Impact of subgingival instrumentation on systemic inflammation and serum bone resorption marker in premenopausal women with periodontitis: a prospective interventional study.

OBJECTIVES: Inflammatory disorders including periodontitis have been investigated for their impact on systemic inflammation and bone health. The present study was conducted with an aim to evaluate impact of control of periodontal inflammation through subgingival instrumentation on serum interleukin 6 and serum C-terminal telopeptide of type I collagen (CTX) in premenopausal females with stage II and III periodontitis. METHOD AND MATERIALS: In this single-arm prospective study, periodontal parameters, serum interleukin 6, serum CTX, and hematologic parameters (total leukocyte count, differential leukocyte count, platelet count, mean platelet volume, and platelet distribution width) were assessed at baseline. Subgingival instrumentation was done, and oral hygiene instructions were given. At week 4, professional plaque control was performed, and oral hygiene instructions were reinforced. Serum and hematologic parameters were reassessed at 8 weeks after subgingival instrumentation, in individuals meeting the clinical endpoints (ie, bleeding on probing < 10%). RESULTS: There was significant reduction in serum interleukin 6 of 0.168 ± 0.164 pg/mL (P = .000), and serum CTX of 17.459 ± 4.363 pg/mL (P = .000) at 8 weeks after subgingival instrumentation. There was significant decrease in eosinophil count (P = .018) and mean platelet volume (P = .016) at 8 weeks after subgingival instrumentation; however, no significant change was found in other hematologic parameters. CONCLUSION: Following subgingival instrumentation, biomarkers of both systemic inflammation (interleukin 6) and bone turnover (CTX) were observed to reduce significantly. This finding hints towards a positive impact of periodontal intervention on bone health.

Impact of Polycystic Ovary Syndrome on Periodontal Status of Women of Adolescent and Adult Age Groups: A Cross-Sectional Study.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is identified as the most common endocrine disorder in reproductive-aged women, and symptoms of PCOS appear during the early pubertal age. There is a gap in knowledge in recognizing the status of gingival inflammation/periodontal destruction and high-sensitivity C-reactive protein levels (hsCRP) in adolescents versus adults with PCOS. This study aimed to observe the impact of PCOS on periodontal status and systemic inflammation in adolescents and compared them with adults with PCOS. METHODS: A total of 100 newly diagnosed female subjects with PCOS were enrolled into two groups: adolescents (11-19 years, n = 50) and adult females (20-40 years, n = 50). Periodontal parameters, anthropometric parameters, PCOS phenotype, hirsutism score, and serum hsCRP levels were recorded. RESULTS: High levels of mean hsCRP, gingival index, and bleeding on probing % were observed in adolescent and adult PCOS groups, though nonsignificant between the groups (p > 0.05). Significantly more sites with probing pocket depth 3-4 mm, higher mean clinical attachment level (CAL) and sites with CAL 1-2 mm, and high frequency of patients (n = 11) with periodontitis (stage 1) were observed in adults with PCOS compared to adolescents (p ≤ 0.05). Similar and predominant prevalence of PCOS phenotype A (66%) and moderate hirsutism (46% adolescents vs. 58% adults) were observed in both groups. CONCLUSION: Similar levels of hsCRP and periodontal inflammation were found in adolescents and adults with PCOS. More periodontal tissue destruction was observed in adults with PCOS as compared to adolescents with PCOS.

Assessment of periodontal status in patients with oral lichen planus.

OBJECTIVE: Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. METHOD AND MATERIALS: 108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured. RESULTS: On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient. CONCLUSION: Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression.

Assessment of Periodontal Status in Patients with Depression: A Cross-Sectional Study.

OBJECTIVE: Depression leads to behavioral and systemic changes making individuals more susceptible to inflammatory diseases. This study was conducted to assess the periodontal status of patients with clinically diagnosed mild and moderate depression. SUBJECTS AND METHODS: This cross-sectional study included 135 participants. Test group 1 (n = 45) consisted of patients clinically diagnosed with mild depression, test group 2 (n = 45) included patients with moderate depression and the control group (n = 45) included non-depressive participants. Sociodemographic characteristics and periodontal parameters were recorded. RESULTS: Plaque levels and gingival inflammation were significantly (p < 0.05) higher in mild and moderate depression patients than in controls. Significant greater number of sites with bleeding on probing, increasing probing pocket depth (PPD), sites with PPD 4-5 mm, ≥6 mm, attachment loss 3-4 mm, and high prevalence with grade C periodontitis were observed in moderate depression patients, compared to patients with mild depression and healthy controls. On applying partial correlation, periodontal parameters were positively correlated with depression, while a negative correlation was found with income status. On regression analysis, bleeding on probing as a dependent variable was also associated with depression. CONCLUSIONS: Patients with moderate depression showed high periodontal destruction and inflammation as compared to those with mild depression. Further, deep pockets were associated with depressive patients. Periodontal care is required in such patients so that the progression of periodontal diseases can be prevented at the earliest.

Clinical evaluation of root coverage in Miller class III/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: a randomized controlled clinical trial.

PURPOSE: The aim of current study was to evaluate percentage root coverage (RC%) in isolated Miller class III/RT2 labial gingival recession (GR) associated with malaligned mandibular anteriors, using interdisciplinary periodontal-orthodontic treatment as compared to mucogingival surgery alone. METHODS: Thirty-six systemically healthy patients having isolated Miller class III/RT2 GR with respect to malaligned mandibular anteriors, were randomly divided into test group: mucogingival surgery using subepithelial connective tissue graft followed by orthodontic treatment and control group: mucogingival surgery alone. Primary clinical parameters included (RC%), recession depth, keratinized tissue width, mid-labial clinical attachment level, interdental clinical attachment level (iCAL), periodontal phenotype (PP), gingival thickness (GT), root coverage esthetics score (RES) and hypersensitivity. Total duration of follow up was 12 months. RESULTS: Mean RC% was significantly more achieved in test group (66.67%±40.82%) in comparison to control group (39.93%±31.41%) at the end of study (P=0.049). Further, complete root coverage was attained in 5/8 cases of test group versus 1/2 cases of control group after 3/12 months respectively. RES and hypersensitivity, showed statistically significant improvement after complete follow up period in both the groups. An ideal RES score of 10 was achieved in 4/7 cases of test group while in 1/2 cases of control group after 3/12 months respectively. Correlation analysis revealed significant negative correlation between RC% and iCAL. Correlation of RC% with GT and PP was non-significant. CONCLUSIONS: Interdisciplinary periodontal-orthodontic approach may be more beneficial in terms of achieving improved RC%, esthetic and resolution of hypersensitivity in the management of Miller class III/RT2 GR in malaligned mandibular anteriors. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04255914.

Assessment of the effect of orthodontic treatment on the stability of pre-orthodontic recession coverage by connective tissue graft: a randomized controlled clinical trial.

OBJECTIVE: To compare the changes in periodontal parameters after orthodontic treatment in patients having isolated gingival recession treated with and without pre-orthodontic gingival recession coverage. METHOD AND MATERIALS: Thirty-six patients requiring orthodontic treatment with a facially positioned mandibular anterior tooth with labial recession were randomly allocated to either test group: root coverage by subepithelial connective tissue graft (SCTG) followed by orthodontic treatment, or control group (orthodontic treatment only). Primary clinical parameters included recession depth, keratinized tissue width, root coverage, root esthetic score, and gingival phenotype. The patients were followed up for at least 1 year. RESULTS: Level of gingival margin attained in test group teeth after SCTG were maintained at end of orthodontic treatment (P = .727). Root coverage achieved was 69.33 ± 30.74% versus 22.36 ± 27.70% in test and control group, respectively (P = .000), and gain in keratinized tissue width was 1.59 ± 0.73 mm in test versus 0.41 ± 0.49 mm in control group (P = .000). The number of teeth with improved gingival phenotype and decreased hypersensitivity was also observed to be statistically significant in the test group (P = .049, P = .002). CONCLUSION: Root coverage procedure may be performed before the planned orthodontic treatment as graft stability is preserved throughout the course of orthodontic treatment.

Efficacy of modified coronally advanced flap in the treatment of multiple adjacent gingival recessions: a systematic review and meta-analysis.

OBJECTIVE: This systematic review (SR) aims to evaluate the efficacy of modified coronally advanced flap (mCAF) on clinical and patient-reported outcomes in the treatment of multiple adjacent gingival recessions (MAGRs). MATERIALS AND METHODS: Randomized controlled trials (RCTs), case-series and prospective clinical studies on treatment of Miller class I/II or RT1 MAGRs with ≥ 6 months follow-up were identified from the electronic databases and hand-searched journals. Complete root coverage (CRC) was the primary outcome variable. To evaluate treatment effects, meta-analysis was conducted, wherever appropriate. RESULTS: A total of 1395 recessions in 408 patients were evaluated in SR and meta-analysis was performed for four RCTs. Overall CRC achieved with mCAF was 70% and mean root coverage (MRC) ranged from 51.58 to 97.27%. Meta-analysis showed that combination of mCAF with connective tissue graft (CTG) or collagen matrix (CM) demonstrated significantly higher CRC% and recession reduction than mCAF alone. Limited evidence is available to support the use of platelet rich fibrin or enamel matrix derivative or acellular dermal matrix graft along with mCAF to further enhance its efficacy. CONCLUSIONS: mCAF is an effective procedure for treating MAGRs and in terms of achieving CRC and MRC. Additional use of CTG or CM further enhances treatment outcomes.

Comparative clinical and radiographic evaluation of demineralized freeze-dried bone allograft with and without decortication in the treatment of periodontal intrabony defects: a randomized controlled clinical study.

OBJECTIVES: Regeneration of intrabony defects is a challenging target of periodontal therapy. The biologic rationale for regeneration not only is based on incorporating the regenerative material, but also takes into consideration the defect's inherent healing capacity. The present study was carried out to evaluate the efficacy of decortication or intramarrow penetration performed with demineralized freeze-dried bone allograft (DFDBA) in the management of intrabony defects. METHOD AND MATERIALS: Forty chronic periodontitis (stage II and III periodontitis) patients having 40 intrabony defects were randomly assigned into test group (intrabony defect filled with DFDBA after intramarrow penetration along with open flap debridement [OFD+IMP+ DFDBA]) and control group (DFDBA along with open flap debridement [OFD+DFDBA]). Primary outcome measures included probing pocket depth, clinical attachment level, and percentage bone fill (%BF). All parameters were recorded at baseline, 6 months, and 9 months postsurgical follow-up. RESULTS: Mean reduction in probing depth and gain in clinical attachment level was statistically significantly higher at the interdental defect site in the test group compared to the control group at 9 months follow-up (P = .02 and .04, respectively). In radiographic parameters, statistically significant improvements in defect depth and gain in defect area were found in the test group (P = .00 and .03, respectively). Statistically significant improvements in %BF and linear bone growth (P = .02 and .00, respectively) were also observed in the experimental group (39.47 ± 13.92% and 1.41 ± 0.54 mm) in comparison with the control group (19.29 ± 14.24%, 0.62 ± 0.49 mm). CONCLUSION: Addition of intramarrow penetration with DFDBA in surgical periodontal therapy may enhance the healing potential of periodontal intrabony defects, as observed by greater improvement in clinical and radiographic outcomes.

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial.

PURPOSE: The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects. METHODS: This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery. RESULTS: Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up. CONCLUSIONS: M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03169920.

Use of modified vertical internal mattress suture versus simple loop interrupted suture in modified Widman flap surgery: a randomized clinical study.

OBJECTIVES: Close approximation and stabilization of gingival flaps, vital for optimum outcome of surgical procedures, may be difficult to achieve in deep periodontal pockets by routinely used suturing techniques. Modified vertical internal mattress sutures have been reported to be useful in reducing dead space along with achievement of wound stability. The present study compares the outcome of flap closure by use of modified vertical internal mattress sutures and simple loop interrupted sutures in the surgical management of chronic periodontitis. METHOD AND MATERIALS: In total, 83 participants with chronic periodontitis received scaling and root planing. After 8 weeks, modified Widman flap surgery was performed in 48 patients at sites with probing pocket depth ≥ 4 mm. Modified vertical internal mattress sutures were placed in the test group (n = 24) and simple loop interrupted sutures were used in the control group (n = 24). Plaque Index (Silness and Loe), Gingival Index (Loe and Silness), bleeding on probing, probing pocket depth, clinical attachment level, and gingival recession were recorded on the day of surgery, and at 3 and 6 months of follow-up. RESULTS: Statistically significant improvement was noted in all the clinical parameters of both groups. The test group showed significantly greater improvement in probing pocket depth, clinical attachment level, bleeding on probing, and Gingival Index, although Plaque Index scores were similar. This improvement was confined to nonmolars only. CONCLUSION: Flap closure by modified vertical internal mattress suturing technique results in better improvement in periodontal clinical parameters than the use of simple loop interrupted sutures, especially in nonmolars.

Influence of mouth breathing on outcome of scaling and root planing in chronic periodontitis.

INTRODUCTION: Dryness is known to be associated with inflammatory diseases such as dry eye disease and atopic dermatitis. There is significant water loss from the oral cavity during mouth breathing. This study is conducted to estimate the influence of mouth breathing on the outcome of scaling and root planing (SRP) in chronic periodontitis (CP). MATERIALS AND METHODS: CP patients comprising of 33 mouth breathers (MBs) and 33 nose breathers (NBs) were recruited. Thirty patients in each group completed the study. At baseline, plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. SRP was done in both groups. At the 4th, 8th, and 12th week, PI, GI, and BOP were recorded. PD and CAL were also assessed at the 12th week. RESULTS: At the 12th week, there was significantly less improvement in GI at palatal sites of maxillary anterior and maxillary posterior teeth in MB group. Sixty-nine percent of BOP positive sites with PD >4 mm were converted into BOP negative sites with PD ≤4 mm in maxillary posterior palatal sites in NB. This success was 38% in MB. CONCLUSION: Control of periodontal inflammation by SRP in CP patients is affected at palatal sites of mouth breathers.

Periodontal status in chronic periodontitis depressed patients on desvenlafaxine: An observational study.

BACKGROUND: A wide variety of drugs have the potential to affect immune and inflammatory responses of periodontium. A class of antidepressant drug, selective serotonin and norepinephrine reuptake inhibitors, has shown anti-inflammatory function. The aim of the present study is to explore the effect of desvenlafaxine on clinical periodontal parameters in patients with chronic periodontitis. MATERIALS AND METHODS: The patients were divided into two groups as follows: test group (n = 63) comprised of participants on 50 mg once-daily dose of desvenlafaxine for ≥2 months and control group (n = 72) included participants who were yet to be prescribed medication for depression. Periodontal parameters of both the groups were analyzed and compared statistically. RESULTS: Participants taking desvenlafaxine revealed lower values of periodontal parameters as compared to those in control group. The number of pockets with greater depth and clinical attachment loss was greater in control group. CONCLUSION: In our study, patients on desvenlafaxine were associated with less pocket depth and bleeding on probing.

Association of periodontal inflammation, systemic inflammation, and duration of menopausal years in postmenopausal women.

OBJECTIVE: The influence of menopause on vascular inflammation and systemic bone loss has been documented. The purpose of this cross-sectional study was to assess the periodontal status, high-sensitivity C-reactive protein (HsCRP) level, and estrogen level in women with early menopause and women with normal menopause. METHOD AND MATERIALS: A total of 103 participants comprising normal menopausal women (n = 53) and early menopausal women (n = 50) were examined. Periodontal parameters, anthropometric parameters, and metabolic parameters including serum levels of HsCRP and estrogen were recorded. RESULTS: Women with early menopause (age 49.02 ± 2.70 years, postmenopausal period 5.86 ± 2.48 years) had higher clinical attachment loss (CAL) and HsCRP along with increased sites with bleeding on probing (BOP) as compared with normal menopausal women (age 50.56 ± 1.94 years; postmenopausal period 2.03 ± 1.15). On partial correlation analysis after controlling for age, Plaque Index (PI), and body mass index (BMI), CAL correlated positively and significantly with HsCRP and duration of menopause (P = .000), and negatively with estradiol in pooled data. Multivariate linear regression analysis revealed that CAL (dependent variable) has significant association with HsCRP (P = .000, r2 = .343) and duration of menopause (P = .001, r2 = .343). Estrogen status also correlated with HsCRP. CONCLUSION: CAL and HsCRP were higher in women with early menopause. CAL was significantly correlated with postmenopausal period and HsCRP in the population studied.

Effect of Non-Surgical Periodontal Therapy Along With Myo-Inositol on High-Sensitivity C-Reactive Protein and Insulin Resistance in Women With Polycystic Ovary Syndrome and Chronic Periodontitis: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study is to evaluate the effect of non-surgical periodontal therapy and medical treatment on the level of a serologic marker of inflammation (high-sensitivity C-reactive protein [hsCRP]) and insulin resistance (homeostatic model assessment [HOMA]) in women with polycystic ovary syndrome (PCOS) and chronic periodontitis (CP). METHODS: Women with PCOS and CP (n = 60) were randomly divided into two groups. The test group was treated with scaling and root planing (SRP) and myo-inositol (MI). The control group was treated with MI and given oral hygiene instructions. Anthropometric, metabolic, and periodontal parameters were assessed at baseline and re-evaluated at 3 and 6 months. All parameters of both groups at 6 months were compared with 25 systemically and periodontally healthy females (group A). RESULTS: Periodontal parameters were significantly improved in the test group compared with the control group at 3- and 6-month follow-up (P <0.001). A statistically significant reduction was observed in hsCRP and HOMA in both groups at 3- and 6-month follow-up (P <0.05). However, significantly more improvement in hsCRP (P <0.05) and a statistically comparable reduction in HOMA (P >0.05) was observed in the test group compared with the control group at 3 and 6 months. Both the test and control group showed significant consistent improvement in metabolic parameters at 3- and 6-month follow-up, which was further comparable to group A. CONCLUSION: SRP together with medical treatment results in a greater reduction of systemic inflammatory burden compared with medical treatment alone in management of women with PCOS and CP.

Association of periodontal disease with glycemic control in patients with type 2 diabetes in Indian population.

This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis (CP) were divided according to tertiles of mean PISA (periodontal inflamed surface area) scores as low, middle and high PISA groups. Simultaneously a group of 67 periodontally healthy individuals (PH) was recruited. Periodontal examinations, including full-mouth assessment of probing depths (PPD), bleeding on probing, clinical attachment level and plaque scores were determined. Blood analyses were carried out for glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2 h post parandial glucose (PPG). Individuals in PH group had significantly better glycemic control than CP group. Upon one-way analysis of variance, subjects with increased PISA had significantly higher HbA1c levels, retinopathy and nephropathy (P < 0.05). After controlling for age, gender, body mass index (BMI), socioeconomic status (SES), family history of diabetes and periodontitis, duration of diabetes, the mean PISA in mm2, PPD 4-6 mm (%) and PPD ≥ 7 mm (%) emerged as significant predictors for elevated HbA1c in regression model (P < 0.05). Logistic regression analysis revealed that PISA was associated with higher risk of having retinopathy and neuropathy (odds ratio). In our study, the association between glycemic control and diabetic complications with periodontitis was observed.

Effect of periodontitis on bone mineral density in postmenopausal women: A non-randomized interventional study.

OBJECTIVE: Chronic periodontitis (CP) is associated with increased systemic inflammation and osteoporosis. Pro-inflammatory cytokines, implicated in systemic bone loss, are also associated with periodontitis. The impact of control of systemic inflammation by scaling and root planing (SRP) on bone mineral density (BMD) in postmenopausal (PM) osteopenic women with CP was investigated in this study. METHOD AND MATERIALS: Sixty-eight PM osteopenic women with CP were included. The test group (n = 34) received SRP along with calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months, while the control group (n = 34) received calcium (500 mg) and vitamin D (250 IU) supplementation twice a day for 6 months. BMD, serum high sensitivity C-reactive protein (hsCRP), and periodontal parameters were recorded at baseline and 6 months. RESULTS: Improvement in BMD and serum hsCRP showed a statistically significant difference between groups at 6 months (P < .001). Binomial logistic regression analysis revealed that the test group was 4.82 (ORadjusted = 4.82; 95% CI = 1.17-19.71; P = .029) times more likely to exhibit normal BMD at 6 months. The results suggest there is an association of control of systemic inflammation by SRP with improved BMD in PM osteopenic women with generalized severe CP.

Effect of hyperlipidemia on response to nonsurgical periodontal therapy: Statin users versus nonusers.

OBJECTIVE: To evaluate the response to nonsurgical periodontal therapy among hyperlipidemic subjects and whether statin use by hyperlipidemic subjects influences the response. MATERIALS AND METHODS: This study was conducted on 107 chronic periodontitis subjects (35 normolipidemic [NL] controls, 36 hyperlipidemics on nonpharmacological therapy and 36 hyperlipidemics on statins). Periodontal (plaque index, gingival index [GI], probing depth [PD], and clinical attachment level [CAL]) and biochemical (plasma triglyceride [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-DL-C [HDL-C] levels) examination was done at baseline and 3 months after nonsurgical periodontal treatment. RESULTS: Both the NL and statin groups exhibited significantly greater improvement in GI as compared to the hyperlipidemic group on nonpharmacological therapy (P = 0.004 and 0.006, respectively). Mean change in PD correlated negatively with baseline TC (r = -0.306) and LDL-C (r = -0.360) while mean change in GI positively correlated with baseline HDL-C (r = 0.219). Regression analyses revealed that mean change in PD was negatively associated with LDL-C (ß = -0.358, P < 0.001) while mean change in GI was positively associated with HDL-C (ß = 0.219, P = 0.023). CONCLUSIONS: While higher baseline lipid levels were somewhat detrimental to the resolution of inflammation postperiodontal treatment, the inclusion of statin therapy among hyperlipidemic subjects seemed to improve clinical response as compared to those devoid of the drug. The findings of the study are suggestive of a possible adjunctive role of statins in periodontal treatment that warrants future studies.

Micronutrients and superoxide dismutase in postmenopausal women with chronic periodontitis: a pilot interventional study.

PURPOSE: The study was aimed at investigating changes in periodontal parameters and superoxide dismutase activity triggered by root surface debridement with and without micronutrient supplementation in postmenopausal women. METHODS: Forty-three postmenopausal chronic periodontitis patients were divided into two groups: group 1 (n=22) were provided periodontal treatment in the form of scaling and root planing (SRP) and group 2 (n=21) patients received SRP along with systemic administration of micronutrient antioxidants. Patients in both groups were subjected to root surface debridement. Group 2 patients also received adjunctive micronutrient antioxidant supplementation. Serum and salivary superoxide dismutase (SOD) activity along with periodontal parameters were recorded at baseline and 3 months after therapy. RESULTS: Salivary and serum SOD values significantly (P<0.05) improved with periodontal treatment. Improvement in systemic enzymatic antioxidant status along with reduction in gingival inflammation and bleeding on probing (%) sites was significantly greater in group 2 as compared to group 1. CONCLUSIONS: Adjunctive micronutrient supplements reduce periodontal inflammation and improve the status of systemic enzymatic antioxidants in postmenopausal women.

Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: a cross-sectional study.

PURPOSE: Both chronic periodontitis (CP) and iron deficiency anemia (IDA) induce oxidative stress in the body and cause an imbalance between reactive oxygen species and antioxidants, such as superoxide dismutase (SOD). This study explored the SOD enzyme activity of saliva and serum in CP patients with and without IDA and analyzed the impact of IDA on CP. METHODS: A total of 82 patients were divided into four groups: control group (CG, 22), periodontally healthy IDA patients (IDA-PH, 20), CP patients (CP, 20), and IDA patients with CP (IDA-CP, 20). After clinical measurements and samplings, serum and salivary SOD levels were determined using an SOD assay kit. RESULTS: IDA-CP patients exhibited a higher gingival index, bleeding on probing, probing pocket depth, and percentage (%) of sites with a clinical attachment loss (CAL) of ≥6 mm (P<0.008) than CP patients. The mean salivary and serum SOD levels were significantly lower in the IDA-PH, CP, and IDA-CP patients than in the CG group (P<0.008). A significant positive correlation between salivary and serum SOD activity was observed in IDA (P<0.05). Furthermore, serum and salivary SOD levels were significantly and negatively correlated with all periodontal parameters including the percentage of sites with CAL of 4-5 and ≥6 mm (P<0.05) except the significant correlation between salivary SOD activity and mean CAL and the percentage of sites with CAL of 4-5 mm (P>0.05) in these patients. CONCLUSIONS: Within the limits of this study, it may be suggested that IDA patients with chronic periodontitis have more periodontal breakdowns than patients with chronic periodontitis. Serum and salivary SOD activity levels were lower in the IDA-PH, CP and IDA-CP groups than in the CG. Iron deficiency anemia influenced the serum SOD activity but did not seem to affect the salivary SOD activity in these patients.