COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes.

OBJECTIVES: To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS: A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS: A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION: Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE: Level 4.

Human chemerin correlation in gingival crevicular fluid and tear fluid as markers of inflammation in chronic periodontitis and type-2 diabetes mellitus.

AIM: The aim of the present study was to evaluate the levels and correlation of human chemerin in gingival crevicular fluid (GCF) and tear fluid in chronic periodontitis (CP) subjects with and without type-2 diabetes mellitus (DM). MATERIALS AND METHODS: A total of 40 subjects were divided into three groups: group 1 had 10 periodontally healthy subjects; group 2 consisted of 15 CP subjects and group 3 had 15 type-2 DM subjects with CP. The GCF and tear fluid levels of human chemerin were quantified using enzyme linked immunosorbent assay (ELISA). Systemic parameters such as body mass index, glycated hemoglobin levels and fasting plasma glucose levels were evaluated. The clinical outcomes evaluated were gingival index (GI), probing depth (PD), and clinical attachment level (CAL), and the correlations of the two inflammatory mediators with clinical parameters were evaluated. RESULTS: Human chemerin levels increased from group 1 to group 2 to group 3. The GCF and tear-fluid values of the inflammatory mediators correlated positively with each other and with the evaluated periodontal parameters (P < 0.05). CONCLUSION: Human chemerin can be considered as possible GCF and tear-fluid markers of inflammatory activity in CP and DM.

Efficacy of locally-delivered 1% metformin gel in the treatment of intrabony defects in patients with chronic periodontitis: a randomized, controlled clinical trial.

OBJECTIVE: Metformin (MF), used for the treatment of type 2 diabetes mellitus, has shown to possess properties favoring osteoblastic proliferation. The present study was designed to investigate the effectiveness of MF 1% gel as an adjunct to scaling and root planing in the treatment of intrabony defects in patients with chronic periodontitis. METHODS: The study comprised 65 individuals divided into two groups: 1% MF with SRP and placebo gel with SRP. Clinical parameters were evaluated at baseline, 3 months, and 6 months; they included plaque index, modified sulcus bleeding index, probing depth (PD), and clinical attachment level (CAL). Intrabony defect depth (IBD) was evaluated at the end of 6 months using computer-aided software. RESULTS: The mean PD reduction, CAL gain, and IBD depth reduction were found to be greater in the MF group than in the placebo group at all visits. The percentage of defect depth reduction was significantly greater in the MF group (26.8 ± 5.52%) than in the placebo sites (4.79 ± 2.30%, P < 0.001). CONCLUSION: One percent MF was found to significantly improve clinical and radiographic parameters in intrabony defects in patients with chronic periodontitis.

Expression of key executioner of apoptosis caspase-3 in periodontal health and disease.

AIM: A highly-regulated form of programmed cell death is apoptosis, and its perturbation has been associated with periodontal disease. Caspase-3 is one of the key executioners of apoptosis. The present study was designed to evaluate and correlate the levels of caspase-3 in gingival crevicular fluid (GCF) and serum in participants with clinically-healthy periodontium, gingivitis, and chronic periodontitis (CP). METHODS: Forty-four sex- and age-matched participants were enrolled into three groups based on clinical parameters. Group 1 participants had clinically-healthy periodontium, group 2 participants had gingivitis, and group 3 participants had CP. GCF and serum samples were collected to evaluate the levels of caspase-3. RESULTS: The mean caspase-3 concentration in GCF and serum was highest in group 3, followed by group 2, and was significantly correlated with gingival index, probing depth (PD), and clinical attachment level (CAL). CONCLUSION: GCF and the serum concentration of caspase-3 proportionally increases with the progression of periodontal disease, that is, gingival inflammation, PD, and CAL.

Adjunctive Local Delivery of Aloe Vera Gel in Patients With Type 2 Diabetes and Chronic Periodontitis: A Randomized, Controlled Clinical Trial.

BACKGROUND: Herbal agents such as Aloe vera (AV) have been used in medical and dental therapy for thousands of years. AV has anti-inflammatory, antioxidant, antimicrobial, hypoglycemic, healing-promoting, and immune-boosting properties. This study aims to investigate the clinical effectiveness of locally delivered AV gel used as an adjunct to scaling and root planing (SRP) in the treatment of patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP). METHODS: Sixty patients with probing depth (PD) ≥ 5 mm and clinical attachment level (CAL) ≥ 3 mm were randomly divided into two groups. All patients underwent SRP. Placebo gel was locally delivered to group 1 and AV gel to group 2. Full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), PD, and CAL were recorded at baseline and 3 and 6 months. RESULTS: Patients in group 2 showed significantly greater mean reductions in PI, mSBI, and PD and mean gain in CAL compared with those in group 1 from baseline to 3 months. Gain in CAL was significantly greater in group 2 at all time intervals versus group 1. CONCLUSION: Adjunctive use of locally delivered AV gel, in comparison to locally delivered placebo gel, is associated with greater reduction in PI, mSBI, and PD as well as more gain in CAL in patients with T2DM and CP.

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet-Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial.

BACKGROUND: A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second-generation, sulfur-containing, hydrophilic statin with potent anti-inflammatory and osseodifferentiation mechanisms of action. Platelet-rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double-masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open-flap debridement (OFD). METHODS: One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). CONCLUSIONS: Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.

Clinical evaluation of the periodontal health condition and oral health awareness in Parkinson's disease patients.

OBJECTIVE AND BACKGROUND: The objectives were to compare periodontal status between subjects with and without Parkinson's disease (PKD) to determine the influence of PKD on periodontal disease. This study was conducted to evaluate the relationship of periodontal status with severity of PKD. MATERIALS AND METHODS: This study was conducted on 45 subjects with PKD (subjects with PKD were divided into 5 groups from group 2 to group 6 according to Hoehn and Yahr stages) and 46 control subjects (group 1). Probing depth (PD), clinical attachment level (CAL), gingival index (GI), plaque index (PI) and percentage of bleeding sites (%BoP) were evaluated. All subjects were interviewed regarding their practice of oral hygiene and access to professional dental care. RESULTS: There were statistically significant differences in PD, CAL, GI, PI and %BoP in subjects with PKD and controls (p < 0.001). All the evaluated periodontal clinical parameters and indices deteriorate with increase in severity of PKD. The mean PD value increased from 2.75 mm for group 1 to 6.17 mm for group 6, and mean CAL value increased from 3.14 mm for group 1 to 6.74 mm for group 6. The mean GI, PI and %BoP values increased from 0.55, 1.35 and 20.37 to 2.66, 3.80 and 70.86, respectively with increasing severity of PKD. CONCLUSION: There is a need for dental care and encouragement to use plaque control methods for subjects with PKD as periodontal pathology presented a high prevalence even in the early stages of PKD.

Periodontal health condition in patients with Alzheimer's disease.

OBJECTIVE: To compare periodontal health status in individuals with and without Alzheimer's disease (AD). METHODS: A total of 58 individuals with AD and 60 cognitively normal (ND) adult individuals, ranging in age from 50 to 80 years, were assessed for periodontal health status. Individuals with AD were further divided as mild, moderate, and severe, based on degree of cognitive impairment as evaluated using Mini-Mental State Examination. Gingival index (GI), plaque index (PI), probing depth (PD), clinical attachment level (CAL), and percentage of bleeding sites (%BOP) were evaluated. RESULTS: All the evaluated periodontal parameters were higher in individuals with AD than that in ND individuals, and the periodontal status deteriorated with the progression of AD. There were significant differences in mean GI, PI, PD, CAL, and %BOP between all the groups. CONCLUSION: The periodontal health status of individuals with AD deteriorates with disease progression and was closely related to their cognitive function.

Correlation of human S100A12 (EN-RAGE) and high-sensitivity C-reactive protein as gingival crevicular fluid and serum markers of inflammation in chronic periodontitis and type 2 diabetes.

OBJECTIVE: The aim of the present study was to evaluate the levels and correlation of human S100A12 and high-sensitivity C-reactive protein (hs-CRP) in gingival crevicular fluid (GCF) and serum in chronic periodontitis (CP) subjects with and without type 2 diabetes mellitus (DM). MATERIALS AND METHODS: A total of 44 subjects were divided into three groups: group 1 had 10 periodontally healthy subjects, group 2 consisted of 17 CP subjects and group 3 had 17 type 2 DM subjects with CP. GCF and serum levels of human S100A12 and hs-CRP were quantified using enzyme-linked immunosorbent assay and immunoturbidimetric analysis, respectively. The clinical outcomes evaluated were gingival index, probing depth and clinical attachment level and the correlations of the two inflammatory mediators with clinical parameters were evaluated. RESULTS: Both human S100A12 and hs-CRP levels increased from group 1 to group 2 to group 3. The GCF and serum values of both these inflammatory mediators correlated positively with each other and with the periodontal parameters evaluated (p < 0.05). CONCLUSION: Human S100A12 and hs-CRP can be considered as possible GCF and serum markers of inflammatory activity in CP and DM.

Association of metabolic syndrome and periodontal disease in an Indian population.

BACKGROUND: Metabolic syndrome, the whole of interconnected factors, presents with local manifestation, such as periodontitis, related by a common factor known as oxidative stress. The aim of the present study was to assess the association between metabolic syndrome and periodontal disease in an Indian population. METHODS: Clinical criteria for metabolic syndrome included 1) abdominal obesity; 2) increased triglycerides; 3) decreased high-density lipoprotein cholesterol; 4) hypertension or current use of hypertension medication; and 5) high fasting plasma glucose. Serum C-reactive protein (CRP) levels were also measured. Periodontal parameters including gingival index (GI) average and deepest probing depth (PD) and clinical attachment level (CAL) were recorded on randomly selected quadrants, one maxillary and one mandibular. Based on the presence or absence of metabolic syndrome, individuals were divided into two groups. RESULTS: The periodontal parameters PD, CAL and GI differed significantly between the two groups. The GI values in Group 1 (2.06 ± 0.57) were greater than in Group 2 (1.79 ± 0.66; p = 0.0025). Similarly PD and CAL values in Group 1 (4.58 ± 1.69 and 2.63 ± 1.61 mm) were significantly greater (p < 0.001) than in Group 2 (3.59 ± 1.61 and 1.61 ± 1.40 mm, respectively). Also, three metabolic components and serum CRP correlated with average PD, and the strength of the correlation was medium in Group 1 as compared to Group 2, in which it was weak. CONCLUSION: The association between metabolic syndrome and periodontal disease was significant, and abdominal obesity appeared to be the most important contributing metabolic factor to periodontal disease.

Association of serum and crevicular visfatin levels in periodontal health and disease with type 2 diabetes mellitus.

BACKGROUND: Levels of visfatin in serum and gingival crevicular fluid (GCF) were explored in patients with periodontal health, periodontal disease with and without type 2 diabetes mellitus (t2 DM) and were found to be elevated with periodontal disease, and were correlated with periodontal clinical parameters. DM and chronic periodontitis (CP) are associated with each other. Adipokines, specifically visfatin, are secreted from adipocytes and are thought to cause insulin resistance. The purpose of this study is to determine the presence of visfatin in serum and GCF in t2 DM among individuals with CP and to find an association, if any. METHODS: Thirty individuals (15 males and 15 females) were selected based on their clinical parameters into three groups: group 1 (10 healthy), group 2 (10 well-controlled t2 DM among individuals with CP), and group 3 (10 individuals with CP and without diabetes). Serum and GCF samples were collected to estimate the levels of visfatin using enzyme linked immunosorbent assay. RESULTS: The mean visfatin concentration increased in both serum and GCF in individuals with t2 DM with CP. Also, it was observed that visfatin in both serum and GCF correlated positively with all the periodontal parameters. CONCLUSIONS: All the samples in each group tested positive for visfatin assay. Serum and GCF visfatin concentration in both t2 DM with CP and individuals with CP and without diabetes correlated positively with all the clinical parameters. Additional large-scale longitudinal studies should be performed to confirm positive correlations.

Pemphigus vulgaris: effects on periodontal health.

Increasing evidence indicates that systemic conditions are risk factors of periodontitis. Pemphigus is a group of bullous diseases affecting the oral cavity. The aim of this study was to assess the periodontal status of pemphigus vulgaris (PV) patients. The periodontal status of 50 PV patients and 50 healthy subjects was assessed by a single examiner. PV patients were assessed based on the Clinical Severity Score (CSS). Periodontal clinical parameters such as plaque score, full mouth gingival bleeding score, probing depth (PD), clinical attachment level (CAL) and radiological bone loss were recorded. Effects of age, gender, daily tooth brushing habit, oral lesions and treatment duration on the periodontal status of PV patients were also determined. A statistically significant difference was found between the PV group and the healthy group with respect to the plaque score, PD and CAL (P < 0.05). Logistic regression analysis confirmed that age, gender, and treatment did not significantly influence clinical severity of the disease (P > 0.05). Increased PD and CAL were found with an increase in the CSS. The poor periodontal status in PV patients suggests that PV may be involved in the initiation or progression of periodontitis.

Serum levels of oncostatin M (a gp 130 cytokine): an inflammatory biomarker in periodontal disease.

OBJECTIVE: Periodontitis is considered to be a risk factor for systemic diseases such as atherosclerosis, diabetes, etc., and cytokines play a key role. The present study was carried out to measure the level of serum oncostatin M (OSM) in patients with chronic periodontitis, and to evaluate the effect of non-surgical periodontal therapy on the serum OSM concentration. MATERIALS AND METHODS: Sixty subjects were divided into three groups (each group n = 20) based on the gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL): group I healthy; group II gingivitis; and group III chronic periodontitis. Group III patients were followed for 8 weeks after non-surgical periodontal therapy as the after-treatment group (group IV). Estimation of serum OSM was done using an enzyme-linked immunosorbent assay. RESULTS: The mean OSM concentrations in serum were highest in the chronic periodontitis group (mean 68.05 pg ml(-1)) and decreased following treatment (39.65 pg ml(-1)) while OSM was undetectable in healthy subjects or in patients with gingivitis. CONCLUSION: Increased serum OSM concentration in patients with chronic periodontitis and its positive correlation with PPD and CAL, suggest its role as an inflammatory biomarker in periodontal disease and it may exaggerate other systemic conditions such as atherosclerosis and rheumatoid arthritis.

Gingival crevicular fluid levels of oncostatin M in periodontal conditions.

OBJECTIVE: The initial study has reported the increased level of oncostatin M (OSM) in gingival crevicular fluid (GCF) of chronic periodontitis patients, and no study has reported its level in gingivitis patients. Therefore, the present study has been carried out to measure the level of OSM in gingival crevicular fluid of gingivitis and chronic periodontitis patients and effect of periodontal therapy on OSM concentration in GCF of chronic periodontitis patients. DESIGN: A total of 60 subjects were divided into three groups (n=20) based on gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL): healthy (group I), gingivitis (group II) and chronic periodontitis (group III). A fourth group (group IV) consisted of 20 subjects from group III, 8 weeks after treatment i.e. scaling and root planning (SRP). GCF samples were collected from all the groups to estimate the levels of OSM using Enzyme-Linked ImmunoSorbentAssay (ELISA). RESULT: The mean OSM concentrations in GCF was found to be the highest in group III i.e. 0.81+/-0.33 pg/microl. The mean OSM concentration in group I was 0.0689+/-0.022 pg/microl in GCF and in group IV it was 0.0943+/-0.037 g/microl). For group II the mean OSM concentration in GCF 0.125+/-0.023 pg/microl, was fell in between the concentrations obtained in groups I and III. CONCLUSIONS: The greater the amount of periodontal tissue destruction there is substantial increase in GCF OSM concentrations. Since, OSM levels are positively correlated with PPD and CAL, it can be considered as an inflammatory biomarker in periodontal diseases.