Search

Introduction: The toothbrush is one of the most commonly used mechanical aids for plaque control, capable of removing plaque efficiently. However, improper toothbrushing habits can lead to tissue trauma, such as abrasion or gingival recession. The design of toothbrush bristles is one of the most common etiological factors for abrasion. Aim: To evaluate and compare the enamel surface abrasion produced by three different toothbrush bristle designs in conjunction with a standard dentifrice. Materials and Methods: In this in-vitro study conducted in the Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India, from June 2023 to January 2024, a total of 21 extracted human premolars were collected. After thorough cleaning, the teeth were stored in normal saline. The crown portions of the teeth were mounted on an acrylic resin base and profilometric analysis was performed to record the average enamel surface roughness (Ra) value. The teeth were randomly divided into three groups based on the toothbrush bristle design used for toothbrushing: Group A: Tapered bristle, Group B: End-rounded bristle, Group C: Flat-trim bristle. Toothbrushing was carried out using a customised toothbrushing device and a standard dentifrice twice daily for six weeks. After six weeks, profilometric analysis was conducted again. Descriptive statistics were expressed as means and standard deviations. The comparison of enamel surface abrasion among the three different toothbrush bristle designs was performed using the One-Way Analysis of Variance (ANOVA) test, followed by the post-hoc Bonferroni test for pair-wise comparison. In this test, a p-value less than or equal to 0.05 was considered statistically significant. All analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: The results showed significantly greater Ra values for Group C (flat-trim bristle: 0.13±0.06) compared to Group A (tapered bristle: 0.09±0.03) and Group B (end-rounded bristle: 0.04±0.02). Group B exhibited the lowest Ra value, indicating the least enamel surface roughness (p-value: 0.038*). Conclusion: Within the limitations of the study, stylus profilometer analysis demonstrated that the flat-trim toothbrush bristle design is more prone to causing enamel surface abrasion than the end-rounded and tapered bristle designs. The end-rounded toothbrush bristle design causes minimal enamel surface abrasion and is safer to use as an effective mechanical plaque control aid.

Introduction: Pigmented gingiva is an aesthetic concern for many individuals. Various treatment modalities have been developed to address this condition, but each carries certain disadvantages. Recently, the use of herbal products has been considered as a treatment modality, as they are safe and readily available. P-Coumaric Acid (p-CA) and Quercetin are two plant-based chemicals that have shown depigmenting effects on the skin. Given the similar cellular structure of skin and gingiva, the present study aimed to test their depigmenting effects on the gingiva. Aim: To evaluate the effectiveness of two phytochemicals, p-CA (3 μM) and Quercetin (20 μM), in reducing the melanin content of pigmented gingival tissue. Materials and Methods: The study was an ex-vivo study conducted in the Department of Periodontology at Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India, from January 2024 to April 2024. A total of 10 patients with a Dummet Oral Pigmentation Index (DOPI) score of two were selected for the study. A surgical depigmentation procedure was performed and the excised tissue was divided into three parts. The first part of the excised tissue served as a control group (Group A), while the second and third parts were treated with p-CA (Group B) and Quercetin (Group C), respectively. Histological analysis was conducted using Haematoxylin and Eosin (H&E) staining and immunohistochemical analysis was performed using the Human Melanoma Black 45 (HMB-45) antibody test. The reduction in melanin content was recorded in all three groups and the results obtained were compared using a t-test. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis, with a p-value of ≤0.05 considered statistically significant. Results: Both p-CA and Quercetin demonstrated a reduction in the level of pigmentation. Comparative analysis indicated that p-CA had a stronger effect than Quercetin. Conclusion: The p-CA and Quercetin can be considered potential depigmenting agents.

A beautiful smile boosts an individual’s self-confidence. The harmony of a smile depends on the shape, colour, and position of teeth, as well as the gingival tissue. Excessive gingival pigmentation is a major aesthetic concern for many people. Gingival hyperpigmentation is usually caused by an abnormal accumulation of melanin in the gingival tissue, which gives the gingiva a dark appearance. A variety of different modalities have been proposed for removing hyperpigmentation like Scalpel technique, LASER, Radiotherapy, Electrocautery, Bur abrasion, Chemical methods etc. Though the initial results of depigmentation procedures are promising, repigmentation is a common problem associated with them which poses a financial burden to the patient. To overcome this hurdle, a promising novel technique which is in vogue in cosmetic dermatology is Microneedling. Microneedling is a minimally invasive, cost effective, simple procedure that creates microholes to facilitate the penetration of topical medications across the connective tissues. The procedure activates the natural healing process, promoting the regeneration of epithelial cells and the breakdown of clusters of melanin pigment. This article gives an insight regarding microneedling technique and also discusses in depth regarding melanin synthesis, classification, indices, etiology, gingival depigmentation procedures, and repigmentation.

Periodontitis can be defined as a multifactorial inflammatory disease of bacterial origin causing destruction of periodontal tissues. Achieving effective regeneration in periodontal therapy still remains a foremost goal. Chemical modification of tooth surface has been the most persistent effort to achieve periodontal regeneration. There are controversies regarding effectiveness of root biomodification due to a mixture of results from clinical and histological studies. This review provides an acumen about root biomodification in clinical conditions as well as a summary on the novel biomodification agents.

Periodontitis, a common inflammatory disease affecting the periodontal tissue, poses diagnostic and management challenges. Conventional methods are not capable of assessing disease activity or identifying individuals who are prone to progression. Biomarkers, measurable substances that indicate the presence, severity, or progression of disease, offer a promising approach to diagnosing periodontitis. Recent discoveries in molecular diagnostics have prompted the search for novel biomarkers, including cell-free DNA (cfDNA). This review article gives an insight into current knowledge regarding the use of cfDNA as a diagnostic marker in periodontal disease diagnosis.

Introduction: Periodontal disease is a chronic inflammatory infectious disease that increases the host’s overall inflammatory burden by inducing a persistent systemic inflammation. This burden has been linked to insulin resistance, the development of diabetes, and its complications. Periodontal therapy plays a vital role in controlling diabetes and its potentially fatal complications. Medical and dental professionals should be aware of this interrelationship between the two diseases to facilitate proper diagnosis and predict better treatment outcomes. Aim: To assess the knowledge of medical practitioners regarding periodontal disease and its inter-relationship with diabetes mellitus. Materials and Methods: This was a questionnaire-based crosssectional study conducted by using google forms between May 2022 and October 2022 among 150 medical practitioners. The questionnaire consisted of 15 questions divided into two parts. The first part gathered personal data, while the second part focused on their knowledge about disease awareness. The collected data were analysed using percentages. Results: Out of 149 participants, who sent completed questionnaires, only 8 practitioners (5.4%) referred all while 99 (66.4%) referred only a few of their patients for dental check-ups. Among them, only 39 participants (26.2%) referred patients for regular general dental check-ups without any complaints or findings. Although 112 (75.2%) had knowledge about the association, only 59 participants (39.6%) knew that it is bidirectional. A total of 80 (53.7%) responses understood that periodontal bacterial load and associated inflammation caused alterations in sugar levels. However, 68 (45.6%) were unaware that periodontal treatment can help improve glycaemic status. Conclusion: It can be inferred that medical practitioners were not aware of the connection between periodontal disease and diabetes mellitus.

Oral health is vital for the general well-being, overall body health and the quality of life throughout our lifetime. Most of the oral diseases and conditions are largely related to the maintenance of oral hygiene, lacking that people suffer from diverse oral diseases at different times in their life. With greater life expectancy, the individuals have teeth involved with periodontal diseases that would not only require professional care but also home gum care for them to last a lifetime. Indian Society of Periodontology (ISP) has recognized the need for systematic documents to update everyday clinical practice of general dental practitioners and have provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral healthcare delivery across the country. The current set of clinical practice recommendations focused to “Gum Care for All”, is aimed at emphasizing and enhancing the awareness regarding oral health promotion, maintenance, and disease prevention. Twenty-five subject matter experts from across the nation, prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three distinct sections, namely pretherapeutic, therapeutic, and post therapeutic, to provide guidance during the respective phases of patient management and may serve as a quick and concise reference to the readers. The guidelines shall provide the distinct definitions, signs and symptoms, treatment required; recall visit specifications for plausible clinical case situations, home care advice regarding maintenance of oral hygiene including information on brushing technique, care and change of brush, use of interdental aids, and mouthwashes, etc. The document should advocate and guide the combined efforts of general dentists, and the population at large toward an empowered, evidence based, integrated, and comprehensive oral health care, which shall enhance the healthful functioning and longevity of the dentition and general health of the individual.

Context: The use of herbal compounds is a comparatively safer alternative to synthetic compounds for periodontal therapy. Aim: This study aims to investigate effect of extracts from pomegranate in a chip and gel form on periodontitis following scaling and root planing in adult periodontitis patients. Settings and Design: An in vivo prospective study. Materials and Methods: Thirty patients of adult periodontitis with initial pocket depth ≥4 mm were enrolled into the research and divided randomly into three groups, (10 in every group). After baseline examination, scaling root planing of tooth was achieved. Then subgingival application of medicated chips in Group 1, gel in Group 2, and placebo in Group 3 was done. Plaque index, gingival index, probing pocket depth, and relative attachment ranges were recorded at baseline, 21 days and 45 days. Statistical Analysis Used: Analysis of variance test. Results: The study confirmed significant improvements of plaque index ratings in Group 1 at day 21. It showed significant improvements of gingival index scores, probing pocket depth, and clinical attachment at day 21 and 45. Gingival index rankings and probing pocket depth were extensively elevated altogether in three groups at day 21 and 45. Relative attachment degree was extensively raised in Group 1 and Group 2 at day 21 and day 45 and in Group 3 at day 45. The relative attachment degrees confirmed significance at day 21 between Group 1 and Group 2, and Group 1 and Group 3. Conclusion: Pomegranate extracts in chip and gel shape may offer additionally advantages to scaling and root planing for remedy of periodontal pockets.

Background: The aim of the present study was to compare the root coverage of localized gingival recession (GR) using modified coronally advanced flap (CAF) (Sanctis and Zucchelli's technique) and root conditioning 24% ethylenediaminetetraacetic acid (EDTA) when done under magnification and without magnification. Materials and Methods: A total of 20 sites were taken with Miller's Class I GR (10 in test and 10 in control). All clinical parameters were recorded at baseline, 1 month, and 3 months. CAF and root conditioning were done with 24% EDTA. Surgical procedure at test site was carried under magnification ×3.5 and at control site was done without magnification. Results: Plaque index, gingival index, clinical attachment level, probing depth, width of keratinized tissue (WKT), recession depth (RD), and recession width (RW) at baseline and 3 months were compared using Student's t- test. Mean WKT at baseline in control and test group was 4.22 ± 2.05 and 3.22 ± 1.09 which increased to 4.56 ± 1.59 and 4.50 ± 0.94, respectively, at 3 months. RD at baseline in control and test groups was 2.56 ± 0.53 and 2.67 ± 0.87 which reduced to 1.83 ± 0.71 and 1.22 ± 1.20, respectively. RW at baseline in control and test group was 3.56 ± 1.13 and 3.67 ± 0.50 which decreased to 3.06 ± 1.01 and 1.72 ± 1.39, respectively. All the clinical parameters were statistically not significant between control and test groups. Mean visual analog scale (VAS) at 7 days postoperatively in control and test groups was 1.78 ± 0.97 and 0.22 ± 0.44, respectively. The VAS scores were found to be significantly lower in the test group at both 3rd and 7th day postoperatively showing less pain in test group. Conclusion: Microsurgery offers less pain and enhanced outcomes when compared to traditional macrosurgery.

Context: Dentinal hypersensitivity (DH) is a chronic disorder in which patients report sharp and acute pain to a variety of stimuli. Till date, a standardized procedure to treat DH is missing, though several alternative treatment strategies have been designed, including laser therapies. Aim: The aim of the study was to treat DH with minimum chemical concentration and least laser energy level with longer follow-up period. Materials and Methods: One hundred and twenty patients were randomly divided into four groups: (i) Group 1-5% potassium nitrate (KNO3); (ii) Group 2 - gallium-aluminum-arsenide diode laser (62.2 J/cm2, wavelength - 980 nm, noncontact pulse mode, and power wattage - 0.5 W); (iii) Group 3 - combined 5% KNO3and the diode laser; and (iv) Group 4 - placebo (control). The visual analog scale (VAS) scores were recorded, analyzed, and compared to tactile stimuli, cold water, and air blast tests at different intervals for 6 weeks. Results: Synergistic use of 5% KNO3and diode laser (Group 3) significantly reduced the DH pain, which was almost negligible after 6th week (97%–99% of the pain was reported to be relieved) and showed promising results than any other studied groups. Further, the diode laser (Group 2) showed better results than 5% KNO3 (Group 1). One-way ANOVA and Bonferroni correction post hoc test revealed the combination of groups with significant differences in the mean VAS scores at the different interval of time (P < 0.01). Conclusions: Convincingly, the combined application of 5% KNO3with the diode laser can be recommended for treating DH patients.

Background: There is a strong evidence that genetic as well as environmental factors affect the age of onset, severity and lifetime risk of developing periodontitis. The objective of the present study was to compare and to evaluate the association between interleukin (IL)-1α(-889) and gene polymorphisms in patients with generalized aggressive periodontitis, chronic periodontitis and healthy controls. Materials and Methods: A total of 60 Indian patients, with 20 aggressive periodontitis, 20 chronic periodontitis and 20 healthy controls were recruited for this study. From each patient, a volume of 2 ml of blood was collected by venipuncture in the ante-cubital fossa and was stored in sodium EDTA vacutainers and was used for genotyping assays with the polymerase chain reaction restriction fragment length polymorphism technique. Clinical parameters such as oral hygiene index, gingival index and clinical attachment loss (CAL) were evaluated for each patient. Genotype distribution between different groups were analyzed using Chi-square test. A P = 0.05 or less was set for significance. Results: The mean oral hygiene index was 3.7 ± 0.86 and 3.25 ± 0.30 for chronic and aggressive periodontitis cases respectively. The CAL was 4.29 ± 0.63 mm for chronic periodontitis and 6.44 ± 0.57 mm for aggressive periodontitis. Homozygous genotype 2,2 was more predominant in cases of aggressive periodontitis whereas in chronic periodontitis, heterozygous genotype 1,2 was more predominant when compared with others (P < 0.001). Odds ratio for aggressive versus chronic periodontitis was calculated as 6.2 (95% confidence interval 6.019-7.892). Conclusion: The results of the present study support a positive association between aggressive periodontitis and the presence of the IL-1α-889, allele 2 polymorphism in Indian patients.

Ablative surgery of the jaws may be necessary when malignant disease or destructive benign disease occurs. Surgical reconstruction needs to include the restoration of masticatory function so that the quality of life after the operation is optimal. When resection includes part of the upper or lower jaw, the aim of reconstruction should encompass not only the restoration of aesthetics, speech and swallowing, but also the recreation of an alveolar ridge suitable for prosthetic rehabilitation of the dental occlusion. In the present case, depth of vestibule was inadequate following implant placement thereby severely compromising prosthetic rehabilitation. Hence vestibuloplasty was done with periosteal fenestration operation, which provided retention and stability of mandibular prosthesis and hence greatly improved his overall quality of life.

Background: The aim of the present study was to evaluate and compare the clinical and microbiological effectiveness of Periochip TM as an adjunct to scaling and root planing (SRP) with SRP alone in patients with chronic periodontitis. Materials and Methods: This randomized, split mouth, 3-month clinical and microbiological trial included 30 sites in 15 patients aged 30-50 years diagnosed with chronic periodontitis. In each patient, two bilateral pockets probing 5-7 mm were randomly assigned to test and control groups. The test group received SRP plus Periochip TM , whereas the control group received SRP alone. Clinical indices and anaerobic culture analysis was done at baseline, 1 month, and 3 months interval. Total bacterial count and analysis of four major periodontopathogenic bacteria Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Aggregatibacter actinomycetemcomitans (Aa), and Fusobacterium nucleatum (Fn) was done. Results: Significant improvement was obtained in all clinical variables in the test group as compared to the control group over the study period. Total colony counts were significantly reduced in the test group as compared to control over the period of time. At baseline Aa was recovered from 4 test group sites and 5 control group sites, Pg from 15 test group and 14 control group sites, Pi from 5 test group and 2 control group sites, Fn from 7 test and 7 control group sites. At 3 months, Aa was recovered from 1 test group and 4 control group sites, Pg from 4 test group and 8 control group sites, Pi from 1 test group and 1 control group site, Fn from 3 test and 4 control group sites. Conclusion: Periochip TM placement as an adjunct to SRP, showed promising results, when compared to SRP alone. Healthy microflora can be maintained for a longer period of time and delay in the repopulation by periodontopathic microorganisms was observed.

Aim: The aim was to assess the levels of HbA1c, C-reactive protein, and lipid profile in patients with type 2 diabetes mellitus by treating the pockets using collagen impregnated sustained release resorbable tetracycline fiber (periodontal plus AB fiber) following scaling and root planing (SRP). Materials and Methods: A total of 40 patients with type 2 diabetes mellitus were randomly distributed into two groups receiving either SRP and tetracycline fiber or SRP alone. Patients were evaluated clinically with gingival index, plaque index, probing depth, and relative attachment level, and bio-chemically with HbA1c, C Reactive Protein, and lipid profile at baseline, 1 month, and 3 months. Results: Significant reduction in all the clinical parameters was seen in the tetracycline group compared to the control group. Bio-chemical analysis also revealed similar results except for cholesterol and High density lipoprotein who did not show any significant reduction. Conclusion: Locally delivered tetracycline as a better treatment modality compared to SRP alone.

Background: This study was carried out to investigate the effectiveness of a propolis-containing mouthrinse in inhibition of plaque formation and improvement of gingival health. Materials and Methods: Thirty subjects were selected and randomly assigned into three groups of ten subjects each, which received a propolis-containing mouthrinse, or a negative control (Saline) or a positive control (Chlorhexidine 0.2%). Plaque index and gingival index were assessed at baseline and at a five-day interval. Results: Chlorhexidine mouthwash was found to be better than propolis and saline in inhibiting plaque formation. Propolis was found to be only marginally better than chlorhexidine in improving gingival scores. Conclusion : The present study suggests that propolis might be used as a natural mouthwash, an alternative to chemical mouthwashes, e.g., chlorhexidine. Further, long term trials are required for more accurate data and any conclusive evidence.

Background: Periodontal diseases are chronic bacterial infections that lead to gingival inflammation, periodontal tissue destruction, and alveolar bone loss. Acting as powerful allies in the fight against periodontal disease, natural compounds can help safeguard against lethal age-related diseases that emanate from our mouths. Punica granatum (pomegranate) shrub belongs to the Punicaceae family which has been used as an astringent, hemostatic, antidiabetic, antihelmintic, and also for diarrhea and dysentery. The aim of the present work was to investigate the possible efficacy of hydroalcoholic extract from Punica granatum fruit as an antiplaque and antigingivitis agent when compared with chlorhexidine. Materials and Methods: Twenty subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into two groups: Group 1 - Pomegranate mouthwash and Group 2 - Chlorhexidine mouthwash. Punica granatum mouthwash was prepared using raw Punica granatum fruit. Patients were instructed to use the prescribed mouthwash for 15 days. Clinical evaluation was undertaken using the gingival index, the plaque index, and bleeding on probing at baseline, 7 days, and 15 days. Results: The clinical study observed significant improvement in gingival status in both the sites (P

Periodontal infections can act as focus of infection, aggravating the immunocompromised state of End Stage Renal Disease patients (ESRD). Aim: Evaluation of the periodontal health status of ESRD patients undergoing haemodialysis and establishing the underlying association between renal failure and periodontal disease. Material and Methods: Eighty control and test subjects were included in the study, after matching age and sex. Creatinine and GFR were measured in each patient. Oral hygiene indexSimplified (OHI-S), Gingival Index (GI), Pocket Depth (PD) and Clinical Attachment Level (CAL) were recorded as periodontal parameters to assess the correlation between the subjects of the two groups. Further, the test group was divided into three sub–groups, on basis of duration, as less than 6 months, from 6 months to one year and more than one year. Statistical Analysis: Student’s t – test and ANOVA were used to analyze the inter–group and intragroup comparisons. Results: Statistical significant difference was observed for all periodontal parameters between the test and control group. However, difference amongst periodontal parameters on basis of duration of haemodialysis was seen between the subgroups of test subjects, it was not found to be statistically significant. Conclusion: Severity of periodontal diseases in ESRD patients undergoing haemodialysis majorly affected due to debilitating condition of the subjects. Dialysis vintage has only a small role to play in worsening of the condition. Further research is needed to potentiate the establishment of two–way relationship between renal disease and periodontal condition.