Cold atmospheric plasma: Its time-dependent effects on the elimination of bacterial colony on periodontal manual scalers.

Background: This in vitro study investigated the time-dependent bactericidal effects of cold atmospheric argon plasma treatment of periodontal hand scalers as well as the scanning electron microscopic view of the scaler tip surfaces before and after plasma treatment. Materials and Methods: The study used 34 periodontal hand scalers which were divided into test and control groups. The scaler tips were inoculated with Escherichia coli and Staphylococcus aureus bacteria, following which the scalers in the control and test groups were subjected to conventional sterilization and argon plasma sterilization, respectively. Varying exposure times of plasma treatment were done on the test group samples to evaluate the minimum time required for complete sterilization. Subsequently, streaks were made on plate count agar using each of these instruments. The agar plates were then kept in an incubator for 24 h, following which bacterial colony count was assessed (colony-forming units/mL). Furthermore, the scanning electron microscopic (SEM) view of the scaler tip was studied before and after plasma treatment. Results: A complete elimination of bacterial load (Gram-positive as well as Gram-negative) from the instrument surface was achieved by the plasma exposure time of 15-20 s. SEM analysis did not show a significant difference before and after plasma treatment as not many organic residues were present on the scaler tip. Conclusion: Cold atmospheric pressure plasma is an efficient and time-saving method of sterilization, capable of destroying both Gram-positive and Gram-negative bacteria.

Comparative clinical evaluation of a local drug delivery of cranberry and garcinia fruit gel with tetracycline fibers for amelioration of periodontitis: A split mouth study.

Background: The present study formulates and evaluates a polyberry gel comprising extracts of cranberry (Vaccinium macrocarpon) and brindle berry (Garcinia cambogia) in patients suffering from chronic periodontitis. Materials and Methods: The polyberry gel was evaluated for various physicochemical parameters, in vitro permeability and stability, and the active phytoconstituents were quantified by High-performance thin layer chromatography (HPTLC). Total phenolic content, total antioxidants, and ascorbic acid were estimated in the two extracts by in vitro assays. Patients suffering from chronic periodontitis with probing pocket depth (PPD) up to 5 mm were divided into 3 groups of 21 patients each and treated with scaling and root planing (SRP) or SRP followed by subgingival placement of polyberry gel or tetracycline fibers (standard). Plaque Index (PI), Gingival Index (GI), PPD, Clinical Attachment Level (CAL), and the salivary aspartate aminotransferase (AST) and C-reactive protein (CRP) levels were recorded at baseline and after 1 month. Results: A significant (P < 0.01) reduction in the periodontic disease parameters was observed in the standard and gel-treated groups between their baseline and 1-month time-interval readings. The polyberry gel treatment significantly (P < 0.05 for AST and P < 0.01 for the rest) attenuated the periodontitis-elevated PI, GI PPD, CAL, AST and CRP levels when compared with SRP at the end of the study and was comparable with tetracycline. Conclusion: The amelioration of periodontitis and gingival inflammation may be attributed to the potent antioxidant activity of the polyphenolic phytoconstituents of the gel. The polyberry gel may thus be used as a safe adjunct to SRP/tetracycline in chronic periodontitis.

Comparative evaluation of the efficacy of a novel tetracycline-coated suture with triclosan-coated and noncoated sutures on bacterial load reduction: A prospective in vitro study.

Background: Surgical site infection (SSI) is one of the common postoperative complications observed after various periodontal surgeries, and sutures play a vital role in its causation. Thus, the aim of this study is to evaluate and compare the efficacy of a novel tetracycline-coated suture with triclosan-coated and nonantibacterial-coated sutures on bacterial load reduction to prevent SSI by measuring the zone of inhibition. Materials and Methods: Twenty systemically healthy individuals with moderate chronic periodontitis were included in this study. Fresh unstimulated saliva was collected from each patient and inoculated on three different blood agar plates. Sutures were divided into three groups (Group A: Tetracycline-coated suture, Group B: Triclosan-coated suture, Group C [control group]: Nonantibacterial-coated suture). The antibacterial efficacy of each suture was evaluated by performing agar diffusion test. The zone of inhibition around each suture was calculated, and statistical analysis was performed for the same using Kruskall-Wallis ANOVA test and Mann-Whitney U-test. Results: On intergroup comparison, there was a statistically highly significant difference seen for the zone of inhibition between the groups (P < 0.01) with the highest values in Group A (14.45 mm), followed by Group B (1.4 mm) and least in Group C (0 mm). Conclusion: Tetracycline-coated suture is more efficacious than triclosan-coated suture to reduce bacterial load and further prevent SSIs. However, in vivo clinical trial is must to prove the same.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

A curious case of gingival enlargement - From seropositive diagnosis for human immunodeficiency virus to periodontal management.

Gingival enlargement may be a result of multifactorial etiology which includes local factors such as calculus, food lodgement, overhanging restorations, and overextended dentures as well as systemic conditions such as hormonal disturbances and blood dyscrasias. Acquired immune deficiency is a manifestation of immune disorder caused by a retrovirus Human Immunodeficiency Virus (HIV). The association of Acquired Immunodeficiency Syndrome or HIV with oral and periodontal lesions is highly significant. Seropositive patients usually present with periodontal diseases and atypical periodontal lesions. These clinical findings may prove to be a link for probing patients' systemic health. This case report describes one such case of a patient, unaware of HIV infection with localized gingival overgrowth, wherein detailed probing and investigation led to the diagnosis of underlying systemic condition as acquired immunodeficiency. Subsequently, antiretroviral therapy was started, and nonsurgical periodontal therapy was performed to resolve the gingival overgrowth.

Gaps in facilities available at Community Health Centers/Rural Hospitals as per Indian public health standards - Study from Western Maharashtra.

BACKGROUND: The launch of the National Rural Health Mission (NRHM) gives us the opportunity to review the functioning and bring up the Community Health Centers (CHC) services to the level of Indian Public Health Standards and thus improve the lives of citizens. OBJECTIVES: Assessment of the gaps in the facilities available at Community health centers/Rural hospitals as per Indian Public health standards. METHODS: Facility based cross-sectional study was conducted in the Satara district of Maharashtra. RESULTS: This study in the majority showed that the gap in the delivery of healthcare according to IPHS. It was observed that the Funded CHCs had a better quality of services than the non-funded CHCs. The non-funded CHCs lacked essential emergency services. Along with ANC care, newborn care in the first few minutes of life is very crucial, but very little priority was given to the newborn care as those services were not as per norms. Specialists as well as paramedical and other support staff are deficient in both funded and non funded CHCs/rural hospitals (RHs). CONCLUSION: Standards were greatly influenced by funds delivered by IPHS itself. A staffing pattern is one of the important pillars in delivering various health services. A better salary, working place with continuous water supply, electricity, and cleanliness will improve the staffing pattern. Therefore, competent manpower and well-built infrastructure will help in the standard delivery of healthcare at CHC/RH and will thus serve the purpose of dispensing basic health services to every individual in the remotest areas.

Efficacy and Safety of Remogliflozin Etabonate, a New Sodium Glucose Co-Transporter-2 Inhibitor, in Patients with Type 2 Diabetes Mellitus: A 24-Week, Randomized, Double-Blind, Active-Controlled Trial.

BACKGROUND: Metformin is the first-line treatment for type 2 diabetes mellitus (T2DM), but many patients either cannot tolerate it or cannot achieve glycemic control with metformin alone, so treatment with other glucose-lowering agents in combination with metformin is frequently required. Remogliflozin etabonate, a novel agent, is an orally bioavailable prodrug of remogliflozin, which is a potent and selective sodium-glucose co-transporter-2 inhibitor. OBJECTIVE: Our objective was to evaluate the efficacy and safety of remogliflozin etabonate compared with dapagliflozin in subjects with T2DM in whom a stable dose of metformin as monotherapy was providing inadequate glycemic control. METHODS: A 24-week randomized, double-blind, double-dummy, active-controlled, three-arm, parallel-group, multicenter, phase III study was conducted in India. Patients aged ≥ 18 and ≤ 65 years diagnosed with T2DM, receiving metformin ≥ 1500 mg/day, and with glycated hemoglobin (HbA1c) levels ≥ 7 to ≤ 10% at screening were randomized into three groups. Every patient received metformin ≥ 1500 mg and either remogliflozin etabonate 100 mg twice daily (BID) (group 1, n = 225) or remogliflozin etabonate 250 mg BID (group 2, n = 241) or dapagliflozin 10 mg once daily (QD) in the morning and placebo QD in the evening (group 3, n = 146). The patients were followed-up at weeks 1 and 4 and at 4-week intervals thereafter until week 24. The endpoints included mean change in HbA1c (primary endpoint, noninferiority margin = 0.35), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), bodyweight, blood pressure, and fasting lipids. Treatment-emergent adverse events (TEAEs), safety laboratory values, electrocardiogram, and vital signs were evaluated. RESULTS: Of 612 randomized patients, 167 (group 1), 175 (group 2), and 103 (group 3) patients with comparable baseline characteristics completed the study. Mean change ± standard error (SE) in HbA1c from baseline to week 24 was - 0.72 ± 0.09, - 0.77 ± 0.09, and - 0.58 ± 0.12% in groups 1, 2, and 3, respectively. The difference in mean HbA1c of group 1 versus group 3 (- 0.14%, 90% confidence interval [CI] - 0.38 to 0.10) and group 2 versus group 3 (- 0.19%; 90% CI - 0.42 to 0.05) was noninferior to that in group 3 (p < 0.001). No significant difference was found between group 1 or group 2 and group 3 in change in FPG, PPG, and bodyweight. The overall incidence of TEAEs was comparable across study groups (group 1 = 32.6%, group 2 = 34.4%, group 3 = 29.5%), including adverse events (AEs) of special interest (hypoglycemic events, urinary tract infection, genital fungal infection). Most TEAEs were mild to moderate in intensity, and no severe AEs were reported. CONCLUSION: This study demonstrated the noninferiority of remogliflozin etabonate 100 and 250 mg compared with dapagliflozin, from the first analysis of an initial 612 patients. Remogliflozin etabonate therefore may be considered an effective and well-tolerated alternative treatment option for glycemic control in T2DM. TRIAL REGISTRATION: CTRI/2017/07/009121.

Comparative evaluation of use of diode laser and electrode with and without two dentinal tubule occluding agents in the management of dentinal hypersensitivity: An experimental in vitro study.

BACKGROUND: The present study aims to assess area of open dentinal tubules by use of diode laser and electrode alone and in combination with hydroxyapatite powder and strontium chloride powder by using the scanning electron microscope (SEM). MATERIALS AND METHODS: A double-blinded study was carried out with 30 extracted teeth with no carious lesion or restored teeth were selected and grouped randomly as Group A - diode laser, Group B - electrode application, Group C - hydroxyapatite powder plus diode laser, Group D - hydroxyapatite powder plus electrode application, Group E - strontium chloride powder plus diode laser, and Group F - strontium chloride powder plus electrode application. All the samples were made by preparing a notch of 2 mm measured with UNC-15 probe at cementoenamel junction using a diamond cylindrical bur at high speed. The teeth were then washed with distilled water and stored in solution containing 2.5% glutaraldehyde solution in 0.1 M sodium phosphate buffer for 24 h. The samples were treated as mentioned in above said groups and were viewed under SEM the degree of occlusion of the dentinal tubules were quantified using an image analyzer. RESULTS: Highest number of open dentinal tubules was found with Group B, that is, electrode application, whereas Group C, that is, hydroxyapatite powder plus diode laser showed highest occluded tubules. One-way ANOVA showed statistically significant difference across all the groups (P = 0.000); further, intergroup comparison with Tukey's test showed better tubular occlusion with Group C. CONCLUSION: The SEM results showed highest tubular occlusion with hydroxyapatite powder plus diode laser and least with electrode.

Comparative evaluation of use of a diode laser and electrode application with and without two dentinal tubule occluding agents in the management of dentinal hypersensitivity - A clinical study.

BACKGROUND: Dentinal hypersensitivity (DH) is common problem in dentistry. Traditional agents along with alternative therapies have been researched. Aim: To study the efficacy of a diode laser (DL) and electrode application with and without hydroxyapatite (HAP) and strontium chloride (SrCl2) powder. MATERIALS AND METHODS: 60 Patients with mild cervical abrasion in at least two quadrant with two teeth per quadrant were selected and randomly divided into four groups: (i) Group 1- DL versus DL with HAP (ii) Group 2 - electrode application versus electrode application with HAP (iii) Group 3 - DL versus DL with SrCl2 (iv) Group 4 - electrode application versus electrode application with SrCl2 and were subjected to tactile stimulus and air blast test and scores were recorded on verbal rating scale (VRS) and visual analogues scale (VAS) at different time for 3 months. The data was statistically evaluated by one way ANOVA and paired t test. RESULTS: In group 1 and 3, DL alone had a short term reduction of hypersensitivity (P = 0.001). Synergistic effect of DL and HAP (group 1) showed a prolonged reduction on both scales (P < 0.001) whereas the additive effect of SrCl2 with DL (group 3) showed statistically significant reduction on both scales at all time (p<0.001). In group 2 there is insignificant difference on both scales at all time (P > 0.05) however group 4 showed significant reduction only in VAS score (p>0.05). CONCLUSION: DL alone had a short lived effect however with adjunctive sustained results were obtained whereas electrode application was neither beneficial nor did cause any adverse effect.

Peripheral giant cell granuloma manifestation in pregnancy.

The peripheral giant cell granuloma (PGCG) is a benign oral lesion occurring on the gingiva and alveolar ridge. It is the most common oral lesion and occurs at an average age of 30 years. The upsurge in the levels of estrogen and progesterone in pregnancy leads to a plethora of changes in various parts of human body, including the oral cavity. In the oral cavity, changes are commonly seen on the gingiva. These include pyogenic granuloma, PGCG and also peripheral ossifying fibroma, etc., The etiology of PGCG in our case might be related to hormonal alterations during the gestation period.

Leiomyoma on gingiva with osseous involvement: An unusual presentation.

Leiomyoma is a smooth muscle tumor which rarely turns into malignancy. This is an unusual case report which presents leiomyoma on gingiva with osseous involvement. This case highlights the importance of histopathological examination for the proper diagnosis of any gingival growth. A 28-year-old female patient reported with localized gingival enlargement. The surgical excision was conducted and excised tissue was sent for histopathological examination. On the basis of clinical and histopathological examination, the diagnosis of leiomyoma was made. Leiomyoma reported low recurrence rate in previous literature. However, this lesion recurred within 15 days. After recurrence, the patient was referred to the oncology center for further evaluation and treatment.

Evaluation of accuracy of cone beam computed tomography for measurement of periodontal defects: A clinical study.

AIMS: The aim of the present study was to evaluate the accuracy of Cone Beam Computed Tomography (CBCT) measurements of alveolar bone defects caused due to periodontal disease, by comparing it with actual surgical measurements which is the gold standard. MATERIALS AND METHODS: Hundred periodontal bone defects in fifteen patients suffering from periodontitis and scheduled for flap surgery were included in the study. On the day of surgery prior to anesthesia, CBCT of the quadrant to be operated was taken. After reflection of the flap, clinical measurements of periodontal defect were made using a reamer and digital vernier caliper. The measurements taken during surgery were then compared to the measurements done with CBCT and subjected to statistical analysis using the Pearson's correlation test. RESULTS: Overall there was a very high correlation of 0.988 between the surgical and CBCT measurements. In case of type of defects the correlation was higher in horizontal defects as compared to vertical defects. CONCLUSIONS: CBCT is highly accurate in measurement of periodontal defects and proves to be a very useful tool in periodontal diagnosis and treatment assessment.