Effect of insertion of xanthan-based chlorhexidine gel in the maintenance phase following the treatment of chronic periodontitis

Probiotics, tetracycline fibres and chlorhexidine gel's effectiveness in treating chronic periodontitis as a supplement to scaling and root planning

A periodontal pocket can result into progressive loss of attachment. Many agents are tried to improve periodontal health. Hence this research was done to estimate the effectiveness of Tetracycline fibers; Probiotics and Chlorhexidine gel as a conjunction to scaling and root planning (SRP) in the treatment of chronic periodontitis. In all, 60 patients between the ages of 25 and 35 who had generalized chronic periodontitis and had a probing pocket depth (PPD) of at least 5 mm were enrolled for this study. Four groups of 15 patients each were created from the patients: Group 1: Tetracycline fibres after SRP, Group 2: Chlorhexidine gel, Group 3: Probiotic mouthwash and Group 4: Rinse with regular saline. At baseline, oral prophylaxis was administered to all groups. Gingival index (GI), Plaque index (PI), and probing depth (PD), among other clinical indicators, were evaluated at baseline, two weeks, and four weeks, respectively. All clinical findings, along withPlaque index (PI), Gingival index (GI), and Probing depth at various time intervals, decreased statistically significantly. Tetracycline fibres, Chlorhexidine gel, and probiotic mouthwash are all similarly effective for treating chronic periodontitis, but they are all more effective than SRP alone, according to an intergroup comparison. When it comes to SRP, local medication delivery methods are beneficial in treating periodontitis.

Streptomyces rochei MS-37 as a Novel Marine Actinobacterium for Green Biosynthesis of Silver Nanoparticles and Their Biomedical Applications

Periodontitis, as one of the most common diseases on a global scale, is a public health concern. Microbial resistance to currently available antimicrobial agents is becoming a growing issue in periodontal treatment. As a result, it is critical to develop effective and environmentally friendly biomedical approaches to overcome such challenges. The investigation of Streptomyces rochei MS-37's performance may be the first of its kind as a novel marine actinobacterium for the green biosynthesis of silver nanoparticles (SNPs) and potentials as antibacterial, anti-inflammatory, antibiofilm, and antioxidant candidates suppressing membrane-associated dental infections. Streptomyces rochei MS-37, a new marine actinobacterial strain, was used in this study for the biosynthesis of silver nanoparticles for various biomedical applications. Surface plasmon resonance spectroscopy showed a peak at 429 nm for the SNPs. The SNPs were spherical, tiny (average 23.2 nm by TEM, 59.4 nm by DLS), very stable (-26 mV), and contained capping agents. The minimum inhibitory concentrations of the SNPs that showed potential antibacterial action ranged from 8 to 128 µg/mL. Periodontal pathogens were used to perform qualitative evaluations of microbial adhesion and bacterial penetration through guided tissue regeneration membranes. The findings suggested that the presence of the SNPs could aid in the suppression of membrane-associated infection. Furthermore, when the anti-inflammatory action of the SNPs was tested using nitric oxide radical scavenging capacity and protein denaturation inhibition, it was discovered that the SNPs were extremely efficient at scavenging nitric oxide free radicals and had a strong anti-denaturation impact. The SNPs were found to be more cytotoxic to CAL27 than to human peripheral blood mononuclear cells (PBMCs), with IC50 values of 81.16 µg/mL in PBMCs and 34.03 µg/mL in CAL27. This study's findings open a new avenue for using marine actinobacteria for silver nanoparticle biosynthesis, which holds great promise for a variety of biomedical applications, in particular periodontal treatment.

Oral cleaning habits and the copy number of periodontal bacteria in pregnant women and its correlation with birth outcomes: an epidemiological study in Mibilizi, Rwanda

BACKGROUND

Since 1996, many studies have reported that periodontal disease during pregnancy may be a risk factor for preterm birth and low birth weight; however, in Africa, periodontal disease is considered a non-high-priority disease. In addition, there are few dental facilities in rural Rwanda; thus, the oral condition of pregnant women has not been investigated. The objective of this study was to assess the tooth brushing habits of pregnant women in rural Rwanda and evaluate whether periodontal bacteria in the oral cavity of pregnant women are related to birth outcomes or oral cleaning habits.

METHODS

A questionnaire survey and saliva collection were conducted for pregnant women in the catchment area population of Mibilizi Hospital located in the western part of Rwanda. Real-time PCR was performed to quantitatively detect total bacteria and 4 species of periodontal bacteria. The relationship of the copy number of each bacterium and birth outcomes or oral cleaning habits was statistically analyzed.

RESULTS

Among the participants, high copy numbers of total bacteria, Tannerella forsythia, and Treponema denticola were correlated with lower birth weight (p = 0.0032, 0.0212, 0.0288, respectively). The sex ratio at birth was higher in women who had high copy numbers of Porphyromonas gingivalis and T. denticola during pregnancy (p = 0.0268, 0.0043). Furthermore, regarding the correlation between oral cleaning habits and the amount of bacteria, the more frequently teeth were brushed, the lower the level of P. gingivalis (p = 0.0061); the more frequently the brush was replaced, the lower the levels of P. gingivalis and T. forsythia (p = 0.0153, 0.0029).

CONCLUSIONS

This study suggested that improving tooth brushing habits may reduce the risk of periodontal disease among pregnant women in rural Rwanda. It also indicated that the amount of bacteria is associated with various birth outcomes according to the bacterial species. Both access to dental clinics and the oral cleaning habits of pregnant women should be important considerations in efforts to alleviate reproductive-related outcomes in rural Africa.

Efficacy of Xanthan-Based Chlorhexidine Gel on the Levels of Interleukin-1β in Chronic Periodontitis: An Interventional Study

Aims and Objectives:

Xanthan-based chlorhexidine gel (Chlosite®) is a local drug delivery system that exposes the sub-gingival bacteria to the effects of chlorhexidine (CHX) for a prolonged time. Hence, the study aimed at evaluating the clinical efficacy of the subgingival application of Chlosite gel as an adjunctive to mechanical scaling and root planing (SRP) and at evaluating the salivary interleukin (IL)-1β level to substantiate the clinical efficacy of xanthan-based CHX gel.

Materials and Methods:

A total number of 40 patients with chronic periodontitis in the age group of 30–50 years were enrolled in this interventional study. The patients were assigned to group A, in which only SRP was done, and group B, in which SRP along with the subgingival application of Chlosite gel was done. Periodontal parameters and salivary IL-1β level were evaluated, and the data obtained were statistically analyzed by using paired and unpaired “t” tests.

Results:

The results obtained showed a statistically significant reduction in the mean gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and salivary IL-1β values in both the groups from baseline to 30 days. There was a statistically significant reduction in GI, in group B when compared with group A, after the treatment. Salivary IL-1β value in group B was slightly lower when compared with group A after the treatment, but it was not statistically significant.

Conclusions:

The xanthan-based CHX gel is therapeutically effective when used as an adjunct to SRP. The study also indicated that salivary IL-1β can be used as a reliable biomarker.

A pilot study to evaluate the effectiveness of adjunctive use of two antimicrobial topical gels in chronic gingivitis

Background

Gingivitis is one of the most prevalent oral disease in humans. The most important etiological factor of gingivitis is dental plaque. Plaque control procedures comprises of several mechanical and chemical methods. Many studies have advocated that chemical plaque control methods can be used successfully as an adjunct to mechanical plaque control procedures. Thus, the aim of this pilot study is to evaluate the effectiveness of two topical antimicrobial gels as an adjunct to mechanical plaque control over a period of 2 weeks in treatment of chronic gingivitis patients.

Material and Methods

This is a single blind, two arm parallel design pilot clinical study including 60 systemically healthy patients with 1) chronic generalized gingivitis (MGI>1), 2) probing depth ≤ 3mm and 3) zero clinical attachment loss. The study participants were randomly assigned into two groups i.e., Group I- Chlorhexidine Gluconate (CHX) gel, Group II- combination gel of Chlorhexidine gluconate and Metronidazole (CHX-MTZ) gel. Clinical parameters viz. Gingival Index (GI) and Modified Sulcus bleeding index (MSBI) were recorded firstly at baseline after Scaling and Root Planing(SRP), and secondly at the end of the study period of two weeks. Intra and inter-group comparisons of clinical parameters were done using appropriate statistical tests.

Results

There was high significant reduction in GI and MSBI scores at the end of 2 weeks period in both the groups. Further, combination gel of Group II (CHX+MTZ) was found to be statistically more effective as compared to Group I (CHX) used alone.

Conclusions

Our study suggests that Chemotherapeutic agents like CHX and combination CHX-MTZ Gel are clinically effective as adjunct to Scaling and Root Planning(SRP) in treatment of Chronic Gingivitis. Further, post statistical comparative analysis has proved CHX-MTZ combination gel regime to be more clinically effective than CHX gel used alone in treatment of Chronic Gingivitis as adjunct to SRP.

Key words:Scaling and Root Planning (SRP), Chronic Gingivitis, Chlorhexidine Gluconate (CHX) gel, Combination (CHX+MTZ) Gel, Metronidazole (MTZ).

Effect of Pistacia atlantica subsp. kurdica Gum in Experimental Periodontitis Induced in Wistar Rats by Utilization of Osteoclastogenic Bone Markers

The aim of this study was to assess the effect of local application of essential oil of Pistacia atlantica kurdica (EOK) gel in treatment of experimentally induced periodontitis in rats and its effect on osteoclastogenic bone markers. Twenty-four male Wistar rats of 250 to 350 g were used in this study and were allocated into four groups. Control negative (without induced periodontitis), control positive (induced experimental periodontitis left without treatment), treatment control (induced experimental periodontitis and treated with Chlorhexidine gel) and EOK treated group (induced experimental periodontitis treated with EOK gel). The animals were sacrificed after 30 days, and the mandibular central incisor and surrounding tissue were dissected from the mandible and further processed for preparing H&E slides. Inflammatory cells, osteoclast cells, and periodontal ligament (PDL) were examined and measured histologically. Finally, the mean concentrations of both markers, receptor activator of nuclear factor kappa-Β ligand (RANKL) and (Interleukin-1β) IL-1β, were analyzed by ELISA. A significant reduction of inflammatory reaction and osteoclast numbers with improvement of PDL and low mean concentrations of RANKL and IL-1β were seen in the EOK treated group in comparison to the control group and the chlorhexidine group as well. The extract showed a protective effect in the healing of periodontitis that had been induced in rats and decreased bone resorption by down regulation of serum RANKL and IL-1β markers.

Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

Background

Subgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of systematic review and meta-analysis justifying the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.

Methods

An electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.

Results

Seventeen studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth ≥ 4 mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15 mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.

Conclusion

Adjunctive subgingival administration of XAN-CHX gel at individual selected sites in NSPT appears to provide slight benefits in PPD reduction compared to NSPT alone for CP. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.

Biosynthesis, Characterization and Antibacterial Efficacy of Silver Nanoparticles Derived from Endophytic Fungi against P. gingivalis

Introduction

Microbial resistance to existing antimicrobial agents in periodontal therapy is a growing problem. Therefore, there is a need for development of new antimicrobial agents.

Aim

To biosynthesize and characterize Silver Nanoparticles (AgNPs) using endophytic fungi and to evaluate the antibacterial efficacy against P. gingivalis.

Materials and Methods

Cut leaf segments of Withania Somnifera (Ashwagandha) were used to isolate the fungi. Fresh cultures of fungi were inoculated in Erlenmeyer flask of 100 ml Malt Glucose Yeast Peptone (MGYP) broth and incubated at 29°C for 72 hours for the biomass to grow. Biomass was filtered and cell free fungal filtrate was used further. Biosynthesized AgNPs were characterized by visual observation, Ultraviolet-Visible (UV-Vis) spectrophotometer, Transmission Electron Microscopy (TEM), Selected Area Electron Diffraction Analysis (SAED) and Fourier Transform Infrared Spectroscopy (FTIR). Antibacterial efficacy was evaluated by agar diffusion method measuring the zone of inhibition. The study groups included different concentrations of AgNPs: A (20 μl), B (40 μl), C (60 μl), D (80 μl) and E (100 μl) of AgNPs, F (0.2% CHX), G (2% CHX), H (Ampicillin) and I (sterile distilled water). The data collected for inhibition zones were statistically analysed using One-way Anova followed by Tukey post-hoc multiple comparison tests.

Results

The fungi were identified as Fusarium semitectum. Characterization studies showed the colour change from colourless to reddish brown; U-V spectrum showed peak 420 nm, TEM revealed the particles spherical in shape and 10-20 nm in size. FTIR analysis revealed the presence of functional groups. AgNPs 80 μl and 100 μl showed mean zone of inhibition 17.33 and 18 mm against P. gingivalis. CHX (0.2%) 17.85 and CHX (2%) 19.97 mm, Ampicillin 20.5 mm and no zone for sterile distilled water.

Conclusion

Biosynthesized AgNPs showed efficient antibacterial efficacy against P. gingivalis hence, creates a new horizon in periodontal therapy.

Influence of application of chlorhexidine gel and curcumin gel as an adjunct to scaling and root planing: A interventional study

Background:

Currently, the most common therapy for periodontal diseases consists of professional scaling and root planing (SRP). However, it was found to be of limited efficacy especially in areas which are inaccessible to periodontal instrumentation. Therefore, treatment strategies using antimicrobials in conjunction with conventional therapy have evolved. Thus, the study was undertaken with an.

Aim:

To evaluate the efficacy of application of chlorhexidine gel and curcumin gel as an adjunct to SRP.

Materials and Methods:

The study was conducted on thirty chronic periodontitis patients who were divided into two groups as control and experimental groups using a split-mouth design. After SRP chlorhexidine gel was applied in control and curcumin gel in experimental groups. The plaque index, gingival index, sulcus bleeding index, probing pocket depth were recorded at baseline and subsequently after 1 month and 45 days.

Results:

The results revealed that both chlorhexidine gel and curcumin gel have an effect on mild to moderate periodontal pockets in chronic periodontitis patients, but greater reduction was observed in the experimental group than the control group.

Conclusion:

It can be concluded that both control and experimental gel can be used as an adjunct to SRP, but the curcumin gel was more effective than the chlorhexidine gel in the treatment of mild to moderate periodontal pockets with a significant reduction in the indice scores when compared to the baseline values.