Betsy Thomas

Students' perceptions regarding educational environment in an Indian dental school

Background: As one of Indias premier dental schools, the Manipal College of Dental Sciences, Manipal, has strived to be in the forefront of dental education ever since its inception in 1965. But one of our main drawbacks has been the lack of students’ perceptions about the educational atmosphere in our institution. Aim: (1) To understand the students’ perceptions of the educational environment. (2) To compare the results with those of other dental/medical schools. Methods: Dundee Ready Education Environment Measure (DREEM) was used to gather information about the environment in our institution. The same was administered to first year and final year students (63 each). Results: The main area of convergence of both groups was that the social atmosphere was not very congenial. But the thought provoking finding was that both groups felt that the teachers were authoritarian. Conclusion: The lack of congenial atmosphere in our institution seems to be due to the attitude of the course organizers. A need for makeover in attitudes and approach on the part of the teachers to make the learning experience more pleasant for the students was made obvious by this study.

Simultaneous detection of periodontal pathogens in subgingival plaque and placenta of women with hypertension in pregnancy

BackgroundThere are many studies documenting increased prevalence of periodontal infection in women with preeclampsia. But, very few studies have attempted to establish causal relationship between the two.ObjectiveTo find out causal circumstantial evidence by isolating specific periodontal pathogens in oral and placental samples.Materials and methodsAntenatal periodontal screening and subgingival plaque collection was carried out in ten women with hypertension in pregnancy and ten normotensive controls on their hospital admission at term for cesarean delivery. Placental biopsy was obtained after aseptic placental collection at the time of elective cesarean delivery. Subgingival plaque and placental biopsy were studied for Porphyromonas gingivalis, Fusobacterium nucleatum, Treponema denticola, Prevotella intermedia and Aggregatibacter actinomycetemcomitans using quantitative polymerase chain reaction technique.Periodontist and laboratory personnel were unaware of case or control status. Periodontal status was not informed to the obstetrician recruiting the cases and laboratory. Microbiology report was not revealed till end of the study.ResultsPeriodontal pathogens were found to be high in the group with hypertension than the controls. P gingivalis was found in all the samples from subgingival plaque and placenta, irrespective of the periodontal disease status.ConclusionIn cases with hypertension, periodontal pathogens are present in higher proportion in subgingival plaque and placenta.

Platelet-rich fibrin as an adjunct to palatal wound healing after harvesting a free gingival graft: A case series

Background: Owing to its stimulatory effect on angiogenesis and epithelialization, platelet-rich fibrin (PRF) is an excellent material for enhancing wound healing. The use of PRF dressings may be a simple and effective method of reducing the morbidity associated with donor sites of autogenous free gingival grafts (FGGs). The purpose of this case series is to document the beneficial role of PRF in the healing of FGG donor sites. Materials and Methods: A total of 18 patients treated with FGGs could be classified into two groups. PRF was prepared, compressed and used to dress the palatal wound followed by a periodontal pack in one group (10 patients) and only a periodontal pack was used in the other group (8 patients). Post-operative healing was assessed clinically at 7, 14 and 21 days and the morbidity was assessed qualitatively by an interview. Results: Sites where PRF was used showed complete wound closure by 14 days and these patients reported lesser post-operative morbidity than patients in whom PRF was not used. Conclusions: PRF as a dressing is an effective method of enhancing the healing of the palatal donor site and consequently reducing the post-operative morbidity.

Stress and periodontal disease: The link and logic!!

Stress is an equated response to constant adverse stimuli. At one point or another everybody suffers from stress. Stress is compatible with good health, being necessary to cope with the challenges of everyday life. Problems start when the stress response is inappropriate to the intensity of the challenge. Psychological stress can down regulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. Direct association between periodontal disease and stress remains to be proven, which is partly due to lack of an adequate animal models and difficulty to quantifying the amount and duration of stress and also there are many factors influencing the incidence and severity of periodontal disease. Nevertheless, more recent studies indicate that psychosocial stress represents a risk indicator for periodontal disease and should be addressed before and during treatment. This paper discusses how stress may modulate host response to bacteria and influence the course and progression of periodontal disease.

Periodontal infection in women with low birth weight neonates

It has been hypothesized that in the presence of periodontal disease, periodontal pathogens are disseminated hematogenously to target the placenta,membranes, and fetus. This bacterial challenge may result in increased cytokine expression, and affect placental function and precipitate preterm labor. The present case-control study was designed to investigate whether women who delivered low birth weight neonates had a higher rate of periodontal infection. Material and Methods: A total of 150 consecutive women admitted in labor (preterm or with evidence of fetal growth restriction) with known gestational age and a first trimester ultrasound dating The control group consisted of women who had delivered a neonate of appropriate size for gestational age at term (≥37–41 weeks), matched to each case participant for age, parity, and socioeconomic status. Oral examinations were carried out within 72 hours of delivery by a periodontist blinded to the case-control status. Results: Periodontal infection was noted in 59% (177/300) of women in the study. The presence of periodontal infection was significantly higher in women with preterm (92.1%; 82/ 89 cases) and growth restricted neonates (91.8%; 56/61 cases) compared with women in the control group (26%; 39/ 150 cases) (p<0.001). All clinical parameters considered to indicate periodontal infection showed a significant association with low birth weight neonates. These parameters, whether used individually or inferred together, were indicative of periodontal infection and correlated with pregnancy outcomes. Conclusion: The findings that periodontal infection is prevalent in pregnancy and significantly higher in women who delivered low birth weight neonates suggest a need for developing preventive strategies. The clinical diagnosis of periodontal infection correlated with either inflammatory mediators or microbiological confirmation would add validity to the claims of a causal relationship.

Periodontal Disease and Pregnancy Hypertension: A Clinical Correlation

BACKGROUND Periodontal disease is thought to be associated with increased risk of systemic diseases and adverse pregnancy outcomes, including pregnancy hypertension (PH). The aim of the present study is to find the prevalence of periodontal disease in females with PH in a rural-based medical institute. METHODS The present case control study was performed with 200 females, 100 with PH and 100 without PH. Antenatal periodontal screening was performed within 72 hours of their hospital admission for delivery. The periodontal parameters assessed were oral hygiene index-simplified, gingival index, mean probing depth, and loss of attachment. RESULTS Prevalence of periodontal disease was 65.5% and was significantly higher (P <0.0001) in females with hypertension (relative risk = 1.5; 95% confidence interval [CI] = 1.3 to 1.9). Socioeconomic status, education, occupation, and body mass index did not appear to influence the relationship between periodontal disease and PH on bivariate multiple logistic regression analysis. Nulliparous females were at higher odds to develop periodontal disease and PH (odds ratio = 1.7; 95% CI = 0.5 to 6.1). As the severity of periodontal disease increased from moderate to severe, the severity of hypertension also increased (r(2) = 0.8 and 0.5 for moderate and severe periodontal disease, respectively). CONCLUSION Periodontal disease is more prevalent in females with PH.

Periodontal awareness in different healthcare professionals: A questionnaire survey

Aim: To assess the awareness of oral hygiene, periodontal disease and availability of treatment techniques among medical professionals. Materials and Methods: One hundred and fifty medical professionals were interviewed through a questionnaire. Those interviewed included an equal number of medical interns, postgraduates, and consultants. Results and Conclusion: A positive attitude towards dental and periodontal check and the treatment needs was observed among those questioned. The difference was statistically significant among the groups. However, inputs from this survey can be used to organize periodontal health programs and for planning of joint ventures.

Efficacy of Human Chorion Membrane Allograft for Recession Coverage: A Case Series

BACKGROUND Membranes of human placentas have been used in the field of medicine for skin grafts, treatment of burns, and ulcerated skin conditions with great success. The use of placenta allografts in dentistry is a more recent development, with the first commercial product being made available in 2008. The unique inherent biologic properties in placenta allografts enhance wound healing and may propagate regeneration. METHODS Ten healthy adult patients presenting with 21 Miller Class I gingival recession (GR) defects (isolated or adjacent multiple) were surgically treated with a modified coronally advanced flap and chorion membrane for root coverage. Clinical parameters measured at baseline, 3 months, and 6 months were probing depth, clinical attachment level, GR height, width of keratinized gingiva, and assessment of gingival biotype. Statistical analysis was performed to compare the treatment outcomes at the follow-up intervals. RESULTS The results showed statistically significant (P <0.001) improvements in all clinical parameters at the 3- and 6-month follow-ups. The mean percentage of root coverage at the end of 6 months was 89.92% ± 15.59%, and 14 of 21 treated GR defects showed 100% root coverage. The gingival biotype also showed a thick biotype in nine sites that had an initial thin biotype. CONCLUSIONS Fetal membranes possess distinctive properties that can be harnessed to promote periodontal healing. The chorion membrane covered by a modified coronally advanced flap is a new approach that has shown promising results in terms of root coverage, increased width of keratinized tissue, and thickness of the gingival biotype.

Periodontal Disease as a Risk Factor for Preterm Delivery and Low Birth Weight

Objective: The objective of the present study was to evaluate the association between chronic periodontitis of mother with preterm delivery and low birth weight. Study design: Two hundred subjects who reported to Department of Obstetric and Gynecology, Kasturba Hospital, Manipal, Karnataka were included in the study. Subjects were divided into cases and controls based on pregnancy outcome. General information on socioeconomic status, obstetric history, dental history, oral hygiene, gingival status and probing pocket depth were also recorded. Results: Poor oral hygiene,moderate to severe gingivitis and increased probing pocket depth was significantly higher in those who delivered small babies (preterm and small for gestational age) than the average sized (74% vs. 11%; x2 81.2, p<0.001). (x2 92.8, p<0.001). (60% vs. 3%; x2 97.9, p<0.001). Conclusion: There was significant co-relation of poor hygiene, gingival inflammation, probing pocket depth to Preterm Delivery and Low Birth Weight.

Identification of multiple strains of Porphyromonas gingivalis using heteroduplex polymerase chain reaction in varying severity of chronic periodontitis

Aim: Research has demonstrated that there are multiple strains of Porphyromonas gingivalis with varying potency to cause periodontal disease. The current study aims at using heteroduplex polymerase chain reaction (PCR) to detect the strain diversity of P. gingivalis in periodontitis lesions of varying severity in a sample of the Indian population. Materials and Methods: Subgingival plaque samples were collected from 60 individuals with varying severity of chronic periodontitis and 30 individuals with a clinically healthy periodontium. The samples were subjected to PCR analysis to identify P. gingivalis, followed by heteroduplex analysis to identify the strain diversity in a given sample. Bacterial culture was carried out as a comparative standard. Results: Of the 56 samples that were positive for P. gingivalis by PCR, 54 samples yielded eight different heteroduplex patterns. Analysis of these patterns indicated that two strains of P. gingivalis were present in 41 individuals (45.6%) and three strains were present in 13 individuals (14.4%). Detection of P. gingivalis by PCR was significantly more in the periodontitis group as compared to the healthy group. Conclusions: Species-specific PCR and heteroduplex analysis provide a simple and accurate method to analyse the strain diversity of P. gingivalis. P. gingivalis was detected in both healthy periodontal sites as well as sites with periodontitis. The presence of two or three P. gingivalis strains was seen in 60% of the samples.