Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial.

AIM: To evaluate the potential of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. MATERIAL AND METHODS: In a single-centred randomized and controlled clinical trial, 90 patients (51 females and 39 males) with untreated chronic periodontitis were randomly assigned to receive SRP with aPDT (test group) or SRP alone (control group). Clinical parameters and halitosis were recorded for 6 months after treatment by a periodontist who was blinded to the procedure. RESULTS: Inter-group and intra-group statistical analyses were performed. Significant difference between the two groups with respect to each variable was assessed using non-parametric Rank Order ancova. Probing pocket depth and clinical attachment levels showed statistically significant reduction in the test group on evaluation at 3 months and 6 months as compared to the control group (p < 0.05). A statistically significant improvement in gingival index and gingival bleeding index was seen for the test group after 2 weeks and 1 month of aPDT (p < 0.01), whereas the improvement in gingival index and gingival bleeding index at 3 months and in plaque index at 2 weeks after aPDT was less (p < 0.05). Also, a significant difference was detected for the test group at 1 month in terms of halitosis (p < 0.05), which did not persist for long. CONCLUSIONS: Antimicrobial photodynamic therapy acts as a beneficial adjunct to SRP in non-surgical treatment and management of chronic periodontitis in short-term. Further studies are required to assess the long-term effectiveness of aPDT.

Perceptions of Indian Healthcare Practitioners Regarding the 2022 Outbreak of Monkeypox Disease.

Introduction Although only a few cases of monkeypox have been reported in India so far, it is vital for healthcare practitioners to have sufficient knowledge about its epidemiology, clinical presentation, diagnosis, and management. Therefore, this study aimed to understand the perception of Indian healthcare practitioners regarding the 2022 outbreak of monkeypox disease. Methods A cross-sectional survey was conducted among 500 medical and dental practitioners from various regions of Kerala, India. The Chi-squared test for proportion was used to determine the significant difference in the knowledge levels of the participants. Binary logistic regression (multivariate) was used to understand the knowledge of healthcare professionals regarding the 2022 outbreak of monkeypox disease. Results A total of 424 healthcare professionals completed this survey. Overall, the level of knowledge was good in 64.9% and poor in 35.1% of the participants (p<0.01). Binary logistic regression analysis did not show any statistical significance (p > 0.05) in terms of demographic characteristics. However, in this sample, participants with 6-10 years of work experience were more likely to have improved knowledge scores (odd's ratio OR 1.764). Similarly, participants between the age of 30-40 years were also likely to have improved knowledge scores (OR: 1.065). Conclusions Indian healthcare professionals had an overall good level of knowledge regarding the 2022 outbreak of monkeypox. However, a low level of knowledge was found related to the clinical presentation and immunization of monkeypox. This may be due to the low prevalence of monkeypox in this region.

Is Obesity a Risk Factor for Periodontal Disease in Adults? A Systematic Review.

There is inconclusive evidence about the link between the severity and prevalence of periodontitis in obese adults. Therefore, this systematic review aims to explore the possibility of significant evidence on the association between obesity and periodontitis and to determine the necessity to consider obesity as a risk factor for periodontitis. We followed the PRISMA protocol, and studies that met the eligibility criteria were included in this review. The risk of bias in individual studies was also evaluated. This review included 15 observational studies (9 cross-sectional studies, 2 case-control, and 4 cohort studies). The total study subjects from these studies were 6603 (males = 3432; females = 3171). Most studies showed a significant association between obesity and periodontitis. Among these studies, a few showed obese females to be at a higher risk, and one study found no association between obesity and periodontal disease at all. Based on the evidence obtained from this review, the body mass index (BMI) should be routinely assessed in patients to assess the risk for periodontal disease and to offer personalized management of periodontitis. Based on the findings of this review, we recommend the need to initiate awareness among clinicians and implement dental hygiene care prevention measures for obese patients.

Relationship between Malocclusion and Periodontal Disease in Patients Seeking Orthodontic Treatment in Southwestern Saudi Arabia.

BACKGROUND: Malocclusion is known to cause plaque accumulation and periodontal breakdown. However, no previous study from Saudi Arabia has assessed this relationship in patients seeking orthodontic treatment for esthetics. OBJECTIVE: The objective of this study was to investigate the relationship between malocclusion and periodontal disease in terms of gingival inflammation, probing pocket depth (PPD) and recession in patients seeking orthodontic treatment for esthetic improvement. MATERIALS AND METHODS: This prospective cross-sectional study was conducted at the Outpatient Division of Periodontics, College of Dentistry, King Khalid University, Saudi Arabia, among consecutive new patients seeking orthodontic treatment for esthetic improvement between June and August 2018. Angle's class of malocclusion, various malalignments, plaque index (PI), gingival index (GI), adequacy of width of attached gingiva (WAG), response to fremitus test, PPD and gingival recession (GR) were recorded. P < 0.05 was considered statistically significant. RESULTS: A total of 410 consecutive patients were included. Of these, 314 patients had Class I, 57 had Class II (division I), 25 had Class II (division II) and 14 had Class III malocclusions. In patients with all types of malocclusion, the majority had a PI and GI of score 2 (74.1% and 83.7%, respectively). Most of the patients (85.9%) had adequate WAG; similarly, 94.9% had a negative fremitus test, which shows the absence of trauma from occlusion. Mean PPD and GR in the maxillary and mandibular arches showed varying results. CONCLUSION: This study demonstrates a relationship between malocclusion and presence of periodontal disease in patients seeking orthodontic treatment for esthetic improvement in the southwestern region of Saudi Arabia. Therefore, in patients seeking orthodontic treatment, careful evaluation of gingival and oral hygiene along with adequacy of attached gingiva should be considered.

Diagnostic accuracy of salivary biomarkers of bone turnover in identifying patients with periodontitis in a Saudi Arabian population.

BACKGROUND/PURPOSE: Salivary markers of bone turnover are useful biomarkers for screening patients advanced periodontal diseases with alveolar bone loss. Hence, the purpose of this study was to determine the diagnostic accuracy of deoxypyridinoline-containing degradation fragment of the C-terminal telopeptide region of type I collagen (CTX), Osteocalcin (OC) and Osteonectin (ON) in identifying patients with alveolar bone loss (BL) due to periodontitis. MATERIALS AND METHOD: Salivary levels of CTX, OC and ON were evaluated in ninety patients (group I, II and III with healthy, periodontitis without Type2 diabetes mellitus-T2DM and periodontitis with T2DM respectively). Group III was included since T2DM is very common among patients attending our clinics. Bleeding on probing (BOP), probing pocket depth (PPD) and BL were recorded for these patients. RESULTS: The concentrations of salivary CTX, OC, and ON were higher in subjects with periodontitis than in controls. Significant correlations were found between these biomarkers and periodontal parameters. CTX, OC, and ON could discriminate between healthy (group I) and diseased (group II & III) regarding BL with excellent sensitivity (90.2-100%) and good specificity (62.1-96.6%). ROC curve gave excellent discrimination regarding BL (AUC: 0.926-0.958) and PPD (AUC: 0.904-0.915). However, none of the cut-off values gave good discrimination regarding BOP. CONCLUSION: It can be concluded that CTX, OC, and ON correlated well with BL and PPD. Among the three biomarkers, ON at 81.80 ng/ml gave the best discrimination for presence or absence of bone loss.

Patients' perceptions of antimicrobial photodynamic therapy in the management of chronic periodontitis.

The aim of this study is to evaluate patients' perception of antimicrobial photodynamic therapy (aPDT) in the management of chronic periodontitis. 90 patients (51 females and 39 males) with untreated localized chronic periodontitis were randomly assigned to receive SRP with aPDT (test group) or SRP alone (control group) in a single-centered double-blinded randomized and controlled clinical trial. Patients' perception in terms of changes in bleeding gums, pain in gums while chewing, bad breath and sensitive gums along with pain during the procedure and patient acceptance were recorded for 6 months after treatment by a periodontist who was blinded to the procedure. Inter-group and intra-group statistical analyses were performed. Significant difference between the frequencies of two groups with respect to each variable was assessed using non-parametric test. Patients' report of bleeding gums and pain in the gums while chewing showed statistically significant reduction in the test group at 2 weeks and 1 month (p<0.05). Also, a significant difference was detected at 1 month between SRP and SRP+aPDT in terms of halitosis (p<0.05). No statistically significant change was observed between two groups in terms of sensitive gums, pain during procedure and patient acceptance. Patients perceived short-term benefits of single session of aPDT therapy due to the reduction in bleeding gums, halitosis and pain while chewing following treatment. Further studies are required to assess the effectiveness of aPDT for a longer-term and following multiple sessions.

In vivo inflammation mapping of periodontal disease based on diffuse reflectance spectral imaging: a clinical study.

Since conventional techniques using periodontal probes have inherent drawbacks in the diagnosis of different grades of gingival inflammation, development of noninvasive screening devices becomes significant. Diffuse reflectance (DR) spectra recorded with white light illumination is utilized to detect periodontal inflammation from the oxygenated hemoglobin absorption ratio R620/R575. A multispectral imaging system is utilized to record narrow-band DR images at 575 and 620 nm from the anterior sextant of the gingivia of 15 healthy volunteers and 25 patients (N=40). An experienced periodontist assesses the level of gingival inflammation at each site through periodontal probing and assigns diagnosis as healthy, mild, moderate, or severe inflammation. The DR image ratio R620/R575 computed for each pixel (8-µm resolution) from the monochrome images is pseudo-color-mapped to identify gingival inflammation sites. The DR image ratio values at each site are compared with clinical diagnosis to estimate the specificity and sensitivity of the DR imaging technique in inflammation mapping. The high diagnostic accuracy is utilized to detect underlying inflammation in six patients with a previous history of periodontitis.

Discrimination of periodontal diseases using diffuse reflectance spectral intensity ratios.

This clinical study was to demonstrate the applicability of diffuse reflectance (DR) intensity ratio R620/R575 in the quantification and discrimination of periodontitis and gingivitis from healthy gingiva. DR spectral measurements were carried out with white-light illumination from 70 healthy sites in 30 healthy volunteers, and 63 gingivitis- and 58 periodontitis-infected sites in 60 patients. Clinical parameters such as probing pocket depth, clinical attachment level, and gingival index were recorded in patient population. Diagnostic accuracies for discrimination of gingivitis and periodontitis from healthy gingiva were determined by comparison of spectral signatures with clinical parameters. Divergence of average DR spectral intensity ratio between control and test groups was studied using analysis of variance. The mean DR spectrum on normalization at 620 nm showed marked differences between healthy tissue, gingivitis, and periodontitis. Hemoglobin concentration and apparent SO(2) (oxygen saturation) were also calculated for healthy, gingivitis, and periodontitis sites. DR spectral intensities at 545 and 575 nm showed a decreasing trend with progression of disease. Among the various DR intensity ratios studied, the R620/R575 ratio provided a sensitivity of 90% and specificity of 94% for discrimination of healthy tissues from gingivitis and a sensitivity of 91% and specificity of 100% for discrimination of gingivitis from periodontitis.