Periodontal inflammatory conditions among gutka chewers and non-chewers with and without prediabetes

Oral Yeasts Carriage in Prediabetic Smokers and Nonsmokers

BACKGROUND

Habitual smoking and prediabetes are independent risk factors for increased oral yeasts carriage (OYC); however, no studies have compared OYC amongst cigarette smokers and nonsmokers with and without prediabetes. The aim was to fill this research gap.

METHODS

Ninety-two participants were included and categorised into 4 groups: group 1, prediabetic (haemoglobin A1c [HbA1c] levels, 5.7%-6.4%) cigarette smokers; group 2, cigarette smokers without prediabetes; group 3, prediabetic nonsmokers; and group 4, nonsmokers without prediabetes. Patient demographics and HbA1c levels were recorded. Data on duration of smoking habit (pack-years) and family history of smoking were collected. Information on daily toothbrushing and flossing and most recent visit to a dentist/dental hygienist was gathered. Clinical and radiographic periodontal examination was performed and unstimulated whole salivary flow rate (UWSFR) was determined. OYC was assessed using the oral rinse sampling method. Power analysis was done, and group comparisons were performed. Logistic regression analysis was performed and P values <5% reflected statistical significance.

RESULTS

Respectively, 23, 24, 22, and 23 individuals with comparable mean ages were included in groups 1, 2, 3, and 4. In groups 1 and 2, participants had a smoking history of (mean ± SD) 24.7 ± 3.2 and 10.6 ± 2.5 pack-years. Plaque index, clinical attachment loss, and probing depth were higher in groups 1 (P < .05), 2 (P < .05), and 3 (P < .05) than in group 4. Number of missing teeth was significantly higher in group 1 compared with groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). There was no difference in UWSFR amongst the groups. OYC was greater in group 1 than in groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). OYC was greater in groups 2 (P < .05) and 3 (P < .05) than in group 4.

CONCLUSIONS

In prediabetic cigarette smokers, OYC appears to be influenced by hyperglycaemia, whilst in nondiabetic smokers, the severity of periodontal inflammation appears to be the determining factor in OYC.

Prevalence of Non-diabetic Hyperglycemia in Young Adults and Its Impact on Periodontal Health

Background Non-diabetic hyperglycemia is a transitional phase of hyperglycemia that poses a hidden risk for the development of diabetes mellitus and related complications, including periodontal destruction. The current study sought to determine the prevalence of non-diabetic hyperglycemia in young adults and any possible links to periodontal health. Methods A total of 400 participants in this cross-sectional study were evaluated for non-diabetic hyperglycemia between the ages of 18 and 35 years. Group I consisted of non-diabetic hyperglycemic participants. Group II comprised an equal number of matched, healthy subjects. The groups' hyperglycemic and clinical periodontal characteristics were contrasted. Using a one-sample t-test and logistic regression analysis, the acquired data were subjected to statistical analysis. Results The prevalence of non-diabetic hyperglycemia was 19%, with men (13%) having a higher prevalence than women (6%). The mean fasting plasma glucose and hemoglobin A1c (HbA1c) levels were 114.47 ± 6.40 mg/dL and 6.10 ± 0.21%, respectively, for group I, and 85.72 ± 7.24 mg/dL and 4.38 ± 0.70% for group II. When compared to healthy controls, all periodontal parameters, including plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment loss, were significantly higher in group I non-diabetic hyperglycemic patients. The regression analysis revealed statistically significant links between hyperglycemic and periodontal parameters. Conclusion The prevalence of non-diabetic hyperglycemia among young adults is a serious concern similar to that of older adults with the risk for periodontal diseases. Non-diabetic hyperglycemic considerations in young adults should be emphasized in dental and medical clinics to reduce the risk of developing diabetes mellitus and to avoid irreversible periodontal tissue damage.

Factors in oral-related quality of life of betel quid users receiving oral mucosal screening: a cross‑sectional study in Taiwan

BACKGROUND

Betel quid (BQ) chewing is associated with poor oral hygiene, psychological impairment, and acute and long-term addictive effects, resulting in worse oral-related quality of life (OHRQoL). The purpose of this study was to characterize the factors associated with OHRQoL among BQ users receiving oral mucosal screening.

METHODS

A cross-sectional study was conducted. Data were collected by random sampling of BQ users who visited outpatient departments receiving oral mucosal screening in a medical center Taiwan. The oral health assessment tool, the state anxiety inventory, the betel quid dependence scale, and the oral health impact profile were used to measure oral health status, anxiety, BQ dependence, and OHRQoL, respectively. Pearson's product-moment coefficient was used to examine the relationship between OHRQoL and the selected independent variables. Independent-samples t-test was used to compare OHRQoL by annual family income, the presence of chronic disease, and BQ dependence. Hierarchical multiple linear regression analysis was used to identify factors associated with OHRQoL.

RESULTS

A total of 175 BQ users were surveyed. Factors associated with OHRQoL included oral health status, anxiety, and BQ dependence. BQ users reporting low oral health status, greater anxiety, and more BQ dependence were more likely to have worse OHRQoL.

CONCLUSIONS

Poor oral health status, anxiety, and BQ dependence negatively impact on OHRQoL among patients with BQ use receiving oral mucosal screening.

Tobacco-product usage as a risk factor for dental implants

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine. A limited number of animal studies have assessed the effect of nicotine on osseointegration. Results from experimental studies have reported a statistically significant decrease, at 4 weeks of follow-up, in bone-to-implant contact among rats exposed to nicotine compared with unexposed rats. Nicotine increases the production of inflammatory cytokines (such as interleukin-6 and tumor necrosis factor-alpha) by osteoblasts. Waterpipe, pipe, and cigarette smokers are at increased risk of developing oral cancer, periodontal disease, and alveolar bone loss. One explanation for this is that smokers (regardless of the type of tobacco product) are exposed to similar chemicals, such as nicotine, tar, oxidants, polyaromatic hydrocarbons, and carbon monoxide. Moreover, raised levels of proinflammatory cytokines have been identified in the gingival crevicular fluid of cigarette smokers with peri-implant diseases. Therefore, it is hypothesized that nicotine and chemicals in tobacco smoke induce a state of oxidative stress in peri-implant tissues (gingiva and alveolar bone), thereby increasing the likelihood of peri-implant disease development via an inflammatory response, which if left uncontrolled, will result in implant failure/loss. In this regard, tobacco smoking (including cigarettes, waterpipe, and pipe) is a significant risk factor for peri-implant diseases. The impact of vaping electronic cigarettes using nicotine-containing e-juices remains unknown. Habitual use of smokeless tobacco products is associated with oral inflammatory conditions, such as oral precancer, cancer, and periodontal disease. However, the effect of habitual use of smokeless tobacco products on the success and survival of dental implants remains undocumented.

Candida sp. Infections in Patients with Diabetes Mellitus

Candidiasis has increased substantially worldwide over recent decades and is a significant cause of morbidity and mortality, especially among critically ill patients. Diabetes mellitus (DM) is a metabolic disorder that predisposes individuals to fungal infections, including those related to Candida sp., due to a immunosuppressive effect on the patient. This review aims to discuss the latest studies regarding the occurrence of candidiasis on DM patients and the pathophysiology and etiology associated with these co-morbidities. A comprehensive review of the literature was undertaken. PubMed, Scopus, Elsevier’s ScienceDirect, and Springer’s SpringerLink databases were searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. Results of the review show that DM patients have an increased susceptibility to Candida sp. infections which aggravates in the cases of uncontrolled hyperglycemia. The conclusion is that, for these patients, the hospitalization periods have increased and are commonly associated with the prolonged use of indwelling medical devices, which also increase the costs associated with disease management.

Impact of jaw location on clinical and radiological status of dental implants placed in cigarette-smokers and never-smokers: 5-year follow-up results

PURPOSE

The aim of this 60 months follow-up investigation was to investigate the impact of jaw location on clinical and radiological status of dental-implant therapy in cigarette-smokers and never-smokers.

MATERIALS AND METHODS

Twenty-nine self-reported cigarette-smokers and 27 nonsmokers were assessed. All implants were categorized into three regions with reference to their location in the maxilla or mandible: (a) Anterior zone: implants located in anterior teeth; (b) Middle zone: Implants located in the premolar region; and (c) posterior zone: implants located in the molar region. Peri-implant crestal bone loss (CBL), bleeding-on-probing (BOP) and probing-depth (PD) ≥ 4 mm and were assessed. Level of statistical significance was set at P < .05.

RESULTS

Mean age of cigarette-smokers (n = 29) and never-smokers (n = 27) was 44.5 years (39-51 years) and 43.6 years (35-49 years), respectively. The average duration of cigarette-smoking was 20.3 years (17-26 years). The mean periimplant PD (P < .05) and CBL (P < .05) were significantly higher in cigarette-smokers in contrast to never-smokers in all zones. No statistically significant differences in CBL, PD, and BOP were observed in the three zones of implant location among cigarette-smokers and never-smokers.

CONCLUSION

Smoking enhanced PD and CBL around dental implants and this relationship was independent of site of implant placement and jaw location.

Self-perceived oral symptoms and periodontal inflammatory conditions in habitual naswar dippers

Objectives:

To compare self-perceived oral symptoms and clinical (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [CAL]) and radiographic (marginal bone loss [MBL]) periodontal parameters among naswar (NW) and non-naswar dippers (NNW).

Methods:

One hundred and forty-two individuals (72 patients consuming naswar and 70 controls) were included. All participants completed a baseline questionnaire that included information regarding demographic characteristics and self-perceived oral symptoms. Clinical periodontal parameters (PI, BOP, PD and CAL) were recorded. MBL was measured on digital panoramic radiographs.

Results:

Pain in teeth, pain on chewing, bleeding gums and burning sensation in the mouth was significantly worse among NW than NNW (p<0.01). Clinical periodontal parameters and MBL were significantly high in NW than NNW (p<0.001). There was statistically significant influence of daily use and mean duration of naswar consumption on the severity of PI, BOP, PD (4 to 6 and >6 mm) and MBL among NW group.

Conclusions:

Self-perceived oral symptoms and periodontal parameters were worse among naswar dippers. It is highly recommended that naswar dipping should be considered a potential threat that could have major effects on periodontal tissues.

Influence of implant location in patients with and without type 2 diabetes mellitus: 2-year follow-up

The aim of the present cross-sectional retrospective 2-year follow-up clinical study was to assess the influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). Twenty-seven patients with T2DM and 25 non-diabetic controls were included. Implants were classified into three zones according to their location: (1) anterior zone: implant/s replacing anterior teeth, (2) middle zone: implant/s replacing premolars, and (3) posterior zone: implant/s replacing molars. Peri-implant bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were measured. P-values less than 0.05 were considered statistically significant. The mean age of patients with T2DM was 42.5 years and that of non-diabetic controls was 40.6 years. The mean fasting blood glucose levels of patients with and without T2DM were 74.5mg/dl (66-80mg/dl) and 82.5mg/dl (79-88.1mg/dl), respectively. The mean duration of T2DM was 4.3 years. There was no significant difference in BOP, PD, or CBL around implants placed in any of the zones in the jaws of patients with and without T2DM. There is no influence of implant location on clinical and radiographic parameters around dental implants placed in patients with and without T2DM.

Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users

OBJECTIVE

The aim was to investigate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant to mechanical curettage (MC) in the treatment of periimplant mucositis in smokeless tobacco (ST) product users.

METHODS

Forty-eight ST product users with periimplant mucositis were randomly divided into 2 groups. In the test-group, participants underwent periimplant MC with adjunct aPDT; and in the control-group, the patients underwent MC alone. Periimplant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were measured at baseline and after 3-months of follow-up. Statistical analysis was performed using the Kruskal-Wallis test. Level of significance was set at P<0.05.

RESULTS

At baseline, periimplant PI, BOP and PD were comparable among individuals in the test- and control groups. At 3-months follow-up, scores of periimplant PI (P<0.05), BOP (P<0.05) and PD (P<0.05) were statistically significantly higher among patients in the control-group compared with the test-group. At 3-months follow-up, the percentages of sites of PI, BOP and PD were statistically significantly higher in the control-sites as compared to the test-sites.

CONCLUSION

Among patients with periimplant mucositis, MC with adjunct aPDT is more effective in reducing periimplant inflammation in ST product users as compared to MC alone; however, the present result should be interpreted with caution as they were based on a short-term follow-up. Further long-term studies are needed in this regard.

Effect of scaling and root planing with and without adjunctive use of an essential-oil-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic patients

AIM

The aim was to assess the effect of scaling and root planing (SRP) with and without adjunctive use of an essential-oil (EO)-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic (T2D) patients.

METHODS

Sixty T2D patients were included. In Group 1 (n = 30), SRP was performed and patients were instructed to rinse twice daily with EO-based oral rinse for 30 days. In Group 2 (n = 30), SRP was performed and participants were instructed to rinse twice daily with water for 30 days. Periodontal parameters (plaque index (PI), bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 4 mm) and hemoglobin A1c (HbA1c) levels were assessed at baseline and after 90 days.

RESULTS

In both groups, periodontal parameters were similar at baseline. After 90 days of follow-up, there was a significant reduction in the severity of periodontal parameters in patients in Group 1 compared with Group 2. After 90 days of follow-up, there was also a significant reduction in HbA1c among patients in Group 1 compared with Group 2.

CONCLUSIONS

Scaling and root planing with adjunct use of an EO-based oral rinse is more effective in the treatment of periodontal inflammation in T2D patients than SRP alone. This approach also helps reduce hyperglycemia in T2D patients as compared with when SRP is performed alone.

Does incorporating zinc in titanium implant surfaces influence osseointegration? A systematic review

STATEMENT OF PROBLEM

Titanium implant surfaces have been modified to improve osseointegration; however, the evidence for incorporating zinc into titanium implants to improve new bone formation and osseointegration is not clear.

PURPOSE

The purpose of this systematic review was to assess the efficacy of treating titanium surfaces with zinc on the osseointegration of implants.

MATERIAL AND METHODS

The focused question addressed was, "Does incorporating zinc in titanium implant surfaces influence osseointegration?" Indexed databases were searched up to January 2016 using the key words "Bone to implant contact"; "implant"; "zinc"; "osseointegration." Letters to the editor, case reports/case series, historic reviews, and commentaries were excluded. The pattern of the review was customized to summarize the pertinent data.

RESULTS

Ten experimental studies were included, all of which were performed in animals (5 in rabbits, 4 in rodents, and 1 in goats). The number of titanium implants placed ranged from 10 to 78. The results from all studies showed that incorporating zinc into titanium implants enhanced new bone formation and/or bone-to-implant contact around implants. One study reported that zinc enhanced the removal torque on implants.

CONCLUSIONS

The current available evidence on adding zinc to titanium implants surfaces to enhance osseointegration remains unclear. Further investigation is necessary to assess its effectiveness and safety in humans and to establish a standard methodology and ideal compound for incorporating zinc ion into titanium implant surfaces in a clinical setting.

Comparison of Peri-Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non-Smokers: 5-Year Follow-Up Results

BACKGROUND

The aim of this study is to compare peri-implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non-smokers.

METHODS

Thirty-one patients with IL implants (16 smokers and 15 non-smokers) and 30 patients with DL implants (17 smokers and 13 non-smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri-implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05).

RESULTS

All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non-smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non-smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non-smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants.

CONCLUSIONS

Tobacco smoking enhances peri-implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri-implant hard and soft tissue status in healthy smokers and non-smokers.

Comparison of clinical periodontal status among habitual smokeless-tobacco users and cigarette smokers

AIM

Investigating the comparative effect of cigarette smoking and smokeless-tobacco use on periodontal health.

BACKGROUND

There is a dearth of studies comparing the effects of smoking and smokeless tobacco on periodontal health. Smokeless tobacco is emerging as a major public health hazard, but is often neglected as a risk factor by many clinicians.

MATERIALS AND METHODS

A cross-sectional study of 286 subjects was conducted. The participants were divided into mutually exclusive groups (i.e. any subject who had the habit of both smoking as well as smokeless tobacco usage was excluded from the study), as follows: a smoking group (SG; n=121); a smokeless-tobacco group (ST; n=81); and a non-tobacco-consuming group (NT; n=84). Data were obtained using a questionnaire and by clinical examination. The Periodontal Disease Index (PDI) and Oral Hygiene Index-Simplified (OHI-S) were used to clinically evaluate the periodontal and dental health status of the subjects. Multivariate analysis was performed to identify statistical correlations.

RESULTS

The Plaque Index was higher in the ST group than in the SG group and was statistically significantly higher in the ST group than in the NT group. Probing depth and gingival inflammation (components of the PDI) were also higher in the ST group than in the SG and NT groups, but this was not statistically significant.

CONCLUSIONS

Within the limits of the study, and for this study population, the impact on the periodontium as a result of smokeless tobacco use appeared to be comparable with that of smoking tobacco. The results of this study affirm the need to consider smokeless tobacco as a possible contributory factor to periodontal disease, in addition to smoking, and to counsel patients accordingly. Further randomised clinical trials are necessary to validate the long-term impact of smokeless tobacco on periodontal disease.

Prediabetes Enhances Periodontal Inflammation Consistent With Activation of Toll-Like Receptor-Mediated Nuclear Factor-κB Pathway in Rats

BACKGROUND

Clinical studies have showed that prediabetes (preDM) is a predisposing factor for periodontitis. However, the pathogenic mechanism involved is unclear. Because it is known that the activation of Toll-like receptor (TLR)-mediated nuclear factor-kappa B (NF-κB) signaling pathway plays a crucial role in periodontitis, it is hypothesized that preDM enhances periodontal inflammation by activation of the TLR-mediated NF-κB pathway.

METHODS

In this study, a preDM rat model is established by feeding a high-fat diet (HFD). HFD-induced rats with preDM (n = 7) and normal chow-fed rats (n = 7) were studied. The animal model was characterized in terms of body weight and the glycemic and insulinemic profiles. The following parameters were assessed to evaluate possible early periodontal alterations and underlying mechanisms: 1) histology analysis of periodontal tissue; and 2) serum and mRNA levels and/or the tissue protein expression of TLRs, myeloid differentiation factor 88 (MyD88), tumor necrosis factor (TNF) receptor-associated factor 6 (TRAF6), NF-κB, cytokines, advanced glucose ends (AGEs), and free fatty acids (FFAs).

RESULTS

Rats with preDM presented higher expression of TLR2 and TLR4 in periodontal tissue in the HFD group compared with the control group. The TLR2 and TLR4 was mostly expressed in gingiva, and TLR4 was expressed in periodontal ligament in rats. Furthermore, the MyD88 and TRAF6 protein levels were significantly increased in gingiva in rats with preDM compared with normal rats. The activity of NF-κB signals was higher in rats with preDM than in normal rats. Regarding cytokines expression, the TNF-α protein levels and interleukin-1β mRNA levels were significantly increased in the HFD group compared with the control group. In the serum, AGEs levels were significantly increased in the rats with preDM. Mean FFAs concentrations were increased in rats with preDM compared with normal rats, but it did not reach statistical significance.

CONCLUSION

In rats with preDM, TLR2 and TLR4 gene and protein levels were higher in periodontal tissue, and the activation of NF-κB may, through TLRs/MyD88, cause more cytokine secretion, which is associated with the onset or development of periodontal disease.

Short-term effects of scaling and root planing with or without adjunctive use of an essential-oil-based mouthwash in the treatment of periodontal inflammation in smokers

OBJECTIVE

The aim of the present short-term follow-up study was to assess the effects of scaling and root planing (SRP) with or without adjunctive use of an essential-oil-based mouthwash in the treatment of periodontal inflammation in smokers.

METHODS

In total, 120 individuals were divided into 2 groups. In Group-1, 60 smokers with periodontal inflammation received SRP alone; and in Group-2, 60 smokers with periodontal inflammation received adjunct essential-oil mouthwash therapy. Periodontal parameters (plaque index [PI], bleeding-on-probing [BOP], and probing pocket depth [PD] ≥ 4 mm) were assessed at baseline and after 90 days of treatment.

RESULTS

There was no significant difference in periodontal parameters (PI, BOP, and PD ≥ 4 mm) among participants in Group-1 and -2. Participants in both groups showed significant reductions in PI (P < 0.01), BOP (P < 0.01), and PD ≥ 4 mm (P < 0.01) at follow-up compared to baseline. At 90 days of follow-up, PI (P < 0.05), BOP (P < 0.05), and PD ≥ 4 mm (P < 0.05) were significantly higher in Group-1 compared to Group-2.

CONCLUSIONS

SRP with adjunct essential-oil mouthwash therapy is more effective in the treatment of periodontal inflammation in smokers as compared to when SRP is performed alone.

Is there a relationship between periodontal disease and oral cancer? A systematic review of currently available evidence

Oral cancer (OC) is known to have a multi-factorial etiology; tobacco, alcohol and betel quid being the major risk factors. Tooth loss and periodontal disease (PD) have been implicated to increase the risk of developing various cancers. The aim of this systematic review was to assess any possible association between PD and OC. Indexed databases were searched using different combinations of the following key words: "oral cancer", "periodontal disease", "tooth loss", "squamous cell carcinoma", "missing teeth" "alveolar bone loss", "clinical attachment loss" and "periodontitis". PRISMA criteria were followed to accrue data and databases were searched from 1984 up to and including June 2015. In total, 12 case-control studies were selected from the published literature.

RESULTS

Nine studies reported a 2-5 fold increase in the risk of OC among patients with PD as compared to those without PD. Three studies reported no association between PD and OC. In one study, an increased risk of tongue cancer was associated with each millimeter of alveolar bone loss and in two studies clinical attachment loss of more than 1.5mm was associated with an increased risk of OC. In studies reporting significant findings these associations persisted after adjusting for major risk factors. PD is associated with a small but significant increase in risk for OC. In several reported studies this association was attenuated following adjustment for tobacco and alcohol use.

Comparison of an essential-oil-based oral rinse and chlorhexidine as adjuncts to scaling and root planing in the treatment of periodontal inflammation

OBJECTIVE

The aim of the present short-term follow-up study was to compare the effects of an essential oil (EO)-based oral rinse and chlorhexidine as adjuncts to scaling and root planing (SRP) in the treatment of periodontal inflammation.

METHODS

In Group-1, SRP was performed and participants were instructed to rinse with EO-based oral rinse; in Group-2, SRP was performed and participants were instructed to rinse with chlorhexidine; and in Group-3, SRP was performed and participants were instructed to rinse with water. Periodontal parameters (plaque index [PI], bleeding-on-probing [BOP], and probing pocket depth [PPD] ≥ 4 mm) were assessed at baseline and after 7 and 30 days.

RESULTS

In all groups, periodontal parameters (PI, BOP, and PPD ≥ 4 mm) were comparable at baseline. In Groups-1 and -2, there was a significant reduction in PI (P < 0.01), BOP (P < 0.01), and PD ≥ 4 mm after 7 days and 30 days of follow-up than baseline. In Group-3, there was a significant reduction in PI (P < 0.01) and BOP (P < 0.01) after 7 days of follow-up compared to baseline. There was no difference in periodontal parameters after 7 days and 30 days of follow-up in Groups-1 and -2.

CONCLUSION

EO-based oral rinses and chlorhexidine digluconate (CHX) are acceptable adjuncts to SRP in the treatment of periodontal inflammation.

Impact of scaling and root planing on clinical periodontal status and glycemic levels in prediabetic patients

OBJECTIVE

The aim was to assess the effect of scaling and root planing (SRP) on clinical periodontal parameters and glycemic levels in prediabetic patients.

METHODS

Fifty prediabetic patients with periodontal disease were included. Demographic data (age, gender, education status, duration of prediabetes, type of treatment adopted for prediabetes management, and oral hygiene maintenance protocols) were recorded using a questionnaire. Patients were randomly divided into two groups (25 patients/group). In Group 1, SRP alone was performed, in Group 2, SRP + oral doxycycline (100 mg) administration. In both groups, fasting blood glucose (FBG) levels and periodontal parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD]) were assessed at baseline and after 6 months. Statistical analysis was performed using one-way analysis of variance.

RESULTS

Age, gender, and duration and treatment of prediabetes were comparable among patients in Groups 1 and 2. PI, BOP, and PD significantly reduced in both groups than baseline values. Reduction in periodontal parameters among Groups 1 and 2 were comparable. There was no significant reduction in FBG levels among patients in Groups 1 and 2 after 6 months of SRP.

CONCLUSION

SRP was effective in reducing periodontal inflammation in prediabetic patients. FBG levels did not show any significant difference after SRP in both groups.

Periodontal Status and Whole Salivary Cytokine Profile Among Smokers and Never-Smokers With and Without Prediabetes

BACKGROUND

Whole salivary interleukin (IL)-1β and IL-6 in smokers and never-smokers with prediabetes remains uninvestigated. The aim of this study is to assess the periodontal status and whole salivary IL-1β and IL-6 levels among smokers and never-smokers with and without prediabetes (controls).

METHODS

Ninety-five males (45 with prediabetes and 50 systemically healthy controls) were included. Twenty-seven controls and 29 patients with prediabetes were smokers. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, and marginal bone loss) were measured, and the number of missing teeth were recorded. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded. Unstimulated whole saliva samples were collected, unstimulated whole salivary flow rate (UWSFR) was determined, and IL-1β and IL-6 levels were measured. P values <0.05 were considered statistically significant.

RESULTS

FBG (P <0.05) and HbA1c (P <0.05) levels were higher among patients with prediabetes than controls. All patients with prediabetes were hyperglycemic. UWSFR was significantly higher among controls than among patients with prediabetes (P <0.05). Periodontal parameters and whole salivary IL-1β and IL-6 levels were comparable among smokers and never-smokers with prediabetes. Among controls, periodontal parameters and whole salivary IL-1β and IL-6 levels were higher among smokers than never-smokers (P <0.05).

CONCLUSIONS

Among controls, periodontal inflammation was worse, and whole salivary IL-1β and IL-6 levels are higher in smokers than never-smokers. Among patients with prediabetes, periodontal inflammation and whole salivary IL-1β and IL-6 levels were comparable between smokers and never-smokers.

Association between glycemic status and oral Candida carriage in patients with prediabetes

OBJECTIVE

This study assessed the association between glycemic status and oral Candida carriage among patients with prediabetes.

STUDY DESIGN

This was a comparative study of oral Candida carriage among individuals with prediabetes. Oral yeast samples were collected from 150 individuals: group A was 43 patients with prediabetes (fasting blood glucose levels and hemoglobin A1c, 100 to 125 mg/dL and ≥5%, respectively); group B was 37 individuals previously considered prediabetic but having fasting blood glucose levels <100 mg/dL and hemoglobin A1c <5%; and group C was 70 medically healthy individuals. Oral yeasts were identified using standard techniques. Unstimulated whole salivary flow rate and number of missing teeth were recorded.

RESULTS

Oral Candida was isolated from 100% of patients with prediabetes and from 65.7% of control participants. Candida albicans carriage was higher among patients with prediabetes (48.7%) (P < .01) and patients in group A (51.2%) (P < .01) than among controls (25.7%). Candida carriage, unstimulated whole salivary flow rate, and number of missing teeth were similar in groups A and B.

CONCLUSIONS

Oral Candida carriage was higher in patients with prediabetes than in controls and was independent of glycemic status in patients with prediabetes.

Self-perceived oral health and periodontal parameters in chronic periodontitis patients with and without rheumatoid arthritis

AIM

It is hypothesized that self-perceived oral health and periodontal status are worse in chronic periodontitis (CP) patients with rheumatoid arthritis (RA) compared to CP patients without RA. The aim of the present study was to assess self-perceived oral health and periodontal parameters in CP patients with and without RA.

METHODS

Fifty CP patients with RA and 50 CP patients without RA were included. Information regarding sociodemographic characteristics and self-perceived oral symptoms were collected using a questionnaire. Periodontal parameters (plaque index, bleeding on probing, probing depth, clinical attachment loss, number of missing teeth, and marginal bone loss) were recorded.

RESULTS

There was no significant difference in socioeconomic status, education status, self-perceived oral symptoms, and periodontal parameters among CP patients with and without RA.

CONCLUSIONS

Self-perceived oral health and periodontal parameters are mainly governed by the intensity of CP, and the role of RA in this context seems to be rather secondary.

Effect of nonsurgical periodontal therapy (with or without oral doxycycline delivery) on glycemic status and clinical periodontal parameters in patients with prediabetes: a short-term longitudinal randomized case-control study

OBJECTIVE

The aim of the present short-term longitudinal randomized case-control study was to assess the effect of nonsurgical periodontal therapy (NSPT) (with and without oral doxycycline delivery) on glycemic status and clinical periodontal parameters in patients with prediabetes.

MATERIAL AND METHODS

Sixty-six patients with prediabetes and periodontal disease were included. Characteristics of the study cohort (age, gender, socioeconomic status [SES] education status, duration of prediabetes, and type of treatment adopted for prediabetes management) were recorded. Patients were randomly divided into two groups (33 patients/group). In group 1, scaling and root planing (SRP) was performed, and in group-2, patients underwent SRP and oral doxycycline (100 mg) administration once daily for 15 days. In each group, the following parameters were investigated at baseline and after 3 months: (a) fasting blood glucose level (FBGL), (b) hemoglobin A1c (HbA1c), and (c) periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], and clinical attachment loss [AL]). Statistical analysis was performed using Student's t test.

RESULTS

There was no significant difference in age, gender, SES, education status, and duration and treatment of prediabetes among individuals in groups 1 and 2. Three months post-NSPT, FBGL and HbA1c were significantly reduced among patients in group 1 (P < 0.05) and group 2 (P < 0.05) compared to baseline. Three months post-NSPT, PI (P < 0.05), BOP (P < 0.05), and PD (P < 0.05) were significantly reduced among patients in group 1 (P < 0.05) and group 2 (P < 0.05) compared to baseline. There was no difference in clinical AL between the groups after 3 months of NSPT.

CONCLUSION

NSPT (with and without oral doxycycline delivery) reduces hyperglycemia and periodontal inflammation in patients with prediabetes.

Cytokine profile in the gingival crevicular fluid of rheumatoid arthritis patients with chronic periodontitis

The aim was to assess the cytokine profile in the gingival crevicular fluid (GCF) of rheumatoid arthritis (RA) patients with chronic periodontitis (CP). Databases were searched from 1991 to August 2013 using a combination of various keywords. Eight studies were included. The GCF concentrations of interleukin (IL)-1β, IL-4, IL-10, matrix metalloproteinase (MMP)-8, MMP-13 and tumor necrosis factor-alpha (TNF-α) were reported to be higher in patients with RA than in healthy controls (HC) without CP. In one study, TNF-α levels in GCF were significantly higher in HC than in RA patients receiving anti-TNF-α therapy. One study reported no significant difference in GCF TNF-α levels among RA patients and HC regardless of anti-TNF-α therapy. One study reported no difference in IL-1β and prostaglandin E2 levels among RA patients and HC with CP. Raised levels of proinflammatory cytokines are exhibited in the GCF of RA patients with CP.

Whole salivary interleukin-6 and matrix metalloproteinase-8 levels in patients with chronic periodontitis with and without prediabetes

BACKGROUND

The cytokine profile in unstimulated whole saliva (UWS) of patients with prediabetes and chronic periodontitis (CP) remains uninvestigated. The aim of this study is to assess interleukin (IL)-6 and matrix metalloproteinase (MMP)-8 levels in UWS of patients with CP with and without prediabetes.

METHODS

Eighty-eight males (aged 39 to 51 years) were divided into three groups: group 1: 28 patients with CP and prediabetes; group 2: 30 patients with CP and without prediabetes; and group 3: 30 controls. Fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, periodontal parameters (plaque index, bleeding on probing, probing depth, attachment loss, and marginal bone loss), and number of missing teeth were recorded. UWS samples were collected, and UWS flow rate (UWSFR) was measured. IL-6 and MMP-8 were measured in UWS using enzyme-linked immunosorbent assay. P values <0.05 were considered statistically significant.

RESULTS

Mean FBG and HbA1c levels were significantly higher in group 1 (119.3 ± 3.1 mg/dL and 6.1% ± 0.2%) than group 2 (80.1 ± 3.5 mg/dL and 4.8% ± 0.5%; P <0.001) and group 3 (75.3 ± 2.2 mg/dL and 4.3% ± 0.2%; P <0.05). UWSFR was significantly higher in groups 2 (0.53 ± 0.1 mL/minute; P <0.05) and 3 (0.51 ± 0.1 mL/minute; P <0.01) than group 1 (0.33 ± 0.05 mL/minute). Periodontal parameters were worse in group 1 (P <0.05) and group 2 (P <0.05) than group 3. There was no difference in periodontal parameters, numbers of missing teeth, or salivary IL-6 and MMP-8 levels between patients in groups 1 and 2.

CONCLUSION

Salivary IL-6 and MMP-8 levels are elevated in patients with CP with and without prediabetes.

Re-stability of dental implants following treatment of peri-implantitis

It is hypothesized that active treatment of peri-implantitis (PI) leads to re-stabilization of dental implants. The aim was to assess whether or not dental implants can re-stabilize following treatment of PI. To address the focused question, MEDLINE/PubMed and Google-Scholar databases were explored from 1977 up to and including August 2013. Any disagreements between the authors were resolved via discussion. Articles published only in English were included. Hand searching was also performed. Thirteen experimental studies were included. The treatment regimes adopted in these studies comprised of antibiotic therapy, guided bone regeneration (GBR), laser therapy, use of bone matrix proteins with membrane, conventional flap surgery and mechanical debridement. In four studies, GBR promoted new bone formation; whereas two studies showed photosensitization therapy (in combination with either mechanical debridement or GBR) to regenerate bone around peri-implant defects. Six studies reported that mechanical debridement in conjunction with antibiotic therapy promoted re-stability of dental implants. In one study, recombinant human bone matrix protein-2 with a collagen membrane helped promote re-stabilization of dental implants. New bone formation may occur to some extent around dental implants following treatment for PI; however, a "complete" re-stability may be difficult to achieve without GBR.

Histomorphometric analysis of bone regeneration using a dual layer of membranes (dPTFE placed over collagen) in fresh extraction sites: a canine model

In untreated extraction sockets, buccal bone remodeling compromises the alveolar ridge width. The aim of this study was to histologically assess the efficacy of using a dual layer of membranes (high-density polytetrafluoroethylene [dPTFE] placed over collagen) for ridge preservation in fresh extraction sites. Eight beagle dogs were used. After endodontic treatment of mandibular bilateral second (P2), third (P3), and fourth (P4) premolars, mandibular bilateral first premolars and distal roots of P2, P3, and P4 were extracted atraumatically. Animals were randomly divided into 4 treatment groups. group 1, the control group, received no treatment; in group 2, allograft was placed in the alveolum and the socket covered with dPTFE membrane; in group 3, allograft was placed in the alveolum, the buccal plate was overbuilt with allograft, and the socket was covered with dPTFE membrane; in group 4, allograft was placed in the alveolum and covered with dual layer of membranes (dPTFE placed over collagen). No intent of primary closure was performed for all groups. After 16 weeks, the animals were sacrificed and mandibular blocks were assessed histologically for buccolingual width of alveolar ridge, percentage of bone formation and bone marrow spaces, and the remaining bone particles. The buccolingual width of the alveolar ridge was significantly higher among sockets in group 4 than in group 1 (P < .05). the amount of newly formed bone in each socket was higher in extraction sockets in group 4 than in groups 1, 2, and 3 (P < .001). A significant difference was found in the percentage of bone marrow spaces among all groups (P < .001). No significant difference was found in the number of nonresorbed bone particles among the groups. Using a dual layer of membrane was more effective in ridge preservation than conventional socket augmentation protocols.

Effect of glycemic control on self-perceived oral health, periodontal parameters, and alveolar bone loss among patients with prediabetes

BACKGROUND

The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self-perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes.

METHODS

A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c ≥5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self-perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs.

RESULTS

Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self-perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self-perceived oral symptoms among patients with prediabetes in group B and healthy controls.

CONCLUSIONS

Self-perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.