Phytocannabinoids and gingival inflammation: Preclinical findings and a placebo-controlled double-blind randomized clinical trial with cannabidiol.

OBJECTIVE: The aim of this study was to: (1) evaluate the anti-inflammatory effects of cannabidiol (CBD) on primary cultures of human gingival fibroblasts (HGFs) and (2) to clinically monitor the effect of CBD in subjects with periodontitis. BACKGROUND: The use of phytocannabinoids is a new approach in the treatment of widely prevalent periodontal disease. MATERIALS AND METHODS: Cannabinoid receptors were analyzed by western blot and interleukin production detected using enzyme immunoassay. Activation of the Nrf2 pathway was studied via monitoring the mRNA level of heme oxygenase-1. Antimicrobial effects were determined by standard microdilution and 16S rRNA screening. In the clinical part, a placebo-control double-blind randomized study was conducted (56 days) in three groups (n = 90) using dental gel without CBD (group A) and with 1% (w/w) CBD (group B) and corresponding toothpaste (group A - no CBD, group B - with CBD) for home use to maintain oral health. Group C used dental gel containing 1% chlorhexidine digluconate (active comparator) and toothpaste without CBD. RESULTS: Human gingival fibroblasts were confirmed to express the cannabinoid receptor CB2. Lipopolysaccharide-induced cells exhibited increased production of pro-inflammatory IL-6 and IL-8, with deceasing levels upon exposure to CBD. CBD also exhibited antimicrobial activities against Porphyromonas gingivalis, with an MIC of 1.5 µg/mL. Activation of the Nrf2 pathway was also demonstrated. In the clinical part, statistically significant improvement was found for the gingival, gingival bleeding, and modified gingival indices between placebo group A and CBD group B after 56 days. CONCLUSIONS: Cannabidiol reduced inflammation and the growth of selected periodontal pathogenic bacteria. The clinical trial demonstrated a statistically significant improvement after CBD application. No adverse effects of CBD were reported by patients or observed upon clinical examination during the study. The results are a promising basis for a more comprehensive investigation of the application of non-psychotropic cannabinoids in dentistry.

Antimicrobial photodynamic therapy for the management of gingivitis and white spot lesions in fixed orthodontic patients: A systematic review.

AIM: We conducted this review to evaluate the safety and efficacy of antimicrobial photodynamic therapy (aPDT) for the management of gingivitis and white spot lesions (WSLs) in fixed orthodontic patients. METHODS: The PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases were searched for randomized controlled trials and clinical trials assessing the clinical effectiveness of aPDT for the management of gingivitis and WSLs in fixed orthodontic patients without time limitation. Primary outcomes were the changes in clinical parameters such as DIAGNOdent, plaque index (PI), bleeding on probing (BOP), and gingival index (GI). Secondary outcomes included measurements of microbial and inflammatory factors, such as cytokine levels (tumor necrosis factor alpha [TNF-α], interleukin-1 beta [IL-1ß], and interleukin-6 [IL-6]), and bacterial counts. RESULTS: Our search yielded a total of 12 studies that met the inclusion criteria. Among the 11 studies that evaluated gingivitis, the majority employed a diode laser (670nm, 150 mW, 22J/cm2, 60seconds) as the light source and methylene blue at a concentration of 0.0005% (applied for 3minutes) as the photosensitizer in a single treatment session. The included studies reported positive effects of aPDT on gingivitis management, with more improvements observed in PI, BOP, and GI following aPDT treatment. Additionally, aPDT was found to reduce the counts of periopathogens such as Porphyromonas gingivalis, as well as inflammatory factors (TNF-α, IL-1ß, and IL-6). Two studies demonstrated that aPDT, particularly when administered in multiple sessions, effectively controlled the extent of WSLs during orthodontic treatment and yielded favorable outcomes that persisted for several months after treatment. CONCLUSION: Based on the available evidence, aPDT appears to be a safe and effective treatment option for managing WSLs and gingivitis in patients with fixed orthodontic appliances. However, further high-quality RCTs are necessary to investigate the impact of potential confounding factors on the efficacy of aPDT.

Desquamative gingivitis treatment with topical tacrolimus applied to a custom tray: an open trial regarding its efficacy on patients' symptoms.

OBJECTIVE: To evaluate the efficacy of topical tacrolimus offered on a custom tray to treat desquamative gingivitis (DG). STUDY DESIGN: Eighteen patients with symptomatic DG related to oral lichen planus (OLP) or mucous membrane pemphigoid (MMP) were selected, of which 13 completed the study. Periodontal treatment was followed by the fabrication of a custom silicone tray to apply a tacrolimus gel formulation (0.1%). Clinical evaluation (complaint of pain and burning - visual analog scale from 0 to 10; and the presence of erythema, desquamation, vesicle/blister, erosion, ulcer, and bleeding) was performed by the same examiner on day 1, and every 15 days for 90 days. RESULTS: Total remission was found in 4 patients (30.76%). Partial remission was found in 69.24% of the patients, classified with an excellent (30.76%), good (30.76%), and regular (7.69%) recovery, respectively. There was a reduction of about 60% in pain and 65% in burning sensation complaints. Wilcoxon test revealed significant differences between pre- and post-treatment pain and burning sensation symptoms (P < .01). CONCLUSION: Topical application of 0.1% tacrolimus gel was effective in the treatment of DG in controlling pain and burning sensation, leading to the clinical remission of gingival lesions in patients with OLP and MMP.

Mouthwashes: Alternatives and Future Directions.

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Comparative Evaluation of 0.25% Lemongrass Oil Mouthwash and 0.2% Chlorhexidine Mouthwash in Fixed Orthodontic Patients Suffering from Gingivitis.

AIM: The aim of this study is to compare the antiplaque and antigingivitis efficacy of 0.25% lemongrass oil mouthwash and 0.2% chlorhexidine mouthwash in patients undergoing fixed orthodontic treatment, who are suffering from gingivitis. MATERIALS AND METHODS: A total of 60 patients undergoing fixed orthodontic treatment with mild-to-moderate gingivitis were selected for the study. The patients were randomly divided into three groups of twenty each, that is, group I: 0.25% lemongrass oil mouthwash (n = 20); group II: 0.2% chlorhexidine mouthwash (n = 20); and group III: oral prophylaxis (n = 20). Baseline gingival index (GI) and plaque index (PI) were accessed followed by oral prophylaxis was done and the PI score was set to zero for all the patients. Patients were asked to swish their mouth with their respective mouthwashes and brushing (twice daily), that is, morning and before bedtime for 21 days. The PI and GI scores were recorded for all three groups on the 14th and the 21st days. The post hoc Bonferroni test was used for multiple comparisons of mean differences among variables after the application of the analysis of variance (ANOVA) test for comparison within the groups. RESULTS: A lower PI and the GI were found in the lemongrass oil mouthwash group by the 14th and the 21st days, respectively, a statistically significant difference (p < 0.001) compared to the chlorhexidine mouthwash group. CONCLUSION: The findings of the current study suggested that 0.25% lemongrass oil mouthwash has the potential to be used as a natural or herbal alternative to chlorhexidine mouthwash. CLINICAL SIGNIFICANCE: It can be suggested that 0.25% lemongrass oil mouthwash may be a good herbal alternative to mouthwash containing 0.2% chlorhexidine gluconate.

Effects of Kangfuxinye on NF-κB and Inflammatory Cytokines in Gingival Crevicular Fluid of Patients with Orthodontic Gingivitis Caused by Orthodontic Treatment.

Explore the Kangfuxinye effection on the expressions of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and inflammatory cytokines (IC) in the gingival crevicular fluid of patients with orthodontic gingivitis caused by orthodontic treatment. 98 patients with orthodontic gingivitis in Qingdao Stomatological Hospital caused by orthodontic treatment were divided into two groups, namely, the control treatment group and the Kangfuxinye treatment group. In this study, the expressions of those proteins and IC in gingival crevicular fluid before and after treatment were analyzed at first, and the correlations of the NF-κB p65 expression with IC were explored. Then the differences in the expressions of those proteins and IC and the efficacy between the control treatment group and the Kangfuxinye treatment group were analyzed. Compared with those before treatment, the expressions of NF-κB-related proteins and IC interleukin-1ß (IL-1ß), tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factor (VEGF)] were significantly decreased after treatment (p<0.05). After treatment, the expression of NF-κB p65 was positively correlated with IL-1ß, TNF-α and VEGF, but negatively related to IL-4 and IL-10. In addition, compared with the control treatment, Kangfuxinye significantly reduced the expressions of those proteins and their messenger ribonucleic acids (mRNAs) (p<0.05), decreased the expressions of IL-1ß, TNF-α and VEGF (p<0.05) but improved the total effective rate of treatment. Kangfuxinye can reduce the NF-κB expressions and IC in the gingival crevicular fluid of patients with orthodontic gingivitis caused by orthodontic treatment and enhance the efficacy.

Randomized clinical trial on the clinical effects of a toothpaste containing extra virgin olive oil, xylitol, and betaine in gingivitis.

To determine the effects on gingival bleeding, dental biofilm, and salivary flow and pH in patients with gingivitis of using toothpaste with extra-virgin olive oil (EVOO), xylitol, and betaine in comparison to a placebo or commercial toothpaste. This controlled, double blinded, and multicenter randomized clinical trial included patients with gingivitis randomly assigned to one of three groups: test group (EVOO, xylitol, and betaine toothpaste), control group 1 (placebo toothpaste), or control group 2 (commercial toothpaste). Percentage supragingival biofilm and gingival bleeding were evaluated at baseline (T0), 2 months (T2), and 4 months (T4), measuring non-stimulated salivary flow and salivary pH. Comparisons were performed between and within groups. The final study sample comprised 20 in the test group, 21 in control group 1, and 20 in control group 2. In comparison to control group 1, the test group showed significantly greater decreases in gingival bleeding between T4 and T0 (p = 0.02) and in biofilm between T2 and T0 (p = 0.02) and between T4 and T0 (p = 0.01). In the test group, salivary flow significantly increased between T2 and T0 (p = 0.01), while pH alkalization was significantly greater between T4 and T0 versus control group 2 (p = 0.01) and close-to-significantly greater versus control group 1 (p = 0.06). The toothpaste with EVOO, xylitol, and betaine obtained the best outcomes in patients with gingivitis, who showed reductions in gingival bleeding and supragingival biofilm and an increase in pH at 4 months in comparison to a commercial toothpaste.

Effect of oral gargle containing Lespedeza cuneata extract on periodontal health improvement and disease prevention: a randomized, controlled clinical trial.

BACKGROUND: This study aimed to evaluate the antiplaque and antibacterial effects of a mouthwash containing Lespedeza cuneata (LC) extract through clinical periodontal disease (PD) indicators and changes in PD-causing bacteria. METHODS: A total of 63 subjects participated in this double-blind clinical trial. Subjects were divided into two groups: 32 participants gargled with LC extract, and 31 used saline. Scaling was performed 1 week before the experiment to secure the homogeneity of the subjects' oral conditions. After gargling with 15 ml of each solution for 1 min, participants spit out the solution to remove any residual mouthwash solution. Then, PD-related bacteria were measured via the O'Leary index, plaque index (PI), and gingival index (GI). The clinical data were collected three times: before gargling, immediately after gargling, and 5 d after gargling. RESULTS: After 5 d, the O'Leary index, PI, and GI scores were significantly reduced in the LC extract gargle group (p < 0.05). PD-inducing Gram-positive and -negative bacteria were also reduced, confirming the LC extract's effect on periodontal health improvement and disease prevention. CONCLUSION: Mouthwash containing LC extract, a new alternative natural substance that is safe and effective, may be used to treat PD because of its ability to inhibit and prevent PD.

Comparison of antiplaque and anti-gingivitis effects of aloe vera mouthwash with chlorhexidine in fixed orthodontic patients-A randomized controlled trial.

BACKGROUND: In daily dental practice, plaque-induced gingivitis is one of the most common periodontal diseases that is frequently encountered. Accumulation of microbial biofilms on surfaces of teeth and poor or inadequate oral hygiene is the chief predisposing factor for this condition. In such a state, antimicrobial mouthwash as an adjunct to mechanical plaque control helps in maintaining good oral hygiene. Among the many conditions, fixed orthodontic treatment is one of the conditions where plaque control becomes challenging to the patient as well as the dentist. In such a situation, antimicrobial mouthwash as an adjunct to mechanical plaque control is highly recommended. Dentistry has recently evidenced a shift of approach for treating many inflammatory oral diseases by using herbal treatment modalities. Aloe vera is one such product exhibiting multiple benefits and has gained considerable importance in clinical research recently. The present study aimed to evaluate efficacy of aloe vera mouth rinse on the dental plaque and gingivitis in patients who were undergoing fixed orthodontic treatment in comparison with 0.2% chlorhexidine mouthwash. MATERIAL AND METHOD: This randomized controlled trial was conducted on 30 subjects with fixed orthodontic treatment. The subjects were grouped in the test group (15 subjects with 10 ml aloe vera mouthwash (99.6% [w/v])) and the control group (15 subjects with 0.2% 10 ml chlorhexidine mouthwash). Plaque index, gingival index and bleeding on probing were recorded for each participant at baseline, 21 days from baseline and 35 days from baseline. The findings were then statistically analysed using student paired and unpaired t-test. RESULTS: Gingival index showed a statistically significant difference from baseline to 21 days and 35 days visit in both the groups. Plaque index and bleeding on probing were statistically significant among both groups when compared baseline to 21 days and 35 days visit, but the difference was not significant between visit 2 and visit 3. CONCLUSIONS: Although chlorhexidine is still the gold standard mouthwash, aloe vera exhibits promising results in reducing plaque and gingivitis scores, without any reported adverse effects. Larger multi-centric trials are needed to prove its effectiveness on dental plaque-induced gingivitis.

Pénfigo vulgar y su manejo integral: reporte de dos casos y revisión de literatura / Pemphigus Vulgaris and its Comprehensive Management: Report of Two Cases and Literature Review

Resumen En la cavidad oral se pueden presentar lesiones en gíngiva que no están asociadas a placa bacteriana, las cuales requieren de un adecuado diagnóstico y tratamiento. La gingivitis descamativa está usualmente relacionada con desórdenes mucocutáneos, como el pénfigo vulgar (PV), donde las lesiones orales incluyendo las lesiones gingivales, pueden preceder las lesiones cutáneas. El manejo es multidisciplinario y el tratamiento incluye terapia farmacológica tópica y sistémica, se requiere un adecuado control de la placa bacteriana por parte del paciente y una estricta supervisión en el tiempo por parte del profesional para el mantenimiento y estabilidad de los tejidos gingivales. Se presentan dos casos clínicos de pacientes con diagnóstico de PV los cuales fueron manejados de manera oportuna e integral para controlar y estabilizar el factor sistémico y local.

Abstract In the oral cavity, gingiva lesions may occur that are not associated with bacterial plaque, which require adequate diagnosis and treatment. Desquamative gingivitis is usually related to mucocutaneous disorders, such as pemphigus vulgaris (PV), where oral lesions, including gingival lesions, may precede skin lesions. Management is multidisciplinary and treatment includes topical and systemic pharmacological therapy, require adequate control of dental plaque by the patient and strict supervision over time by the professional for the maintenance and stability of the gingival tissues. Two clinical cases of patients with a diagnosis of PV are presented, which were managed in a timely and integral way to control and stabilize the systemic and local factor.

A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis.

BACKGROUND Streptococcus oralis (S. oralis) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis. CASE REPORT The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient's diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized. CONCLUSIONS This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.

Effect of Pudilan Keyanning antibacterial mouthwash on dental plaque and gingival inflammation in patients during periodontal maintenance phase: study protocol for double-blind, randomised clinical trial.

INTRODUCTION: Plaque control plays a critical role in the prevention and treatment of periodontitis. Antibacterial mouthwash is one of the most important tools for plaque control. Pudilan, including extracts of Scutellaria baicalensis root, Taraxacum mongolicum, Bunge corydalis herb and Isatis indigotica, was reported playing the role of anti-inflammatory and anti-bacterial. However, its effect on dental plaque and periodontal inflammation remains unknown. We aimed to assess the efficacy of Pudilan Keyanning antibacterial mouthwash which contains the active essence of Pudilan and 0.03%-0.06% cetylpyridinium chloride, as well as Pudilan active essence for plaque control and gingival anti-inflammation in patients during periodontal maintenance phase. METHODS AND ANALYSIS: In this double-blind, randomised, placebo-controlled clinical trial, a total of 120 participants during periodontal maintenance phase will be enrolled. After supragingival scaling, they will be randomly assigned into three groups in a 1:1:1 ratio: the Pudilan Keyanning antibacterial mouthwash group, a chlorhexidine acetate mouthwash (0.12%) group or a placebo group with mouthwash containing the same components as the Pudilan Keyanning mouthwash except for Pudilan active ingredients. They will rinse with mouthwash, respectively, two times per day for 6 weeks. Clinical parameters (such as plaque index, bleeding index) and the level of volatile sulfide in the breath will be measured and analysed. The subgingival plaque will be collected and analysed microbiologically. Questionnaire feedback will be analysed. ETHICS AND DISSEMINATION: The study protocol (V.4) was reviewed and approved by the Medical Ethical Committee of Peking University School and Hospital of Stomatology (Ethics Approval No. PKUSSIRB-201950153b). All participants signed a written consent form. TRIAL REGISTRATION NUMBER: ChiCTR2000041253.

EFFECTIVENESS OF COMPOSED HERBAL EXTRACT IN THE TREATMENT OF GINGIVITIS AND ORAL AND PHARYNGEAL MUCOSA - REVIEW OF STUDIES.

Intensive studies on properties of synthetic compounds are simultaneously conducted with studies on the effectiveness and safety of drugs derived from natural compounds. These drugs have been effectively used for years in dentistry, in treatment of inflammatory conditions of the oral cavity and in laryngology, in treatment of pharyngeal inflammatory conditions. The subject of this article is a compilation of studies conducted on medicinal products containing composed ethanolic extract as an active substance, and obtained from: chamomile capitulum (Matricaria recutita L.), oak bark (Quercus spp.), sage leaf (Salvia officinalis L.), arnica herb (Arnica spp.), calamus rhizome (Acorus calamus L.), peppermint herb (Mentha piperita L.), thyme herb (Thymus spp.) Preclinical studies confirmed that a particular tested plant extract exhibits antimicrobial (antibacterial, antifungal and antiprotozoal) as well as anti-inflammatory, immunomodulatory and astringent properties. Under clinical conditions, it was confirmed that drugs containing the analysed extract used in periodontology, in prevention and complex treatment of gingivitis, periodontitis as well as diseases of oral mucosa (but also the throat) of viral, bacterial, fungal and protozoal aetiology significantly improved the effectiveness of therapy, shortened the treatment and improved the patients' quality of life. The above preparations used in dental surgery contributed to faster tissue regeneration, more quickly relieved pain and swelling after a surgery or difficult dentition. Furthermore, drugs containing the above-mentioned extract can also be successfully used for oral cavity decontamination in the case of various diseases of teeth or the oral and pharyngeal mucosa. The tested composed herbal extract (CHE), applied in the form of a mouthwash and in the form for topical application with benzocaine content (CHEB), is a component of drugs which are great alternatives to widely used synthetic drugs. They are characterised with high effectiveness, comparable to that of synthetic agents, and a higher safety profile. Results of pharmacological and clinical studies justify their use in both prevention and treatment of inflammatory diseases of the gums, periodontium, oral cavity and pharynx.

Clinical and Immunological Efficacy of Mangosteen and Propolis Extracted Complex in Patients with Gingivitis: A Multi-Centered Randomized Controlled Clinical Trial.

BACKGROUND: Mangosteen and propolis extracts (MAEC) have been potential therapeutic agents known to exhibit powerful antioxidant and anti-inflammatory properties. The aim of the current study was to evaluate the clinical and immunological efficacy of MAEC as well as safety and patient-reported outcomes (PROMs) on gingivitis and incipient periodontitis. METHODS: This study was performed on 104 patients diagnosed with gingivitis or incipient periodontitis. At baseline, the participants were randomly allocated to either the test group, with daily intake of a single capsule containing 194 mg of MAEC for eight weeks, or control group, with placebo. Clinical periodontal evaluation and immunological parameters from saliva and gingival sulcular fluid were assessed at baseline, four, and eight weeks. Individual PROMs were assessed by OHIP-14 questionnaires. RESULTS: There was a significant difference of modified gingival index at four and eight weeks between the test and control groups. In the test group, crevicular interleukin (IL)-6 was reduced, and the salivary matrix metalloproteinase (MMP)-9 was increased after eight weeks. PROMs were improved up to four weeks compared to placebo. CONCLUSION: Oral administration of MAEC would have a potential to reduce gingival inflammation clinically and immunologically in the patients with gingivitis and incipient periodontitis.

Treatment of periodontal diseases by the local drug delivery system using 1% chlorhexidine gel: A randomized clinical trial.

The idea of the local drug delivery system is getting popular nowadays to treat gingivitis and periodontitis. The method of delivering the drug locally is quite easy and requires minimal intervention. This delivery system not only treats the periodontal diseases effectively but also prevents the side effects linked with the use of the drugs which are used orally for longer periods to cure these diseases. Chlorhexidine (CHX) is being widely used to treat these conditions because of its broad spectrum anti-bacterial effect and is found to be more effective in lowering plaque formation. The aim of this study was to appraise the effect of the local drug delivery system by using 1% CHX gel in patients with periodontal diseases. 1% CHX gel was prepared and its physicochemical characteristics were then assessed. Clinical parameters and inflammatory salivary biomarkers were evaluated in two groups of patients. Group I: standard treatment group. Group II: gel treatment group. These parameters were evaluated before treatment and after 4 weeks of treatment. 1% CHX gel was highly effective in reducing gingivitis and periodontitis by using the local drug delivery system which allowed the drug to retain into the periodontal pocket for prolong period of time.

Interferon therapies in small animals.

Interferons (IFNs) are cytokines that play an important role in the immune response of animals and humans. A number of studies reviewed here have evaluated the use of human, canine and feline IFNs as treatments for infectious, inflammatory and neoplastic disease in dogs and cats. Recombinant canine IFN-γ is deemed an efficacious therapy for canine atopic dermatitis. Recombinant feline IFN-ω is effective against canine parvoviral enteritis and has also been recommended for canine atopic dermatitis. Based on limited evidence, recombinant canine IFN-α could be a topical treatment option for dogs with gingivitis and keratoconjunctivitis sicca. Conclusive evidence is lacking for other diseases and large randomised controlled trials are needed before IFNs can be recommended for other indications.

Atypical paronychia: don't forget herpesvirus.

Paronychia is usually caused by bacterial infections. Herpetic whitlow is an acute infection of the fingers or toes caused by herpes simplex viruses and it typically presents with vesicles. We report the case of a 78-year-old woman with gingivostomatitis and atypical paronychia in several fingers without blisters.

Use of amnion-derived cellular cytokine solution for the treatment of gingivitis: A 2-week safety, dose-ranging, proof-of-principle randomized trial.

BACKGROUND: A 6-week Phase I clinical trial was performed to primarily evaluate the safety and secondarily determine the preliminary efficacy of a novel biological solution, ST266, comprised of a mixture of cytokines, growth factors, nucleic acids, and lipids secreted by cultured amnion-derived multipotent progenitor cells on gingival inflammation. METHODS: Fifty-four adults with gingivitis/periodontitis were randomly assigned to 1X ST266 or diluted 0.3X ST266 or saline topically applied on facial/lingual gingiva (20 µL/tooth). Safety was assessed through oral soft/hard tissue exam, adverse events, and routine laboratory tests. Efficacy was assessed by modified gingival index (MGI), bleeding on probing, plaque index, probing depth (PD), and clinical attachment level (CAL). Assessments were performed on day 0, 8, 12, and 42. ST266 and saline applied daily starting at day 0 through day 12 except weekend days. Plasma was analyzed for safety and proinflammatory cytokines, interleukin (IL)-1ß, IL-6, tumor necrosis factor-alpha, and interferon gamma. Gingival crevicular fluid (GCF) was analyzed for the same cytokines. Subgingival plaque was primarily analyzed by checkerboard DNA-DNA hybridization. Comparisons with saline were modeled through a generalized estimating equations method adjusting for baseline. RESULTS: No safety concern was found related to ST266. Statistically significant reduction in MGI was noted at day 42 by 1X ST266 compared with saline (P = 0.044). PD and CAL were reduced by both doses of ST266 at day 42 (P <0.01) and by 1X ST266 at day 12 (P <0.05). GCF IL-1ß and IL-6 levels were reduced by both doses of ST266 at day 12 (P <0.05, P <0.01, respectively). IL-6 was also significantly reduced in plasma of both ST266 groups (P <0.05). Significant reductions in red complex bacteria were detected in both ST266 doses. CONCLUSIONS: In this "first in human oral cavity" study, topical ST266 was safe and effective in reducing gingival inflammation in 6 weeks. Longitudinal studies with large sample sizes are warranted to assess the therapeutic value of this novel host modulatory compound in the treatment of periodontal diseases.

Proanthocyanidins and Flavan-3-Ols in the Prevention and Treatment of Periodontitis-Antibacterial Effects.

Flavan-3-ols and their oligomeric forms called proanthocyanidins are polyphenolic compounds occurring in several foodstuffs and in many medicinal herbs. Their consumption is associated with numerous health benefits. They exhibit antioxidant, anti-inflammatory, cytoprotective, as well as antimicrobial activity. The latter property is important in the prevention and treatment of periodontal diseases. Periodontitis is a multifactorial polymicrobial infection characterized by a destructive inflammatory process affecting the periodontium. Using non-toxic and efficient natural products such as flavanol derivatives can significantly contribute to alleviating periodontitis symptoms and preventing the disease's progress. Therefore, a comprehensive systematic review of proanthocyanidins and flavan-3-ols in the prevention and treatment of periodontitis was performed. The present paper reviews the direct antibacterial effects of these compounds against periodontic pathogens. The immunomodulatory effects, including animal and clinical studies, are included in a separate, parallel article. There is significant evidence supporting the importance of the antibacterial action exerted by proanthocyanidins from edible fruits, tea, and medicinal herbs in the inhibition of periodontitis-causing pathogens.

Zinc chloride inhibits lysine decarboxylase production from Eikenella corrodens in vitro and its therapeutic implications.

OBJECTIVES: Dentifrices containing zinc reduce gingival inflammation and bleeding better than control dentifrices (no zinc). How zinc might work is not understood. We have shown that lysine decarboxylase (LdcE), an enzyme from Eikenella corrodens, converts lysine to cadaverine in dental biofilms. The lack of lysine impairs the dentally attached cell barrier to biofilm, causing biofilm products to leak into junctional epithelium and stimulate inflammation. In year-old beagle dogs, immunization with LdcE, induces antibodies that inhibit LdcE activity and retard gingivitis development. We therefore examined whether a zinc-mediated loss of LdcE activity could explain the beneficial effect of zinc dentifrices. METHODS: We grew E. corrodens in modified tryptic soy broth with or without zinc chloride, and extracted LdcE from the cell surface using a Potter Elvehjem homogenizer. RESULTS: Up to 0.96 mM zinc chloride in the bacterial growth medium did not change cell yield, but reduced the extracted protein content by 41% (R2 = 0.27, p < 0.05) and LdcE activity/mg extracted protein by 85% (R2 = 0.90, p < 0.001). In extracts from cells grown without zinc, 78 times this zinc chloride concentration (73 mM) was required to reduce LdcE activity by 75%. CONCLUSIONS: Zinc ions inhibit the production of protein with LdcE activity at E. corrodens cell surfaces. The zinc ions may attach to cysteine residues that are unique to the N-terminal region of LdcE by interfering with the non-covalent polypeptide assembly that produces enzyme activity. CLINICAL SIGNIFICANCE: Zinc ion-mediated inhibition of LdcE assembly may provide a rationale for the improved control of gingival inflammation by zinc dentifrices.