Non-surgical Periodontal Treatment In Patients Research Articles

Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial.

Diabetes mellitus (DM)-associated hyperinflammatory host response significantly provokes periodontal tissue destruction. In this context, the support of nonsurgical periodontal therapy in diabetics with host modulation agents is a current field of study. This clinical study aims to investigate the clinical efficacy of melatonin supplementation and discuss its possible biological mechanisms in nonsurgical periodontal treatment in patients with DM and periodontitis through some fundamental markers. In this randomized controlled and single-blind study, 27 of 55 diabetic patients with periodontitis (stage III/IV and grade C) underwent full-mouth scaling and root planing (fmSRP) alone and 28 patients underwent melatonin administration (6mg daily, 30days) in addition to fmSRP (full-mouth scaling and root planing plus melatonin, fmSRP-mel). The potential therapeutic contribution of melatonin was evaluated clinically and biochemically (gingival crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels) at 3rd and 6th months. Melatonin (tablet, 6mg daily, 30days) did not cause any local or systemic side effects. fmSRP alone resulted in significant reduction in serum IL-1β levels, pocket depths, gingival inflammation, and gingival crevicular fluid RANKL and MMP-8 levels (p<0.05). Moreover, melatonin supplementation resulted in a more significant decrease in bleeding and pocket depth scores at probing, especially at 3months (p<0.05). Furthermore, RANKL and MMP-8 levels were significantly lower at 3months and IL-1β levels at 6months compared to the control group (p<0.05). However, OPG levels were not affected significantly by the treatments (p>0.05). Melatonin, as a host modulation agent, significantly increases the clinical efficacy of fmSRP. The reduction in periodontal inflammation and pocket depths may be a result of marked suppression of RANKL-associated osteoclastogenesis and extracellular matrix damage by melatonin.

Effect of Non-Surgical Periodontal Therapy on Systemic Inflammatory Markers, Glycemic Status and Levels of Proteinuria in Type 2 Diabetic and Non-Diabetic Patients With Chronic Periodontitis.

The present study aimed to evaluate the effect of non-surgical periodontal therapy (NSPT) on systemic inflammatory markers, glycemic status, and levels of proteinuria in Type 2 diabetic and non-diabetic individuals with chronic periodontitis. A total of 120 patients, categorized into three groups of 40 each, were included in this randomized observational study. Group 1 comprised patients with chronic periodontitis; Group 2 had chronic periodontitis with controlled diabetes; and Group 3 represented patients with chronic periodontitis with uncontrolled diabetes based on fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) levels. Periodontal clinical parameters like plaque index, gingival index, bleeding on probing, pocket depth, and clinical attachment levels were evaluated. Blood samples and urine samples were collected and assessed for the levels of FBS, HbA1c, total protein, albumin, globulin, and proteinuria. All parameters recorded at baseline and three months after non-surgical periodontal therapy were analyzed for statistical significance at p <.05 using SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc. A significant reduction in the periodontal clinical parameters within the groups, except for the clinical attachment level in Group 1 patients (p = 0.05), was observed. Glycemic status revealed a significant reduction after non-surgical periodontal therapy (p < 0.001), and on intragroup comparison, the total protein, albumin, globulin, and microprotein blood and urine levels showed significance among the evaluated groups (p < 0.001). Non-surgical periodontal treatment can effectively improve the periodontal and circulating inflammatory status. Results of our study showed improved glycemic control and a reduction in systemic inflammatory markers and proteinuria after performing non-surgical periodontal treatment in patients with type 2 diabetes.

Dental anxiety and oral health-related quality of life before and after non-surgical periodontal treatment.

To (1) investigate dental anxiety (DA) and oral health-related quality of life (OHRQOL) before and after non-surgical periodontal treatment (NSPT) and (2) determine correlations between these patient-reported measures. Demographics, smoking habits, dental pain, Modified Corah's Dental Anxiety Scale (MDAS), and Oral Health Impact Profile (OHIP-14) were assessed in eighty-two participants. Mean age was 48.3years ± 11.5. At baseline, 8.5% reported being active smokers. Of non-smokers, 11% reported being an ex-smoker. After NSPT, 11.0% reported smoking. Patients' maximal pain in the last month decreased after therapy. Before treatment, participants reported higher DA. Extreme DA was observed in 8.5% of participants before therapy. Afterwards, 2.4% of participants reported extreme DA. Fear of having a foreign object in the mouth decreased after NSPT. All OHIP-14 scores, except functional limitation, improved post-treatment. Higher DA was associated with worse OHRQoL before treatment. After treatment, total MDAS score was associated with OHIP-14 global score, physical pain, psychological disability, and social disability. Worse MDAS sub-scores were associated with a higher OHIP-14 global score. Individuals with "normal/slight anxiety" had a significant improvement in OHRQoL, whereas people in the "moderate and extreme anxiety" group did not report a significant improvement. Patients diagnosed with generalized periodontitis (GP) stage III grade B and GP stage IV grade B reported less anxiety after NSPT. Associations of MDAS subcategories with OHIP-14 domain scores were found before and after therapy. DA decreases and OHRQoL enhances after NSPT in patients with "normal/slight" anxiety to dental treatment. Dental practitioners should plan strategies to cope with anxiety to dental treatment and prevent decreases in OHRQoL. Within the limitations of this study, DA and OHRQoL were positively correlated in patients with periodontitis, before and after NSPT, using the MDAS and OHIP-14 questionnaires. The results of our study suggest that treatment is effective in terms of alleviating DA and improving oral health, along with quality of life, in patients that report "normal/slight" anxiety to dental treatment. Nonetheless, results must be interpreted with caution since patients are generally anxious before any type of dental treatment. DA may not just be confined to NSPT per se. According to our results, evaluation of both outcomes should be an integral part of routine periodontal clinical evaluation and periodontal reevaluation of initial therapy. It is important that clinicians learn to identify patients that suffer from anxiety and take time to explain the treatment procedures to the patient, to strive for patient's emotional well-being before, during, and after dental care services. The use of specific questionnaires for both DA and OHRQoL may be more appropriate to demonstrate the psychological and quality of life differences due to periodontal disease and NSPT.

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.

Total Salivary Immunoglobulin A Determination Before and After Non-Surgical Periodontal Treatment in Patients with Aggressive Periodontitis

Total Salivary Immunoglobulin A Determination Before and After Non-Surgical Periodontal Treatment in Patients with Aggressive Periodontitis

The Effect of Adiposity on the Outcome of Non-Surgical Periodontal Therapy

Background: Non-surgical periodontal therapy constitutes the first step in controlling periodontal infections, and its outcome is affected by the presence of other systemic diseases and conditions. Obesity is a modifiable risk factor for periodontitis and its effect on the outcome of non-surgical periodontal therapy has not been clearly determined. Aim: To determine the impact of central adiposity on the outcome of non-surgical periodontal treatment in patients with periodontitis. Methodology: This prospective interventional study included 39 obese patients with periodontitis (Group A) and 39 normal?weight patients with periodontitis (Group B). The waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), Simplified oral hygiene index (OHIS), bleeding on probing (BOP), probing pocket depth (PPD), number of sites with PPD ≥ 4 mm, and clinical attachment loss (CAL) were measured at baseline and 3 months after non-surgical periodontal treatment. Chi-square test was used to compare categorical variables between the groups. Independent samples t-tests and paired t-test were used to analyse the numerical intergroup and intragroup data, respectively. Pearson’s correlation coefficients and multiple regression analyses were used to assess the strength and impact of central adiposity on periodontal treatment outcomes. Data were analysed using the IBM Statistical Package for Social Sciences version 20.0 and statistical significance was set at P &lt; 0.05. Results: At baseline, the mean PPD and CAL were comparable in both Groups A and B; while the mean percentage of sites with gingival BOP and percentage of sites with periodontitis were significantly higher in Group A. All periodontal parameters significantly improved after treatment in Groups A and B. However, participants in Group B had a better improvement in sites with gingival BOP and percentage of sites with periodontitis after treatment compared to Group A. Multiple regression analysis showed that central adiposity had a significant (P &lt; 0.05) negative impact on the treatment outcome of gingival BOP, PPD and percentage of sites with periodontitis (PPD ≥ 4 mm) after adjusting for age, sex and socio-economic status. Conclusions: The findings indicated that central adiposity has a negative impact on gingival bleeding on probing, probing pocket depth and percentage of sites with periodontitis.

Peptidomic changes of saliva after non-surgical treatment of stage I/II generalized periodontitis.

To explore the changes of peptidome profiles of saliva, serum, and gingival crevicular fluid (GCF) before and after non-surgical periodontal treatment in patients with generalized periodontitis (stage I/II). Saliva, serum, and GCF samples were collected from 17 patients at baseline (T0 ), one week after ultrasonic supragingival scaling (T1 ) and eight weeks after subgingival scaling and root planning (T2 ). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was carried out to detect changes in peptidomic profiles. Then, nano-liquid chromatography-electrospray ionization-tandem mass spectrometry (nano-LC/ESI-MS/MS) was performed to identify potential peptide biomarkers. Most of the peptides from the patients exhibited a decreasing trend from the time point of pretreatment to that of post-treatment. Cluster analysis and scatter plots using these peptides indicated that salivary peptidome has an acceptable capability of reflecting the status of stage I/II generalized periodontitis. Seven of these peptides were successfully identified as α-1-antitrypsin, immunoglobulin κ variable 4-1, haptoglobin, and immunoglobulin heavy constant γ2. Certain peptides in saliva, serum, and GCF were down-regulated after non-surgical periodontal treatment, demonstrating the application prospects of saliva in monitoring and surveillance of periodontal diseases in both clinical settings and communities.

Evaluation of Oxidative Stress before and after Using Laser and Photoactivation Therapy as Adjuvant of Non-Surgical Periodontal Treatment in Patients with Rheumatoid Arthritis.

(1) Background: The aim of this split-mouth design study was to analyze the clinical periodontal indexes and oxidative stress markers in gingival crevicular fluid modifications after three periodontal disease treatment possibilities (scaling and root planning—SRP; SRP and diode laser—L; SRP and photodynamic therapy—PDT). (2) Methods: The study was conducted on 52 patients: systemically healthy subjects with periodontal disease—non-RA (n = 26); and test group (n = 26) subjects with rheumatoid arthritis and periodontal disease—RA. Clinical periodontal measurements (probing depth—PD; Löe and Silness gingival index—GI; papillary bleeding index—PBI; and periodontal community index of treatment needs—CPITN) and oxidative stress markers (8-hydroxy-2’-deoxyguanosine (8-OHdG) and 4 hydroxynonenal (4-HNE)) were analyzed at baseline (T0), after three sessions of periodontal treatment (T1), and 6 months after treatment (T2). (3) Results: Periodontal therapy improved clinical periodontal measurements and oxidative stress markers in both analyzed groups, with supplementary benefits for laser- and PDT-treated periodontal pockets. (4) Conclusions: The analyzed oxidative stress markers decreased significantly following non-surgical periodontal therapy in both rheumatoid arthritis and systemically healthy patients. All the periodontal disease treatment possibilities analyzed in this study offered clinical and paraclinical improvements; however, the association of laser with SRP and photodisinfection with SRP yielded the best clinical and paraclinical outcomes when compared to SRP alone.

Effect of adjunctive diode laser in the non-surgical periodontal treatment in patients with diabetes mellitus: a systematic review and meta-analysis.

This study aimed to systematically review and analyze the present randomized clinical trials (RCTs) regarding the clinical efficacy of a diode laser (DL) adjuvant to scaling and root planning (SRP) in patients with chronic periodontitis (CP) who have diabetes mellitus (DM). Five databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trails, Web of Science, and Chinese BioMedical Literature Databases) were searched. A meta-analysis was implemented to evaluate periodontal parameters including probing depth (PD) and clinical attachment level (CAL) as primary outcomes. Hemoglobin A1c (HbA1c), plaque index (PI), and the gingival index (GI) were also observed as secondary outcomes. Independent scanning of 239 papers resulted in 9 RCTs. Moderate evidence demonstrated that the test groups showed significant benefits for PD reduction, CAL gain, and HbA1c reduction after 3 and 6months. Significant differences in PI and GI reduction were not found except for GI reduction within 1month. The collective evidence suggested that the DL with SRP had significant improvements in clinical results compared to SRP alone. Based on our results, the DL could be a recommended therapy for patients with CP who have DM.

Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial

BackgroundThis study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis.MethodsFourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n = 21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n = 21). They were analyzed for the clinical variables BOP (primary outcome at six months), probing depth (PD), attachment level, four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons.ResultsIn both groups, the clinical variables PD, attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5 mm was significantly lower in the test group than in the control group after six months. At six months versus baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group.ConclusionsSubgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5 mm when compared with subgingival instrumentation only.Clinical relevanceThe adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery.Trial registration The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL.

Does Periodontal Treatment Help in Arterial Hypertension Control? A Systematic Review of Literature.

Arterial hypertension and periodontal diseases are two of the pathologies with more prevalence worldwide. In the last few years, several scientific evidences have demonstrated the relationship between both diseases. Besides the etiopathogenic and causal relationship, some recent publications have pointed out that the therapeutic approach of periodontitis could have positive effects on the control of arterial hypertension.The aim of this systematic review is to determine whether there is a decrease in or better control of blood pressure after performing nonsurgical periodontal treatment in patients with periodontitis.A thorough search in PubMed, Scopus, and ISI Web of Science databases with the keywords “‘periodontal disease’ OR ‘periodontitis’ OR ‘periodontal’ AND ‘blood pressure’ OR ‘hypertension’ OR ‘arterial hypertension’” was conducted. The quality of the reported information was assessed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews.Eight articles were considered for this systematic review. Five of the studies showed statistically significant reduction in systolic blood pressure (SBP) values.Despite the limitations of the review, nonsurgical treatment of periodontal disease seems to reduce SBP values. Further research with larger and longer-term clinical trials are needed to demonstrate this potential positive effect.

Increased levels of interleukin-32 isoforms alpha, beta, gamma, and delta in the gingival crevicular fluid and plasma of the patients with periodontitis.

Interleukin (IL)-32, which has been recently reported to be associated with periodontitis, has been suggested to have pleiotropic effect due to its 9 different isoforms. The aim of this study was to investigate the levels of IL-32α, IL-32β, IL-32γ, IL-32δ isoforms in gingival crevicular fluid (GCF) and plasma before and after non-surgical periodontal treatment in patients with periodontitis (P). Twenty-seven P and 27 periodontally healthy controls (C) were recruited in this study. Non-surgical periodontal treatment was performed to periodontitis patients. GCF and plasma sampling and clinical periodontal parameters were evaluated before and 1month after treatment. Enzyme-linked immunosorbent assay was used to analyze the levels of IL-32α, IL-32β, IL-32γ, IL-32δ isoforms in GCF and plasma samples. The levels of IL-32α, IL-32β, IL-32γ, and IL-32δ in plasma and GCF were significantly higher in patients with periodontitis than healthy controls (P<.001). In P group, plasma and GCF IL-32α, IL-32β, IL-32γ, and IL-32δ levels after non-surgical periodontal treatment were lower when compared to baseline (P<.001). Moreover, there was a positive correlation between GCF and plasma IL-32α, IL-32β, IL-32γ, and IL-32δ levels in all groups at baseline and after treatment (P<.05). The study supported that there was a relationship between elevated levels of IL-32 isoforms and periodontitis. Also, our novel findings suggest that the pro-inflammatory role of IL-32 in the periodontitis may be originated from IL-32α, IL-32β, IL-32γ, and IL-32δ isoforms.

The effect of photobiomodulation therapy on nonsurgical periodontal treatment in patients with type 2 diabetes mellitus: a randomized controlled, single-blind, split-mouth clinical trial.

Photobiomodulation therapy (PBMT) is a method currently used in the treatment of hard and soft tissue injuries due to its accelerating and enhancing effects on healing. In this study, we aimed to evaluate the possible additional benefits of applying PBMT with nonsurgical periodontal treatment in type 2 diabetes mellitus (DM) patients with chronic periodontitis (CP). Twenty-two type 2 DM patients with CP were enrolled in this clinical split-mouth study. Probing pocket depth (PPD), gingival index (GI), plaque index (PI), and clinical attachment level (CAL) were measured by intracaliber clinician (H.G.) at baseline and at 1 m, 3 m, and 6 m after treatment. Gingival crevicular fluid (GCF) samples were collected at baseline and at 1 week and 1 m, 3 m, and 6 m after treatment. According to split-mouth design, one randomly selected quadrant was treated with PBMT + nonsurgical periodontal treatment (NSPT) and the other quadrant was treated only non-surgical periodontal treatment. PBMT was applied the test quadrant on NSPT day and first, third, and seventh day after treatment at an energy density of 7.64 J/cm2. Repeated measures analysis of variance test was used for the intragroup comparison and a "paired t test" in the intergroup comparison of the clinical and laboratory findings. Comparing the test and control quadrant after treatment, the test quadrant showed significant decrease in PPD at 1 month, 3 months, and 6 months; in GI at 3 months and 6 months; in CAL at month 6; in GCF at 1 week, 1 month, 3 months, and 6 months; and in IL-1β data at 3 months in comparison to the control quadrant. In contrast, there was no statistically significant difference in PI data at all times. Within the limitation of this study, adjunct use of PBMT on NSPT in patient with DM may positively affect the clinical and biochemical parameters.

Professional tooth cleaning prior to non-surgical periodontal therapy: A randomized clinical trial.

This study was aimed to investigate if professional oral prophylaxis before scaling and root planing (SRP) has an effect on the outcome of non-surgical periodontal treatment in patients with chronic periodontitis. Fifty-two individuals with chronic periodontitis receiving non-surgical periodontal therapy by SRP with (test) and without (control) two appointments of professional tooth cleaning but with motivation and instruction were monitored for clinical variables, four selected microorganisms and two biomarkers at baseline, before SRP as well as 3 and 6 months after SRP. Statistical analysis included non-parametric tests for intra- and intergroup comparisons. Probing depth (PD), attachment level, bleeding on probing (BOP), and interproximal plaque index (API) were significantly improved in both groups 3 and 6 months after SRP. PD, BOP, API, and the number of sites with PD ≥5mm were significantly lower in the test group than in the control group at the appointment immediately before SRP. Tannerella forsythia was significantly reduced in both groups at 3 and 6 months, Porphyromonas gingivalis only in the test group. Interleukin-1β was significantly reduced in the control group 3 and 6 months after SRP, matrix metalloproteinase-8 level decreased in the test group 3 months after SRP. There was no significant difference of any clinical and non-clinical variable between both groups at 3 and 6 months after SRP. Professional tooth cleaning before the SRP does not improve the clinical results of the SRP. It has no obvious long-lasting effects on major periodontopathogens in the subgingival biofilm as well as on biomarkers in the gingival crevicular fluid after SRP.

Effects of smoking on non-surgical periodontal therapy in patients with periodontitis Stage III or IV, and Grade C.

To evaluate possible effects of smoking on clinical, biochemical, and microbiological outcomes of non-surgical periodontal treatment in patients with periodontitis Stage III or IV and Grade C. Conventional quadrant-wise non-surgical periodontal treatment was performed and whole-mouth periodontal measurements were recorded at baseline, 1, 3, and 6 months after completion of treatment. Saliva, gingival crevicular fluid, subgingival plaque, and blood samples were obtained at the same time points. Inflammatory cytokine levels, presence, and quantities of 11 different bacterial species were determined. Smoking status was validated by cotinine assay. Fourteen smoker and 13 non-smoker patients completed the study protocol and revealed similar clinical findings except for the higher plaque scores in the non-smokers at 6 months (P <0.01). Significant differences were found between the study groups in biofluid cytokine levels at 1 and 3 months (P <0.01). Gram-negative bacteria were more abundant in the smokers at baseline and so were Gram-positive bacteria in the non-smokers (P<0.01). Gram-negative bacteria repopulated in the smokers faster than in the non-smokers (P<0.01). The present findings suggest that smoker patients with periodontitis Stage III and IV, Grade C respond well to the non-surgical periodontal treatment during the 6-month follow-up. However, smokers exhibit faster repopulation of Gram-negative bacteria.

Efficacy of green tea mouth wash as an adjunct to non-surgical periodontal treatment in patients with chronic periodontitis

Background and objectives: Periodontal disease is the most common disease associated with microbial infection with the destruction of supporting structures. This study was carried out to evaluate the effectiveness of green tea as a mouthwash in the management of chronic periodontitis in comparison to chlorhexidine mouthwash. Patients and methods: A randomized controlled trial on 45 healthy humans with mild to moderate localized chronic periodontitis. They were randomly assigned into 3 equal groups (15 patients each), and they all received scaling and root surface debridement treatments. Group A used prepared green tea 5% as mouth wash for 2 weeks, group B used chlorhexidine mouthwash 0.12% for 2 weeks and group C did not use any mouth wash. Intra-oral clinical examination and blood samples collection were done for all patients for estimating the biochemical parameters C-reactive protein, alkaline phosphatase, Malondialdehyde at baseline and 30 days after periodontal therapy. For statistical analysis, SPSS program was used. Results: The study groups showed significant reduction in clinical periodontal parameters and inflammatory markers after 30 days of periodontal therapy ( P&lt;0.001). A significant difference was seen between group A and group B in relation to clinical periodontal parameters and inflammatory markers after periodontal therapy P&lt;0.05, while the difference between group B and group C was non-significant in relation to gingival index, clinical attachment level, C-reactive protein, alkaline phosphatase, and Malondialdehyde. Conclusion: Green tea as a mouthwash could be an appropriate and effective choice as an adjunctive measure in the treatment of chronic periodontitis.

Periodontal and Dental Considerations in Florid Cemento-Osseous Dysplasia: Clinical and Radiographic Analysis of 11 Cases.

Florid cemento-osseous dysplasia (COD) is a well-described condition that occurs predominantly in black women. The lesion is usually asymptomatic, but in severe cases, symptoms can occur in association with focal expansion due to infection. The safety of dental procedures that involve areas with florid COD has been little discussed. Therefore, the present study aims to emphasise the importance of nonsurgical periodontal treatment in patients with periodontal diseases and COD. Four thousand five hundred panoramic radiographs from the image bank of the School of Dentistry of Ribeirão Preto were clinically and radiographically evaluated. Eleven patients had images compatible with florid COD. Eight patients were asymptomatic and three symptomatic. All patients were diagnosed with chronic periodontitis (CP) and their panoramic radiographs showed mixed radiopaque and radiolucent images in the alveolar bone. In symptomatic patients, besides the clinical signs of CP, exposed bone with severe suppuration occurred in the posterior region of the mandible. The maintenance of systemic and oral health is mandatory to prevent secondary infections, and knowledge about the interface between different dental specialties and florid COD management may prevent erroneous decisions and ensure patient safety, taking into account the dental treatment that can be performed without further complications.

Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: A randomized controlled clinical trial.

Generalized aggressive periodontitis (GAgP) is a distinct type of periodontal disease characterized by rapid loss of attachment and alveolar bone occurring in young individuals. Photodynamic therapy (PDT) was introduced in periodontology as an adjunctive approach to non-surgical periodontal treatment (NPT) in periodontitis patients. In this trial, the aim was to evaluate the clinical and microbiological effects of adjunctive PDT to NPT in patients with GAgP. In this prospective controlled clinical study, 24 systemically healthy, non-smoking subjects with GAgP were enrolled. Subjects were randomly assigned into a control group (n = 12) treated with NPT only or to a test group (n = 12) treated with NPT and PDT. Plaque index, sulcus bleeding index (SBI), probing depth (PD), relative attachment level, gingival recession, and tooth mobility were recorded at baseline and on day 63. Microbiological samples were obtained from the sites with PD ≥ 5 mm at both time periods and evaluated for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola via micro-IDent® test. Clinical and microbial parameters declined significantly in both groups after the treatments (P < 0.01). The comparisons between the groups showed that only the full mouth SBI score of the test group was significantly lower than the control group on day 63 (P < 0.05). Although the reduction in periodontopathogens of the test group was greater than the control group, there was no significant difference between the groups (P > 0.05). Within the limits of this study, it can be concluded that in the treatment of GAgP, usage of PDT as an adjunct to NPT does not lead to any beneficial effects on the investigated clinical and microbiological parameters except for SBI. Nevertheless, the statistically significant difference for the SBI score demonstrates that PDT may have additional effect on the reduction in gingival bleeding. Lasers Surg. Med. 51:167-175, 2019. © 2018 Wiley Periodicals, Inc.

Assessment of glycosylated hemoglobin (HbA1c) in type 2 diabetics before and after non-surgical periodontal treatment. A short-term follow-up study

Aim: To evaluate glycosylated hemoglobin (HbA1c) before and after non-surgical periodontal treatment in patients with type 2 diabetes mellitus (DM-2). Methods: Twenty subjects diagnosed with periodontitis and DM-2 were treated using an NSPT protocol. Periodontal examination and blood measurements were performed at baseline and after three months. Patients with DM-2 treated for at least a year, with at least 10 teeth and with probing depths between 4-6 mm in more than three regions were included. The variables evaluated were HbA1c in blood and periodontal measures (probing depths, insertion level, gingival bleeding on probing, dental plaque, calculus, inflammation, clinical attachment and mobility). All patients were informed of the conditions of the therapy used. Scaling and root planning (SRP) of the full mouth was performed using an ultrasonic scaler and hand instrument under local anesthesia, supragingival prophylaxis and oral hygiene instruction. Also, 0.12% chlorhexidine digluconate was formulated twice a day for two weeks. Statistical analyses were performed using StataIC 14. The values are shown as the mean, median and standard deviation (SD) or interquartile rank (IR), and p&lt;0.05 was considered significant. Results: Twenty subjects completed the three-month follow-up and were included in the analysis. Three months after the non-surgical periodontal treatment, most periodontal parameters had a meaningful reduction (p&lt; 0.05) and a large effect size &gt;0.8. Clinical attachment level showed no improvement. The HbA1c values were not significantly decreased (p=0.94). Conclusions: Although non-surgical periodontal therapy eliminates local inflammation, it is insufficient to significantly reduce HbA1c levels in a short time period.

An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes.

To provide an update of the systematic review by Engebretson and Kocher J Clin Periodontol. 2013 Apr;40 Suppl 14:S153 on the effect of periodontal therapy on glycaemic control of people with diabetes. PubMed Literature search restricted to meta-analyses published from 2013 to the present was conducted. The search resulted in seven meta-analyses of RCTs. Reduction in HbA1c at 3-4months was reported in all reviews for the treatment group ranging from -0.27% (95% CI: -0.46, -0.07, p=.007) to -1.03% (95% CI: 0.36, -1.70, p = 0.003). At 6months post-treatment, an HbA1c reduction ranging from -0.02 (95% CI: -0.20, -0.16, p=.84) to -1.18% (95% CI: 0.72%, 1.64%, p < 0.001) was reported. The magnitude of the reduction in HbA1c, which is found to be associated with non-surgical periodontal treatment in patients with diabetes, seems to have clinically significant effects on systemic health, and thus should have a place in the treatment of diabetic patients. Periodontal treatment (SRP) results in a statistically significant reduction in HbA1C levels at 3months, with a lower reduction at 6months.