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Abstract: The severe respiratory infections in the current pandemic coronavirus disease-19 (COVID-19) have influenced more or less every human life. The first person to get infected with this virus was reported in the capital of Hubei province (Wuhan), China, in late December 2019. Since the disease has been declared a pandemic, research scholars and experts have been manufacturing new vaccines or targeted therapies to curb the spread of SARS-CoV-2. However, only limited options have emerged so far, which yet require complete scientific validation by long-term data collection regarding safety and efficacy. In the wake of the recent emerging wave of the pandemic viz omicron variant, changing facets of the viral genome and dearth of preventative and therapeutic possibilities for the management of COVID-19, the usage of Convalescent Plasma Therapy (CPT) may be looked at as a potentially viable option of treatment in the existing situation. Earlier, immune plasma has been used with success in the management of H1N1 influenza virus, MERS-CoV, and SARS-CoV-1 epidemics. In the present unpredictable situation created by the COVID-19 pandemic, the CPT is used with a positive outcome amongst many infected individuals in different parts of the world with acceptable efficacy. This article aimed to present an up-to-date evaluation of existing literature on the efficacy of convalescent plasma as a potential therapy, its safety and effectiveness and the challenges in treating COVID-19.

BACKGROUND: Evaluation of the working postures and development of new techniques is paramount in reducing the awkward postures and occurrence of musculoskeletal disorders (MSDs). The Kinect sensor, a portable and cost-effective device, appears to be a promising alternative to study work postures. OBJECTIVE: The current study aimed to evaluate the validity of Kinect against the gold-standard instrument (electro-goniometers) for body joint angle measurements. METHODS: A unique software application was developed to measure the critical body joint angles for postural evaluation by using the Kinect’s skeletal tracking feature. The body joint angle data of ten volunteers were measured simultaneously by both Kinect and electro-goniometers. The validation analysis was conducted in both static and dynamic domains of application. RESULTS: Minimal variation was observed between the two techniques, and the Kinect correlated well for upper-arm joint angles of 45∘, 60∘ and 90∘; lower-arm joint angles of 30∘, 45∘, 60∘, and 90∘; straight neck position, neck joint angle at maximum possible flexion; straight trunk position, trunk bend angle at full flexion. In dynamic analysis, four out of five ICC values were > 0.75 except for the upper arm. Discrepancies in the results indicated the disapproval of Kinect for only wrist measurements. CONCLUSION: Results of the static and dynamic studies gave a sufficient basis to consider the Kinect tool as an alternative to contemporary posture-based ergonomic evaluation methods.

Human oral microflora is one of the most complex microbial communities known. A consistent competitive environment in this niche necessitates the generation of bacteriocins or antimicrobial peptides (AMPs), which play a significant impact on niche ecology by inhibiting the growth of closely related inhabitants. In the current study, draft genomes of oral commensal Streptococcus salivarius strains were analyzed using various bioinformatic tools to design novel short antibiofilm peptides. The antimicrobial potency of peptides was predicted by using AMP database and Bactibase. Novel short peptides were designed, synthesized and evaluated against oral oppurtinistic pathogenic microbes. Synthetic short peptides (SSPs) displayed effective inhibition of biofilm formation by specific oral bacterial strains, indicating their potential applicability as targeted antibiofilm agents for variety of dental material surface coating applications.

Staphylococcus auerus (S. aureus) biofilms are a frequently associated cause of artificial implant infections and failures. Surface coating of titanium (Ti), a widely used implant biomaterial with antimicrobial agents may appear a promising approach to prevent and reduce the periimplant infections and associated failures. Natural antimicrobial peptides (AMPs) viz laterosporulins (LS) from soil bacteria Brevibacillus spp. were bound on titanium (Ti) substrates using a simple, time and cost effective chemical processing technique. Resistance of the AMP coated Ti substrates against biofilm formation of the bacterium S. aureus was determined by crystal violet staining, in vitro. Further the antibiofilm activity was visualized in replicate experiments on Hydroxyapatite (HA) discs also to simulate enamel surfaces consistently layered by saliva in oral cavity to ascertain the biofilm inhibition assessment. AMP coated Ti substrates showed marked reduction in the biofilm formation by S. aureus, in vitro compared against the control-Ti surfaces. Further, Coated HA discs also substantiated the findings in a similar trend compared with control-Ti substrates. The findings suggested a promising potential for laterosporulins as effective antibiofilm agents for coating titanium surfaces for various applications, including dental implants used in oral cavity.

Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients. The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020. Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate. Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures. Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [ Z = 2.44, P = .01], CAL [ Z = 2.52, P = .01], PI [ Z = 2.76, P = .006] and not statistically significant for PPD [ Z = 0.27, P = .79] and BOP [ Z = 1.47, P = .14]. Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.

Adherence to the dental practice regulatory guidelines instituted during the COVID-19 pandemic is essential to minimize the transmission of SARS-CoV-2 strains. Given the lack of a valid and reliable survey tool to assess the adherence to dental practice guidelines, this study aims to develop, validate, and test a survey tool on a pilot sample of dental clinicians practicing in India. A survey tool was developed/validated through a sequential phasic approach: Phase I- developing survey using conceptual and literature framework; Phase II: ascertaining its validity and reliability; Phase III: pilot testing; and Phase IV: assessing construct validity by exploratory factor analysis (EFA) on the responses collected in Spring 2021. The EFA was achieved using a traditional unweighted least squares extraction method through a varimax rotation with Kaiser normalization. A six-factor solution with 18 items (with the global reliability of 86%) related to screening, regular infection prevention measures, infection control inside the dental operatory, disinfection of the dental unit, disposal, and other COVID-19-specific preventive measures were extracted. Our sample had higher compliance with regard to providing alcohol-based hand scrubs, providing protective gear to attendees, collecting travel/medical history, and screening patients for COVID-19 symptoms. In contrast, less compliance was observed regarding the use of paperless forms of practice and rubber dams in the operatory. The use of a validated survey tool ensures the collection of reliable and valid data, which can serve as baseline data to measure the uptake and effectiveness of dental practice regulatory guidelines in a clinical setting and community dental health clinics.

Bioaerosols and splatters generated by air syringes, ultrasonic scalers and high-speed turbine handpieces during dental treatment pose a potential hazard of infection not only to the patients but, to the dentists, dental hygienists, dental assistants as well as other healthcare workers. Severe infectious diseases such as Severe Acute Respiratory Syndrome (SARS), influenza, measles, tuberculosis, hepatitis, HIV AIDS can be transmitted through aerosols. With the emergence of β-coronavirus (COVID-19), questions concerning the protection from such viral transmission in the dental hospital setting have arisen due to close contact and its transmission through the exposure of saliva, blood and other body fluids. A systematic electronic search with relevant key terms viz. Aerosol Management, Dental Aerosols, Dentistry and COVID-19, Dental Unit Waterlines, Preprocedural Mouth rinsing, High Volume Suction Evacuators (HVE) and CDC Guidelines was executed in PubMed and Medline databases for literature extraction and data has been interpreted by including articles based on predefined inclusion criteria.In this review article, we address the importance of understanding and implementation dental safety by following various systems for the management of dental aerosols

Aim: To determine and analyse the most common chief complaints associated with chronic periodontitis in patients suffering from periodontal disease in Derabassi, Punjab, India. Materials and Methods: Dental records of 7680 patients were examined. Categorisation of all the subjects on the basis of periodontal diagnosis, age and gender was carried out. The various chief complaints reported at first visit were grouped into 3 major groups based on patient perception. A rank order was created based upon the frequency of chief complaints and number of chief complaints per subject and analysed. Results: Out of total (20750) 13 chief complaints recorded, only 5 were considered periodontitis symptoms and the remaining chief complaints were related to esthetics/ dental emergencies according to patient perception. Periodontitis symptom, as chief complaint was maximum for age group 41-50 years and female category, and the difference observed was statistically highly significant. Conclusion: Deposits, stains and bleeding gums were the first, second and the third most common chief complaints respectively in the study population and most of them were related to esthetics according to patient’s perception. This information should be utilised for enhancing awareness in general public for early diagnosis and effective periodontal treatment in early stages of periodontitis.

A bacterial strain was isolated from the waste slurry of an industrial effluent treatment plant near Patancheru, Hyderabad, India, and designated as PI-S10-B5A

Postural inaccuracies in persistent dental tasks indicated an upsurge in the prevalence of musculoskeletal disorders in dentists. This makes it imperative to restrain awkward postural movements while working. Biased results in self-reporting surveys; discomfort, expense, and time consumption involved in using wearable sensors; and expert’s opinion are required in observational methods. Hence, it is important to use significantly reliable, cheap technology as a substitute to overcome the shortcomings of the mentioned techniques. In this study, the markerless Kinect V2–based system was developed and compared with the conventional imaging technique for real-time postural assessment of dental seating tasks. The study assessed the angle parameters related to the dentist’s bodily movement of upper arm, lower arm, wrist, neck, and trunk. Ten dentists from the local dental institution volunteered for the study. Dentists were monitored with both techniques while performing real-time dental procedures. The agreement between the techniques was assessed using Bland–Altman plot at 95% bias, Pearson’s (r1) and concordance (r2) correlation coefficients, mean difference, and percentage error. For conclusive agreement analysis, contingency coefficient, proportion agreement index, Cohen’s kappa, and Mann–Whitney U at 95% confidence interval (CI) were evaluated. Data acquired from both techniques possessed strong correlations (r1 and r2 >0.90). Good agreement in Rapid Upper Limb Assessment data using Cohen’s kappa (0.67) at standard Landis and Koch’s scale was also observed. Postural analysis of slow-motion tasks like dentistry using the Kinect V2 system proved to be unobtrusive and efficient. This may be used by dentists to have periodic postural check. In future, Kinect V2–based feedback system may be used to develop an assistive technology using predictive algorithms, which may help in reducing the probability of occurrence of work-related musculoskeletal disorders in dentists.

Gender-based heterogeneity in periodontal disease has been witnessed in the recent past with huge mounting evidence. The composite effect of sex-based genetic structure and the sex steroid hormones runs in line with the corresponding gender-related differences in risk for chronic periodontitis. Since estrogens, the predominant sex hormones in women, show immune protective and anti-inflammatory effects in hormonally active premenopausal women, they show better periodontal status compared to age-matched men. Conversely, after menopause with a weakening estrogen signal, women may show an equal or even more serious periodontal status compared to men. Periodontal status of postmenopausal women may be improved by menopausal hormone therapy. Alveolar bone loss, an irreversible sign of past periodontal disease activity can be easily observed on radiographs in an objective manner. Orthopantomographs provide a fairly accurate assessment of the status of alveolar bone in the whole mouth. A cross-sectional retrospective panoramic radiographic analysis has been carried out in a north Indian dental institute to decipher the gender-based distribution of periodontal bone loss. The current chapter shall provide an update on gender-based differences in oral health, underlying mechanisms, differences in patterns and distribution of alveolar bone loss (case study), and potential gender-specific disease protection and management strategies.

Objective: The objective of the study was to assess the effect of non-surgical periodontal therapy (NSPT) on the levels of anti-inflammatory cytokine interleukin 10 (IL-10) in serum, gingival crevicular fluid (GCF), and saliva of chronic periodontitis patients. Methods: A comprehensive search was made on PubMed, Embase, and Scopus databases from Jan 2000 to Sep 2020. Three focused questions were addressed: Do GCF, serum, saliva and IL-10 levels change significantly after NSPT? Randomized and Non-Randomized clinical trials were included in the study. Results of the meta-analysis are expressed as standardized mean differences and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: A total of 709 studies were retrieved and 17 met the inclusion criteria for systematic review, whereas subgroup meta-analysis was performed on seven studies (GCF-5, serum-2). All studies included had low risk of bias. IL-10levelin GCF showed an increase at 3 months after NSPT with subsequent decrease at 6 months. However, increased serum IL-10 level at 6 months was seen after therapy. Conclusion: Within the limitations, there is moderate evidence that NSPT significantly alters the IL-10 levels in body fluids. IL-10 levels increased in GCF at 3 months whereas decrease was seen at 6 months. Increased IL-10 levels were seen in serum at 6 months.

Dental profession is at a very critical conjecture owing to novel coronavirus sickness, COVID-19. Dentistry is a profession where healthcare professionals are extremely susceptible of being infected as well as retain a high susceptibility to cross infect and transmit the contagious viral sickness among general public attending dental clinics. The grounded reality for an average dental practitioner is that walking back to operative clinical work in dentistry post-pandemic is quite tedious. Most of the safeguards and practices recommended in the current COVID-19 pandemic phase need significant alterations in the ways to practice clinical dentistry in terms of prevention and transmission of cross infection. 3D printing or additive manufacturing is the most upcoming surge of technology in the field of health care. Many novel research-driven and technology-based interventions from 3D printing technologies must be exploited and adapted to find ways and means to fight out the outburst of the pandemic. Many such 3D printed mass produced and cost-effective tools, equipments, and barrier materials instilled in clinical dental practice shall prevent or minimize COVID-19 cross contamination and transmission by ensuring safe clinical practices.

Human oral cavity is a complex habitat comprising about 700 microbial species and represents the most complex microbiota after gastrointestinal tract. In fact, oral microbiota directly influences health, metabolism and immune responses of the host. Metagenomic studies based on 16S rDNA profiling has reported the inhabitant bacteria mainly belonging to phyla Firmicutes, Proteobacteria, Actinobacteria, Fusobacteria, Spirochaetes and Bacteroidetes. Therefore, it is essential to isolate these strains and characterize in detail to understand their interaction. We have isolated strains from subgingival plaque from healthy to diseased individuals and the molecular characterization based on 16S rRNA gene sequence analysis showed predominance of Firmicutes, specifically members of the genus Streptococcus. Species of Lactobacillus and Veillonella were also found in significant number, which are considered as secondary colonizers. However, the population of Lactobacillus was decreased in diseased conditions with the increase in opportunistic pathogenic strains pertaining to genera like Campylobacter, Neisseria, Enterobacter, Pseudomonas and Morococcus. Further, we have also made an attempt to gain genomic insights on adaptation features and interactions of an isolate, Lactobacillus sp. strain DISK7 by performing whole genome sequencing and analysis, subsequently biochemical characterization to explore its functional and metabolic properties for the development as probiotic agent.

Background and Objectives: The elicitation of a host’s immune–inflammatory responses to overcome oral bacterial biofilm challenges is mediated by numerous cytokines. We explored the role of three such cytokines, viz. interleukin (IL)-17, 18 and 21, by measuring their levels in the gingival crevicular fluid (GCF) of Indian individuals with healthy gingiva, chronic gingivitis, or chronic periodontitis. Materials and Method: Ninety systemically healthy individuals were enrolled in the study on the basis of predefined criteria and were categorized into three groups of 30 participants each. Groups A, B and C were composed of a control group with healthy gingiva, subjects with chronic gingivitis and subjects with chronic periodontitis, respectively. The periodontal disease status was assessed on the basis of a subject’s gingival index, probing pocket depth, clinical attachment loss and radiographic evidence of bone loss. After the complete history-taking and identification of gingival sulcus/pocket depth areas for GCF collection, a sample was collected from each subject in all groups for an estimation of the cytokine levels using ELISA. Statistical analysis was performed using SPSS v 21.0. Intergroup comparisons were conducted using a post hoc Tukey’s test. A value of p < 0.05 was considered to be statistically significant. Results: The mean IL-17, 18 and 21 concentrations in pg/mL was the greatest for Group C (99.67 ± 18.85, 144.61 ± 20.83 and 69.67 ± 12.46, respectively), followed by Group B (19.27 ± 2.78, 22.27 ± 2.43 and 22.74 ± 1.43, respectively) and finally by Group A (healthy control; 11.56 ± 0.99, 17.94 ± 1.24 and 12.83 ± 1.21 respectively). A statistically significant difference in the mean concentrations of two interleukins (IL-17 and IL-18) was observed between Groups A and C and also between Groups B and C. A statistically significant difference in the mean concentrations of IL-21 was observed between Groups B and C. Conclusions: Within the limitations of the present study, the findings revealed that the GCF levels of IL-17, IL-18 and IL-21 rose and correlated well with the severity of the disease. Thus, these cytokines present in GCF have the potential to be considered as biomarkers for periodontal tissue destruction. IL-21 in particular appears to be a promising biomarker for differentiating between gingivitis and periodontitis.

The purpose of this meta-analysis is to systematically evaluate published evidence literature pertaining to report the differences in the survival rate of immediate implant placement in infected sites and non-infected sites.After the application of the search strategy in PUBMED, SCOPUS, and EMBASE research databases, a total of 1864 papers were found. Titles and abstracts were screened, yielding 77 full-text papers. After the overall assessment, 23 articles were recruited based on the inclusion criteria for analysis of data.Out of 23 studies, 14 studies were combined to assess the risk ratio of survival rate of immediate implant placement between infected and non-infected sites, depicting no significant difference on the survival rate. Further pooled estimate of proportion of survival rates were 0.98 suggesting 98% survival rate of immediate implants placed in infected sockets when 9 retrospective and prospective studies (no control studies) were combined. These findings demonstrate that successful outcomes can be expected for immediate implants when placed into infected extraction sockets.Within the limitations of this systematic review, equal predictability for successful osseointegration and long-term functioning of immediate implants was found in infected as well as in healthy extraction sites, but astringent antiseptic environment is mandatory for wound healing of immediate implants.

Despite recent improvement in implant survival rates, there remains a significant demand for enhancing the long-term clinical efficacy of titanium (Ti) implants, particularly for the prevention of peri-implantitis. Bioactive substances such as antimicrobial peptides are emerging as effective alternatives for contemporary antimicrobial agents used in dental health care. Current research work was focused to use laterosporulins that are non-haemolytic cationic antimicrobial peptides from Brevibacillus spp. for coating commercially available Ti discs. The coated Ti surfaces were evaluated in vitro for biofilm formation by two dental plaque isolates Streptococcus gordonii strain DIGK25 and S. mutans strain DIGK119 as representatives of commensal and pathogenic streptococci respectively. The biofilm inhibition was ascertained with replicated experiments on hydroxyapatite discs and confirmed by florescence microscopy. The laterosporulin coated Ti discs showed significantly reduced biofilm formation by oral streptococci and displayed promising potential to enhance the antibacterial surface properties. Such improvised Ti surfaces may curb the menace of oral streptococcal biofilm formation on dental implants and the associated implant failures.

Periodontists—dental professionals associated with tooth scaling (cleaning) tasks—are often prone to work-related musculoskeletal disorders (WMSDs). Tooth scaling involves the repetitive and forceful grip of scaling tool handle. Trauma related to hectic scaling job leaves periodontists susceptible to upper extremity disorders like cumulative trauma disorders (CTDs) like carpal tunnel syndrome (CTS), etc. Limited studies have been conducted to evaluate effect of tool handle design on upper extremity muscles involved in periodontal task. Optimally designed dental scaling tool design is expected to reduce the prevalence of WMSDs in periodontists. Twelve variations of modified dental scaling tool handle sleeves were fabricated using 3D printing technology. Design parameters like diameter and shape were assessed while performing simulated scaling task. The individual and interactive effects of design parameters on upper extremity flexor/extensor muscles were recorded by Electromyography (EMG). Thumb pinch force readings were recorded simultaneously. Results of the study indicated the reduction in muscle and thumb pinch forces in octagonal handle having 11 mm diameter. Proving taper to the tool handle design was also responsible for reduction in muscle loads. The current study not only aims at guiding the periodontists for adopting optimally designed tool but also engineers and researchers to design ergonomically sound tool handle designs.

Prevalence of Musculoskeletal Disorders is high amongst dental practitioners all over the world. Indian population comprises of nearly three lakh dentists, making it crucial to ergonomically assess the dental occupation using different methods of an ergonomic assessment. The dental profession comprises of highly frequent hand-arm motions and necessitates the implementation of the appropriate ergonomic assessment tools. Assessment of Repetitive Tasks (ART) has been created primarily to evaluate the risk involved in the repetitive movement of upper extremity body parts such as arms and hands. Umpteen numbers of studies have been done using other ergonomic tools (RULA, REBA, SI, and OCRA) in dentistry. Limited investigations have been conducted using the ART technique for assessing the dental profession ergonomically. In the study, ART was used as the key tool to assess the risk levels involved in the Indian population of dentists. The study deduced that the new improved ergonomic methods like ART may prove effective in determination of risk factors responsible for prevalent MSDs in dentistry.

Postural inaccuracies in persistent dental tasks indicated an upsurge in the prevalence of musculoskeletal disorders in dentists. The study assessed the angle parameters related to the bodily movement of upper arm (UA), lower arm (LA), wrist (W), neck (N), and trunk (T) using self-developed markerless Kinect V2 system and conventional imaging technique. Ten dentists were monitored with both techniques while performing real-time dental procedure. The agreement between the techniques was assessed using Bland–Altman at 95% bias, Pearson and concordance correlation coefficients (r1 and r2), mean difference, and percentage error. For conclusive agreement analysis, contingency coefficient (C), proportion agreement index (Po), Cohen’s kappa (k), and Mann–Whitney at 95% confidence interval were evaluated. Data from both techniques possessed strong correlations (r1 and r2 > 0.90). Cohen’s kappa (0.67) at standard Landis and Koch scale showed good agreement in RULA data. Postural analysis of slow-motion tasks like dentistry using Kinect V2 system proved as unobtrusive and efficient. This may be used by dentists to have periodic postural check.

A strictly anaerobic bacterial strain designated as SKVG24 was isolated from subgingival dental plaque samples of patients suffering from periodontitis. Cells were stained Gram-positive, rod shaped with endospore. The strain showed negative reaction to catalase and oxidase enzymes, but positive for gelatinase activity. Optimal growth was observed at 37 °C temperature and 7.0 pH. The 16S rRNA gene sequence BLAST analysis assigned strain SKVG24 to the genus Paraclostridium as it displayed 99.93% identity with P. benzoelyticum JC272T followed by P. bifermentans ATCC 638T (99.79%). However, average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) of the whole genome sequence showed

3D printing is a revolutionary technique witnessed by the world in past some years and it has changed the face of almost all areas of life. A change in the paradigm from mechanical to biologic therapeutic solutions have been realized in health care, particularly, restoration of lost or damaged body parts with 3D printing. Oral health care is a wide scope area for immense applications from this latest technology. In order to tap the huge potential of 3D printing for dental applications, a great deal of research is going on for customized therapeutics catering to individual case conditions. Material science is undergoing tremendous growth to keep pace with the rapid rate of advances in imaging technologies for data capturing, information technologies devising newer design algorithms and devices and newer time and cost-effective printing machines. Diverse novel materials aimed at specific applications are being researched for providing optimized patient oral care. The current chapter provides an update of the materials used in most common oral health care applications and discusses the future trends and issues pertaining to material perspectives in oral health care management.

Gingival recession (GR) is a common finding seen in the periodontics clinic. It has a significant functional and esthetic impact on the patient's dentition and quality of life.The current study aimed to develop the descriptive mathematical models for different domains of GR based on the data obtained from the North Indian population.Cross-sectional observational study.Consecutive 130 participants were enrolled between June and August 2019. Complete case history and thorough oral examination were carried out including assessment of periodontal variables, for example, pocket depth (PD), gingival marginal level, clinical attachment level (CAL), simplified oral hygiene index, and gingival index. Prediction models for different domains of GR, namely Miller's class, severity, extent, and distribution of recession were made, and further, the best-fitted model on the basis of "coefficient of determination (Multiple linear regression.Nine factors, i.e., mean CAL, mean PD, tooth mobility, abrasion, width of attached gingiva, number of teeth present, age, type of brush, and socioeconomic status showed a significant association with different domains of the GR. In addition, a high degree of overlap was observed among factors associated with different domains of the GR.Diverse clinical (mean CAL, mean PD, tooth mobility, and abrasion), biological (width of attached gingiva, number of teeth present, and age), and environmental factors (type of brush and socioeconomic status) were found to have a significant association with the occurrence of GR in the North Indian population. Owing to the multifactorial etiology of GR, the identification of susceptible patients based on the presence of risk factors is an essential step in developing action plans for the prevention of the disease.

As the beginning of the COVID-19 pandemic, numerous attempts have been made to identify specific antiviral mouth rinses which may help reduce the salivary viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Although the results from

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

There is a significant increase in the discovery of new antimicrobial compounds in recent past to combat drug resistant pathogens. Members of the genus Bacillus and related genera have been screened extensively due to their ability to produce wide range of antimicrobial compounds. In this study, we have isolated and characterized a new antimicrobial peptide from a marine bacterium identified as Virgibacillus species. The low molecular mass and stability of the antimicrobial substance pointed towards the bacteriocinogenic nature of the compound. The RAST analysis of genome sequence showed presence of a putative bacteriocin biosynthetic cluster containing genes necessary for synthesis of a lanthipeptide. Translated amino acid sequence of mature C-terminal propeptide showed identity with salivaricin A (52.2%) and lacticin A (33.3%). Accordingly, the mass (2417 Da) obtained by MALDI analysis was in agreement with posttranslational modifications of the leader peptide to yield three methyl lanthionine rings and a disulfide bond between two free cysteine residues. The lanthipeptide was named as virgicin, which selectively inhibited the growth of Gram-positive bacteria and biofilm formation by Enterococcus faecalis. Inhibition of biofilm formation by E. faecalis was also observed in in vitro model experiments using hydroxyapatite discs. Thus, virgicin appears to be a promising new bacteriocin to control oral biofilm formation by selective pathogens.

A strictly anaerobic bacterial strain, designated as PI-S10-A1B, was isolated from a sludge sample collected from an industrial effluent dump site at Hyderabad, India. Cells stained Gram-positive and contained terminal endospores. Optimal growth was observed at 30 °C and pH 7.0. It showed negative reactions to catalase and oxidase activities. Phylogenetic analysis of the 16S rRNA gene led to strain PI-S10-A1BT being assigned to the genus Clostridium . It displayed high sequence similarity to species of cluster XIVa including Clostridium amygdalinum BR-10T (99.84 %), Clostridium saccharolyticum WM1T (98.93 %) and Clostridium indolis DSM 755T (98.31 %). It formed a coherent cluster with members of cluster XIVa. Despite high 16S rRNA gene sequence similarity, strain PI-S10-A1BT displayed only 25.3 % identity in DNA–DNA hybridization tests with C. amygdalinum BR-10T. A draft genome exhibited low values for average nucleotide identity and in silico DNA–DNA hybridization with strains of cluster XIVa. The DNA G+C content was 42.3 mol%. Major lipids were phosphatidylglycerol and diphosphatidylglycerol, with an abundance of phosphoglycolipids. Further, analysis of the draft genome revealed genomic insights against functional aspects. Considering the phenotypic differences and low genomic identity with phylogenetic relatives, strain PI-S10-A1BT is concluded to represent a new species of the genus Clostridium , for which the name Clostridium indicum sp. nov. is proposed with type strain PI-S10-A1BT (=MTCC 12282T=DSM 24996T=JCM 32788T).

Background: Local drug delivery is most commonly used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease. Varied success rates have been documented for various vehicles used for intrasite delivery of active therapeutic agents. Recently, varnishes acting as a reservoir of chlorhexidine have shown potential for the management of chronic periodontitis patients. The aim of the present investigation was a comparative evaluation of the clinical effectiveness of single and multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) along with SRP in patients with chronic periodontitis. Materials and Methods: The present study included 30 patients with chronic periodontitis divided into three groups based on the number of subgingival applications of chlorhexidine varnish single application (Group A), two applications at a week's interval (Group B), and three applications with 7-day interval in between two applications (Group C). Clinical parameters, namely plaque index (PI), sulcus bleeding index, probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month and 3 months in all three groups to compare the clinical efficacy. Results: A statistically significant reduction was observed in PI, sulcus bleeding index, PPD, and RAL at 1 and 3 months in all the three groups. Greater (though statistically nonsignificant) improvements were observed in Groups B and C. Conclusion: Within limitations of the study, it can be concluded that multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) have an added benefit over the single application in the treatment of chronic periodontitis.

Additive manufacturing is an emerging technique that has almost revolutionized the material science and mechanical engineering in recent years. The technique started to help engineers to actualize the concepts of their minds by fabricating diverse three-dimensional objects in a layer-by-layer fashion. Multitude of processes such as stereolithography (SL), polyjet, fused deposition modeling (FDM), laminated object manufacturing (LOM), 3D printing (3DP), prometal, selective laser sintering (SLS), laser engineered net shaping (LENS), and electron beam melting (EBM) is considered as a part of additive manufacturing. Recently, additive manufacturing has received a lot of attention in the healthcare sector for fabricating devices for the purpose to restore, support, and repair defected human body parts. Particularly, the field of dentistry rather extensively deals with such restorative work in order to improve the functional and aesthetic demands of today’s oral healthcare sector. This chapter shall present a focussed update on the current concepts, methods and diverse applications in the field of oral health care, based on contemporary published literature relevant to the subject. Further, it shall provide the future scope of research to address the challenges, for the widespread clinical utilization of additive manufacturing technologies in routine clinical dental care.

Background: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. Aim: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. Settings and Design: Tertiary health care center, cross-sectional case-control observational study. Materials and Methods: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. Statistical Data Analysis: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). Results: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. Conclusion: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.

Context: Dentists across the globe are witnessing a completely unforeseen and uncertain professional situation during these times of COVID-19 pandemic. There is conflicting evidence regarding the effectiveness of routinely used mouthwashes and especially Chlorhexidine, to reduce the viral load in oral cavity and the aerosols during oral procedures. Aims: Comparative evaluation of the effectiveness of the current 'gold standard' chlorhexidine and povidone iodine as a control agent, through an in-vitro analysis. Settings and Design: In-vitro laboratory analysis. Methods and Material: All the experiments for analysis of antiviral efficacy of chlorhexidine digluconate (2%)and povidone iodine(1%), against SARS-CoV-2 virus were performed in the BSL3 facility at the Council of Scientific and Industrial Research-Institute of Microbial Technology, using the VeroE6 cell lines. The analysis of the virus inactivation was based on quantification of viral RNA (Cycle threshold (Ct) profile) present in the culture supernatant using Real-Time Quantitative Reverse Transcription PCR (qRT-PCR). Statistical Analysis Used: Descriptive analysis (Statistical package for social sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows). Results: Chlorhexidine digluconate in 0.2% concentration inactivated more than 99.9% of SARS CoV 2 virus, in minimal contact time of 30 seconds, which was considered better efficacy than povidone-iodine utilized for 30 and 60 seconds. Subtle differences were observed in the activity of both the compounds in terms of percent inactivation of virus, though a greater relative change in Ct values was observed for chlorhexidine. Conclusions: Within the limitations of the present study, it can be concluded that Chlorhexidine digluconate in 0.2% concentration inactivated SARS CoV 2 in minimal contact time i.e 30 secs, however both compounds tested i.e Chlorhexidine and povidone-iodine were found to have antiviral activity against SARS CoV2 virus.

Background: Along with conventional periodontal surgical therapy, local delivery of antibiotics may provide more effective treatment in smokers by targeting tissue-invasive bacteria. The aim of this randomized, clinical trial was to evaluate the adjunctive effects of subgingivally delivered 0.5% azithromycin (AZM) as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis in smokers versus non smokers. Methods: 38 sites in patients of chronic periodontitis were randomized and categorized into two treatment groups: Group 1 consisted of 19 sites in patients who were smokers and Group 2 consisted of 19 sites in non smokers, who received Scaling and Root Planing (SRP) plus 0.5% azithromycin gel Local drug delivery. Clinical parameters were recorded at baseline, 1 and 2 months. They included probing depth (PD) and clinical attachment level (CAL) and percentage bone fill. Results: Azithromycin resulted in significant improvements in both the groups. Mean decrease in PD in non smokers by the end of 2 months was 3.903mm and in smokers was 3.917mm. Gain in CAL in non smokers by the end of 2 months was 3.879mm and in smokers it was 3.920mm. Mean bone fill at one month for smokers was 15.86% and was 26.58% at 2 months. In non-smokers the mean bone fill was 17.19% at 1 month and 24.03% at 2 months. Conclusions: When compared to the non smokers, the adjunctive use of 0.5% AZM resulted in similar improvement in clinical outcome in the treatment of chronic periodontitis among smokers. Local drug delivery of Azithromycin gel contributed to decrease in probing pocket depth, gain in clinical attachment level and in alveolar bone. The apparent bone regeneration also raises the intriguing possibility that Azithromycin encourages bone formation once tissue inflammation has subsided.

With exponential increase in the number of cases of cancers worldwide in recent past, it is imperative to enhance our understanding about the etiologic and risk factors associated with this seriously morbid condition. Increasing attention has been focussed on chronic infections and inflammatory diseases, implicating a role in carcinogenesis, particularly in developing countries. Periodontal disease is a bacterially induced chronic inflammatory process that affects tooth supporting connective tissue and alveolar bone in the oral cavity, potentially leading to tooth loss. The concept of these diseases as localized entities affecting only the teeth and supporting apparatus has been revised lately, in the light of mounting evidence of periodontal infection’s influence on chronic inflammatory disease states. Periodontal disease has been linked to several systemic conditions like cardiovascular diseases, diabetes mellitus, adverse pregnancy outcomes, obesity and cancers, yet underlying mechanisms are still elucidating. The focus of this review article will be an in depth discussion of the role of chronic inflammation, particularly chronic periodontal inflammation in causation or association of human cancers and discussion of possible biological mechanisms involved.

There is a huge body of literature suggesting an association and a bidirectional relationship between periodontal disease and diabetes. Diabetes and periodontal diseases are both chronic diseases with a high prevalence. Dentists/periodontists, in their daily clinical practice, very often attend to diabetes patients with diverse oral health conditions and cater to their dental treatment needs. Safe and effective periodontal therapy in this population requires a broad understanding of diabetes, medical management of diabetes, and essential modifications to dental/periodontal therapy that may be required. This paper describes a joint statement put forth by the Indian Society of Periodontology and the Research Society for the Study of Diabetes in India aiming to provide expert consensus and evidence-based guidelines for optimal clinical management of periodontal conditions in diabetes patients or patients at risk for diabetes. Although this paper is not envisioned to be a comprehensive review of this topic, it intends to provide the guidelines for dental professionals and periodontists.

Antimicrobial peptides (AMPs) from prokaryotic source also known as bacteriocins are ribosomally synthesized by bacteria belonging to different eubacterial taxonomic branches. Most of these AMPs are low molecular weight cationic membrane active peptides that disrupt membrane by forming pores in target cell membranes resulting in cell death. While these peptides known to exhibit broad-spectrum antimicrobial activity, including antibacterial and antifungal, they displayed minimal cytotoxicity to the host cells. Their antimicrobial efficacy has been demonstrated in vivo using diverse animal infection models. Therefore, we have discussed some of the promising peptides for their ability towards potential therapeutic applications. Further, some of these bacteriocins have also been reported to exhibit significant biological activity against various types of cancer cells in different experimental studies. In fact, differential cytotoxicity towards cancer cells as compared to normal cells by certain bacteriocins directs for a much focused research to utilize these compounds as novel therapeutic agents. In this review, bacteriocins that demonstrated antitumor activity against diverse cancer cell lines have been discussed emphasizing their biochemical features, selectivity against extra targets and molecular mechanisms of action.

Periodontal diseases are chronic infectious disease in which the pathogenic bacteria initiate the host immune response leading to the destruction of tooth supporting tissue and eventually result in the tooth loss. It has multifactorial etiological factors including local, systemic, environmental and genetic factors. The effect of genetic factors on periodontal disease is already under extensive research and has explained the role of polymorphisms of immune mediators affecting disease response. The role genetic factors in pathogens colonisation is emerged as a new field of research as “infectogenomics”. It is a rapidly evolving and high-priority research area now days. It further elaborates the role of genetic factors in disease pathogenesis and help in the treatment, control and early prevention of infection. The aim of this review is to summarise the contemporary evidence available in the field of periodontal infectogenomics to draw some valuable conclusions to further elaborate its role in disease pathogenesis and its application in the clinical practice. This will open up opportunity for more extensive research in this field.

Epigenetics refers to changes in gene expression that are not mediated by alterations of the genetic code itself but are caused by biochemical modifications of the nucleotide bases that alter the three-dimensional structure of DNA. The epigenome, consisting of chromatin and its modifications, functions as an interface between the inherited genome and the dynamism imposed by the environment. Over the past decade, there has been mounting evidence suggestive of associations between epigenetic modifications and various human conditions such as aging, and most common human diseases viz. cancer, cardiovascular diseases, diabetes, rheumatoid arthritis, HIV, etc., and the clearest evidence as the central mechanism for common multifactorial diseases has been identified with the factors involved in the inflammatory response. This emerging knowledge can give a great contribution to the field of medicine as it can be potentially utilized to develop newer understandings about pathogenesis, diagnostics, and therapies for major chronic human diseases, e.g., chronic metabolic diseases, immune-inflammatory disorders (including periodontal disease), and cancers, etc. The current paper aims to provide the clinicians a comprehensive review, based on the available supportive evidence to update this interesting concept capable of providing a better comprehension of the underlying disease mechanisms, so as to develop and decipher the novel methodologies to diagnose and treat these diseases.

Background Successful management of periodontitis requires treatment strategy that integrates therapies addressing both pathogen and host aspects of disease etiology. To evaluate sub gingivally applied curcumin gel in treatment of chronic periodontitis based on clinical and biochemical parameters. Materials & methods A randomized, double blind, parallel-group trial was carried out on 30 patients suffering from chronic generalized periodontitis with probing pocket depth≥5mm on at least 4 sites who were then randomly allocated to two groups. Control group was treated with Scaling and Root Planing (SRP) alone while experimental group was treated with SRP followed by subgingival application of curcumin gel. Saliva collection was done and the clinical parameters were recorded at baseline and follow up periods. Saliva analysis for IL-1β was done by ELISA. The statistical differences for the intra-group and intergroup measurements were analyzed by using Mann Whitney test. Spearman's rank correlation coefficient was used to examine the relationship between Interleukin - 1β and clinical parameters. Results Study elucidated mild adjunctive benefit of curcumin gel in reduction of gingival inflammation for a limited period of time. Though improvement in other clinical parameters was also greater in subjects treated with curcumin gel, results were not statistically different from those treated with SRP alone. None of the subjects who received curcumin gel experienced any adverse effect. Conclusion Within limitations, it can be concluded that single application of curcumin (turmeric) gel has limited added benefit over scaling and root planing in treatment of chronic periodontitis.

The production of natural antimicrobial peptides (AMPs) is an innate immunity trait of all life forms including eukaryotes and prokaryotes. While these AMPs are usually called as defensins in eukaryotes, they are known as bacteriocins in prokaryotes. Bacteriocins are more diverse AMPs considering their varied composition and posttranslational modifications. Accordingly, this review is focused on cysteine-rich AMPs resembling eukaryotic defensins such as laterosporulin from Brevibacillus spp. and associated peptides secreted by the members of related genera. In fact, structural studies of laterosporulin showed the pattern typically observed in human defensins and therefore, should be considered as bacterial defensin. Although the biosynthesis mechanism of bacterial defensins displayed high similarities, variations in amino acid composition and structure provided the molecular basis for a better understanding of their properties. They are reported to inhibit Gram-positive, Gram-negative, non-multiplying and human pathogenic bacteria. The extreme stability is due to the presence of intra-molecular disulfide bonds in prokaryotic defensins and reveals their potential clinical and food preservation applications. Notably, they are also reported to have potential anticancer properties. Therefore, this review is focused on multitude of diverse applications of bacterial defensins, exploring the possible correlations between their structural, functional and possible biotechnological applications.

New approaches to periodontal diagnosis, including advanced microbiologic, biochemical, and genetic tests, have been shown to provide the clinician with the information not available by traditional means. The purpose of a diagnostic test is to confirm, exclude, classify, or monitor disease to guide treatment. Their clinical value depends on whether the information they provide leads to improved patient outcomes. This can be assessed by randomized trials, which compare patient outcomes from the new diagnostic test versus the old test strategy. Being nonmandatory for marketing approval, such trials are not always feasible because of large sample sizes requirements. So, many diagnostic tests enter the practice without being critically analysed for any additional benefits. Effective diagnosis is just as essential as the selection of effective treatments for the success of periodontal therapy. So, the current paper aims to focus on the practical utility of this rapidly emerging plethora of periodontal diagnostic tools, emphasizing the critical issues surrounding the clinical application of microbiologic and biochemical investigations, employed for periodontal diagnosis.

Periodontal disease, is the most prevalent inflammatory affliction characterized by the loss of supporting structures of the teeth. Although bacteria are identified as prime agents initiating the disease, but major part of tissue destruction is driven by the host immune response to infecting agent and is responsible for the clinical presentation of the disease. Porphyromonas gingivalis (P. gingivalis) has been identified as main microbial factor for causation and progression of periodontal disease. Three emerging concepts of periodontal disease viz wide prevalence, polymicrobial nature and their role in perpetuation of systemic diseases bear critical significance on the development of novel therapeutic approaches to eradicate or alleviate the disease burden. Therefore, development of preventive approaches such as periodontal vaccine appears as an exciting modality which can prove as a significant adjunct to current periodontal therapies. The new generation diagnostics including microbial genome sequencing and bioinformatics analysis are available now to detect and analyze the whole genomic and proteomic data regarding almost all human pathogens for exploring these as novel drug targets for vaccine development. The current review, aims to provide an update of wide-ranging virulence factors of P. gingivalis as potential antigenic targets for periodontal vaccine development.

Much of the work in periodontal microbiology in recent years has focused on identifying and understanding periodontal pathogens. As the majority of oral microbes have not yet been isolated in pure form, it is essential to understand the phenotypic characteristics of microbes to decipher their role in oral environment. In this study, strain DISK18 was isolated from gingival sulcus and identified as a Megasphaera species. Although metagenomics studies revealed Megasphaera species as a major group within the oral habitat, they have never been isolated in cultivable form to date. Therefore, we have characterized the DISK18 strain to better understand its role in the periodontal ecosystem. Strain Megasphaera sp. DISK18 displayed the ability to adhere and self-aggregate, which are essential requisite features for inhabiting and persisting in oral cavity. It also coaggregated with other pioneer oral colonizers like Streptococcus and Lactobacillus species but not with Veillonella. This behaviour points towards its role in the ecologic succession of a multispecies biofilm as an early colonizer. The absence of virulence determining genes as observed in whole genome sequence analysis coupled with an inability to degrade collagen reveals that Megasphaera sp. strain DISK18 is likely not a pathogenic species and emphasizes its commensal lifestyle.