A tangible prospect for the treatment of gingivitis using a potentially probiotic strain Lactobacillus plantarum MK06 isolated from traditional dairy products: a triple blind randomized clinical trial.

BACKGROUND: Frequent bacterial plaque buildup at the gingival margin and crevice can provoke an inflammatory reaction in gingival tissues which manifests as gingivitis. Probiotics could serve as a beneficial complementary therapy for treating gingival inflammation. The main aim of this research was to investigate the effect of the Lactobacillus plantarum MK06 probiotic strain on the treatment of gingivitis. METHODS: Patients with gingivitis, who were referred to a private clinic and were systematically healthy, were included in this randomized, triple-blind, placebo-controlled trial. They were instructed to use either placebo or Lactobacillus plantarum suspensions for one minute two times a day after tooth-brushing for four weeks. Then, the clinical parameters of gingivitis, including plaque index (PI), gingival index (GI), bleeding on probing (BOP), and oral hygiene index (OHI-s), were measured in the first, second, and fourth weeks. A total of forty-two patients were randomly assigned to the experimental (n = 21) and control (n = 21) groups. The mean age of the experimental and control groups was 29.10 and 28.48, respectively. RESULTS: The mean scores of BOP, GI, PI, and OHI-s reduced over time in both the control and test groups. However, according to the Mann-Whitney test, the difference between the two groups was not significant at the same time intervals (P ≥ 0.05) and only GI showed a significant difference in the fourth week (GI-3, P = 0.006). Nevertheless, the experimental group experienced a higher overall reduction rate than the control group. The BOP, GI, PI, and OHI-s scores decreased by 0.081, 0.204, 0.186, and 0.172 times in the second week, respectively, resulting from the interaction of time and the intervention, which considerably diminished these indices. CONCLUSION: This study shows the potential of the probiotic Lactobacillus plantarum MK06 suspension as a promoting therapeutic adjuvant in the treatment of gingivitis.

Gingivectomy with Diode Laser Versus the Conventional Scalpel Surgery and Nonsurgical Periodontal Therapy in Treatment of Orthodontic Treatment-Induced Gingival Enlargement: A Systematic Review.

Background and objective: Some studies support the superiority of diode laser gingivectomy to scalpel surgery and nonsurgical treatments. However, a systematic review on this topic is lacking. This study aimed to compare gingivectomy with diode laser versus the conventional scalpel surgery and nonsurgical periodontal therapy (NSPT) in the treatment of orthodontic treatment-induced gingival enlargement (GE). Materials and methods: In this systematic review, an electronic search of the relevant literature was conducted in Web of Science, Medline/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ProQuest with no language restriction. Randomized clinical trials published between 1985 and 2020 on comparative treatment of orthodontic treatment-induced GE by diode laser gingivectomy and scalpel surgery or NSPT regarding intraoperative and postoperative bleeding and/or pain were included. Risk of bias was assessed by the Cochrane 1 tool. Results: Of the initially retrieved 288 articles, 40 were duplicates and excluded; 236 articles were excluded following title and abstract screening, and 5 others were excluded following full-text assessment. Finally, 7 studies underwent systematic review. In the risk-of-bias assessment, 5 studies scored 2, and 2 studies scored 3 out of 6. Intraoperative and postoperative bleeding and pain were found to be significantly lower in the laser group. Conclusions: Within the limitations of this systematic review and with respect to the quality of evidence, the present results revealed lower level of pain and bleeding in diode laser gingivectomy compared with the conventional scalpel surgery and NSPT for treatment of orthodontic treatment-induced GE.

Comparing Circumferential Supracrestal Fiberotomy with Surgical Scalpel Versus Photobiomodulation in Orthodontic Relapse Reduction: A Clinical Trial.

Objective: This investigation aimed to compare the efficacy of circumferential supracrestal fiberotomy (CSF) with surgical scalpel, laser CSF, and photobiomodulation for reduction of relapse after orthodontic tooth rotation. Background: Relapse is the tendency of teeth to move back to their preoperative position after removal of orthodontic appliances. Materials and methods: This randomized controlled clinical trial was conducted on 90 rotated teeth at the final stages of fixed orthodontic treatment. The teeth were randomly divided into six groups (n = 15) of (1) control (no intervention), (2) photobiomodulation alone (wavelength of 940 nm, 0.2 W, and 4 J/cm2), (3) conventional CSF, (4) laser CSF (wavelength of 940 nm, 1.5 W, and 4 J/cm2, and power density of 160 mW/cm2), (5) conventional CSF plus photobiomodulation, and (6) laser CSF plus photobiomodulation. Measurements were made on clinical photographs and dental casts using the AutoCAD software. Level of pain of patients was measured within the first 24 h after fiberotomy using a visual analog scale. Data were analyzed by ANOVA and Kruskal-Wallis test (α = 0.05). Results: The magnitude (p = 0.014) and percentage (p = 0.035) of relapse were significantly different among the six groups, and they were the highest in the control group followed by photobiomodulation alone, laser CSF, conventional CSF, conventional CSF plus photobiomodulation, and finally, laser CSF plus photobiomodulation. Moreover, photobiomodulation plus laser CSF and photobiomodulation plus conventional CSF had significantly different results from the other groups. The six groups had no significant difference in sulcus depth changes, gingival recession (difference in primary and secondary crown height), or pain score (p > 0.05). Conclusions: This study suggests that utilizing photobiomodulation combined with laser CSF or conventional CSF can be effective in reducing relapse. However, further clinical trials are required to support this idea. Iranian Registry of Clinical Trials (IRCT20210621051653N1).

Evaluation of the Salivary Matrix Metalloproteinase-9 in Women With Polycystic Ovaries Syndrome and Gingival Inflammation: A Case-Control Study.

Background Polycystic ovary syndrome (PCOS) is an endocrine disease of women of reproductive age that impacts their oral and systemic well-being. This study aimed to compare the gingival inflammation indices and matrix metalloproteinase-9 (MMP-9) of non-obese women with PCOS. Materials and methods This is a case-control study in which 78 women were referred to the Babol Clinic Hospital in Northern Iran between 2018 and 2019. They were divided into three groups: 26 women with PCOS and gingivitis, 26 women with PCOS with no gingivitis, and 26 women with no PCOS and no gingivitis as a control group. After recording the anthropometric and demographic variables, fasting saliva samples were taken from all participants before any periodontal intervention. These samples were transferred to Babol Molecular Cell Research Center under highly guaranteed cold-chain conditions to measure the serum levels of MMP-9. Periodontal status was evaluated for Gingival Index (GI), Plaque Index (PI), and Bleeding on Probing (BOP). Analysis of variance was used to compare the mean results for these indices. The significance level was considered when p ≤ 0.05. Results All the gingival indices were significantly higher for women with PCOS with gingivitis compared to the results for women from the other two groups. Similarly, women with PCOS showed high salivary MMP-9 levels but were within the normal reference ranges. Conclusion The gingival indices (GI, PI, and BOP) and salivary MMP-9 are higher in women with PCOS, regardless of the gingival status.

Serum and Salivary Level of Nitric Oxide (NOx) and CRP in Oral Lichen Planus (OLP) Patients.

STATEMENT OF THE PROBLEM: Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology while a few cases of disease become malignant. PURPOSE: This study aimed to evaluate the level of nitric oxide (NOx) and C-reactive protein (CRP) as oxidative stress and inflammation status in sample of OLP patients. MATERIALS AND METHOD: In this case-control study, serum and salivary NOx and CRP levels were evaluated in twenty two OLP patients as the case group confirmed by clinical and histopathological diagnosis, and twenty two healthy control groups collected from Tooba Oral Pathology Laboratory in Sari in 2016. The data were analyzed by using independent-samples t-test, Mann-Whitney U-test and Chi-square by using SPSS version 21. The statistical significant level was considered at p< 0.05. RESULTS: Salivary and serum NOx levels in case group showed statistically significantly higher than healthy control group (p= 0.035 and p= 0.001, respectively). CRP values were significantly higher both in serum (p= 0.001) and in saliva (p= 0.035). A significant correlation was found between CRP and NOx values in serum (r= 0.521, p= 0.0001) and saliva (r= 0.427, p= 0.045). CONCLUSION: Oxidative stress causes damage to organs in the human body. Correct understanding of oxidative stress and its association with free radicals and inflammatory markers related to oral disease are important for effective treatments. The results of the study advocate the effects of NOx and CRP levels in pathogenesis of OLP. Therefore, antioxidant drugs might probably be considered in the treatment of OLP.

Serum levels of interleukin-23 and 35 in patients with and without type 2 diabetes mellitus and chronic periodontitis.

BACKGROUND: Type 2 diabetes mellitus (DM) and chronic periodontitis (CP) show common pathophysiological features. We investigated the serum levels of IL-23 and IL-35 in people with type 2 DM and CP. METHODS: In a cross-sectional study, 72 patients were divided into four equal groups: group A, participants without type 2 DM and CP; group B, patients with type 2 DM without CP; group C, patients with CP and without type 2 DM; and group D, patients with type 2 DM and CP. Demographic data were obtained and periodontal conditions including clinical attachment loss, bleeding on probing, plaque index, gingival index, and probing depth was evaluated on all existing teeth. Fasting blood sugar (FBS) levels, hemoglobin (Hb) A1c, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed. In addition, serum levels of IL-23 and 35 were measured using enzyme-linked immunosorbent assay. RESULTS: The serum levels of IL-23 and 35 showed no significant differences between all groups (P>0.05). A significant positive correlation between the serum concentration of IL-23 and clinical attachment loss in the control group (r: 0.548, P=0.019) was detected. A significant negative correlation between IL-35 and the plaque index in group B (r: -0.578, P=0.012), plus significant negative correlations between IL-23 with ESR (r: -0.487, P=0.040) and CRP (r: -0.498, P=0.035) in groups C and D were also detected. CONCLUSION: Despite significant associations of serum concentration of IL-23 and 35 with certain periodontal and inflammatory indices, neither type 2 DM nor CP differentially affects serum levels of these two cytokines.

Relation between Periodontitis and Prediabetic Condition.

STATEMENT OF THE PROBLEM: Prediabetic condition, which is characterized by impaired glucose tolerance, impaired fasting blood glucose, and hemoglobin A1c (HbA1c) higher than normal might be associated with periodontitis. Early diagnosis of this condition might decrease consequent tissue damage caused by periodontitis. PURPOSE: The present study aimed to evaluate the association between prediabetes and periodontitis. MATERIALS AND METHOD: This cross-sectional study was conducted on 108 prediabetic patients screened by primary fasting blood sugar (FBS) test (100-125 mg/dL). Three subsequent blood tests including FBS, HbA1C, and oral glucose tolerance test (GTT) were performed for ultimate diagnosis of these patients. The periodontal health was evaluated by employing bleeding on probing (BOP), clinical attachment loss (CAL), and plaque index (PI), Lِe-Silness gingival index (GI), and pocket depth (PD). Data were analyzed by SPSS version 16, using t-test, ANOVA, and chi-square tests. RESULTS: The sample included 20 (19%) male and 88 (81%) female individuals with mean age of 49 years and mean BMI of 27.5. The mean FBS, GTT, and HbA1C were 107 MG/DL, 137MG/DL, and 5.9%, respectively. Clinical evaluation showed 33% of patients involved with periodontitis. The mean CAL, BOP, PI, PD, GI was 3.7, 0.62, 1.9, 2.1, 1.5, respectively (p< 0.05). A significant difference in periodontal index was found among patients with prediabetes. Moreover, in the patients with periodontitis, a statistically significant relationship between FBS and BMI, BOP and GTT, and finally between CAL and HbA1C was detected. CONCLUSION: Periodontitis is associated with prediabetic condition. While diabetes is an important risk factor for periodontitis, the risk of periodontitis would be greater if glycemic control is poor. Glycemic control in prediabetic patients can reduce the severity of periodontal disease. Early diagnosis and prevention is crucial to avoid the largely irreversible tissue damage that occurs in periodontitis.

Periodontitis in rheumatoid arthritis patients, abundance and association with disease activity.

Background: There are some discrepancy in association between activity of rheumatoid arthritis (RA) and periodontitis. The aim of this study was to evaluate the periodontal status of outpatients with RA. Methods: The study was conducted in 2013-14 in a rheumatology clinic in Sari, north of Iran on 74 patients with RA. Evaluation of RA disease activity was according to disease activity score 28 (DAS28). Periodontitis was evaluated by probing depth (PD), gingival index (GI), clinical attachment level (CAL index), plaque index (PI), and panoramic X-ray. Statistical analysis included independent ttest and Mann-Whitney U test for quantitative, and chi square and OR for qualitative variables and evaluation of RA activity and periodontitis severity. Results: The mean±SD of age and disease duration were 47.01±8.1 and 8.93±8.6 years, respectively and the mean±SD number of teeth was 20.70±6.8. Twenty-seven (36.5%) patients had moderate to severe disease. Forty-seven cases (63.5%) were found with periodontitis and 14 (12.2%) were identified to have moderate to severe periodontitis, unrelated to disease activity (p=0.22). For active/inactive periodontitis OR =1.33 (95% CI: 0.46 - 3.87) was computed. There was no association between RA disease activity and number of teeth, CAL, PI, PD, and GI, (p>0.05). Conclusion: About 60% of RA patients suffered from periodontitis, but there was not any significant relation between RA disease activity and severity of periodontitis. Periodontitis may interfere with management and follow up of RA, so periodic periodontal examination is suggested in these patients.

Relationship between Type 2 Diabetic Retinopathy and Periodontal Disease in Iranian Adults.

BACKGROUND: Periodontal disease in diabetic patients can compromise a patient's ability to maintain a proper metabolic control and may be associated with diabetic complication. AIMS: This study was designed to evaluate the frequency of periodontal disease in patients with type 2 diabetes mellitus (DM) and how this was related with the presence of diabetic retinopathy (DR). MATERIALS AND METHODS: A comparison was made of periodontal parameters (plaque index (PI), community periodontal index of treatment needs (CPITN), periodontal disease severity measured in quartiles of probing depth (PD), and clinical attachment loss (CAL)) in a group of diabetic patients with retinopathy (n = 84) versus a group of diabetic patients without retinopathy (n = 129). In addition, 73 age- and sex-matched individuals were selected to serve as the control group. Analysis was performed to evaluate the relationships between periodontal disease and DR. RESULTS: In terms of PI, no statistically significant differences were observed, so, oral hygiene was similar in both groups. Diabetic patients with retinopathy had greater CPITN (P < 0.001) and more severe periodontal disease (P < 0.001) than no retinopathy. Also, our results indicated a relationship between type 2 DM and periodontal disease. CONCLUSIONS: The patients with diabetes retinopathy appear to show increased periodontal disease susceptibility.

Unilateral gingival lymphangioma: A first case report.

Lymphangiomas are classified as vascular malformations. A 17-year-old male patient was referred with asymptomatic gingival enlargement with a vesicular feature on the buccal aspect of the central and lateral teeth of the right mandible; the lesion showed easy bleeding. After local anesthesia, subgingival, and sulcular incisions was performed on the buccal and lingual gingiva of the right central and lateral incisors of the mandible. Microscopic evaluation showed lymphangioma. A 3-year follow-up showed promising results.

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial.

OBJECTIVE: Treatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects. MATERIAL AND METHODS: In this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant. RESULTS: Only the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups. CONCLUSION: The results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared with a resorbable barrier with bone material. The differences in radiographic changes between the two groups, however, were not statistically significant.

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial

OBJECTIVE: Treatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects. MATERIAL AND METHODS: In this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant. RESULTS: Only the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups. CONCLUSION: The results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared ...

A periodontal health assessment of hospitalized patients with myocardial infarction.

BACKGROUND: Recent researches have known long term infections such as periodontal disease to be related with the process of atherosclerosis. Periodontitis causes peripheral inflammation and immune cell stimulation which leads to an increase in C - reactive protein (CRP) and IgA Ab and there is a definite relation between cardiovascular disease, CRP increase and Periodontitis. The aim of this study was to evaluate the periodontal health status of patients with myocardial infarction who were hospitalized in Babol and Sari Hospitals. METHODS: This descriptive study was done on 95 men and women age ranging from 40 to 70 years old hospitalized due to myocardial infarction diagnosis in Babol and Sari Hospitals. Periodontal health, of patients evaluated via Cowell Bleeding Index, Green and vermillion Debri Index, Tooth Mobility, Clinical attachment Level on Ramfjord teeth. Data were analyzed with SPSS and Kruskal-Wallis test and Mann-whitney test. RESULTS: Considered indexes were evaluated in 81men and 14 women studied which showed no significant difference among them in the average BI (p=0.52), average tooth mobility (p=0.117) and average CAL index (p=0.745). The only significant difference between men and women was found in average DI index (p=0.08). There was a significant difference between average CAL in Ramfjord teeth of upper and lower jaw (p=0.002). CONCLUSION: According to high prevalence of periodontitis in our study, periodontitis may be a risk factor of cardiovascular disease, it should be pointed out that here is the cardiologists' emphasis on their patients referring to the dentists.