Background: The aim of this systematic review and associated meta-analysis was to compare manual and powered brushes in relation to the removal of plaque and gingival health. Stain removal, adverse effects and microbiological evaluation cost were also considered. Materials and Methods: To be included in the review, a trial had to be a randomized-controlled trial (RCT) comparing manual and powered brushes. Trials confined to comparing different types of powered or different types of manual brushes were excluded. Split mouth designs were eligible. Trials with subjects of specific age group (18-25 years) were included. The primary outcomes were plaque and gingival health with data defined as short-term (0-28 days) duration were analyzed. Powered brushes were categorized into three groups depending on mode of action. Numerical data extracted were checked by a fourth reviewer for accuracy. Results: Three trials with full articles were identified. These include trials published between 2002 and 2005. The trials involved 56 subjects at baseline, without loss of subject for follow up. Powered brushes reduced plaque and gingivitis at least as effectively as manual brushing. Ionic brushes statistically significantly reduced plaque and gingivitis. Conclusion: In general there was no evidence of a statistically significant difference between powered and manual brushes. However, ionic brushes significantly reduce plaque and gingivitis in both the short-term evaluations. The clinical significance of this reduction is not known. Observation of methodological guidelines and greater standardization of design would benefit both future trials and meta-analyses.

Green tea is particularly rich in health-promoting flavonoids (which account for 30% of the dry weight of a leaf), including catechins and their derivatives. The most abundant catechin in green tea is epigallocatechin-3-gallate, which is thought to play a pivotal role in the green tea's anticancer and antioxidant effects. Catechins should be considered right alongside of the better-known antioxidants like vitamins E and C as potent free radical scavengers and health-supportive for this reason. It has been suggested that green tea also promotes periodontal health by reducing inflammation, preventing bone resorption and limiting the growth of certain bacteria associated with periodontal diseases.

The theory of focal infection, which was promulgated during the 19 ^th and early 20 ^th centuries, stated that "foci" of sepsis were responsible for the initiation and progression of a variety of inflammatory diseases such as arthritis, peptic ulcers, and appendicitis. In the oral cavity, therapeutic edentulation was common as a result of the popularity of the focal infection theory. Since many teeth were extracted without evidence of infection, thereby providing no relief of symptoms, the theory was discredited and largely ignored for many years. Recent progress in classification and identification of oral microorganisms and the realization that certain microorganisms are normally found only in the oral cavity have opened the way for a more realistic assessment of the importance of oral focal infection. It has become increasingly clear that the oral cavity can act as the site of origin for dissemination of pathogenic organisms to distant body sites, especially in immunocompromised hosts such as patients suffering from malignancies, diabetes, rheumatoid arthritis, or in patients undergoing other immunosuppressive treatment. A number of epidemiological studies have suggested that oral infection, especially periodontitis, may be a risk factor for systemic diseases.

Background: Periodontitis is a bacterial disease modified by multiple factors. Interleukin-1 (IL-1) is a key regulator of the host response and a major modulator of extracellular matrix catabolism and bone resorption. It has been reported that variations in IL-1 gene are associated with increased susceptibility to periodontitis. The aims of the study were 1) to analyze the distribution of single nucleotide polymorphism of IL-1 (IL-1A-+4845 and IL-1B-+3954) and 2) to correlate the association of the composite genotype with the severity of chronic periodontitis. Materials and Methods: Sixty patients aged above 35 years were selected. Following a periodontal examination, using the clinical parameters plaque index, gingival bleeding index, probing depth, and clinical attachment loss (CAL), the selected subjects were categorized into four groups of differing disease severity based on CAL. Five milliliters of venous blood was drawn. DNA was isolated by phenol chloroform method. Amplification of IL-1A+4845 and IL-1B+3954 was done by polymerase chain reaction (PCR). Detection of genotype was done using restriction fragment length polymorphism using the enzymes FnU4HI for IL-1A and TaqI for IL-1B. The results obtained were analyzed statistically. Results: The frequencies of IL-1A-+4845 and IL-1B-+3954were significantly greater in severe periodontitis patients. The distribution of composite genotype (allele 2 of IL-1A+4845and allele 2 of IL-1B+3954) also correlated with the severity of periodontitis. Genotype-positive subjects had a higher mean bleeding index (%) when compared to genotype-negative patients. But no correlation was observed between mean plaque level among genotype-positive and -negative subjects. Conclusion: IL-1 gene polymorphism IL-1A+4845, IL-1B+3954 and composite genotype is an indicator of susceptibility to severe periodontitis in adults.

Background: The role of chemotherapeutic agents in periodontal therapy as adjuncts to mechanical debridement maybe justified by the inherent limitations of mechanical therapy. The aim of this study was to evaluate the long term efficacy of a locally delivered 2% minocycline gel as an adjunct to scaling and root planing in managing chronic periodontitis. Materials and Methods: This was a randomized controlled trial using a split-mouth study design. Twenty two pairs of sites with similar probing depths were randomly allocated to test and control groups. All sites received thorough scaling and root planing followed by minocycline gel application in the test sites. Probing depths, relative attachment levels, plaque index, and microbiological parameters were evaluated for both the groups over a 9-month period. Results: Overall parameters improved from baseline in both the test and control groups. For most parameters, the differences between test and control groups were not significant at different time intervals. The probing depth values in the test group at six (3.64±0.83 mm) and nine months (3.81±0.79 mm) were significantly less than control group(4.24±0.95 mm at six and 4.63±0.94 mm at nine months), these differences being significant at P<0.05 and <0.01, respectively. At the end of nine months, the number of non-motile bacilli in test group (21.65±3.74) were significantly less than control group (25.5±3.01), the difference being significant at P<0.02. Conclusion: The overall view of results in our investigation did not show any significant advantage of using 2% minocycline gel over scaling and root planning as an effective local drug delivery system and calls for further clinical trials to objectively evaluate its adjunctive in treatment of periodontitis.

Background: Conventional, non-surgical periodontal therapy consists of supra- and subgingival tooth debridement. However, it is a technically demanding procedure and is not always efficient at eradicating all periodontal pathogens and in reducing inflammation. Therefore, local subgingival application of other chemotherapeutic agents may be used as an adjunct to non-surgical therapy. The aim of this study was to investigate the clinical and histological outcomes of local subgingival application of 0.2% hyaluronic acid gel (GENGIGEL®) as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients. Materials and Methods: One hundred and twenty sites were chosen from 26 patients with chronic periodontitis (criteria being periodontal pockets ≥5mm). Experimental sites additionally received HA gel subgingivally at baseline, 1 ^st , 2 ^nd , and 3 ^rd week. Clinical parameters were re-assessed at 4 ^th , 6 ^th , and 12 ^th week. At 4 ^th week recall, a gingival biopsy was obtained from test and control site for histologic examination. Results: Intra-group analysis of all the clinical parameters at all sites from baseline to 4 ^th , 6 ^th , and 12 ^th week showed statistically significant changes. Experimental sites showed statistically significant improvement in Gingival index and Bleeding index at 6 ^th and 12 ^th week when compared with control sites. However, no statistically significant differences were observed in the PPD and RAL between control and experimental sites at 4 ^th , 6 ^th , and 12 ^th week time interval. No statistically significant association was found between the histological grading of the sites that received HA treatment. Conclusion: Subgingival placement of 0.2% HA gel along with SRP provided a significant improvement in gingival parameters. However, no additional benefit was found in periodontal parameters. Histologically, experimental sites showed reduced inflammatory infiltrate, but it was not statistically significant.

Background and Objectives: Coenzyme Q ₁₀ is a well studied antioxidant in medical literature, but studies regarding its efficacy in periodontal diseases are few. Hence, the aim of this study was to test the efficacy of coenzyme Q ₁₀ in the form of gel (Perio-Q) in patients with chronic gingivitis and periodontitis. Materials and Methods: A total of 12 patients were enrolled. A split mouth design was used for topical (extrasulcular) application, intra-pocket application alone, intra-pocket application combined with scaling and root planing (SRP) and SRP only in each quadrant, respectively. Clinical parameters such as plaque index, gingival index, gingival bleeding index, probing pocket depth, clinical attachment level were assessed at baseline, 3rd week, and 6th week. The results were subjected to statistical analysis, which were expressed as mean±SD and proportions as percentages. Intra group comparisons were made by paired t-test and one way analysis of variance (ANOVA) for inter-group comparisons. Categorical data was analyzed by Fisher's exact test. Results: The results showed on intra-group analysis significant reduction (P<0.01) of clinical parameters (plaque index (PI), gingival index (GI), gingival bleeding index (GBI), periodontal probing pocket depth (PPD), and clinical attachment level (CAL)) in all four treatment groups, whereas on inter-group analysis, intra-pocket gel application in combination with SRP showed significant reduction (P<0.05) for PI, GI, GBI, and CAL in comparison to intra-pocket gel alone. Interpretation and Conclusion: In the present study, in chronic periodontitis patients, sub-gingival mechanical debridement only and with Perio-Q gel showed almost similar clinical results without any statistically significant differences. Hence, it confirmed the primary role of basic mechanical approaches in periodontal therapy and did not provide enough clinical support for the superiority of adjunctive use of Perio-Q gel. However, it appears that Perio-Q gel in this study may have a potential additive effect. Further, long term clinical studies of Perio-Q gel with various doses and duration need to be conducted.

Background: Investigators have sought different methods to deliver antimicrobials to periodontal pockets. This study was designed to assess the efficacy of locally made doxycycline gel versus locally made doxycycline implant as biodegradable controlled local delivery systems, by evaluating the pharmacological drug release and improvement in gingival status, gain in attachment, and reduction in pocket depth. Materials and Methods: Thirty patients with localized periodontal pockets ≥5 mm were randomly divided into three groups. The first group received the doxycycline gel, the second the doxycycline implant, and the third received only scaling and root planing (the control group). The patients in the first two groups were selected for the drug release. Clinical parameters such as gingival index, plaque index, probing depth, and attachment levels were recorded at baseline and the 90 ^th day. Gingival crevicular fluid (GCF) and saliva samples were collected 1 hour following gel and implant placement and then on the 10 ^th , 30 ^th , and 60 ^th days. Results: There was a statistically significant difference in the release of doxycycline from the gel when compared with the implant in the GCF and saliva on the 10 ^th and 30 ^th days. All the three groups showed improvement in clinical parameters. The improvements in both gel and implant groups were greater when compared with the control group with no statistically significant difference between the implant and gel systems. Conclusion: The use of local delivery of doxycycline through gel and Implant media further enhances the positive changes obtained following scaling and root planing. The release of doxycycline from the implant and the gel was comparable.

Background: In the contemporary dental practice, alleviation of pain is the most important factor to ameliorate patient's condition and to gain one's confidence towards the skills of the operator. Such confidence aids to the ultimate success of the treatment procedures. Aims and Objectives: This study compares the pain response of a group of 10 subjects to the Wand^® with the response to traditional syringe injections and also compares the extent of the area anesthetized. Materials and Methods: 10 subjects were selected for the study and 20 injections were given contralaterally to them, 10 with Wand^® , and rest with the traditional aspirating syringe. Each subject received 2 injections on the palate, Left side with Wand^® (test) and Right side with Traditional syringe (control). All injections were given by the same investigator without the use of topical anesthetic spray/gel. Pain perception levels were recorded with a visual analogue scale. Also the extent of area anesthetized with a single palatal injection was assessed by probing. Results: The results showed injections with the syringe were more painful than injections with the Wand^® in 2 of 10 subjects. Also the extent of the area anesthetized by both the techniques was similar except in 2 patients. Conclusion: The Wand^® results in less painful injections; however, mean ratings of pain for both the groups, were mostly below the annoying level of pain. Also, the areas covered by the anesthetic effect of both the injections were comparatively similar.

Objective: Our objective was to determine the efficacy of pre-procedural rinsing with chlorhexidine in reducing bacterial aerosol contamination during use of ultrasonic scaler and comparing the efficacy of water, non-tempered chlorhexidine and tempered chlorhexidine in reducing bacterial count in aerosols when used as a pre-procedural rinse. Materials and Methods: The study was designed to include 30 systemically healthy patients in different age groups. The patients were divided randomly into 3 groups (I, II, III) of 10 patients each to be administered with sterile water, non tempered chlorhexidine and tempered chlorhexidine, respectively, as a pre-procedural rinse. The aerosol produced by the ultrasonic unit was collected at 3° clock, 6° clock and 12° clock positions on blood agar plates within a range of 4 feet in all the three groups. The blood agar plates were incubated for 48 hours and the total number of colony forming units (CFUs) were counted and statistically analyzed. Results: The results showed that CFU in group III and group II were significantly reduced when compared to group I with F=1084.92, P<0.001 (ANOVA). Also, CFU in group III was significantly reduced when compared to group II with P<0.001. Conclusions: Pre-procedural rinse can significantly reduce the viable microbial content of dental aerosols and tempered chlorhexidine was more effective than non-tempered chlorhexidine.

Background: Predictable root coverage and good colour match are the major therapeutic end points in the treatment of gingival recession. Alloderm has been used as a substitute to connective tissue graft, but its colour match in populations with a high degree of melanin pigmentation has not been extensively studied. The aim of this study was to evaluate the effectiveness of an Acellular dermal matrix graft for root coverage procedures and to objectively analyze the post-operative esthetics using a Visual Analog Scale (VAS). Materials and Methods: Both male and female patients were selected, aged 20-50 years presenting with aesthetic problems due to the exposure of recession defects when smiling. A total of 14 patients contributed to 15 sites, each site falling into Miller's class I or class II gingival recession. Results: A total of 15 sites were treated and a mean coverage of (85.56±21.70 and 83.33±21.82%) was obtained at the end of 3 ^rd and 12 ^th month respectively. A mean VAS score of 7.93±1.03 and 8.13±0.99 (3 ^rd and 12 ^th month) and 5.73±0.70 and 6.87±0.83 (3 ^rd and 12 ^th month) was obtained when the colour match recorded by the patients and an independent observer, respectively. Conclusion: The study showed that acellular dermal matrix graft (alloderm) may be successfully used to treat gingival recession, as adequate root coverage may be predictably obtained. The grafted areas underwent melanization from the 6 ^th month onwards and complete blending with the adjacent sites was obtained at 1 year.

Background: Gingival recession resulting in root exposure is a common problem faced by clinicians. This clinical study compared the results obtained by treating gingival recession using enamel matrix derivative (Emdogain gel^® ) along with coronally positioned flap and coronally positioned flap alone. Materials and Methods: Twenty patients with a total of 46 gingival recession defects, each patient with a minimum of two recession defects, were included in the study. The test group, which consisted of 10 patients with 22 recession defects, was treated by enamel matrix derivatives (Emdogain gel) in combination with a coronally positioned flap, while the control group, which consisted of 10 patients with 24 gingival recession defects, was treated with 24% ethylenediaminetetraacetic acid (EDTA; Prefgel^® ) in combination with coronally positioned flap. Results: Student's paired and unpaired t-test was used for statistical analysis. If the probability value (P) was less than 0.05, it was considered significant. Data from this study demonstrated that application of (EMD) Emdogain gel resulted in a statistically significant increase in root coverage, gain in the clinical attachment level (CAL), and probing pocket depth (PPD) reduction when compared with coronally advanced flap (CAF) alone, but there was no statistically significant difference in the width of keratinized gingiva (WKG) between the two groups.

Background: Gingival inflammation may be caused by injury or plaque-related disease and reduction in inflammation can be a useful indicator of gingival recovery. There has been little research on development of non-index method to measure gingival condition. The study aimed to investigate the quantitative analysis of gingival swelling and color characteristics of gingiva by digital images before and after treatment of individual patients. Material and Methods: Twenty volunteers with gingival inflammation were recruited and digital images were taken. Duplicate measurements were made on the first visit by the same examiner. At a subsequent visit (1 month) following scaling and root planing, second images were taken. Gingival changes were determined by assessing redness and tooth surface area visible between the level of the inter-proximal papillae and the gingival margin. Results: Significant difference was found between the pre-operative and post-operative photographs with regard to swelling and gingival redness. Conclusion: Thus this method aids in quantitative analysis of swelling and color characteristics of gingiva by digital images may become a valuable, objective, practicable non-index and inexpensive evaluation procedure of gingival inflammation.

Background: Resorption of the alveolar ridge often leaves insufficient bone volume. Very few studies have investigated the quantity and quality of bone formation in humans, following alveolar ridge augmentation, using autogenous bone and bovine bone mineral (BBM) under titanium mesh. Materials and Methods: Sixteen alveolar bone defects divided into two groups; control group with symphyseal autogenous bone covered by titanium mesh; and test group with symphyseal autogenous bone mixed with BBM in 1: 1 ratio and covered by titanium mesh. The outcomes were evaluated clinically, histologically, and histomorphometrically. Results: Clinical measurements showed that the horizontal bone gain was 3.44±0.54 mm and 2.88±0.57 mm, on average, for control group and test group, respectively. While graft absorption was 2.66±0.98 mm (43.62%) and 1.67±1.00 mm (36.65%), on average, for control group and test group, respectively. In the test group, BBM particles were still recognizable, on histologic analysis. They were surrounded completely or partly by newly formed bone. Clear signs of resorption of the BBM were found, with osteoclast cell noticed in the area. Histomorphometrically, the newly formed bone was 78.40%±13.97% and 65.58%±6.59%, whereas connective tissue constituted 21.60%±13.97% and 23.87%±4.79% for control group and test group, respectively. The remaining BBM particles occupied 10.55%±1.80%. All differences between the control and test groups were not significant (P>.05). Conclusion: This investigation suggests that horizonal ridge augmentation with titanium mesh and autogenous bone alone or mixed with BBM are predictable and ridges were augmented even if mesh exposure occurs.

Background: Several synthetic alloplastic materials have been used in the past as an implant in infrabony defects with a goal to reconstruct the lost part of attachment apparatus via new osseous tissue formation. The present study was undertaken to evaluate and compare clinico-radiographically, the effect of bioactive glass (BG), hydroxyapatite (HA), and BG-HA composite bone graft particles in the treatment of human infra-bony periodontal defects. Materials and Methods: Indigenous synthetic HA, BG, and BG-HA composite bone graft materials were developed in the laboratory. Twenty eight infrabony periodontal defects were equally distributed (i.e., seven defects) into four groups. The defects were treated separately with three types of graft materials and non-grafted manner (open flap debridement alone, control) to evaluate both the soft and hard tissue responses after six months of surgery. Evaluation was done by studying different parameters such as plaque index, gingival index, relative attachment level, probing pocket depth, and radiographic bone fill in Intra Oral Peri-Apical radiograph. Results: The healing of defects was uneventful and free of any biological complications. The gain in relative attachment level, reduction of probing pocket depth, and bone fill was statistically significant in all four groups. BG and BG-HA synthetic bone graft implanted sites showed significant bone fill (P<0.05) than hydroxyapatite and unimplanted control sites. Conclusion: The performance of BG and its composite was better compared to HA and open flap debridement alone for the reconstruction of infrabony defects. The BG-HA composite particles may effectively be used as an alternative bone graft material for infrabony defects.

Aim: The aim of the present study was to evaluate the efficacy of a bovine derived xenograft Bio-Oss™ and to compare with open flap debridement in human infrabony periodontal defects. Materials and Methods: Twelve healthy patients (5 males, 7 females; aged 30-50 years), with no systemic disease with moderate to severe periodontitis were treated. Surgically defects were included only if presence of two or more vertical osseous defects as verified by radiographs with associated probing pocket depth of ≥5.0 mm following non-surgical therapy. Final selection included 24 defects. The defects were randomly assigned treatment with bovine derived xenograft Bio-Oss™ as experimental sites or open flap debridement as control sites. Soft tissue and hard tissue measurements were recorded on the day of surgery and six months post-operatively. Results: The results showed significant difference statistically between experimental and control sites in all measurements. Soft tissue measurements for the experimental sites included probing pocket depth reduction of 4.33±0.651 mm and attachment gain of 2.92±0.9003 mm, while the control sites showed a probing pocket depth reduction of 2.92±0.669 mm and a attachment gain of 0.583±0.515 mm. Osseous measurements showed bone fill of 1.936±1.046 mm (54.065±12.642%) for experimental sites and 0.02±0.01 mm (0.534±0.384%) for the control sites. Defect resolution was 50.75% for the experimental sites and 5.45% for the control sites. Conclusion: Bio-Oss™ is a bone graft material of considerable promise. However, further long term clinical studies with histological evaluation are warranted.

Periodontal procedures require injection of local anesthetic solution to avoid patient discomfort. Multiple injections are required to anesthetize the anterior maxilla in the region of the premolars to incisors. Anterior middle superior alveolar nerve block is a single palatal injection technique, which anesthetizes the facial and palatal gingiva as well as pulp in the region of the maxillary central incisors to the premolars without any collateral facial anesthesia. This case series presents the application of the anterior middle superior alveolar nerve block in periodontal therapy.

Hyperimmunoglobulin E syndrome (HIES), also known as Job's syndrome, is a rare primary immunodeficiency characterized by eczema, recurrent skin and lung infections, elevated serum IgE, and connective tissue and skeletal abnormalities. Individuals with HIES share a characteristic facial appearance and many oral manifestations including retained primary dentition, a high-arched palate, variations of the oral mucosa and gingiva, and recurrent oral candidiasis. An 18-year-old lady presented with gingival swelling, bleeding from the gums, recurrent skin infections, and recurrent respiratory infections with intermittent fever. After thorough extra oral, intra oral and radiographic examination, serological investigations were performed. Growth of candida hyphae in the biopsy specimen of gingiva and increased levels of serum IgE with typical extra oral findings established the diagnosis as Job's syndrome (hyper IgE syndrome). Treatment with anti-fungal antibiotics and phase-I therapy including scaling and root planing followed by gingivoplasty using diode laser (980 nm) was performed. HIES was previously defined on the basis of clinical manifestations and laboratory markers that were not specific to the disease. With the identification of STAT3 mutations as the cause of HIES, we can definitively characterize the disease at molecular and immunologic levels. This case emphasizes the role of the dentist in the diagnosis of rare syndromes which alters the treatment plan.

Papillon-Lefèvre syndrome is a very rare syndrome of autosomal recessive inheritance characterized by palmar-plantar hyperkeratosis and early onset of a severe destructive periodontitis leading to premature loss of both primary and permanent dentitions. Various etiopathogenic factors are associated with the syndrome; but a recent report has suggested that the condition is linked to mutations of the cathepsin C gene. Two cases of Papillon-Lefèvre syndrome in the same family, having all of the characteristic features are presented. An 11-year-old girl, and her elder sister, a 13-year-old girl complained of loose teeth and discomfort in chewing along with recurrently swollen and friable gums. Both patients also had premature shedding of their deciduous teeth. The family history revealed consanguineous marriage of the parents. Both patients presented with persistent thickening, flaking and scaling of the skin of palms and soles. Severe generalized periodontal destruction with mobility of teeth was evident on intraoral examination; orthopantomograph examination showed severe generalized loss of alveolar bone in both the patients.

Arterio-venous malformation (AVM) is an abnormal communication between an artery and a vein. The incidence of its occurrence in oral and maxillofacial region is rare, and if present, the most common sign is gingival bleeding. A 12-year-old female patient presented with an extra oral swelling in relation with upper lip. Intra oral examination showed non tender gingival swelling with spontaneous bleeding associated with maxillary arch. On initiation of phase I therapy using hand instruments, spontaneous brisk bleeding was encountered which was difficult to control. Because of severe nature of hemorrhage encountered, some type of vascular abnormality was suspected. Ultrasonography followed by angiography confirmed AVM in relation with upper lip. Embolization of lesion was followed by gingivectomy procedure and no recurrence was reported during one year of follow-up. Thus, proper recognition and therapeutic intervention is essential to avoid serious complications and potentially tragic outcome in such situations.

Systemic sclerosis is a rare connective tissue disorder with a wide range of oral manifestations. This case series reports significant oral and periodontal changes and also makes an attempt to correlate oral and systemic findings in these patients which enable the clinician for a better diagnosis and evolve a comprehensive treatment plan. Six patients with a known diagnosis of systemic sclerosis were included. After obtaining the patient's informed consent, relevant medical history, oral manifestations including periodontal findings and oral hygiene index simplified index were recorded. In these patients, oral changes included restricted mouth opening and, resorption of the mandible. The periodontal changes observed were gingival recession, absence or minimal gingival bleeding on probing, and widened periodontal ligament space, radiographically. Patients with systemic sclerosis often show wide range of oral manifestations, which is of major concern for the dentist.

This case report describes a rare benign tumor in a 21-year-old female was referred to the department of Periodontics, regarding areas of gingival enlargement affecting both the maxilla and mandible on the right side. She was not having any systemic and family history. Surgical excision of the lesions was carried out under local anesthetic. Histopathological examination confirmed the diagnosis of giant cell fibroma. The condition responded to surgical excision and appears to have limited growth potential. It may affect a wide spectrum of ages, but it is most commonly found in young people and can be alarming due to rapid enlargement and ulceration; so careful diagnosis is important to avoid unnecessary aggressive treatment.

Gingival enlargement is a common clinical feature of gingival and periodontal diseases. Currently, more than 20 prescription medications are associated with gingival enlargement. Although the mechanisms of action may be different, the clinical and microscopic appearance of drug-induced gingival enlargement is similar with any drug. Gingival enlargement produces esthetic changes, and clinical symptoms including pain, tenderness, bleeding, speech disturbances, abnormal tooth movement, dental occlusion problems, enhancement of caries development and periodontal disorders. Sodium valproate is considered to produce gingival enlargement, but very rarely. This case report features sodium valproate induced gingival enlargement in a patient with pre-existing chronic periodontitis, who came to the Dental Department, Chinmaya Mission Hospital, Bangalore. The case is special as the patient did not develop the enlargement in spite of taking phenytoin for 1 year and developed enlargement with sodium valproate within 6 months.

Injuries to oral soft tissue can be accidental, iatrogenic, and factitious trauma. Chemical, thermal, and physical agents are the main causative agents for oral soft-tissue burns. The present case describes the chemical burn of oral mucosa caused by tetracycline hydrochloride and its management. Diagnosis was made on the basis of definitive history elicited from the patient. The early detection of the lesion by the patient and immediate institution of therapeutic measures ensure a rapid cure and possible prevention of further mucogingival damage. In addition, we believe that proper guidance and education of the patient is an important prophylactic measure in preventing this self-inflicting injury.

A deep understanding of the relationship between root morphology and periodontal destruction is crucial to successful periodontal care. Most mandibular molars have two roots (one mesial and the other distal) and three canals. The major variant of this tooth type is the presence of an additional third root distally or mesially or a supernumerary lingual root. This article presents a case report of a 14-year-old girl with mandibular first molar having three roots bilaterally which is contributing to the periodontal destruction. There were three walled defect distal to first molar with Grade II furcation involvement distally. Regenerative surgeries were performed and patient was kept under maintenance. The relationship between additional third root and periodontal destruction seldom has been described clearly. This paper has been presented in 34 ^th national conference at Dharwad.