Periodontal and glycemic effects of nonsurgical periodontal therapy in patients with type 2 diabetes stratified by baseline HbA1c.

We evaluated the effects of nonsurgical periodontal therapy in 100 patients with type 2 diabetes and chronic periodontitis. The participants were classified as having good (n = 48) or poor (n = 52) glycemic control and were further randomly allocated to receive either scaling and root planning treatment group or no treatment (n = 50 each). The effect of nonsurgical periodontal therapy was compared among diabetic patients with good glycemic control, those with poor glycemic control, and 25 nondiabetic individuals. Periodontal and metabolic status was recorded at baseline, 3 months, and 6 months. In patients receiving treatment, periodontal parameters significantly improved and HbA1c decreased by 10.8%. Improvements in gingival index and bleeding on probing were greater in the nondiabetic participants and the treated patients with good glycemic control than in the treated patients with poor glycemic control (P < 0.05). Regression analysis showed that improvement in periodontal status was independently associated with glycemic improvement. Nonsurgical periodontal therapy improved glycemic control and periodontal health in patients with type 2 diabetes. However, patients with poor baseline glycemic control had less clinical improvement than did those without diabetes and those with good glycemic control.

A randomized clinical trial of salivary substitute as an adjunct to scaling and root planing for management of periodontal inflammation in mouth breathing patients.

We investigated the outcome of conventional periodontal treatment in mouth breathing patients with chronic periodontitis, and compared the efficacy of applying salivary substitute to the anterior sextants as an adjunct to conventional treatment in such patients. In this randomized, investigator-blind, clinical study involving parallel groups, 40 mouth breathing patients were divided into two groups: a control group (CG, n = 20) comprising patients who received scaling and root planing (SRP), and a test group (TG, n = 20) who received salivary substitute as an adjunct to SRP for treatment of chronic periodontitis. The patients were followed up at various time intervals, and improvement of the gingival index (GI) was examined as the primary outcome. Student's t-test, repeated-measures ANOVA and Mann-Whitney U test were applied for statistical analysis. Although periodontal parameters were improved in both groups after 8 weeks of follow-up, the test group showed better improvement in terms of GI and percentage bleeding on probing. Within the limits of this study, our results suggest that the use of salivary substitute has a beneficial adjunctive effect for improvement of periodontal parameters in mouth breathing patients with chronic periodontitis.

Effect of Fluoxetine on Periodontal Status in Patients With Depression: A Cross-Sectional Observational Study.

BACKGROUND: Fluoxetine, a selective serotonin reuptake inhibitor, has been reported to reduce periodontal disease severity in a rat ligature-induced periodontitis model. The objective of the present study is to investigate the influence of fluoxetine intake on periodontal parameters in patients with periodontitis with clinical depression. METHODS: A sample of 236 patients with chronic periodontitis and clinical depression were assessed for clinical parameters of periodontal disease. Of these, 115 patients were taking fluoxetine (20 mg/day) for ≥2 months, and 121 patients were not. Participants taking fluoxetine were further analyzed for correlation between duration of drug intake and periodontal parameters. RESULTS: All periodontal parameters, except plaque index, were significantly lower in participants taking fluoxetine (P <0.01). Partial correlation analysis, adjusted for confounders, revealed a significant and negative correlation between duration of fluoxetine intake and attachment loss (AL) (R(2) = -0.321, P <0.05). Logistic regression analysis revealed that fluoxetine intake was associated with a lower risk of having AL ≥3 (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.96) and lower odds of increased bleeding on probing (BOP) percentage values (OR = 0.62, 95% CI = 0.34 to 0.97). CONCLUSION: In this observational study, use of fluoxetine was associated with lower BOP percentages and reduced AL.

Periodontal status and high-sensitivity C-reactive protein levels in polycystic ovary syndrome with and without medical treatment.

BACKGROUND: Recently, some studies have revealed the effect of polycystic ovary syndrome (PCOS) on gingival inflammation. This cross-sectional study attempts to assess the periodontal status and systemic inflammation of women receiving medical treatment for PCOS and women newly diagnosed with PCOS. METHODS: A total of 126 participants comprising 41 newly diagnosed patients with PCOS (PCOS-N), 45 patients with PCOS on medical treatment (PCOS-MT), and 40 systemically healthy controls (control group [CG]) were examined. Periodontal parameters, anthropometric parameters, and serum levels of high-sensitivity C-reactive protein (hsCRP) were recorded. RESULTS: Women with newly diagnosed PCOS had increased sites with bleeding on probing (BOP), probing depth, clinical attachment level (CAL), waist circumference (WC), hsCRP, and prevalence of periodontitis compared with control and PCOS-MT groups (P ≤0.05). On partial correlation analysis after controlling for confounders, BOP and CAL correlated positively and significantly with hsCRP (P = 0.01 and P = 0.005). Multivariate linear regression analysis revealed that BOP and CAL (dependent variable) (P = 0.009/R(2) = 0.05 and P = 0.005/R(2) = 0.07, respectively) had significant association with hsCRP. Furthermore, hsCRP, when considered as outcome, also exhibited association with CAL and WC (P = 0.002/R(2) = 0.07 and P = 0.04/R(2) = 0.106). Logistic regression analysis demonstrated that the PCOS-N group had 2.88 times increased likelihood of having moderate periodontitis (adjusted odds ratio 2.88, 95% confidence interval 1.18 to 6.98). CONCLUSIONS: Women with newly diagnosed PCOS may have increased prevalence and likelihood for periodontitis, with higher measures of periodontal inflammation and breakdown than those on medical treatment for PCOS and systemically healthy females. Furthermore, periodontal breakdown might depend on systemic inflammation and vice versa.

Association of bone mineral density with periodontal status in postmenopausal women.

AIM: Menopausal changes expose an individual towards risk of various pathologies during midlife transition. This study aimed to investigate the possible association of bone mineral density (BMD) with periodontal parameters in early postmenopausal Indian women. METHODS: In 78 dentate postmenopausal female patients periodontal examination was performed including clinical attachment loss, pocket depth, plaque index and sulcular bleeding index. Alveolar crestal height was measured on proximal surfaces of all posterior teeth except third molars with the help of bitewing radiographs. Patient's BMD was assessed with dual energy X-ray absorptiometry. Statistical analysis was performed to assess the correlation between BMD and periodontal parameters. RESULTS: Pocket depth, clinical attachment loss and alveolar crestal height were found to have negative and statistically significant (P = -0.000 each) correlation with T-score, with the value of Pearson's correlation coefficient being -0.474, -0.426, and -0.419 respectively. Number of teeth lost due to periodontitis was not significantly correlated with T-score (P > 0.05). Results of anova and the post-hoc Tukey test revealed a statistically significant difference of mean clinical attachment loss, pocket depth and alveolar crestal height for the osteoporotic versus osteopenic group and the osteoporotic versus normal group. However, between the osteopenic and normal group, the differences of mean were statistically nonsignificant (P > 0.05). Body mass index was found to have a weakly positive (r = 0.376) and statistically significant (P = 0.001) correlation with T-score. CONCLUSIONS: Bone mineral density is an important risk indicator for periodontitis in postmenopausal women. Number of teeth lost due to periodontitis is not significantly affected by the BMD of the early postmenopausal phase.

Supracrestal gingival tissue: assessing relation with periodontal biotypes in a healthy periodontium.

This cross-sectional study assessed the variability in supracrestal gingival tissue (SGT) dimensions in a healthy periodontium. SGT dimensions were evaluated for differences across various locations, tooth types, and periodontal biotypes. All measurements were made with a vernier caliper to the nearest 0.1 mm. A total of 1,932 sites in 366 teeth were statistically analyzed. Median overall SGT was recorded as 3.50 mm with a range from 1.80 to 6.20 mm. The thick-flat biotype exhibited greater median SGT than the thinscalloped biotype. When planning crown lengthening surgery, periodontal biotype may have a significant role in determining SGT dimensions.

Significance of periodontal health in primary immune thrombocytopenia- a case report and review of literature.

Primary immune thrombocytopenia is an acquired bleeding disorder with no clinically apparent cause of thrombocytopenia. Clinical indicators of ITP include easy bruising of the skin, prolonged bleeding on injury, mucocutaneous lesions such as petechiae and ecchymosis, epistaxis, gastrointestinal bleeding, hematuria and bleeding from the gums. It is important for a dentist to be aware of the clinical manifestations of ITP as it may not only lead to successful management of the patient, but in some cases it may even lead to formation of a provisional diagnosis of the condition in previously undetected cases. However, very few cases of ITP have been reported in dental practice making it difficult for a dentist to identify the disorder when a patient suffering from ITP reports for dental treatment. A case report of a female patient with ITP is thus described with emphasis on the importance of periodontal health in such patients to prevent consequent unwanted sequelae. It is followed by discussion of oral manifestations of the disorder and dental management of such patients.

Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study.

BACKGROUND: Previous studies on crown lengthening (CL) report contradictory results regarding stability of crown length gained at the time of surgery. The "3-mm rule" has dictated the amount of alveolar bone to be removed during CL surgery for decades. With the current understanding of wide variations in supracrestal gingival tissue (SGT) dimensions, bone removal can be customized to the situation. The purpose of this study is to assess alterations in periodontal tissue levels 6 months after CL surgery and to evaluate factors that may influence stability of CL achieved over time. METHODS: Sixty-four patients requiring CL surgery on 64 teeth are included in this study. Clinical parameters were recorded along six surfaces of treated tooth and neighboring teeth. Sites were labeled as treated sites, adjacent sites, and non-adjacent sites. Bone was reduced based on the minimal amount of tooth structure required for restorative purpose and SGT dimensions at each site. Patients were re-evaluated at 3 and 6 months. RESULTS: Significant soft-tissue rebound (0.77 ± 0.58 mm) was observed 6 months after CL surgery. This rebound was found to be significantly correlated with periodontal biotype (r = 0.325, P = 0.000) and post-suturing flap position (r = -0.601, P = 0.000). SGT was not reestablished to its preoperative dimensions by the end of 6 months (P = 0.001). CONCLUSIONS: Crown length gained during surgery significantly decreased 6 months post-surgery. Suturing the flap ≤3 mm from the osseous crest and thick-flat biotype were associated with greater tissue rebound.

Periodontal status and hyperlipidemia: statin users versus non-users.

BACKGROUND: The association between serum lipids and periodontal disease has been studied predominantly in patients with chronic periodontitis with limited data available regarding periodontal status of patients with hyperlipidemia. Meanwhile, the impact of statins on the periodontal health of the population also remains largely underexplored. This study aims to assess the periodontal status among patients with hyperlipidemia and users of statins. METHODS: In this cross-sectional study, 94 patients with hyperlipidemia (50 receiving statins and 44 receiving non-pharmacologic therapy) and 46 control individuals who were normolipidemic underwent periodontal examination (plaque index, gingival index [GI], probing depth [PD], and clinical attachment level [CAL]). Biochemical parameters measured included serum triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein cholesterol levels. RESULTS: PD and GI were significantly higher in patients with hyperlipidemia who were non-statin users compared with the normolipidemic individuals (P <0.001 [PD] and P <0.05 [GI]) and the statin group (P = 0.001 [PD] and P <0.05 [GI]). Periodontal parameters between statin users and the normolipidemic group did not differ significantly. After adjusting for confounders, positive and significant correlations were observed between PD and TG, and TC and LDL, whereas CAL shared correlation with TC and LDL. GI was correlated with TG and TC. Regression analyses revealed that whereas TC was associated significantly with PD (P <0.001), LDL showed significant association with CAL (P = 0.013). TG showed significant association with GI (P = 0.020). CONCLUSIONS: Our findings suggest that relative to the general population, patients with hyperlipidemia are more prone to periodontal disease. Also, within the limits of this study, statins have a positive impact on periodontal health.

Correlation of tooth mobility with systemic bone mineral density and periodontal status in Indian women.

Imbalanced bone remodelling associated with osteopaenic or osteoporotic conditions can lead to a net bone loss throughout the skeleton, including the oral cavity, possibly leading to tooth mobility. This study investigated possible associations between systemic bone mineral density and both tooth mobility and periodontal status in peri-menopausal women. Subjects comprised 119 dentate, peri-menopausal Indian women between 40 and 54 years old. Clinical parameters recorded were systemic bone mineral density (BMD), tooth mobility in terms of Periotest value (PTV score), clinical attachment loss (CAL), pocket depth (PD), plaque index (PI) and sulcular bleeding index (SBI). Statistical analysis was performed to assess correlations between PTV score and T-score. PTV score correlated significantly (P < 0.05) with T-score, PD and CAL. The partial correlation coefficient between PTV score and T-score after adjusting for confounders was -0.3676 (P < 0.05). Results of one-way analysis of variance showed a significant difference between mean PTV scores for osteoporotic, osteopaenic and normal patients. In this population of peri-menopausal women, systemic bone mineral density represented an independent factor associated with tooth mobility.

Primary Non-Hodgkin Lymphoma of Palatal Gingiva.

INTRODUCTION: Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of lymphoproliferative malignancies that can disseminate to organs and tissues that do not ordinarily contain lymphoid cells (extranodal sites). Primary extranodal NHL of the oral cavity is rare, and gingiva is one of the rarest intraoral sites involved. The majority of oral NHLs reported are of diffuse large B-cell type. Such lymphomas are more prevalent in immunocompromised patients. Because of their malignant nature, early recognition, diagnosis, and treatment are essential for a patient's survival. To the best of our knowledge, this report presents the first case of diffuse mixed small and large B-cell lymphoma involving the gingiva in a non-immunocompromised patient. CASE PRESENTATION: A female patient presented with a growth located on the palatal aspect of the right maxillary molar region involving marginal and interdental gingiva. Routine laboratory tests and clinical examination were within normal limits. An incisional biopsy of the gingival tissue was evaluated using histologic techniques and immunohistochemistry. A diagnosis of extranodal diffuse mixed small and large B-cell lymphoma was established. The patient underwent a complete workup to rule out other systemic lesions, thereby supporting the primary nature of the lesion. CONCLUSION: Gingival overgrowth may rarely be the first manifestation of extranodal NHL. Only histopathological examination of the specimen with immunohistochemistry can ascertain a confirmed diagnosis of NHL. The present case report stresses the importance of routine biopsy examination for growth lesions of long duration when an infectious etiology has been ruled out, even if the lesions appear benign.

Clinical evaluation of guided tissue regeneration combined with autogenous bone or autogenous bone mixed with bioactive glass in intrabony defects.

Conflicting data exist on the combined use of grafting materials and barrier membranes in comparison to guided tissue regeneration (GTR) with membrane alone. The aim of the present study was to compare the clinical outcomes of GTR with collagen membrane (CM) alone (control group) or CM combined with autogenous bone graft (test group 1) or autogenous bone mixed with bioactive glass (test group 2) in intrabony defects. A total of 32 intraosseous defects in 22 subjects were treated randomly. After 6 months, significant probing depth reduction, clinical attachment level gain (CAL) and defect resolution were observed in all groups with significantly greater improvements in the test groups. There was no significant difference between the two test groups in any parameter. Results of the present study suggest that autogenous bone can be mixed with bioactive glass if the amount of the harvested bone is not sufficient.