Systemic immune-inflammation index in patients with generalized stage III grade C periodontitis.

OBJECTIVES: Systemic immune-inflammation index (SII) is a novel, inflammatory biomarker whose role in predicting several chronic systemic diseases has been recently identified. However, its association with generalized stage III grade C periodontitis in young adults remains unknown. MATERIAL AND METHODS: The study is a multicentered, double-blind, hospital-based case-control clinical study. Periodontal examination comprised of recording plaque index, sites with bleeding on probing, pocket depth and clinical attachment loss for patients with generalized stage III grade C periodontitis and periodontally healthy group. Complete blood counts were obtained and used for calculating SII, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio. Collected data were then subjected to statistical analyses. RESULTS: SII was significantly higher in patients with generalized stage III grade C periodontitis compared to periodontally healthy individuals (723.87 vs. 537.74 × 109 /L, p < 0.0001). SII is associated with severe periodontitis in young adults (odds ratio [OR]:11.86, 95% CI 9.61-20.76, p < 0.0001) after adjusting for factors found significant in univariate analysis. Receiver operative curve analysis demonstrated a fair predictive validity of SII in detecting generalized stage III grade C periodontitis in young adults (AUC: 0.766, 95%CI 0.731-0.799, p < 0.0001, sensitivity 81.27%, specificity 76.50% and diagnostic accuracy 78.89%). SII did not exhibit superior predictive validity when compared with NLR in the context of generalized stage III grade C periodontitis (AUC for SII: 0.766, 95%CI 0.731-0.799, AUC for NLR: 0.788, 95% CI 0.754-0.819; p = 0.28). CONCLUSION: SII is associated with generalized stage III grade C periodontitis in young adults.

Clinical and diagnostic significance of blood leukocyte ratios in young patients with stage III grade C periodontitis.

OBJECTIVES: Blood leukocyte ratios have been recently proposed as simple, rapid, cheap and easily accessible biomarkers of systemic inflammation. However, little is known about the relationship of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with periodontitis, which might not only serve as the potential biomarkers of systemic inflammation but also aid in diagnosis/screening of severe periodontitis. Hence, the purpose of this study was to evaluate the differences in the serum levels of these leukocyte ratios in healthy subjects and patients with generalized stage III Grade C periodontitis, and their applicability in identifying patients with the risk of developing severe periodontitis. MATERIAL AND METHODS: The subjects were categorized into case and control group. Clinical parameters including Plaque index (PI), modified Gingival Index (mGI), Mean ratio of bleeding sites, Probing Pocket depth (PPD) and the clinical attachment loss (CAL) were assessed in both the groups. Venous blood samples were collected from subjects from both groups for the biochemical analysis and blood leukocyte ratios- NLR, PLR and LMR were calculated. The values were then subjected to statistical analysis. RESULTS: The results showed significantly higher NLR and lower LMR values in patients with generalized stage III grade C periodontitis. Both the blood leukocyte ratios were moderately associated with increasing clinical parameters of periodontal disease. However, the values of PLR, although found to be higher in the periodontitis group, did not make a significant difference when compared with periodontally healthy subjects. The cut-off value of >2.15 for NLR and <7.16 for LMR fairly predicted the risk of severe periodontitis in young adults. CONCLUSIONS: NLR and LMR can provide a new insight into the relationship between periodontitis and systemic diseases and can be of potential diagnostic value in identifying patients with severe periodontitis of younger age group.

An In Vitro Study of Bactericidal Effect of Gallium Aluminium Arsenide Laser on Anaerobic Photosensitized Periodontopathics.

AIM: To investigate the bactericidal effect of gallium aluminium arsenide (GaAlAs) laser on photosensitized predominant periodontopathogenic anaerobic organisms. MATERIALS AND METHODS: The present prospective study was carried out among 50 patients of chronic periodontitis with pockets ≥ 5 mm depth. For sample analysis of P. intermedia and P. gingivalis, a subgingival plaque was collected from periodontal pockets using sterile curettes under aseptic conditions. The sample was then immediately transported to microbiology laboratory using Transport media, Thioglycollate broth with Vitamin K and Hemin. After incubation period again the number of the viable bacterial count was carried out using a magnifying glass and expressed as CFU/mL, to determine the bactericidal effect of GaAlAs laser. A predetermined number of colonies (for P. intermedia 500 colonies were taken initially; for P. gingivalis 400 colonies were taken initially) were taken equally as control group and case group. The data was statistically analyzed using the SPSS statistical software version 16. Mann-Whitney Test was used for statistical analysis with p value less than 0.05 considered statically significant. RESULTS: Study group shows a reduction in colony count of P. intermedia after being exposed to GaAlAs diode laser for 1 minute from 369-229, 134 and 41 which was statistically significant with p value <0.0001. Study group shows a decrease in colony count of P. gingivalis after being exposed to GaAlAs diode laser for 1 minute from 286.52-197, 94 and 39 which was statistically significant with p value <0.0001. CONCLUSION: The result of our study implies that for all tested bacterial strains, the effect of GaAlAs laser for 1 minute resulted in a significant reduction in the viable counts of photosensitized predominant periodontopathogenic anaerobic organisms. Photodynamic therapy (PDT) kills the bacteria and also leads to the detoxification of endotoxins. Further, it can thus be safely concluded that this technique is an alternative method adjunct to mechanical therapy. CLINICAL SIGNIFICANCE: The application of an alternative method to eradicate bacteria from periodontal pockets is desirable. One such approach is photodynamic therapy (PDT), i.e., laser therapy. Owing to the emergence of antibiotic resistance, PDT has to turn out to be a feasible alternative antibacterial therapy for biofilm-related diseases.

Total and Differential Leukocyte Counts in the Peripheral Blood of Patients with Generalised Aggressive Periodontitis.

PURPOSE: To compare the total and differential leukocyte counts in the peripheral blood of generalised aggressive periodontitis patients with that of periodontally healthy subjects in a central Indian population. MATERIALS AND METHODS: Seventy-five patients with generalised aggressive periodontitis and 63 periodontally healthy subjects were enrolled for the purpose of the study. All participants received a full-mouth periodontal examination in which probing depth and clinical attachment level were recorded. The haematological variables analysed included total leukocyte count, neutrophil count, lymphocyte count, monocyte count, neutrophil percentage, lymphocyte percentage, monocyte percentage and platelet count. RESULTS: The patient group showed a significantly higher total leukocyte count (7.62 ± 1.70 x 109 cells/l, p = 0.008), neutrophil count (5.06 ± 1.47x109 cells/l, p < 0.001) and neutrophil percentage (70.61 ± 8.73, p < 0.001), as well as a significantly lower lymphocyte count (1.82 ± 0.65 x 109 cells/l, p = 0.002) and lymphocyte percentage (26.55 ± 8.05, p < 0.001) compared to the control group. Logistic regression analyses showed significant associations between aggressive periodontitis and elevated total leukocyte (p = 0.012) and neutrophil counts (p = 0.001). CONCLUSION: The findings of the present study suggest that patients with generalised aggressive periodontitis might also demonstrate a systemic inflammatory response, as evidenced by increased leukocyte counts. This systemic inflammatory response observed in patients with generalised aggressive periodontitis may be associated with an increased risk for cardiovascular diseases.

Nonsurgical Periodontal Therapy decreases the Severity of Rheumatoid Arthritis: A Case-control Study.

INTRODUCTION: Rheumatoid arthritis (RA) and periodontitis are common chronic inflammatory conditions. Several studies suggested a relationship between RA and periodontitis. Recent studies have shown a beneficial effect of periodontal treatment on the severity of active RA. So the aim of this study was to examine the effect of nonsurgical periodontal therapy on the clinical parameters of RA. MATERIALS AND METHODS: A total of 60 subjects with moderate-to-severe chronic generalized periodontitis and active RA in the age range 18 to 65 were selected for the study. They were divided into two groups. Group A (control group) consisted of 30 subjects with chronic generalized periodontitis and RA, and group B of 30 subjects with chronic generalized peri-odontitis and RA and they received nonsurgical periodontal therapy (scaling, root planning, and oral hygiene instructions). Evaluation of clinical observations of Simplified Oral Hygiene Index (OHI-S), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), number of swollen joints (SJ), number of tender joints (TJ), values of erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) for patient's global assessment, 3 months disease activity score (DAS) index, and C-reactive protein (CRP) was done at baseline and 3 months. Statistical evaluation of clinical observations was carried out. RESULTS: Group B subjects who received nonsurgical periodon-tal therapy showed statistically significant improvement in all periodontal and RA parameters at 3 months, compared with group A who did not receive periodontal therapy. CONCLUSION: It can be concluded from the result that nonsurgical periodontal therapy may contribute to reduction in severity and symptoms of RA. CLINICAL SIGNIFICANCE: Rheumatoid arthritis patients should be evaluated for periodontitis and treated for the same in order to reduce its severity level.

Association of Circulating Orexin-A Level With Metabolic Risk Factors in North Indian Pre Menopausal Women.

The present study was designed to investigate the association between circulating Orexin-A level with metabolic risk factors in North Indian adult women. 342 women were enrolled for the case-control study, 172 women were with metabolic syndrome (mets) and 170 healthy control women were without metabolic syndrome, (womets) according to (NCEP ATP III criteria). Circulating Orexin-A level was determined by enzyme-linked immunosorbent assay. Observations indicated low levels of orexin-A (26.06 ± 6.09 ng/ml) in women with mets and other metabolic risk factors compared to women without metabolic syndrome (36.50 ± 10.42 ng/ml). Further, in women with metabolic syndrome, circulating Orexin A was significantly associated with waist circumference, triglyceride (negative correlation) and hyperdensity lipoprotein (positive correlation). Our study shows that circulating Orexin A was found to be significantly associated with hyperlipidemia, obesity and obesity-related disorders in North Indian premenopausal women.

Pre and post-operative serum levels of titanium cobalt and aluminium after implant placement.

The preoperative serum levels and postoperative serum levels of titanium, cobalt and aluminium from dental implants in order to assess the release of these ions and to assess any risk of toxicity from these ions after dental implant placement is of interest to dentists. It was observed that there was very slight increase in serum concentration of titanium, cobalt and aluminium after 12 months of placement of implants as compared to before placement of implants. However the increase was non-significant statistically. Our study concluded that the use of dental implants does not pose any risk of toxicity of metal ions like titanium, aluminium and cobalt because of very slight non-significant increase in serum levels of these ions 12 months after implant placement.

Nanogels as Drug Delivery Carrier: A Narrative Review on Formulation Techniques, Characterization, Applications, and Patents.

Under the umbrella of targeted drug delivery systems, several techniques are unleashed in the market that allow a drug or other pharmacologically active material to be delivered to the target cell to treat a condition or health problem. The improvement of the pharmaceutical delivery systems' effectiveness, safety, and stability is accomplished through the Formulation of the nano-gel-based delivery system. Nanogels are aqueous dispersions of submicronsized, three-dimensional, strongly cross-linked networks of hydrophilic polymers that are inflated by water. Through a variety of delivery routes, such as oral, pulmonary, nasal, parenteral, and intraocular, an active pharmaceutical agent or therapeutic agent with a high or low molecular weight can be easily encapsulated into nanogels. Nanogels have been researched as drug delivery systems due to their beneficial qualities, such as biocompatibility, high stability, flexible particle size, drug loading capacity, and potential surface modification for active targeting by attaching ligands that recognize cognate receptors on target cells or tissues. By responding to internal or external stimuli, including pH, temperature, light, and redox, nano gels can be made to be stimulus-responsive, allowing for regulated drug release. Thus, in the fact of said characteristics' of nano gels, this review manuscript aims to provide an overview of characterization, evaluation, formulation technique, recent applications, and patents of nano gels.

Impact of periodontitis on oral health-related quality of life of patients with psoriatic arthritis.

BACKGROUND: Since oral health issues can have a negative influence on a person's physical functioning, social status, and wellbeing, oral health-related quality of life (OHRQoL) becomes an indispensable part of overall health. Previous published studies report that periodontitis (PD) and psoriatic arthritis (PsA) have a significant negative impact on OHRQoL. Based on these findings, it would be reasonable to assume that patients with coexisting PsA and PD would see a comparable or maybe synergistic effect on their OHRQoL. Hence, the aim of the present study is to evaluate the OHRQoL and its impact among subjects with concurrent PsA and PD. MATERIAL AND METHODS: The present study was a comparative, cross-sectional investigation. A total of 200 participants were categorized into four groups- PD-PsA (n = 50), PsA (n = 50), PD (n = 50), and healthy controls (n = 50). Demographic data and periodontal parameters-plaque index, sites with gingival bleeding, probing pocket depth, gingival recession, and clinical attachment level were recorded for all the four groups. Number of mobile teeth due to periodontitis was recorded for the PSA-PD and PD groups. OHIP-14 questionnaire was administered to all the four groups. Collected data was then subjected to statistical analysis. RESULTS: The severity of OHIP-14 summary scores was highest in the PsA-PD group (18.06 ± 11.22) followed by the PD group (17.02 ± 9.99) and lowest in the healthy group (6.32 ± 5.59) (p < .0001). The scores of all the domains- oral pain, oral function, orofacial appearance and psychological impact were highest among the PsA-PD group followed by the PD group (p < .0001). The combined interaction of PsA and PD on the OHRQoL was statistically significant (F = 6.33, p = .012). Results of the multiple linear regression analysis indicated that there was a moderate collective significant effect between age, past dental visit, frequency of daily tooth brushing, use of other oral hygiene aids, and OHIP-14 (F(3,196) = 13.08, p < .001, R2  = 0.17, adjusted R2  = 0.15). CONCLUSION: The negative impact on OHRQoL was highest in the patients with concurrent presence of PD with PsA followed by those with PD alone. While the summary scores and dimensional scores of OHIP-14 were insignificant when patients with PsA-PD and PD alone were compared, these scores were significantly higher in patients with PsA-PD than patients with PsA alone.

A Comparative Analysis of the Occluding Effects on Dentinal Tubules With the Use of Er:YAG Laser and a Commercially Available Desensitizing Agent: An In Vitro Scanning Electron Microscopic Study.

Objective This in vitro scanning electron microscopic (SEM) study aimed to compare the effect of Er:YAG laser and a commercially launched dental product namely 8% arginine-calcium carbonate on exposed dentinal tubules. Materials and methods A total of 120 tooth samples prepared from healthy maxillary first premolars extracted due to orthodontic reasons were grouped randomly into four groups of 30 samples each - Group I: control group (C); Group II: laser group (LG); Group III: toothpaste group (TP) and Group IV: laser + toothpaste group (LT). The samples in Group II-IV were treated with the respective test agents and were placed under SEM to study the changes in the dentinal tubule number and diameter. The data obtained from SEM were then subjected to statistical analysis using an unpaired t-test. Results The unpaired t-test revealed extreme statistical differences in means between the test and the control groups and among the test groups (p<0.0001). The results we obtained within the scope of this study showed that both the Er:YAG laser (1.3 W, 100 mJ, 3 Hz, 60 s twice) and dentifrice containing 8% arginine-calcium carbonate as the main ingredient can significantly reduce the number and diameter of the open dentinal tubules. Conclusion Our findings have demonstrated that both the 8% arginine-calcium carbonate technology and Er:YAG laser successfully reduced the number and diameter of the open dentinal tubules and hence can be promising agents to deal with dentinal hypersensitivity in future clinical studies.

Peer feedback as a medium to facilitate reflective practice among pharmacy students in a case-based learning environment.

INTRODUCTION: The ability to reflect is a key element in preparing pharmacy professionals to meet the challenges of a dynamic health care environment. This mixed-methods study explored the pedagogical benefits of peer feedback by designing, developing, and implementing a peer feedback activity to facilitate reflective practice among pharmacy students. METHODS: Twenty second-year doctor of pharmacy (PharmD) students in a required pharmacotherapy course participated in a systematic peer feedback activity and five of these students volunteered for semi-structured interviews. RESULTS: No significant correlation was found between perceived effectiveness of peer feedback and students' reflective thinking skills. Qualitative interview data revealed three major themes regarding PharmD students' perception of peer feedback as an instructional strategy to promote reflective practice: (1) the cognitive process of providing feedback, (2) the cognitive process after receiving peer feedback, and (3) perceptions of peer feedback as a tool to exercise reflective practice. CONCLUSIONS: Although limited in sample size, important lessons were learned on how to design, develop, and implement a peer feedback activity.

Neuroprotective Role of Nutritional Supplementation in Athletes.

BACKGROUND: Neurodegenerative disorders belong to different classes of progressive/ chronic conditions that affect the peripheral/central nervous system. It has been shown through studies that athletes who play sports involving repeated head trauma and sub-concussive impacts are more likely to experience neurological impairments and neurodegenerative disorders in the long run Aims: The aim of the current narrative review article is to provide a summary of various nutraceuticals that offer promise in the prevention or management of sports-related injuries, especially concussions and mild traumatic brain injuries. METHODS: This article reviews the various potential nutraceutical agents and their possible mechanisms in providing a beneficial effect in the injury recovery process. A thorough survey of the literature was carried out in the relevant databases to identify studies published in recent years. In the present article, we have also highlighted the major neurological disorders along with the associated nutraceutical(s) therapy in the management of disorders. RESULTS: The exact pathological mechanism behind neurodegenerative conditions is complex as well as idiopathic. However, mitochondrial dysfunction, oxidative stress as well as intracellular calcium overload are some common reasons responsible for the progression of these neurodegenerative disorders. Owing to the multifaceted effects of nutraceuticals (complementary medicine), these supplements have gained importance as neuroprotective. These diet-based approaches inhibit different pathways in a physiological manner without eliciting adverse effects. Food habits and lifestyle of an individual also affect neurodegeneration. CONCLUSION: Studies have shown nutraceuticals (such as resveratrol, omega-3-fatty acids) to be efficacious in terms of their neuroprotection against several neurodegenerative disorders and to be used as supplements in the management of traumatic brain injuries. Protection prior to injuries is needed since concussions or sub-concussive impacts may trigger several pathophysiological responses or cascades that can lead to long-term complications associated with CNS. Thus, the use of nutraceuticals as prophylactic treatment for neurological interventions has been proposed.

Association between Periodontitis and COVID-19 Based on Severity Scores of HRCT Chest Scans.

BACKGROUND: A relationship between periodontitis and COVID-19 may exist, as highlighted by several hypothetical models. However, the evidence is limited. Hence, the present study was conducted to determine whether an association exists between periodontitis and COVID-19. METHODS: A cross-sectional study was carried out with patients diagnosed with COVID-19 who were divided into three groups-mild, moderate, and severe COVID-19-based on the COVID-19 severity score of high-resolution computed tomography (HRCT) chest scans. Periodontal parameters-including the plaque index (PI), ratio of sites with gingival bleeding (BOP), pocket depth (PD), gingival recession (REC), clinical attachment loss (CAL), and mean numbers of mobile and missing teeth due to periodontitis-were recorded for all three groups. Statistical analyses were applied to the data. RESULTS: Of 294 patients with COVID-19, approximately 50.68% (n = 149) had periodontitis, and the highest percentage (87.5%) was reported in the severe COVID-19 group. Additionally, severe and advanced stages of periodontitis (stage III-IV) were found to be significantly more frequent in subjects with severe COVID-19 than in the other two groups. The HRCT severity score (CT-SS) was moderately correlated with increased levels of periodontal parameters. CONCLUSIONS: Results of logistic regression analyses showed that the probability of developing severe COVID-19 was 2.81 times higher in patients with periodontitis. An association exists between periodontitis and severe COVID-19.

Serum Vitamin D level and its association with red blood cell indices in patients with periodontitis.

Background: Research of late has brought to light a connect between Vitamin D and anemia. The level of 25hydroxyvitamin D (25(OH) D) is decreased in periodontitis subjects as against subjects without periodontitis and this reduced level could be related to more risk for anemia in periodontitis patients. Objective: This study aimed to evaluate the serum 25(OH) D levels and red blood cell indices in patients affected by generalized Stage III Grade B periodontitis and healthy controls and to assess the association between level of Vitamin D and red cell indices in periodontitis patients. Materials and Methods: The subjects were categorized into (i) case and (ii) control group of 30 each. Clinical parameters including oral hygiene index simplified, mean ratio of sites that bled on probing, gingival index, probing pocket depth, and the clinical attachment loss were assessed in both the groups. Subjects' blood samples (venous) were taken for the biochemical analysis. Results: In contradiction to healthy subjects, periodontitis subjects had significantly diminished 25(OH) D levels, hemoglobin (Hb), hematocrit, and mean corpuscular hemoglobin concentration (MCHC). 25(OH) D was moderately correlated with MCHC (r = 0.53) and it was statistically significant (P = 0.002). Conclusion: Periodontitis impacts Vitamin D status which further causes anemia. It suggests that effective management of periodontitis can help maintain sufficient Vitamin D status and may be vital in preventing anemia.

Thymoquinone: Review of Its Potential in the Treatment of Neurological Diseases.

Thymoquinone (TQ) possesses anticonvulsant, antianxiety, antidepressant, and antipsychotic properties. It could be utilized to treat drug misuse or dependence, and those with memory and cognitive impairment. TQ protects brain cells from oxidative stress, which is especially pronounced in memory-related regions. TQ exhibits antineurotoxin characteristics, implying its role in preventing neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease. TQ's antioxidant and anti-inflammatory properties protect brain cells from damage and inflammation. Glutamate can trigger cell death by causing mitochondrial malfunction and the formation of reactive oxygen species (ROS). Reduction in ROS production can explain TQ effects in neuroinflammation. TQ can help prevent glutamate-induced apoptosis by suppressing mitochondrial malfunction. Several studies have demonstrated TQ's role in inhibiting Toll-like receptors (TLRs) and some inflammatory mediators, leading to reduced inflammation and neurotoxicity. Several studies did not show any signs of dopaminergic neuron loss after TQ treatment in various animals. TQ has been shown in clinical studies to block acetylcholinesterase (AChE) activity, which increases acetylcholine (ACh). As a result, fresh memories are programmed to preserve the effects. Treatment with TQ has been linked to better outcomes and decreased side effects than other drugs.

Assessment of Periodontal status in Patients with Psoriatic Arthritis: A retrospective, case-control study.

BACKGROUND: Psoriatic arthritis (PsA) and periodontitis both represent chronic inflammatory disorders that share similar pathophysiological processes. However, very few studies have been done to address the link between the two diseases which remains poorly understood. The present study aimed to assess and compare the periodontal status in patients suffering from PsA and systemically healthy subjects to identify whether a possible association exists between PsA and periodontitis. MATERIAL AND METHODS: Periodontal parameters - PI, BOP, mGI, PPD and CAL were recorded in 110 patients with PsA and 110 age- and gender-matched systemically healthy patients. Mean values of the periodontal parameters were calculated for both groups and subjected to statistical analysis. Logistic regression analysis was performed to correlate the demographic data with periodontitis. RESULTS: The frequency of periodontitis and mean values of BOP, mGI, PPD and CAL were found to be significantly higher in patients with PsA than in systemically healthy controls. The number of patients with stage III periodontitis was found to be significantly higher in the PsA group. CONCLUSIONS: A possible link exists between periodontitis and psoriatic arthritis, as exhibited by the results of the present study. Dental and medical health professionals should be aware of this relationship depending on which, they should carry out adequate treatment strategies involving periodic periodontal evaluation and care. Key words:Periodontitis, psoriatic arthritis, chronic inflammation, probing pocket depth, clinical attachment loss.

Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population.

BACKGROUND: Findings of studies testing the association between smokeless tobacco (SLT) use and periodontal health have shown varying results in different populations. Considering the high prevalence of SLT use in India, the present study was conducted to understand the pattern of periodontal destruction within different areas of the dentition among SLT users. METHODS: Age, gender, oral hygiene habits, the frequency and duration of SLT consumption, the type of SLT product used, and the site of retention of the SLT product in the oral cavity were recorded among 90 SLT users. Probing depth (PD), recession (REC), and clinical attachment loss (CAL) at SLT-associated and non SLT-associated teeth of the mandibular arch were compared based on the site of retention of the SLT product, the type of product used, and the duration of the habit. RESULTS: REC and CAL were significantly higher at the SLT-associated zones compared to non SLT-associated zones and at both interproximal and mid-buccal sites of SLT-associated teeth. Among individuals who had the habit for more than 5 years and also among those who had the habit for 5-10 years, PD, REC, and CAL were significantly higher at SLT-associated teeth than at non SLT-associated teeth. Significantly greater periodontal destruction was observed at SLT-associated teeth among khaini users and gutkha users. CONCLUSIONS: Smokeless tobacco consumption resulted in greater destruction of periodontal tissues. The severity of periodontal destruction at SLT-associated sites differed depending on the type of smokeless tobacco used, the site of retention of the SLT, and the duration of the habit.

An In Vitro Study to Determine the Physicochemical, Mechanical, and Antibacterial Properties of a Novel Spirulina Containing Controlled Release Intrapocket Drug Delivery System.

CONTEXT: Periodontitis is primarily an inflammatory condition caused by an array of microorganisms present in dental plaque. Elimination or adequate suppression of periodontal pathogens in the subgingival microflora is essential for adequate periodontal healing to take place. The development of subgingivally placed controlled delivery systems has provided the possibility of effective intrapocket concentration levels of antibacterial agents for an extended period of time, resulting in an altered subgingival flora and enhanced healing of the attachment apparatus. Although a number of synthetic antimicrobial agents are being used as local drug delivery, currently, pharmaceutical technology development has focused on the ingredients derived from nature. Natural phytochemicals have proven to be worthy substitutes of their synthetic and chemical-laden counterparts owing to their extensive natural activity, advanced safety margins, and inferior costs so that they can be of huge benefits, especially to the lower socioeconomic population around the world and spirulina platensis (SP) is one such emerging remedy. AIMS: The aim of the study was to develop three controlled release drug delivery systems containing different concentrations of SP to be used inside the periodontal pockets. The study also aimed to determine the antimicrobial activity of all the three concentrations of SP drug delivery system against major periodontopathic microorganisms and to test the physicochemical properties of the delivery system that exhibited maximum antimicrobial efficacy so that the suitability of its use inside the periodontal pocket could be determined. SETTINGS AND DESIGN: The study was an in vitro experimental design. SUBJECTS AND METHODS: Three different controlled release SP hydrogels (4%, 6%, and 12%) to be used inside the periodontal pockets were developed and antibacterial properties against periodontal pathogens were assessed. The hydrogel exhibiting maximum antimicrobial efficacy was then tested of physicochemical and mechanical properties to determine its suitability of its use inside the periodontal pocket. STATISTICAL ANALYSIS USED: Data were analyzed using one-way analysis of variance. Post hoc Tukey honestly significant difference test was used for comparison within the group and between the different groups. RESULTS: 12% SP hydrogel was found to have maximum antimicrobial efficacy against major periodontal pathogens, and its physicochemical and mechanical properties were also optimum to be used inside the periodontal pocket. CONCLUSIONS: 12% SP hydrogel can act as a promising adjunct to periodontal mechanical therapy and may also reduce the chances of more invasive periodontal surgical procedures.

Exploring student perceptions and attitude towards various aspects of peer feedback in a pharmacotherapy course.

BACKGROUND: The purpose of this study is to gauge pharmacy students' perceptions and attitude towards peer feedback in a pharmacotherapy course. METHODS: An explanatory sequential mixed-method approach with a 20-item electronic survey and semi-structured interviews were used to collect data from students enrolled in a required pharmacotherapy course at a major public university in the southeast United States. A survey design with descriptive statistics were used for the quantitative part and constant comparative approach was used to analyze qualitative data. RESULTS: Seventy-three completed surveys (53%) were received (n = 73). Majority of the students (90%) believed that they will be using peer feedback in their future pharmacy careers. Most students (90%) agreed that their peers are competent enough to provide constructive feedback, whereas only 78% believed in their own competency to provide feedback to their peers. Over 81% of students preferred receiving feedback from a peer they have previously worked with. Interviews with five second-year pharmacy students (n = 5) revealed three major themes regarding PharmD students' perception of peer feedback activity, namely, (1) participants' perspectives about the value of peer feedback, (2) learning from peer feedback, and (3) significance of the individuals participating in the peer feedback activities. CONCLUSIONS: Perceptions of competency, the perceived value of peer feedback and interrelationship among peers are important determinants of effective peer feedback practices. Education and training in techniques and benefits of peer feedback, as well as opportunity to practice the skill can help students promote a positive attitude towards peer feedback.

Assessment of Level of Perceived Stress and Sources of Stress Among Dental Professionals Before and During the COVID -19 Outbreak.

CONTEXT: The recent spread of SARS-CoV-2 pandemic has resulted in a number of mental health issues among healthcare workers and dentists are no exception to this due to their nature of work. Hence, the aim of this study was to evaluate the level of perceived stress (PS) among Chhattisgarh dentists and identify the sources of stress before and during the COVID-19 crisis. MATERIALS AND METHODS: An online questionnaire-based survey was done to assess the level of PS using perceived stress scale (PSS) and sources of stress among dentists of Chhattisgarh state of India before the onset of COVID-19 in the state and immediately after the nationwide lockdown was announced owing to COVID-19 outbreak. Based on the type of work, the dental practitioners were categorized into three groups--dental practitioners (group A), dental academicians (group B), and dentists who are practitioners as well as academicians (group C). Frequency, percentages, and mean values were calculated and compared among different participant characteristics using Student's t test, paired t test, and one-way ANOVA. RESULTS: During phase I, mean PSS for dentists was 18.61 ± 6.87 which increased to 20.72 ± 1.95 in phase II. Group C dentists recorded higher mean PSS during phase I, while group A dentists reported higher mean PSS during phase II. No family time due to long working hours (90%) was the major stressor among the three groups of dentists during phase I and concern about getting infected (83.3%) was identified as the most frequent stressor during phase II followed by stress over financial implications. CONCLUSION: Chhattisgarh dentists are reeling under psychological stress, which could be highly deteriorating to their mental health. Hence, concerned authorities should come forward and support the dentists by providing adequate guidelines, policies, and monetary support to them.