Management Of Periodontitis Research Articles

Role of Dietary Fibre in Managing Periodontal Diseases-A Systematic Review and Meta-Analysis of Human Intervention Studies.

Periodontitis is a chronic multifactorial inflammatory disease, that leads to tooth loss and is associated with other systemic diseases. The role of dietary fibre in the prevention and management of periodontal diseases is not well understood. The objective of this systematic review and meta-analysis was to assess how an intake of dietary fibre affects periodontal diseases in humans and any concomitant effects on systemic inflammation. Human interventional studies investigating the effects of oral fibre intake on various clinical parameters of periodontal diseases were included. Search strategy with MeSH and free-text search terms was performed on the following database: CINAHL Complete, EMBASE, MEDLINE, SciVerse Scopus®, and Web of Science Core Collection on 21 October 2021 and updated on 19 February 2023 to identify relevant studies. Articles were filtered using the Covidence© web-based platform software. Data were pooled using random effects meta-analysis. From all databases, a total of 19,971 studies were obtained. Upon title and abstract screening, 101 studies were included for full-text screening. Upon full-text screening, six studies were included for analysis. Of these, five were randomised controlled trials, and one was a sequential feeding trial involving fibre-rich daily diet for a 4-8 weeks period. Fibre-rich dietary intervention significantly reduced Clinical Attachment Loss/Level by 0.48 mm/tooth (95% CI, -0.63 to -0.33, p < 0.001), Bleeding On Probing by 27.57% sites/tooth (95% CI -50.40 to -4.74, p = 0.02), Periodontal Inflamed Surface Area by 173.88 mm2 (95% CI -288.06 to -59.69, p = 0.003), Plaque Index by 0.02 (95% CI -0.04 to -0.00, p = 0.04), and Gingival Index by 0.41 (95% -0.67 to -0.16, p= 0.002). A non-significant reduction was observed for Probing Depth (-0.17 mm/tooth; 95% CI, -0.37 to 0.02, p = 0.09). Fibre-rich dietary interventions are associated with a reduction of clinical and particularly inflammatory markers of periodontal diseases. This shows a promising effect of dietary fibre as an intervention for inflammatory conditions like periodontal diseases.

Periodontal Practice and Referral of Patients by General Dental Practitioners in Province No.1 Nepal

Introduction: General dental practitioners and periodontists working in a close alliance is considered to bestow effective outcome in the context of diagnosis and management of periodontal diseases. Recently, general practitioners are inclined to render the majority of non-surgical procedures by themselves and avoid surgical part. This obscures functional as well as esthetic demand contributing to periodontally challenged conditions. In advanced stages, no matter how efficiently a skilled periodontist handles the case, redemption is not possible.&#x0D; Objectives: To assess the periodontal practice and referral of patients by general dental practitioners to periodontists.&#x0D; Methodology: An online survey using Google Forms was conducted among the general dental practitioners working in private clinics in province no.1, Nepal from November 2021 to January 2022. A total of 64 general dental practitioners were surveyed using a self-administered questionnaire. Descriptive statistics were calculated.&#x0D; Results: The response rate for the present study was 51.2% out of which only 17.2% referred patients to periodontists for non-surgical periodontal therapy and scaling was the most performed procedure by all the practitioners themselves. However, 92.2% referred patients to periodontists for surgical procedures and a majority of the referrals were for mucogingival surgeries. Majority of them expressed satisfaction regarding the number of continuing dental education programs being conducted despite minimum participation.&#x0D; Conclusion: Majority of the general dental practitioners seemed to perform non-surgical periodontal therapy by themselves while considering referral for surgical interventions. Also, minimum participation despite remarkable satisfaction in the conduction of continuing education programmes calls for a need to explore the inadequacy.

Patient-reported understanding and dentist-reported management of periodontal diseases - a survey: do you know what gum disease is?

Introduction Mild-to-moderate gingivitis is treatable by effective toothbrushing with appropriate over-the-counter oral health care products; however, rates remain high.Aim To determine patient knowledge of gingivitis and dentists' views on management.Methods Surveys were completed by dentists and dental hospital patients.Results In total, 224 patients and 50 dentists participated. Clinical health, gingivitis, or periodontitis was detected in 2%, 33% and 56% of patients, respectively; 32% reported never suffering gingival bleeding. Moreover, 74% of patients reported gingival health as very important but only 53.7% with gingivitis occasionally/often were moderately-extremely worried about their symptoms. More than 50% of patients knew gingivitis causes poor oral health but <20% knew it elevated risks of other systemic conditions. Patients thought education on risks associated with poor oral health and product recommendations were most likely, and daily reminders least likely, to improve compliance with oral health advice (OHA). Also, 40% of dentists thought their patients were relatively unaware of the importance of gingival health, 76.9% of their patient-base had gingivitis, and 96% give OHA to these patients but only 30% thought this effected improvement. The most useful tools for improving oral health were better patient knowledge of the consequences and one-to-one instruction.Conclusion Patients struggle to attain oral health following OHA. Education about gingivitis-associated risks might improve OHA compliance.

Piperine-Loaded In Situ Gel: Formulation, In Vitro Characterization, and Clinical Evaluation against Periodontitis.

Periodontitis is an inflammatory disorder associated with dysbiosis and characterized by microbiologically related, host-mediated inflammation that leads to the damage of periodontal tissues including gingiva, connective tissues, and alveolar bone. The aim of this study was to develop an in situ gel consisting of piperine. Eight in situ gel formulations were designed by varying the concentration of deacylated gellan gum cross-linked with sodium tripolyphosphate, and poloxamer-407. The prepared gels were evaluated for gelation temperature, gelation time, viscosity, piperine-loading efficiency, and piperine release. Finally, the optimized formula was evaluated for anti-inflammatory effectiveness among human patients during a 14-day follow-up. The optimized in situ gel formulation exhibited a gelation temperature of 35 ± 1 °C, gelling of 36 ± 1 s, excellent syringeability, and piperine loading of 95.3 ± 2.3%. This formulation efficiently sustained in vitro drug release for up to 72 h. In vivo studies revealed an efficient sol-to-gel transformation of optimized in situ gel formulation at physiological conditions, permitting an efficient residence time of the formulation within a periodontitis pocket. Most importantly, a clinical study revealed that treatment with the optimized formulation elicited a significant reduction in the mean plaque score (p = 0.001), gingival index (p = 0.003), and pocket depth (p = 0.002), and exerted a potent anti-inflammatory potential, compared to the control group. Collectively, piperine-loaded in situ gel might represent a viable therapeutic approach for the management of gingival and periodontal diseases.

Evaluation of Osteogenic Potential of Fucoidan Containing Chitosan Hydrogel in the Treatment of Periodontal Intra-Bony Defects-A Randomized Clinical Trial.

Periodontal diseases significantly impact about half of the global population, and their treatment often encompasses relieving symptoms as well as regenerating the destroyed tissues. Revolutionary research in the management of periodontal disease includes biomaterials, a boon to re-generative dentistry owing to their excellent biological properties: non-toxicity, anti-inflammatory, biocompatibility, biodegradability, and adhesion. This study aimed to fabricate an injectable fucoidan containing chitosan hydrogel and prove its effectiveness in periodontal bone regeneration. The injectable hydrogel was prepared using the sol-gel method and was subjected to various physical, chemical, and biological characterizations to understand its efficacy in formation of new bone. The effectiveness of the developed hydrogel was assessed in periodontal bony defects to study the soft and hard tissue changes. A total of 40 periodontitis patients with bony defects were recruited and randomized into two groups to receive fucoidan-chitosan hydrogel and concentrated growth factor, respectively. Customized acrylic stents were used to guide the hydrogel placement into the defect site. Post-surgical changes in clinical parameters were assessed at 3, 6, and 9 months to appreciate the soft and hard tissue changes using repeated measures analysis of variance and Bonferroni's post hoc test. Significance was kept at 5%. The porosity, water uptake of the prepared hydrogel showed good efficacy, with particle size of the fucoidan containing chitosan hydrogel of 6.000 nm. The MG-63 osteoblasts cell line revealed biocompatibility, biodegradability and showed slow and sustained drug release, increased cell proliferation, and enhanced alkaline phosphatase secretion. Mineralization assay was greatest in the fucoidan containing chitosan hydrogel. Clinically, it exhibited significantly lower probing depth values and a higher mean improvement in clinical attachment level as compared to the concentrated growth factor (CGF) group at the end of 3 and 6 months (p < 0.05). The mean of the defect fills in the fucoidan containing chitosan group was 1.20 at the end of 9 months (p < 0.001) as compared with defect fills observed in the CGF group. The presence of fucoidan in the hydrogel significantly contributed to bone regeneration in humans, thus strengthening its potential in tissue engineering. Fucoidan-chitosan will be a promising biomaterial for bone tissue regeneration.

Association between periodontal disease status and risk of atrial fibrillation: a nationwide population-based cohort study

BackgroundPeriodontal disease can activate an immune process linked to systemic diseases, including atrial fibrillation. However, the relationship between periodontal disease and atrial fibrillation remains unclear.AimThis study aimed to investigate whether changes in periodontal disease status are associated with the risk of atrial fibrillation.MethodsUsing the National Health Insurance Database Korea, participants who underwent the first oral health examination in 2003 and a second examination in 2005–2006 without a history of atrial fibrillation were included. Participants were grouped according to changes in periodontal disease status during two oral examinations: periodontal disease-free, periodontal disease-recovered, periodontal disease-developed, and periodontal disease-chronic. The outcome was the incidence of atrial fibrillation.ResultsThe study included 1,254,515 participants, with a median follow-up of 14.3 years and 25,402 (2.02%) cases of atrial fibrillation occurred. During follow-up, the risk of atrial fibrillation was highest in the periodontal disease-chronic group, followed by the periodontal disease-developed, periodontal disease-recovered, and periodontal disease-free groups (p for trend < 0.001). Moreover, recovery from periodontal disease was associated with a reduced risk of atrial fibrillation compared to a chronic periodontal disease status (Hazard ratio: 0.97, 95% Confidence interval: 0.94—0.99, p = 0.045). The development of periodontal disease was associated with an increased risk of atrial fibrillation compared to being periodontal disease-free (Hazard ratio: 1.04, 95% Confidence interval: 1.01—1.08, p = 0.035).ConclusionOur findings suggest that changes in periodontal disease status impact the risk of atrial fibrillation. Management of periodontal disease may help prevent atrial fibrillation.

Dietary omega-3 fatty acids in the management of feline periodontal disease: What is the evidence?

Periodontal disease is an oral disorder with high prevalence in cats from 2 years of age, resulting from an inflammatory response against bacterial plaque. Treatment depends on the stage of the disease and may include dental scaling, local application of perioceutics, tissue regeneration and/or even tooth extraction and periodontal surgery. As multimodal therapy is often required, new strategies have been developed to improve the therapeutic response in these patients. Adjuvant use of omega-3 fatty acids has been reported in humans with periodontal disease, but the current evidence of its effect in companion animals, especially cats, is still considered to be scarce and conflicting. This review describes the state of the art regarding feline periodontal disease and seeks to clarify the potential effect of omega-3 fatty acids on its clinical management in light of the evidence available in the current literature.

Methodological Considerations in Salivary Proteomics for Periodontal Research-A Review.

The diagnosis and management of periodontal diseases can be enhanced by the identification of biomolecules which can predict disease susceptibility, indicate current disease activity, and monitor response to therapy. Salivary proteomics is a major avenue in the ongoing search for a biomarker in periodontal research. Saliva is a valuable diagnostic vehicle which "mirrors" oral and systemic health and disease. Standardized methods of saliva sampling and processing will increase diagnostic test accuracy and decrease bias in measurements. Prominent databases such as PubMed/Medline, PMC, Scopus, and Google Scholar were searched and literature evidence from January 2000 till September 2022 were studied to identify the methodological considerations employed in salivary proteomics for periodontal research. Evidence and recommendations in this regard were collated into this narrative review. The methods of saliva collection and processing presented in this review will help researchers conduct salivary proteomic studies with standardized protocols.

Porphyromonas gingivalis under palmitate-induced obesogenic microenvironment modulates the inflammatory transcriptional signature of macrophage-like cells.

Metabolic diseases and low-grade chronic inflammation are interconnected: obese persons are at higher risk of developing periodontitis. However, the molecular mechanisms involved in the development and progression of periodontitis in an obesogenic microenvironment in response to periodontopathogens are still lacking. This study aims to investigate the combined effects of palmitate and Porphyromonas gingivalis on the secretion of pro-inflammatory cytokines and on transcriptional landscape modifications in macrophage-like cells. U937 macrophage-like cells were treated with palmitate and stimulated with P. gingivalis for 24h. Cytokines IL-1β, TNF-α and IL-6 were measured by ELISA in the culture medium and cell extracted RNA was submitted to a microarray analysis followed by Gene Ontology analyses. P. gingivalis, in presence of palmitate, potentiated IL-1β and TNF-α secretion in comparison to palmitate alone. Gene Ontology analyses also revealed that the combination palmitate-P. gingivalis potentiated the number of gene molecular functions implicated in the regulation of immune and inflammatory pathways compared to macrophages treated with palmitate alone. Our results provide the first comprehensive mapping of gene interconnections between palmitate and P. gingivalis during inflammatory responses in macrophage-like cells. These data highlight the importance of considering systemic conditions, specifically obesogenic microenvironment, in the management of periodontal disease in obese patients.

Bioactive Efficacy of Identified Phytochemicals Solasodine, Lupeol and Quercetin from Solanum xanthocarpum against the RgpB Protein of Porphyromonas gingivalis—A Molecular Docking and Simulation Analysis

Periodontal diseases are highly prevalent oral conditions associated with severe complications in the oral cavity. These inflammatory diseases are caused by the oral microbiome and are influenced by several factors, such as aging, tobacco usage, systemic illness and inadequate oral hygiene. Plant-derived phytochemicals are extensively utilized in managing various periodontal diseases due to the presence of antioxidant, anti-inflammatory and antibacterial activities. Plant materials have shifted attention from conventional medicine to indigenous medicine. Solanum xanthocarpum is a medicinal herb found in India. It exhibits various pharmacological properties essential for periodontal disease prevention and management. The current work analyzes various pharmacological properties of S. xanthocarpum aqueous extract. The S. xanthocarpum extracts’ antioxidant, anti-inflammatory and anti-microbial properties were ascertained by DPPH assay, HRBC membrane stabilization assay and disk diffusion assay, respectively. S. xanthocarpum’s active phytochemical components were detected using gas chromatography–mass spectrometry (GC-MS) estimation. Furthermore, molecular docking and simulation analysis were conducted to determine the interaction between phytocompounds and the RgpB protein of Porphyromonas gingivalis. Phytocompounds possessing anti-microbial, antioxidant and anti-inflammatory properties were detected through GC-MS estimation. The molecular docking and simulation analysis revealed the inhibitory mechanisms of the phytocompounds Solasodine, Lupeol and Quercetin against arginine-specific gingipain RgpB protein. Insilico analysis revealed that Lupeol had the highest binding energy of −263.879 Kcal/mol among the phytocompounds studied, followed by Solasodine with a binding energy of −102.457 Kcal/mol and Quercetin with a binding energy of 33.6821 Kcal/mol. The study revealed that S. xanthocarpum has significant potential as an herbal remedy for preventing and treating periodontal diseases. This may facilitate drug development in the future.

Revisiting the Role of Periodontal Plastic Surgery in Regenerative Therapies Clinical Criteria and Biological Principles

One of the manifestations of periodontitis is bone loss and tooth mobility. Thus, periodontal regeneration plays a vital in reinstating the lost alveolar bone and periodontal tissue. This study aims at the different literary resource that highlight the role of periodontal plastic surgery; clinical criteria and biological principles that facilitates the process of regeneration. Several corrective steps are implemented for the management of chronic periodontal disease, such as the first line of intervention which is the non-surgical treatment that consists of Oral hygiene instructions and removal of biofilms. After non-surgical phase of treatment once the tissue is healed, surgical techniques are to be considered for the management of the remaining pockets also known as residual pockets or to formulate a gingival apparatus that promotes plaque control. However, if there is a loss of tissue it is quintessential to take into consideration regenerative procedures. KEYWORDS: Periodontal plastic surgery, biological principals, regeneration

Alveolar Bone Loss Detection and Localization in Dental X-Ray Images using YOLOv5

Periodontal disease, characterized by alveolar bone loss, is a prevalent oral health condition that requires early detection and management to prevent further progression. This paper proposes a novel approach for alveolar bone loss detection and localization in dental X-ray images using the YOLOv5 object detection algorithm. We annotated a dataset of dental radiographs with alveolar bone loss regions and fine-tuned the YOLOv5 model on this dataset. Our approach achieved high accuracy and robustness in detecting and localizing alveolar bone loss regions, with precision, recall, and F1 score exceeding 90%. The real-time processing capabilities of YOLOv5 make it suitable for clinical implementation, providing an efficient and accurate solution for periodontal disease management. The automated alveolar bone loss detection and localization using YOLOv5 can significantly assist dentists in the early diagnosis and treatment planning of periodontal diseases, leading to improved patient outcomes and reduced risks of tooth loss. The proposed method has the potential to be integrated into clinical practice, providing a valuable tool for dental practitioners in the field of periodontics.

Magnolia kobus Extract Suppresses Porphyromonas gingivalis LPS-Induced Proinflammatory Cytokine and MMP Expression in HGF-1 Cells and Regulates Osteoclastogenesis in RANKL-Stimulated RAW264.7 Cells.

Clinical prevention is of utmost importance for the management of periodontal diseases. Periodontal disease starts with an inflammatory response in the gingival tissue, and results in alveolar bone destruction and subsequent tooth loss. This study aimed to confirm the anti-periodontitis effects of MKE. To confirm this, we studied its mechanism of action using qPCR and WB in LPS-treated HGF-1 cells and RANKL-induced osteoclasts. We found that MKE suppressed proinflammatory cytokine protein expression by inhibiting the TLR4/NF-κB pathway in LPS-PG-induced HGF-1 cells and blocking ECM degradation by regulating the expression of TIMPs and MMPs. We also confirmed that TRAP activity and multinucleated cell formation were reduced in RANKL-stimulated osteoclasts after exposure to MKE. These results were confirmed by inhibiting TRAF6/MAPK expression, which led to the suppression of NFATc1, CTSK, TRAP, and MMP expression at the gene and protein levels. Our results confirmed that MKE is a promising candidate for the management of periodontal disease based on its anti-inflammatory effects and inhibition of ECM degradation and osteoclastogenesis.

Role of Artificial Intelligence in Periodontology

This study focuses into the possible links between patient demographics, smoking habits, treatment received, and periodontal disease severity before and after treatment. A new dataset of 1,000 patients was created, with information on age, smoking status, periodontal disease severity before and after therapy, and whether or not treatment was received. To obtain insight into the correlations between the variables, descriptive and inferential statistical analyses were performed using SPSS. A machine learning model was also created and trained on the information to predict the severity of periodontal disease following treatment. Despite the apparent complexity of the disease process, the machine learning model was discovered to be a reliable tool for forecasting disease development. The findings demonstrate an insignificant relationship between age and post-treatment severity, implying that age may not be a significant role in the progression of periodontal disease after treatment. The performance of the machine learning model, its implications for clinical practice, and prospective applications of AI in periodontology are also examined. The findings have important implications for periodontal disease patient management and treatment decisions. Furthermore, they lay the door for future AI implementations in periodontal disease prediction and management that are more sophisticated. More research is needed, however, to corroborate these findings and include more different parameters into the machine learning model. Keywords: Artificial Intelligence, Periodontology, Dental healthcare, Diagnosis,Treatment

Estimating Crestal Thickness of Alveolar Bones on Intra-oral Ultrasonograms.

Alveolar crestal bone thickness and level provide important diagnostic and prognostic information for orthodontic treatment, periodontal disease management and dental implants. Ionizing radiation-free ultrasound has emerged as a promising clinical tool in imaging oral tissues. However, the ultrasound image is distorted when the wave speed of the tissue of interest is different from the mapping speed of the scanner and, therefore, the subsequent dimension measurements are not accurate. This study was aimed at deriving a correction factor that can be applied to the measurements to correct for discrepancy caused by speed variation. The factor is a function of the speed ratio and the acute angle that the segment of interest makes with the beam axis perpendicular to the transducer. The phantom and cadaver experiments were designed to validate the method. The comparisons agree well with absolute errors not more than 4.9%. Dimension measurements on ultrasonographs can be properly corrected by applying the correction factor without recourse to the raw signals. The correction factor has reduced the measurement discrepancy on the acquired ultrasonographs for the tissue whose speed is different from the scanner's mapping speed.

NANOPERIODONTICS: A NEW ERA IN THE MANAGEMENT OF PERIODONTAL DISEASE

Nanotechnology is science, engineering and technology conducted at the nanoscale that deals with the development and application of nanoparticles or nanomaterials. This field is considered as the greatest of all inventions humans have ever made till date. The associated research and applications are diverse, ranging from extensions of conventional technology to new approaches based upon the property of molecular self-assembly. Nanotechnology has been greatly advanced in the past few decades and the role of nanotechnology in field of dentistry and particularly in periodontology has evolved greatly. The use of various nanoparticles and materials has brought a new insight into the prevention, diagnosis and management of periodontal disease. In the near futureinvention of dental nanorobots will help in precise diagnosis and may lead us to new treatment opportunities. This review focuses on the updated applications of nanotechnology in the field of Periodontics.

Oral Health Factors Related to Rapid Oral Health Deterioration among Older Adults: A Narrative Review.

Older adults who face systemic health issues and lack adequate social support are at risk for oral health deterioration. How rapidly such changes take place depends on the severity of their medical condition and their ability to access oral health services in a timely manner. The management of dental caries and periodontal disease in this cohort is made complex by the interaction of local and host factors such as the presence of dry mouth, involvement of root surfaces, and altered wound healing. in addition to enhanced maintenance needs to avoid recurrence or progression. Tooth replacement can be beneficial in restoring oral function, allowing patients to enjoy a healthy and nutritious diet but requires careful consideration to avoid further damage to remaining dental units. Establishing a dental home for the older adult can facilitate routine surveillance, disease prevention, and patient/caregiver education to achieve oral health goals commensurate with overall health. This narrative review details oral health factors that are related to rapid oral health deterioration among older adults.

Guided Biofilm Therapy: A Novel Approach in Professional Dental Biofilm Management

There are many different kinds of microorganisms that live in the oral cavity, from good ones to those that could be harmful. It is a well-established fact that periodontal diseases are linked to dental plaque. A biofilm is a community of microcolonies of microorganisms in an aqueous solution that is surrounded by a glycocalyx matrix. This matrix also binds the bacterial cells to a solid substratum (surface), which can be hard or soft tissues or inanimate surfaces such as clear aligners, prosthetics, or orthodontic bands of the oral cavity. Although scaling and root planing (SRP) is considered the gold standard for mechanical plaque debridement, it also has some drawbacks, such as inaccessibility to deeper areas on the root surfaces and patient discomfort, including root hypersensitivity. To overcome these disadvantages, minimally invasive nonsurgical approaches have been introduced. One such novel alternative is guided biofilm therapy (GBT), which uses a disclosing agent to visualize the biofilm before removing it with a specialized air-abrasive powder and removing supra- and subgingival calculus with specialized instruments. Biofilm can be effectively removed around an implant or tooth with GBT. As a component of either supportive periodontal therapy or nonsurgical periodontal therapy, GBT was found to have a lower perception of pain and better patient compliance than SRP. GBT, as a monotherapy, can be advised as a basic treatment plan for teeth and implants. The various aspects of GBT in the management of periodontal and peri-implant diseases will be highlighted in this review.

Laser-assisted healing: transforming periodontal and prosthodontic treatments: A narrative review

Laser technology has emerged as a transformative tool in modern dentistry, offering precision, efficiency, and enhanced healing capabilities in periodontal and prosthodontic treatments. This abstract explores the significant impact of laser-assisted therapies on the management of periodontal diseases and the fabrication of dental prostheses. Laser therapy in periodontics involves various applications, including soft tissue management, decontamination of periodontal pockets, and promotion of tissue regeneration. Similarly, in prosthodontics, lasers are utilized for precise tissue sculpting, implant site preparation, and accelerated healing around dental implants. The integration of lasers into periodontal and prosthodontic practice has led to improved treatment outcomes, reduced patient discomfort, and enhanced esthetic results. This abstract highlights the transformative potential of laser-assisted healing in periodontal and prosthodontic treatments, emphasizing the need for further research and clinical integration to maximize its benefits for patients.

Does adjunction of Melaleuca alternifolia to periodontal treatment protocol improve clinical outcome?

Objective To assess the evidence on possible clinical periodontal benefits of tea tree oil (TTO) as an adjunct in the management of periodontal disease.