CONTEXT: Although Lactobacilli as a probiotic was established as a treatment for a wide range of systemic infections, its role in periodontitis and oral microbiota is still under investigation. AIMS: The present randomized clinical trial was aimed to evaluate the effects of probiotic chewable tablets containing Lactobacillus reuteri UBLRu-87 along with initial periodontal therapy on clinical parameters and oral microbiota of chronic periodontitis (CP) patients. SETTINGS AND DESIGN: The randomized controlled clinical trial. SUBJECTS AND METHODS: Thirty CP patients were selected who received scaling and root planing (SRP) and were randomly allocated into two treatment groups; Groups A and B. Group A received L. reuteri-containing chewable probiotic tablets. The clinical parameters (plaque index, gingival index, probing pocket depth, clinical attachment level), and microbiological parameters (Porphyromonas gingivalis and L. reuteri levels using real-time polymerase chain reaction) were evaluated at baseline, following treatment at 1 month and 3 months in both groups. STATISTICAL ANALYSIS: Paired t-test and unpaired t-test were used for the statistical analysis. RESULTS: On intergroup analysis, statistically significant improvement in clinical as well as microbiological parameters was observed in Group A (SRP + PROBIOTIC) compared to Group B (SRP ALONE) at all evaluation time points. CONCLUSION: Probiotic chewable tablets containing L. reuteri may be a useful adjunct along with initial periodontal therapy to slow recolonization of periopathogens along with improvement in clinical outcomes of CP. Further long-term trials are necessary to establish the optimal dosage of probiotics.
CONTEXT: Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets. MATERIALS AND METHODS: Forty-five chronic periodontitis patients with pocket depth 5-7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day. RESULTS: The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria. CONCLUSION: The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.
AIM: Chemokines released by different host cells when exposed to the components of periodontopathic bacteria induce and maintain an inflammatory response in the periodontium. The aim of the study was to estimate the salivary levels of two chemokines, macrophage inflammatory protein-1 alpha (MIP-1α) and monocyte chemo attractant protein-1 (MCP-1) in health, gingivitis and periodontitis and to evaluate their role as reliable salivary biomarkers in discriminating gingivitis and periodontitis from health. METHODS: A cross sectional study was designed to estimate the levels of MIP-1α and MCP-1 in whole unstimulated saliva from 75 patients who were divided into healthy (Group 1, n = 25), gingivitis (Group 2, n = 25) and chronic generalized periodontitis (Group 3, n = 25). MIP-1α and MCP-1 levels were estimated by using ELISA and were correlated with clinical parameters. ROC curve analysis was done to determine the sensitivity and specificity of these biomarkers in distinguishing periodontal disease from health. RESULTS: Both the biomarkers were detected in all the saliva samples. There was a statistically significant difference in the concentration of both the analytes in Group 3 and Group 2 compared with Group 1 (p < 0.001). ROC curve analysis showed 100% sensitivity and specificity for MIP-1α and MCP-1 in discriminating periodontitis from health. For discriminating gingivitis from health, MIP-1α had a higher sensitivity and specificity (100% & 88% respectively) compared to MCP-1(84.1% & 80% respectively). CONCLUSION: There is a substantial increase in the concentration of both MIP-1α and MCP-1 with increasing severity of periodontal disease. Both the analytes showed promising results as biomarkers for discriminating periodontal disease from health.
AIM: Hepatocyte growth factor (HGF) is a multifunctional cytokine with a wide range of actions, and plays a role in periodontal disease (PD) progression. Smoking significantly increases the risk for PD progression. Thus, aim of the present study was to estimate salivary HGF levels of non-smokers and smokers with chronic periodontitis (CP) and to compare its levels before and after therapy. METHODS: A total of 75 participants were recruited and divided into three groups: group 1 included 25 healthy participants, group 2 included 25 non-smokers with CP, and group 3 included 25 smokers with CP. Salivary HGF levels were estimated by enzyme-linked immunosorbent assay and correlated with clinical parameters before and after treatment. RESULTS: Salivary HGF levels of non-smokers and smokers with CP were significantly higher than the control group. There was a significant reduction in salivary HGF in smokers and non-smokers with CP after non-surgical periodontal therapy (NSPT). CONCLUSION: Salivary HGF levels positively correlated with PD progression and smoking status. A significant reduction in HGF levels was seen after NSPT. Thus, within limits, it can be suggested that HGF plays a role in PD progression and can be used as a diagnostic biomarker to detect disease activity. Salivary HGF levels could also be useful to monitor response to periodontal therapy.
Chronic Periodontitis/metabolism , Chronic Periodontitis/therapy , Hepatocyte Growth Factor/metabolism , Saliva/chemistry , Smokers , Adult , Biomarkers/metabolism , Case-Control Studies , Enzyme-Linked Immunosorbent Assay , Female , Humans , Male , Middle Aged
AIM: Periodontists frequently experience inconvenience in accurate assessment and treatment of furcation areas affected by periodontal disease. Furcation involvement (FI) most commonly affects the mandibular molars. Diagnosis of furcation-involved teeth is mainly by the assessment of probing pocket depth, clinical attachment level, furcation entrance probing, and intraoral periapical radiographs. Three-dimensional imaging has provided advantage to the clinician in assessment of bone morphology. Thus, the present study aimed to compare the diagnostic efficacy of cone-beam computed tomography (CBCT) as against direct intrasurgical measurements of furcation defects in mandibular molars. SUBJECTS AND METHODS: Study population included 14 patients with 25 mandibular molar furcation sites. CBCT was performed to measure height, width, and depth of furcation defects of mandibular molars with Grade II and Grade III FI. Intrasurgical measurements of the FI were assessed during periodontal flap surgery in indicated teeth which were compared with CBCT measurements. Statistical analysis was done using paired t-test and Bland-Altman plot. RESULTS: The CBCT versus intrasurgical furcation measurements were 2.18 ± 0.86 mm and 2.30 ± 0.89 mm for furcation height, 1.87 ± 0.52 mm and 1.84 ± 0.49 mm for furcation width, and 3.81 ± 1.37 mm and 4.05 ± 1.49 mm for furcation depth, respectively. Results showed that there was no statistical significance between the measured parameters, indicating that the two methods were statistically similar. CONCLUSION: Accuracy of assessment of mandibular molar FI by CBCT was comparable to that of direct surgical measurements. These findings indicate that CBCT is an excellent adjunctive diagnostic tool in periodontal treatment planning.
This case report presents a case of drug induced gingival overgrowth in a 28-year-old female patient with history of Coronary Artery Disease (CAD) and was prescribed digoxin in combination with furosemide and acitrom for the same. On clinical examination, the patient presented with severe gingival overgrowth. The volume of enlargement seen did not correlate solely with the diagnosis of inflammatory Gingival Enlargement (GE), hence an added drug induced component to the Gingival Overgrowth (GO) was suspected. It was decided to treat the condition using initial therapy {meticulous Scaling and Root Planning (SRP)} followed by a period of observation and maintenance. On recall, since there was no marked improvement, surgical intervention was planned. Periodic treatment combining surgery and maintenance ultimately produced the desired results clinically. Thus, this article within limits highlights that because of time-relationship between the starting of the medication that is digoxin and manifestation of GO, a causal relationship is likely.
BACKGROUND AND OBJECTIVES: This study was designed to evaluate whether the oral administration of lactobacilli could change the bacterial population in subgingival plaque. SUBJECTS AND METHODS: Forty-two healthy volunteers with chronic generalized mild to moderate periodontitis were given a probiotic drink containing Lactobacillus casei for 1 month. Subgingival plaque samples were collected at baseline, after which the patients were asked to consume the probiotic drink once daily for 1 month. At the 1 month interval, plaque samples were collected, and the drink discontinued. The patients were recalled at 2 months interval for collection of the final samples. The bacterial amounts in the plaque samples were analyzed by multiplex polymerase chain reaction procedure. RESULTS: Of the three periodontopathic bacteria selected, Porphyromonas gingivalis showed highly significant reductions in the bacterial levels at 1-month and 2 months intervals. In comparison, Aggregatibacter actinomycetemcomitans, when present higher than 10 × 10(3) at baseline, and Prevotella intermedia present higher than 2 × 10(3) at baseline, showed moderately significant reduction in their numbers. INTERPRETATION AND CONCLUSION: Oral administration of the probiotic lactobacilli reduced the numerical sum of the three selected periodontopathic bacteria and could contribute to the beneficial effects on periodontal conditions.
Lacticaseibacillus casei , Periodontitis/microbiology , Probiotics , Adult , Female , Humans , Male , Middle Aged , Young Adult
Enlargement of the gingiva can be due to various causes. Most prevalent are the inflammatory type and drug-induced type of gingival hyperplasia. However, sever enlargement associated with an aggressive type of periodontitis is an infrequent finding. Reported here is a case of a female patient aged 18 years who presented with severe enlargement of the maxillary and mandibular gingiva. Examination revealed enlargement extending up to the incisal edge of all the teeth and also an associated generalized loss of attachment with radiographic evidence of reduced bone height resembling an aggressive type of periodontitis. There were no associated systemic signs and symptoms or any family history except that there was generalized vitiligo of the skin and oral mucous membrane. The case was treated by gross electrosection of the gingiva.
PURPOSE: Fluctuations in female sex hormones result in changes in the gingival and periodontal tissues. The purpose of this study was to compare the periodontal status of premenopausal women at different time points during their menstrual cycle and to find the associated subgingival microbiota. MATERIALS AND METHODS: One hundred premenopausal women participated in the study and were divided into two groups: group I consisted of 50 subjects with clinically healthy gingival, and group II consisted of 50 subjects with chronic gingivitis. Group II was further divided into group IIa and group IIb. Group IIa consisted of 25 subjects who did not receive any periodontal therapy during the study period. All the examinations were performed at three points during the menstrual cycle: ovulation (OV), pre-menstruation (PM) and menstruation (M). Plaque Index (PI), Gingival Index (GI), Papillary Bleeding Index (PBI), probing depth (PD), subgingival temperature (ST) recording, gingival crevicular fluid (GCF) collection, and estimation and microbiological examination using the benzoyl-DL-arginine-naphthylamide (BANA) test was carried out. For group IIb subjects, all the examinations were performed again during the next menstrual cycle, which followed 4 weeks after periodontal therapy. RESULTS: Women with clinically healthy gingiva exhibited negligible changes throughout the menstrual cycle, whereas women with gingivitis showed aggravated inflammation during ovulation and pre-menstruation as compared to menstruation. However, there was no alteration in subgingival microbiota. After treating gingivitis, the next menstrual cycle following 4 weeks after periodontal therapy was monitored, and no periodontal changes were detected. CONCLUSION: Ovarian hormones have a negligible effect on clinically healthy periodontium. However, these hormones may exaggerate pre-existing inflammation in gingival tissues, but the clinical significance of these changes remains uncertain.
Menstrual Cycle/physiology , Periodontal Index , Adolescent , Adult , Benzoylarginine-2-Naphthylamide , Body Temperature/physiology , Dental Plaque Index , Female , Follow-Up Studies , Gingiva/microbiology , Gingival Crevicular Fluid/chemistry , Gingival Hemorrhage/classification , Gingival Hemorrhage/therapy , Gingivitis/classification , Gingivitis/microbiology , Gingivitis/therapy , Humans , Luteal Phase/physiology , Menstruation/physiology , Ovulation/physiology , Periodontal Pocket/classification , Periodontal Pocket/therapy , Premenopause/physiology , Young Adult
With increased awareness about dental esthetics, multidisciplinary periodontal therapy has begun to gain momentum. Management of severely attrited teeth is a challenging situation and is dealt with a multidisciplinary approach. In cases of severe tooth wear, the crown height is drastically reduced, in some cases up to the gingival level. This might require a contribution from the disciplines of endodontics, periodontics, orthodontics and prosthodontics for predictable results. Herein we describe the management of one such case.
