Nd Gupta

Comparative evaluation of serum C-reactive protein levels in chronic and aggressive periodontitis patients and association with periodontal disease severity

Objective: C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. Materials and Methods: A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. Results: Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. Conclusion: The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.

Drug addiction and periodontal diseases.

The prevalence of drug addiction is increasing globally. Drug abuse damages many parts of the body such as oral cavity, lungs, liver, brain, heart etc., Addicts suffer from physical, psychological, emotional and behavioral problems. Their nutrition is also compromised. There is certainly an impact of all these factors on the health of periodontium. Dentists should be aware of the effects of drugs while treating the drug addicts. This article correlates the studies done on the impact of abused drugs such as alcohol, tobacco, opiates, cannabis, amphetamines etc., on general and periodontal health.

Periodontal ligament distraction: A simplified approach for rapid canine retraction

Distraction osteogenesis is a method of inducing new bone formation by applying mechanical strains on preexisting bone. The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of “distracting the periodontal ligament” is proposed to elicit rapid canine retraction in two weeks. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 mm/day, immediately after the extraction. Canine was distracted 6.5 mm into the extraction space within two weeks.

Diagnosis and management of nonsyndromic hereditary gingival fibromatosis in a 13 year old girl: Report of a rare case.

Hereditary gingival fibromatosis is a rare condition characterized by various degree of gingival overgrowth. It usually develops as an isolated disorder but can manifest with multisystem syndrome. We are here presenting a case of a 13-year-old girl who presented with severe enlargement of gingiva covering all most the entire crown involving both maxillary and mandibular arches. Differential diagnosis includes drug-induced and idiopathic gingival enlargement. Excess gingival tissue was removed by full mouth gingivectomy and sent for histopathological examination. Postoperative course was uneventful and patients esthetics improved significantly. A 12 month postoperative period shows no recurrence.

Probiotic – An emerging therapy in recolonizing periodontal pocket

One of the etiological factors in the pathogenesis of periodontitis is reduction or the absence of the so-called beneficial bacteria. Most of the globally applied treatment approach is based on subgingival bacterial elimination but recolonization with less pathogenic bacteria is seen within weeks. Therefore, researchers have started focusing on shifting the current treatment approach from specific bacterial elimination to restoring periodontal pocket with beneficial bacteria. This alteration in the ecology of niches from the one with the pathological plaque to the one with the biofilm of commensals can be achieved via subgingival application of probiotics. This article suggests the important prospects of subgingival delivery of probiotics in guiding periodontal recolonization with beneficial bacteria and emphasizes research in this study field.

Child-Oral impacts on daily performances: A socio dental approach to assess prevalence and severity of oral impacts on daily performances in South Indian school children of Bangalore city: A cross-sectional survey

Background: Oral disorders can have a negative impact on the functional, social and psychological well-being of children and their families. Oral health and dental treatment may have an impact on eating, speaking and appearance, thereby affecting quality of life. Thus, there has been a greater focus on the measurement of quality of life as a complement to the clinical measures. Objective: The aim was to assess the prevalence, characteristics and severity of oral impacts in south Indian school children using Child-Oral Impacts on Daily Performances (Child-OIDP) index as a measure of oral health related quality of life. Methodology: A cross-sectional study was undertaken among the six government, and six private school children aged 11-12 years, of Karnataka, South India randomly selected as cluster, and all their 563 children were invited to participate. A cross culturally adapted and validated oral health-related quality of life measure; Child-OIDP was used to assess oral impacts. Results: The common perceived oral health problems were tooth ache reported by 342 children, a sensitive tooth reported by 230 children, tooth decay - hole in the tooth reported by 226 children. Eating was the most common performance affected (68.3%). The severity of impacts was high for eating and cleaning mouth and low for the study and social contact performances. Conclusion: The study reveals that oral health impacts on quality of life of school children of Karnataka aged 11-12 years. Oral impacts were prevalent, but not severe. The impacts mainly related to difficulty eating. Toothache, a sensitive tooth, tooth decay and bleeding gums contributed largely to the incidence of oral impacts.

Primary gingival tuberculosis in pregnancy: A rare combination

Tuberculosis (TB), a common chronic-specific granulomatous disease, has become rare in the developed countries. However, it is still a common cause of morbidity and mortality in India. Although it commonly involves the lungs, its presentation in the oral cavity is quite uncommon. The very rare incidence of primary gingival TB, particularly in the absence of active pulmonary involvement often leads to misdiagnosis. Clinical features of oral lesions may include ulceration, nodules, granulomas, and fissures. TB in pregnant women is a major cause of obstetric complications and increased risk of maternal and child mortality. This report highlights a rare case of primary TB of gingiva, presenting as severe gingival overgrowth in a patient with 4th month of pregnancy. This case strongly suggests the importance of suspecting TB as the differential diagnosis of gingival overgrowth and therefore, playing a critical role in the early detection and treatment. Interdisciplinary collaboration for diagnosis and management resulted in the successful outcome and prevented the obstetric complications in this case.

Grinspan syndrome with periodontitis: Coincidence or correlation?

Grinspan syndrome is a syndromic complex which comprises a triad of hypertension, diabetes, and oral lichen planus. It remains an enigmatic condition that whether it is separate entity or drug-induced lichenoid reaction emerging due to medications used to treat hypertension and diabetes. Diabetes is related to long-term hyperglycinemia leading to accelerated destruction of both nonmineralized connective tissue and bone leading to periodontitis. Moreover, there is also a possible link between cardiovascular disease and periodontitis. Here, we are presenting a case with the symptomatic triad fulfilling the diagnostic criteria of Grinspan syndrome. A 50-year-old female with type 2 diabetes mellitus and vascular hypertension came with the chief complaint of bleeding gums and severe burning sensation of the oral cavity. In addition, she was having generalized alveolar bone loss and clinical attachment loss. To the best of our knowledge, this coexistence has not been reported earlier. This needs further evaluation so that the preventive measures can be taken at early stage.

Osteoporosis and periodontitis in postmenopausal women: A systematic review

This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral density (BMD) and clinical attachment loss, respectively. The Pubmed, Cochrane central, EMBASE, and Google Scholar were searched from year 1990 to 2015 for studies on association between chronic periodontitis and osteoporosis. Studies measuring osteoporosis in terms of central BMD and periodontitis in terms of clinical attachment level were studied. Data were extracted and descriptive analysis was performed. Screening of 1188 articles resulted in 24 articles for review after reading the titles and abstracts. Fifteen studies were shortlisted for inclusion in systematic review. Ten of these studies showed an association between periodontitis and osteoporosis. It implies that patients with severe periodontitis should also be evaluated for systemic bone health and vice versa.

Mental depression as a risk factor for periodontal disease: A case-control study

Aim: Periodontal disease is an immune-inflammatory response of tooth supporting structures to microbial dental plaque. It is influenced by various factors such as poor oral hygiene, smoking, systemic diseases, and psychological factors such as stress. This case-control study was performed to consider mental depression as a risk factor for periodontal disease. Materials and Methods: A total of 170 subjects were selected. All the subjects were assessed for the presence of depression by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and severity of depression was measured by Hamilton depression rating scale. For assessment of periodontal disease, clinical periodontal parameters oral hygiene index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. Results: Univariate logistic regression analysis demonstrated that subjects with depression had significantly higher values of debris index, calculus index, gingival index, PPD, and CAL (P < 0.001). Periodontal status was poor in patients with severe and very severe grade depression patients (P = 0.049). For all the indices/parameters, mean values of patients with > 6 months of illness were higher (P < 0.05). Conclusion: Within the limits of this study, it is concluded that mental depression significantly affects the periodontium. It may be considered as risk factor for periodontal disease.