Rameshwari Singhal

Assessment of the effect of periodontal treatment in patients with coronary artery disease: A pilot survey

Background: Periodontitis is a chronic inflammatory condition believed to cause a low but long lasting systemic inflammatory reaction which in turn contributes to the development of atherosclerosis. Recent data suggests that around 40% cases of coronary artery disease remain unaccounted despite the identification of the classical risk factors. Objectives: To evaluate the efficacy of non surgical periodontal therapy on the levels of serum inflammatory markers in subjects with chronic periodontitis and known coronary artery disease. Materials and Methods: Twenty subjects with known coronary artery disease (CAD) were recruited from the Department of Cardiology, CSM Medical University, Lucknow, India, for this study. Periodontal disease was measured through the clinical parameters bleeding on probing (BOP) and probing depth (PD). All subjects received non surgical periodontal therapy that included oral hygiene instructions and meticulous scaling and root planing. Systemic levels of inflammatory markers such as high-sensitivity C reactive proteins (hsCRP), tumor necrosis factor-α (TNF-α), and white blood cell (WBC) counts were measured prior to and 1 month after periodontal therapy. Results: Subjects experienced significant reductions in bleeding on probing (BOP) and probing depth (PD), indicating improvement in overall periodontal health. In all subjects, high-sensitivity C reactive proteins (hsCRP), and WBC counts were reduced significantly,; however, tumor necrosis factor-α (TNF-α) levels showed no statistically significant reduction. Conclusion: In this study, periodontal treatment resulted in a significant decrease in bleeding on probing (BOP) and probing depth (PD), and this treatment lowered the serum inflammatory markers (hsCRP and WBC counts) in patients with coronary artery disease. This may result in a decreased risk for coronary artery disease in the periodontally treated patients.

Probiotics and oral health

Probiotics utilize the naturally occurring bacteria to confer health benefits. Traditionally, probiotics have been associated with gut health, and are being mainly utilized for prevention or treatment of gastrointestinal infections and disease; however, recently, several studies have suggested the use of probiotics for oral health purposes. The aim of this review is to understand the potential mechanism of action of probiotic bacteria in the oral cavity and summarize their observed effects with respect to oral health.

An innovative cosmetic technique called lip repositioning

A clinical report describing the successful use of the lip repositioning technique for the reduction of excessive gingival display. A female patient aged 34 years reported with a chief complaint of gummy smile and was treated with this technique performed under local anesthesia with the main objective to reduce gummy smile by limiting the retraction of elevator muscles (e.g., zygomaticus minor, levator anguli, orbicularis oris, and levator labii superioris). The technique is fulfilled by removing a strip of mucosa from maxillary buccal vestibule and creating a partial thickness flap between mucogingival junction and upperlip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display.

Role of Space Provision in Regeneration of Localized Two-Wall Intrabony Defects Using Periosteal Pedicle Graft as an Autogenous Guided Tissue Membrane

BACKGROUND Marginal pedicle periosteum (MPP) has been used as a rigid membrane in guided tissue regeneration (GTR) for osseous defects. The present study aims to study the effect of space provision by an alloplastic graft material in bone defect area (BDA) reduction of 2-wall defects. METHODS Twenty interproximal intrabony 2-wall defects in healthy non-smoking patients with chronic periodontitis were randomly divided in control (group 1, periosteum alone) and experimental (group 2, periosteum with alloplastic graft material) groups. Measurements of probing depth (PD), clinical attachment level (CAL), and radiographic BDA were done at the baseline and 6-month postoperative evaluations. RESULTS The 6-month postoperative assessment showed clinical and radiographic improvements with PD reduction, CAL gain, and changes in BDA in both groups, which was statistically significant compared with baseline (P <0.05). However, BDA reduction was statistically greater in group 2 (48.88% ± 18.61%) compared with group 1 (14.08% ± 12.97%) at the 6-month follow-up (P = 0.009). CONCLUSION Within the limitations of this study, it can be concluded that space provision by an alloplastic graft material increases the regenerative potential of MPP as a GTR membrane and results in increased defect fill.

Periodontal regeneration in deep intrabony periodontal defect using hydroxyapatite particles with platelet rich fibrin membrane-a case report.

BACKGROUND Growth factors such as platelet-derived growth factors exert potent effect on wound healing including the regeneration of periodontium. Platelet-rich fibrin (PRF) membrane provides a concentrate of such growth factors, accelerating the wound healing process. MATERIALS AND METHODS In this case report, regeneration of the deep periodontal intrabony defect was attempted using hydroxyapatite particles mixed in the PRF membrane to assess if regeneration of new bone is possible. RESULTS AND CONCLUSION This resulted in a rapid and complete healing with the decrease in the pocket depth and a gain in the clinical attachment level. Rapid regeneration of the periodontium can be achieved with bone substitutes by incorporating the various growth factors from autogenous blood.

Comparative evaluation of periosteum as a barrier membrane with and without an alloplastic bone graft in periodontal osseous defects: A 9 months follow-up study

Background: Regenerative procedures frequently include the use of barrier membranes and bone grafting materials to encourage the growth of key surrounding tissues. The present study aims to evaluate and compare the ability of periosteum in intrabony defect regeneration. Materials and Methods: A total of ten intrabony defects were equally divided in two treatment groups. Group I consisted of Periosteum used as a barrier memebrane and Group II of periosteum as barrier membrane alongwith graft material. Nine months post operative evaluation of defect fill was done radiographically. Results: Mean defect fill (CEJ-BBD) was found to be significantly lower in Group II as compared to Group I (P = 0.041). Conclusion: Within the limitations of this study, alloplastic graft material supplimentation results in better regeneration with Periosteum used as a barrier membrane.

Efficacy of Acacia arabica gum as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized controlled clinical trial

Aim The aim of the present study was to explore the adjunctive use of Acacia arabica gel in the treatment of chronic periodontitis. Methods Single centre, randomised, triple blind, controlled trial on mild to moderate chronic periodontitis patients; Group I (SRP + Acacia arabica, n = 40) and Group II (SRP + placebo, n = 40); were analysed for clinical improvements in periodontal pocket depth (PPD) and clinical attachment levels (CAL) at baseline, 15 and 90 days on application of gels. Gingival index and plaque index were assessed as secondary parameters. Results Statistically significant PPD reduction (p < .05) and CAL gain (p < .05) was observed with use of Acacia arabica gel. The reduction in sites with moderate PPD was observed more among Group I than Group II and the difference was statistically significant (p = .001). Secondary outcome variables; Plaque Index and Gingival Index showed better resolution with Acacia arabica gel. Conclusion Acacia arabica leads to better clinical outcomes in patients with mild to moderate chronic periodontitis with effective antiplaque and anti-gingivitis action. It may be recommended adjunct to SRP for maintenance in patients with mild to moderate chronic periodontitis.

Gerodontology: An Interdisciplinary Approach

The aim of this review is to throw light on the interrelationship between periodontics, restorative dentistry and prosthodontics in geriatric population. Increased life expectancy along with appropriate dental treatment in the younger ages leads to retention of more number of teeth in the advanced ages. To maintain these teeth disease free and in function in the older individuals is a multi-faceted challenge. This article describes the various restorative and prosthodontic treatment modalities that are commonly used in the dental rehabilitation of geriatric patients and their relationship with the periodontium and gingival health.

Survey of Extent of Translation of Oral Healthcare Guidelines for ICU Patients into Clinical Practice by Nursing Staff

Nosocomial infections in critically ill/ventilated patients result from bacterial load in oropharyngeal regions. Oral decontamination serves as the easiest effective means of controlling infections. Knowledge, attitude, and practices followed by healthcare personnel in intensive care settings need to be assessed to implement concrete measures in health-care. Survey questionnaire was constructed and implemented following its validation on seventy nursing and paramedical staff working in government and private intensive care units throughout Lucknow city. 21-item questionnaire consisted of three parts of seven questions each. 78% of respondents had knowledge regarding oral care and its importance in critical settings but 44% of respondents considered it to be unpleasant task. 36% of respondents claimed to have provided oral care to all patients in ICU. Uniform guidelines for translation of oral healthcare in ICU settings are not being implemented. Previous studies in literature from various geographic diverse regions also point out to similar lacunae. Based on present survey, most respondents were aware of importance of oral care with protocols covered in academic curriculum. Attitude towards oral care is positive but respondents feel a need for specialised training. Practice for oral care is not sufficient and needs improvement and proper implementation.

Treatment of multiple adjacent gingival recessions in a single surgical approach with expanded subepithelial connective tissue graft – An innovative approach

BACKGROUND Gingival recession on anterior teeth compromises facial esthetics and is associated with dentinal hypersensitivity. Multiple teeth recession requires multiple surgeries for adequate coverage. METHODS Six anterior mandibular teeth were treated with single Subepithelial Connective Tissue Graft (SCTG) expanded with the use of alternate vertical incisions. A brief review of SCTG is included. RESULTS 90 days evaluation revealed adequate recession coverage. Patient was satisfied with the esthetic results. CONCLUSION The present technique may be an innovative approach for single surgical harvesting and placement of SCTG over long expanse multiple adjacent gingival recessions. This technique prevents multiple surgical traumas to the patient and enhances esthetics.