lesions and includes: Genetic/Developmental disorders; Specific infections; Inflammatory and immune conditions and lesions; Reactive processes; Neoplasms; Endocrine, Nutritional and metabolic diseases; Traumatic lesions; and Gingival pigmentation.

Relationship between xerostomia and gingival condition in young adults.

BACKGROUND AND OBJECTIVE: Xerostomia is a subjective symptom of dryness in the mouth. Although a correlation between xerostomia and oral conditions in the elderly has been reported, there are few such studies in the young adults. The aim of this study was to examine the relationship of xerostomia with the gingival condition in university students. MATERIAL AND METHODS: A total of 2077 students (1202 male subjects and 875 female subjects), 18-24 years of age, were examined. The disease activity and severity of the gingival condition were assessed as the percentage of teeth with bleeding on probing (%BOP) and the presence of teeth with probing pocket depth of ≥ 4 mm, respectively. Additional information on xerostomia, oral health behaviors, coffee/tea intake and nasal congestion was collected via a questionnaire. Path analysis was used to test pathways from xerostomia to the gingival condition. RESULTS: One-hundred and eighty-three (8.8%) students responded that their mouths frequently or always felt dry. Xerostomia was related to %BOP and dental plaque formation, but was not related to the presence of probing pocket depth ≥ 4 mm. In the structural model, xerostomia was related to dental plaque formation (p < 0.01), and a lower level of dental plaque formation was associated with a lower %BOP. Xerostomia was associated with coffee/tea intake (p < 0.01) and nasal congestion (p < 0.001). CONCLUSION: Xerostomia was indirectly related to gingival disease activity through the accumulation of dental plaque. Nasal congestion and coffee/tea intake also affected xerostomia. These findings suggest that xerostomia should be considered in screening for gingivitis risk in young adults.

Factors associated with gingival inflammation among adults with systemic sclerosis.

OBJECTIVE: To identify factors associated with increased gingival inflammation in adults with systemic sclerosis (SSc, scleroderma). METHODS: In this cross-sectional study, forty-eight adults with SSc received assessment of gingival inflammation using Löe and Silness gingival index (LSGI), measurement of oral aperture and evaluation of manual dexterity to perform oral hygiene using the Toothbrushing Ability Test, as well as completion of an oral health-related questionnaire. RESULTS: Three explanatory variables in the final multiple predictor models for the LSGI outcome were statistically significant--manual dexterity to perform oral hygiene, flossing in the evening and SSc subtype, with higher (i.e., worse) LSGI score among those with impaired manual dexterity, not flossing in the evening and diffuse form of SSc. In addition, posterior teeth had higher LSGI scores compared with that of the anterior teeth after adjusting for other variables. CONCLUSIONS: Results suggest that dental health professionals take manual dexterity into consideration when educating patients with SSc to improve their oral hygiene and educate them on paying more attention on cleaning their posterior teeth and the importance of flossing in the evening--especially those who only floss once a day or less often.

Microsurgical approach for the management of gingival cleft: A case series and decision-making process.

BACKGROUND: Gingival clefts, once known as "Stillman's Cleft", now considered an obsolete phenomenon, cannot be neglected in clinical practice, especially when it is persistent and epithelialized. The attached gingiva and alveolar mucosa are composed of epithelial layers with subjacent connective tissue. Gingival clefts, notwithstanding their intrinsic differences, may exhibit keratinized or non-keratinized tissue. Coupled with additional risk factors, it can result in progressive attachment loss and gingival recession. METHODS: Two cases with three distinct types of gingival clefts were described. Case 1 was identified as having a 2 mm white cleft coupled with lack of attached gingiva, while Case 2 was described as having a 3 mm white and red cleft which were treated with gingival cleft approximation subsequent to connective tissue grafting, non-surgical periodontal therapy and cleft approximation, respectively. The diagnostic confirmation was verified using an operating microscope set at a magnification of 5×, while the subsequent surgical stages were carried out with a magnification of 8×. These treatments yielded complete elimination and closure of the gingival clefts in addition to increased width of attached gingiva and soft tissue phenotype in Case 1 where bilaminar approach was utilized. The three clefts were effectively addressed using an operating microscope for both non-surgical and surgical interventions in the cleft management. RESULTS: All the three clefts exhibited complete elimination and closure of the gingival cleft. At 3 years follow up, there was reduction of the probing depth (1 mm) and attachment gain (1 mm) in all the three clefts. There was increase in width of attached gingiva to 3 mm and increase in soft tissue thickness in Case 1, where connective tissue graft was utilized. As microsurgical treatment approach was employed, the patients did not manifest with any intra-operative or postoperative complications. The first case showed the presence of soft tissue bulk at the treated site warranting debulking at 12 months postoperatively. The stability of the width of attached gingiva was maintained over the course of the 3-year follow-up period. The use of a microsurgical method in these settings enhances the predictability of outcomes than a macrosurgical approach. CONCLUSIONS: The utilization of microsurgical techniques for the closure of gingival clefts allows for the accurate and meticulous insertion and placement of grafts, resulting in improved outcomes and enhanced aesthetic results. These techniques also minimize tissue trauma and postoperative discomfort. The treatment technique should be personalized to the individual's specific needs, considering factors such as type and extent of cleft, etiology and amount of attached gingiva. Nonetheless, microsurgical approaches for such cases are no more a discretion but an obligation. KEY POINTS: Identification of gingival cleft should not be overlooked during routine periodontal examination. Diagnosed gingival clefts should be observed for clinical changes after completion of Phase I therapy. Only "white" gingival clefts require definitive surgical treatment. Untreated clefts can lead to root sensitivity, root caries and marginal tissue recession.

Inflammation and tissue remodeling mediator expression during gingivitis: A comparison between experimental, naturally occurring gingivitis, and periodontal health.

BACKGROUND: The aim of this study is to evaluate the immune regulation and tissue remodeling responses during experimental gingivitis (EG) and naturally occurring gingivitis (NG) to provide a comprehensive analysis of host responses. Gingival crevicular fluid (GCF) was obtained from 2 human studies conducted in university settings. METHODS: The EG study enrolling 26 volunteers provided controls for the baseline (Day 0) from healthy disease-free participants, while Day 21 (the end of EG induction of the same group) was used to represent EG. Twenty-six NG participants age-matched with those of the EG group were recruited. GCF samples were analyzed for 39 mediators of inflammatory/immune responses and tissue remodeling using commercially available bead-based multiplex immunoassays. The differences in GI and mediator expression among groups were determined at a 95% confidence level (p ≤ 0.05) by a 2-way analysis of variance (ANOVA) with a post-hoc Tukey's test. RESULTS: Our findings showed that EG had a greater gingival index than NG and was healthy (p < 0.01 of all comparisons). Furthermore, EG showed significantly higher levels of MPO (p < 0.001), CCL3 (p < 0.05), and IL-1B (p < 0.001) than NG. In contrast, NG had increased levels of MIF (p < 0.05), Fractalkine (p < 0.001), angiogenin (p < 0.05), C3a (p < 0.001), BMP-2 (p < 0.001), OPN (p < 0.05), RANKL (p < 0.001), and MMP-13 (p < 0.001) than EG. CONCLUSIONS: Consistent with the findings from chronic (NG) versus acute (EG) inflammatory lesions, these data reveal that NG displays greater immune regulation, angiogenesis, and bone remodeling compared to EG.