Interdental Areas Research Articles

Enhancing Periodontal Health with Oral Irrigation Devices: A Review

Oral irrigation devices are mostly used for oral physiotherapy in homes & dental clinics all over the world. The broad perspective in the use of oral irrigation devices has been the possibility of injury to the sulcular epithelium & underlying tissue. The existing oral irrigation devices exerts immense pressure on the sulcular epithelium. The patient found the procedure pleasant & neither injuries nor staining were noted. The technique may be useful in patients whose interdental areas can’t be assessed properly. This study focuses on reduction on plaque, gingival bleeding & may therefore, be an adjunct to normal oral hygiene.

The association between interdental cleaning and periodontitis in an urban Thai adult cohort: a cross-sectional study.

Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort. Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes. Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group. Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health. The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 ( https://www.thaiclinicaltrials.org ).

The Associations of Adherent Gingival Thickness in the Buccal and Palatal Regions of the Maxilla and Mandibula with Age and Gender

Purpose: This study aimed to investigate gingival thickness variations regarding age, gender, and sites where mini-screws are frequently applied and to guide mini-screw size selection. Materials and Methods: In our study, gingival thickness measurements were performed by a transgingival probing method in 224 patients who presented for examination to the Department of Orthodontics, Faculty of Dentistry, XXXX University. Fifty-six females and 56 males aged 14-20 and 21-27 years were enrolled in the study. In each individual, measurements were made from the mucogingival junction at the interdental area in the buccal mandibular and buccal maxillary regions, whereas at the interdental area within 4 mm and 8 mm distance from the gingival crest in the palatinal maxilla. Results: Comparisons between genders indicated that gingival thickness in the buccal region of the maxilla was statistically significantly greater in males than in females (p

Evaluation of mandibular trabecular and cortical structure by fractal analysis in hyperlipidemia and hypertension patients

IntroductionThis study aimed to evaluate the mandibular trabecular and cortical changes in patients with hyperlipidemia (HL) and/or hypertension (HT) using fractal dimension (FD) analysis, mandibular cortical width (MCW), panoramic mandibular index (PMI) and mandibular cortical index (MCI). Materials and methodsPanoramic radiographs of 100 patients were evaluated. FD measurement of three region of interest (ROI) including the angulus, corpus and interdental bone area were made. MCW, PMI and MCI were also measured and noted. ResultsAngulus, corpus and interdental FD values were significantly lower in three disease groups than the control group. Angulus, corpus, and interdental FD values were significantly lower in the HL+HT group than in the HL group and HT group. MCW value was significantly lower in the HL group, HT group, and HL+HT group than the control group. The cortical index C1 was more common in the control group while C2 was more common in the HT, HL and HL+HT group. ConclusionThe fact that FD was significantly lower in the HL+HT group compared to the HL and HT groups indicates the positive effect of their association on bone loss and quality. FD measurements on images obtained using a direct digital panoramic system can be used for treatment planning and follow-up of patients with HL and/or HT.

Evaluation of the efficacy of inter-dental brush and dental floss for peri-implant mucositis: A crossover randomized clinical trial.

To evaluate the most effective method for mechanical inter-dental plaque removal between inter-dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri-implant mucositis (PIM); to identify possible factors related to the patient or to the single implant-supported element that could influence plaque accumulation and inflammation of peri-implant tissues. Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter-dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter-dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. Both inter-dental cleaning devices were effective in reducing PI and GI in the inter-dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. IDB was the most effective method for inter-dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.

The Use of Injectable Platelet-Rich Fibrin As an Alternative Treatment for Interdental Papilla Reconstruction in Black Triangle Case

Introduction: Interdental papilla is triangular soft tissues that fill the gaps between teeth andfunction as protective periodontal tissues and are important in terms of aesthetics, ifinadequate, they will form black triangles, which are blackish areas between teeth. Non-surgical treatment of black triangle is preferred by patients as it is painless. Injectable Platelet-Rich Fibrin (i-PRF) is a platelet concentrate derived from the patient's blood that does notcause immunological reactions and contains growth factors for remodeling the interdentalpapilla. Case Report: A 20-year-old female patient, systemically healthy, came to Prof.Soedomo UGM Dental Hospital with complaints that the gums of the middle part of her upperteeth had a blackish area and disturbed her confidence. An objective examination was carriedout including, gingival biotype, black triangle area, and radiographs, so it was concluded thatthe black triangle was classified as class I Nordland and Tarnow and interdental papillareconstruction to correct the black triangle could be planned. The patient refused surgery so i-PRF can be used as an alternative non-surgical treatment. The black triangle closed completelyafter the i-PRF injection was given. Discussion: I-PRF has the ability to accelerate cellproliferation and migration as well as angiogenesis so that it can modulate fibroblastregeneration in the interdental papilla area. Conclusion: The use of i-PRF can be an alternativenon-surgical option for the treatment of interdental papilla reconstruction.

Management of interdental papillary defects using subperiosteal hyaluronic acid injection overlay technique: a prospective longitudinal clinical study.

Currently, there is no established treatment protocol to treat Interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid (HA) gel. Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow up time points (1 month, 3 months and 6 months). The interdental papillary defect height in the upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient. Subperiosteal tunneling with HA injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up with reduction in improvement after 6 months.

A Novel 3D Tunneling Surgical Technique (3DT) for the Treatment of Gingival Recessions with Reconstruction of the Deficient Interdental Papilla and Interproximal Attachment Regeneration: Case Series.

Current concepts in periodontology emphasize an important distinguishing aspect of the interproximal attachment, assigning its major influential significance as a key diagnostic and prognostic factor. A complete regeneration of the interproximal clinical attachment has become a primary determinant of the periodontal success. Since mid - 20th century have been published numerous articles on root coverage procedures but mostly for non-proximal gingival recessions. When it comes to the interdental area, literature does not inspire the same level of confidence. This study is aimed to introduce an innovative 3D - Tunneling Surgical Technique for the gingival papilla reconstruction and supra-alveolar interproximal attachment regeneration. The technique is described step by step and shown on three selected clinical cases of multiple bilateral adjacent gingival recessions type 2 and 3 in the lower anterior area with follow - up results of up to 6.5 years. A total of 18 proximal, mid-buccal and mid-lingual recessions were treated simultaneously. Mean root coverage up to 88.9% has been achieved in the proximal area. Within its limits, this study demonstrates a possibility of treating gingival recessions with deficient papilla in the mandibular anterior region, achieving a significant clinical improvement with the long-term stability.

Knowledge and Perception on Oral Hygiene Instructions and Periodontal Health Education (OHIPE) among UiTM Dental Undergraduates

This study was aimed to evaluate the knowledge and perception of oral hygiene instructions and periodontal health education (OHIPE) among dental undergraduates of Universiti Teknologi MARA (UiTM) after the modification of OHIPE protocol. This cross-sectional study was carried out among 134 clinical dental year students of UiTM. The data was collected by distributing a self-administered structured questionnaire to the participants. The questionnaire was divided into two different sections in order to assess knowledge and perception independently. The 5-point Likert Scale was used to evaluate perception. Data analysis was done via SPSS version 27.0. Results: There was 51.3% (n=40) year 5 students obtained good knowledge score compared to only 21.4%(n=12) of year 4 students. The remaining 48.7%(n=38) of year 5 and 71.4%(n=40) year 4 students recorded average knowledge (P <0.001). Students’ perception regarding OHIPE showed that the response on each of the six questions were almost similar. However, there were statistically significant differences between the two groups regarding giving information about patient’s periodontal status and advice on cleaning interdental areas of the teeth (P = 0.01 – 0.031). Most students agreed that usage of patient’s own periodontal chart and radiograph is important and useful during OHIPE. Conclusion: Periodontal health care knowledge score for OHIPE among clinical years students are between average and good. The knowledge and awareness of year 4 students were lower than year 5 students which could be due to reduced clinical sessions during pandemic of Covid-19. Perception of students were similar among all participants as they have more clinical experience in managing periodontal patients.

The working angle in low-abrasive air polishing has an influence on gingival damage-an ex vivo porcine model.

To investigate the influence of instrumentation angle during low-abrasive air polishing (LAA) on the oral gingiva using an ex vivo porcine model. Six tissue samples from each of 14 porcine mandibles were randomly selected and instrumented. Two different LAA powders (glycine 25μm, tagatose 15μm) were investigated. An application angle of either 30-60° or 90° was selected. Gingival specimens from different mandibles served as untreated references. Gingival biopsies were examined by scanning electron microscopy and paraffin histology for tissue destruction using a five-level scale. LAA caused significantly less tissue damage at a 90° angle than at a 30-60° angle. This effect was seen in both the glycine-based powder arms (p = 0.002, p = 0.046) and the tagatose-based powder arms (p = 0.003, p = 0.011). However, at identical working angles, the two powders did not show significant differences in terms of gingival erosion (p = 0.79 and p = 0.57; p = 0.91 and p = 0.78, respectively). LAA may cause less tissue damage at an application angle of 90°. Consequently, it seems advisable to air-polish the soft tissue as perpendicularly as possible. Additionally, glycine and tagatose LAA powders do not seem to differ in concern of soft tissue damage. Within the limitations of this ex vivo animal model, this study argues for an application that is as close as possible to the 90° angle intending to minimize soft tissue damage. Manufacturer specifications, however, mainly request applications deviating from the right angle. In order to work in interdental areas using LAA safely, the use of subgingival nozzles might be considered.

A rare case of bilateral pulse granuloma of maxilla

Pulse or hyaline ring granulomas are rare but are well-defined oral and extraoral lesions due to implantation of the cellulose moiety of plant foods in contrast starch components. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. It is Microscopic oral inflammatory lesion characterized by the presence of giant cells and hyaline rings. The features of pulse granuloma are not considered clinically distinctive and remain primarily microscopic. Extensive knowledge of abnormal sites of origin and clinical manifestations enables clinicians to recognize the diagnostic risks of confusing pulse granuloma with other entities.

Awareness Regarding Usage of Interdental Aids and their Role in Oral Hygiene among Medical Undergraduates in District Sheikhupura, Pakistan-A Questionnaire-Based Study

Aim: The contemplations and actions of medical undergraduates concerning their oral well-being mirror their perception of the significance of interdental cleaning aids in the maintenance of oral hygiene. The current study aimed to evaluate understanding and discernment of the practice of interdental aids as well as their role in the maintenance of oral hygiene among medical undergraduates in the district of Sheikhupura, Pakistan. Methods: A questionnaire-based cross-sectional analysis was performed from June 2021 to December 2021 at Amna Inayat Medical College in the district of Sheikhupura, Pakistan on a total of 220 medical undergraduates who were enrolled by convenient sampling method. Data were assembled using a standardized questionnaire that was circulated amongst students of 1st Year MBBS to Final Year MBBS. Associations between awareness regarding interdental cleaning and oral hygiene practice among both genders and all the years of study were assessed through the Pearson Chi-Square test. Results: The study comprised 123 females and 97 males with an average age range of 18 - 25 years. Most of the students i.e. 47.3% knew that the interproximal tooth surface is the most difficult to clean and cannot be effectively cleansed with a toothbrush only. Significant differences were seen in gender regarding the cleaning of teeth (P ≤ 0.001), the challenging surface of the tooth to clean (P ≤ 0.01), reasons for bad breath (P ≤ 0.003), knowledge of gum disease (P ≤ 0.000) and information regarding interdental cleaning (P ≤ 0.000). Practical Implication: Imparting knowledge regarding the maintenance of oral hygiene is crucial due to the connection between the oral cavity and the rest of the body. In a developing country like Pakistan, awareness, and understanding of oral hygiene is not up to the mark even in the medical population. Hence, improvement in oral hygiene can be brought about by creating public awareness regarding interdental aids in addition to brushing alone. Conclusions: Outcomes of the existing research propose that the overall understanding and awareness amongst medical undergraduates related to interdental aids was satisfactory. Established on these conclusions, additional communal-focused oral health promotions are requisite to piloting the degree of the dwelling of medical undergraduates. Keywords: Awareness, Dental, Dentist, Interdental area, Gingivitis, Knowledge, Medical Undergraduates, Oral Health, Periodontitis, Plaque.

Assessment of Oral Hygiene Practices and the Factors Influencing Selection of Tooth and Interdental-Cleaning Devises: A Cross Sectional Survey of Pakistani Adults

Objective: The current study aimed at determining and characterizing the oral hygiene habits and behaviors of a subset of Pakistani population seeking dental care at a private hospital in Karachi. Study Design: Cross-sectional survey. Place and Duration of Study: The study was conducted in the department of Oral Medicine and Diagnosis in Dental Out-Patient-Department of Ziauddin University Karachi from January 2022 to July 2022. Methodology: A total of 530 adult males and females who visited Ziauddin Dental Out-patient-department (OPD) were recruited using non-probability consecutive sampling, as a representative sample of the Pakistani population. After obtaining an informed consent, interviews using a structured questionnaire were conducted. Data analysis was performed with SPSS version 22. Results: The majority of the subjects interviewed (58.3%) use toothbrush, while 5.8% use miswak, 23.2% use both toothbrush and miswak, and 5.5% use their fingers to clean their teeth. There was no significant difference in selection of oral hygiene device between genders, age groups, level of education, and social economic status. To clean interdental areas, majority participants use toothpicks (39.6%), 13.4% use dental floss, 4.5% use interdental brush while 34.1% use none. 14.3% of the participants reported that they use a mouth-rinse. Conclusion: An assessment of oral hygiene practices serves as a guide for designing effective health education programs that fulfils the periodontal requirements of the target population. Efforts should be made to promote the correct brushing techniques and timings and implement the usage of interdental cleaning aids. Keywords: dental health education, miswak, toothbrushing, floss, mouth rinse

Ispitivanje korelacije nivoa gubitka alveolarne kosti u interdentalnom i interradikularnom prostoru primenom radiografske analize

Introduction: One of the consequences of the presence of periodontitis is the loss of alveolar bone in the interdental and interradicular space. Bone loss is very important for assessing the severity of the disease and applying therapeutic procedures. Aim: The objective was to determine and compare the loss of interdental and interradicular alveolar bone using radiographic analysis. Material and methods: 100 patients, aged 40 to 60 years, with chronic periodontitis and involvement of grade III and IV furcations in mandibular molars were examined. After orthopantomographic imaging, morphological measurements of mesial and distal interdental bone loss were performed, as well as the measurements of interradicular space. Then, their interrelationship was analyzed. Results: The mean value of mesial interdental bone loss was 5.90 ± 2.4mm, and the mean value of distal was 6.1 ± 6.1mm, while the mean value of interradicular bone loss was 3.55 ± 5.1mm. The correlation between interradicular and interdental bone loss was statistically significant (p<0.001). A higher correlation was present in respondents older than 50 years compared to younger respondents. Regarding gender, no statistically significant difference was observed between the examined bone levels. Interradicular bone loss of 0.8 mm and more was observed in subjects with bone loss in the interdental area of at least 3.7 mm. Conclusion: The results show that there is a correlation between the loss of alveolar bone levels in the interdental and interradicular space of the molars in chronic periodontitis, so interdental and interradicular bone loss can be used as an additional test in diagnosing the disease. Additional research is needed, which would include the use of three-dimensional radiography to determine the severity of the disease and therapeutic procedures.

GINGIVECTOMY IN GINGIVAL ENLARGEMENT CASES USING CONVENTIONAL TECHNIQUE

Introduction: Gingival enlargements is an abnormal condition that localizedor generalized on the gingival cause by some factor. Gingival enlargements isalways associated with chronic gingival irritation due to traumatic occlusion,calculus and the presence of rough edges on tooth restoration, drug inducedor cause by systemic disease. Gingivectomy is an excision in the gingivalarea. By removing the pocket wall, gingivectomy provides visibility andaccessibility to the removal of calculus as a whole. Case: A 12th years oldmen came to the Klungkung District Hospital complaining of a lump in theupper front gum since 6 months ago, clinically there was gingival swelling at11,12,13,21,22,23. Case Treatment: The treatment procedure performedwas gingivectomy with an conventional technic. Conventional Technic areused routinely for surgical procedures because predictable result. Examplefor Growth excision, excision or incision biopsy, white lesion ablation, andgingivectomy are common in intraoral procedures. Discussions: The resultsof treatment after one week and two weeks showed good condition withslight complaints of pain. Conclusion: The gingivectomy technique in thiscase was performed using a continuous technique because the gingival enlargement was found in the marginal and interdental areas. The results oftreatment for more than a week show good condition.

The influence of artificial saliva on the cleaning force of interdental rubber picks: an in-vitro comparison

BackgroundThe familiar aids for interdental cleaning such as dental floss or interdental brushes (IDB) are often associated with difficult handling or an increased potential for trauma. Interdental picks (IRP), which have no metal core and silicone flaps instead of nylon brushes, offer the alternative. However, in-vitro studies found a lower cleaning effectiveness combined with higher forces for cleaning compared with conventional IDBs. The aim of this in-vitro study was to measure the experimental cleaning forces (ECF) using IRP with versus without an artificial saliva (AS; GUM Hydral, Sunstar Suisse SA, Etoy, Switzerland).MethodsThe test set-up was developed to investigate the cleaning of 3D-printed interdental area (IDR) mimicking human teeth (Form 2, Formlabs Sommerville, MA, USA) under standardized conditions. Three different morphologies (isosceles triangle, convex, concave) and three different sizes (1.0 mm,1.1 mm,1.3 mm) were used. Two different IRPs (GUM Soft-picks Advanced: SPA versus GUM Soft-picks Advanced Plus: SPA+, Sunstar Suisse SA, Etoy, Switzerland) in three sizes (small, regular, large), were used with versus without AS. ECF during ten cleaning cycles were recorded by a load cell [N].ResultsUsing AS leaded to significant lower values for ECF than without (1.04 ± 0.66 N versus 1.97 ± 1.01 N, p < 0.001). In general, a lower ECF was recorded for convex IDR compared to isosceles triangle and concave morphologies (p < 0.001) as well as for gap sizes of 1.3 mm compared to the smaller sizes (p < 0.001). For SPA+ we found significantly higher force values than for SPA (1.67 ± 0.93 N versus 1.31 ± 0.97 N, p < 0.001) independent of the use of AS.ConclusionWithin the study´s in-vitro limitations, we found AS reduced ECF of IRPs by half and allowed using larger diameters interdentally, which could be associated with (1) a higher cleaning effectiveness and (2) a higher acceptance e.g. of patients with dry mouth. This has to be confirmed by further clinical investigations.

Comparison of interproximal delivery and flow characteristics by dentifrice dilution and application of prepared toothpaste delivery technique.

In home care, the toothpaste technique, which can enhance the caries-preventive effect without changing the amount of dentifrice and fluoride ion concentration, is of great significance. This study aimed to construct a model and experimental system that reproduces the interdental part and to clarify the relationship between the change in dentifrice viscosity due to dilution and washout in the high-risk approximal area of caries. Additionally, the effectiveness of the toothpaste technique and appropriate devices for delivering dentifrice to the interdental area at a low dilution were investigated. Diluted toothpaste samples were prepared (: ×1.00, ×1.25, ×1.50, ×1.75, ×2.00, ×3.00, and ×4.00). An acrylic interproximal model was created for this experiment. The flow characteristics and viscosity by dentifrice dilution were measured. In the case of low dilution of 57% (1.75×) or more, it was shown that the dentifrice in the high-risk area may be washed out early because of the decrease in viscosity, and the caries-preventive effect may be reduced. It was also suggested that to keep the dentifrice in the interdental area for 120 s at the end of brushing, a dilution must be devised to a concentration of at least 50% (2.00×). The prepared toothpaste delivery (PTD) method of delivering dentifrice to the interdental area while maintaining it at a low dilution is an effective toothpaste technique in terms of dentifrice dilution and viscosity. The use of finger brushes in the PTD method could increase the efficiency of dentifrice delivery.

Assessment of oral health status and treatment needs of HIV positive transgenders in Odisha - a cross-sectional study.

SummaryIntroductionHuman Immunodeficiency virus (HIV) causes the human immunodeficiency infection which is a major global health problem. Oral health status of people infected by HIV is also compromised. There is limited literature on oral health status of HIV/AIDS transgenders in Odisha.AimThis study was conducted to assess the oral health status of HIV-positive transgenders.MethodologyA cross-sectional study was conducted among the HIV positive transgenders in Odisha. Snowball sampling technique was employed to reach the population. Oral health was recorded using modified WHO 2013 proforma. Clinical examination using disposable mouth mirror and explorer. Chi square statistics was used for finding the association between the socio-demographic variables and DMFT, CPI, and LOA scores.ResultsThe study included 153 participants out of which seventy participants belonged to the age group 18-30 years. Majority of the participants were unemployed and most of them had spent around 6-10 years in school. Majority of the participants used toothbrush for cleaning their teeth and the average duration of cleaning tooth was less than two minutes. Toothpick was the most common method used for cleaning interdental areas and none of the participants used dental floss or interdental brushes. The mean DMFT score which was recorded to be 1.424. Around 28.10% (43) inmates had pockets of depth 4 mm to 5 mm. Loss of attachment of 6 mm to 8 mm was found in majority (57, 37.25%) of the participants. Most of the participants did not require any prosthesis both in the upper and lower arches. Around 32 participants (20.91%) had very mild fluorosis, 29 participants (18.95%) exhibited signs of moderate fluorosis. Age was found to be significantly associated with loss of attachment score (p = 0.023). Occupation had an association with the DMFT score (p = 0.002) while years in school was found to be significantly associated with CPI score (p = 0.045).ConclusionThe oral health status of transgenders is poor and needs immediate attention.

Fibrous epulis - case report

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Histologically, there are several different &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid66&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 458.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.933634);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;types of epulis. Fibrous epulis is benign tumor of gingiva that most of&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid68&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 478.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.956314);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;ten occurs in interdental papilla area as a result of local irritation (in&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid70&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 498.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.92806);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;adequate restorative fillings, carious teeth, subgingival deposits or the &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid71&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 518.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.908543);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;combination of them). The aim of this paper is to present a clinical case &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid72&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 538.511px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.919242);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;of fibrous epulis.&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid73&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.983097);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;Case report.&amp;lt;/span&amp;gt;&amp;lt;/strong&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid74&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 468.103px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif;&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt; &amp;lt;/span&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 473.815px; top: 567.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.966329);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;A 25-year-old girl reported to the Specialist Center for &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid75&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 587.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.949471);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;Dentistry in Foca. Clinical examination revealed a gingival tissue en&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid77&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.978601);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;largement in the area of&amp;lt;/span&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 550.203px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif;&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt; &amp;lt;/span&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 555.903px; top: 607.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.970168);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;the upper jaw central incisors with speech &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid78&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 627.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.948603);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;and chewing function disturbances. Intraoral examination revealed a &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid79&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 647.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.955671);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;change above the level of gingiva, reddish-pink in color with smooth &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid80&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 667.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.897711);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;surface texture and soft consistency. The size of the change was 1 x 1.5 &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid81&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 687.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.939751);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;cm. It was connected to the interdental gingiva between teeth 12 and &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid82&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 707.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.922157);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;21 by a narrower base. Clinically, a significant amount of soft and hard &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid83&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 727.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.964691);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;dental deposits surrounded the remaining teeth. Remaining gingiva &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid84&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 747.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.910207);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;was swollen, red, bleeding on provocation. The anamnesis did not con&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid86&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 767.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.911782);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;firm the presence of other acute and chronic diseases. The patient was &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid87&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 787.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.902162);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;not pregnant. She was informed about clinical condition assessment, as &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid88&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 807.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.938384);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;well as possible therapeutic procedures. Our patient was treated with &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid89&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 827.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.936212);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;non-surgical periodontal therapy and surgical excision of the enlarge&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid91&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 847.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.952075);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;ment. After histopathological examination of the removed tissue, the &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid92&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.900182);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;diagnosis was made:&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid93&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 518.036px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif;&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt; &amp;lt;/span&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 521.234px; top: 867.96px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.861328);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;&amp;amp;ldquo;Fibrous epulis cum ulceration&amp;amp;rdquo;.&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid94&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.972244);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;Conclusion.&amp;lt;/span&amp;gt;&amp;lt;/strong&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid95&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 462.603px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif;&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt; &amp;lt;/span&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 467.385px; top: 897.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.945574);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;Clinical examination is insufficient for definite diagnosis. &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid96&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 917.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.938323);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;Therefore, a histopathological examination of the tissue is mandatory &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid97&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 937.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.921552);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;for fibrous epulis definite diagnosis. Treatment of choice is surgical ex&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid99&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 957.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.921339);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;cision of the enlargement and removal of predisposing factors to avoid &amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;span id=&amp;quot;page359R_mcid100&amp;quot; class=&amp;quot;markedContent&amp;quot;&amp;gt;&amp;lt;span dir=&amp;quot;ltr&amp;quot; style=&amp;quot;left: 377.953px; top: 977.409px; font-size: 16.6667px; font-family: sans-serif; transform: scaleX(0.901523);&amp;quot; role=&amp;quot;presentation&amp;quot;&amp;gt;recurrence.&amp;lt;/span&amp;gt;&amp;lt;/span&amp;gt;&amp;lt;/p&amp;gt;

Correlative Assessment of Interdental and Interradicular Bone Loss in Horizontal and Vertical Bone Defects In Chronic Periodontitis: A Clinical and Radiographic Study

It is important to treat periodontitis before involvement of furcation areas because of their complex anatomy and difficulty of access. Literature confirms that it is difficult to accurately determine the relationship of the amount of bone loss in the interdental areas associated with the interradicular areas and correlate them with the clinical periodontal status. The aim of this study was therefore to assess the existence of such an association, if any, in subjects with chronic periodontitis. The threshold of alveolar bone loss associated with progression of periodontal destruction and involvement of interradicular areas of the furcations is not clearly defined in the literature. The aim of this study was to investigate a correlation, if any between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Periapical (IOPA) radiographs of mandibular molars were obtained from 193 sites in 33 males and 21 females between the age group of 25 and 55 years having chronic periodontitis. These were then scanned and digital measurement of linear distances was performed using dicom software of height and width of defect (horizontal and vertical), bone defect angle and interradicular bone loss. These measurements were correlated to pocket depth (PD) and clinical attachment loss (CAL) using One-way ANOVA followed by Tukeys HSD post hoc tests. Bone height significantly correlated with probing depth and CAL in horizontal defects (p&lt;0.005) with hardly any furcation involvement (1.55%)whereas both bone height and width showed significant correlation with probing depth and CAL in vertical defects(P&lt;0.001) with nearly 77% of sites showing furcation defects. A strong correlation of clinical parameters with bone defect dimensions suggests that early diagnosis and management of interdental bone loss may be critical to prevent furcation involvement.