Illegal drugs and periodontal conditions

In recent years, the practice of dentistry and periodontology has become complicated by several risk factors, including the treatment of an increasing number of patients with substance use disorder. This review presents an update in the current literature of the impact of illegal drug use on periodontal conditions and their possible effect as risk factors or indicators. The main illegal drugs that may have an impact on periodontal health and conditions are described, including their effect, medical manifestations, risks, and the overall effect on oral health and on the periodontium. Where available, data from epidemiologic studies are analyzed and summarized. The clinical management of periodontal patients using illegal drugs is reported in a comprehensive approach inclusive of the detection of illicit drug users, screening, interviewing and counseling, the referral to treatment, and the dental and periodontal management. With regard to the impact of illegal substance use on periodontal conditions, there is moderate evidence that regular long-term use of cannabis is a risk factor for periodontal disease, manifesting as a loss of periodontal attachment, deep pockets, recessions, and gingival enlargements. Limited evidence also shows that the use of cocaine can cause a series of gingival conditions that mostly presents as chemical induced-traumatic lesions (application of cocaine on the gingiva) or necrotizing ulcerative lesions. There is a scarcity of data regarding the impact of other drug use on periodontal health. There is evidence to suggest that regular long-term use of cannabis is a risk factor for periodontal disease and that the use of cocaine can cause a series of periodontal conditions. The dental treatment of subjects that use illegal substances is becoming more common in the daily clinical practice of periodontists and other dental clinicians. When the clinicians encounter such patients, it is essential to manage their addiction properly taking into consideration the impact of it on comprehensive dental treatment. Further studies and clinical observations are required to obtain sound and definitive information.

The impact of non-surgical therapy of periodontal disease on surrogate markers for cardiovascular disease: A literature review

PURPOSE

To review the literature on the effects of non-surgical periodontal treatment on surrogate markers of cardiovascular diseases (CVDs) and to clarify the impact of periodontal disease on systemic inflammation.

METHODS

PRISMA guidelines for systematic reviews and meta-analyses have been adopted. An electronic search in PubMed up to December 2018 was performed using the following search terms and keywords alone or in combination: non surgical periodontal therapy, atherosclerotic vascular disease (AVD), operative surgical procedures, CVD, IL-6, CRP, cholesterol, LDL, oxidized low density lipoprotein, HDL, endothelial dysfunction, dependent dilatation, carotid intima media thickness, periodontitis, tunica intima.

RESULTS

The electronic search resulted in the inclusion of 28 articles that were grouped and discussed based on the investigated surrogate markers. Meta-analysis was not carried out due to the heterogeneity of the results. The included studies demonstrated that periodontal treatments contribute to the resolution of oral inflammation and in turn might positively modulate the levels of systemic inflammatory markers. The initial phase of periodontal therapy has a positive impact on the short-term reduction of a series of systemic markers that are considered as surrogate markers of AVD.

CLINICAL SIGNIFICANCE

The non-surgical therapy of periodontal disease would positively reduce the levels of systemic inflammation markers, decreasing the vascular risk and the possibility of developing CVD or the subclinical progression of the disease.

The effect of miniaturized manual versus mechanical instruments on calculus removal and root surface characteristics: An in vitro light microscopic study

Objectives

The aim of this study was to evaluate by light microscopy analysis the effect of the use of miniaturised piezoelectric tips versus mini‐five area specific curets on calculus removal and postoperative root surface alterations.

Methods

A total of 20 extracted teeth were used. Two square surfaces (5×5 mm) were marked on each root surface with a diamond bur mounted on a high‐speed handpiece. Before and after instrumentation, a series of magnified images (4.2×) of each experimental surface were taken with a standardized approach. According to a randomization list, the two surfaces on each sample were instrumented in a standardised fashion either with a mine‐five curet or a slim piezoelectric tip. The images were processed using an imaging software. Data were summarised as means and standard deviations for the two outcomes (calculus and alterations.) at each time (pre and post) for both of the groups (manual and mechanical).

Results

Both manual and mechanical instrumentation significantly reduced the calculus deposits (p < .001) without significant differences between the two groups. Both manual and mechanical treatments significantly increased alterations (p < .01). There was a statistically significant evidence of a greater increase in alterations from mechanical treatment.

Conclusions

Slim mechanical piezoelectric tips and manual mini‐five area‐specific curets have similar effects on calculus removal. Manual instrumentation results in a more homogeneous postoperative root surface with less root alterations.