Severe Periodontitis Patients Research Articles

An integrated preventive and therapeutic magnetic nanoparticle loaded with rhamnolipid and vancomycin for combating subgingival biofilms

ObjectivesMechanical debridement supplemented with antibacterial agents effectively eradicates subgingival biofilms formed in the periodontal pockets of severe periodontitis patients. However, the available antimicrobial agents have limited penetrating ability to kill the bacteria encased in the deep layers of biofilms. This study aimed to fabricate a novel magnetic nanoparticle (MNP) loaded with rhamnolipid (RL) and vancomycin (Vanc, Vanc/RL-Ag@Fe3O4) to combat subgingival biofilms. MethodsThe multispecies subgingival biofilm was formed by periodontal pathogens, including Streptococcus oralis (S. oralis), Streptococcus sanguinis (S. sanguinis), Actinomyces naeslundii (A. naeslundii), Porphyromonas gingivalis (P. gingivalis) and Fusobacterium nucleatum (F. nucleatum). Scanning electron microscope (SEM), confocal laser scanning microscopy (CLSM), and quantitative real-time polymerase chain reaction (qRT-PCR) were used to determine the anti-biofilm efficacy of Vanc/RL-Ag@Fe3O4 with or without a magnetic field on multispecies subgingival biofilms. ResultsThe minimal inhibitory concentration (MIC) values of Vanc/RL-Ag@Fe3O4 on S. oralis, S. sanguinis, A. naeslundii, P. gingivalis, and F. nucleatum were 25, 50, 100, 50, and 25 μg/mL, respectively. Vanc/RL-Ag@Fe3O4 (200 μg/mL) reduced the 7-d biofilm thickness from 22 to 13 µm by degrading extracellular polymeric substance (EPS) and killing most bacteria except for tolerant F. nucleatum. A magnetic field enhanced the anti-biofilm effect of Vanc/RL-Ag@Fe3O4 by facilitating its penetration into the bottom layers of biofilms and killing tolerant F. nucleatum. SignificanceVanc/RL-Ag@Fe3O4 MNPs can release RL, Vanc, and Ag and eradicate subgingival biofilms by disrupting EPS and killing bacteria. Vanc/RL-Ag@Fe3O4 combined with a magnetic force is a promising approach for combating periodontal infection.

Identification of Porphyromonas gingivalis in Periodontally Healthy Adults and Chronic Periodontitis Patients Using Polymerase Chain Reaction

Context: Periodontitis, a complex multifactorial, polymicrobial infection, involves deterioration of the supporting tissues surrounding teeth. Among the polymicrobiota, Porphyromonas gingivalis is a keystone pathogen implicated in chronic periodontitis. Aim: Identification of P. gingivalis in periodontally healthy adults and chronic periodontitis patients using polymerase chain reaction (PCR). Settings and Design: This cross-sectional study was conducted at the Department of Periodontics, KLE V. K. Institute of Dental Sciences, Belgaum. The 60 patients were selected from the outpatient department considering the selection criteria, using convenience sampling. Materials and Methods: Patients were categorized into three groups: periodontally healthy, moderate, and severe periodontitis. Plaque index, probing depth, and clinical attachment level (CAL) were measured. The plaque samples were collected from patients and were cultured and analyzed for black-pigmented colonies, followed by biochemical characterization and DNA isolation. Samples showing bacterial DNA bands were further selected for PCR analysis with species-specific primer to confirm P. gingivalis. Statistical Analysis: Descriptive analysis was done using Kruskal–Wallis ANOVA, Chi-square, and Mann–Whitney U-test (P < 0.05). Results: Age and gender showed no significance in the prevalence of P. gingivalis. P. gingivalis was absent in periodontally healthy patients and detected in 10% of moderate periodontitis and 50% of severe periodontitis patients (P = 0.0001). No statistical significance with the prevalence of P. gingivalis was observed between moderate and severe periodontitis patients. In severe periodontitis patients, P. gingivalis was significantly associated with higher mean pocket probing depth scores (P = 0.0073) and CAL scores (P = 0.0022). Conclusion: The prevalence of P. gingivalis was significant in both moderate and severe periodontitis patients; however, a higher prevalence was observed in severe periodontitis patients. PCR analysis revealed a significant rise in the frequency of P. gingivalis with an increased periodontal pocket depth and clinical attachment loss, indicating a correlation with the severity of periodontal destruction.

Interaction between implants and natural teeth in patients with severe periodontitis:a retrospective study

Objective: To evaluate the clinical outcomes after implant restoration in the posterior region of severe periodontitis patients and to investigate the factors of natural tooth affecting the implant from the perspective of improving natural periodontal health, which may provide a reference for clinical practice. Methods: Fifty-three patients with severe periodontitis who visited the Department of Periodontology at the Affiliated Stomatological Hospital of China Medical University from June 2014 to June 2023 and completed posterior implant treatment with single crown were included, among which were 16 males and 37 females, aged (52.2±8.0) years old, with a total of 136 implants, 135 adjacent natural teeth in the edentulous area. We retrospectively compared the changes of probing depth (PD), bleeding on probing (BOP) and tooth mobility (TM) before and after implant placement. Besides, we explored the effects of the natural periodontal status on PD, BOP and marginal bone loss (MBL) of the implant at the last follow-up examination by univariate analysis and multivariate analysis. Results: Fifty-three patients were followed up for (44.5±14.1) months in average, with longest interval of (8.3±2.7) months. The PD of adjacent natural teeth in the edentulous area improved from 4.3 (3.6, 4.6) mm before implantation to 3.6 (3.2, 4.0) mm in the last review (P<0.01), while the proportion of BOP (+) improved from 69.6% (94/135) before implantation to 46.7% (63/135) in the last review (P<0.01). The proportion of teeth with mobility≥Ⅱ decreased from 15.6% (21/135) to 5.9% (8/135) (P<0.01). The percentage of natural teeth with PD≥4 mm in the same segment improved from 21.0% (13.3%, 26.0%) before implantation to 18.0% (12.0%, 25.0%) in the last review (P<0.05). The BOP (+)% improved from 29.0% (24.0%, 35.0%) before implantation to 23.0% (18.0%, 31.0%) in the last review (P<0.05), and the number of teeth with mobility≥Ⅱ decreased from 0.0 (0.0, 1.0) to 0.0 (0.0, 0.8) (P<0.05). The functional tooth unit score of full natural teeth increased from 8.0 (6.0, 10.0) points before implantation to 12.0 (12.0, 12.0) points in the last review (P<0.01). PD≥4 mm % increased from 11.0% (6.0%, 25.0%) before implantation to 13.0% (3.0%, 21.0%) in the last review (P<0.05) and there was no significant differences in BOP (+)% [(17.0±9.7) % vs (14.6±7.2) %, P>0.05]. The number of teeth with mobility≥Ⅱ decreased from 1.0 (0.0, 1.8) to 0.0 (0.0, 0.8) (P<0.05). Conclusions: Under the premise of regular supportive care, implant restorative treatment in the posterior region of severe periodontitis patients is helpful to improve the PD, BOP and TM of remaining natural teeth. Besides, the stages and grades of periodontitis at initial diagnosis can affect the PD and BOP of implants.

Emergence of Antibiotic-Resistant Porphyromonas gingivalis in United States Periodontitis Patients.

Antibiotic resistance patterns of the major human periodontal pathogen Porphyromonas gingivalis were assessed over a 20-year period in the United States. Subgingival P. gingivalis was cultured pre-treatment from 2193 severe periodontitis patients during three time periods: 1999-2000 (936 patients), 2009-2010 (685 patients), and 2019-2020 (572 patients). The clinical isolates were tested for in vitro resistance to 4 mg/L for clindamycin and doxycycline, 8 mg/L for amoxicillin, and 16 mg/L for metronidazole, with a post hoc combination of data for metronidazole plus amoxicillin. Clindamycin-resistant P. gingivalis was significantly more prevalent in 2009-2010 (9.1% of patients) and 2019-2020 (9.3%; 15-fold increase) as compared to 1999-2000 (0.6%). P. gingivalis resistance to amoxicillin also significantly increased from 0.1% of patients in 1999-2000 to 1.3% in 2009-2010 and 2.8% (28-fold increase) in 2019-2020. P. gingivalis resistance to metronidazole, metronidazole plus amoxicillin, and doxycycline was low (≤0.5% prevalence), and statistically unchanged, over the 20-year period. These findings are the first to reveal marked increases over 20 years in clindamycin-resistant and amoxicillin-resistant P. gingivalis in United States periodontitis patients. Increased antibiotic resistance of P. gingivalis and other periodontitis-associated bacteria threatens the efficacy of periodontal antimicrobial chemotherapy.

Sirtuin6 and Lipoxin A4 levels are decreased in severe periodontitis.

Sirtuin6 plays an important role in the regulation of inflammation, homeostasis, and apoptosis, and it has anti-inflammatory effects on several diseases. Lipoxin A4 is a pro-resolving lipid mediator of inflammation and inhibits hypoxia-induced apoptosis and oxidative stress. Considering that Lipoxin A4 and Sirtuin6 have protective effects on inflammatory diseases, the aim of this study is to determine the possible roles of these molecules on periodontitis inflammation in saliva and serum and to reveal the relationship of these data with clinical periodontal parameters. A total of 20 stage III/grade B periodontitis and 20 periodontally healthy subjects were included in this cross-sectional study (all never smokers and systemically healthy). Clinical periodontal parameters (plaque index, probing pocket depth, bleeding on probing, clinical attachment loss) were recorded. Saliva and serum levels of Sirtuin6 and Lipoxin A4 were analyzed by enzyme-linked immunosorbent assay. Serum Sirtuin6 and saliva Lipoxin A4 levels were significantly lower in the periodontitis group than the control group (respectively, p = 0.0098, p = 0.0008). There were negative correlations between all periodontal clinical parameters and saliva Lipoxin A4 level (p < 0.05) and between probing pocket depth, clinical attachment loss, and serum and saliva Sirtuin6 levels (respectively, r = - 0.465 and r = - 0.473, p < 0.05). Decreased levels of serum Sirtuin6 and saliva Lipoxin A4 in periodontitis patients and their correlation with clinical periodontal parameters suggest that serum Sirtuin6 and saliva Lipoxin A4 may be related with periodontal inflammation. Scientific rationale for the study: Sirtuin6 is one of seven members of the family of NAD + dependent protein that played an important role in the regulation of inflammation, energy metabolism, homeostasis, and apoptosis. Sirtuin6 is associated with the pathogenesis of several diseases. Lipoxin A4 is a lipid mediator that inhibits hypoxia-induced apoptosis and oxidative stress, and it has an active role in the resolution of periodontal inflammation. No studies that investigated the potential role Sirtuin6 and its relationship with inflammation resolution and apoptosis mechanisms in severe periodontitis patients. the serum Sirtuin6 and saliva Lipoxin A4 levels were significantly lower and negatively correlated with clinical periodontal parameters in the patients with periodontitis than the healthy controls. this study shows that serum Sirtuin6 and saliva Lipoxin A4 may be candidate biomarkers related with periodontal inflammation and estimating to periodontal status. NCT05417061.

Messenger RNA Expression and Quantification of L-plastin in Subgingival Tissue Samples of Generalized Severe Chronic Periodontitis Patients with and without Type 2 Diabetes Mellitus

Messenger RNA Expression and Quantification of L-plastin in Subgingival Tissue Samples of Generalized Severe Chronic Periodontitis Patients with and without Type 2 Diabetes Mellitus

Neutrophil extracellular traps and extracellular histones potentiate IL-17 inflammation in periodontitis.

Neutrophil infiltration is a hallmark of periodontitis, a prevalent oral inflammatory condition in which Th17-driven mucosal inflammation leads to destruction of tooth-supporting bone. Herein, we document that neutrophil extracellular traps (NETs) are early triggers of pathogenic inflammation in periodontitis. In an established animal model, we demonstrate that neutrophils infiltrate the gingival oral mucosa at early time points after disease induction and expel NETs to trigger mucosal inflammation and bone destruction in vivo. Investigating mechanisms by which NETs drive inflammatory bone loss, we find that extracellular histones, a major component of NETs, trigger upregulation of IL-17/Th17 responses, and bone destruction. Importantly, human findings corroborate our experimental work. We document significantly increased levels of NET complexes and extracellular histones bearing classic NET-associated posttranslational modifications, in blood and local lesions of severe periodontitis patients, in the absence of confounding disease. Our findings suggest a feed-forward loop in which NETs trigger IL-17 immunity to promote immunopathology in a prevalent human inflammatory disease.

Molecular Iodine Mouthrinse Antimicrobial Activity Against Periodontopathic Bacteria.

This study compared two molecular iodine mouthrinses for their in vitro bactericidal effects against subgingival biofilm bacteria from severe periodontitis patients. In a subgingival biofilm eradication assay, dilution aliquots of subgingival microbial specimens from 32 adults with severe periodontitis were mixed in vitro with either a mouthrinse containing 100 parts per million (ppm) molecular iodine (Iorinse®) or one containing 150 ppm molecular iodine (iClean®), followed by mouthrinse neutralization after 60 seconds with 3% sodium thiosulfate. The mixtures, along with unexposed subgingival biofilm aliquots, were inoculated onto enriched Brucella blood agar and incubated anaerobically for 7 days to quantitate total viable bacterial counts and selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Campylobacter rectus, and Fusobacterium nucleatum). Both molecular iodine mouthrinses significantly reduced total viable bacterial counts in the subgingival biofilm samples, with iClean® providing significantly greater in vitro suppression than Iorinse®. Both molecular iodine mouthrinses also significantly reduced total red/orange complex periodontal pathogens, with significantly greater suppression also exhibited by iClean®. The molecular iodine mouthrinses exerted marked bactericidal activity in vitro against human subgingival biofilm microbial species, including red/orange complex periodontal pathogens associated with severe periodontitis, with iClean® providing significantly better antimicrobial activity than Iorinse®. These findings suggest potential value of molecular iodine mouthrinses in the treatment and prevention of periodontal diseases.

Study on the imbalance of M1/M2 macrophage polarization in severe chronic periodontitis.

Macrophages commonly exist in two distinct subsets in different microenvironments: classically activated macrophages (M1) and alternatively activated macrophages (M2). The imbalance of M1-M2 macrophage polarization is often related to various diseases or inflammatory states. The purpose of this study was to determine whether there is an imbalance in the expression of M1 and M2 macrophage-related cytokines in severe chronic periodontitis. A total of 30 clinical specimens, including severe chronic periodontitis tissues (n= 15) and healthy control tissues (n= 15), were used in this study. Reverse transcription polymerase chain reaction (RT-PCR) and Western blot methods were used to detect the mRNA and protein expression levels of M1 macrophage-related cytokines (inducible nitric oxide synthase (iNOS) and signal transducer and activator of transcription 1 (STAT1)) and M2 macrophage-related cytokines (arginase-1 (Arg-1) and STAT6), respectively. The mRNA and protein expression levels of M1 macrophage-related cytokines (iNOS and STAT1) and M2 macrophage-related cytokines (Arg-1 and STAT6) were significantly increased in severe chronic periodontitis patients. In addition, the ratios of iNOS/Arg-1 and STAT1/STAT6 in the severe chronic periodontitis group were also significantly increased (P< 0.01). The imbalance of M1/M2 macrophages exists in the pathogenesis of severe chronic periodontitis, and has a tendency towards M1 polarization. Therefore, maintaining the immune balance of M1/M2 macrophages may be a novel therapeutic alternative for the management of severe chronic periodontitis.

Glucose and lipid metabolism indexes and blood inflammatory biomarkers of patients with severe periodontitis: A cross-sectional study.

To investigate the relation of established glucose and lipid metabolism indexes and blood inflammatory biomarkers with severe periodontitis in systemically healthy patients. Systemically healthy Stage III/IV periodontitis patients (case group) (n=397), Stage II periodontitis patients (n=36), and periodontally healthy subjects (control group) (n=285) were recruited. A periodontal examination, complete blood cell examination, and blood biochemical examination were conducted for all participants. Full-mouth apical films were taken for the case group. Both the case and control groups were divided by age into younger (≤ 35 years) and elder subjects. Multiple logistic regression analysis and Pearson correlation analysis were conducted. A logistic least absolute shrinkage and selection operator (LASSO) model was constructed for the younger subgroups. Various glucose and lipid metabolism indexes and blood inflammatory biomarkers significantly differed between severe periodontitis patients and healthy controls, and the younger subgroups presented a greater degree of statistical differences than the elder ones. More pairs of periodontal parameters and blood indexes with significantly fair linear correlations were found in the younger patient subgroup. A logistic LASSO regression model containing eight blood indexes to assess a severe periodontitis outcome in younger subgroups showed satisfactory predictive ability. The present study revealed various glucose and lipid metabolism indexes and blood inflammatory biomarkers significantly differ between severe periodontitis patients and healthy controls, especially in the younger subgroups. A LASSO regression model could be a viable option to assess severe periodontitis risk for younger patients.

PRDX6 alleviates lipopolysaccharide-induced inflammation and ferroptosis in periodontitis

Objective Periodontitis is a progressive and inflammatory oral disease and results in the damage of the supporting tissues of teeth. Peroxiredoxin 6 (PRDX6) is an antioxidant enzyme identified as a regulator in ferroptosis. This study aimed to investigate whether PRDX6 could protect human gingival fibroblasts (HGFs) from lipopolysaccharide (LPS)-induced inflammation and its mechanisms. Material and methods Both inflamed and non-inflamed human gingival tissues were collected to assess the expression of PRDX6 and nuclear factor erythropoietin 2-related factor 2 (NRF2) by Immunohistochemistry and Western blotting. Furthermore, the molecular mechanisms of PRDX6 have been clarified in PRDX6 silenced cells. The inflammatory cytokines in HGFs were measured by RT-qPCR and ELISA. The lipid hydroperoxide (LOOH) was detected by C11-BODIPY. Results The expression of PRDX6 and NRF2 were decreased in gingival tissues of severe periodontitis patients. The increased LPS-induced LOOH and inflammatory cytokines were found in PRDX6 knockdown HGFs. Besides, the inhibition of ferroptosis or PRDX6 phospholipase A2 activity (PLA2) alleviated LPS-induced inflammatory cytokines and LOOH. However, inhibiting NRF2 signalling upregulated those in HGFs. Conclusions Therefore, this study provided a new mechanistic insight that PRDX6, regulated by the NRF2 signalling, alleviates LPS-induced inflammation and ferroptosis in human gingival fibroblasts.

Periodontal disease status in the diabetic patients with different glycemic levels – A cross sectional study

Periodontitis is often associated with diabetes and might be considered one of the chronic complications of diabetes mellitus (DM), both in Type 1 (T1DM) and Type 2 (T2DM). This cross sectional study was designed to evaluate the possible association between clinical periodontal disease status and glycemic levels in diabetes patients (T2DM) among the population of city Hyderabad, INDIA. A total of 200 individuals were examined and out of which 179 were enrolled fulfilling the selection criteria were initially given a health questionnaire to gather information regarding their demographic data, oral hygiene practices. Based on Fasting plasma glucose (FPG) levels, they were grouped into: Good, Moderately and Poorly controlled Type 2 Diabetic patients. Oral hygiene index-simplified, CPI and clinical attachment level (CAL), Tooth mobility and Tooth loss due to mobility were evaluated. Nearly Half the individuals have good glycemic control. (47.5% are &amp;#60;121mg/dl), 29.1% have moderately controlled (&amp;#60;121-180mg/dl), 23.5% have poorly controlled (&amp;#60;181-240mg/dl) plasma sugar levels. Average Patients showed 5-10 years of diabetic history with 121- 180mg/dl fasting plasma glucose (FPG) levels. Average participants had fair OHI-S scores. Patients with Good FPS levels showed fair oral hygiene status. Community periodontal index (CPI) scores showed (14.52%) Gingivitis, (20.11%) mild, (8.93%) moderate, (2.79%) severe periodontitis patients with good controlled FPS Levels. Average CAL values ranged between 3-5mm in good to moderately controlled FPS levels. Tooth mobility and tooth loss is less in over all participants. Patients with high plasma sugar levels were more susceptible for severe periodontal disease. CPI values and mobility of teeth was less in subjects with FPG&amp;#60;126mg/dl. With Loss of attachment up to 5mm was observed. Both Periodontist and Diabetologist individually and together should improve awareness regarding periodontal health and diabetic control.

A STUDY OF CHLORHEXIDINE CHIP IN THE TREATMENT ALONE IN INDIVIDUALS WITH PERIODONTITIS

Aim: The aim of this study was to clinically evaluate the use of biodegradable chlorhexidine chip when used as an adjunct to scaling and root planing (SRP) in the treatment of moderate to severe periodontitis patients. The study also intended to compare the combined therapy (SRP and Chlorhexidine chip) with chlorhexidine chip alone in individuals with periodontitis. Fifteen patients with three sitesMaterials and Methods: having a probing depth of 5-8mm were considered for the study. Sites were numbered 1, 2, 3 randomly. The clinical parameters assessed were the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD). Following baseline evaluation, on two sites scaling and root planing (SRP) was performed, no treatment was carried out in the third site. Chlorhexidine chips were placed on one site with SRP and another without SRP. A periodontal pack was placed on the site to prevent dislodgement of the CHX chip. Clinical parameters were recorded at baseline, one month and three months. Duration of the study was for three months. All three groupsResults: presented with an improvement in the clinical parameters compared to baseline. There was no statistically signicant difference between the SRP and SRP + CHIP group in all parameters. There was a signicant difference when these two groups were compared to the chip alone group. The mean reductions in PPD were 2.9mm (SRP group),2.5(SRP+CHIP group), 0.9 (chip alone group) The mean gain in CAL were 2.9mm (SRP group), 2.7 (SRP+CHIP group), 0.6 (chip alone group). Reduction in bleeding on probing were signicant for the SRP and SRP +CHIP group but not for the chip alone group. The CHX chip did not provide any clinical benet beyond that achieved with conventional scaling and rootplaningConclusion: after a three month period.

IDF21-0569 Periodontal disease is associated with increased risk of Diabetes and Pre-diabetes

Background: Early diagnosis of diabetes mellitus and pre-diabetes is essential for the timely management of diabetes and its complications as well as the prevention of diabetes in individuals with pre-diabetes. Periodontal disease has also been recognized as the sixth complication of diabetes although this is still under-appreciated by endocrinologists or physicians in general. Since it has been suggested that severe periodontitis might be an early complication of diabetes, therefore periodontal disease may be a useful indicator to screen for the risk of diabetes or pre-diabetes in dental patients who otherwise do not know of their glycemic status. Aim: In this study, HbA1c levels and subsequently the prevalence of diabetes and pre-diabetes in participants with and without periodontitis of various stages were investigated. Method: From 88 mild periodontitis patients, 132 moderate periodontitis patients, 210 severe periodontitis patients and 66 patients without periodontitis (control), HbA1c values were obtained by a finger-prick blood sample taken from each participant which was then tested in a point-of-care HbA1c analyzer. Differences in mean HbA1c values and prevalence of diabetes and pre-diabetes between the different periodontitis and control groups were analyzed. Multivariate analyses were performed, correcting for known risk indicators for diabetes screening. Results: In this cohort of a total of 496 participants, 29(5.8%) and 154 (31.0%) patients were identified with HbA1c levels corresponding to the ADA guideline levels for diabetes (HbA1c > 6.5%) and pre-diabetes (HbA1c 5.7–6.4%), respectively. In addition, the mean HbA1c levels increases as the stage of periodontitis increases from no periodontitis to severe periodontitis. Periodontal disease of all stages have higher proportion of hyperglycaemia as compared to non-periodontitis(control) patients. However, it is the severe periodontitis group that showed a significantly higher percentage of patients with HbA1c values in the diabetes range as compared with the mild/moderate periodontitis group (p < 0.001). The prevalence of pre-diabetes was significantly higher in patients with moderate periodontitis compared with patients without periodontitis or with patients having mild periodontitis. In the severe periodontitis group, 18 (8.6%) patients had HbA1c levels in the diabetes range and 51 (24.3%) patients could be diagnosed with prediabetes according to the ADA-guidelines, whereas in the moderate periodontitis group, 59 (44.7%) subjects had HbA1c levels in the pre-diabetes range and only 2 (1.5%) of them reached HbA1c values for diabetes diagnosis. Discussion: Periodontitis is associated with increased levels of HbA1c and subsequently with an increased prevalence of those at risk for diabetes and pre-diabetes. We suggest that severe periodontal disease may be a useful risk indicator for early diabetes or pre-diabetes. This study also demonstrates the important role that dentists can play in the early referral of their patients who may already have undiagnosed diabetes and pre-diabetes to endocrinologist so as to receive timely medical diagnosis, prevent or delay progression from pre-diabetes to overt diabetes mellitus and intervention to prevent potential diabetes complications which in turn reduces disease burden.

Characterization of Acidic Mammalian Chitinase as a Novel Biomarker for Severe Periodontitis (Stage III/IV): A Pilot Study.

Periodontitis is a chronic inflammatory condition characterized by gingival infection, periodontal pocket formation, and alveolar bone loss. Acidic mammalian chitinase (AMCase), an active chitinase enzyme, increased its expression under severe inflammation and related systemic disorders. However, AMCase expression and molecular mechanism in periodontal inflammation, have not been elucidated yet. This study was aimed to characterize AMCase in severe periodontitis patients compare to those in periodontally healthy subjects. In total, 15 periodontally healthy subjects and 15 severe (stage III/IV) periodontitis patients were enrolled with their informed consent. Tissue samples were collected and analyzed using Western blot and enzyme-linked immunosorbent assay (ELISA). AMCase protein expressions in periodontal patients were significantly more increased than those of periodontally healthy individuals. ELISA resulted in median values (first quartile to third quartile) of the periodontally healthy group 0.654 ng/mL (range, 0.644–0.827 ng/mL) and the periodontitis group 0.965 ng/mL (range, 0.886–1.165 ng/mL). AMCase was expressed significantly higher levels in periodontitis patients than in periodontally healthy individuals (p < 0.05). This suggests that AMCase may play a potential role as a biomarker for the screening and early diagnosis of severe periodontitis.

Non-surgical periodontal therapy in severe chronic periodontitis patients associated with Type II Diabetes mellitus: A case report

Diabetes mellitus is a condition that affects both adults and children and is caused by insulin insufficiency, insulin resistance, or both. Gingivitis, periodontitis, recurrent periodontal abscess, delayed healing after extraction, etc. are the most common oral symptoms. Early identification and management of diabetes mellitus with simultaneous periodontal therapy can improve the oral complications. Close coordination between the medical and dental teams can benefit the diabetic individuals. The goal of this article was to raise awareness regarding the oral signs and complications of diabetes mellitus.

Clinical Effects of Locally Delivered Lactobacillus reuteri as Adjunctive Therapy in Patients with Periodontitis: A Split-Mouth Study

Different methods and products have been investigated as measures of adjunctive therapy to scaling and root planing (SRP). Probiotic use has gained interest for this particular application, especially Lactobacillus spp. This split-mouth interventional prospective study aimed to evaluate the clinical effects of L. reuteri DSM 17938 with local application in periodontal pockets of severe periodontitis patients. The study was conducted on 40 subjects with stage 3–4 periodontitis who, based on a split-mouth model, followed SRP and SRP + L. reuteri solution in five weekly sessions. Probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were assessed at baseline and at three months after probiotic treatment completion. Both SRP and SRP + L. reuteri generated significant improvements of all three clinical parameters, but the changes were significantly better for SRP + L. reuteri treated sites. Therefore, we can conclude that adjunctive therapy with L. reuteri DSM 17938 could represent an interesting treatment option, particularly for severe periodontitis cases.

A Comparative Evaluation between the Efficacy of Scaling &amp; Root Planing (SRP) with Local Delivery of Chlorhexidine Gluconate and SRP Alone in Periodontal Pocket Reduction Therapy

Aim: The aim of the present study was to compare the efficacy of locally delivered chlorhexidine as an adjunct to scaling and root planning (SRP) &amp; SRP alone in bringing reduction of pocket depth in the treatment of moderate to severe periodontitis patients. &#x0D; Materials and Methods: A total number of 15 patients both males and females in the age group of 30-55 years were selected with total number of 30 sites with periodontal probing pocket depth measuring 5-8mm in different quadrant of the mouth. A randomized, double blind, controlled clinical trial design was followed for the study. On one side scaling and root planning was done and on the other side scaling and root planning was done along with local delivery of chlorhexidine glugocate then the patient was examined after 0, 45, and 60 days using The clinical parameters the Plaque Index (PI), gingival index (GI), Bleeding on probing (BOP), Clinical attachment level (CAL) and Probing pocket depth (PPD).&#x0D; Statistical Analysis: Student paired T-test has been carried out for this present study.&#x0D; Results: The mean reduction of Plaque Index score between 0-45 day between control site and test site was 1.58±0.11 and the mean reduction of Plaque Index score between 0-60 day between control site and test site was 2.42±0.34 which is found not significant. At the Control site the mean plaque index score on 0 day was 2.2, on 45th day was 1.88 and on 60th day was 1.82. At the test site the mean plaque index score on 0 day was 2.6, on 45th day was 1.82 and on 60thday was 1.59. There was change from the base line values of mean plaque index between the control sites and test sites but was not significant.&#x0D; Conclusion: There was improvement in all the clinical parameters of the test sites in comparison to the control sites from base line to 60 days, but the adjunctive use of chlorhexidine showed a significant improvement only on the clinical attachment level.

Efficacy and risks of tooth-supported prostheses in the treatment of partially edentulous patients with stage IV periodontitis. A systematic review and meta-analysis.

The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4years was low (n=17 studies; weighted mean incidence (WMI)=4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI=6.9% (n=18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials.

Impact of stress on clinical outcomes of non-surgical periodontal therapy in patients with severe generalized periodontitis

Relevance.Aim – to assess the impact of psychosocial stress on the clinical outcomes in severe periodontitis patients treated with Nonsurgical Periodontal Therapy (NPT).Materials and methods.Patients received 2 psychological questionnaires to score their stress levels, while clinical data were obtained 1 week before and six weeks after the completion of NPT.Results.A total of 55 patients were consecutively included in the study and subsequently categorized into different stress levels (low stress level n = 22 and moderate/high stress level n = 33). All clinical parameters were found to be comparable at baseline between groups. While reduction in full-mouth bleeding scores was found to be statistically significantly lower in group with higher stress levels, a similar improvement in the other clinical parameters was observed at the completion of NPT.Conclusion.Psychosocial stress seems to influence negatively the results of NPT and highly stressed patients may represent a risk category for disease progression.