Effectiveness of Conventional Periodontal Treatment With Tetracycline Fiber Versus Minocycline Gel Application Subgingivally in Periodontitis Patients.

BACKGROUND: Locally delivered antibiotics are adjunctive therapies for the selective removal or inhibition of pathogenic microbes in combination with scaling and root planing (SRP) for the management of periodontitis. OBJECTIVE: The primary objective of this study was to evaluate the effectiveness of tetracycline fibers against minocycline gel when used as local drug delivery in conjunction with SRP for treating periodontitis. METHODS AND MATERIALS: This is a pilot randomized open single, blinded trial study comparing three treatment modalities: SRP with topical tetracycline fibers (SRP+T), SRP with topical minocycline HCL 2% gel (SRP+M), and SRP only as a control group. Probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) percentages were recorded at baseline, one month, and at the end of three months. The data were subjected to analysis using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Repeated measures ANOVA was used to compare the clinical outcomes between the three treatment groups, accounting for the repeated measurements at baseline, one month, and three months. A p-value less than 0.05 at a 95% confidence interval was deemed statistically significant. RESULTS: There were statistically significant changes within the groups in all the clinical parameters, including pocket depth, clinical attachment loss, and bleeding on probing score, at different time intervals, with the greatest mean pocket depth changes seen in the tetracycline group after one month (mean changes = 1.4 mm, P < 0.001) and over three months (mean changes = 1.79 mm, p < 0.001). For clinical attachment loss, after one month, the highest improvement in clinical level was seen in the minocycline group (mean changes = 0.7mm, p < 0.05), and the overall improvement was seen in the control group (mean changes = 1.1mm, p < 0.05). The minocycline group showed greater mean changes in bleeding on probing percentage, with the greatest changes after one month (mean changes = 19.34%, p < 0.001) and over three months (mean changes = 26.42%, p <0.001). However, there was no significant difference between the groups. CONCLUSION: Locally delivered tetracycline and minocycline gel are effective as adjuncts to SRP and may improve the healing outcome in the management of periodontitis.

A Dive into Delivery of Oral Hygiene Advice Based on the Personalized Oral Hygiene Advice Model.

Oral health's impact on overall well-being highlights the importance of preventive measures through effective oral hygiene practices. Currently, there is growing recognition of the need for customized oral hygiene advice depending on the patient's unique needs and circumstances. This narrative review addresses the gap in understanding the significance of personalized guidance through the proposal of the Personalized Oral Hygiene Advice Model (POHAM) as a comprehensive guide for oral health professionals. This model was developed to adapt to evolving patient demographics and diverse challenges, promoting a patient-centric and effective oral health approach. The POHAM comprises a flow chart of strategies from establishing a good rapport with patients, conducting comprehensive assessment through history-taking, psychosocial and technology proficiency evaluation, tailored education modules, and customized oral care product recommendations until the reassessment. These strategies aim to enhance patient engagement and adherence, as well as act as a guide for oral health professionals to use in the clinical setting before and during the course of oral treatment. Nevertheless, continued research, education, and technological advancements are needed to realize the full potential of personalized oral hygiene strategies, ensuring a transformative and sustainable oral healthcare landscape.

Risk factors and approaches for detection of Trichomonas tenax, the silent culprit in periodontal disease: A narrative review.

Introduction: Periodontal disease is the inflammation of the periodontium tissues surrounding the teeth, potentially leading to loss of tooth attachment. In individuals with periodontal disease, the presence of Trichomonas tenax, a parasitic protozoan of the oral cavity has been observed and its frequency tends to rise as the disease progresses. Methods: A literature search was conducted in the online databases of PubMed, Google Scholar, Web of Science, and Scopus using the combination of keywords: "Trichomonas tenax" AND "periodontal disease" OR "gum disease", OR "oral disease" OR "periodontitis". A total of 9 articles satisfied the inclusion criteria and were included in this study. Results: This review highlights the incidence of T. tenax with periodontal diseases, the risk factors that contribute to the infection of T. tenax and available detection methods for the identification of the protozoan. Conclusion: The inhabitation of the oral cavity by T. tenax prospers with the severity of periodontal diseases. Extensive research should be conducted to fully understand the potential pathogenic role and damaging effect of T. tenax in the oral cavity.

A Review of Bacterial Colonization on Dental Implants With Various Hygiene Instruments.

Peri-implant diseases can still develop despite oral hygiene practices being maintained. Consequently, regular debridement must be carried out to ensure the implant is sustained. This review evaluated bacterial colonization on implants following the use of different hygiene instruments. A literature search was conducted in PubMed, ScienceDirect, and Scopus databases for articles published from 2012 to 2022. A total of 19 full-text papers were selected. The number of bacteria colonized was most commonly evaluated with a scanning electron microscope (SEM) or by colony-forming unit (CFU) counts, crystal violet assays, plaque index, probing depth, bleeding on probing, turbidity test, and live-dead assays. Rubber cup polishing with an abrasive paste showed a significantly greater reduction in biofilm formation compared with air abrasion with glycine powder, while the air abrasion treatment was found to be more efficient than piezoelectric, carbon, and stainless steel scalers. Surface treatment with Er, Cr: YSGG laser, and Er: YAG laser resulted in statistically significant superior dental biofilm removal compared with titanium curettes and photodynamic therapy. Air abrasion, plastic curette, titanium curette, and ultrasonic scaler showed no significant differences in bacterial colonization, but air abrasion and plastic curette were safer for zirconia implant decontamination. Furthermore, the titanium brush showed better results in decontaminating the implant surface than the Er: YAG laser. Although no single instrument or method could be considered as offering a gold standard in treating peri-implant diseases, the use of air abrasion with glycine powder, laser therapies, rubber cup polishing with an abrasive paste, and a titanium brush had high levels of cleaning efficacy and acceptance by patients.

Biodegradability of Amniotic Membrane as Potential Scaffold for Periodontal Regeneration.

Background In the periodontal regenerative procedure, the membrane used should possess good mechanical stability with suitable resorption time to allow restoration of the lost periodontium. Amniotic membrane (AM) has regenerative potential as a scaffold or barrier membrane due to its various beneficial properties. However, its degradation rate is not clearly reported. Methodology This study aimed to evaluate the resorption capacity of AM and its surface architecture after being subjected to hydrolytic degradation analysis in phosphate buffer solution (PBS). AM was cut into sizes of 10 × 10 mm2 for three replicates. The membranes were weighed before and at different time intervals (days 7, 14, 21, and 28) after immersion in PBS. The degradation rate was determined by the percentage of mean weight loss from the initial weight at different time intervals. The AM surface profile was observed under scanning electron microscopy (SEM) before and after 28 days of immersion. Results The result shows a 92% loss of weight over 28 days with the highest attained in the first seven days (67%), followed by 7%, 17%, and 1% after days 14, 21, and 28, respectively. SEM of the AM surface before the degradation test showed a polygonal shape forming a well-arranged mosaic pattern covered with microvilli. At day 28, the remaining AM appears as porous surface architecture, irregularly arranged fibers, and no microvilli seen. Conclusions This study demonstrated that over four weeks of degradation analysis, AM was not entirely degraded but had lost some of the microstructure. The biodegradability of AM should be further evaluated to elucidate its stability within adequate time parallel with the tissue healing process in periodontal tissue regeneration.

Periodontal health status, Porphyromonas gingivalis and anti-cyclic citrullinated peptide antibodies among rheumatoid arthritis patients.

Porphyromonas gingivalis (P. gingivalis) is the primary periodontal pathogen involved in protein citrullination, which triggers the production of anti-cyclic citrullinated peptide (anti-CCP) antibodies, exacerbating rheumatoid arthritis (RA). This study aims to evaluate the amount of P. gingivalis and its association with anti-CCP antibodies in RA patients with periodontitis. This cross-sectional study involves 100 RA patients with a mean age of 52.36 (SD 13.90) years. Smokers and patients with other uncontrolled systemic diseases were excluded. Disease Activity Score-28 (DAS-28) was used to determine RA disease severity. Periodontal parameters were examined to determine periodontal status. Subsequently, plaque samples were collected from the subgingival periodontal pocket for assessment of P. gingivalis bacterial load using the loop-mediated isothermal amplification method. Blood samples (5 ml) were obtained from all participants to analyse anti-CCP antibody levels. Data was analysed by using SPSS version 24.0. Most participants were female (85.0%) and had low RA disease severity (62%). The mean RA disease duration was 7.77 (SD 6.3) years, with a mean DAS-28 of 3.17 (SD 1.0). Forty-seven per cent of participants had periodontitis, but all periodontal parameters were not associated with RA disease activity (P = 0.38). P. gingivalis bacterial load ranged from 10 to 109 copies/µl. Fifty-five per cent of the collected samples showed positive anti-CCP antibody levels, but no significant association was observed with the P. gingivalis bacterial load (P = 0.58). Considering the study's limitations, although periodontitis is prevalent among RA patients, there is a lack of association between P. gingivalis bacterial load and anti-CCP antibody levels, which should be investigated further.

Potential Effects of Non-Surgical Periodontal Therapy on Periodontal Parameters, Inflammatory Markers, and Kidney Function Indicators in Chronic Kidney Disease Patients with Chronic Periodontitis.

Chronic kidney disease (CKD) and chronic periodontitis (CP) contribute to the increased level of inflammatory biomarkers in the blood. This study hypothesized that successful periodontal treatment would reduce the level of inflammatory biomarkers in CKD patients. This prospective study recruited two groups of CP patients: 33 pre-dialysis CKD patients and 33 non-CKD patients. All patients underwent non-surgical periodontal therapy (NSPT). Their blood samples and periodontal parameters were taken before and after six weeks of NSPT. The serum level of high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and periodontal parameters were compared between groups. On the other hand, kidney function indicators such as serum urea and estimated glomerular filtration rate (eGFR) were only measured in CKD patients. Clinical periodontal parameters and inflammatory markers levels at baseline were significantly higher (p < 0.05) in the CKD group than in the non-CKD group and showed significant reduction (p < 0.05) after six weeks of NSPT. CKD patients demonstrated a greater periodontitis severity and higher inflammatory burden than non-CKD patients. Additionally, CKD patients with CP showed a good response to NSPT. Therefore, CKD patients' periodontal health needs to be screened for early dental interventions and monitored accordingly.

Successful management of dentin hypersensitivity: A narrative review.

The prevalence of dentin hypersensitivity (DH) is increasing around the world. At least one in 10 individuals in the general population has been diagnosed with DH. It is a diagnosis that has significant negative effects on a person's oral health-related quality of life. This condition, which is characterized by sharp, short tooth pain in response to thermal, chemical, tactile, and evaporative stimuli, is more commonly seen in adults. DH has a tremendous impact on the social and financial aspects of patients and society at large. It is essential to recognize the factors that can contribute to a successful treatment outcome to guarantee the overall well-being of DH patients. The aim of this narrative review was to highlight strategies that can lead to successful DH treatment outcomes, along with current updates on DH mechanisms, treatment options, and the latest management approaches. A positive treatment outcome for DH requires a concerted effort from both the patient and the dental practitioner. Highly motivated patients and dental practitioners with sound knowledge of DH diagnosis and available treatment options will ensure successful long-term improvement of DH symptoms.

Amniotic Membrane: An Approach to Periodontal Regeneration.

Over the years, various materials have been used for scaffold-based periodontal tissue engineering to regenerate lost periodontal tissues. The use of amniotic membrane (AM) as a scaffold for periodontal regeneration has gained great interest among researchers. This narrative review aims to appraise the properties of AM and its potential clinical applications in periodontal regeneration. PubMed, ScienceDirect, Scopus, and Wiley Online Library databases were searched for relevant articles that highlighted the properties and applications of AM in periodontal regeneration. AM has a unique structure and components contributing to its exceptional properties such as anti-inflammatory (presence of anti-inflammatory factors), low immunogenicity (presence of human leukocyte antigen-G), anti-scarring (downregulation of transforming growth factor-ß), antimicrobial (expression of antimicrobial factors), promotion of epithelialization (production of growth factors), and reduction of pain (protection of exposed nerve endings). Its use in the treatment of periodontal tissue defect has shown to be effective. AM showed various beneficial properties as an ideal scaffold. Future studies and long-term clinical trials on the efficacy and survival rate of AM are required to completely understand the potential application of AM in periodontal regeneration.

Refining the Mechanism of Drug-Influenced Gingival Enlargement and Its Management.

Drug-influenced gingival enlargement (DIGE) or overgrowth manifests as abnormal enlargement of the gingiva due to an adverse effect of certain drug reactions in patients treated with anticonvulsants, immunosuppressants, or calcium channel blockers (CCBs). As the gingival enlargement became significant, it may interfere with the normal oral hygiene measures, aesthetics, as well as masticatory functions of the patients. The exact mechanism of how this undesirable condition develops is yet unknown, and complicated, with non-inflammatory and inflammatory pathways involved. This review illuminates these putative pathways of DIGE and highlights various treatment approaches based on existing research and current observations.

Investigation of Salivary RANKL and OPG Levels in Periodontitis Patients at Hospital Universiti Sains Malaysia.

OBJECTIVE: This study was aimed to determine the levels of salivary receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) and its association with periodontal status among periodontitis patients. MATERIALS AND METHODS: A cross-sectional study was designed and performed at the Dental Clinic, Hospital Universiti Sains Malaysia (HUSM). Random sampling was employed to identify 88 participants into three groups: 30 mild periodontitis, 30 moderate to severe periodontitis, and 28 healthy (nonperiodontitis) patients. Periodontal parameters: periodontal pocket depth (PPD), clinical attachment level (CAL), plaque score (PS), and gingival bleeding index (GBI) were recorded. In total, 4 mL of unstimulated whole saliva was collected to determine the levels of salivary RANKL and OPG proteins by using ELISA technique. Data were analyzed by using SPSS software version 24.0. RESULTS: Mean values for PPD (5.3 ± 0.5) and CAL (5.6 ± 0.5) were observed higher for moderate to severe periodontitis as compared with values (4.4 ± 0.2) (4.5 ± 0.2) in mild periodontitis patients. The mean salivary RANKL and OPG was 0.23 ± 0.07 ng/mL and 1.78 ± 0.70 ng/mL respectively in moderate to severe periodontitis. Only salivary RANKL levels were significantly and positively correlated with all the clinical periodontal parameters. CONCLUSION: The levels of salivary RANKL were higher as opposed to lower OPG levels in periodontitis patients in contrast to healthy (nonperiodontitis) patients. RANKL levels were significantly associated with the periodontal parameters. Therefore, we can conclude that RANKL can potentially aid as an adjunctive diagnostic protein in evaluating periodontal disease.

Anti-Cyclic Citrullinated Peptide Antibody and Periodontal Status in Rheumatoid Arthritis Patients.

OBJECTIVES: Studies have shown that periodontal disease and Rheumatoid Arthritis (RA) shared similar pathogenesis. Anti-Cyclic Citrullinated Peptide anibodies (anti-CCP) has recently been used for diagnosis of RA. Thus, this study aimed to assess the levels of anti-CCP antibodies and periodontal status in RA patients. METHODS: Forty four RA patients were included in this study. The blood samples were analysed for anti-CCP levels. Plaque Score (PS), Gingivitis Score (GS), Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL) were recorded for assessment of periodontal status. Relevant clinical information was obtained from medical records. RESULTS: Mean anti-CCP level was 180.8 ± 290.3 Unit/ml. The results showed that 27.3% patients had poor oral hygiene (PS >60%; mean anti-CCP 84.22 ± 167.51 Unit/ml), 52.3% had generalized gingivitis (mean anti-CCP 145.07 ± 269.17 Unit/ml), and 20.5% had mean CAL of >3mm (mean anti-CCP 56.81 ± 119.02 Unit/ml). None of patients presented with deep PPD > 4mm. The levels of anti-CCP showed no significant association with periodontal status (p=0.27). CONCLUSION: Most RA patients were positive for anti-CCP antibodies and presented with generalized gingivitis. Oral hygiene education should be reinforced in RA patients to prevent further progression of periodontal disease. Nevertheless, studies with larger sample size should be carried out to obtain more conclusive findings.

Accuracy of four tooth size prediction methods on malay population.

Objective. To examine the accuracy of Moyers 50%, Tanaka and Johnston, Ling and Wong and Jaroontham and Godfrey methods in predicting the mesio-distal crown width of the permanent canines and premolars (C + P(1) + P(2)) in Malay population. Materials and Methods. The study models of 240 Malay children (120 males and 120 females) aged 14 to 18 years, all free of any signs of dental pathology or anomalies, were measured using a digital caliper accurate to 0.01 mm. The predicted widths (C + P(1) + P(2)) in both arches derived from the tested prediction equations were compared with the actual measured widths. Results. Moyers and Tanaka and Johnston methods showed significant difference between the actual and predicted widths of (C + P(1) + P(2)) for both sexes. Ling and Wong method also showed statistically significant difference for males, however, there was no significant difference for females. Jaroontham and Godfrey method showed statistical significant difference for females, but the male values did not show any significant difference. Conclusion. For male Malay, the method proposed by Jaroontham and Godfrey for male Thai proved to be highly accurate. For female Malay, the method proposed by Ling and Wong for southern Chinese females proved to be highly accurate.