Jaideep Mahendra

Multifactorial relationship of obesity and periodontal disease.

Obesity is a chronic disease of mutifactorial origin, where there is increase in body fat. Periodontitis is an inflammatory disease of tooth supporting tissues resulting in destruction of periodontal ligament and alveolar bone. Periodontitis and obesity are both chronic health problems and the literature supports this association. A hyperinflammatory state observed in obesity is proposed as a mechanism to explain this association. This low grade inflammation in obese subjects triggers the worsening of non transmissible chronic diseases like periodontitis. So the aim of this article is to get the overview of association between adipose tissue derived cytokines and periodontal disease.

Effect of curcumin against oxidation of biomolecules by hydroxyl radicals.

BACKGROUND Among various reactive oxygen species, hydroxyl radicals have the strongest chemical activity, which can damage a wide range of essential biomolecules such as lipids, proteins, and DNA. OBJECTIVE The objective of this study was to investigate the beneficial effects of curcumin on prevention of oxidative damage of biomolecules by hydroxyl radicals generated in in vitro by a Fenton like reaction. MATERIALS AND METHODS We have incubated the serum, plasma and whole blood with H2O2/Cu2+/ Ascorbic acid system for 4 hours at 37 0C and observed the oxidation of biomolecules like albumin, lipids, proteins and DNA. RESULTS Curcumin at the concentrations of 50,100 and 200 μmoles, prevented the formation of ischemia modified albumin, MDA, protein carbonyls, oxidized DNA and increased the total antioxidant levels and GSH significantly. CONCLUSION These observations suggest the hydroxyl radical scavenging potentials of curcumin and protective actions to prevent the oxidation of biomolecules by hydroxyl radicals.

Prevalence of eight putative periodontal pathogens in atherosclerotic plaque of coronary artery disease patients and comparing them with noncardiac subjects: A case-control study.

BACKGROUND The study was aimed to assess the prevalence of periodontal pathogens namely Tannerella forsythia (T.f), Campylobacter rectus (C.r), Eikenella corrodens (E.c), Porphyromonas gingivalis (P.g), Treponema denticola (T.d), Prevotella nigrescens (P.n) ,Aggregatibacter actinomycetemcomitans (A.a), P.g (fi mA gene) and Prevotella intermedia (P.i), in the subgingival and the atheromatous plaque of patients with coronary artery disease (CAD), and comparing them with the noncardiac subjects thereby indicating the role of periodontal pathogenic bacteria in the progression of atherosclerosis in south Indian population. MATERIALS AND METHODS 51 cardiac and non cardiac subjects within the age group of 40-80 years,who met the eligibility criteria, were selected and categorized as the experimental and control group respectively. Total number of teeth was recorded, and oral hygiene was evaluated using Plaque Index and Oral Hygiene Index (OHI). Periodontal pocket depth and clinical attachment level were also assessed as a part of periodontal examination. Subgingival plaque samples were collected with the help of with Graceys curette in both the groups. In experimental group, biopsy was obtained from the atherosclerotic plaque during Coronary artery bypass grafting CABG procedure. Both, subgingival and the coronary atherosclerotic plaque samples were subjected to polymerase chain reaction (PCR) analysis for identification of the periodontal bacteria. STATISTICAL ANALYSIS Mean, standard deviation and test of significance of quantitative variables such as periodontal parameters were compared between experimental group and control group. Kappa measures of agreement was done to analyze the relationship between the presence/absence of microorganisms in the subgingival and atherosclerotic plaque samples in the experimental group. RESULTS The mean Plaque Index, Gingival Index, Russels Periodontal Index, OHI, clinical attachment level, Pocket Depth Index was statistically significant in both the groups. Association of T.f, E.c, C.r, P.g, P.g (fi mA), T.d, P.i, P.n was significantly associated. A.a was absent in the control group, whereas only one patient in the experimental group was positive for the bacteria. Kappa analysis showed the significant association of periodontal bacteria T.f, C.r, P.g, P.g (fi mA), P.i and P.n in subgingival plaque and atherosclerotic plaque of the same patients of the experimental group. CONCLUSION It is concluded that CAD subjects had higher prevalence of periodontal pathogens in subgingival biofilms as compared to the non cardiac subjects. Further, the number of bacteria was significantly associated between the subgingival and atherosclerotic plaques of the cardiac patients in south Indian population.

Prevalence of periodontal pathogens in coronary atherosclerotic plaque of patients undergoing coronary artery bypass graft surgery

BackgroundChronic bacterial infections have been associated with an increased risk for atherosclerosis and coronary artery disease. The ability of oral pathogens to colonize in coronary atheromatous plaque is well known. The aim of our study was to detect the presence of four common periodontal pathogens in coronary plaques. We detected the presence of 16S rRNA of Treponema denticola, Eikenella Corrodens, Porphyromonas gingivalis and Campylobacter rectus in subgingival and atherosclerotic plaques of CABG surgery by using Polymerase Chain Reaction.Methods51 patients in the age group of 40 to 80 years with chronic periodontitis were recruited for the study. These patients were suffering from Coronary Artery Disease (CAD) and underwent Coronary Artery Bypass Grafting (CABG). DNA was extracted from the subgingival plaque and coronary atheromatous plaque samples. Universal Primer for the general detection of bacterial DNA and the primers for T.denticola, E. Corrodens, C.rectus and P.gingivalis were used to amplify part of 16SrRNA gene by Polymerase Chain Reaction.ResultsT.denticola, E.corrodens, C.rectus and P.gingivalis were detected in 49.01 %, 27.45 %, 21.51% and 45.10% of atherosclerotic plaque samples. In both subgingival and coronary plaque samples, T. denticola was detected in 39.21% of the cases, E.corrodens in 19.60%, C.rectus in 11.76% and P.gingivalis in 39.22% of the cases respectively.ConclusionOur study revealed the presence of significant bacterial DNA of oral pathogens in coronary plaques. This suggests possible relationship between periodontal infection and atherosclerosis and can help devise preventive treatment strategies.

Significance of maternal periodontal health in preeclampsia

Objective: The aim of the present case-control study was to evaluate the association between maternal periodontitis and preeclampsia. Association studies between maternal periodontitis and elevated risk for preeclampsia have shown conflicting results. Periodontal maintenance is necessary to reduce the risk of adverse pregnancy outcomes like preeclampsia. Materials and Methods: Periodontal parameters [bleeding on probing, probing depth (PD), and clinical attachment level (CAL)] of 1320 women were assessed, followed by retrieval of their demographic and medical data from the medical records. Based on the medical records, 80 women were excluded from the study, leaving 1240 females as the eligible sample for the study. The women were divided into control group (1120 non-preeclamptic women who gave birth to infants with adequate gestational age) and case group (120 preeclamptic women). Logistic regression analysis revealed that primiparity and maternal periodontitis were the two significant variables causing preeclampsia. Further analysis was carried out by matching the two groups for primiparity to find the significance of maternal periodontitis. Maternal periodontitis was defined as PD ≥4 mm and CAL ≥3 mm at the same site in at least four teeth. Results: The results showed that maternal periodontitis (odds ratio 19.8) was associated with preeclampsia. Maternal periodontitis also remained associated with preeclampsia after matching for primiparity, which was another significant confounding factor in the study (odds ratio 9.33). Conclusion: Maternal periodontitis is a risk factor associated with preeclampsia, emphasizing the importance of periodontal care in prenatal programs.

Toll-Like Receptors: A Key Marker for Periodontal Disease and Preterm Birth – A Contemporary Review

The receptors of the innate immune system have evolved to recognize pathogenic bacteria in a complex manner. Out of these immune receptors, the pattern recognition receptors (PRRs) such as Toll like receptors have gained importance off late to play a key role in the activation of cascade of inflammatory cytokines in pathogenesis of preterm birth. Preterm birth has become leading cause of neonatal deaths globally. The concept of oral infection influencing the occurrence of preterm delivery has gained importance. Translocation of periodontal pathogens and inflammatory mediators play role in the pathogenesis of preterm labour. The transmembrane toll like receptors of innate immunity have been recently implicated in the association of periodontal infection and preterm labour. The TLRs are considered as a key marker and TLR blockade can be a critical method for treating women who are exposed to periodontal pathogens. This review is aimed at discussing the role of TLR in periodontal disease and its relationship with preterm birth.

Identification of Predictable Biomarkers in Conjunction to Framingham Risk Score to Predict the Risk for Cardiovascular disease (CVD) in Non Cardiac Subjects

INTRODUCTION Although the cardiovascular disease (CVD) burden is rising in different countries, the morbidity and mortality rate is not reduced to much extent because of lack of application of the biomarkers for diagnosing CVD. Hence, we aimed to establish the predictable biomarkers in conjunction to framingham risk score in order to predict the risk for CVD in non cardiac patients. MATERIALS AND METHODS Three hundred subjects were screened for the study who came for the master health checkup. Out of them 50 patients were excluded as they were under medication. 23 patients were excluded due to various systemic diseases like fever and infection etc. The remaining of 227 patients with age range of 30-80 y was randomly selected for investigation. These subjects were divided into four different groups: Group I - controls with age range: 30-60 y (n=50) these subjects were free from all the systemic ailments and risk factors. Study groups comprised of Group II - (n=44) with age range: 30-40 y, Group III - (n=50) with age range: 41-50 y and Group IV - (n=83) with age range: 51-80 y. Patients with different risk factors without medication participated as study groups. Routine biochemical parameters were analysed using fully automated analyser and atherosclerotic biomarkers was analysed using ELISA kit. In addition to this, framingham risk scores was calculated in all the groups, for 30 y risk prognosis for CVD. RESULTS The atherosclerotic biomarkers such as E-selectin, Leptin, osteoprotegerin (OPG) and Ox-LDL were elevated among the study groups as compared to control group. Pearson correlation showed a significant association between the individual risk score (30 y framingham risk for CVD) of individuals, and the above biomarkers. The Receiver operating curve (ROC) analysis also showed a greater area under curve with higher sensitivity and specificity. CONCLUSION We conclude the application E-Selectin, leptin, OPG and Ox-LDL as biomarkers along with the framingham risk scores in prediction risk for CVD in the individuals with subclinical atherosclerosis. It is more reliable and predictable as compared to the individual biomarkers alone.

Defensins in periodontal health

Defensins are abundant and widely distributed peptides in human and animal tissues that are involved in host defence. Defensins not only have the ability to strengthen the innate immune system but can also enhance the adaptive immune system by chemotaxis of monocytes, T-lymphocytes, dendritic cells and mast cells to the infection site. Defensins also improves the capacity of macrophage phagocytosis. A greater understanding of how these peptides act in the healthy, gingivitis and periodontitis conditions would definitely open new opportunities for identification, prevention and treatment of periodontal diseases. This discussion focuses on recent studies about biological function of defensins in human diseases and animal models.

Clinical effects of subgingivally delivered spirulina gel in chronic periodontitis cases: a placebo controlled clinical trial.

AIMS AND OBJECTIVES The aim of this study was to assess the clinical effects of Spirulina in-situ gel as an adjunct to Scaling And Root Planning (SRP) in the treatment of chronic periodontitis subjects. MATERIAL AND METHODS 64 sites were selected with probing pocket depth of ≥5mm and they were divided into 2 groups; 33 sites were treated with SRP along with spirulina gel (Group A) and 31 sites were treated with SRP alone (Group B). Clinical parameters were recorded at baseline before SRP and at 120(th) day after the treatment therapy. The parameters included Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). RESULTS Both the groups showed significant improvement in the parameters. However, Group A (SRP along with spirulina) showed statistically significant decrease in mean probing pocket depth and gain in the clinical attachment level after 120 days as compared to Group B SRP alone. CONCLUSION Locally delivered spirulina gel, along with scaling and root planning, has been shown to cause a beneficial impact. The efficacy of the product as a local drug delivery system in the non-surgical treatment of periodontitis without any side effects has been proved. Spirulina appears to be promising. It exerts strong anti-inflammatory effects which are closely connected with its antioxidative activity. This study can have a significant impact on the treatment procedures of periodontitis, with the use of blue green algae in the future.

Minocycline Ointment as a Local Drug Delivery in the Treatment of Generalized Chronic Periodontitis - A Clinical Study

INTRODUCTION The primary goal in periodontal therapy includes removal of the etiological factors by mechanical periodontal treatment, which sometimes fail to eliminate the anaerobic infection at the base of the pocket and requires adjuvant chemical therapy. AIM The aim of the study was to evaluate the effectiveness of 2% minocycline ointment when used as an adjunct to periodontal flap surgery and post-operative maintenance period for the treatment of generalized chronic periodontitis. MATERIALS AND METHODS The study included 30 subjects comprising of 60 posterior sextants in a split mouth design in which 30 sextants were treated as experimental and 30 sextants as control with a probing pocket depth≥6mm. In Group A (experimental group) 30 sextants were treated with open flap debridement followed by the application of minocycline ointment as a local drug delivery. In Group B (control group) 30 sextants were treated with open flap debridement alone. Minocycline hydrochloride ointment was applied on the 0 day and 3(rd) month. The clinical parameters such as plaque index, probing pocket depth, clinical attachment level and gingival bleeding index were recorded at 0 day, 3(rd) month and 6(th) month in both the groups. Paired and unpaired t-test were used to compare the means of the two groups. RESULTS When Group A and Group B were compared, Group A showed significantly greater reduction in gingival bleeding index, probing pocket depth and gain in clinical attachment level than Group B, from 0 day to 3 months and from 0 day to 6 months. Group A showed significant reduction in plaque index than Group B when they were compared at 6 months. CONCLUSION The results demonstrate that there was significant reduction in the clinical parameters with improvement in the periodontal status on application of minocycline ointment as an adjunct to periodontal flap surgery in generalized chronic periodontitis.