Association between tooth loss and risk of occurrence of oral cancer - A systematic review and meta-analysis.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067-3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00-68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Clinicoradiographic comparative evaluation of 1% melatonin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

BACKGROUND: The present study aims to evaluate and compare the effects of 1% melatonin gel plus platelet-rich fibrin (PRF) and PRF alone in treatment of furcation defects, clinically and radiographically using cone-beam computed tomography. METHODS: This split-mouth clinical trial included 23 patients with 46 bilateral Grade II furcation defects in first or second maxillary or mandibular molars. Control group was treated with PRF alone while the test group was treated with 1% melatonin gel and PRF. Clinical attachment level (CAL) and horizontal probing depth (HPD) were primary outcome parameters while secondary outcome parameters were pocket probing depth (PPD) and defect volume (DV) assessed at 3 and 6 months postoperatively. RESULTS: Significantly greater mean reduction of PPD, HPD, and CAL gain was observed in test group (2.23 ± 0.41, 2.36 ± 0.68, and 2.97 ± 0.62 mm, respectively) in comparison with control group (2.83 ± 0.78, 2.85 ± 0.67, and 3.21 ± 0.86 mm, respectively) at 6 months. A significant reduction in the mean DV was exhibited radiographically in test group (1.06 ± 0.5 mm3 ) as compared with control group (3.94 ± 1.32 mm3 ) at the end of 6 months. Both the groups showed improvements in assessed parameters. CONCLUSIONS: In Grade II furcation defects the combination therapy of 1% melatonin + PRF shows a statistically significant degree of bone fill within the periodontal tissues and also better results in terms of decrease in PPD, HPD, and a greater CAL gain.

Comparative evaluation of 1% melatonin gel in the treatment of intrabony defect: A randomized controlled clinical trial.

BACKGROUND: The present study aims to evaluate and compare the efficacy of locally delivered 1% melatonin gel as an adjunct to non-surgical periodontal therapy (NSPT) in treatment of intrabony defect in Stage III periodontitis, clinically, and radiographically using cone-beam computed tomography (CBCT). METHODS: This split-mouth clinical trial randomly allotted 44 bilateral intrabony defect (in 22 patients) into two groups where Group I was treated with NSPT with locally delivered placebo gel while Group II was treated with NSPT with 1% melatonin gel. The intrabony defect fill measured from cemento-enamel junction (CEJ)-base of the defect (BD), and the difference in the measurement values of CEJ-BD from baseline to 6 months denoting the bone fill and bone volume evaluated at 6 months using CBCT were the primary outcome measures. Secondary outcome measures were change in probing depth (PD), clinical attachment level (CAL), plaque index, and modified sulcus bleeding index recorded at baseline, 3 months, and 6 months. RESULTS: Both the study groups showed improvements in assessed parameters, however, a significant gain in intrabony defect fill was observed in Group II (1.46 ± 0.58) as compared with Group I (0.50 ± 0.38) and change in bone volume for Group I was 21.4645 ± 8.8980 mm3 and for Group II was 51.8418 ± 30.2329 mm3 with P < 0.0001.The mean reduction in PD and gain in CAL was 3.90 ± 0.78 and 2.94 ± 0.80 in Group II and in Group I it was 3.23 ± 0.90 and 1.96 ± 0.80 (P < 0.0001). CONCLUSION: The use of 1% melatonin gel as an adjunct to NSPT is more beneficial in achieving better clinical and radiographic outcome at 6 months which indicates that adjunct use of melatonin gel to NSPT as a local drug delivery is preferred when compared with NSPT and placebo gel alone.

Randomized, controlled clinical trial to evaluate efficacy of sticky bone and concentrated growth factor in the management of intrabony defects: 12 months follow-up study.

Background: Platelet derivatives are enriched growth factors that ameliorate various cellular processes in regeneration. The present clinical trial aimed to evaluate and compare the effects of sticky bone and concentrated growth factors (CGFs) in the treatment of intrabony osseous defects by cone-beam computed tomography (CBCT). Materials and Methods: The study included 20 patients having 40 intrabony defects. 20 sites each were included in both test group (Sticky bone) and Control group (CGF alone). The clinical parameters including probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline and 6 and 12 months posttherapy. The radiographic parameters including the depth, mesiodistal (MD), and the buccolingual (BL) width of the defect to assess the amount of bone fill were examined at baseline and after 12 months using CBCT. Results: Twelve months posttherapy clinical results indicated a significant reduction of PPD and gain in CAL in both the study groups. Similar observations were recorded with CBCT radiographic parameters where the intrabony defect depth and MD defect width for the test group and control group significantly reduced after 12 months' posttherapy (P < 0.0001). However, no significant reduction in BL defect width was observed in control group (P = 0.577) in contrast to the test group (P = 0.028) after 12 months' posttherapy. Conclusion: Intrabony defects treated with sticky bone showed improved clinical and radiographic parameters indicative of enhanced periodontal regeneration as compared to CGF alone treated sites.

Effect of Aloe vera as a local drug delivery agent in the management of periodontal diseases: A systematic review and meta-analysis.

BACKGROUND: Aim of the present meta-analysis was to evaluate the effect of Aloe vera in various forms such as gel, mouthwash, and dentifrice on gingival and plaque index (PI) in comparison to various allopathic products such as chlorhexidine, metformin, chlorine dioxide, fluoridated toothpaste, and alendronate. MATERIALS AND METHODS: A comprehensive electronic search was conducted on PubMed/MEDLINE, GOOGLE SCHOLAR, and HAND SEARCH of reference list of archived articles published till January 2020. Randomized controlled trials were searched comparing the Aloe vera product with other products which used PI and gingival index (GI) to evaluate the outcomes. Finally, nine studies assessing PI and four studies evaluating GI were considered for the meta-analysis. After extracting the information, a risk of bias was estimated. The standardized mean differences (SMDs) and fixed and random effect models were obtained from the mean treatment differences. RESULTS: The estimates of SMD of PI from fixed effects (SMD = 0.271, 95% confidence interval [CI] = 0.00134-0.407, P < 0.001) and random effects (SMD = 0.288, 95% CI = 0.048-0.529, P = 0.019) were found slightly different, the models showed consistent results yielding positive and significant treatment effects. For GI fixed effects (SMD = 0.27, 95% CI = -0.035-0.575, P = 0.0803, not significant) and random effects (SMD = 0.259, 95% CI = 0.049-0.469, P = 0.016, significant) were found slightly different and positive. However, one model showed significant and another model showed nonsignificant treatment effects. CONCLUSION: Results from our meta-analyses confirmed the beneficial effects of A. vera in improving the periodontal parameters and hence may be considered as a safe alternative drug delivery agent for the management of periodontal diseases in future.

Quantitative analysis of gingival phenotype in different types of malocclusion in the anterior esthetic zone.

BACKGROUND: For any esthetic treatment planning, the shape and form of gingiva should be a prime factor of concern. The correct identification of gingival phenotype (GP) ensures a firm foundation for future health and prognosis of the treatment indicated. Hence, the aim of the present study was to evaluate the correlation between the GP in the anterior esthetic zone with different types of maloclussion and severity of crowding. MATERIALS AND METHODS: A total of 110 periodontally healthy controls were equally divided into two groups depending on the type of malocclusion. They were further divided according to the levels of dental crowding as mild, moderate, and severe. GP was measured on the anterior esthetic teeth using transgingival probing, and width of the attached gingiva (WAG) was measured using histochemical staining method. RESULTS: In severe crowding group, the GP in 12 and 22 region was found to be thick (P = 0.035) while, in 32 and 42 region was thin (P = 0.042). The WAG shows a significant difference between WAG with 23 in severe crowding group with P = 0.042, whereas there was no significant relationship found between the GP with Angle's classification. CONCLUSION: Within the limitations of the study, it can be concluded that the teeth in the maxillary and mandibular anterior esthetic region showed the thin phenotype. When the severity of crowding increases, the GP and WAG vary depending on the position of the tooth. There is no association between the Angle's classification and the mean GP of the maxillary and mandibular anterior region teeth.

Clinico-radiographic evaluation of 1% alendronate gel as an adjunct and smart blood derivative platelet rich fibrin in grade II furcation defects.

BACKGROUND: The treatment of molar furcation involvement is unpredictable due to the complex anatomy and poor access for instrumentation. Previous studies have reported successful regeneration with endogenous regenerative material such as platelet rich fibrin (PRF) and bisphosphonates as alendronate (ALN). Hence, the present study was aimed to evaluate clinically and radiographically the efficacy of 1% ALN gel in combination with PRF (PRF+ALN) and PRF alone in the treatment of grade II furcation defects. METHODS: A split mouth study with 40 bilateral furcation defects was randomly divided into PRF group and PRF+ALN group. Bone defect volume was the primary outcome evaluated at the end of 6 months with CBCT while the secondary outcomes being changes in clinical parameters including Probing pocket depth (PPD), Clinical attachment level (CAL) and Horizontal probing depth (HPD) recorded at baseline, 3 and 6 months. RESULTS: The mean reduction in PPD, CAL and HPD was 1.85 ± 0.59 mm, 1.9 ± 0.64 mm and 1.7 ± 0.73 mm respectively for PRF group and 2.85 ± 0.88 mm, 3.05 ± 0.98 mm and 2.3 ± 0.73 mm respectively for PRF+ ALN group (p < 0.05). At the end of 6 months, mean reduction in bone defect volume for PRF and PRF+ ALN group was 8.65 ± 3.84 mm3 and 11.98 ± 4.13 mm3 respectively. CONCLUSION: PRF+ ALN treated defects exhibited better clinical and radiographic outcomes suggestive of enhanced periodontal regeneration when compared to PRF alone treated sites.

Quantitative analysis of mast cell count and density in chronic periodontal disease.

BACKGROUND: Mast cells play a crucial role in activation of acquired immune response to inflammatory conditions of periodontal diseases. They promote inflammation by releasing pro-inflammatory mediators and bring about angiogenesis, degeneration of the extracellular matrix, and tissue remodeling. Since there is little literature regarding the role of mast cells in periodontitis, the present study was aimed to evaluate mast cell count (MCC) and density in periodontitis. MATERIALS AND METHODS: A total of eighty participants, Group I (n = 40) healthy participants and Group II (n = 40) participants with moderate chronic periodontitis, were included in the study. Tissue samples of 5 micron were obtained from each participant and were fixed in 10% formalin. Inflammation assessment was carried out after staining the sections with hematoxylin/eosin (H and E) followed by toluidine blue and mast cells were counted. RESULTS: MCC in healthy group (1.32 ± 0.43) was significantly smaller than periodontitis group (10.28 ± 1.15) and also mast cell density in healthy group (98.08 ± 37.40) was smaller than periodontitis group (803.43 ± 89.94) with P < 0.0001. CONCLUSIONS: It could be concluded that participants with chronic periodontitis have a higher MCC and density when compared with healthy participants.

Comparative analysis of salivary sialic acid levels in patients with chronic obstructive pulmonary disease and chronic periodontitis patients: A biochemical study.

AIM: Sialic acid plays a central role in the functioning of biological systems, in stabilizing the glycoproteins and cellular membranes, assisting in cell-cell recognition and interaction. The aim of this study is to evaluate and compare the periodontal health status and salivary Sialic acid levels in patients suffering from chronic obstructive pulmonary diseases (COPD) and chronic periodontitis patients. MATERIALS AND METHODS: Ninety subjects were included in the study, which were divided into the following groups, 30 in each group. Group 1: patients suffering from COPD and chronic periodontitis, Group 2: periodontitis patients without any systemic diseases Group 3: healthy subjects. Unstimulated whole saliva samples were collected around 9-10 AM; 2 h after the subjects had breakfast. The sialic acid content was determined by a combined modification of the thiobarbituric acid method of Skoza and Mohos. RESULTS: The mean salivary sialic acid levels were least in the healthy group followed by the periodontitis group, and it was highest in the COPD group. CONCLUSIONS: We can thus conclude that promotion of dental care knowledge is very much essential in the prevention and treatment of COPD. Thus, estimation of levels of salivary sialic acid can be used as an adjunct to diagnose the current periodontal disease status and to assess the treatment outcomes in subjects with COPD and chronic periodontitis.

Association between kharra chewing and periodontal health status in oral submucous fibrosis patients of Central India, Nagpur.

PURPOSE: Kharra is a mixture of areca nut and tobacco. Arecoline, an areca nut extract, disrupts the harmony of the periodontal cells and thus leads to destruction of the periodontium. Oral submucous fibrosis (OSMF) is a premalignant condition that arises due to the consumption of kharra. The aim of this study was to evaluate and compare the effects of kharra chewing on periodontal status in patients with OSMF. MATERIALS AND METHODS: Forty-five patients were divided into Group I: healthy periodontium (n = 15), Group II: chronic periodontitis without OSMF group (n = 15), and Group III: chronic periodontitis with OSMF group (n = 15). The clinical parameters assessed for patients with chronic periodontitis were gingival index (GI), plaque index (PI), probing pocket depth (PPD; overall and regional) ≥3 mm, and clinical attachment level (CAL; overall and regional) ≥3 mm. For patients in Group III, the OSMF diagnosis and staging were based on Khanna's classification. The level of significance was set at P < 0.05. RESULTS: The sample with a mean age of 35 years had a frequency of chewing kharra >6 times per day for at least 3 years. PI, PPD and CAL in Group III were 2.1 ± 0.4, 3.2 ± 0.6, and 4.8 ± 0.6 mm, respectively. the results of the clinical parameters in Group III and Group II were higher than Group I. GI was higher in Group II as compared to the other groups. CONCLUSION: The habit of chewing kharra is found to be associated with poor periodontal health in patients with OSMF.

Assessment of postgraduate dental students using mini-clinical examination tool in periodontology and implantology.

INTRODUCTION: Mini-clinical examination (mini-CEX) is a new assessment tool that observes the student using a standard rating form. The aim of this study was to evaluate the feasibility and usefulness of the mini-CEX as an assessment and feedback tool in the postgraduate setting in periodontology. MATERIALS AND METHODS: Eight postgraduate students and two evaluators were included in this study carried out for 4 months during which the students were made to appear for four encounters evaluated on a standardized nine-point Likert scale. Feedback was obtained from the students about this assessment after the fourth encounter. RESULTS: Sixty-three percent of the students felt that mini-CEX is better than the conventional assessment tools. Seventy-five percent of the students felt that this type of mini-CEX assessment helped improve the student-teacher relationship and student-patient relationship. Sixty-three percent of the students were satisfied with this assessment pattern and were willing to face more encounters as it helped them improve their competencies. Seventy-five percent of the students agreed that they felt anxious on being observed while taking cases. CONCLUSION: The training and assessment of a wide range of procedures make dentistry unique. Good communication skills and counseling can allay patient's fear and anxiety. This structured way of assessment of clinical skills and feedback provides good clinical care and helps improve the quality of the resulting information which would induce confidence, improve clinical competencies, and alleviate the fear of examination among the students.

Expression of periodontal inflammation into left ventricular hypertrophy in Type 2 diabetes mellitus: A cross-sectional study.

BACKGROUND: Chronic periodontitis, an inflammatory disease, is closely related to certain systemic conditions such as cardiovascular diseases, obesity, and Type 2 diabetes mellitus. These conditions, occurring as comorbidities, synergically affect periodontal tissues. AIM: This study aims to examine whether chronic gingivitis and chronic generalized severe periodontitis in patients with Type 2 diabetes mellitus are associated with increased left ventricular mass (LVM). MATERIALS AND METHODS: A total of 45 patients affected with Type 2 diabetes mellitus were recruited and divided into three groups with 15 patients each according to their periodontal status: Group I consisting of healthy individuals, Group II consisting of chronic gingivitis, and Group III consisting of chronic generalized severe periodontitis. They were assessed clinically, biochemically, and echocardiographically. LVM was calculated according to Devereux formula and was indexed to height. RESULTS: The differences in the means for LVM and LVM index (LVMI) were statistically significant in three groups with a P = 0.006 and 0.014, respectively. After adjusting for the confounders, the mean values of LVM in Group I, II, and III were 149.35 ± 35.51 g, 147.95 ± 31.59 g, and 156.36 ± 36.57 g, respectively and for LVMI, the mean values were 43.61 ± 12.16 g/m(2.7) (Group I), 47.12 ± 10.84 g/m(2.7) (Group II), and 46.34 ± 12.55 g/m(2.7) (Group III). CONCLUSIONS: A positive association between chronic generalized severe periodontitis and increased LVM in Type 2 DM patients was observed, suggesting the role of periodontal disease in the left ventricular hypertrophy.

Estimation of salivary and serum total sialic Acid levels in periodontal health and disease.

BACKGROUND: Chronic gingivitis and periodontitis are inflammatory diseases. An important function of host sialic acid is to regulate innate immunity. The aim of the study was to assess the concentration of Total sialic acid (TSA) in saliva and serum and also to find out their association if any, in periodontal health and disease. MATERIALS AND METHODS: A total of 90 subjects were clinically examined and distributed into three groups (n=30) according to the periodontal status namely healthy, chronic gingivitis and chronic periodontitis.Clinical measurements including probing depth, clinical attachment level, gingival index, oral hygeine index were recorded .TSA concentration was determined in saliva and serum of all subjects. RESULTS: In healthy group the mean salivary TSA level was 39.05mg/dl ±6.35(p<0.0001), mean serum TSA level was 49.75 mg/dl ± 4.87 (p<0.0001). In the chronic gingivitis group the mean salivary TSA level was 68.23 mg/dl ± 2.71 (p<0.0001), mean serum TSA level was 65.65 mg/dl ±3.56 (p<0.0001). In the chronic periodontitis group the mean salivary TSA was 81.33 mg/dl ±3.94 (p<0.0001), mean serum TSA level was 75.98 mg/dl ±3.58 (p<0.0001). CONCLUSION: The present data indicates that salivary & serum TSA levels can differentiate between chronic periodontitis patients and normal individuals. Thus it can be used as an adjunct to diagnose, monitor response to therapy, to determine the current periodontal disease status and to assess the treatment outcomes.

The dynamic relationship between pathological migrating teeth and periodontal disease.

BACKGROUND: Pathologic migration is defined as change in tooth position resulting from disruption of the forces that maintain teeth in normal position in relation to their arch. The disruption of equilibrium in tooth position may be caused by several etiologic factors. So, the aim of the study was to evaluate the pathologic tooth migration (PTM) in the upper anterior sextant and its relationship with predisposing and external factors such as bone loss, tooth loss, gingival inflammation, age, parafunctions, lingual interposition in the tongue thrust, and oral habits. AIM: The aim of the study was to evaluate the PTM in the upper anterior sextant and its relationship with predisposing and external factors such as bone loss, tooth loss, gingival inflammation, age, parafunctions, lingual interposition in the tongue thrust, and oral habits. MATERIALS AND METHODS: The study sample consisted of 100 subjects of both sexes, with age ranging from 19 to 72 years. The probing pocket depth and gingival index were recorded for each patient. Competency of lips was also evaluated as competent or incompetent. Habits such as tongue thrusting, nail biting, and lip sucking were evaluated in relation to pathological migration of the tooth. RESULTS: The results showed that no single factor by itself is clearly associated with PTM. As bone loss increases, the association of PTM with additional factors such as tooth loss and gingival inflammation increases. CONCLUSION: Further studies would be of great help to identify under which circumstances PTM is reversible according to the influence of gingival inflammation, malocclusion, and other factors. This information would contribute to a better understanding of some biological implications of the so-called minor tooth movement.