Diabetes mellitus and periodontal disease: The call for interprofessional education and interprofessional collaborative care - A systematic review of the literature.

Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.

Retrospective analysis of Desmoplastic Ameloblastoma: Clinical review.

BACKGROUND: Desmoplastic Ameloblastoma (DA) is a rare, true neoplasm of jaws with reported incidence of 4-13% among other variants of Ameloblastoma, however this appears distinct than the classic Ameloblastoma in anatomical distribution and clinical presentation. This is often mistaken as a fibro-osseous lesion because of its similar radiological appearance. MATERIAL AND METHODS: To describe the clinical, radiographic and histopathological characteristics through a series of new cases of histologically proven DA including a case of an exceptionally large, recurrent lesion along with retrospective analysis of cases from literature available for an improved understanding of the behaviour and prognosis of DA. A total of 50 cases were analysed for the anatomical distribution, radiographic presentation and management. Out of the 50 cases, 47 cases were from the English literature reported from 2011 to 2019 and 3 were new cases. RESULTS: DA showed a slight male predilection (male: female=1.17:1) with a predominance in the fourth and fifth decade of life. Mandibular involvement (52%) was more commonly seen with a marked tendency for the anterior region. Radiographically, most of the lesions presented mixed radiopacity with radiolucency(80%) and root displacement was observed in only 70.27 % cases. Recurrence rate of 26 .47 % was observed. Cases treated with resection resulted in lesser recurrence as compared to those treated with enucleation and curettage. CONCLUSIONS: DA is distinguished by a peculiar display of clinicalopathological parameters. DA has tendency of local disposition and propensity of recurrence, which thus necessitates its aggressive management. It is not possible to conclude or report on the aggressive/recurrent nature and appropriate treatment modality for DA due to inadequate follow-up results.

Perception of Complete Visually Impaired Children to Three Different Oral Health Education Methods: A Preliminary Study.

AIM: To evaluate the perception of visually impaired children to three different methods of oral health education. STUDY DESIGN: Sixty total visually impaired children were divided into three groups of 20 children each. Children in group-I received oral health education through a lecture. Children in group II received Demonstration on a Model by Tell and Touch method (DMTT) and children in group III were self trained on oral hygiene skills. All children received written instructions in Braille. Their knowledge and practice of oral hygiene methods were recorded by a questionnaire and their method of brushing and rinsing was assessed during a personal interview. Data obtained was subjected to statistical analysis. RESULTS: Children in group II were able to brush and rinse significantly better (p <0.05) as compared to the other groups. Demonstration on a Model by Tell and Touch method was found to be the most preferred method of oral health education. CONCLUSION: Oral health education given through DMTT method was perceived well by the visually impaired children.

Association of chronic periodontitis and psoriasis: periodontal status with severity of psoriasis.

OBJECTIVES: The chronic periodontitis (CP) and psoriasis share common risk factors and co-morbidities. This study was designed to explore how frequently CP is associated with patients with psoriasis compared to systemic healthy subjects. MATERIALS AND METHODS: The periodontal clinical parameters probing depth (PD), periodontal attachment level (PAL), and presence or absence of radiographic bone loss (J Periodontol, 78, 2007, 1387) were recorded in 33 psoriasis subjects and 35 healthy subjects. The severity of psoriasis was assessed and recorded by Psoriasis Area and Severity Index as described earlier by Cohen et al (J Dermatolog Treat, 16, 2005, 308). The other oral health characteristics were also recorded. RESULTS: Probing depth and PAL showed significant higher values in psoriasis group compared with healthy group. It was also found that periodontal status was associated with severity of psoriasis. CONCLUSIONS: The results showed a link between CP and psoriasis. This suggests the need for a multidisciplinary approach to manage psoriasis patients with chronic periodontitis, especially in relation to current and future treatment.

Design, synthesis and ex-vivo release studies of colon-specific polyphosphazene-anticancer drug conjugates.

Colon-specific azo based polyphosphazene-anticancer drug conjugates (11-18) have been synthesized and evaluated by ex-vivo release studies. The prepared polyphosphazene drug conjugates (11-18) are stable in acidic (pH=1.2) buffer which showed that these polymer drug conjugates are protected from acidic environment which is the primary requirement of colon specific targeted drug delivery. The ex-vivo release profiles of polyphosphazene drug conjugates (11-18) have been performed in the presence as well as in the absence of rat cecal content. The results showed that more than 89% of parent drugs (methotrexate and gemcitabine) are released from polymeric backbone of polyphosphazene drug conjugates (14 and 18) having n-butanol (lipophilic moiety). The in-vitro cytotoxicity assay has also been performed which clearly indicated that these polymeric drug conjugates are active against human colorectal cancer cell lines (HT-29 and COLO 320 DM). The drug release kinetic study demonstrated that Higuchi's equation is found to be best fitted equation which showed that release of drug from polymeric backbone as square root of time dependent process based on non-fickian diffusion. Therefore, the synthesized polyphosphazene azo based drug conjugates of methotrexate and gemcitabine are the potential candidates for colon targeted drug delivery system with minimal undesirable side effects.

The expression of IL6 and 21 in crossbred calves upregulated by inactivated trivalent FMD vaccine.

Foot and mouth disease (FMD) is an economically important disease and a whole-virus inactivated trivalent virus vaccine is the mainstay for controlling the disease in India. The protective humoral immune response to FMD vaccination is a complex, but, tightly regulated process mediated by the interplay of interleukins (IL). Based on the specific role of IL6 and 21 in adaptive immune response, we hypothesized that inactivated trivalent FMD vaccine would stimulate IL6 and 21 expression in the circulating lymphocytes. The expressions of IL6 and 21 were assayed on 0, 28, 60, 90, and 120 d post-vaccination (DPV) by quantitative PCR (qPCR) with simultaneous assessment of FMDV antibody titer by liquid phase blocking ELISA. The results revealed that the peak expression of IL6 and 21 was on DPV 28 which correlated well with the FMDV antibody titer and plummeted to the prevaccination titer level by 60 DPV. As IL21 is the final effector of antibody production as compared to IL6, we investigated the expression of IL21 in calves that had protective titer (>1.8) with the unprotected group (<1.8). Expression of IL21 on 28 DPV was numerically higher in the protected than that of the unprotected group of calves.

Genetic characteristics and pathogenic mechanisms of periodontal pathogens.

Periodontal disease is caused by a group of bacteria that utilize a variety of strategies and molecular mechanisms to evade or overcome host defenses. Recent research has uncovered new evidence illuminating interesting aspects of the virulence of these bacteria and their genomic variability. This paper summarizes some of the strategies utilized by the major species - Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Porphyromonas gingivalis - implicated in the pathogenesis of periodontal disease. Whole-genome sequencing of 14 diverse A. actinomycetemcomitans strains has revealed variations in their genetic content (ranging between 0.4% and 19.5%) and organization. Strikingly, isolates from human periodontal sites showed no genomic changes during persistent colonization. T. forsythia manipulates the cytokine responses of macrophages and monocytes through its surface glycosylation. Studies have revealed that bacterial surface-expressed O-linked glycans modulate T-cell responses during periodontal inflammation. Periodontal pathogens belonging to the "red complex" consortium express neuraminidases, which enables them to scavenge sialic acid from host glycoconjugates. Analysis of recent data has demonstrated that the cleaved sialic acid acts as an important nutrient for bacterial growth and a molecule for the decoration of bacteria surfaces to help evade the host immune attack. In addition, bacterial entry into host cells is also an important prerequisite for the lifestyle of periodontal pathogens such as P. gingivalis. Studies have shown that, after its entry into the cell, this bacterium uses multiple sorting pathways destined for autophagy, lysosomes, or recycling pathways. In addition, P. gingivalis releases outer membrane vesicles which enter cells via endocytosis and cause cellular functional impairment.

AMELX gene association to early childhood caries in south-Indian children: a case-control study.

PURPOSE: Genetic variants of AMELX gene can affect the protein content, organization of enamel prisms, microstructure and microhardness of the enamel, thus altering the caries susceptibility. The present study aims to assess the association between polymorphisms rs17878486, rs5934997, and rs5933871 of AMELX gene and Early Childhood Caries (ECC). MATERIALS AND METHODS: This case-control study was conducted on 200 participants, aged 3-6 years, with 100 controls and 100 children with ECC. A questionnaire was used to collect demographic data, birth-weight, type of delivery, oral hygiene practices, feeding history and 24-h diet diary. DNA was isolated from blood and subjected to PCR followed by Sanger sequencing. RESULTS: The CC genotype of rs17878486 showed an OR of 1.93 (0.34-10.81; P = 0.73). In a recessive model, the CC genotype of rs17878486 reported an OR of 2.04 (0.36-11.40; P = 0.68); rs5593871 reported an OR of 1.00 (0.31-3.21). Statistically significant differences (P ≤ 0.05) between genotype and allele frequencies of rs17878486, rs5934997, and rs5933871 were not observed between children with ECC and the controls. CONCLUSION: Polymorphisms of AMELX gene did not show a significant association with ECC in this population. However, documentation of genetic data in a global context of ECC may be essential for the future.

Plasma neurological biomarkers as a measure of neurotoxicity in pediatric dental general anesthesia: a prospective observational feasibility study.

PURPOSE: Neurotoxicity concerns have been raised over general anesthesia and sedation medication use in children. Such concerns are largely based on animal studies, historical anesthetic agents, and assessment tools, thus warranting further investigations. Blood biomarkers in detecting neuronal inflammation and apoptosis are novel methods for detecting neuronal damage. Therefore, the aim of this feasibility study was to assess the usefulness of the levels of four plasma biomarkers in dental general anesthesia (DGA) as surrogate markers of neurotoxicity in children. The secondary aim was to compare changes in motor manipulative skills pre- and post-anesthetic exposure. METHODS: This single-center prospective observational study included 22 healthy children aged between 3 and 6 years old who underwent DGA. Subclinical neurotoxicity was measured with a panel of four plasma biomarkers: Caspase-3, neuron-specific enolase (NSE), neurofilament light chain, and S100B at three time points (1; at start, 2; end and 3; on recovery from DGA). The Skillings-Mack test was used to identify the difference in the biomarker levels at three time points. Motor manipulative score assessment, prior and two weeks after DGA was also performed. RESULTS: A total of 22 study participants (mean age = 5 ± 1 years) were included with a median DGA duration of 106 ± 28 min. A reduction in Caspase-3 levels was recorded, with pairwise comparison over three time points, reporting a statistical significance between time point 2 vs. 1 and time point 3 vs. 1. Although fluctuations in NSE levels were recorded, no significant changes were found following pairwise comparison analysis. Among other biomarkers, no significant changes over the three periods were recorded. Furthermore, no significant changes in manipulative motor scores were reported. CONCLUSION: Caspase-3 reduced significantly in the short time frames during day-care DGA; this might be due to the relatively short anesthesia duration associated with dental treatment as compared with more extensive medical-related treatments. Therefore, further studies on Caspase-3 as a potential biomarker in pediatric DGA neurotoxicity are required to further ascertain results of this study.

Streptococcus cristatus ArcA interferes with Porphyromonas gingivalis pathogenicity in mice.

BACKGROUND AND OBJECTIVE: Porphyromonas gingivalis has been implicated as one of the major pathogens in chronic periodontitis, an infectious disease affecting the majority of the adult population. We have previously demonstrated that a surface protein, arginine deiminase (ArcA), of Streptococcus cristatus represses production of P. gingivalis long fimbriae and interrupts the formation of P. gingivalis biofilms in vitro. Our in vivo studies have also shown that the distribution of P. gingivalis and S. cristatus in human subgingival plaque is negatively correlated. The objective of this study was to determine if S. cristatus ArcA inhibits P. gingivalis colonization and attenuates its subsequent pathogenesis in alveolar bone loss in the murine oral cavity. MATERIAL AND METHODS: A wild-type strain of S. cristatus (CC5A) and its arcA knockout mutant (ArcAE) were used as initial colonizers in the oral cavity of BALB/cByJ mice. Colonization of P. gingivalis on the existing S. cristatus biofilms was assessed by quantitative PCR, and P. gingivalis-induced alveolar bone loss was measured 6 wk after P. gingivalis infection. RESULTS: The presence of S. cristatus CC5A, but not its arcA mutant, attenuated P. gingivalis colonization in the murine oral cavity. In addition, P. gingivalis-induced alveolar bone loss was significantly lower in mice initially infected with S. cristatus CC5A than in those infected with the arcA mutant. CONCLUSION: This study provides direct evidence that S. cristatus ArcA has an inhibitory effect on P. gingivalis colonization, which may in turn attenuate the pathogenicity of P. gingivalis.

Papillon-Lefevre syndrome.

Papillon-Lefevre syndrome is a very rare syndrome of autosomal recessive inheritance characterized by palmoplanter hyperkeratosis of the skin and severe periodontal disease extending to destruction of the alveolar bone surrounding deciduous and permanent teeth as they erupt leading to precocious loss of dentition. Although the exact pathogenesis of this syndrome is still unknown immunologic, microbiologic, and genetic bases have been proposed. Here we report a case of Papillon-Lefevre syndrome. The patient had generalized plaque accumulation along with halitosis, mobile teeth with periodontal pocket with pus exudation. Blood & biochemical report was within normal limit with a low CD3+ and CD4+.

Prevalence of oral health status in visually impaired children.

INTRODUCTION: The epidemiological investigation was carried out among 228 children selected from two schools of similar socioeconomic strata in and around Chennai city. MATERIALS AND METHODS: The study population consisted of 128 visually impaired and 100 normal school going children in the age group of 6-15 years. The examination procedure and criteria were those recommended by W.H.O. in 1997. RESULTS: The mean DMFT/deft was 1.1 and 0.17,0.87 and 0.47 in visually impaired and normal children, respectively. Oral hygiene levels in both groups were: mean value in good category was 0.19 and 0.67, in fair category was 0.22 and 0.1, and in poor category 0.40 and 0.23 in visually impaired children and normal children, respectively. Trauma experienced children were 0.29 and 0.13 in visually impaired children and normal children, respectively. CONCLUSION: The conclusions drawn from this study were that there was a greater prevalence of dental caries, poorer oral hygiene, and higher incidence of trauma in visually impaired children.

The controversial issue of centric relation: a historical and current dental perspective?

Human mandible is related to the anatomic skull in several positions among these; centric relation is a significant spatial position. It contributes not only as a reference position to build optimal occlusion in artificial dentition, but is also related to sound periodontal health and stomatognatic function. The purpose of this article is to critically discuss the historical and current definitions of centric relation, the different methods used for recording the same and its clinical implication in the restorative dental practice.

Human identification through DNA analysis of teeth using powder-free method - A case study.

Change is the universal law of nature, and human bodies after death cannot be an exception for a long time. In forensic science, the tissue from the hardest part of the human body is the only hope to establish the identity, and maternity/paternity of unidentified dead bodies. In this case, a foreign national on a tourist visa to one of the Himalayan states went missing when passing through a dense forest. His relatives could not trace him despite the best efforts of the search team, because of inaccessible hilly terrain. Later on, shepherds while grazing their livestock in the forest area accidentally came across the fragmented remains of a human skeleton. They informed the villagers, and then the police. Teeth collected during the autopsy and blood samples of the putative son, and wife of the missing foreign national on FTA (Flinders Technology Associates) cards were sent to DNA Division, State Forensic Science Laboratory, Junga, Shimla, Himachal Pradesh to establish the identity. DNA profiles obtained from the blood samples of the putative son, wife of missing foreign national, and teeth showed a complete, and concordant match, which established the identity of the skeleton. Moreover, the probability of paternity (>99.99%) between unidentified deceased person and the putative son also assessed the identity of the deceased. Hence, human teeth from unidentified dead bodies can establish the identity of unidentified deceased persons.

Use of knotless barbed sutures for closure of intraoral incisions for maxillofacial trauma: a randomised controlled trial.

The objective of this study was to assess the efficacy of knotless barbed sutures in intraoral wound closure for maxillofacial trauma in comparison with conventional (vicryl) sutures. This was a randomised controlled clinical trial involving 40 patients with isolated mandibular angle fractures who required intraoral incisions for open reduction and internal fixation (ORIF). The sample was randomised into the study group (20 patients) and control group (20 patients). Following fracture fixation by a standardised surgical protocol, the wound closure was done with bidirectional knotless barbed suture and vicryl for the study and control groups, respectively. The wounds were closed in layers (periosteum and mucosa). All operations were performed by a single surgeon. Outcome parameters measured were intraoperative wound closure time and wound healing using 'Landry's wound healing index' on the first, third, and seventh postoperative days. Statistically significant difference in suturing time was noted between the study and control group (p value <0.001). The study group demonstrated a mean (SD) suturing time of 9.46 (2.01) minutes, compared with the 17.61 (2.57) minutes in the control group. Wound healing was found to be better and statistically significant in the study group than the control group (p value<0.001). Knotless barbed suture is a promising alternative to vicryl for intraoral wound closure.

Antidiuretic hormone inhibits osteogenic differentiation of dental follicle stem cells via V1a receptors and the PLC-IP3 pathway.

OBJECTIVE: The aim of this study was to elucidate the molecular mechanism by which antidiuretic hormone (ADH) inhibited osteogenesis in dental follicle stem cells. DESIGN: Rat dental follicle stem cells were cultured in osteogenic differentiation medium supplemented with ADH. Alkaline phosphatase enzyme activity, Alizarin Red S staining, MTT assay and RT-qPCR was used to examine ADH's impact on cell mineralization, viability, and osteogenic gene expression. Real-time calcium imaging analysis was performed to identify the ADH receptor and its mechanism of action. RESULTS: ADH supplementation to the osteogenic differentiation medium inhibited cell mineralization without compromising cell viability and downregulated the expression of key osteogenic genes: DCN (Decorin), RUNX2 (Runt-related transcription factor 2) and BSP (Bone sialoprotein). Real-time calcium imaging analysis revealed that ADH (1-1000 nM) increased intracellular calcium in a concentration-dependent manner. Pretreatment of cells with V2255, a V1a receptor blocker, inhibited the calcium signals, but not with the V1b (Nelivaptan) or V2 (Tolvaptan). V2255 also reversed the inhibitory effect of ADH on osteogenesis. Furthermore, U73122, a Phospholipase C (PLC) inhibitor, 2-APB, an Inositol Triphosphate (IP3) receptor blocker, and depletion of endoplasmic reticulum calcium stores abolished the calcium signals by ADH. CONCLUSIONS: Our results demonstrated that ADH activates V1a receptors and the PLC-IP3 pathway to stimulate intracellular calcium signals, which inhibits cell mineralization and osteogenic gene expression. These findings uncovered a novel function for ADH as a negative regulator of osteogenesis in dental follicle stem cells. The role of ADH in the pathogenesis of bone diseases remains to be determined.

Prospective randomized clinical trial comparing lightweight mesh and heavyweight polypropylene mesh in endoscopic totally extraperitoneal groin hernia repair.

BACKGROUND: The purported advantage of lightweight large-pore meshes is improved biocompatibility that translates into lesser postoperative pain and earlier rehabilitation. However, there are concerns of increased hernia recurrence rate. We undertook a prospective randomized clinical trial to compare early and late outcome measures with the use of a lightweight (Ultrapro) mesh and heavyweight (Prolene) mesh in endoscopic totally extraperitoneal (TEP) groin hernia repair. METHODS: A prospective study was performed on 402 patients (191 in Ultrapro and 211 in Prolene group) with bilateral groin hernias who underwent endoscopic TEP groin hernia repair from March 2006 to June 2007. All operations were performed by five consultants following a standardized operative protocol. Chronic groin pain and hernia recurrence were evaluated as primary outcome measures. Secondary outcome measure were early postoperative pain, operative time, number of fixation devices required to fix the mesh, return to normal daily activities of work, seroma, and testicular pain. RESULTS: At 1-year follow-up, incidence in Ultrapro versus Prolene group for chronic groin pain was 1.6% vs. 4.7% (p = 0.178) and recurrence was 1.3% vs. 0.2% (p = 0.078). In Ultrapro versus Prolene group, mean visual analogue score for postoperative pain at day 7 was 1.07 vs. 1.31 (p = 0.00), mean return to normal activities was 1.82 vs. 2.09 days (p = 0.00), and mean number of fixation devices per patient required to fix the mesh was 4.22 vs. 4.08 (p = 0.043). CONCLUSION: Lightweight meshes appear to have advantages in terms of lesser pain and early return to normal activity. However, more patients had hernia recurrence with lightweight meshes, especially for larger hernias. We surmise that the lightweight meshes have greater tendency to get displaced from their intended position during desufflation at the conclusion of endoscopic TEP repair.

Comparative evaluation of the efficacy of different concentrations of chlorhexidine mouth rinses in reducing the mutans streptococci in saliva: an in vivo study.

BACKGROUND: Is low-concentration chlorhexidine effective against reducing the mutans streptococci (MS) in saliva? AIM: To compare the efficacy of different concentrations of chlorhexidine mouth rinses, i.e. 0.02%, 0.06% and 0.12%, in reducing the mutants streptococci count in saliva. DESIGN: Forty subjects in the age group of 12-14 years were selected from the schools of Chennai and were equally divided into four groups. The first three were study groups and the fourth group was the control group. The subjects were instructed to rinse with a measured amount of mouth rinse for 1 min, twice-daily, for 1 week. Salivary samples were collected at baseline and 1 week after mouth rinsing with various concentrations and were cultured on MSB agar. The number of MS colonies was counted on agar medium under anaerobic conditions. RESULTS: The results of the study confirmed that children using chlorhexidine of concentration 0.12% showed the maximum reduction in MS when compared with subjects using 0.02% and 0.06% concentrations. But, children using chlorhexidine of concentration 0.06% also showed significant reduction in MS when compared with the control group. CONCLUSION: From the above study, we conclude that chlorhexidine used in different concentrations (0.02%, 0.06%, 0.12%) efficiently reduced the mutans count.

Marsupialization: a conservative approach for treating dentigerous cyst in children in the mixed dentition.

Dentigerous cysts are usually encountered in the practice of pediatric dentistry. The treatment modalities range from marsupialization to enucleation of the lesion and are based on the involvement of the lesion with the adjacent structures. However, loss of a permanent tooth in the management of a dentigerous cyst can be devastating to a child who has already a congenitally missing tooth. The first case describes the technique of marsupialization in which we extracted the grossly carious deciduous 1st molar and created a window through the extracted socket to decompress the lesion. In this case the 2nd premolars were congenitally missing on both sides of the mandible for which we had not gone for enucleation of the dentigerous cyst along with the developing 1st premolar. The second case is a developmental type of a big dentigerous cyst where marsupialization was followed by enucleation of the cystic lining but without removal of the affected tooth. Both the teeth erupted in the oral cavity.