Estimation of salivary malondialdehyde Levels in smokeless tobacco chewers with chronic periodontitis-A cross sectional clinico biochemical study / Estimación de los niveles de malondialdehído salival en masticadores de tabaco sin humo con periodontitis crónica: un estudio bioquímico clínico transversal

ABSTRACT: Despite the reported effects of smokeless tobacco (ST) on the periodontium and high prevalence of ST use in rural populations and in males studies on this specific topic are limited. The purpose of this cross-sectional investigation was to measure lipid peroxidation (as an end product of oxidative stress) end product i.e. Malondialdehyde (MDA) in saliva of patients with gingivitis, chronic periodontitis and to assess the influence of smokeless tobacco on Salivary Malondialdehyde (S-MDA). Total 30 patients with gingivitis, 30 with chronic periodontitis and 30 Smokeless Tobacco Chewers with Chronic Periodontitis and 30 periodontally healthy subjects were included in the study. Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PD), and Clinical Attachment Loss (CAL) were recorded followed by stimulated Saliva sample collection. Salivary MDA Levels were assessed by UV Spectrophotometry. There was a statistically significant increase in the salivary MDA levels in gingivitis, chronic periodontitis and in smokeless tobacco chewers with chronic periodontitis when compared with healthy group. Higher salivary MDA levels in gingivitis group, chronic periodontitis, and smokeless tobacco chewers with chronic periodontitis reflects increasedoxygen radical activity during periodontal inflammation.

RESUMEN: A pesar de los efectos reportados del tabaco sin humo (TS) sobre el periodonto y la alta prevalencia del uso de TS en poblaciones rurales y en hombres, los estudios sobre este tema específico son limitados. El propósito de esta investigación transversal fue medir el producto final de la peroxidación lipídica (como producto final del estrés oxidativo), es decir, malondialdehído (MDA) en la saliva de pacientes con gingivitis, periodontitis crónica y evaluar la influencia del tabaco sin humo en el malondialdehído salival (S-MDA). Se incluyeron en el estudio un total de 30 pacientes con gingivitis, 30 con periodontitis crónica y 30 masticadores de tabaco sin humo con periodontitis crónica y 30 sujetos periodontalmente sanos. Se registraron el índice de placa (PI), el índice gingival (GI), la profundidad de la bolsa de sondeo (PD) y la pérdida de adherencia clínica (CAL), seguidos de la recogida de muestras de saliva estimuladas. Los niveles de MDA en saliva se evaluaron mediante espectrofotometría UV. Hubo un aumento estadísticamente significativo en los niveles de MDA en saliva en gingivitis, periodontitis crónica y en masticadores de tabaco sin humo con periodontitis crónica en comparación con el grupo sano. Los niveles más altos de MDA en saliva en el grupo de gingivitis, periodontitis crónica y masticadores de tabaco sin humo con periodontitis crónica reflejan un aumento de la actividad de los radicales de oxígeno durante la inflamación periodontal.

Effect of smokeless tobacco use on salivary glutathione levels among chronic periodontitis patients before and after non-surgical periodontal therapy.

INTRODUCTION: Smokeless tobacco (SLT) jeopardizes periodontal health and also produces an imbalance between reactive oxygen species (ROS) and antioxidants (AO) such as glutathione. Glutathione is an important redox regulator in saliva and its maintenance is essential for periodontal health. Periodontitis patients have a reduced total AO capacity in whole saliva, and periodontal therapy restores the redox balance. Hence, the purpose of this study was to investigate the effects of smokeless tobacco use on saliva glutathione levels in patients with chronic periodontitis and to evaluate these effects after non-surgical periodontal therapy. METHODS: The study included 100 subjects in four groups; healthy, gingivitis, and chronic periodontitis (CP) patients with and without SLT use. Saliva samples were collected, and clinical periodontal parameters were recorded at baseline and at one month after non-surgical periodontal therapy. Glutathione levels were analyzed using spectrophotometry at 412 nm. Statistical analysis was carried out using paired t-test, chi-squared, and analysis of variance (ANOVA). RESULTS: Mean glutathione values in saliva were found to be lower in periodontitis patients compared to SLT users at baseline and at 1 month post non-surgical periodontal therapy (p<0.001) In addition, non-surgical therapy leads to a highly significant improvement in the glutathione levels in gingivitis, in the CP with and without ST groups (p<0.001). CONCLUSIONS: Successful non-surgical periodontal therapy leads to considerable progress in the redox balance, thus regulating glutathione levels and reducing the effects of SLT on the periodontium. This emphasises the importance of non-surgical therapy, especially among SLT users.

Gamma Glutamyl Transpeptidase, Smokeless Tobacco, Chronic Periodontitis: Exploring the Link.

INTRODUCTION: Oxidative Stress (OS) is implicated in the pathogenesis of many systemic and oral diseases such as periodontal disease. Smokeless tobacco extract produces apoptosis and causes an imbalance between reactive oxygen species and antioxidants, such as Gamma Glutamyl Transpeptidase (GGT). Epidemiological research implied serum GGT within its normal range to be an early sensitive enzyme related to OS. AIM: To assess how GGT fares as a biomarker in periodontitis subjects with or without the usage of smokeless tobacco and correlate it with clinical parameters. MATERIALS AND METHODS: Ninety subjects were divided into three groups of healthy, chronic periodontitis, and smokeless tobacco users with chronic periodontitis from the dental outpatient department of P.M. Nadagouda Memorial Dental College and Hospital. Serum samples of patients were collected after obtaining consent and analyzed for GGT. Statistical Analysis was performed using ANOVA, and Pearson's correlation coefficient. RESULTS: GGT levels were found to be significantly higher in chronic periodontitis patients compared to smokeless tobacco users with chronic periodontitis and healthy subjects. Conclusion: GGT may be used as a quick, easy and precise marker for measuring OS in patients with chronic periodontitis and smokeless tobacco users.

Determining the Effect of Gutkha on Serum Levels of Vitamin B12 and Folic Acid as Compared to Smoking among Chronic Periodontitis Subjects : A Cross-Sectional Study.

BACKGROUND: Periodontitis, being a common inflammatory disease has a multifactorial origin , with smoking and gutkha as few of the causative entities. The role of smoking as a risk factor for periodontitis is been well documented in literature. Cigarette smoke also affects vitamin B12 and folic acid mechanisms. Nutritionally derived vitamin B12 occurs mainly as either hydroxycobalamin or deoxyadenosycobalmin. Folic acid is also heat sensitive and water soluble, closely linked to vitamin B12 in its metabolism. However, effect of smokeless tobacco in form of gutkha on serum levels of vitamin B12 and folic acid is yet to be explored. AIMS AND OBJECTIVES: To estimate and correlate serum vitamin B12 (VB12) and folic acid (FA) levels among periodontally healthy subjects and Chronic Periodontitis (CP) subjects with habit of smoking and gutkha chewing. MATERIALS AND METHODS: The study included 111 subjects ranging in age from 18 to 60 y. Participants were divided into four groups: 30 healthy subjects (Group I), 29 subjects with CP (Group II), 25 smokers with CP (Group III) and 27 gutkha chewers with CP (Group IV). Clinical parameters included pocket probing depth (PPD), clinical attachment level (CAL) & gingival index (GI) following which VB12 and FA levels were estimated through UV-spectrophotometry method and data was analysed using Statistical Package for Social Scientists software, Mann-Whitney U-test and Pearson correlation coefficient. p-values less than 0.05 were considered as significant. Results : Pairwise comparison by Mann-Whitney U-test showed an increase in the serum VB12 in Group IV when compared to Group I (p=0.01) and Group II (p=0.01). Although serum FA levels were found to be low in Group III (7.61 ug/ml) & Group IV (8.64 ug/ml), Group III was found to be statistically significant (P=0.046). The clinical parameters GI, PPD and CAL among the four groups of patients were also statistically significant (p < 0.05). CONCLUSION: The study results suggested that among the patients with periodontal disease, serum VB12 levels are directly related while serum FA levels are inversely related to inflammation and tissue destruction in periodontium as occurred in Group IV.

Lemongrass essential oil gel as a local drug delivery agent for the treatment of periodontitis.

BACKGROUND: It has been long recognized that periodontal diseases are infections of the periodontium, comprising the bacterial etiology, an immune response, and tissue destruction. Treatment strategies aiming primarily at suppressing or eliminating specific periodontal pathogens include adjunct use of local and systemic antibiotics as part of nonsurgical periodontal therapy. Unwanted side effects and resistance of microorganisms toward antibiotics due to their widespread use have modified the general perception about their efficacy. Research in phytosciences has revealed various medicinal plants offering a new choice of optional antimicrobial therapy. Cymbopogon citratus, Stapf. (lemongrass) is a popular medicinal plant. At a concentration ≤2%, lemongrass essential oil inhibits the growth of several kinds of microorganisms including periodontal pathogens, especially the reference strains Actinomyces naeslundii and Porphyromonas gingivalis, which were resistant to tetracycline hydrochloride. AIMS: To evaluate the efficacy of locally delivered 2% lemongrass essential oil in gel form as an adjunct to scaling and root planing, as compared to scaling and root planing alone for the treatment of chronic periodontitis. MATERIALS AND METHODS: 2% Lemongrass essential oil gel was prepared and placed in moderate to deep periodontal pockets after scaling and root planing. RESULTS: Statistically significant reduction in probing depth and gingival index and gain in relative attachment level were noted in the experimental group as compared to the control group at 1 and 3 months. CONCLUSION: Locally delivered 2% lemongrass essential oil gel offers a new choice of safe and effective adjunct to scaling and root planing in periodontal therapy.

Interleukin-6 promoter polymorphism (-174 G/C) in Indian patients with chronic periodontitis.

Recent studies have focused on genetic polymorphism of the interleukin-6 (IL-6) gene, which has led to a better understanding of the intricate interactions between host response, microorganisms, and genetics. Genotype prevalence appears to vary by the race and ethnicity of the population studied. We used a polymerase chain reaction technique to determine the prevalence of single nucleotide polymorphism in IL-6 at position -174 G>C in a population of 30 South Indians. Blood samples were collected from 15 chronic periodontitis patients and 15 healthy controls. The results showed that the G/G genotype was significantly more frequent in the chronic periodontitis group and that the C/C genotype was significantly more frequent in the control group (P = 0.0069 for both). The G allele was more frequent in chronic periodontitis patients (76.67%), whereas the C allele was more frequent in the control group (73.33%). Among chronic periodontitis patients, the odds ratio for having the G allele, as compared with the controls, was 9.04. In this population, the presence of the G/G genotype of IL-6 (-174) might increase susceptibility to chronic periodontitis, whereas the C/C genotype may have a protective effect.

Herpesviruses in chronic and aggressive periodontitis patients in an Indian population.

Many recent studies have assessed the prevalence and role of herpesviruses in the etiopathogenesis of periodontal diseases, which has led to the realization of intricate interactions between viruses and bacteria within periodontal pockets. It has also been shown that the occurrence of herpesviruses may vary depending upon the age of the patient and the race of the population studied. Thus, the present study aimed at detecting herpes simplex virus type 1 and 2 (HSV 1 and 2), Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) in periodontal pockets of Indian patients with chronic and aggressive periodontitis. Subgingival plaque samples (n = 33) were collected from 19 randomly chosen chronic periodontitis and 14 aggressive periodontitis patients. Herpesviruses were detected using multiplex polymerase chain reaction technique. Chronic periodontitis patients revealed presence of HSV-1 in 19 (100%) samples, HSV-2 in 3 (15.7%), EBV in 15 (78.9%) and HCMV in 5 (26.31%) samples. Samples from aggressive periodontitis patients showed the presence of HSV-1 in 8 (57.14%), EBV in 4 (28.57%) and HCMV in 1 (7.14%), whereas HSV-2 was not detected in any specimen. In this population, herpesviruses were found more frequently in chronic periodontitis than in aggressive periodontitis patients and their prevalence may vary according to the age and race of the patient.

Gingival hemangioma with port wine nevi of the face. A case report.

Hemangioma is a proliferating mass of blood vessels. Its occurrence in gingiva is rare. The diagnosis and treatment of hemangioma is complex, and any attempt to carry out biopsy/surgical excision may lead to fatal consequences due to severe hemorrhage. A rare case of gingival hemangioma with port wine nevi of face is reported. The case is of periodontal interest because the lesion occurred on the gingiva, a reliable diagnostic approach (Ultrasound Spectra Doppler Flow) was used and a conservative treatment using a sclerosing agent was employed.

Peripheral ossifying fibroma and pyogenic granuloma. Are they interrelated?

Peripheral ossifying fibroma (POF) and pyogenic granuloma (PG) belong to the group of "focal reactive overgrowths," having different histomorphologic representations. The pathogenesis of POF remains controversial. It has been observed that POF in some cases may initially develop as a PG that undergoes subsequent fibrous maturation and calcification. A case of focal reactive gingival overgrowth with a recurrence is presented. Clinical, radiological and histological examinations were performed and included a detailed history of the lesions to come up with the proper diagnosis. The primary lesion was diagnosed as POF and the recurrent lesion as PG. The POF might have developed initially as PG and subsequent maturation led to the ossification of the lesion. These two lesions represent the progressive stages of the same spectrum of pathosis.

The effect of ibuprofen on bleeding during periodontal surgery.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications for both medical and dental ailments. These drugs have been shown to increase bleeding during surgeries, which may prompt practitioners to discontinue their use before surgical procedures. The aim of the present study is to assess the effect of a common NSAID, ibuprofen, on bleeding during periodontal surgery. MATERIALS AND METHODS: The study group consisted of 10 patients who were scheduled to undergo periodontal surgery of similar type, complexity, and duration. Each subject acted as control as well as case group. The case group consisted of 10 surgeries in which patients were administered ibuprofen prior to surgery, whereas ibuprofen was not administered in control group. Bleeding time was measured at first visit and prior to first and second surgeries. The volume of blood loss during each surgery was measured by subtracting the amount of water used for irrigation from the total volume of fluid collected in the portable aspirator at the end of the surgery. RESULTS: The result showed a statistically significant (P < 0.05) increase in intraoperative bleeding during periodontal surgery when ibuprofen was preadministered. In addition, there was statistically significant (P < 0.05) increase in bleeding time. CONCLUSION: Ibuprofen taken prior to periodontal surgery increases intraoperative bleeding and should be administered cautiously before periodontal surgeries.