Conventional Periodontal Treatment Research Articles

Effect of Omega-3 Fatty Acid Supplementation on Periodontal Inflammation and Pocket Depth Reduction

ABSTRACT Background: Chronic inflammation of the tooth’s supporting tissues is known as periodontal disease. It causes pockets to develop, attachments to break, and eventually the loss of teeth. Because of their well-known anti-inflammatory qualities, omega-3 fatty acids have been recommended as an additional therapy for periodontal inflammation. Materials and Methods: A randomized controlled study of 60 individuals suffering from persistent periodontitis was carried out. Two groups of participants were randomly assigned: The test group (n = 30) got conventional periodontal treatment with omega-3 fatty acid supplementation (1000 mg/day), while the control group (n = 30) received normal periodontal therapy alone. Measurements of periodontal parameters were made at baseline, 3 months, and 6 months after therapy, including bleeding on probing (BOP) and pocket depth. Paired t-tests and analysis of variance were used in the statistical analysis to determine the significance of the group differences. Results: Participants in the test group showed a greater reduction in probing pocket depth (PPD) and BOP at both 3 and 6 months. Specifically, the mean PPD decreased from 5.4 ± 0.7 mm to 3.0 ± 0.4 mm, and BOP reduced from 71.2 ± 14.5% to 28.3 ± 9.2% in the test group, with both outcomes showing statistically significant differences compared to the control group (P < 0.01). Conclusion: In individuals with chronic periodontitis, omega-3 fatty acid supplementation dramatically improves the decrease of periodontal pocket depth and inflammation when administered as an adjuvant to regular periodontal treatment.

A Three-Month Clinical Trial on the Efficacy of Hyaluronic Acid Adjunctive Non-Surgical Therapy for Periodontitis in Patients with Type 2 Diabetes Mellitus.

Background/Objectives: Conventional periodontal treatment for patients with diabetes has shown promising results, primarily focusing on glycated hemoglobin (HbA1c) levels as an endpoint measure. The properties of hyaluronic acid (HA) have been harnessed in various periodontal therapies, and it is a promising agent also in a non-surgical approach. The aim of this clinical trial was to assess the efficacy of hyaluronic acid in a local adjunctive non-surgical treatment for periodontitis in patients with type 2 diabetes. Methods: Eighty adult participants with well-controlled type 2 diabetes (HbA1c 7% (53 mmol/mol) or less) took part in the trial. The clinical parameters of periodontitis as well as the glycated hemoglobin (HbA1c) levels were evaluated, and an analysis of the potential differences between the control (placebo) and intervention (HA) groups was performed. Results/Conclusions: A decrease in all the clinical values of periodontitis after treatment was observed in the vast majority of patients in both groups. Differences in the clinical parameters were observed 12 weeks after the intervention between the patients in the placebo and HA therapy groups. Bleeding on probing (BoP) was reduced in the control group to 15-25% and was approximately 5.5% more in the intervention group (9.5-18.25%). The clinical attachment level (CAL) decreased 1 mm more in the HA therapy group (1-2 mm) than in the no adjunctive treatment group (2-3 mm). The probing depth (PD) was reduced similarly in both groups (3-3.75 mm). Due to the bilateral relationship between diabetes and periodontitis, healthcare professionals seek advancements in managing periodontal inflammation. The results of this study indicate that non-surgical periodontal treatment with HA as an adjunctive agent is worth considering in the therapy for patients with diabetes.

Histological and Biochemical Evaluation of Silibinin in Treatment of Periodontitis Induced in Rats with Liver Cirrhosis.

This study aimed to evaluate the impact of silibinin as a therapeutic agent on ligature-induced periodontitis in rats with liver cirrhosis. Twenty-five Wistar rats were enrolled in this study. Group A (Control) included eight rats. The other 17 rats received CCl4 to develop cirrhosis, which was confirmed by sacrificing one of the rats and performing a histological examination of its liver tissue. Periodontitis was induced in the remaining 16 rats then they were allocated into (n = 8) group B-periodontitis with cirrhosis and group C-silibinin-treated group, 5 times/week starting from week 11 till week 14. Animals of the three groups were euthanized, and biochemical analysis comprising of liver functions assessment (serum levels of glutamate-pyruvate transaminase, serum levels of glutamate-oxalate transaminase, TIMP1) and oxidative stress index [MDA, nitric oxide (NO), superoxide dismutase (SOD), and catalase (CAT)] and histological examination were conducted by the end of week 14. Group C revealed a more organized orientation of the periodontal ligament (PDL) collagen fibers with a marked regain of the alveolar bone height compared to group B. Biochemical analysis confirmed the potent therapeutic effect of silibinin manifested by a significant improvement in the biochemical parameters: tissue inhibitor of metalloproteinase-1, MDA, NO levels, and antioxidant enzymes. Group B was associated with the most unfavorable biochemical findings and the maximum periodontal destruction. Group C demonstrated a positive osteogenic capacity and a noteworthy improvement in biochemical findings, which were comparable to those of group A, which displayed normal and healthy findings. The study highlights the potential use of silibinin as a natural remedy with minimal side effects for treating periodontitis in rats with liver cirrhosis. The findings could be translated to human clinical trials, which may lead to new treatment strategies using silibinin as a targeted therapy or as adjunctive therapy to conventional periodontal treatment for patients with liver cirrhosis who are more susceptible to periodontitis. How to cite this article: Shawky HA, Ahmed NM, Essawy MM, et al. Histological and Biochemical Evaluation of Silibinin in Treatment of Periodontitis Induced in Rats with Liver Cirrhosis. J Contemp Dent Pract 2024;25(7):631-638.

Efficacy of periodontal treatment modalities in Down syndrome patients: a systematic review and meta-analysis.

The systematic review aimed to review the existing evidence, to identify and appraise the effectiveness of periodontal prevention and treatment modalities in individuals diagnosed with Down syndrome (DS) and to determine the estimates of the effects of implemented periodontal prevention and treatment strategies compared to chromosomally normal (CN) individuals. The systematic review was conducted and reported in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The study protocol was registered in the Open Science Framework. Electronic and manual searches, in accordance with PICO framework and delineated inclusion/exclusion criteria, were conducted in multiple databases. The initial search identified 11,704 studies. After removing duplicates, 9,048 remained. Title and abstract screening narrowed these to 281 for full-text review. Ultimately, 16 studies met the inclusion criteria, with 4 eligible for quantitative data synthesis. Results of the meta-analysis indicated that professional tooth cleaning in combination with oral hygiene reinforcement was less effective in the reduction of PPD in patients with DS compared to those without DS (Mean difference (MD): 0.23; 95% Confidence Interval (CI): 0.14 to 0.32; p < 0.001). These findings suggest that conventional periodontal treatment is less effective in managing periodontitis in patients with DS. Thus, tailored periodontal care strategies that address the specific needs of individuals with DS should be implemented to improve treatment outcomes for this population The presence of moderate to high risk of bias in the included studies underscores the need for rigorously designed research that minimizes bias through effective blinding, randomization, control of confounding factors, and inclusion of diverse treatment outcomes to further investigate these associations. Based on the best available evidence, professional tooth cleaning combined with oral hygiene instructions appears to be less effective in reducing pocket depths in individuals with DS compared to those without DS. https://doi.org/10.17605/OSF.IO/UXTCG.

Influence of treatment to remove oral inflammation foci on the systemic malnutrition and inflammation markers of dialysis patients: A series of cases

Background and objectives: Studies report a more precarious oral health status, with a higher prevalence of periodontal disease, in hemodialysis patients. Also, oral inflammation foci, mainly periodontal disease, are related to systemic inflammation and malnutrition which have a negative impact on morbidity and mortality in these patients. The aim of this study is to observe the influence of dental on the general status of these patients. Material and Methods: The study is a series of cases and was conducted in two phases: data collection and treatment phase and monitoring phase. Dental treatment was performed on 13 patients, with ages between 43-69 years of age, diagnosed with moderate or severe periodontal disease. Oral status parameters (plaque and gingival bleeding index, pocket depth, attachment level, DMFT and CPITN index) and general parameters (C-reactive protein, albumin, hemoglobin, calcium phosphate product, calcium and phosphate levels, erythropoietic-stimulating agents) were registered and monitored. Conventional periodontal treatment, dental extractions, endodontic treatments were performed. Results: Oral assessment showed a statistically significant improvement of oral parameters, at both 1 month and 3 months post-treatment. Mean values for albumin, C-reactive protein, hemoglobin, calcium phosphate product and calcium levels had a slight improvement, but the difference was not statistically significant. Conclusion: The oral status, characterized by the measured periodontal parameters, improved visibly and statistically significant after the dental treatment. The parameters of the general status did not change significantly following the intervention.

Clinical evaluation of laser therapy (diode laser) in the treatment of periodontal disease in smoking and non-smoking patients

Periodontal disease is multifactorial, in terms of potential etiological factors and modifiers of achieved therapeutic effects. The wide spectrum of positive therapeutic reflections in the periodontal-tissue complex achieved by laser therapy represents a challenge for the application of this modality in the modern therapy of periodontal disease. The objective of this study was to evaluate the clinical results of the application of laser therapy with diode laser, as an additional therapeutic method to conventional periodontal treatment in smoking and non-smoking patients. Therefore verification of the anti-inflammatory influence of the laser light and the effects of the application of laser therapy with a diode laser were the main points of this study. A comparative analysis was made between the studied groups. The study was conducted on 60 patients with periodontal disease divided into four groups: two groups of smokers and two groups of non-smokers. A conventional periodontal therapeutic procedure was carried out in all subjects, and then in half of the subjects the treatment was supplemented with laser therapy (diode laser). The evaluation of the clinical results was done using the following indices: 1. Evaluation of gingival inflammation through the index of Loe and Silness and 2. Assessment of the presence of periodontal pocket bleeding, during probing, through the index of bleeding according to Loe and Silness. The obtained results showed a positive clinical evaluation in patients treated with diode laser, as an additional therapeutic method, compared to those who received conventional treatment. The comparative analysis carried out between patients who smoke and those who do not smoke, the positive clinical evaluation i.e. positive clinical effects were evaluated in non-smokers.The application of laser therapy with a diode laser as an additional method to conventional periodontal treatment gives good clinical results, reduces relapses and maintains therapeutic results for a longer period of time.

Effectiveness of Probiotic Therapy in the Management of PeriodontalDisease in Diabetic Patients: A Scoping Review.

Probiotics can compete with periodontal pathogens in the formation of dental biofilm, and they are able to modulate local and systemic immune responses. Thus, its use in diabetic patients with periodontal disease (PD) can overcome the limitations of conventional periodontal treatment. This scoping review aimed to understand the extent and type of evidence in relation to the effects of probiotic therapy on periodontal and glycaemic parameters of diabetic patients with PD. An electronic search was performed in the following databases: Cochrane Library, EMBASE, Virtual Health Library (including LILACS and BBO), PubMed (including Medline), Scopus, Web of Science, and Google Scholar. The review included clinical trials on patients with type 2 diabetes, diagnosed with gingivitis or periodontitis, who received probiotic therapy as a single therapy or adjuvant to scaling and root planning, and on whom the analyses of clinical periodontal, immunological, microbiological, or glycaemic parameters were performed. The electronic search yielded a total of 1165 articles. After removing duplicate titles and performing systematic screening, 6 studies were included in the qualitative summary. Probiotic administration improved clinical periodontal parameters (bleeding on probing and probing depth), oxidative stress markers, and inflammatory cytokines (IL-8, IL-10, and TNF-α) in relation to control groups. Experimental groups were also more advantageous in reducing the frequency of periodontopathogenic bacteria. However, the evidence of probiotics in decreasing glycated hemoglobin is still uncertain. Probiotics may provide safe additional benefits to periodontal parameters of patients with type 2 diabetes and periodontal disease.

Probiotic Chewing Gums for Adjuctive Treatment of Periodontitis in Diabetics

INTRODUCTION; The treatment of Periodontal disease in Diabetic subjects should also focus on lowering blood glucose levels, which might act as an adjuvant to conventional Periodontal treatment. In the form of Probiotics, Bacterial therapy offers a dual role in controlling blood glycemic levels and reducing colonization of oral bacteria. This study aimed to evaluate the efficacy of probiotics in managing Periodontitis among Diabetic and Non-Diabetic subjects. METHODOLOGY; This study was designed as a randomized, double-blinded clinical trial among Diabetic and Non-diabetic subjects with Periodontitis. Twenty-four subjects in each Diabetic and non-diabetic group were randomly assigned into two probiotic test sub-groups and one placebo sub-group. Lactobacillus fermentum MCC2760 and Bifidobacterium longum NCIM5684 probiotic chewing gums were provided to subjects in test groups to use twice a day for 30 days. Supragingival plaque samples were collected at baseline and 30 days to analyze total bacterial count and subgingival plaque for P.gingivalis, A.actinomycetemcomitans through qPCR. Clinical parameters were recorded at baseline, 30, 45, and 90 days. RESULTS; After 30 days, a significant reduction in PI, GI, PPD, and Gingival bleeding Index was observed in SRP and SRP+Probiotic groups. There is a significant reduction in total bacterial count among probiotic groups compared to placebo. PCR analysis revealed non-significant reduction of p.gingivalis and A.actinomycetemcomitans in test groups. Intergroup comparison between Diabetic and Non-diabetic groups did not show any significant differences either in clinical or microbial parameters. CONCLUSION; Probiotic functional foods can be delivered as an adjunct to SRP to manage Periodontitis in systemically compromised subjects. Long-time use of probiotics is recommended to maintain the recolonization of bacteria in periodontal tissues.

A 30-year retrospective cohort outcome study of periodontal treatment of stages III and IV patients in a private practice.

Tooth loss studies show that periodontal treatment is effective. However, it is not known whether these results can be projected into a lifetime of treatment. The aim of the study was to study all patients with stages III/IV of periodontitis over 30 years in a private practice. All patients referred between 1986 and 1990 were monitored for 30 years for tooth loss and prognostic factors. All dropouts were accounted for. In all, 386 patients were followed, of whom 283 patients dropped out, leaving 103 patients (67 females and 36 males, average age 40.1 years) monitored over 30 years. Tooth loss was stable until 16 years, when the population was divided into groups of low (n = 65), moderate (n = 18) and high (n = 20) tooth loss, losing 1.05 (SD 1.27), 4.83 (SD 0.96) and 11.90 (SD 4.25) teeth, respectively. The strongest prognostic factors were first-degree relatives with periodontitis, periodontal treatment before the age of 35 years, diabetes and patients with teeth with initial hopeless prognosis. The majority of patients with stages III and IV periodontitis could be successfully treated with conventional periodontal treatment over a period of 30 years. The findings suggest that retrospective studies with shorter observation times cannot automatically be projected onto the outcome of a lifetime of periodontal treatment.

Photodynamic therapy as adjunctive treatment of single-rooted teeth in patients with grade C periodontitis: A randomized controlled clinical trial

BackgroundThe present study aimed to evaluate the adjunctive effect of an antimicrobial photodynamic therapy (aPDT) protocol on single-rooted teeth of patients with grade C periodontitis. MethodsSixty-four single-rooted teeth (14 patients) were included in each group of this double-blinded split-mouth randomized clinical trial. The teeth were randomly divided into scaling and root planing + aPDT (test group) and scaling and root planing+sham aPDT (control group). The aPDT protocol consisted of incubation with 1% methylene blue for 5 min, rinsing, and application of a diode laser (wavelength of 660 nm, power of 100 mW) for 10 s. aPDT was repeated after 7 days. Bleeding on probing (BoP), probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) were recorded before and 3 months after treatment. A 5% significance level was adopted for statistical analysis. ResultsFinal PD was significantly (P = 0.02) lower in the test group (2.87 ± 1.40 mm) compared to control (3.12 ± 1.69 mm). The test group showed a significantly higher percentage of sites with PD≤4 mm and concomitant BoP compared to control (91%x86%;P < 0.001). At sites with baseline PD>4 mm, final PD and CAL were significantly (P = 0.01) lower in the test group (4.11 ± 1.66 and 4.89 ± 2.49 mm, respectively) compared to control (4.88 ± 1.99 and 5.89 ± 2.74 mm, respectively). ConclusionsaPDT combined with scaling and root planning provided slightly better periodontal clinical results than the latter procedure alone, exerting a superior effect at sites with greater baseline PD. aPDT might be used as adjunctive treatment in grade C periodontitis affecting single-rooted teeth since it improves the response to conventional periodontal treatment.

An Overview of the Systematic Evidence on the Adjunctive Use of Laser Therapy in Non-surgical Periodontal Treatment.

This overview aimed to recapitulate the evidence related to laser application in non-surgical periodontal treatment along with conventional periodontal treatment for optimum clinical practice based on the available systematic reviews (SRs). An advanced literature search in the English language was conducted in the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), ScienceDirect, and Scopus databases from January 2000 to October 2022. Two independent reviewers screened all the databases and extracted the data in duplicate. The risk of bias in the selected studies was assessed with the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) guideline for SRs. Cohen's kappa statistics were performed to assess the level of agreement for the assessment of the risk of bias. A total of 556 studies (PubMed = 115, Scopus = 66, ScienceDirect = 298, and MEDLINE = 77) were identified after the initial search using the keywords from different databases. After removing the duplicates and assessing the full manuscripts, a total of 24 studies were selected based on the inclusion criteria for the current overview. A total of three, four, 12, and five systematic reviews were classified as high, moderate, low, and critically low-quality SRs as per the AMSTAR 2 quality assessment tool. Cohen's Kappa statistics showed perfect (𝛋 =1.000) agreement between the two reviewers. Adjunctive laser therapy along with conventional non-surgical periodontal treatment might be effective in short-term treatment outcomes; however, evidence of long-term effects is still lacking.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis.

A growing body of evidence from multiple areas proposes that periodontal disease, accompanied by oral inflammation and pathological changes in the microbiome, induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A subgroup of NAFLD patients have a severely progressive form, namely nonalcoholic steatohepatitis (NASH), which is characterized by histological findings that include inflammatory cell infiltration and fibrosis. NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma. The oral microbiota may serve as an endogenous reservoir for gut microbiota, and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis. Gut dysbiosis increases the production of potential hepatotoxins, including lipopolysaccharide, ethanol, and other volatile organic compounds such as acetone, phenol and cyclopentane. Moreover, gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall, leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation. In particular, many animal studies support that oral administration of Porphyromonas gingivalis, a typical periodontopathic bacterium, induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis. NAFLD, also known as the hepatic phenotype of metabolic syndrome, is strongly associated with metabolic complications, such as obesity and diabetes. Periodontal disease also has a bidirectional relationship with metabolic syndrome, and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively. In this review, we will describe the link between periodontal disease and NAFLD with a focus on basic, epidemiological, and clinical studies, and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome. In conclusion, it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease, gut microbiota, and metabolic syndrome. Thus, the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics, prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Evaluation of the adjuvant effect of topic Bach floral in the clinical response to non-surgical periodontal treatment in patients with type 2 diabetes: pilot study

Objective: To evaluate the clinical response of periodontal tissues after periodontal therapy associated with the use of Bach Flower (Rock Rose gel) in participants with type 2 diabetes mellitus. Methodology: This randomized, doble-blind, split-mouth, single-center, placebo-controlled clinical trial selected 20 participants with moderate, severe, or advanced periodontitis (stage II, III, and IV). They were divided into groups, where group 1 received Floral Rock Rose gel and group 2, saline gel. All groups received conventional periodontal treatment characterized by scaling and root planing before gel application. Clinical evaluation was performed using periodontal clinical parameters: Plaque Index (PI), Gingival Index (GI), probing depth (PPD), gingival recession (GR), and Clinical Insertion Level (CAL). Biometric parameters and hematological parameters were also evaluated. All clinical and laboratory parameters were obtained at baseline and after three months. Results: There was an improvement in periodontal clinical parameters before and after treatment in both groups (P&lt;0.05). There was no statistically significant difference between the intervention, control, and floral groups (P&gt;0.05). Conclusion: The periodontal treatment performed with Rock Rose adjuvant gel (Bach Flower) was safe, efficient, and promoted the improvement of periodontal clinical parameters. However, it did not show superior results to conventional periodontal therapy.

A RARE CASE OF PAPILLON-LEFEVRE SYNDROME: A CASE REPORT

Papillon Lefevre syndrome is an extremely rare autosomal recessive disorder characterized by diffuse palmoplantar hyperkeratosis, rapidly progressive and devastating periodonitis, and pyodermas. The etiopathogenesis of the disorder is multifactorial, with genetic and immunological factors playing a major role. Consanguinity is a contributing factor. Genetic mutations of the gene 11q14- q21 encoding for cathepsin-c, a lysosomal protease that activates enzymes involved in a variety of inflammatory and immune processes. Management directed towards halting periodontal destruction using conventional periodontal treatment, systemic antibiotics, oral hygiene instructions, antiseptic mouth rinses. Palmoplantar hyperkeratosis usually treated with topical application of emollients, keratolytic agents, topical steriods and systemic retinoids.

Emerging role of photodynamic therapy as an adjunct to nonsurgical periodontal therapy on periodontal status and glycemic control in patients with type 2 diabetes: A clinical study.

Periodontal disease is considered to be the sixth most common complication of diabetes mellitus (DM). Antibiotics (systemic and local) enhance the outcome of conventional mechanical debridement but frequent use of antimicrobials may develop resistance to microorganisms. To overcome this complicacy, the current study assessed the effectiveness of photodynamic therapy (PDT) in chronic periodontitis patients with type 2 diabetes when used as a combination therapy to standard periodontal therapy by assessing the various clinical and glycemic parameters. A total of 16 known cases of chronic Periodontitis patients who were suffering from type 2 DM were allocated into two groups. The test group (n = 8) was treated with standard scaling and root planing (SRP) along with PDT while the control group was treated with SRP alone. Various clinical parameters assessed were plaque index, gingival index, pocket probing depth, clinical attachment level, and Glycated hemoglobin level at baseline and 90 days after therapy. At the end of the study, both the groups showed improvements with regard to all clinical and glycemic parameters compared to baseline. However, the test group presented statistically significant favorable results (all P < 0.05). Conventional periodontal treatment aided with PDT proved to be a beneficial therapeutic measure and effective alternative in patients with chronic periodontitis with diabetes when compared with standard periodontal therapy alone.

Efficacy of One Stage Full Mouth Disinfection on the Oral Health-Related Quality of Life in Patients with Generalised Chronic Periodontitis

Introduction: Intraoral translocation of periodontal pathogens from untreated intraoral niches can lead to recolonisation and reinfection of recently treated periodontal pockets. Poor oral health hampers the patient’s Quality of Life (QoL) as it causes social isolation, inferiority and the development of psychiatric conditions. Full Mouth Disinfection (FMD) performed within 24 hours using chlorhexidine has reported significant improvements in clinical, microbiological and psychological parameters when compared to conventional periodontal treatment. Aim: To investigate the long-term effect of FMD on Oral HealthRelated Quality of Life (OHRQoL) in patients with generalised chronic periodontitis. Materials and Methods: This study was a prospective clinical study conducted in the Department of Periodontology, Dr DY Patil Dental College and Hospital, Pune, Maharashtra, India, from October 2019 to December 2021. Study consisted of 60 participants who were allotted into two groups; 30 periodontally healthy volunteers (control group) and 30 patients (test group) diagnosed with generalised chronic periodontitis. The test group was asked to fill out the Oral Health Impact Profile-14 (OHIP-14) questionnaire to assess the OHRQoL at baseline followed by FMD protocol. All the patients were kept at periodic recall, and the OHRQoL was assessed again taken after one months three months, and six months. The control group was asked to fill out the questionnaire at the baseline. Repeated measure analysis of variance with post-hoc bonferroni test was used to compare differences in variation present from baseline to one month, three months and six months. For intergroup comparison at different time intervals, an unpaired t-test was applied. Results: The age group of participants ranged from 25- 55 years with a mean age of 41.3 years. Test group had 18 males and 12 females and, 20 males and 10 females were in the control group. The mean OHIP-14 score at baseline was 3.58±3.29 in the control group and 42.35±4.32 in the test group at baseline, showing a mean difference of -38.76±0.93, which was statistically significant. After one month there was a significant improvement in the OHIP-14 scores of the test group (26.35±2.60), which was further reduced to -13.58±0.81 and -9.0±0.88 by the end of three and six months. Therefore, a notable improvement in the QoL and periodontal conditions of the patients following FMD was appreciated. Conclusion: Periodontitis negatively impacts the OHRQoL. FMD provides an improvement in the perceived QoL among periodontitis patients.

Photodynamic Periodontal Therapy vs. Diode laser as an Adjunctive to Conventional periodontal treatment in Management of Chronic Periodontitis

Purpose: This study was made to evaluate and compare the efficacy of photodynamic periodontal therapy and diode laser as an adjunctive approach to conventional periodontal therapy in management of chronic periodontitis. Subjects and methods: 30 patients with chronic periodontitis and age range from 30-40 years old were divided randomly into three groups. Group I (control group) 10 patients received conventional periodontal therapy alone. Group II (laser group): patients received SRP + additional application of a 940-nm diode laser. Group III (photodynamic group): patients received SRP + antimicrobial photodynamic therapy by using low level 670 nm diode laser application in addition to application of 1% toluidine blue as photosensitizer. Results: there were a significant difference of PD, CAL, IL-1β, IL6, NO, NO2 between three groups with superior result found in photodynamic group, but there were no significant differences between three groups in the term of NO3. Conclusion: Diode laser and photodynamic therapies add a beneficial effect in clinical and biochemical parameters when used as adjunctive to scaling and root planning but there was no significant difference between them.

Evaluating clinical utility of subgingival and salivary endotoxin activity levels as periodontal biomarkers.

The use of periodontal biomarkers for identification and monitoring of unique patient populations could foster better stratification of at-risk groups, increase access to treatment for those most in need, facilitate preventive measures and improve personalised care plans. The aim of this study was to examine the diagnostic and prognostic utility of oral lipopolysaccharides as bacterially-derived periodontal biomarkers. Periodontal parameters were recorded, and saliva and subgingival plaque samples were collected at the beginning of the study from periodontally healthy volunteers and periodontitis patients, and three months after completion of conventional periodontal treatment in the periodontitis group. Endotoxin activity in the samples was measured using the recombinant factor C assay. Associations between clinical periodontal parameters and subgingival and salivary endotoxin activities were analysed using a multivariate regression model, while the ROC curve was applied to estimate the sensitivity, specificity and c-statistics for salivary and subgingival endotoxin activities as diagnostic biomarkers for periodontitis. Significant correlations were found between subgingival endotoxin activities, probing pocket depth and periodontal diagnosis, which were independent from patients' age, gender and smoking status. In addition, subgingival endotoxin levels had high specificity and sensitivity in detecting periodontal health and disease (0.91 and 0.85 respectively). Salivary endotoxin activity was positively associated with periodontal diagnosis, mean probing pocket depth, percentages of sites over 4 mm and full mouth bleeding score. However, it was inferior in discriminating patients with stable periodontium from those with periodontitis (sensitivity = 0.69, specificity = 0.61) compared to subgingival endotoxin activity. Subgingival endotoxin activity has good diagnostic and prognostic values as a site-specific periodontal biomarker and is not influenced by the patient's age, gender or smoking status. In contrast, salivary endotoxin activity, as a patient-level biomarker, is dependent on patient's age, has poorer diagnostic and prognostic capability, but shows good correlations with disease susceptibility and both its extent and severity.

İdiopatik kırmızı lezyon: olgu serisi

The first step in the treatment of periodontal diseases is to mechanically remove plaque and dental calculus, which play a role in the etiology of periodontal diseases, and to establish oral hygiene. In some cases of oral diseases, some drugs and chemical agents can be used for various reasons in addition to mechanical treatment. Corticosteroids are frequently used in oral mucocutaneous diseases because of their strong anti-inflammatory, antiallergic and immunosuppressive effects in the treatment of many other diseases. Although there are different ways of using corticosteroids, the topical form is often preferred in the treatment of oral lesions associated with oral mucosal diseases. This case series aims to evaluate the effect of topical corticosteroid application on red lesions in the gingiva that do not heal with conventional periodontal treatment.

Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report

Objectives: Squamous cell carcinoma is a malignant neoplasm of epithelium. In the U.S., carcinoma of the gingiva constitutes 4% to 16% of all oral carcinomas. This case report highlights such a case in maxillary gingiva and emphasizes the vital role of dental professionals, especially periodontists and endodontists, in being cognizant that an inflammatory lesion can mimic a serious condition like squamous cell carcinoma. Case Presentation: A patient who visited the screening clinic for an ulcerated lesion in the gingiva was otherwise healthy with no associated history of tobacco or any traumatic/persistent traumatic events. The patient was treated for pseudoepitheliomatous hyperplasia based on the current condition and negative history of malignancy. On three months of follow-up, computed tomography radiographic evaluation and a biopsy were done, which were positive for the malignancy. Follow-up after six months includes PET, Head MRI, and chest X-ray examinations to rule out any metastatic entity. Results: A six-month follow-up radiographic examination revealed metastasis of the entity. Additional findings include pleural effusion and underlying infections. Conclusion: Early diagnosis is the key to the treatment plan. It further highlights the role of advanced imaging as a vital tool in determining the extent of the disease. Therefore, any persistent lesion exhibiting features that are not responding to conventional gingival and periodontal treatment options for more than two weeks should be referred for further evaluation to rule out cancer.