Unraveling the cognitive implications among individuals with co-occurring chronic periodontitis and type 2 diabetes mellitus: a cross-sectional study.

OBJECTIVES: Chronic periodontitis and type 2 diabetes mellitus (T2DM) are associated with cognitive decline when examined individually. To gain deeper insight into the combined effects of these conditions on cognitive decline, the present study aimed to examine the cognitive status of individuals with co-occurring T2DM and chronic periodontitis. METHODS: We recruited 220 participants categorized into four groups: Group I, healthy subjects; Group II, individuals with chronic periodontitis; Group III, individuals with T2DM; and Group IV, individuals with both T2DM and chronic periodontitis. Medical histories were recorded for all participants, followed by periodontal examination and evaluation of cognitive status using the Montreal Cognitive Assessment (MoCA) scale. Finger dexterity was assessed using the nine-hole peg test. RESULTS: A statistically significant increase in the proportion of mild cognitive impairment (MCI) was observed between groups I and IV (p<0.001). Logistic regression analysis revealed that, among the parameters assessed in this study, the adjusted odds ratio (OR) was significant for age, finger dexterity scores, and co-occurrence of T2DM and periodontitis. CONCLUSIONS: The findings of this study suggest that the co-occurrence of chronic periodontitis and T2DM can have a detrimental effect on the cognitive abilities of an individual. Subsequent research should include longitudinal monitoring of the cognitive status in patients with concurrent conditions during treatment to gain deeper prognostic insights into the relationship between these co-occurring conditions and cognitive decline.

Evaluation of Risk Factors of Peri-Implant Disease Using a New Manual Risk Assessment Model: A Clinical study.

Background: Implants are being widely used as a treatment option and are considered the best line of treatment owing to their high level of predictability. However, over 5 years, 0-14.4% of dental implants have demonstrated peri-inflammatory reactions associated with loss of crestal bone and ultimately loss of the implant. Peri-implant diseases are categorized into peri-implant mucositis and peri-implantitis. There are a number of risk factors associated with these conditions, and the early detection of these possible risk factors, change in the treatment protocol whenever required along with a regular follow-up, can ensure a better survival rate of dental implants. In the present study, an attempt has been made to evaluate the risk factors associated with peri-implant diseases and also to correlate these risk factors to the prevalence of peri-implant diseases using the formulated risk assessment model. Methodology. The risk assessment model was prepared based on existing literature explaining the risk factors for peri-implant diseases. This study was conducted as a pilot study, and the method of complete sampling was used wherein all subjects in whom implants have been placed at the Department of Periodontology and Department of Prosthodontics were recalled and assessed. The model was then evaluated on patients in whom dental implants were placed and the implants were loaded for a year. A total of 13 subjects with 21 implants were assessed for the presence or absence of risk factors, and a score was given. Test of proportion and chi-square test was done. Results and Discussion. Of the 21 implants assessed, 15 implants were found to be at low risk and 6 implants with moderate risk of peri-implant disease. The number of implants with low risk was higher in implants with peri-implant mucositis (25%) whereas the implants with moderate risk was higher in implants with peri-implantitis (75%). This comparison was statistically significant with a p value of 0.022. Conclusion: This risk assessment tool can be used in the early detection of peri-implant disease, and identifying the risk factor may help in the success rate of the implant survival.

Metabolomics: Paving the path for personalized periodontics - A literature review.

The pathogenesis of periodontal disease is governed by a multitude of factors ranging from the macroscopic to the microscopic scale. Among the factors that constitute the etiological agents of the disease, a major element is the role played by the body's metabolome-i.e., the complete collection of microscopic molecules and metabolic products of cells and tissues in the body. Being of a regulatory nature, the interplay of these molecules exerts a considerable effect on the development as well as the progression of disease, which differs in each individual based on their phenotype. Exploring this connection and application into the field of diagnostic as well as prediction of risk for periodontitis will ultimately result in a personalized standard of care for patients in the future.

Attitudes toward and knowledge of collaboration of dental and medical practice among medical students in Southern India: a cross-sectional questionnaire survey.

BACKGROUND: Enhancing oral health care services provided through inter-professional collaboration between medical and dental practitioner is important, and even essential. The purpose of this study is to assess the attitude toward and knowledge of medical-dental collaborative practice among medical students attending colleges in Southern India. METHODS: A cross sectional questionnaire survey was conducted among medical students and interns of medical colleges in coastal South India with prior information and permission. The questionnaire consisted of 11 questions to assess attitude toward and knowledge of medical-dental collaborative practice. The demographic backgrounds of participants were also recorded. Chi square test was employed for data analysis. The responses obtained were correlated with age, gender and year of study of participants using Pearson's correlation test Results: A total 250 questionnaires were distributed and 234 responses were appropriately completed. Most of the students agreed that oral health was an integral part of systemic health, however participants disagreed on attending compulsory rotation in dentistry at a statistically significant level (p<0.05), moreover participants did not agree with physicians having an active role in motivating their patients for regular dental check-up. 82% of the medical students believe that dental check-up should be included in health packages under health insurance. A statistically significant (p<0.05) difference was observed among 3 rd year & 4 thyear students and interns and also it was found that female students provided more positive responses towards medical-dental collaboration. CONCLUSIONS: Even though medical students showed fairly positive attitudes and knowledge towards dentistry, the analysis within the study groups showed that knowledge and attitudes regarding the collaborative practice worsened over the academic years among the medical students. In order to destigmatize and foster interdisciplinary collaboration which would contribute to higher resource efficiency and the standard of care, continuing education in both the disciplines would be highly beneficial.

Evaluation of papilla levels following three different techniques for the second stage of implants - A clinical and radiographic study.

OBJECTIVE: Papilla formation after placement of an implant is influenced by the underlying bone and the periodontal biotype. The second-stage surgery to uncover the implants may have an effect on the regeneration of papilla and various techniques such as the scalpel, diode laser, and punch technique are used. In the present study, an attempt has been made to evaluate papillary fill levels following three different techniques of second-stage implant surgery. MATERIALS AND METHODS: A total of 35 patients with 45 implants (39 single implants and 3 sites with two adjacent implants) were randomly divided into three groups with 15 implants each: second-stage implant surgery with midcrestal incision using scalpel (Group I), with I-shaped incision using scalpel (Group II), and using diode laser (Group III). The mean papillary fill and mean crestal bone loss for all three groups were compared at baseline, 3 months, and 6 months of prosthesis delivery. RESULTS: Complete papilla fill at 6 months was seen in 60% and 73.3% of sites in Group II and Group III, respectively. Bone level contacting implant and adjacent teeth was less in both Groups II and III. Bone level from the contact point to the bone crest was least in Groups II and III. CONCLUSION: The use of diode laser during second-stage surgery showed maximum papillary fill and minimal crestal bone loss when compared with other two techniques. Irrespective of technique used for second-stage surgery, bone loss did occur after prosthesis delivery.

Evaluation of Cognitive Impairment in Type 2 Diabetic Patients with Chronic Periodontitis: A Cross-sectional Study.

BACKGROUND: Type 2 diabetes mellitus is an important risk factor for dementia; it also shares a bidirectional relationship with periodontitis. It is hypothesized that the increased severity of periodontitis is associated with cognitive decline in patients having uncontrolled diabetes mellitus. An added risk for future development as well as progression of dementia may be prophesied in such a scenario. Therefore, the present study was conducted to find a correlation between the cognitive impairment (CI) and periodontitis in type 2 diabetes mellitus patients. MATERIALS AND METHODS: A total of 160 older adults aged ≥60 years in Mangalore, Karnataka, India, were included in the present analysis. Known T2DM patients aged ≥60 years and diagnosed with periodontitis with a minimum clinical attachment loss (CAL) of ≥2 mm were considered in the present study. Montreal cognitive assessment test assessed the CI. The analysis was carried out using the χ2 test, an independent t-test. Binary logistic regression analysis (enter method) was performed to derive the odds ratios (95% confidence interval). RESULTS: The study included 160 participants, out of which 120 had CI and 40 did not have CI. A statistically significant association was observed between moderate-to-severe periodontitis, HbA1c levels ≥7%, and CI after excluding the confounding factors like age, gender, diet, lifestyle habits, and education. CONCLUSION: In the present study, cognitive impairment was found to coexist with HbA1c levels ≥7% and moderate-to-severe periodontitis in the elderly diabetics. The clinical implication of these findings adds opportunities to form disease modifiable areas in the elderly diabetic population at a risk for the development of dementia. Additionally, the impact of pre-existing CI on progression of periodontitis and vice versa has been discussed.

Knowledge, attitude and oral care practices for preventing ventilator-associated pneumonia among critical care nurses - A questionnaire study.

BACKGROUND: A cross-sectional study was conducted among intensive care unit (ICU) nurses in private hospitals in India to identify knowledge and practice of ICU nurses in the prevention of ventilator-associated pneumonia (VAP). METHODS: Knowledge of 135 nurses working in ICU was tested using a questionnaire consisting of 18 questions. Fourteen forms were excluded from the statistical analysis due to incomplete data entry by the participants. The data of 121 filled questionnaires were analyzed. The information letters, consent forms, and questionnaires were handed to ICU nurses by Research assistant. Data were coded and entered into SPSS version for descriptive and inferential statistics. RESULTS: A majority of the participants perceived oral care as a necessity in all critically ill patients. Nurses were generally aware of the most likely mechanism of acquiring pneumonia. The type and frequency of oral care varied widely. Many of them stated that they had adequate supplies to provide oral care. Although a majority of nurses had some formal training in oral care, they would appreciate an opportunity to enhance and improve their knowledge and skills. CONCLUSION: The methods of oral care provided vary widely. In summary, randomized controlled trial to date has demonstrated that tooth brushing is associated with a trend toward lower rates of VAP in intubated mechanically ventilated critically ill patients. But it is also to be noted that there was no clear difference between electric and manual tooth brushing. In-house training and workshop can provide required skills needed for the betterment of the treatment provided.

Candidal carriage in saliva and subgingival plaque among smokers and non-smokers with chronic periodontitis-a cross-sectional study.

BACKGROUND AND OBJECTIVES: Studies of gum or periodontal disease have focused mainly on bacterial pathogens. However, information related to fungal species in the saliva and subgingival mileu is particularly lacking in smokers with periodontitis. This cross-sectional study compared the prevalence of various Candida species in saliva and subgingival plaque samples of smokers and non-smokers with periodontal disease. METHODOLOGY: Study subjects were recruited into three group-Group 1: Smokers with chronic periodontitis (N = 30), Group 2: Non-smokers with chronic periodontitis (N = 30) and Group 3: Healthy controls (N = 30). Clinical parameters recorded included plaque index (PI), gingival index (GI), periodontal probing depth (PPD) and clinical attachment loss (CAL). Saliva and subgingival plaque samples were collected from subjects from the above groups. The collected samples were processed for isolation and identification of various Candida species using CHROMagar chromogenic media. Additionally, antifungal susceptibility tests were performed for the isolated Candida species in order to assess antifungal drug resistance to fluconazole and voriconazole. RESULTS: Prevalence of Candida species in saliva samples was quantified as 76.6% in Group 1, 73.3% in Group 2 and 36.6% in Group 3 and statistically significant differences were observed between groups 1 & 3. Prevalence of Candida species in subgingival plaque samples was quantified as 73.3% in Group 1, 66.6% in Group 2 and 60% in Group 3 and no statistically significant differences were observed between groups. Candida albicans was the most frequently isolated species followed by Candida krusei and Candida tropicalis. A positive correlation was observed for smoking exposure, pack years and Candida colonization. A marginally significant positive correlation was observed between Candida colonization and increasing pocket depth and attachment loss. Antifungal drug resistance was mainly observed for Candida krusei in both saliva and subgingival plaque samples. CONCLUSION: Based on the results we can conclude that oral candidal carriage is significantly increased in smokers with periodontal disease. Mechanistic studies are needed to understand the importance of Candida species in periodontal disease.

Periodontal disease and hemolysis in glucose-6-phosphate dehydrogenase deficiency: Is there a nexus?

BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an erythrocyte enzyme defect that amplifies the susceptibility of erythrocytes to oxidative stress due to excessive levels of reactive oxygen species. Consequently, erythrocyte destruction and hemolysis occur. HIGHLIGHT: The possible mechanism of oxidative stress-mediated destruction of erythrocytes in G6PD deficient individuals induced by periodontal infection is highlighted. CONCLUSION: Periodontal diseases feature systemic loading of reactive oxygen species, and they may increase the risk of hemolysis in individuals with G6PD deficiency.

Bidirectionally positioned flap technique for molar class II furcation defect- 1 year follow up.

In the treatment of Class II furcation defects, guided tissue regeneration (GTR) in combination with bone grafts has provided better treatment outcomes in comparison to GTR alone. A 48-year-old male patient reported with a chief complaint of pain and bleeding in the right lower back teeth area from 3 months. On clinical and radiographic evaluation, a Class II buccal furcation defect was detected in tooth #46. A bidirectionally positioned flap (BPF) technique in combination with bone graft was done to treat the defect following nonsurgical therapy. The healing was satisfactory postoperatively. The patient was recalled for supportive periodontal therapy at 3, 6, and 12 months. Clinical and radiographic outcomes after 12 months revealed possible new attachment and stable periodontal status. It is concluded that inner periosteal flap in BPF technique may serve as an alternative technique to GTR barrier membranes in case of Class II furcation defects.

Towards a Common Etiopathogenesis: Periodontal Disease and Endometriosis.

CONTEXT: Periodontal disease and endometriosis are seen to share a common pathogenesis. There is only one report suggesting the possible association between the two conditions. AIMS: To study the association between endometriosis and periodontal disease. SETTINGS AND DESIGN: This was a case-control study. SUBJECTS AND METHODS: Periodontal screening was carried out in 25 women with endometriosis and 25 women without endometriosis. Severity of periodontal disease was classified based on the extent of loss of attachment. STATISTICAL ANALYSIS USED: Student's t-test, Mann-Whitney U test, and Karl Pearson correlation coefficient tests were used for statistical analysis. Results: The proportion of women with severe periodontitis was seen to be higher among women with endometriosis (70%). CONCLUSIONS: The results of the present study indicate the existence of a relationship between endometriosis and periodontal disease. However, further studies among larger cohorts of endometriosis may provide evidence about the association.

Comparison of minimally invasive coronally advanced flap and modified coronally advanced flap for the management of multiple adjacent gingival recession defects: A split mouth randomized control trial.

INTRODUCTION: Various minimally invasive surgical approaches are proposed for the management of gingival recession. A modified surgical approach coined as minimally invasive coronally advanced flap (MICAF) was compared with modified coronally advanced flap (MCAF) for the management of multiple adjacent gingival recession defects. MATERIALS AND METHODS: Seven systemically healthy subjects with bilateral multiple adjacent maxillary facial gingival recession defects (Miller I) were included in this study. In each patient, MICAF performed on one side and on the other side MCAF was performed. Comparisons of the surgical sites were made with clinical measurements at 6 months follow-up. RESULTS: No statistically significant differences were observed between MICAF and MCAF sites in the change in gingival recession depth, gingival recession width, clinical attachment level, width of the keratinized tissue, mean, and complete root coverage after 6 months. However, patient reported outcomes of esthetics and postoperative morbidity were statistically significant (P <0.001) between the MICAF and the MCAF sides with better results in the MICAF side. CONCLUSIONS: Within the confines of this study, the results depicted that MICAF is more patient-friendly procedure with better patient acceptance. Further, long-term studies with more sample sizes are needed for a stronger evidence base. CLINICAL SIGNIFICANCE: Miller Class I gingival recessions can be treated with the MICAF with successful clinical outcomes and patient acceptance. This paper reports the clinical and patient reported outcomes of the MICAF and the MCAF.

A perspective on NETosis in diabetes and periodontal diseases.

Neutrophil-mediated immunity is the first host defense response against any infection. Crevicular efflux of neutrophils against bacteria is considered to be a novel defense mechanism in periodontal diseases. As a part of defense mechanism, neutrophils extrude its content and exhibit its antimicrobial activity by forming a web-like structure called neutrophil extracellular trap (NET) and undergo a process of cell death called NETosis. Under physiological conditions, NET production is limited and is balanced with its degradation, whereas NET production is found to be aggravated in chronic systemic inflammatory conditions such as diabetes mellitus and also in periodontal diseases. It is well known that a two-way relationship exists between diabetes mellitus and periodontal diseases. Interference in the process of NETosis might form a link between the two. The aim of this review is to focus on the potential role of NETosis in the pathogenesis of periodontitis and diabetes mellitus.

Comparative Evaluation of the Efficacy of Bioactive Ceramic Composite Granules Alone and in Combination with Platelet Rich Fibrin in the Treatment of Mandibular Class II Furcation Defects: A Clinical and Radiographic Study.

INTRODUCTION: Predictable closure of furcation defects with bone grafts, Guided Tissue Regeneration (GTR) and a combination of the two has remained an elusive goal so far. Hence, evaluation of biomimetic agents as candidate technologies for periodontal regeneration merit due consideration. In this study, Choukroun's Platelet Rich Fibrin (PRF), a second generation platelet concentrate, is combined with bone graft to examine if the addition enhances the therapeutic potential of bone graft in the management of Class II furcation defects. AIM: To evaluate and compare the clinical effectiveness of Bioactive Ceramic Composite Granules (BCCG) alone and in combination with PRF in the treatment of mandibular Class II furcation defects. MATERIALS AND METHODS: Twenty mandibular Class II furcation defects in 16 systemically healthy patients were randomly allocated to test and control groups. Test sites were treated with PRF and bone graft, while control sites were treated with BCCG alone. Soft tissue parameters (probing pocket depth and clinical attachment loss), hard tissue parameters (vertical and horizontal depth of furcation defects) and radiographic parameter (radiographic alveolar bone density) were measured at baseline and six months post surgery. Statistical analysis was performed using Wilcoxon signed rank test for intragroup comparison of parameters and Mann-Whitney U test for intergroup comparison. RESULTS: Statistically significant improvement was observed in the test group compared to the control group with respect to all the measured parameters. However, complete furcation closure was not observed at any of the treated sites. CONCLUSION: Adjunctive use of PRF with bone graft may be a more effective treatment modality in the management of mandibular Class II furcation defects when compared to bone graft alone.

A Clinical Evaluation of Biphasic Calcium Phosphate Alloplast with and without a Flowable Bioabsorbable Guided Tissue Regeneration Barrier in the Treatment of Mandibular Molar Class II Furcation Defects.

BACKGROUND: Guided tissue regeneration (GTR) therapy has shown good results in the management of mandibular molar class II furcation defects. Advances in biomaterial sciences have developed alloplastic bone replacement graft materials and bioabsorbable GTR barrier membranes with good biologic response and handling properties. The aim of this study was to compare the attachment gain and the bone fill obtained with an alloplast [biphasic calcium phosphate (BCP) 60% hydroxyapatite (HA) and 40% beta tricalcium phosphate (b-TCP)] with and without a bioabsorbable GTR barrier [flowable poly (DL-lactide) (PLA) dissolved in N-methyl-2-pyrrolidone (NMP)] in the treatment of mandibular molar class II furcation defects. MATERIALS AND METHODS: A total of 20 class II furcation defects were treated in 16 patients with chronic periodontitis in a comparative study. Ten defects were treated with Camceram(®) (BCP 60% HA and 40% - TCP) bone replacement graft material (group I) and 10 defects with a combination of Camceram® bone replacement graft material with Atrisorb® Freeflow™, bio-absorbable GTR barrier (flowable PLA dissolved in NMP) (group II). At baseline and at 6 months postsurgery, clinical parameters of vertical probing depth (PD) and horizontal probing depth (P-H), clinical attachment level (CAL), gingival recession (GR), and vertical depth of furcation defect (VDF) and horizontal depth of furcation defect (BP-H) were evaluated. RESULTS: Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) program. Intergroup comparisons made at 6 months postsurgery by unpaired Student's t-test showed mean reduction in PD in group I was 3.10 ± 0.73 mm and in group II was 3.20 ± 1.03 mm (p > 0.05). Mean reduction in P-H in group I was 1.60 ± 0.69 mm and in group II was 1.90 ± 0.73 mm (p > 0.05). Gain in CAL in group I was 2.80 ± 1.03 mm and in group II was 2.90 ± 0.94 mm (p > 0.05). Change in GR in group I was -0.30 ± 0.48 mm and in group II was -0.30 ± 0.48 (p > 0.05). Reduction in VDF in group I was 1.30 ± 0.67 mm and in group II was 1.80 ± 0.63 mm (p ≤ 0.01). Reduction in BP-H in group I was 1.30 ± 0.67 mm and in group II was 1.90 ± 0.73 mm (p ≤ 0.05). CONCLUSION: It was concluded that the combination technique of BCP alloplast with a flowable bioabsorbable GTR barrier led to better results in regard to defect bone fill as compared with when the BCP alloplast alone was used.

Parkinson's disease and periodontitis - the missing link? A review.

OBJECTIVE: In this article an attempt has been made to postulate a possible link between Parkinson's disease and periodontal disease. BACKGROUND: Various systemic diseases such as cardiac disease, diabetes, renal diseases, low birth weight and Alzheimer's disease have been proposed to be linked with periodontal disease on the basis of systemic inflammation. Parkinson's disease is a chronic progressive neurodegenerative disorder with multifactorial aetiology. Until now, periodontal disease and Parkinson's disease has been linked only on the basis of poor motor and cognitive control in Parkinson's patient which leads to poor oral health maintenance. Evidence now suggests that chronic neuroinflammation is consistently associated with the pathophysiology of Parkinson's disease. Also, recently, systemic inflammation has been suggested as one of the contributing factors for neurodegeneration. MATERIAL AND METHODS: Dental and medical literature especially those dealing with neurosciences were selected which highlighted the link between systemic inflammation and infection. RESULTS: So far there is no direct evidence implicating an effect of periodontitis in the pathogenesis of Parkinson's disease. To clarify this link, studies on population based case-control or cohort design are needed. This would be especially significant in the present era where there is paucity for preventive measures as far as a cognitive disorder such as Parkinson's disease is concerned. CONCLUSION: We cannot cure Parkinson's disease, but if in future this missing link is established, an attempt can be made to prevent it by tackling one of its possible contributors (periodontitis) for systemic inflammation by simple preventive oral hygiene measures.

Semilunar Coronally Advanced Flap with or without Low Level Laser Therapy in Treatment of Human Maxillary Multiple Adjacent Facial Gingival Recessions: A Clinical Study.

PURPOSE: Semilunar coronally advanced flap (SCAF) and its modifications or adjuncts have been proposed in the literature for root coverage. Low level laser therapy (LLLT) has been shown to enhance wound healing. The aim of this split-mouth randomized controlled clinical trial was to assess the effects of LLLT application with respect to root coverage after SCAF procedure for the treatment of human maxillary multiple adjacent facial gingival recessions. MATERIALS AND METHODS: Ten subjects with bilateral multiple adjacent maxillary facial gingival recession defects (Miller I and II) were included in this study (20 in test, 20 in control group). A diode laser (810 nm) at 0.3 watts was applied to test sites during and 1 week after surgery for 10 seconds. Comparisons of the surgical sites were made with clinical measurements. RESULTS: Statistically significant differences were observed between test and control sites in the change in gingival recession depth, gingival recession width, clinical attachment level, and width of the keratinized tissue measurements after 6 months (p = 0.003, p = 0.001, p = 0.006, and p =< 0.001, respectively). The test group presented significantly greater complete root coverage (N = 18/20, 90%) compared with the control group (N = 6/20, 30%) at 6 months post-operatively. CONCLUSION: Within the confines of this study, the results depicted that a Low Level Laser Technique application may enhance the predictability of SCAF procedure. Further long-term studies with more sample sizes are needed for a stronger evidence base. CLINICAL SIGNIFICANCE: Gingival recessions are commonly encountered in dentistry and pose an esthetic concern. Minimal gingival recessions can be treated by a Semilunar Coronally Advanced Flap (SCAF), but the predictability and stability of the outcomes are quiet questionable. In the present report, a Low Level Laser Technique (LLLT) application adjunct to SCAF depicted a significant improvement in the predictability and stability of root coverage outcomes (for a period of 6 months) compared with as achieved by SCAF alone. From this report, it can be stated that LLLT may be effectively used in a day to day practice for enhancing the root coverage outcomes of SCAF.

Levels of Myeloperoxidase and Alkaline Phosphatase in Periimplant Sulcus Fluid in Health and Disease and After Nonsurgical Therapy.

PURPOSE: The study evaluated 2 biomarkers (myeloperoxidase [MPO] and alkaline phosphatase) along with clinical parameters in periimplant sulcus fluid (PISF) in conditions of periimplant health and disease. The effect of nonsurgical therapy was also evaluated on the biochemical and clinical parameters in diseased implants at 3 months after the baseline. MATERIALS AND METHODS: A total number of 30 implants were studied in 20 subjects and divided into healthy group (group 1) and periimplant disease group (group 2). PISF was collected in both groups along with recording of clinical parameters. The periimplant disease group was then instituted a nonsurgical anti-infective therapy. The clinical and biochemical parameters were evaluated and compared at baseline and at the end of 3 months. RESULTS: Group 2 showed statistically significant higher PISF MPO values at baseline as compared with groups 1 and 2 (at 3 months) (P < 0.001). Also, difference in the mean value of PISF MPO in group 2 (at 3 months) was greater than that in group 1 and was statistically nonsignificant (P = 1.85). CONCLUSION: Within confines of the study, it can be concluded that evaluation of biochemical markers in PISF can be a useful diagnostic tool to aid the clinician in decision making regarding the management of the condition.

Oral Candida Carriage and Morphotype Differentiation in Chronic Periodontitis Patients with and without Diabetes in the Indian Sub-Continent.

The aim of this study was to assess the oral Candida carriage and morphotype differentiation of Candida species in chronic periodontitis patients, with and without diabetes mellitus. This cross sectional study included 30 subjects in the age range of 40-60 years, who were divided into two groups: 15 chronic periodontitis only (CP) patients, and 15 chronic periodontitis patients with diabetes (CPD). Clinical measurements included plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and fasting blood sugar level (FBS). The unstimulated whole saliva samples were collected for fungal analysis. Candida carriage was analyzed by measuring colony forming units (CFU) following the culture of samples. Qualitative morphotype differentiation of Candida species from yeast to hyphal form was analyzed using Periodic acid-Schiff (PAS) staining. There was no statistically significant difference between CP and CPD groups for the periodontal parameters. However, a significantly higher Candida species CFU count was found in CPD (0.33 ± 0.23) as compared to CP (0.05 ± 0.04) group. This pilot study suggests that the occurrence of Candida species is higher in the saliva of chronic periodontitis patients with diabetes as compared to patients with chronic periodontitis alone.

Evaluation of cortisol levels in gingival crevicular fluid and saliva in anxious and non-anxious patients with chronic periodontitis.

BACKGROUND: To evaluate gingival crevicular fluid (GCF) and salivary cortisol levels in anxious and non-anxious patients with chronic periodontitis. MATERIALS AND METHODS: A total of 45 patients with a mean age 43.4 ± 6.12 years were assigned to three groups: Healthy control group (Group 1), group with chronic periodontitis but no anxiety (Group 2) and group with chronic periodontitis and with anxiety (Group 3). State - Trait anxiety inventory and Hamilton Anxiety rating scale were used to assess the anxiety levels of all the subjects. Clinical measures such as plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were recorded. GCF and unstimulated whole saliva samples were collected, and cortisol levels were determined using ELISA kit. RESULTS: PI, GI, PPD, and CAL were higher in Group 3. Hormone level was significantly higher in Group 3. A positive correlation was found among salivary and GCF cortisol and CAL in Group 3. CONCLUSION: Based on the obtained results individuals with high-levels of anxiety seem to be more prone to have periodontal disease. Salivary and GCF cortisol levels can be used as biomarker for evaluating part of the etiopathogenesis of chronic periodontitis.