Effect of Nonsurgical Periodontal Therapy on the Glycaemic Control of Nondiabetic Periodontitis Patients: A Clinical Biochemical Study.

PURPOSE: To compare the HbA1c levels in nondiabetic subjects with periodontitis and periodontally healthy controls and to evaluate the effect of nonsurgical periodontal therapy on the glycaemic control in nondiabetic subjects with periodontitis. MATERIALS AND METHODS: A total of 220 nondiabetic subjects between 35 and 60 years old were selected and divided into two groups: group A (case group), comprised of subjects with chronic periodontitis, and group B (control group), comprised of subjects with healthy periodontium. Periodontal clinical parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment level) were used to assign the subjects into the respective groups. The HbA1c level was estimated for both groups using a commercially available kit. Subjects in group A underwent nonsurgical periodontal therapy in two to four sessions along with oral hygiene instructions. The periodontal parameters and HbA1c levels were again evaluated in the test group three months following periodontal therapy. RESULTS: The HbA1c levels were higher in the case group (A) than the control group (B). Three months following periodontal therapy in group A, there was improvement in periodontal parameters. The HbA1c levels decreased significantly from baseline to 3 months. CONCLUSION: The results of this study found chronic periodontitis to be associated with a significant increase in glycosylated haemoglobin levels in nondiabetic periodontitis subjects. Furthermore, with improvement of periodontal status, the glycaemic levels return to near normal values.

Burden of oral precancer and cancer among an indigenous tribal population of South India - An evaluative study.

Context: Oral cancer is of major concern in the Indian subcontinent and is found to be high among low socioeconomic groups. One such high-risk group is considered to be the tribal people, who are economically and socially marginalised. Aims: The aim of the present study is to assess the prevalence of oral cancer and precancer lesions among the Narikurava population in Puducherry state, India. Methods and Material: A total of 329 Narikurava tribal people were included in this study. Data was collected by clinical examination of the oral cavity by door-to-door screening. The oral cavity was examined for white/red lesions, ulcerative changes, leathery changes and tissue growths. Statistical Analysis Used: Prevalence was calculated in terms of percentages. Descriptive statistics included the calculation of percentages, mean, and standard deviation. Results: The prevalence of precancer in the population is 48.3%. The majority of the lesions were observed in the buccal mucosa: 41.6% had white lesions, 9.1% had red lesions, 0.3% had ulcerations or growth, and 28.3% had leathery changes followed by the labial mucosa: 0.6% had white lesions, 0.6% had red lesions, 0.3% had ulcerations or growth and 16.4% had leathery changes. Conclusions: The present study observed a high prevalence of precancerous lesions among the Narikurava tribe. The main reason for the high prevalence is attributed to tobacco and tobacco-related habits. Hence, cancer control activities should be prioritised. Designing a model to detect precancer and cancer early and to constantly monitor the detected cases in such populations is of utmost importance.

Understanding Cachexia in Head and Neck Cancer.

One of the major comorbidities of cancer and cancer therapy is posing a global health problem in cancer cachexia. Cancer cachexia is now considered a multifactorial syndrome that presents with drastic loss of body weight, anorexia, asthenia, and anemia. Head and neck cancer (HNC) patients are at a greater risk for development and severity of cachexia syndrome as there is direct involvement of structures associated with nutritional intake. Yet, the scientific evidence, approach, and management of cachexia in HNCs are yet to be largely explored. The article aims to succinctly review the concepts of cancer cachexia with relevance to HNCs and summarizes the current findings from recent research.

Assessment of Knowledge, Awareness and Attitude towards Oral Precancer and Cancer among Narikuravar Population in Pondicherry State.

Objective Literature revealed that oral health status and awareness about oral hygiene measures of Narikuravar tribes were very poor. There was also an increased prevalence of tobacco usage among this population. Considering this, incidence and prevalence of oral precancerous and cancerous lesions are expected to be high in this population. Surprisingly, the literature search revealed a lack of data on the awareness, knowledge, and prevalence of oral cancer and precancer in this group. The primary objective of this survey is to assess knowledge, awareness and attitude toward oral precancer and cancer among the Narikuravar tribal population in Pondicherry state. Materials and Methods This questionnaire survey is a part of the Model for Oral Cancer Eradication project conducted among the Narikuravar population in Pondicherry, which is funded by Indian Council of Medical Research (ICMR). A total of 153 participants were recruited for the survey. A prevalidated questionnaire was used for the survey. Results The results indicated that 47% of the participants were aware of what is oral precancer and cancer. As much as 62% knew that chewing tobacco causes oral cancer and 44% thought that the growth of tissue in the mouth could be a sign of oral cancer. Almost 100% did not think that the presence of a red lesion, white lesion, or limitation of mouth opening could be signs of cancer or precancer. Only 16% thought that oral cancer is preventable. Conclusion Awareness about oral cancer and precancer is inadequate among the Narikuravar population of Pondicherry. Majority of the population is not aware of the risks, signs, or treatment options of oral precancer and cancer. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) identified the people's knowledge gaps, and improving awareness is one of the strategies of the program.

Salivary Interleukin-6 Levels among Polycystic Ovary Syndrome Patients with and Without Chronic Periodontitis - A Comparative Study.

BACKGROUND: Periodontitis is associated with various systemic diseases one of which is poly cystic ovarian syndrome (PCOS). PCOS is a genetically complex endocrinopathy of uncertain etiology affecting women of the reproductive age group which results in the most common cause of anovulatory infertility, menstrual dysfunction, and hirsutism. PCOS has a close association with cardiometabolic risk profile, insulin resistance (IR), hyperinsulinemia, central obesity, dyslipidemia, and increasing the prevalence of cardiovascular risk factors. The common pathway is the chronic low-grade inflammation which is constituted by pro-inflammatory cytokine interleukin (IL)-6. AIM: The aim of the study was to compare salivary IL-6 levels among polycystic ovary syndrome (PCOS) patients with and without chronic periodontitis. MATERIALS AND METHODS: Newly diagnosed PCOS patients were selected for the study, and the periodontal parameters were recorded. Group A consists of 42 patients of PCOS with periodontitis and Group B consists of 42 patients of PCOS without periodontitis. Salivary levels of IL-6 were compared between the two groups and were assessed by enzyme-linked immunosorbent assay kit (bioassay). RESULTS: The mean pocket depth in Group A was 4.23 ± 0.134 and that of Group B was 1.30 ± 0.06. The mean bleeding on probing in Group A was 1.40 ± 0.40 and in Group B it was 0.91 ± 0.18. The mean clinical attachment level in Group A was 4.87 ± 0.124 and that of Group B was 1.30 ± 0.06. The mean difference in clinical parameters was statistically significant between the groups (P ≤ 0.001). IL-6 level in group A is 102.59 ± 18.2 and in Group B it was 51.3 ± 25.3. CONCLUSION: Salivary IL-6 levels show a double-fold increase in PCOS with periodontitis than in PCOS without periodontitis. This study reflects the importance of periodontal health and the prevention of periodontal disease so as to minimize IR in PCOS patients with periodontitis.

Assessment of Self Perception of Competencies among a Group of Dental interns in Pondicherry, India.

CONTEXT: The general dentist must not only have a broad biomedical and clinical education but also be able to demonstrate professional and ethical behavior as well as effective communication and interpersonal skills. In addition he or she must have the ability to evaluate and utilize emerging technologies, continuing professional development opportunities, and problem-solving and critical thinking skills to effectively address current and future issues in health care. But the extent to which the core competencies are taught and the students' level of proficiency in these competencies in Indian scenario is to be explored at large. AIMS: The present study aims at assessing the self-perceived level of competencies and their importance for future practice and the extent to which the competencies are taught in the curriculum among interns of dental college in Pondicherry, India. SETTINGS AND DESIGN: The cross-sectional observational study was conducted among dental interns of Indira Gandhi Institute of Dental Sciences, Pondicherry. SUBJECTS AND METHODS: A total of 72 interns participated in the study. A short version of the Freiburg Questionnaire to Assess Competencies in Medicine" was used in this study. Questionnaire has three sections with same set of questions, which the student had to rate: (i) To what extent do you have the following competencies at your disposal? (ii) To what extent will your future job require the following competencies? and (iii) To what extent is competencies taught to you? After the results were obtained a focused group discussion with the responders was done. Focused group discussion consisted of open questions to the groups in all the four domains and the responses of the students were scribed. RESULTS: In all four domains, self-perceived level of competency was not satisfactory. However, all students stated that the competencies were highly relevant for their future practice. Despite this, most of the competencies are not taught to necessary extent in the curriculum. The results of the present survey revealed that the participating students perceived deficiencies in all domains of competencies. CONCLUSIONS: These results indicate that the core competencies are still barely integrated into dental curricula and that further research in this field is needed.

Clinical Evaluation of Increase in the Width of Attached Gingiva using Modified Apically Repositioned Flap: A 9-Month Follow-up Study.

AIM: The purpose of this study is to evaluate the increase in the width of attached gingiva (AG) in single/multiple adjacent teeth using variation of modified apically repositioned flap (MARF). MATERIALS AND METHODS: A total of 20 systemically healthy controls with inadequate width of AG were recruited for the study based on inclusion and exclusion criteria. In all the individuals, variation of MARF technique was performed to increase the width of AG. Outcomes of the surgical techniques were measured in terms of probing pocket depth, clinical attachment level, width of AG, and width of keratinized gingiva (KG). The results were followed up at 3 months and continued till 9 months to confirm the stability of results. RESULTS: Treatment with this procedure resulted in a significant increase in the width of the KG and AG. The increase in KG ranged from baseline (2.0 mm) to 3.85 mm at 3rd month and the results were stable till 9th month (P < 0.001), and the increase in AG ranged from baseline (1.0 mm) to 2.85 mm at 3rd month and the results were stable till 9th month (P < 0.001). CONCLUSION: MARF is an effective technique in increasing the width of the keratinized tissue and AG around teeth and also offers considerable advantages over other mucogingival surgery techniques.

Fibrotic encapsulation of orthodontic appliance in palate.

Iatrogenic trauma though not serious is very common in dental practice. Orthodontic treatment can inflict such injuries as they are prolonged over a long period of time. Ill-fabricated orthodontic appliances, such as wires and brackets, or the patients' habits such as application of constant pressure over the appliance can traumatize the adjacent oral soft tissues. In rare cases, these appliances can get embedded into the mucosa and gingival tissues. This case report describes one such case of iatrogenic trauma to the palatal mucosa due to entrapment of a tongue spike appliance and its surgical management.

Self-reported prenatal oral health-care practices of preterm low birth weight-delivered women belonging to different socioeconomic status: A postnatal survey.

BACKGROUND: The differences in the oral health status between the individuals with a high socioeconomic status (SES) and those with a low SES had markedly increased. There is, however, minimal information available on women understanding the need of dental hygiene for overall health and whether pregnant women comply with the current oral health strategies. In Lieu with the above, the present study aims to assess the awareness, dental hygiene practices, and the frequency of dental visits during pregnancy in postnatal women who delivered preterm low birth weight babies of different SES in and around Puducherry. MATERIALS AND METHODS: A total of 200 individuals who visited Rajiv Gandhi Maternity Centre, Puducherry for delivery were selected. Information regarding onset of prenatal care, referral to dentist, and oral hygiene habits such as frequency of brushing, type of brush used, method of brushing, and frequency of brush change were obtained. Periodontal health status was recorded using PSR system. RESULTS: Awareness of oral hygiene practices was more among upper middle class and lower middle class compared to upper lower strata. Visit to dentist during perinatal period was high among upper middle class compared to other socioeconomic strata. CONCLUSIONS: The awareness of oral health-care practices and importance of oral care during perinatal period were less among low socioeconomic strata.

Mouth the mirror of lungs: where does the connection lie?

Periodontitis is the chronic destructive disease of the periodontium (Gums) caused by host bacterial interactions. The effect of such host bacterial interactions in oral cavity also evokes a systemic response. Numerous studies have found common mechanisms of destruction for periodontal diseases and other chronic diseases like diabetes mellitus, atherosclerosis, respiratory diseases, and adverse pregnancy outcomes. Oral colonization by respiratory pathogens appears to be a risk factor for development of respiratory diseases and oral interventions aimed at reducing oral bacterial count have resulted in reduced incidence of these reparatory illness. This reflects the importance of oral hygiene among patients with respiratory illness. This review highlights the association between periodontal diseases and respiratory diseases.

Evaluation of oral health attitude and behavior among a group of dental students in Puducherry, India: A preliminary cross-sectional study.

CONTEXT: Oral behavior reflects individual perception on oral health. Behavior and attitude of oral health providers, especially dentists, towards oral health affect their capacity to deliver oral health care services. This attitude plays a important role in determining the oral health condition of population. AIM: The purpose of this study is to evaluate the oral health attitude and behavior among a group of dental students in India and to find any gender-based differences in terms of oral health attitude and behavior. MATERIALS AND METHODS: A total of 282 dental students of Indira Gandhi Institute of Dental Sciences, SBV University, Puducherry, India participated in the study. A simplified English version of Hiroshima University Dental-Behavioral Inventory (HU-DBI) was adopted. STATISTICAL ANALYSIS USED: SSP version 2.80 software was used to analyze the data. Chi-square test was used to find the differences in the distribution of "yes" among students from the different academic year as well as between male and female students. Statistical significance was set at P ≤ 0.05. RESULTS: Statistical significance was observed for the responses between the students from different academic years brushing frequency, careful brushing of teeth, using brush with hard bristles, careful self-evaluation of brushing and satisfied appearance of teeth and gums. Male students preferred to use a tooth brush with hard bristles and regular mouth washes than female students. With regards to worrying about bad breath, male students had more "yes" responses than females. CONCLUSIONS: Oral health attitude and behavior increased with the increasing levels of dental education, and no significant differences were observed among male and female dental students.

Efficacy of combination therapy using anorganic bovine bone graft with resorbable GTR membrane vs. open flap debridement alone in the management of grade II furcation defects in mandibular molars - A comparative study.

CONTEXT: Invasion of the bifurcation and trifurcation of the multi-rooted teeth resulting in furcation involvement is one of the serious complications of periodontitis. AIM: The purpose of the study was to evaluate the efficacy of combination therapy using anorganic bovine bone graft and resorbable guided tissue regeneration (GTR) membrane versus open flap debridement alone in the management of Grade II furcation defects in mandibular molars. MATERIALS AND METHODS: The study included a total number of 20 sites in 10 patients with bilateral mandibular furcation defects, out of which 10 sites were treated as test group and 10 as control group. The test group was treated with combination therapy and the control group with open flap debridement alone. The parameters were recorded on 0 day (baseline), 90th day, and 180th day, which included vertical probing depth and horizontal probing depth of the furcation defect, clinical attachment level, and defect fill. STATISTICAL ANALYSIS USED: Mean and standard deviation were calculated for different variables in each study group at different time points. Mean values were compared by using Wilcoxon signed ranks test, after adjusting the P values for multiple comparison by using Bonferroni correction method. RESULTS: Both the test and control groups showed a definitive improvement in clinical parameters, which was statistically significant. On comparison, the vertical probing depth showed significant reduction in the test group with a mean reduction of 3.1 ± 0.7 mm, when compared to the control group which showed a mean reduction of 1.5 ± 0.5 mm. The horizontal probing depth of furcation defects was also significantly reduced in the test group with a mean reduction of 2.2 ± 0.6 mm, when compared to the control group in which the mean reduction was 0.9 ± 0.3 mm. There was also significant gain in attachment level in the test group which showed a mean gain of 3.2 ± 0.6 mm, when compared to the control group which showed a gain of 1.2 ± 0.6 mm. Radiographic defect fill was found to be more in the test group with a mean gain of 2.0 ± 0.1 mm, when compared to the control group which showed a defect fill of 0.2 ± 0.1 mm. CONCLUSIONS: The results of this study demonstrated that the combined use of anorganic bovine bone graft and resorbable GTR membrane is effective than open flap debridement alone in the treatment of mandibular grade II furcation defects.

Clinical effects of subgingivally delivered spirulina gel in chronic periodontitis cases: a placebo controlled clinical trial.

AIMS AND OBJECTIVES: The aim of this study was to assess the clinical effects of Spirulina in-situ gel as an adjunct to Scaling And Root Planning (SRP) in the treatment of chronic periodontitis subjects. MATERIAL AND METHODS: 64 sites were selected with probing pocket depth of ≥5mm and they were divided into 2 groups; 33 sites were treated with SRP along with spirulina gel (Group A) and 31 sites were treated with SRP alone (Group B). Clinical parameters were recorded at baseline before SRP and at 120(th) day after the treatment therapy. The parameters included Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). RESULTS: Both the groups showed significant improvement in the parameters. However, Group A (SRP along with spirulina) showed statistically significant decrease in mean probing pocket depth and gain in the clinical attachment level after 120 days as compared to Group B SRP alone. CONCLUSION: Locally delivered spirulina gel, along with scaling and root planning, has been shown to cause a beneficial impact. The efficacy of the product as a local drug delivery system in the non-surgical treatment of periodontitis without any side effects has been proved. Spirulina appears to be promising. It exerts strong anti-inflammatory effects which are closely connected with its antioxidative activity. This study can have a significant impact on the treatment procedures of periodontitis, with the use of blue green algae in the future.