Clinical effects of Lactobacillus reuteri probiotic in chronic periodontitis - a systematic review.

OBJECTIVE: This systematic review examines the effectiveness of Lactobacillus reuteri as an adjunct to scaling and root planing in the treatment of chronic periodontitis. MATERIALS AND METHODS: Scopus, PubMed, and Web of Science databases were searched according to specific inclusion and exclusion criteria in October 2022. Randomized control trials that evaluated the effects of Lactobacillus reuteri in patients with periodontitis were included. The primary outcome was pocket depth and clinical attachment levels, while the secondary outcome considered was bleeding on probing, microbial levels, and gingival index score. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool. RESULTS: A total of eleven studies that examined 369 subjects were included in the review. Adults in the age group of 18-70 years of age suffering from chronic periodontitis were evaluated. Eight out of the eleven studies reported statistically significant improvement in the intergroup pocket depths, whereas seven studies showed a statistically significant reduction in the clinical attachment levels in the probiotic group. Three studies showed no significant improvement in the pocket depth levels in the probiotic group as compared to the controls. Four studies showed no significant reduction in clinical attachment levels between the two groups. The overall risk of bias was high in four studies, while seven studies reported some concerns about the risk of bias. CONCLUSIONS: Based on the limited evidence available, the adjunctive use of Lactobacillus reuteri to scaling and root planing may provide some additional benefit in improving periodontal parameters.

Diode laser targeting red-complex bacteria in periodontitis: a systematic review.

OBJECTIVE: This systematic review examines the effectiveness of diode laser irradiation in reducing the levels of red complex bacteria as well as periodontal parameters of pocket depth and clinical attachment level. MATERIALS AND METHODS: We conducted electronic searches across databases such as Scopus, Embase, Medline, and Web of Science databases in July 2022. Randomized controlled trials that evaluated the reduction of red-complex bacteria in patients with periodontitis using diode lasers were included. The primary focus was the reduction in the microbial count of red complex bacteria, whereas probing depth and attachment level were considered secondary outcomes. Articles in languages other than English were excluded. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool. RESULTS: After searching the databases, eight independent studies were included, with a sample size of 210 subjects. The average age group of the study population was 30-60 years, and there was a lack of consensus on the antimicrobial effect of diode lasers. Out of the eight studies, four studies reported no significant difference in the levels of red complex bacteria before and after laser application. Three studies reported significantly lower levels of red complex bacteria in the intergroup comparison. One study reported that laser had no significant effect on intergroup bacterial levels. The combination of diode laser irradiation with scaling reduced the count of red complex bacteria and improved the clinical parameters, although not significantly. CONCLUSIONS: Based on the limited evidence available, the adjunctive use of diode laser for scaling and root planning may provide some additional benefit in terms of reduction of red complex bacterial count and clinical parameters. Further well-designed trials and the use of objective measures are necessary before outlining universal guidelines for best practice. The adjunctive use of diode laser in non-surgical periodontal therapy may provide a reduction in the red complex microbial count and improvement in clinical parameters, decreasing the need for periodontal surgery.

Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances.

OBJECTIVES: The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances. PATIENTS AND METHODS: The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels. RESULTS: Interleukin (IL)-1α, 1ß, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1ß, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1ß were increased higher than other cytokines in both the treatment groups. CONCLUSION: Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

Effects of periodontal disease on systemic health.

About one in two adults in the United States has periodontal disease. Chronic periodontitis is an oral disease affecting the supporting structures of the teeth leading to progressive loss of the attachment apparatus and bone around teeth. It is characterized by gingival pocket formation and/or gingival recession. The disease is initiated by bacteria and their components like lipopolysaccharide and causes a heightened host inflammatory response. This cascade of inflammatory response ultimately leads to an increased osteoclastic activity and bone loss. Individuals with periodontitis have increased systemic levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as INF- gamma (Interferon gamma), TNF-α (Tumor necrosis Factor- Alpha), IL (Interleukin)-1ß, IL-2 and IL-6. As periodontitis works on the same chronic inflammation model seen in systemic diseases, there is sufficient evidence to suggest a bi-directional link between the two. This article summarizes the established associations between periodontal disease and systemic health.

Role of Dental Profession in Oral Cancer Prevention and Diagnosis.

The incidence of oral cancer is increasing worldwide. Malignant neoplasms of the mouth and pharynx have been rated as the 10th most common cancer in men and 7th in women, though geographical variations exist.1Generally, in a society, oral cancer is not properly understood. The sign and symptoms are frequently overlooked in the initial stages when it is responsive to treat.

Waterpipe smoking among health sciences university students: Knowledge, attitude and patterns of use.

INTRODUCTION: Although waterpipe smoking is common in Gulf counties, its prevalence in Saudi Arabia is uncertain. The purposes of this study were (a) to assess the prevalence of waterpipe smoking among healthcare university students in Saudi Arabia and (b) to determine their attitudes and practices of waterpipe smoking. MATERIALS AND METHODS: A cross-sectional survey was conducted among university students of three different health sciences colleges, namely medical, dental, and pharmacy, of a public university, through random cluster sampling. The questionnaire was designed to ask specific questions related to smoking in general and to waterpipe smoking specifically. The study was approved by the institutional research & ethics committees. RESULTS: A total of 535 participants were included in the study. More than one-third of the participants that reported having ever smoked a waterpipe (n = 198, 37%), and the majority of these were current smokers (62.1%, n = 123); dental students were the most common (45.5%, n = 90). Curiosity and pleasure-seeking were the main factors associated with starting waterpipe smoking. About one-sixth (14.9%, n = 80) of the participants failed to identify a single harmful effect, while a vast majority of participants considered waterpipe smoking to be less unhealthy than cigarette smoking. CONCLUSION: Waterpipe smoking is very popular among Saudi university students, and knowledge among university students about the dangers of waterpipe smoking is alarmingly low.

Assessing the Risk of Oral Cancer associated with Gutka and Other Smokeless Tobacco Products: A Case-control Study.

INTRODUCTION: Tobacco and tobacco-related products have been attributed to be causative factors for oral cancer. Newer, chewable, and commercially available smokeless tobacco (ST) products, such as gutka pose further threat in this direction. The aim of the study was to evaluate the risk of oral cancer associated with gutka and other ST products. MATERIALS AND METHODS: A case-control study of 134 cases and 134 controls, over a period of 6 months (July-December 2014), was carried out at the Baqai University, Karachi, Pakistan. An interview-based questionnaire was used to collect data on sociodemographic characteristics, oral hygiene practices and type, duration, and frequency of use of tobacco-related products. Data were analyzed using the Pearson's chi-square (χ2) test with the level of significance set as p < 0.05. RESULTS: Gutka showed the highest odds ratio toward developing oral cancer ratio among all the tobacco-related products [odds ratio (OR) 5.54; 95% CI 2.83-10.83; p < 0.001)]. Participants who consumed other ST products also showed 2 to 4 times higher odds ratio of developing oral cancer than compared to those who did not consume these products. CONCLUSION: The study provided strong evidence that gutka and other ST products are independent risk factors for oral cancer. CLINICAL SIGNIFICANCE: This study highlights the strong association of different types of ST and oral cancer. This results in identification of high-risk groups for targeted screening for potential oral cancer lesions.

Experimentation and correlates of electronic nicotine delivery system (electronic cigarettes) among university students - A cross sectional study.

OBJECTIVE: E-cigarettes are becoming popular among youth as safe nicotine delivery systems. Many have expressed concern, however, that e-cigarettes may serve as a gateway to future smoking, given their low perceived risk, or that their use may prevent regular smokers from quitting by maintaining their nicotine addiction. The aim of this study was to assess experimentation with and correlates of e-cigarette use among university students. MATERIAL AND METHODS: A cross-sectional study was carried out among 480 university students from four faculties at a university in Riyadh in August-October 2014. A modified version of the World Health Organization's Global Adult Tobacco Survey was used, and multinomial logistic regression was carried out to assess correlations with e-cigarette variables in the whole study sample and among smokers. RESULTS: Almost all students, including the majority of ex-smokers (96.3%) and smokers (94.4%), reported having heard about e-cigarettes. In addition, about one-quarter of the sample (54.2% of smokers, 24.7% of ex-smokers, 6% of never smokers) had experimented with e-cigarettes at least once during their lifetime. Curiosity and peer influence were reported as the main reasons for the use of e-cigarettes. Factors found to be correlated significantly with e-cigarette use were male gender, being a traditional cigarette smoker, having friends who have tried e-cigarettes, and having a strong belief that e-cigarettes could aid smoking cessation. CONCLUSION: E-cigarettes are popular among Saudi youth, especially among smokers and ex-smokers. Well-designed health education programs and regulatory interventions are required to address this issue.

Knowledge, perceptions, and attitudes of dental students towards obesity.

AIMS: Obesity is a chronic medical condition associated with various oral health problems. The aim of this study was to assess the knowledge, perceptions, and attitudes of dental students towards obesity. MATERIAL AND METHODS: Second-, third-, and fourth-year dental students completed a self-administered questionnaire. An ethics committee approved the study. Participants were asked questions focused on three areas: (i) knowledge, (ii) perceptions, and (iii) attitudes about obesity. Data analyses were carried out using SPSS version 20. RESULTS: Among the dental students, 78.9% received 0-1 h of formal education about obesity. The mean score of the total time allocated for obesity-related education was 1.31 ± 0.23 h. Eighty-nine percent of the dental students agreed that obesity is a chronic medical condition, 30% agreed that they would modify their equipment and office furniture to accommodate obese patients, and 46.8% were interested in learning more about obesity in dental school. CONCLUSION: Obesity-related education should be implemented as a formal component of dental student training. Oral health practitioners should also provide their patients with information about how weight loss is beneficial to both general and oral health.

Knowledge and attitude of tobacco use and cessation among dental professionals.

AIM: Smoking is the one of the most preventable causes of death worldwide. Dental professionals may play an important role in anti-smoking campaigns. The aim of this study was to evaluate current knowledge of and attitudes toward smoking and its cessation among dental professionals. MATERIALS AND METHODS: This questionnaire-based study was carried out among general dental practitioners (GDPs) and dental students in Saudi Arabia. The questionnaire was used to collect data on sociodemographic characteristics, knowledge, and attitudes toward tobacco use and cessation. Data were analyzed using SPSS software (version 18.0; IBM) and the Mann-Whitney U-test, with a significance level of p < 0.001. RESULTS: A total of 342 participants (130 GDPs, 212 dental students) with the mean age of 24 (standard deviation, 5) years participated in the study. One-third (33.8%, n = 44) of GDPs and 30.2% (n = 64) of dental students were smokers; small percentages (GDPs, 9.1% [n = 4]; dental students, 7.8% [n = 5]) were heavy smokers. The majority of participants rated both smoking cessation and prevention together as a very important preventive measure. Families were rated as the most important factor responsible for smoking cessation, whereas general practitioners were rated as the most important factor for providing assistance with cessation. CONCLUSION: More meaningful participation of dental professionals in tobacco cessation is needed, with implications for related curriculum changes.

Assessing the accuracy of autofluorescence, chemiluminescence and toluidine blue as diagnostic tools for oral potentially malignant disorders--a clinicopathological evaluation.

OBJECTIVES: Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders. MATERIALS AND METHODS: A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia. RESULTS: Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively. CONCLUSION: While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity. CLINICAL RELEVANCE: These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.

Utility of chemiluminescence (ViziLite™) in the detection of oral potentially malignant disorders and benign keratoses.

BACKGROUND: Oral potentially malignant disorders (OPMD) are known to precede the development of oral cancer. Detection of OPMD allows delivery of interventions that may reduce the evolution of these disorders to malignancy. Following oral examinations, the accuracy of detection of OPMD by chemiluminescence was evaluated using a commercially available detection kit - ViziLite. Data derived were compared in relation to conventional oral examination and surgical biopsy. METHODS: A total of 126 patients, 70 men and 56 women (mean age 58.5 ± 11.9 years) attending Oral Medicine Clinics at King's and Guy's Hospitals, London, with oral white, red, and mixed white and red patches were enrolled. Sixty-one patients were current smokers, 28 were ex-smokers, while 92 were alcohol users. In a detailed investigation, these patients underwent ViziLite examination followed by surgical biopsy. RESULTS: Based on the clinical diagnosis, 70 patients had oral leukoplakia/erythroplakia, 32 had oral lichen planus, nine had chronic hyperplastic candidiasis, and rest had frictional keratosis (13) or oral submucous fibrosis (2). Of 126 lesions, 95 (75.4%) showed aceto-whitening. Most oral leukoplakias had enhanced visibility and sharpness of the lesion when viewed with the ViziLite system. Following biopsy, 44 had oral epithelial dysplasia (29 mild, eight moderate, and seven severe). The sensitivity (se) and specificity (sp) of chemiluminescence for the detection of a dysplastic lesion were 77.3% and 27.8%, respectively. CONCLUSION: While ViziLite has the ability to detect OPMD, it does not accurately delineate dysplastic lesions. The device can be used as a general oral mucosal examination system and may in particular improve the visualization of leukoplakias.

Evaluation of an autofluorescence based imaging system (VELscope™) in the detection of oral potentially malignant disorders and benign keratoses.

Early detection of oral cancer is crucial in improving survival rate. Identification and detection of oral potentially malignant disorders (OPMD) allow delivery of interventions to reduce the evolution of these disorders to malignancy. A variety of new and emerging diagnostic aids and adjunctive techniques are currently available to potentially assist in the detection of OPMD. The objective of the present study was to evaluate the accuracy of autofluorescence against conventional oral examination and surgical biopsy. A total of 126 patients, 70 males and 56 females (mean age 58.5±11.9 years) who presented to the Oral Medicine Clinics at King's and Guy's Hospitals, London with oral white and red patches suspicious of OPMD were enrolled. Following a complete visual and autofluorescence examination, all underwent an incisional biopsy for histopathological assessment. Seventy patients had oral leukoplakia/erythroplakia, 32 had oral lichen planus, 9 chronic hyperplastic candidiasis and rest frictional keratosis (13) or oral submucous fibrosis (2). Of 126 lesions, 105 (83%) showed loss of fluorescence. Following biopsy 44 had oral epithelial dysplasia (29 mild, 8 moderate and 7 severe). The sensitivity (se) and specificity (sp) of autofluorescence for the detection of a dysplastic lesion was 84.1% and 15.3% respectively. While VELscope was useful in confirming the presence of oral leukoplakia and erythroplakia and other oral mucosal disorders, the device was unable to discriminate high-risk from low-risk lesions.