Periodontal Disease in Patients with Newly Diagnosed Systemic Lupus Erythematosus.

Statement of the Problem: Most of the studies assessing the relationship between systemic lupus erythematosus (SLE) and periodontal disorder are focused on patients with previously diagnosed SLE whose periodontal hygiene may be influenced by immunosuppressive therapies. Purpose: This study aimed to evaluate the frequency of periodontal disease among patients with newly diagnosed lupus before starting immunosuppressive therapy and its association with presenting laboratory and clinical symptoms of lupus. Materials and Method: This case-control cross-sectional study was conducted on 36 consecutive newly diagnosed SLE patients before starting any treatment. The control group consisted of first-degree relatives of the patients whose demographic and social characteristics matched with the patients and who had no personal history of a disease. Periodontal indices included community periodontal index (CPI) and plaque index (PI). Results: Participants in both groups had some degree of periodontal disorder. The mean value of CPI was 1.47±0.82 and 1.31±0.72 in SLE patients and healthy subjects (P=0.84), respectively. Moreover, the mean values of PI were 1.15±0.55 and 1.17±0.46 in SLE patients and controls, (P=0.37), respectively. Besides, the frequency of periodontal disorders based on CPI score (positive: higher than two) was 22.2% in SLE patients and 16.7% in controls (P=0.55). Moreover, there was no association between periodontal disease and lupus-related clinical and laboratory characteristics in our patients. Conclusion: The frequency of periodontal disorders is similar between newly diagnosed lupus patients without undergoing immunomodulatory therapies and healthy controls with the same demographic and social characteristics. Moreover, periodontitis was not associated with clinical and laboratory symptoms of our patients.

Evaluation of Cytotoxicity and Antimicrobial Activity of Experimental Composites Containing Chitosan-Silver Oxide Particles Against Two Main Pathogenic Bacteria in Periodontal Disease.

INTRODUCTION: Bacterial biofilm is known as the main cause of periodontal disease. Generally, the anaerobic Gram-negative, such as Porphyromonas gingivalis and Fusobacterium nucleatum, are considered the most identified bacteria. OBJECTIVE: This study aimed to investigate the antimicrobial effect and cytotoxicity of two experimental composites containing chitosan-silver oxide (CH-Ag2O) particles. MATERIALS AND METHODS: Four experimental groups, including Ag2O and CH, along with two composites of CH-Ag2O 20 and CH-Ag2O 60 mg, were prepared. Antimicrobial activity was performed against Porphyromonas gingivalis (ATCC#33277) and Fusobacterium nucleatum (ATCC#25586) using the agar dilution method. Moreover, the cytotoxicity assay was performed on human gingival fibroblasts (HGF) by the use of the MTT method. The obtained data were analyzed with descriptive methods, one-way ANOVA, and Tukey's LSD tests. RESULTS: The antibacterial activity of both composites was higher than both CH and Ag2O, and the greatest antibacterial properties were presented in CH-Ag2O 60. In all three measurements (24, 48, and 72h), the greatest cytotoxicity was seen in Ag2O, followed by CH, CH-Ag2O 20, and CH-Ag2O 60 in descending order, respectively. The cytotoxicity of these components was related to the concentration and not to the time of exposure. The results showed that Ag2O in 3.7 and 7.5 µg/ml concentrations and CH-containing groups in 250 and 500 µg/ml were toxic to the cultured HGF. CONCLUSION: The experimental composite containing CH-Ag2O 60 showed the greatest antibacterial properties against two periodontal pathogens evaluated. In order to clarify the clinical significance of composite cytotoxicity, further clinical studies are necessary.

Effect of Bone Grafting on Hard and Soft Tissue Changes Following Immediate Implant Installation in Mandibular Molar Sites: A Double-Blind Randomized Clinical Trial.

This study investigated the effect of bone grafting on hard and soft tissue alterations after immediate implant insertion in mandibular molar sites. This randomized, double-blind clinical trial consisted of 30 healthy patients (17 women and 13 men aged 22-58 years) who required immediate implant installation to replace a first or second mandibular molar. Only subjects with a buccal gap between 2 and 4 mm were selected. The participants were randomly allocated to two groups. In the experimental group, the gap was augmented by an allograft, whereas in the control group no graft was applied. Marginal bone level, probing depth, keratinized gingival width, and bleeding on probing were assessed at the time of implant placement (T0), 1 month (T1), and 3 months (T2) after surgery. There was no significant difference in hard and soft tissue parameters between the grafted and nongrafted sites at any of the durations (P < 0.05). Bone level decreased significantly in both groups (P < 0.05). However, the amount of probing depth and the frequency of cases showing bleeding on probing did not alter over the experiment either in the test or in the control group (P > 0.05). Bone grafting simultaneously with immediate implant installation had no significant effect on hard and soft tissue outcomes when the buccal gap size was between 2 and 4 mm. Therefore, the use of a bone substitute is not mandatory up to the jumping distance of 4 mm in immediate implant surgery.

Low level laser therapy, Er,Cr:YSGG laser and fluoride varnish for treatment of dentin hypersensitivity after periodontal surgery: A randomized clinical trial.

This clinical trial aimed to compare the effects of low-level laser therapy (LLLT), Er,Cr;YSGG laser, and fluoride varnish, as compared to the placebo laser on decreasing dentin hypersensitivity (DH). This randomized, double-blinded clinical trial included 60 jaw quadrants in 24 patients who underwent periodontal surgery. The quadrants were randomly assigned to 4 groups and received treatments as follows. Group 1: LLLT with a combination of red and infrared wavelengths, group 2: Er,Cr:YSGG laser (0.25 W and 0.5 W), group 3: fluoride varnish, and group 4: placebo laser. The sensitivity response to the cold spray was recorded using visual analogue scale (VAS) at baseline, immediately, and 1 week post-treatment. The data were analyzed by repeated measures analysis at the significance level of P<0.05. There was a significant reduction in DH after treatment by low-level lasers, Er,Cr:YSGG laser, or fluoride varnish compared to the baseline data (P<0.05), but the placebo group displayed no significant alteration in DH (P=0.069). At 1 week, the VAS score in the Er,Cr:YSGG laser group was significantly lower than that of the LLLT (P= 0.043) and placebo (P<0.001) groups. Furthermore, the subjects who received fluoride varnish exhibited significantly lower DH compared with the placebo group (P = 0.023). Er,Cr:YSGG laser was the most effective strategy in dealing with DH, as it caused the greatest pain reduction over the study period and showed a significant superiority over LLLT and placebo groups. Alternatively, the application of fluoride varnish could be recommended for attenuating DH following periodontal surgery.

Comparative evaluation of IL-17 and TGF-ß expression in tissues of patients with chronic periodontitis and healthy individuals using real-time PCR.

Background: The present study aimed to determine the association between periodontal disease and the Th17/Treg balance by examining the genetic expression of IL-17 and TGF-ß, which influence incidence and suppression of inflammation. Methods: In this case-control study, samples were collected in a randomized and task-oriented order. Thirty-seven patients referred to professional periodontology clinics in Mashhad and the Periodontology Department of the Mashhad Dentistry Faculty for periodontal (case) or crown-length (control) surgery was enrolled. IL-17 and TGF-ß gene expression indices were measured in tissue samples by real-time polymerase chain reaction. Results: The IL-17 gene expression index was higher in the case group (2.68±0.91) than in the control group (1.68±0.41), but this difference was not significant. The TGF-ß gene expression index was significantly higher in the case group (54.42±7.88) than in the control group (24.12±3.38). Conclusion: L-17 and TGF-ß expression is increased in chronic periodontitis patients, but TGF-ß plays a more important role in periodontal inflammation in patients with chronic periodontitis. Further studies of the roles of Th17 and Treg cells are warranted.

Relationship between periodontal variables and disease severity in patients with chronic obstructive pulmonary disease.

Background: The present study investigated the relationship between certain periodontal variables and severity of disease in COPD patients. Methods: The present cross-sectional study included 50 patients suffering from COPD. Lung function examination, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, SpO2, and Modified Medical Research Council (MMRC) Dyspnea Scale were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), gingival index (GI) and plaque index (PI). A quality of life validated index, the COPD assessment test (CAT index), was also calculated. Results: The FEV1 and FVC indices showed a significant negative correlation with PI and AL variables only. The COPD assessment test (CAT) index showed a significant but positive correlation with PI and AL variables only. The SpO2 index presented a significant negative correlation with GI and AL variables. The FEV1/FVC ratio was found to have a negative correlation with PD and AL variables. It is worth noting that MMRC exhibited no significant relationship with any of the periodontal variables. The only variable that was significantly different (P=0.022) among the three smoking groups was the FVC index. The FVC value was significantly higher in the group of subjects who smoked more than 10 cigarettes per day versus the non-smoking group (P=0.017). Conclusion: Based on the findings of this study, in view of the relationship between periodontal variables and respiratory indices in the course of COPD, early treatment of periodontal diseases, might considerably reduce the severity of COPD.

Relationship between BMI ≥25 and periodontal status: A case‒ control study.

Background: Obesity is an important subject in both developed and developing countries. Obesity is a risk factor for many diseases, including cardiovascular diseases, hypertension and osteoarthritis. Periodontitis is a prevalent, chronic disease and multiple factors have been proposed to contribute to its progression. we aimed to compare the periodontal status of normalweight and obese individuals. Methods: In this study, we consecutively selected 100 patients (50 obese and overweight as the case group, based on body mass index [BMI], and 50 others with normal weight, as the control group) referred to the Periodontology Department of Mashhad Dental School. The demographic data of the participants were recorded, including age, gender, height and weight. The following periodontal parameters were assessed: periodontal pocket depth (PPD), clinical attachment level (CAL) and plaque index. Kolmogorov-Smirnov test, chi-squared test and independent t-test, as well as ANCOVA, were used to analyze data. Results: We found that the mean PPD was similar in the test and control groups (P=0.168). Moreover, CAL was not significantly different between the two groups (P=0.494). Conclusion: Our findings indicated that obesity and overweight do not seem to have an association with periodontal parameters such as periodontal pocket depth and clinical attachment loss. Further research is needed to evaluate this relationship.

Effect of 1% Phenytoin Muco-Adhesive Paste on Improvement of Periodontal Status in Patients with Chronic Periodontitis: A Randomized Blinded Controlled Clinical Study.

STATEMENT OF THE PROBLEM: Phenytoin (PHT) has been known to promote wound healing in some medical conditions owing to its proliferative as well as anti-inflammatory effects. Yet, its application in oral lesions was less investigated. PURPOSE: The aim of this study was to evaluate changes in periodontal indices following the topical use of phenytoin in chronic periodontitis. MATERIALS AND METHOD: In this doubled-blind, randomized, split-mouth controlled clinical study, 20 patients with moderate to severe chronic periodontitis referred to Periodontology Department of Shahid Sadoughi Medical University of Yazd in 2014 were selected consecutively. After initial therapy (scaling and root planning and oral hygiene instructions), periodontal indices including bleeding on probing (BOP), periodontal pocket depth (PPD) and modified gingival index (MGI) were recorded. Gingival facial surface of two posterior sextants with at least two teeth with similar conditions, were selected randomly. Then one surface received PHT paste whereas the other side had placebo as control. Patients were received the mucoadhesive pastes under strict control by an examiner, twice a day for a week. Periodontal indices were measured 3 weeks after treatment. Data was analyzed with t-test and paired t-test by using SPSS 21 software. RESULTS: It was observed that periodontal pocket depth was significantly more decreased in phenytoin side in comparison with placebo one (p< 0.05). In addition, inflammatory indices including bleeding on probing and modified gingival index declined more in the phenytoin group (p= 0.001 and p< 0.05 respectively). CONCLUSION: These encouraging results support the use of 1% phenytoin mucoadhesive paste as an adjunctive in periodontal treatment.