Srinivas Sulugodu Ramachandra

Options to avoid the second surgical site: a review of literature

As esthetics gain importance, periodontal plastic surgical procedures involving soft tissue grafts are becoming commoner both around natural teeth as well as around implants. Periodontal soft tissue grafts are primarily used for the purpose of root coverage and in pre-prosthetic surgery to thicken a gingival site or to improve the crestal volume. Soft tissue grafts are usually harvested from the palate. Periodontal plastic surgical procedures involving soft tissue grafts harvested from the palate have two surgical sites; a recipient site and another donor site. Many patients are apprehensive about the soft tissue graft procedures, especially the creation of the second/donor surgical site in the palate. In the past decade, newer techniques and products have emerged which provide an option for the periodontist/patient to avoid the second surgical site. MucoMatrixX, Alloderm®, Platelet rich fibrin, Puros® Dermis and Mucograft® are the various options available to the practicing periodontist to avoid the second surgical site. Use of these soft tissue allografts in an apprehensive patient would decrease patient morbidity and increase patient’s acceptance towards periodontal plastic surgical procedures.

Extraction protocols for orthodontic treatment: A retrospective study

Background and Objectives: Various extraction protocols have been followed for successful orthodontic treatment. The purpose of this study was to evaluate the extraction protocols in patients who had previously undergone orthodontic treatment and also who had reported for continuing orthodontic treatment from other clinics. Materials and Methods: One hundred thirty eight patients who registered for orthodontic treatment at the Faculty of Dentistry were divided into 10 extraction protocols based on the Orthodontic treatment protocol given by Janson et al. and were evaluated for statistical significance. Results: The descriptive statistics of the study revealed a total of 40 (29%) patients in protocol 1, 43 (31.2%) in protocol 2, 18 (13%) in protocol 3, 16 (11.6%) in protocol 5, and 12 (8.7%) in Type 3 category of protocol 9. The Type 3 category in protocol 9 was statistically significant compared to other studies. Midline shift and collapse of the arch form were noticed in these individuals. Conclusion: Extraction of permanent teeth such as canine and lateral incisors without rational reasons could have devastating consequences on the entire occlusion. The percentage of cases wherein extraction of permanent teeth in the crowded region was adopted as a treatment option instead of orthodontic treatment is still prevalent in dental practice. The shortage of orthodontists in Malaysia, the long waiting period, and lack of subjective need for orthodontic treatment at an earlier age group were the reasons for the patients to choose extraction of the mal-aligned teeth such as the maxillary canine or maxillary lateral incisors.

Anti-tobacco Messages on Tobacco Products in India: Do They Really Hit the Mark?

The Indian Government has recently introduced various fiscal and nonfiscal measures for tobacco control, including pictorial health warnings on tobacco packaging. Health warnings on tobacco products are arguably the most cost-effective tool for educating on the health risks of tobacco use. However, interventions are effective upon being transferred from one setting to another with appropriate adjustment to the local context. Authors argue that there is a need to strengthen and target the health messages in a better way to ensure that the warnings reach all smokers, including those buying loose cigarettes/bidis. Any measures that make anti-tobacco messages more meaningful in the Indian context will lead to significant contributions towards the fight against tobacco.

Dental management of patient with Williams Syndrome - A case report.

Williams syndrome is a multisystemic rare genetic disorder caused by deletion of 26-28 genes in the long arm of chromosome 7. It is characterized by developmental and physical abnormalities including congenital cardiovascular abnormalities, mental retardation, neurological features, growth deficiency, genitourinary manifestations, gastrointestinal problems, musculoskeletal problems, unique behavioral characteristics, and dental problems. Dental abnormalities include malocclusion, hypodontia, malformed teeth, taurodontism, pulp stones, increased space between teeth, enamel hypoplasia, and high prevalence of dental caries. Authors report a 17-year-old female patient with underlying Williams syndrome. Oral features and problems seen in the patient are listed. Malocclusion and screwdriver shaped teeth were noticed. Generalized widening of the periodontal ligament space with vital teeth was seen. This finding has not been reported in cases of Williams syndrome earlier. Precautions taken during dental treatment in patients with Williams syndrome are also discussed.

Oral health: charcoal brushes.

3 of this alkaloid and produce pilocarpine from callus cell lines in order to save this endangered species.1 New methods of detection of pilocarpine are being employed. Alexndra Sawya and Ilka Abreu used HPLC-ESI-MS/MS (high-performance liquid chromatography-tandem mass spectrometry) method to detect pilocarpine in paste that is left over after industrial extraction of pilocarpine to permit additional studies of biosynthetic pathway.3 Genetic breeding programmes have been proposed by Moura and Pinto.4 Jaborandi, the only known source of pilocarine, is at the verge of extinction due to human impact. Overharvesting has placed many medicinal species at risk of extinction. We must safeguard our remaining medicinal treasures in the wild for future generations. Preena Sidhu, Malaysia

Combined soft and hard tissue augmentation for a localized alveolar ridge defect

Ideal alveolar ridge width and height allows placement of a natural appearing pontic, which provides maintenance of a plaque-free environment. The contour of a partially edentulous ridge should be thoroughly evaluated before a fixed partial denture is undertaken. Localized alveolar ridge defect refers to a volumetric deficit of the limited extent of bone and soft-tissue within the alveolar process. These ridge defects can be corrected by hard tissue and/or soft-tissue augmentation. A 30-year-old male patient was referred to the Department of Periodontology for correction of Seiberts Class III ridge defect in the lower anterior region. Granulation tissue/connective tissue present at the base of the defect was removed after elevation of full thickness flap. MucoMatrixX, an animal derived, collagen based soft-tissue graft was sutured to the labial flap and bone graft was placed into the defect. If a soft-tissue graft material could be used to replace the palatal grafts, then all the possible complications associated with donor site would be eliminated and above all periodontal plastic surgery and ridge augmentation would be better accepted by patients.

Interleukin 1β (+3954; −511) genotype polymorphism and its association with severe chronic generalized periodontitis in the Malaysian Population

Introduction: Single-nucleotide polymorphisms (SNPs) in interleukin 1β (IL-1β) gene have been known to be associated with increased susceptibility to chronic periodontitis among various ethnic populations. SNPs are more commonly observed at loci + 3954 and − 511. The aim of this study was to evaluate the role of IL-1β gene polymorphism at loci +3954 and − 511, and its association with severe chronic generalized periodontitis among the ethnic Malay, Chinese, and Indians within the Malaysian population. Materials and Methods: Saliva samples from 120 subjects (60 cases and 60 controls) in the age group of 25–50 years were collected for isolation of genetic material using Norgen technique. Clinical attachment loss of ≥5 mm was considered as severe chronic generalized periodontitis. SNPs at loci +3954 and − 511 were identified and analyzed using Kompetitive Allele Specific Polymerase Chain Reaction Genotyping System (KASP™). Differences in the allele/genotype frequencies were assessed by Chi-square test (P < 0.05). Results: On the comparison between cases and controls of IL-1β genotype polymorphism (+3954 and − 511), the difference in the genotype frequencies was statistically insignificant in all the three ethnicities. The genotype frequency in both groups in all three ethnicities of the Malaysian population was similar. Conclusion: IL-1β genotype polymorphism at +3954 and − 511 was found to be not associated with severe chronic generalized periodontitis among the three ethnicities in Malaysia. Studies with larger sample size should be done to confirm the findings of this study.

Differential diagnosis between chronic versus aggressive periodontitis and staging of aggressive periodontitis: A cross-sectional study

Background: Differentiating between chronic periodontitis (CP) and aggressive periodontitis (AgP) is challenging. The aim of this study was to assess the variations in diagnosis between CP versus AgP and the staging of AgP based on the disease-staging index for AgP among periodontists, specialists in oral medicine, and general dental practitioners (GDPs). Materials and Methods: Fifteen cases diagnosed as either CP or AgP were included in a “case document” and sent electronically to 75 respondents. Case document included a detailed history with periodontal charting, clinical features, images, and radiographs for all the cases. Diagnosis and staging for the case (if diagnosed as AgP) were requested. A reordered case document (cases in a different sequence) was again sent to respondents after a gap of 1 month. Statistical analysis: Descriptive statistics including frequency and percentage were calculated. Pearsons Chi-square test was used to analyze the data collected. Results: For the “case document,” 10.17% of the responses were different from those of the authors for diagnosis, whereas 4.48% of the responses were different from those of the authors for the staging of AgP. The agreement in the overall responses was in the range of 0.69–0.84, which was considered good. Comparison of the responses for diagnosis showed statistically significant (P = 0.009) difference between specialists in oral medicine and GDPs. Conclusions: Variations exist among respondents regarding the diagnosis of CP versus AgP. Staging of AgP based on the listed criteria showed low variations.

Association between Smoking, Body Mass Index, and Periodontal Disease: A Case-Control Study

Introduction: Smoking and obesity are associated with chronic periodontal disease. Chronic periodontal disease has been suggested to be an associated risk factor for obesity. The aim of this study was to evaluate the effect of smoking on body mass index (BMI) and periodontal status of patients. Materials and Methods: A total of 134 subjects (67 smokers and 67 nonsmokers) aged between 24 and 45 years were included in the study. Periodontal status was categorized into healthy, gingivitis, and periodontitis (mild, moderate, and severe, and into localized and generalized). BMI was calculated using height and weight of the patients. A simple descriptive statistics was obtained by analyzing the collected data using MedCalc 15.4. Results: The results indicated that nonsmokers have higher BMI (mean = 23.4 kg/cm 2 , 95% confidence interval [CI] = 22.7-24) as compared to smokers (mean = 21.1 kg/cm 2 , 95% CI = 20.7-21.6). Among 134 subjects, 49 were suffering from chronic periodontitis. People in the overweight category were 26. Subjects who were both overweight and suffering from chronic periodontitis were only 6% (n = 8). Conclusions: The study found an association between periodontal disease and smoking, but no association between obesity and periodontal disease was noticed. Studies with larger sample size and patients from obesity clinics should be studied.

Lessons learned from the disruption of dental training of Malaysian students studying in Egypt during the Arab spring.

Background: Political crisis and worsening security situation in Egypt in late 2013 resulted in Malaysian students who were pursuing their dental education in Egypt being recalled home to Malaysia. The Ministry of Higher Education in Malaysia took steps to integrate these students into public and private universities in Malaysia. Methods: We used a questionnaire and informal interviews to learn from students returning from Egypt about their experiences transitioning from dental schools in Egypt to Malaysia. Results: We discuss the challenges students faced with regards to credit transfer, pastoral care, the differences in the curriculum between the dental faculties of the two nations, and the financial implications of this disruption of their training. Discussion: We live in a fragile world where similar political situations will surely arise again. The approaches used by the Malaysian government and the lessons learned from these students may help others. The perspectives of these students may help educators reintegrate expatriate students who are displaced by political instability back into the education system of their own countries.