Efficacy of a herbal mouthwash for management of periodontitis and radiation-induced mucositis - A consolidated report of two randomized controlled clinical trials.

BACKGROUND: Oral diseases like periodontitis and mucositis often require home care using topical agents in the form of mouthwashes. Many herbal mouthwashes are found to be beneficial; however lack proper scientific evidence to support their use. OBJECTIVES: Study 1 evaluated clinical efficacy of herbal mouthwash in the management of chronic periodontitis in comparison with chlorhexidine mouthwash. Study 2 aimed at assessment of herbal mouthwash in patients of radiation-induced mucosititis. METHODS: The novel herbal mouthwash used in the present study wa prepared from extracts of five plants namely Emblica Officinalis, Terminalia chebula, Terminalia bellerica, Glycyrrhiza glabra, and Azadirachta indica. 50 periodontitis patients were randomly allocated to two groups. As per allocation, they were instructed to use either herbal mouthwash or chlorhexidine mouthwash twice daily for two weeks after nonsurgical periodontal therapy. Similarly, patients with radiation-induced mucositis were randomly given herbal mouthwash and soda saline mouthwash. Intergroup and intragroup comparisons of continuous variables were conducted using paired and unpaired t-tests. Categorical variables were compared using the chi-square test. RESULTS: Significant reductions in gingival bleeding, plaque accumulation, and pocket depth were noticed in periodontitis patients in both groups. Patients reported acceptable taste, freshness, and satisfaction after the use of herbal mouthwash. The herbal mouthwash group noticed a significant reduction in the severity of radiation-induced mucositis and analgesic requirements. The intensity of pain, dryness of mouth, oral hygiene, and need for the use of antibiotic and antifungal during radiotherapy was not significant among the groups. CONCLUSION: The results of this preliminary clinical trial support the use of the tested herbal formulation mouthwash as an adjunct in the treatment of periodontitis as well as radiation-induced mucositis. CLINICAL TRIAL REGISTRATION NUMBER: For Study 1: CTRI/2019/10/021574, Study 2: CTRI/2020/04/024851.

Evaluation of salivary glycated albumin in periodontitis patients with and without type 2 diabetes mellitus and its changes with non-surgical periodontal therapy.

Background: Bidirectional relationship exists between diabetes mellitus and periodontitis. Glycated albumin is an emerging biomarker to assess intermediate glycemic control. Salivary glycated albumin has not been evaluated in periodontitis. Aim: The aim of the study was to compare salivary glycated albumin in periodontitis patients with and without diabetes mellitus before and after periodontal therapy. Materials and Methods: This comparative cross-sectional study was conducted in the Department of Periodontics. Ninety subjects (mean age 41.8 ± 6.82) were categorized into three groups. Clinical examination and saliva sample collection were done at baseline and 4 weeks after scaling and root debridement. Salivary glycated albumin levels were estimated using an enzyme-linked immunosorbent assay. One-way analysis of variance with post hoc test and paired t-test was done for inter- and intra-group comparison. The optimal cut-off value was calculated using the receiver operating characteristic curve and by maximization of the Youden index. Results: Mean salivary glycated albumin was the highest in diabetic patients followed by non-diabetic periodontitis patients and least in healthy controls. All the intergroup comparisons were significant. A cut-off value of 72.19 ng/ml of salivary glycated albumin could predict diabetic status with a sensitivity and specificity of 75%. Salivary glycated albumin was significantly reduced in a similar manner in both groups after periodontal therapy (19.4% and 18.5%). Conclusion: Periodontitis patients with diabetes mellitus were presented with the highest salivary glycated albumin. Non-surgical periodontal therapy resulted in a similar reduction of salivary glycated albumin in periodontitis with and without diabetes mellitus.

Adjunctive benefit of probiotic supplementation along with nonsurgical therapy for peri-implant diseases - A systematic review and meta-analysis.

Peri-implant diseases are prevalent conditions, but a predictable management strategy is still lacking. The objective of the present article was to evaluate the adjunctive benefits of probiotics with nonsurgical therapy in the management of peri-implant diseases. The review protocol was registered in PROSPERO and prepared according to PRISMA guidelines. Randomized controlled clinical trials in patients diagnosed with the peri-implant disease where probiotic was used as an adjunct to nonsurgical therapy were included in the study. The risk difference of percentage reduction in bleeding on probing, plaque accumulation, and mean difference in probing pocket depth reductions at implant level were estimated using a random effect model due to high heterogeneity among studies. Four studies fulfilled the criteria for selection. Two of them presented data on both peri-implantitis and peri-implant mucositis and they were considered separate studies during meta-analysis. Significant reduction in percentage of bleeding on probing was noticed at 1 and 3 months (-0.28 [-0.48, -0.09], P = 0.004 and - 0.19 [-0.35, -0.02], P = 0.03, respectively), but the reduction was not statistically significant at 6 months. Similar results were also observed for plaque accumulation. No statistically significant reduction in probing pocket depth was observed in the probiotic group during any of the re-evaluations. Conclusion: Adjunctive therapy of probiotics may improve the efficacy of nonsurgical therapy of peri-implant diseases for up to 3 months. However, moderate certainty was observed for a reduction in bleeding on probing after 1-month re-evaluation alone.

Efficacy of injectable platelet-rich fibrin (i-PRF) for gingival phenotype modification: a split-mouth randomized controlled clinical trial.

OBJECTIVES: Gingival phenotype is decisive in periodontal health, aesthetics, and function and is a predictor of treatment outcomes. Injectable platelet-rich fibrin is a recently proposed method of gingival augmentation due to its enhanced regenerative potential. The objective of the present study was to evaluate the efficacy of injectable platelet-rich fibrin for gingival phenotype modification. MATERIALS AND METHODS: In this split-mouth study, 30 healthy volunteers with thin gingival biotypes in either maxillary or mandibular incisors were included. iPRF was prepared using 64 g relative centrifugal force for 3 min. i-PRF was injected into the attached gingiva using a 27-gauge disposable needle in relation to the test sites (n = 360), and contralateral sites were kept as control. Re-evaluation was done at the end of 3 and 6 months. Post-operative complications and patient-reported experience measures were also recorded. Statistical analysis was done using paired t-test and analysis of covariance. RESULTS: Statistically significant increase in gingival thickness was found in the test group at the individual site and tooth level. An overall increase in gingival thickness of 26.56% after 3 months and 29% after 6 months compared to baseline was noticed in the test group. No significant difference was found in the width of keratinized gingiva in any of the comparisons. CONCLUSION: The non-surgical application of i-PRF is promising for enhancing gingival thickness. Future well-controlled studies with long-term follow-up in different patient populations can provide more evidence. CLINICAL RELEVANCE: Gingival phenotype modification is a useful therapy to prevent the occurrence of gingival recession in patients with thin phenotypes. TRIAL REGISTRATION: Clinical Trial Registration Number: CTRI/2021/04/032650.

Deciphering the Multifarious Charge-Transport Behaviour of Crystalline Propeller-Shaped Triphenylamine Analogues.

A collection of para-substituted propeller-shaped triphenylamine (TPA) derivatives have been computationally investigated for charge-transport characteristics exhibited by the derivatives by using the Marcus-Hush formalism. The various substituents chosen herein, with features that range from electron withdrawing to electron donating in nature, play a key role in defining the reorganisation energy and electronic coupling properties of the TPA derivatives. The TPA moiety is expected to possess weak electronic coupling on the basis of poor orbital overlap upon aggregation, owing to the restriction imposed by the propeller shape of the TPA core. However, the substituent groups attached to the TPA core can significantly dictate the crystal-packing motif of the TPA derivatives, wherein the variety of noncovalent intermolecular interactions subsequently generated drive the packing arrangement and influence electronic coupling between the neighbouring orbitals. Intermolecular interactions in the crystalline architecture of TPA derivatives were probed by using Hirshfeld and quantum theory of atoms-in-molecules techniques. Furthermore, symmetry-adapted perturbation theory analysis of the TPA analogues has revealed that a periodic arrangement of energetically stable dimers with significant electronic coupling is essential to contribute high charge-carrier mobility to the overall crystal.

Differential expression of transcription factors NF-κB and STAT3 in periodontal ligament fibroblasts and gingiva of healthy and diseased individuals.

OBJECTIVE: Pathogens and host mediators can activate transcription factors in periodontal cells to bring about gene level alterations, thereby accentuating the periodontal disease process. Nuclear factor-kappa B (NF-κB) and signal transducers and activators of transcription 3 (STAT3) are two pivotal transcription factors implicated in chronic inflammatory diseases. But their importance in periodontal pathogenesis has not been investigated in detail. The aim of the present study was to evaluate the expression of activated transcription factors and their target genes in healthy and diseased periodontium. DESIGN: Primary culture of periodontal ligament fibroblasts (PDLF) were established from healthy and diseased periodontium using explant culture methods. NF-κB and STAT3 activation in these cells by Porphyromonas gingivalis LPS (lipopolysaccharide) was demonstrated using confocal microscopy and mRNA expression of target genes were evaluated by quantitative real time PCR. NF-κB and STAT3 expression in diseased and healthy gingival tissues were analyzed using immunohistochemistry. RESULTS: A basal upregulation of transcription factors and their target genes were noted in diseased PDLF compared to healthy ones. LPS challenge induced differential expression of NF-κB and STAT3 and their target genes in diseased PDLF compared to healthy ones. Immunohistochemical analysis revealed significant activation of transcription factors in diseased gingival tissues. CONCLUSION: The findings of the present study reveal the role of transcription factors NF-κB and STAT3 in periodontal pathogenesis and disease susceptibility of fibroblast subpopulations in periodontal disease could be mediated through activation of NF-κB and STAT3. Since genetic factors are nonmodifyable, transcription factors are promising targets for future host modulation therapy.

Unveiling the role of stress in periodontal etiopathogenesis: an evidence-based review.

Periodontal disease is a multifactorial disease affecting the supporting tissues of the teeth, resulting in progressive attachment loss and bone loss. Periodontal disease is influenced by various systemic, environmental, and psychologic factors that have the potential to alter periodontal tissues and host immune response, resulting in more severe periodontal destruction. Several studies have documented the relationship between psychosocial stress and chronic forms of periodontal disease. Stress impairs periodontal health through changes in behavior and complex interactions among the nervous, endocrine, and immune systems. The influence of stress on periodontal disease is affected by the emotional coping skills of the individual. Psychologic stress and depression may also influence the outcome of periodontal therapy. Stressful life events and coping skills are factors to consider in the risk of periodontal disease destruction and the potential for successful periodontal therapy. Therefore psychosocial stress is considered as an important risk factor for periodontal disease, and emotional stress in periodontitis patients should be diagnosed and treatment should be administered for the proper management and successful outcome of periodontal disease.

Expression of activated transcription factor nuclear factor-kappaB in periodontally diseased tissues.

BACKGROUND: Chronic periodontitis is an inflammatory disease found mainly in adults. Little is known about molecular level changes associated with host response in this condition. Nuclear factor-kappaB (NF-kappaB) is a transcription factor implicated in immune and inflammatory responses. NF-kappaB activation has also been reported to be associated with many chronic inflammatory diseases. The purpose of this paper was to compare the nuclear and cytoplasmic expression of NF-kappaB transcription factor (p50/p65) and cytoplasmic expression of IkappaB in periodontal tissues of periodontitis patients and controls. METHODS: Twenty patients with chronic periodontitis and 20 healthy controls were included in the study. Gingival tissues taken during extraction were processed for immunohistochemical staining and evaluation. RESULTS: Nuclear (activated) p50 was found in 90% of periodontal patient tissues compared to only 30% of healthy tissues. A more significant result was obtained with p65 (75% versus 5%). Intense cytoplasmic immunoreactivity was also observed in periodontitis tissues. IkappaB, the inhibitor of NF-kappaB, was expressed only in 5% of periodontally diseased tissues. CONCLUSION: Activation of NF-kappaB (p50/p65) is significant in periodontally diseased tissues, suggesting the potential of inhibitors of NF-kappaB in managing periodontitis.