Background: Senescence is a multifactorial process that in humans may be accompanied by inflammation and immune dysfunction in the oral cavity. Notably, periodontal disease, considered one of the most common inflammatory disorders in the oral cavity, has also been linked to the onset of other chronic inflammatory diseases common in the elderly. Thus, investigating immunity and inflammation during senescence may not only illuminate the pathophysiology of periodontal disease, but also identify new therapeutic targets. Materials and Methods: To this end, we retrospectively and systematically reviewed studies of immune molecules associated with periodontal disease. These studies were identified in PubMed from three independent searches based on distinct sets of search terms. Results: The data highlight the need to further investigate inflammatory molecules involved in chronic periodontal disease in the elderly, but strongly suggest that interleukin (IL)-33 is involved. Indeed, various genetic and environmental factors appear to contribute to pathogenesis via IL-33. Conclusion: The IL-33 axis may be promising therapeutic target in elderly patients.

Background: Plaque control has been shown to have a pivotal role in maintaining optimal periodontal health. Toothbrushing as a mechanical plaque control tool is the most popular and effective option for self-performed oral health maintenance. However, the detrimental effects of bristle hardness and force exerted by toothbrushes on the tooth surface are the areas of concern. Objective: The aim of this in vitro study was to evaluate the abrasive effect of two different manual toothbrushes exerting predetermined forces on cemental surfaces of the teeth. Materials and Methods: Sixty extracted first molars were selected. Totally six experimental groups were formed based on the three predetermined forces 1.5, 3, and 4.5 Newton (N) and two types of manual toothbrushes, i.e., soft and medium bristle hardness. Buccal and lingual surfaces were independently brushed for 5000 cycles using specially designed toothbrushing machine. Throughout the experiment, type and quantity of toothpaste were kept constant. Post 5000 cycles of toothbrushing, change in surface roughness was measured using profilometer in microns and change in weight indicating loss of substance was measured in milligrams. Results: Abrasion of cementum is force dependent. Data revealed that both soft and medium bristle hardness toothbrushes cause significant cemental abrasion at 3 and 4.5 N forces. Conclusions: Higher is the force, more is the cemental surface abrasion. Soft bristled toothbrush causes more cemental abrasion than medium bristled toothbrush at 3 and 4.5 N forces.

Background: The present study aims to comparatively evaluate the isolation and quantification of stem cells derived from dental pulp and periodontal ligament of a permanent tooth and to assess their viability and proliferation on a platelet-rich fibrin (PRF) scaffold. Materials and Methods: A total of 15 systemically healthy individuals between the age group of 15–25 years requiring third molar or orthodontic premolar extractions. Teeth were extracted atraumatically and transported to the laboratory. Stem cells were isolated from dental pulp and periodontal ligament. After attaining more than 90% confluency by the 7^th day, these cells were tested for their viability and characterization. Stem cells were also incubated with PRF and viability was assessed on the 7^th day. Results: The mean number of cell for dental pulp stem cells (DPSCs) and periodontal ligament stem cell (PDLSC) was statistically insignificant (P > 0.05). The mean live cell viability was compared between DPSC (98.07%) and PDLSC (98%). Both DPSC and PDLSC showed a high percentage of expression of CD73 markers, 30.40% and 29.80%, respectively. However, DPSCs and PDLSCs lacked expression of CD34 expressing only 3.47% and 3.53%, respectively. PRF membrane as a scaffold exhibited no cytotoxic effects on DPCS's or PDLSC's. The cell viability of cells cultured with PRF was statistically insignificant (P > 0.05) when compared to the cells cultured with culture media. Conclusion: The study thus indicates that dental pulp and periodontal ligament are both rich sources of mesenchymal stem cells and can be successfully used for obtaining stem cells. PRF exhibits no cytotoxic effects on the cells and can be used in conjunction with dental stem cells.

Context: Periodontal surgical procedures produce varying degree of stress in all patients. Nitrous oxide-oxygen inhalation sedation is very effective for adult patients with mild-to-moderate anxiety due to dental procedures and needle phobia. Aim: The present study was designed to perform periodontal surgical procedures under nitrous oxide-oxygen inhalation sedation and assess whether this technique actually reduces stress physiologically, in comparison to local anesthesia alone (LA) during lengthy periodontal surgical procedures. Settings and Design: This was a randomized, split-mouth, cross-over study. Materials and Methods: A total of 16 patients were selected for this randomized, split-mouth, cross-over study. One surgical session (SS) was performed under local anesthesia aided by nitrous oxide-oxygen inhalation sedation, and the other SS was performed on the contralateral quadrant under LA. For each session, blood samples to measure and evaluate serum cortisol levels were obtained, and vital parameters including blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were monitored before, during, and after periodontal surgical procedures. Statistical Analysis Used: Paired t-test and repeated measure ANOVA. Results: The findings of the present study revealed a statistically significant decrease in serum cortisol levels, blood pressure and pulse rate and a statistically significant increase in respiratory rate and arterial blood oxygen saturation during periodontal surgical procedures under nitrous oxide inhalation sedation. Conclusion: Nitrous oxide-oxygen inhalation sedation for periodontal surgical procedures is capable of reducing stress physiologically, in comparison to LA during lengthy periodontal surgical procedures.

Background: Visually impaired people encounter numerous challenges in their daily life which makes it a cumbersome task to pay special attention to oral health needs. Furthermore, there is little knowledge about oral health practices among caretakers and visually impaired individuals, due to which oral health is often neglected when compared to the general health. Hence, there was a need to educate visually challenged individuals about oral hygiene practices in a customized format so that the comprehension of brushing techniques could be conveyed at its best. Materials and Methods: The present study was a randomized control trial of sixty visually impaired adolescents who were divided into three groups of 20 each. In Group 1, Braille was used, whereas in Group 2, audio-tactile performance (ATP) technique and in Group 3, a combination of both the methods were used to teach tooth brushing as a part of oral health education. Pre- and post-plaque index score using Silness and Loe (1967) after health education were calculated and tabulated for statistical analysis. Results: The postintervention mean plaque index score increased in Group 1 from 29.45 to 42.98, whereas the mean plaque score decreased in Groups 2 and 3 from 30.83–29.9 to 30.23–18.73, respectively. Intergroup comparison of postplaque index score using Kruskal–Wallis and ANOVA analysis showed significant difference among all three study groups. Conclusion: The combination of Braille and ATP technique of health education served as the most effective medium to teach oral hygiene methods to visually impaired adolescents.

Background: To compare treatment modalities: Open flap debridement (OFD) alone (Group I), OFD in combination with PerioGlas^® (Group II), and OFD in combination with autologous platelet-rich fibrin (PRF) (Group III) for periodontal intrabony defects (IBDs). Aim: To evaluate on clinical and radiographic basis, effectiveness of PerioGlas^®, and PRF in treating IBDs. Settings and Design: IBDs selected on the basis of the inclusion criteria were randomly assigned to Groups I, II, and III by coin toss method. Materials and Methods: The study was conducted on patients reporting to the department of periodontology and oral implantology. Thirty-eight patients with ninety periodontal IBDs of moderate to severe periodontitis were selected and assigned to Groups I, II, and III. In each patient, a minimum number of two sextants were present with pocket depths ≥5 mm in at least three teeth. Statistical Analysis: Statistical analysis based on mean values, standard deviation, and P values. Results: Compared to baseline, 9 months postoperatively: (1) mean probing pocket depth reduction for Group I was 3.68 mm ± 0.72, for Group II was 5.57 mm ± 1.10, and for Group III was 6.11 mm ± 0.92. (2) The mean relative attachment level gain for Group I was 4.14 mm ± 0.76, for Group II was 6.57 mm ± 1.45, and for Group III was 6.74 mm ± 1.55. (3) Mean radiographic IBD fill for Group I was 69.29% mm ± 7.73, for Group II was 74.44% mm ± 8.57, and for Group III was 75.01% mm ± 7.85. Conclusion: This study shows marked improvements in the clinical parameters and radiographic outcomes with both PerioGlas^® and autologous PRF to treat periodontal IBDs as compared to OFD alone.

Aim: The aim of this study is to determine the effectiveness of stevia as a daily mouthrinse among 12–15 year-old schoolchildren in Nellore District, Andhra Pradesh. Materials and Methods: A randomized, controlled triple blind trial was carried out among 108 children in B. V. S Municipallity Girls High school in Nellore. Children were randomly allocated into four groups comprising 27 in each group. Four mouthrinses composed of 0.2% chlorhexidine gluconate; 0.05% sodium fluoride, 10.6% stevioside and placebo were provided to the study participants. Plaque index, gingival index, and International Caries Detection and Assessment System (ICDAS) II, respectively, were used for assessing oral condition. The mouthrinsing was carried out for 6 months. Results: Group C showed maximum reduction of 8% and 10% on plaque and gingival scores, respectively, followed by Group A and Group B. However, Group D participants showed 1.5% and 1.8% increase in plaque and gingival scores, respectively. Analysis of ICDAS scores at 6 months indicated that values recorded were same as baseline for all the three groups except that for Group D, there was an increase in the prevalence of cavitated lesion D_2–6from 5.6% to 5.8%. Conclusion: Stevia demonstrated very potent antiplaque and antigingivitis properties as compared to other mouthrinses at the end of 6 months trial.

Context: Periodontitis is an inflammatory disease of microbial origin. Locally delivered antimicrobials reduce subgingival flora. Achyranthes aspera gel has antimicrobial, antioxidant, anti-inflammatory, and immunostimulant effects. Aims: To evaluate the efficacy of local drug delivery of A. aspera gel in the management of chronic periodontitis. Materials and Methods: Thirty patients with chronic periodontitis were considered in the study and categorized into two equal groups (Group A: scaling and root planing (SRP) with A. aspera gel, Group B: SRP with placebo gel). Patients were enlisted from the Department of Periodontics, Mamata Dental College and Hospital. The clinical parameters (gingival index, bleeding on probing, probing pocket depth, and clinical attachment level) were recorded at baseline and 3 months. Statistical Analysis Used: All the obtained data were sent for statistical analyses using SPSS version 18. Results: The periodontitis and the Achyranthes were statistically analyzed. A comparison of clinical parameters for test group and control group from baseline to 3 months was done using paired t-test. Intergroup comparison for both the groups was done using independent sample t-test. Conclusions: A. aspera gel when delivered locally along with SRP showed a beneficial effect. A. aspera gel as a non-surgical local drug delivery system proved to be without any side effects in the management of periodontitis. A. aspera gel has strong anti-inflammatory effects in addition to its antioxidant activity.

Background: Patient compliance is an important predictor of periodontal prognosis, therapy, and maintenance. Limited studies concentrate up on the factors which affect patient compliance. Thus, the aim of the study is to determine the relationship between sociodemographic data, patient's oral health awareness (OHA) and treatment satisfaction (TS) to patient compliance. Materials and Methods: A total of 150 patients were subjected to a prevalidated questionnaire comprising of thirty questions. Questions covered different aspects such as sociodemographic data, OHA, and level of patient TS. Statistical analysis was done using mean, percentages, and Spearman's correlation coefficient. Results: A sample of 150 people was included into the study of which 93 were females and 67 males with a mean age of 38 years. The total OHA scores when divided into three categories such as 5–7, 8–9, and >10 and plotted against number of missed appointments; the difference found was statistically significant (P < 0.001). The mean TS was divided into four subgroups of score >24, 25–27, 28–30, and >31 and then plotted against the average number of missed appointments, and the difference was found to be statistically significant (P < 0.001). The correlation between the OHA score and number of missed appointments was −0.59 (P < 0.001) and TS score and number of missed appointments was −0.40 (P < 0.001). Conclusion: Within the limitations of the study, it can be concluded that patient education, OHA, and TS are the variables that influence the patient compliance.

Background: Oral hygiene is the most essential factor in the prevention and therapy of many diseases, especially the periodontal disease. The aim of this study was to evaluate the oral hygiene-related knowledge, self-efficacy, and motivation of the young adults of rural-based Tamilian population, with their current oral hygiene practices to assess the effect of patient motivation after initial periodontal therapy. Materials and Methods: A hundred patients filled out questionnaires based on their oral hygiene-related knowledge. Plaque index, gingival index, and gingival bleeding index were recorded and correlated with their questionnaire knowledge. Initial periodontal therapy and motivation were done to all patients. After 6 months, oral health status was evaluated again. Results: There was a lower correlation value with insignificant P value between the questionnaire score and plaque and gingival index score, (r = 0.125, 0.166). However, the correlation between questionnaire score and modified papilla bleeding index score was high (r = 0.254) with significant (P = 0.011). After 6 months following the initial periodontal treatment, significant decrease in all the three indices scores was noted with significant (P < 0.001). Conclusion: Oral hygiene-related motivational approaches targeting rural young adult population has the potential to predict oral hygiene behavior and influences the clinical outcomes.

Leiomyoma is a smooth muscle tumor which rarely turns into malignancy. This is an unusual case report which presents leiomyoma on gingiva with osseous involvement. This case highlights the importance of histopathological examination for the proper diagnosis of any gingival growth. A 28-year-old female patient reported with localized gingival enlargement. The surgical excision was conducted and excised tissue was sent for histopathological examination. On the basis of clinical and histopathological examination, the diagnosis of leiomyoma was made. Leiomyoma reported low recurrence rate in previous literature. However, this lesion recurred within 15 days. After recurrence, the patient was referred to the oncology center for further evaluation and treatment.

Plasma cell mucositis (PCM) is a rare benign proliferative disorder affecting various mucosal surfaces usually seen in elderly patients. In the present case, a 13-year-old young boy reported with the complaint of swollen upper lip and enlarged gums in relation to upper front teeth. The diagnosis of plasma cell mucositis is complex and frequently requires histopathological examination and immunohistochemistry. Management included conventional gingivectomy and intralesional steroid. Regular follow-up of PCM is essential based on the possibility of recurrence, the potential involvement of other mucosal surfaces and unknown potential for malignant transformation.

This report presents the clinical results of peri-implant plastic surgical approaches for hard and soft tissues before and during the implant placement in a patient with vertical ridge deformation and a shallow vestibule sulcus, and the subsequently performed prosthetic rehabilitation. The surgical approaches used in this case reduced the crown-height space and crown-to-implant ratio and ensured that the implants were placed in their ideal positions, and peri-implant tissue health was maintained. In conclusion, developments in the peri-implant plastic surgery enable the successful augmentation of hard and soft tissue defects and provide the implant-supported fixed prosthetic rehabilitation.

In the modern day dental practice, synergy is fundamental. This synergistic effect must exist among various disciplines of dentistry for proper diagnosis, treatment planning, sequencing and execution of treatment in complex and challenging dental situations. Such collaborative effect between an orthodontist and a periodontist is essential as both works with same element, the tooth as crown-root unit with its supporting tissues. The orthodontic treatment is carried out through the medium of periodontium, so a healthy tooth supporting system is an essential prerequisite. Every potential candidate for orthodontic treatment should undergo a thorough periodontal examination. Any lousily diagnosed or conducted orthodontic treatment could be a facilitator of periodontal inflammatory or infectious process especially when the patient's oral hygiene is explicitly deficient. This case report demonstrates a challenging situation to a periodontist where patient had completed her orthodontic treatment but ended up with severe periodontal disease. The patient was thoroughly examined and a comprehensive treatment was planned and executed. Regenerative surgical procedures were done using platelet rich fibrin and hydroxyapitatite bone graft. Patient was followed up for 2 years. As sequelae of surgical procedures, patient had developed black triangles in the anterior region. The patient was unwilling for further perioplastic surgical procedures and further orthodontic treatment, so a gingival prosthesis using valplast was fabricated addressing her esthetic concerns.

The aim of the present study was to assess the clinico-histopathological picture and to examine the recurrence of various localized hyperplastic gingival growths after their surgical treatment. Twenty patients of localized hyperplastic gingival outgrowth were evaluated in the present clinico-histopathological study. The data regarding age, sex, location, size, and duration of lesion were summarized. After 4 weeks of initial therapy, an excision of the growth with conventional flap surgery was performed. The excised tissues were sent for histopathological analysis, and the lesions were reclassified into four groups. All the patients were recalled after 3 and 6 months to study the recurrence of the growth. Twenty lesions were inspected, the pyogenic granuloma was the most common (55%), followed by peripheral fibroma (25%), peripheral giant cell granuloma (15%), and calcifying fibroblastic fibroma (5%). Out of the twenty lesions evaluated, the pyogenic granuloma was the most common with no recurrence in any case.