Rupali Agnihotri

Association of Cigarette Smoking With Superoxide Dismutase Enzyme Levels in Subjects With Chronic Periodontitis

BACKGROUND Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). In the present study, the influence of smoking on the periodontium was determined by estimating the levels of SOD in light and heavy smokers with periodontitis. METHODS Seventy subjects in the age range of 20 to 55 years, including 60 smokers and 10 non-smokers (controls), were selected. Clinical parameters recorded were plaque index (PI), probing depth (PD), and attachment loss (AL). Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (> or = 10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. Gingival crevicular fluid (GCF) and saliva samples were collected. SOD levels were analyzed using spectrophotometric assay. RESULTS The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and intergroup analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. CONCLUSIONS There was a progressive reduction in SOD levels from healthy non-smokers to light smokers to heavy smokers. These findings highlight the need to augment the efforts of smoking-cessation programs. The benefits of reduced smoking and improved antioxidant levels may motivate smoking cessation.

Green tea: A novel functional food for the oral health of older adults

Functional foods are foods with positive health effects that extend beyond their nutritional value. They affect the function of the body and help in the management of specific health conditions. Green tea, a time‐honoured Chinese herb, might be regarded as a functional food because of its inherent anti‐oxidant, anti‐inflammatory, antimicrobial and antimutagenic properties. They are attributed to its reservoir of polyphenols, particularly the catechin, epigallocatechin‐3‐gallate. Owing to these beneficial actions, this traditional beverage was used in the management of chronic systemic diseases including cancer. Recently, it has been emphasized that the host immuno‐inflammatory reactions destroy the oral tissues to a greater extent than the microbial activity alone. Green tea with its wide spectrum of activities could be a healthy alternative for controlling these damaging reactions seen in oral diseases, specifically, chronic periodontitis, dental caries and oral cancer, which are a common occurrence in the elderly population. Geriatr Gerontol Int 2014; 14: 238–250.

Alzheimer's disease and chronic periodontitis: Is there an association?

Alzheimers disease, an affliction of old age, is one of the leading causes for dementia worldwide. Various risk factors including family history, genetics and infections have been implicated in its pathogenesis. The cognitive decline in this condition is mainly a result of the formation of amyloid deposits that provoke neuroinflammation, ultimately resulting in cell death. Recently, an association between peripheral inflammation and Alzheimers disease was hypothesized. It was suggested that chronic systemic inflammation worsened the inflammatory processes in the brain. This was mainly attributed to increased levels of pro‐inflammatory mediators, such as interleukin‐1, interleukin ‐6 and tumor necrosis factor‐α in the plasma. As chronic periodontitis is a widespread peripheral immunoinflammatory condition, it has been proposed to play a significant role in the aggravation of Alzheimers disease. With this background, the current review focuses on the relationship between Alzheimers disease and chronic periodontitis, and its therapeutic implications. Geriatr Gerontol Int 2015; 15: 391–404.

Chemically modified tetracyclines: Novel therapeutic agents in the management of chronic periodontitis

Chronic periodontitis is a complex infection initiated by gram-negative bacteria which destroy the supporting structures of the tooth. Recently, it has been recognized that it is the host response to bacterial infection which causes greater destruction of the connective tissue elements, periodontal ligament and alveolar bone in periodontitis. This has led to the development of various host modulating approaches to target cells and their destructive mediators involved in tissue degradation. Chemically modified tetracyclines (CMTs) are derivatives of tetracycline group of drugs which lack antimicrobial action but have potent host modulating affects. They inhibit pathologically elevated matrix metal loproteinases, pro-inflammtory cytokines and other destructive mediators. Bone resorption is also suppressed due to their combined anti-proteinase and apoptotic affects on osteoblasts and osteoclasts, respectively. Development of resistant bacteria and gastrointestinal toxicity seen with parent tetracyclines is not produced by CMTs. Hence, CMTs are viewed as potential therapeutic agents in the management of chronic diseases like periodontitis that involve destruction of connective tissue and bone.

Implications of tobacco smoking on the oral health of older adults

Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It specifically influences the geriatric population as a result of chronic exposure to toxins. Its role in various systemic and oral diseases including cancer, premalignant lesions, periodontitis, tooth loss, dental caries and implant failures is well established. Smoking causes immuno‐inflammatory imbalances resulting in increased oxidative stress in the body. The latter hastens the immunosenescence and inflammaging process, which increases the susceptibility to infections. Thus, implementation of smoking cessation programs among older adults is imperative to prevent the development and progression of oral and systemic diseases. The present review focuses on smoking‐associated oral health problems in older adults, and the steps required for cessation of the habit. Geriatr Gerontol Int 2014; 14: 526–540..

Rheumatoid arthritis in the elderly and its relationship with periodontitis: A review

Periodontitis and rheumatoid arthritis are chronic inflammatory diseases commonly seen in the elderly. It has been proposed that the two conditions are interrelated and influence the severity of each other. Recently, the role of Porphyromonas gingivalis, a periodontopathogen, has been explained in the pathogenesis and progression of rheumatoid arthritis. It can be inferred from the present review that the two conditions share a common pathobiology, genetics and environmental risk factors. Furthermore, a thorough understanding of the aforementioned mechanisms might enable the development of conjoint treatment modalities beneficial in treating the geriatric population afflicted by both the disorders. Geriatr Gerontol Int 2014; 14: 8–22.

Trace Mineral Micronutrients and Chronic Periodontitis—a Review

Trace mineral micronutrients are imperative for optimum host response. Populations worldwide are prone to their insufficiency owing to lifestyle changes or poor nutritional intake. Balanced levels of trace minerals like iron (Fe), zinc (Zn), selenium (Se) and copper (Cu) are essential to prevent progression of chronic conditions like periodontitis. Their excess as well as deficiency is detrimental to periodontal health. This is specifically true in relation to Fe. Furthermore, some trace elements, e.g. Se, Zn and Cu are integral components of antioxidant enzymes and prevent reactive oxygen species induced destruction of tissues. Their deficiency can worsen periodontitis associated with systemic conditions like diabetes mellitus. With this background, the present review first focusses on the role of four trace minerals, namely, Fe, Zn, Se and Cu in periodontal health followed by an appraisal of the data from case control studies related to their association with chronic periodontitis.

Phenobarbital induced Stevens-Johnson syndrome in a child.

Phenobarbital, an antiepileptic agent has numerous adverse reactions including Stevens– Johnson syndrome (SJS), a rare medical emergency. A 12-year-old male epileptic child with phenobarbital-induced SJS was referred for the management of severe pain in relation to extensively decayed molar tooth and oral mucosal ulcerations. The patient was managed by withdrawal of phenobarbital and palliative treatment of the lesions.

Amlodipine-induced gingival overgrowth: considerations in a geriatric patient.

A “geriatric patient” is an older adult who is frail, dependant, or both and who requires health and social support services to attain an optimum level of physical, psychological and social functioning. Eighty percent of older adults over 65 years of age are diagnosed with one or more chronic conditions and 20% are limited in their ability to take care of themselves. Chronic diseases such as arthritis, hypertension and respiratory illnesses are the most commonly reported disorders in this age group. Older adults are also affected by social issues such as poverty, retirement and dependency. All these factors together play an important role in understanding the needs of a geriatric patient. Geriatric medicine has developed an approach that does not attribute symptoms to aging alone. It attempts to critically evaluate and assess the problems to help develop a comprehensive care plan. Its focus is on illness developed as a consequence of chronic disability. “Geriatric dentistry” emphasizes an interdisciplinary approach to the diagnosis, treatment and prevention of dental and oral diseases. In the clinical setting, time should be dedicated towards identification of factors that can improve the quality of life and level of functioning of an aged patient. Hypertension is highly prevalent among the elderly. It is frequently managed with antihypertensive agents like calcium channel blockers. Approximately 5% of the older adults in the USA are prescribed these medications. Reports have shown that there has been an increase in the total annual prescription of these drugs. In the early 1980s, nifedipine (a calcium channel blocker) associated gingival overgrowth was first reported. Later, there were reports describing gingival overgrowth associated with diltiazem, verapamil, amlodipine and felodipine. Although nifedipine has been more frequently associated with gingival overgrowth (15–85%), the prevalence is relatively low with amlodipine (<3.3%). Amlodipine is a member of the dihydropyridine class of calcium antagonists which selectively inhibit the influx of calcium ions across the cell membranes. Its antihypertensive action is through direct peripheral arterial vasodilation and reduction in peripheral vascular resistance. The severity of enlargement is influenced by various factors like plaque control, sex and age. However, the degree of plaque control is considered to be the most important among the aforementioned factors. The clinical manifestations usually appear within 1–3 months of the initiation of the therapy. It has been reported that amlodipine may result in gingival overgrowth as early as 2 months of administration of the drug. The interdental papillae and the anterior segment of the labial surfaces appear lobulated causing unfavorable esthetics. Mastication, speech, nutrition and access for oral hygiene are also affected. This increases the susceptibility to oral infection, caries and periodontal diseases. In an older adult the goal of periodontal therapy should be to preserve functional and comfortable dentition. The functional, psychological and socioeconomic parameters should also be assessed when planning the treatment for an elderly patient. Drug-induced gingival overgrowth (DIGO) as well as old age may negate the ability to maintain self-performed plaque control. The presence of pockets along with abundant plaque accumulation may lead to development of periodontitis. Studies have shown that conventional periodontal treatment associated with a meticulous plaque control program can elicit a positive treatment response thereby eliminating the need for surgical treatment. A multidisciplinary approach is often needed to improve the oral health status in these patients. Due consideration should be given to the possibility of discontinuing or changing the medication. The patient should be closely monitored for at least 6–12 months following the discontinuation of the drug for a possible resolution of gingival enlargement before surgical treatment is implemented. Geriatr Gerontol Int 2010; 11: 365–368

Health Effects of Trace Metals in Electronic Cigarette Aerosols—a Systematic Review

Electronic cigarettes (ECs) are essentially nicotine delivery devices that mimic the appearance of a conventional cigarette (CC). Lately, they have been marketed as tools for quitting smoking. Even though they are promoted as safe alternatives to CC, they are not devoid of hazardous components. Literature reveals that the EC aerosols and e-liquids are a potential source of elements that induce and promote development of chronic conditions. These include trace metals which are leached from their core assembly. Some of these metals like nickel, chromium, cadmium, tin, aluminum, and lead are potential carcinogens. They have been associated with fatal conditions like lung and sinonasal cancer. Besides, they may have adverse effects on oral tissues like periodontal ligament and mucosa where they may trigger chronic periodontitis and oral cancer. However, there is only trivial evidence related to health hazards of metals released from ECs. With this background, the present review first focuses on the structure of the ECs followed by an appraisal of the data from experimental studies about the metals released in EC aerosols and their associated health hazards.