Real-World Glycemic Outcomes with Early Omnipod 5 Use in Youth with Type 1 Diabetes.

Background: Pivotal trials of diabetes technologies have demonstrated glycemic improvements; however, these trials include patients of limited diversity and ranges of glycemic control. We assessed changes in glycemic control during the first 90 days of Omnipod 5 use in a real-world cohort of youth with type 1 diabetes (T1D). Methods: Youth 2-21 years with T1D initiating Omnipod 5 at two pediatric academic centers were included. Fourteen days of baseline (BL) continuous glucose monitoring (CGM) data were compared against data from the first 90 days of Omnipod 5 use. Outcome measures included changes in time in range (TIR), hemoglobin A1c (HbA1c), and CGM and insulin pump metrics based on the duration of Omnipod 5 use. Results: Among 195 youth (78.9% non-Hispanic White, 15.4% publicly insured, age 11.7 years, T1D duration 3.3 years) TIR increased 11%-points, from 49% to 61% (P < 0.001), and HbA1c decreased 0.5%-points, from 7.5% to 6.9% (P < 0.001). TIR improved within the first 9 days of Omnipod 5 use (p < 0.001) and did not change significantly thereafter (P = 0.1) despite decreases in user-initiated boluses (5.1 vs. 5.0, P = 0.01) and carbohydrate entries (4.2 vs. 4.1, P = 0.005) from days 1-9 to days 1-90. TIR improved 15%-points among youth with BL TIR <60% compared to a 5%-point increase for youth with BL TIR ≥60% (P < 0.001). Conclusions: Glycemic control improved within 9 days of Omnipod 5 initiation in this real-world cohort, and improvements were sustained over the first 90 days of use despite concomitant decreases in user-initiated boluses. These improvements were comparable to those observed in the pivotal trial.

Comparative Evaluation of Fibrin Network Formation after Root Conditioning using Erbium, Chromium-Doped Yttrium Scandium Gallium and Garnet Laser, Ethylene-Diamine-Tetra-Acetic Acid, and Tetracycline on Dentin: A Scanning Electron Microscopic Study.

Context: Regeneration of periodontal tissues depend on the adhesion and development of fibrin clots to the root surface. Demineralization of the root surface ensures removal of smear layer uncovering dentin tubules and collagen matrix. Root conditioning agents were introduced to remove the smear layer and enhance the adhesion of blood components. Aims: The aim of the study was to determine the effect of erbium, chromium-doped yttrium, scandium, gallium and garnet (Er, Cr: YSGG) laser on smear layer removal (SLR) and fibrin network formation when compared to tetracycline, and ethylene-diamine-tetra-acetic acid (EDTA) for periodontal regeneration. Settings and Design: The study was conducted at Amrita school of dentistry and the study design involves in vitro comparative study. Subjects and Methods: Forty dentinal sections were prepared from freshly extracted teeth that were periodontally affected. The samples were divided into four groups: Scaling and root planing (SRP), tetracycline, EDTA, and Er, Cr: YSGG laser. The samples were assessed using a scanning electron microscope and photomicrographs were taken and analyzed for removal of smear layer, blood component adhesion (BCA), and fibrin network formation. Statistical Analysis Used: Analysis of variance test and Kruskal-Wallis test with P < 0.05 considered to be statistically significant. Results: There was a significant difference between Er, Cr: YSGG laser, tetracycline hydrochloride, and EDTA categories when compared with SRP categories. There was no significant difference between Er, Cr: YSGG laser, tetracycline, and EDTA according to SLR scoring and BCA scoring. Conclusions: It can be concluded that Er, Cr: YSGG laser-treated samples presented complete elimination of smear layer, formation of fibrin network, and BCA along with desensitizing effect for a better reduction in dentin hypersensitivity.

Periodontal Approaches to Esthetic Dentistry: A Review on Current Trends.

AIM: Thepresent review is to discuss the current trends in periodontal approaches for improving the esthetics in dentistry. BACKGROUND: Esthetics is an essential component of today's dental care. A growing awareness of esthetics has fueled an increase in esthetic demand in dentistry in recent years. The ultimate goal in modern dentistry is to attain "white and pink esthetics" in the esthetically important zone Review results: Current evidence-based periodontal approaches for improving esthetic dentistry are discussed. The periodontal management of esthetics is mainly focused on proper assessment of the case scenario including the associated mucogingival deformities and selection of a proper technique for the correction of the same. CLINICAL SIGNIFICANCE: There is drastic increase in esthetic demand for the dental procedures in recent years. With the evolution of innovative techniques, clinicians can fulfill the patient's esthetic demands. Thus it is important to be updated in this field about the current innovative approaches. CONCLUSION: Newer procedures are being developed all the time and are gradually being integrated into periodontal practice. The practitioner should be mindful that novel approaches are sometimes presented without appropriate clinical research. Our ongoing progress toward better therapeutic approaches should be guided by critical analysis of freshly offered methodologies.

Effectiveness of ginger on pain following periodontal surgery - A randomized cross-over clinical trial.

BACKGROUND: Ibuprofen is one of the generally prescribed Non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain after periodontal surgery, but are contraindicated in certain patients. Ginger, which is the rhizome of Zingiber officinale, being a common herbal drug having anti-inflammatory as well as analgesic activities can be an efficient substitute for synthetic agents like Ibuprofen. OBJECTIVES: To compare the effectiveness of ibuprofen and dried ginger powder on pain and gingival inflammation following open flap debridement. MATERIALS AND METHODS: Ten systemically healthy individuals with chronic generalized periodontitis were selected for this single-blinded randomized cross-over clinical trial and underwent open flap debridement in at least two quadrants. Each quadrant was randomly allocated to receive either Ibuprofen (400 mg) or Ginger powder capsules (400 mg) thrice daily for three days. Subjects were requested to note down the pain score on the Visual Analogue Scale (VAS) provided in a printed format, for the first eight hours after surgery and on the following two days, and gingival inflammation was assessed after one week, using Modified Gingival Index (MGI). RESULT: The difference in the VAS score and MGI between the two groups was not of statistical significance. CONCLUSION: Effectiveness of ginger powder for the management of pain and gingival inflammation following open flap debridement is comparable to that of ibuprofen.

Inhibition of the facilitative sugar transporters (GLUTs) by tea extracts and catechins.

Tea polyphenolics have been suggested to possess blood glucose lowering properties by inhibiting sugar transporters in the small intestine and improving insulin sensitivity. In this report, we studied the effects of teas and tea catechins on the small intestinal sugar transporters, SGLT1 and GLUTs (GLUT1, 2 and 5). Green tea extract (GT), oolong tea extract (OT), and black tea extract (BT) inhibited glucose uptake into the intestinal Caco-2 cells with GT being the most potent inhibitor (IC50 : 0.077 mg/mL), followed by OT (IC50 : 0.136 mg/mL) and BT (IC50 : 0.56 mg/mL). GT and OT inhibition of glucose uptake was partial non-competitive, with an inhibitor constant (Ki ) = 0.0317 and 0.0571 mg/mL, respectively, whereas BT was pure non-competitive, Ki  = 0.36 mg/mL. Oocytes injected to express small intestinal GLUTs were inhibited by teas, but SGLT1 was not. Furthermore, catechins present in teas were the predominant inhibitor of glucose uptake into Caco-2 cells, and gallated catechins the most potent: CG > ECG > EGCG ≥ GCG when compared to the non-gallated catechins (C, EC, GC, and EGC). In Caco-2 cells, individual tea catechins reduced the SGLT1 gene, but not protein expression levels. In contrast, GLUT2 gene and protein expression levels were reduced after 2 hours exposure to catechins but increased after 24 hours. These in vitro studies suggest teas containing catechins may be useful dietary supplements capable of blunting postprandial glycaemia in humans, including those with or at risk to Type 2 diabetes mellitus.

Effect of Non-Surgical Periodontal Therapy on the Serum Sialic Acid Levels in Diabetic Patients with Periodontitis.

Sialic acid (SA), a family of acetylated derivatives of neuraminic acid, an acute phase reactant by itself. It usually occurs as a terminal component at the non-reducing end of carbohydrate chains of glycoproteins and glycolipids. SA participates in multiple physiological functions, such as cell-to-cell interactions, cell migration and proliferation. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by rise in blood glucose level. Periodontitis is a chronic inflammatory disease of the periodontal tissue, leading to destruction of bone surrounding the tooth and ultimately tooth loss. There is a two way relationship between diabetes mellitus and periodontitis. Periodontitis is the sixth complication of diabetes along with retinopathy, nephropathy, neuropathy, macrovascular disease, and altered wound healing. Inflammatory mediators like interleukin-6 and tumor necrosis factor-alpha produced during periodontal inflammation can interfere with the actions of insulin receptors and worsen the glycemic control of diabetic patients. Periodontitis is a major cause of tooth loss, affecting over 300 million people and bacteria associated with periodontitis are also linked with systemic problems like endocarditis, atherosclerosis. Recent work has highlighted a major role for the host sugar sialic acid in the biofilm physiology and host-pathogen interactions of T. forsithya, a key periodontal pathogen. There exists a need for a biomarker, for early detection of disease evolution and more robust therapy efficacy measurements. Serum sialic acids were estimated in Indian population by diphenylamine method and Thiobarbituric acid method. The average values were 68 ± 2.6 mg percent by DPA method and 56 ± 5 mg percent by TBA (thiobarbituric acid assay) method. Age and sex showed no influence on serum sialic acid level. Objectives of the present study was to compare (TSSA) level in healthy subjects, subjects with (CMP) with and without (NIDDM) and its effect on non-surgical periodontal therapy. In the present study, the participants were divided into three groups: Group A, B and C. Group A consists of systemically healthy subjects, Group B consists of subjects with (CMP) while Group C consists of subjects with (CMP) with (NIDDM) and results of this study indicated that, at baseline, there were significant differences between Group A, B and Group C with respect to all the clinical parameters, including (GI), (OHI-S), (PPD), (CAL), (TSSA) and (HbA1c) levels. Thus (TSSA) level could be considered as novel biomarker in the progression of periodontal disease and diabetic status. Periodontitis could be considered as a potential, modifiable, and independent risk factor for the development of diabetes. Early detection of elevated (TSSA) level may help in interpreting the progression of periodontitis, risk of development of diabetes mellitus in future and also to prevent complications.

The effect of gender and clinical experience on shade perception.

OBJECTIVE: Shade matching is a critical procedure in prosthetic dentistry. The correct identification of the shade by the doctor as well as the perception of the shade by the dental technician becomes critical due to the high patient expectations. The current study aims to evaluate the effect of gender and clinical experience on shade perception by dental professionals. MATERIALS AND METHODS: A total of 100 dental professionals with normal color vision who were categorized as dental students, dental doctors, and dental specialists were included in the study. Masked A2 and B2 shades tabs were made to match with a complete set of shade guide. The obtained data were entered, coded, and analyzed using SPSS version 17 for Windows. RESULTS: Total number of participants who identified both shade tabs correctly was 44%. There were no statistically significant differences among the gender or the clinical experience with regard to correct identification of shade tabs. CONCLUSION: Within its limitations of fewer number (two) of shade tabs for comparison, the study concludes that multiple opinions may be taken clinically irrespective of the gender or clinical experience as gender and experience do not have a significant role to play for shade matching in prosthetic and restorative dentistry.

Preliminary impression techniques for microstomia patients.

The Prosthetic rehabilitation of microstomia patients presents difficulties at all the stages. The difficulty starts with the preliminary impression making. This is due to the tongue rigidity and the decreased oral opening. A maximum oral opening which is smaller than the size of the tray can make prosthetic treatment challenging. Due to the restricted mouth opening, insertion and removal of the impression trays is extremely cumbersome and various modifications of the trays have been used in the past. Among these are the flexible trays and the sectional trays used with different modes of reassembling the segments extra orally after the impression is made. This article reviews the literature published from 1971 to 2015 concerning preliminary impression techniques used in making impressions for patients with microstomia based on various tray designs. An electronic search was performed across three databases (PubMed, Science Direct and Google Scolar) for relevant citations. The keywords/combinations used for the search were microstomia, limited/constricted/restricted mouth opening/oral access, trismus, sectional trays, impressions and prosthetic/prosthodontic rehabilitation. The search was limited to papers written in English which resulted in a total of 45 related articles of which 17 articles were included for discussion of this review.