Effectiveness of Azadirachta indica (neem) mouthrinse in plaque and gingivitis control: a systematic review.

OBJECTIVES: The aim of this systematic review was to evaluate the effectiveness of Azadirachta indica (neem)-based herbal mouthrinse in improving plaque control and gingival health. METHODS: Literature search was accomplished using electronic databases (PubMed, Cochrane Central Register of Controlled Trials and EMBASE) and manual searching, up to February 2015, for randomized controlled trials (RCTs) presenting clinical data for efficacy of neem mouthrinses when used alone or as an adjunct to mechanical oral hygiene as compared to chlorhexidine mouthrinses for controlling plaque and gingival inflammation in patients with gingivitis. RESULTS: Of the total 206 articles searched, three randomized controlled trials evaluating neem-based herbal mouthrinses were included. Due to marked heterogeneity observed in study characteristics, meta-analysis was not performed. These studies reported that neem mouthrinse was as effective as chlorhexidine mouthrinse when used as an adjunct to toothbrushing in reducing plaque and gingival inflammation in gingivitis patients. However, the quality of reporting and evidence along with methods of studies was generally flawed with unclear risk of bias. CONCLUSION: Despite the promising results shown in existing randomized controlled trials, the evidence concerning the clinical use of neem mouthrinses is lacking and needs further reinforcement with high-quality randomized controlled trials based on the reporting guidelines of herbal CONSORT statement.

Management of gingival inflammation in orthodontic patients with ozonated water irrigation--a pilot study.

OBJECTIVE: Ozonated water irrigation has recently been tried for its antimicrobial and anti-inflammatory effects in treatment of periodontitis. During orthodontic treatment, gingival inflammation occurs along with increased lactate dehydrogenase (LDH) enzyme levels in gingival crevicular fluid (GCF). Thus, the aim of this pilot study was to evaluate the clinical effects of a single subgingival irrigation with ozonated water on gingival inflammation in orthodontic patients and also to correlate the clinical effects with LDH enzyme activity in GCF. METHODS: Fifteen systemically healthy orthodontic patients (seven men and eight women, mean age 17.3 years) with full-mouth brackets were included in this prospective, cross-sectional, clinical and laboratory investigation. Clinical parameters, LDH enzyme activity and GCF volume were measured at baseline (0 day) followed by subgingival irrigation with 0.01 mg l(-1) ozonated water. These parameters were again assessed on 14th and 28th day. RESULTS: There was significant (P < 0.05) reduction in values of clinical parameters, GCF LDH activity and GCF volume after subgingival irrigation with ozonated water. Also, a significant correlation (r = 0.50, P = 0.01) was observed only between the post-treatment changes of plaque index and LDH values, among the clinical parameters assessed. CONCLUSIONS: A single subgingival irrigation of 0.01 mg l(-1) ozonated water can effectively reduce the gingival inflammation in orthodontic patients, which is also reflected in the reduction of LDH enzyme levels. However, further randomized controlled trials are required to validate the use of ozone irrigation in orthodontic patients for plaque control measures.

Dental Fluorosis and Periodontium: an Original Research Report of In Vitro and In Vivo Institutional Studies.

Fluorosis is one of the global problems that have persisted for a very long time now without any specific treatment and cure. Fluoride is known for its influence on the tooth structures like enamel and dentin, but little information exists on its effect on the surrounding periodontal structures and bone. With this background, we conducted multiple studies assessing etiological, diagnostic, therapeutic and clinical criteria in subjects with and without dental fluorosis in a single group of the population residing in high fluoride water areas (1.5-3.0 ppm) of Davangere District, Karnataka, India. These preliminary studies conducted are hereby elaborately presented and discussed in this comprehensive review article along with their important conclusions.

The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesions.

BACKGROUND: The periodontal lesions with cellular proliferation can be assessed by various methods. One of the most recent methods to determine the proliferative activity is silver-staining nucleolar organizer region (AgNOR) staining. The purpose of the present study was to evaluate, if AgNOR count can act as a proliferative marker and can aid in the diagnosis and prognosis of periodontal lesions. MATERIALS AND METHODS: For this study, subjects with healthy gingival status, non-neoplastic lesions, neoplastic lesions, and plaque-induced gingivitis were included. Following the provisional diagnosis of clinical entity, biopsies were taken from the respective selected sites for histopathological diagnosis. In plaque-induced gingivitis cases, a second biopsy was taken from the selected sites 3 weeks following scaling. After histological confirmation, one more section was prepared, which was subjected to AgNOR staining, and AgNOR numbers were counted by individual and cluster counts and statistically analyzed. RESULTS: Results showed the highest AgNOR count in neoplastic lesions. Non-neoplastic lesions showed a higher AgNOR count as compared to clinically healthy gingiva. Plaque-induced gingivitis showed a considerable reduction in AgNOR count after treatment. CONCLUSION: Results of this study confirmed that AgNOR count reflects the cellular proliferation and has a limited diagnostic value. However, the prognostic value of AgNOR for periodontal lesions is dependable.

Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs.

BACKGROUND: Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socioeconomic status and risk factors including tobacco usage and oral hygiene status. However, there is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. The aim of the study was to investigate the effect of dental fluorosis on the periodontal status using community periodontal index of treatment needs (CPITN), as a clinical study. The purpose of this study is to determine the periodontal status using CPITN index in a population aged between 15 and 74 years residing in the high fluoride areas of Davangere district. The possible reasons for the susceptibility of this population to periodontal disease are discussed. MATERIALS AND METHODS: 1029 subjects, aged between 15 and 74 years suffering from dental fluorosis were assessed for their periodontal status. Clinical parameters recorded were OHI-S to assess the oral hygiene status, Jackson's fluorosis index to assess the degree of fluorosis and CPITN index to assess the periodontal status where treatment need was excluded. RESULTS: Gingivitis and periodontitis were more common in females (65.9% and 32.8%,respectively) than in males (75.1% and 24.2%, respectively). Periodontitis was significantly more common in females. As the age advanced from 15 to 55 years and above, gingivitis reduced from 81.0 to 42.9% and periodontitis increased steadily from 18.0 to 57.1%, which was significant. Periodontitis was high in subjects with poor oral hygiene (81.3%), compared to those with good oral hygiene (14.5%), which was significant. As the degree of fluorosis increased, severity of gingivitis reduced and periodontitis increased, i.e, with A degree fluorosis, gingivitis was 89.4% and periodontitis 8.5%, but with F degree fluorosis the former was 64% and the latter 35.8%, which was statistically significant. CONCLUSION: The results suggest that there is a strong association of occurrence of periodontal disease in high-fluoride areas. The role of plaque is well understood in contrast to the effect of fluorides on periodontal tissues. It goes a long way to reason out fluoride as an important etiological agent in periodontal disease.

The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study.

PURPOSE: Periodontal disease is a commonly prevalent problem faced alike by both the developed and third world countries but showing wide variations in prevalence and severity across different geographical areas. The purpose was to identify Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Ekinella corrodens (Ec), Campylobacter rectus (Cr), Bacteroides forsythus (Bf), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) in Indian adult periodontitis and rapidly progressive periodontitis patients. MATERIALS AND METHODS: Paper points were used to collect the sample from 28 sites in both adult periodontitis and rapidly progressive periodontitis (8 healthy/20 diseased sites) patients and DNA analysis done. The categorical data was analysed by Fishers exact test and difference in the clinical parameters was tested by Mann-Whitney test. RESULTS: In healthy sites of adult and rapidly progressive periodontitis patients, Aa, Ec, Bf and Aa, Pg, Pi, Td, Fn were detected respectively. However, when diseased and healthy sites were compared in both adult periodontitis and rapidly progressive periodontitis patients respectively, only Pg( P =0.004), Cr( P =0.04), Fn( P =0.014) and Pg( P =0.002), Cr( P =0.02), Fn( P =0.008) were statistically significant. CONCLUSION: The prevalence of the microorganisms correlate with the clinical parameters like probing depth and bleeding on probing as seen in the Japanese and Western periodontitis patients' population.

Detection and measurement of oral malodour in periodontitis patients.

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.

Effects of Tetracycline, EDTA and Citric Acid Application on Nonfluorosed and Fluorosed Dentin: An In Vitro Study.

UNLABELLED: Fluorosis is one of the factors that may bring about mineralization changes in teeth. Routine treatment of root biomodification is commonly followed during Periodontal therapy. BACKGROUND: The Purpose of the present study was to compare and evaluate the morphological changes in fluorosed and nonfluorosed root dentin subsequent to the application of Tetracycline, EDTA and Citric acid. Both fluorosed and nonfluorosed teeth comprising of periodontally healthy and diseased were included in this study. METHOD: Each of them was grouped into Tetracycline Hydrochloride, EDTA and Citric acid treatment groupes. Using scanning electron microscope (SEM), the photomicrographs of dentin specimens were obtained. RESULTS: Showed that there was no significant difference in exposure of number of tubules in different groups, while significant increase in the tubular width and tubular surface area was seen in fluorosed healthy, followed by fluorosed diseased groups, nonfluorosed healthy and nonfluorosed diseased groups after root biomodification procedure using various root conditioning agents. The root biomodification procedure brings in definite difference between fluorosed and nonfluorosed dentin specimens.

Azithromycin buccal patch in treatment of chronic periodontitis.

AIM: This study aims to explore the clinical, microbiological, and biochemical impact of azithromycin (AZM) buccal patch in chronic generalized patients as a monotherapy as well as an adjunct to nonsurgical therapy. MATERIALS AND METHODS: A parallel design was used forty periodontitis patients were randomly allocated into five groups, namely Group 1 scaling root planing (SRP) alone, Group 2 (SRP + AZM patch group), Group 3 (SRP + AZM tablet group), Group 4 (AZM patch monotherapy), and Group 5 (AZM tablet as monotherapy). Plaque index, gingival bleeding index, modified gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and 21 and 90 days. Subgingival pooled plaque sample was collected to assess periodontopathogens like Porphyromonas gingivalis and Prevotella intermedia (Pi) by anaerobic culture method. Tumor necrosis factor alpha (TNF-α) was also evaluated at baseline and 21 days. Periodontal maintenance was performed in Group 1 until 90(th) day, and clinical parameter was assessed at the end of 90(th) day. RESULTS: SRP + AZM tablets showed greater reduction in clinical parameters (P < 0.05) AZM as monotherapy did not offer clinical benefits over SRP. Baseline data were compared at the end, i.e., 90(th) day a significant reduction in plaque scores, gingival bleeding, and PPD was observed however no significant gain in the clinical attachment was observed. CONCLUSION: The monotherapy resulted in no improvement of periodontal parameters, microbial parameters, and TNF-α level. It is safe to use AZM + SRP as a mode of nonsurgical treatment in periodontitis patients.

Three-dimensional finite element analysis of stress in the periodontium.

The aim of this study is to calculate the stress produced in the periodontium at different bone levels under occlusal load. Four finite element models of maxillary incisors were designed consisting of the tooth, pulp, periodontal ligament and alveolar bone at various levels of bone height (25%, 50% and 75%). An occlusal load of 24 kg at an angle of 50 degrees to the long axis of the tooth was applied on the palatal surface, at the level of the middle third of the crown. All the models were assumed to be isotropic, linear and elastic and the analysis was performed on a Pentium IV computer using the NISA II Display III software. The results showed that maximum stress in the tooth was seen at the cervical region and to a greater extent at the apex for all the models. In periodontal ligament, maximum stress was seen at the alveolar crest in models with normal alveolar bone height and with reducing alveolar bone height maximum stress was at the apex. There was no significant stress distribution in alveolar bone, while no stress was seen on the pulp. The results of the study demonstrated a significant increase in stress concentration at the apex with loss of alveolar bone height.

Comparative assesment of gingival thickness using transgingival probing and ultrasonographic method.

A decided attitude of expectation among many patients has given a new perspective to regenerative and plastic periodonta surgery. With authors emphasizing on the importance of gingival thickness, attempts are being made to obtain necessary information atraumatically and rapidly. Hence in the present study an attempt has been made to compare the two methods of assessing gingival thickness i.e transgingival probing and ultrasonographic method and also assess the gingival thickness in relation to central incisor lateral incisor and canine in Indian population. The gingival thickness was assessed in patients with healthy gingiva by both the methods. It was observed that transgingival probing method significantly over estimated the thickness of gingiva than the ultrasonographic method and the thickness of gingiva varies with morphology of the crown. It was concluded that compared to transgingival probing ultrasonographic method assesses gingiva thickness more accurately, rapidly and atraumatically.

FEM in periodontal research.

The changes in the periodontal tissues either due to pathologic processes on external forces have been investigated from histologic, histochemical, biochemical, physiologic, and bioelectrical (bony response) and biochemical viewpoint. However, because of the complexity of stress analysis or experimental techniques, no information is available on the stress induced in the periodontal tissues. The Finite Element Method (FEM), which is introduced as one of the methods for numerical analysis, has become a useful technique for stress analysis in biologic systems. The FEM makes it possible to analytically apply various force systems at any point and in any direction. From the periodontal point of view, FEM would provide different stress levels in periodontal structures based on the biomechanical principle, which in turn may prompt occlusal correction at an earlier date.

Treatment of gingival recession by modified Langer and Langer technique.

In recent years, stronger need for esthetics and growing cosmetic demand for a pleasing smile has made many individuals more conscious of the recession on facial aspect of the teeth. Here we report a case illustrating treatment for facial gingival recession using modified Langer and Langer technique. The clinical results showed good soft tissue coverage of the root surfaces and improving esthetics.

Autologous Stem Cell Application in Periodontal Regeneration Technique (SAI-PRT) Using PDLSCs Directly From an Extracted Tooth···An Insight.

Periodontal regeneration represents the ultimate goal of periodontal therapy. The current regenerative techniques have limited success rates especially in advanced periodontal defects. Currently the research is focused on novel cell-based approaches for periodontal regeneration to overcome the limitations of existing treatment. The human clinical trial on stem cells based periodontal regeneration is promising. The plethora of animal studies provide sound evidence to support the belief that periodontal ligament stem cells (PDLSCs) can be used for periodontal regeneration. The direct application of autologous periodontal stem cells in treatment of intrabony defects is attempted for the first time in periodontal literature. Stem cell Application in Periodontal Regeneration Technique (SAI-PRT) using direct PDLSCs has overcome the limitations and concerns of ex- vivo stem cell culture methods like high cost, technique sensitivity, loss of stemness during cell passage, genetic manipulation and tumorigenic potential. Clinical feasibility, success and cost effectiveness over currently available techniques are encouraging. The clinical utility of this novel idea is recommended.

Clinical and radiographic evaluation of Emdogain as a regenerative material in the treatment of interproximal vertical defects in chronic and aggressive periodontitis patients.

This study evaluated the efficacy of Emdogain enamel matrix proteins as a regenerative material in interproximal vertical defects both clinically and radiographically. Patients aged 18 to 45 years and diagnosed with chronic or aggressive periodontitis were included. Sixteen intrabony defects in eight patients were surgically treated using a split-mouth design. Emdogain placement was done at experimental sites. Since both chronic and aggressive periodontitis patients were included, an attempt was made to interpret results between the two types of cases. Postsurgical measurements at 9 months revealed no significant difference in mean pocket depth reduction, clinical attachment level gain, amount of defect fill, or defect resolution between control and experimental groups. Mean pocket depth reduction and amount of defect fill were significant in both groups. The results were interpreted separately for chronic and aggressive periodontitis cases. This study demonstrated no added advantage of using Emdogain compared to surgical debridement alone. Further long-term and large-sample-size evaluation is required to prove Emdogain's consistent efficacy.

Prepubertal periodontitis: a report of 2 cases.

PURPOSE: Prepubertal periodontitis is a term suggested for a form of periodontitis that starts soon after the eruption of primary teeth. There is increased awareness that the disease entity known as "periodontitis" is in all probability a family of related but reasonably discrete diseases. The purpose of this report is to describe the clinical, radiographic, and laboratory findings in 2 patients, as well as treatment of prepubertal periodontitis. METHODS: This study presents 2 cases of generalized prepubertal periodontitis: a 5-year-old girl and a 13-year-old girl. RESULTS: Case 1 presented to the clinic because of parental concern for the early exfoliation of her teeth. All of her teeth with Grade III mobility, ie, 8.5, were extracted and the rest were scaled and root planed with subgingival irrigation of 0.2% chlorhexidine. She received a program of 3-month maintenance scaling and 6 months later, there was no further progression of periodontal lesions. Case 2 demonstrated the destruction of tooth roots along with extensive loss of tooth roots and alveolar bone. Since all the permanent teeth were Grade II mobile, the patient was advised to have total extraction with replacement of teeth by complete denture prosthesis at a later date. CONCLUSIONS: In case 2 premature root resorption was occurring concurrently with unexplained extensive alveolar bone loss. In Case 1, the elimination of the pathogenic microflora during primary dentition by early extraction of the teeth involved, plus daily local, mechanical and chemical control of the irritant factors may have prevented subsequent damage to remaining teeth in prepubertal periodontitis.

A comparative evaluation of an ultrasonic and a manual toothbrush on the oral hygiene status and stain removing efficacy.

The efficacy of ultrasonic toothbrush and a manual toothbrush was compared on the oral hygiene status and on microbial parameters. 26 dental students from the College of Dental Sciences Davangere, Karnataka, were selected for this single blind study of 4 weeks duration. The participants were in the age group of 18-25 years. The brushes were randomly allotted by the co-investigator, who also supervised the brushing technique throughout the study period. The subjects were instructed to refrain from brushing their teeth for 12-14 hours prior to each follow up visit. The main investigator assessed all the clinical parameters at baseline, 14th, 21st and 28th day. Statistical analysis was carried out by an independent statistician who remained blind to the test products. Each of the tooth brushes tested, showed significant reductions in all the clinical parameters between 0 and 28th day. The reductions within the groups were significant although no significant differences between the groups were found. The reductions in stain index, bleeding index and gingival index was higher in ultrasonic toothbrush compared to manual toothbrush. It is concluded that ultrasonic toothbrush is safe and effective in the removal of plaque, stains, reduction of gingival inflammation and gingival bleeding.

Eosinophilic granuloma with oral manifestations: a case report.

Eosinophilic granuloma is the most benign disorder of the triad commonly known as histocytosis X. In this article a case of a 6 year old female child with multiple eosinophilic granuloma with additional liver dysfunction and its oral manifestation is presented. This case demonstrated that oral findings, may be an early manifestation of the disease, definitive diagnosis needs to be determined by correlation of the clinical findings with histologic features. For the duration of 8 years the case has been followed up, there has been a progressive healing of the lesion, the clinical manifestations of the disease resolved with only chemotherapy and provided a very good prognosis.

DNA probe analysis in smoker and non smoker rapidly progressive periodontitis patients--a pilot study.

Smoking is one of the most significant risk factors in the development and further advancement of inflammatory periodontal disease. The bacteria A. actinomycetemcomitans, P. gingivalis and P. intermedius as indicated as the potential pathogens associated with periodontal disease. Since the bacteria mentioned as well as smoking are factors associated with periodontitis it is of importance to elucidate the interrelationship between these factors. The purpose of this study was to investigate the prevalence of A. actinomycetemcomitans, P. gingivalis and P. intermedius in subgingival plaque samples obtained form healthy and diseased sites of patients with rapidly progressive periodontitis who were smokers and non smokers along with other clinical parameters.