Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
March-April 2020
Volume 24 | Issue 2
Page Nos. 93-185

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EDITORIAL  

Can we make the practice of Periodontology attractive? p. 93
Ashish Kumar
DOI:10.4103/jisp.jisp_41_20  
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PRESIDENT’S MESSAGE Top

Patient dentist relationship (the decisive factor for optimal results) p. 95
Nymphea Pandit
DOI:10.4103/jisp.jisp_51_20  
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SECRETARY’S MESSAGE Top

Periodontology: Yearning for zero-gravity thinkers p. 97
Harpreet Singh Grover
DOI:10.4103/jisp.jisp_25_20  
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REVIEW Top

Career opportunities in periodontics: A road map to the future p. 98
Aishwarya Lakshmi Billa, Haritha Avula, Yashaswini Chakravarthy
DOI:10.4103/jisp.jisp_434_19  
A solid career plan is crucial as it can provide a roadmap to the future. The motivating factors for selecting any career are complex, and periodontics is no exception. Periodontics is a dynamic profession that includes sophisticated treatment planning and a wide variety of treatment modalities ranging from conventional to advanced therapies. It is a unique branch of dentistry that enables both saving teeth and also replacing them in an effective way with implants. The purpose of this article is to provide an overview of various career opportunities for a periodontist. Career options in periodontics are manifold and diverse, enabling a periodontist a professionally gratifying and secure lifestyle. Future of the profession of periodontics appears exciting and rewarding but is not likely to happen without great effort and challenges. However, periodontics is not a static field and continues to evolve leaving a periodontist with no dearth in career opportunities.
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ORIGINAL RESEARCH Top

Early and accurate detection of bacterial isolates from dental plaque in subjects with primary, mixed, and permanent dentition by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry technique p. 104
Amitabh Srivastava, Sonali Saha, Chinmoy Sahu
DOI:10.4103/jisp.jisp_303_19  
Background: Bacterial colonization of dentition in different age groups can impact prognosis in different dental diseases. Latest diagnostic technique such as matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF) is increasingly being used for accurate identification of bacteria. This study was undertaken to evaluate the MALDI-TOF MS technique to identify bacterial pathogens from dental plaques in subjects with primary, mixed, and permanent dentition. Materials and Methods: The study included 150 subjects of different age groups and were divided into three groups - Group A: Subjects with primary dentition (n = 50), Group B: Subjects with mixed dentition (n = 50), and Group C: Subjects with permanent dentition (n = 50). Subgingival dental plaque samples were collected from buccal and lingual surfaces of premolar and molar teeth. Clinical parameters such as gingival index were recorded. Samples were cultured in routine aerobic and anaerobic medium. Bacterial growths were assessed by semiquantitative methods. Bacterial isolates were confirmed by MALDI-TOF MS technique. Results: MALDI-TOF MS detected all the culture-grown bacteria. In primary dentition group, purple and yellow complex bacteria predominated. Streptococcus spp. was the predominant bacteria (51%) followed by Escherichia coli (19%) and Veillonella spp. (19%). In mixed dentition and permanent group also, Streptococcus spp. was predominant (46%) followed by Veillonella spp. (24%) and E. coli(19%). However, in both groups, orange complex bacteria (bridge complex) such as Prevotella nigrescens and red complex bacteria (Porphyromonas gingivalis, 3%) were seen. For majority of bacteria, the load increased with age. Conclusions: The bacterial isolates showed a distinct age-specific colonization. The use of advanced technique such as MALDI-TOF MS is helpful in the detection of periodontal pathogens, and the effective oral health programs can be implemented to minimize the risk of periodontal diseases.
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Comparative evaluation of the effect of curcumin and chlorhexidine on human fibroblast viability and migration: An in vitro study p. 109
Sangeetha Kolathuparambil Sukumaran, Rosamma Joseph Vadakkekuttical, Harikumar Kanakath
DOI:10.4103/jisp.jisp_173_19  
Background and Objective: Chemical plaque control acts as an adjunct to mechanical periodontal therapy. Chlorhexidine (CHX) is considered as the gold standard in chemical plaque control, but the main concern is about its fibroblast cytotoxicity. Curcumin, a lipophilic polyphenol, may offer as a promising antiplaque agent. This study was conducted to compare the effect of curcumin (0.003%, 0.03%, 0.06%, 0.1%, and 0.12%) and CHX (0.03%, 0.06%, 0.1%, 0.12%, and 0.2%) on gingival fibroblast cell viability and wound healing at different time periods (1, 2, 4, 6, 8, and 10 min). Materials and Methods: The minimum inhibitory concentration (MIC50) was determined before the evaluation of cytotoxicity and wound healing property. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and morphological examination by direct invert microscopy were carried out to determine cytotoxicity. Wound healing was evaluated by scratch wound assay. Results and Discussion: The MIC50 of CHX and curcumin was at 0.1% and 0.003%, respectively. The mean percentage of fibroblast viability at different concentrations of CHX and curcumin at each time period showed a significant difference. Curcumin exhibited less cytotoxicity as compared to CHX at all concentrations and at varying time periods. There was a significant difference between mean percentage of fibroblast viability at MIC50 of CHX (0.1%) and curcumin (0.003%) at different time periods. The difference between percentage wound healing at antibacterial concentrations of CHX and curcumin at varying time periods was significant. Conclusion: The antibacterial concentration of curcumin (0.003%) exhibits less fibroblast cytotoxicity and excellent wound healing property as compared to CHX. Curcumin may offer as a promising chemical plaque control agent which is less cytotoxic, cost-effective, safe, easily available, and with a possibly beneficial effect on wound healing.
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Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients p. 117
Sangamesha Bevinagidad, Swati Setty, Anand Patil, Srinath Thakur
DOI:10.4103/jisp.jisp_440_19  
Introduction: The initial carious lesions are the so-called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re-mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy. Materials and Methods: All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk's test and Wilcoxon test were applied to the data collected for statistical analysis. Results: There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH. Conclusion: Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84%). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.
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Effect of antidepressants on various periodontal parameters: A case–control study p. 122
Afshan Bey, Syed Saeed Ahmad, Suhail Ahmed Azmi, Sameena Ahmed
DOI:10.4103/jisp.jisp_210_19  
Background: Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case–control study was conducted to know the effect of two commonly prescribed antidepressants – venlafaxine (serotonin–norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti-inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. Materials and Methods: The study sample consisted of 182 depressed patients divided into three study groups: Group I – the control group diagnosed as depressed on the first visit, Group II – depressed patients taking fluoxetine 20 mg/day, and Group III – patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire-based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. Results: The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti-inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants-SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). Conclusion: The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti-inflammatory properties.
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Comparative evaluation of the precision of cone-beam computed tomography and surgical intervention in the determination of periodontal bone defects: A clinicoradiographic study p. 127
Unnati Pitale, Hitesh Mankad, Rohit Pandey, Pritish Chandra Pal, Shikha Dhakad, Antush Mittal
DOI:10.4103/jisp.jisp_118_19  
Context: Major limitations of conventional radiography are overlapping and lack of 3D information. Surgical exposure, though being able to provide accurate information, provides very little time to plan-out the type of periodontal regeneration required during surgery. Cone Beam Computed Tomography (CBCT) has emerged as a feasible tool and found to be accurate. Unfortunately, in-vivo studies are still scarce. Aim: Aim of the present study was to assess the efficacy of CBCT in the detection of periodontal bony defects while determining its quantitative precision in the measurement of alveolar bone height as against the open flap debridement (OFD) procedure which is set as the gold standard. Setting and Design: Present study is a cross-sectional study. Materials and Methods: The present study includes patients with Chronic Periodontitis indicated for periodontal surgeries. Bone defects were measured with the help of CBCT and with William's periodontal probe during surgical intervention and compared. Statistical Analysis: Measurements were compared with Student's t-test; unpaired t-test & correlation were tested with Pearson's correlation coefficient test. P < 0.05 was considered statistically significant. Results: The mean CBCT & surgical value of palatal/lingual & distal sites of anterior teeth showed statistically significant difference (P = 0.001). All the values for posterior teeth were statistically non-significant. Conclusion: Statistically CBCT & clinical measurement with OFD have similar potential of accuracy to access the bony topography but CBCT provides good accessibility to visualize the sites which are difficult to access during surgical interventions like palatal sites & the distal sites of the posterior teeth.
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Efficacy of liquid nitrogen and electrocautery assisted gingival depigmentation in term of patient's perception, histological wound healing - A randomized triple blind clinical trial p. 135
Sanjeev Kamboj, Sanjeev Kumar Salaria
DOI:10.4103/jisp.jisp_438_19  
Background: Hyper-melanin pigmentation of the gingiva (GMP) is one of the imperative contributory factors for smile-sensitive individuals. Numerous gingival depigmentation (GD) procedures have been attempted in the literature to evaluate the clinical outcome mostly. Hence, a randomized clinical-histopathological triple-blinded trial was planned to evaluate the pain experienced by the patient, gingival wound healing, and density of melanocytes following liquid nitrogen-assisted GD (LNAGD) and electrocautery-assisted GD (ECAGD) procedures. Materials and Methods: Thirty-two arches with bilateral physiologic labial/buccal GMP extending from distal aspect tooth #14–24 and #34–44 in 16 healthy individuals were selected and were equally treated with LNAGD and ECAGD techniques. Dummett oral pigmentation index and Hedin melanin index were evaluated at baseline and 3 months' postoperatively (PO). The visual analog scale was utilized for the intensity of pain assessment at baseline (immediately after treatment) and 1st day and 7th day PO. Histological wound healing and density of melanocytes were evaluated using Gal et al.'s wound-healing assessment index and Patsakas et al.'s criterion, at baseline (0), 8, 24, 72, and 96 h; 1st, 2nd, 3rd, and 4th week; and 3 months and at 0 and 3 months' PO, respectively. Statistical analysis was done using one-way ANOVA, post hoc Tukey, unpaired, and paired “t” test. Results: Both groups showed a statistically significant influence on the parameters evaluated. Conclusion: The LNAGD had a substantial superior result in terms of early wound healing, reduction in density of melanocytes, reduction in pain experienced by the patient, with reduction and delay in the recurrence of GMP.
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Clinical and microbiological evaluation of the synergistic effects of diode laser with nonsurgical periodontal therapy: A randomized clinical trial p. 145
Shiva Manjunath, Deepak Singla, Rika Singh
DOI:10.4103/jisp.jisp_101_19  
Context: Nonsurgical and surgical therapies along with local and systemic antibiotic regimens have been advocated in the treatment of periodontitis. Due to increasing risk of developing antibiotic resistance and inability of nonsurgical periodontal therapy to completely eradicate the pathogenic microorganisms, lasers have been used as an adjunct to conventional therapy. Aim: The aim of the present study is to evaluate the effectiveness of the use of diode lasers as adjunct to scaling and root planing (SRP) compared to SRP alone on various clinical and microbiologic parameters in chronic periodontitis patients. Settings and Design: Patients were taken from the department of periodontology and implantology, who were having chronic periodontitis. Materials and Methods: A total of forty patients participated in the study and they were divided into Group I – the test group (SRP + diode laser) and Group II – the control group (SRP alone). The following clinical parameters were assessed: oral hygiene index simplified; clinical attachment level (CAL); probing pocket depth (PPD); bleeding on probing (BOP) at baseline, 4 weeks, and 12 weeks after the treatment; and colony-forming units (CFUs) 1 week postoperatively. Statistical Analysis Used: The statistical analysis was performed using paired t-test, unpaired t-test, Wilcoxon signed-rank test, and Mann–Whitney test. Results: There was reduction in BOP, PPD, and gain in CAL from baseline to 3 months and also a reduction in CFU 1 week postoperatively. Conclusion: There was a significant improvement in clinical parameters in test group (SRP + laser) as compared to the control group (SRP alone).
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Comparative evaluation of use of diode laser and electrode with and without two dentinal tubule occluding agents in the management of dentinal hypersensitivity: An experimental in vitro study Highly accessed article p. 150
Chitra Laxmikant Patil, Rajesh Prabhakar Gaikwad
DOI:10.4103/jisp.jisp_136_19  
Background: The present study aims to assess area of open dentinal tubules by use of diode laser and electrode alone and in combination with hydroxyapatite powder and strontium chloride powder by using the scanning electron microscope (SEM). Materials and Methods: A double-blinded study was carried out with 30 extracted teeth with no carious lesion or restored teeth were selected and grouped randomly as Group A - diode laser, Group B - electrode application, Group C - hydroxyapatite powder plus diode laser, Group D - hydroxyapatite powder plus electrode application, Group E - strontium chloride powder plus diode laser, and Group F - strontium chloride powder plus electrode application. All the samples were made by preparing a notch of 2 mm measured with UNC-15 probe at cementoenamel junction using a diamond cylindrical bur at high speed. The teeth were then washed with distilled water and stored in solution containing 2.5% glutaraldehyde solution in 0.1 M sodium phosphate buffer for 24 h. The samples were treated as mentioned in above said groups and were viewed under SEM the degree of occlusion of the dentinal tubules were quantified using an image analyzer. Results: Highest number of open dentinal tubules was found with Group B, that is, electrode application, whereas Group C, that is, hydroxyapatite powder plus diode laser showed highest occluded tubules. One-way ANOVA showed statistically significant difference across all the groups (P = 0.000); further, intergroup comparison with Tukey's test showed better tubular occlusion with Group C. Conclusion: The SEM results showed highest tubular occlusion with hydroxyapatite powder plus diode laser and least with electrode.
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Comparative assessment of periodontal regeneration in periodontal intraosseous defects treated with PepGen P-15 unaided or in blend with platelet-rich fibrin: A clinical and high-resolution computed tomography scan-assisted volumetric analysis p. 156
Jyotsna Goyal, Surinder Sachdeva, Sanjeev Kumar Salaria, Nishu Vakil, Amit Mittal
DOI:10.4103/jisp.jisp_351_19  
Background: PepGen P-15, a xenograft, has proven its periodontal regenerative potential. Platelet-rich fibrin (PRF) is an autologous platelet concentrate which too contributes to periodontal redevelopment through the release of different polypeptide progression factors. The present study intended to evaluate the regenerative potential of PepGen P-15 xenograft when used unaccompanied or in blend with PRF in periodontal intraosseous defects in humans through clinical and a novel computed tomography (CT) scan analysis technique. Materials and Methods: Twelve chronic periodontitis individuals with paired periodontal intraosseous defects were randomly treated either with PepGen P-15 exclusively (Control/Group A) or in concoction with PRF (Test/Group B) utilizing split-mouth study design. Pocket probing depth (PPD), relative attachment level (RAL), and relative position of gingival margin were assessed at 3- and 6-month interval, whereas the linear and volumetric bone defect regeneration were assessed at 6 months postoperatively using CT scan. Results: Both the groups validated statistically significant PPD reduction, RAL gain at 3 and 6 months, but on intergroup comparison, test group CT images revealed significantly greater linear bone gain and volumetric bone gain, with mean difference of 0.73 ± 0.28 (P = 0.018) and 2.70 ± 1.36 (P = 0.06) at 6 months in comparison to the baseline data. Conclusions: PepGen P-15 and PRF blend had better regeneration potential for the management of intrabony defects. Further long-term investigations on large sample size are recommended to authenticate the same.
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Prevalence of herpesviruses in periodontal disease of the North Indian population: A pilot study p. 163
Rameshwari Singhal, Amita Jain, Pavitra Rastogi
DOI:10.4103/jisp.jisp_62_19  
Introduction: Periodontitis is a multifactorial disease of diverse microbiome, predominantly bacterial. Bacterial infection alone may not explain complete pathophysiology and clinical variations in disease pattern. Concept of herpesviruses playing a significant role in periodontal pathogenesis has been explored globally. Studies show varied results and difference may be accounted to variations existing in studied populations. The present study explored the prevalence of herpesviruses in periodontal disease of the North Indian population. Materials and Methods: In this case–control study, tissue samples were collected from the normal gingiva (control: n = 48) and deepest pocket (cases: n = 48) using a single curette stroke. Periodontal disease status was assessed through the gingival index, pocket depth, and clinical attachment level which were compared to viral marker positivity. Results: Ninety samples from 48 healthy gingiva and 48 periodontitis patients were assessed between the age range of 17–60 years. The prevalence of cytomegalovirus was 2.083% (cases) and 2.083% (controls) and Epstein–Barr virus (EBV) was 18.75% (cases) and 0% (controls). Odd's ratio for EBV in patients with periodontitis is calculated (Haldane–Anscombe correction) to be 21.82%. Herpes simplex virus 1/2 and varicella-zoster virus were absent in both groups. Conclusions: Within the limitation of this study, EBV was found in cases of periodontitis patients. Its role in disease initiation and progression is not clear. Further studies are required to ascertain EBV as risk factor in periodontal disease.
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Association between obesity and its determinants with chronic periodontitis: A cross-sectional study p. 167
Neha Nasa Gulati, Sujata Surendra Masamatti, Priyanka Chopra
DOI:10.4103/jisp.jisp_157_19  
Background: Various systemic disorders such as cardiovascular, diabetes, and osteoporosis are linked to periodontitis. Obesity is one such epidemic, and although many studies have addressed its relationship with periodontitis, the mechanism still remains unclear. Aim: This study aims to assess the association between obesity and its determinants with clinical periodontal parameters in adult patients visiting a dental college in Haryana. Materials and Methods: This cross-sectional study was performed in 317 patients visiting a dental college in Gurugram. Obesity parameters such as body mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist–hip ratio (WHR) were assessed using body fat analyzer (Omron HBF 701). Depending on their BMI, individuals were stratified as overweight (OW), Class 1, Class 2, and Class 3 obese. Periodontal status was assessed by plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level. These periodontal parameters were correlated with BMI, BF%, WC, and WHR. Statistical analysis was done, and P ≤ 0.05 was considered as statistically significant. Results: The prevalence of periodontitis in OW, Class 1, Class 2, and Class 3 obese was 16.4%, 79.2%, 2.8%, and 1.6%, respectively. PPD was significantly associated with obesity determinants, especially among Class 2 and Class 3 obese individuals. Similarly, BF% was associated with all the periodontal parameters. Conclusion: Within the restrictions of the study, it can be concluded that obesity and chronic periodontitis are interlinked.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Chronic idiopathic neutropenia: A periodontist's diagnosis p. 173
Subash Chandra Raj, Annuroopa Mahapatra, Poonam Agrawal, Kaushik Patnaik, Shib Shankar Pradhan
DOI:10.4103/jisp.jisp_149_19  
Our aim is to report the periodontal findings of a 10-year-old boy who visited the outpatient department of periodontology, with the chief complaint of swelling in the right cheek region for the last 2 months, increasing mobility of the teeth, and frequent bleeding from the gums. Since the age of 4 years, he suffered from recurrent febrile episodes, with boils and furuncles on the face. After several hematological and immunological investigations, he was diagnosed with chronic idiopathic neutropenia. He was prescribed a 150 μg subcutaneous injection of recombinant granulocyte colony-stimulating factor, once daily for 8 days. For reducing oral inflammation, he was advised an oral rinse of 15 ml of chlorhexidine gluconate (0.12%) twice daily and advised for a routine periodontal checkup, every 3–4 weeks for evaluation, maintenance, and avoiding any acute inflammatory flare-ups.
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Ibuprofen-induced localized frontal and temporal forehead swellings: A rare case report p. 178
Aditi Chopra, Rachana Pappu, Karthik Sivaraman
DOI:10.4103/jisp.jisp_119_19  
Ibuprofen, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), is one of the most commonly prescribed analgesics for managing musculoskeletal, orofacial, and postoperative pain after periodontal therapy. Although considered as one of the safest analgesic agents, the onset of adverse drug reactions after ibuprofen intake has been recently observed. The present report aims to highlight the development of localized swellings in the temporal and frontal forehead following intake of 200 mg of ibuprofen after routine oral prophylaxis. This is the first case report to document the development of an adverse drug reaction with ibuprofen in a patient following a routine dental procedure. The article also aim to comprehensively describe the most appropriate and effective method to diagnose, manage, and prevent NSAIDs-induced adverse drug reactions in routine dental practice.
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Autologous platelet-rich derivatives along with alloplastic bone substitute in the management of complex perio-endo cases Highly accessed article p. 182
Lata Goyal, Namita Gupta, Narinder Dev Gupta
DOI:10.4103/jisp.jisp_81_19  
Combined endodontic periodontal lesion is one of the most challenging dental conditions as making a definite diagnosis and henceforth treatment plan is a daunting task. The prognosis of complex lesion involving both endodontic and periodontic components is complex, but success rate can be improved with regenerative therapies. However, there is paucity of literature regarding its effectiveness in the clinical scenario as only few case reports have been documented in literature for the use of platelet-rich derivatives in regenerative osseous surgery requiring both endodontic and periodontal treatment. We are hereby presenting three cases requiring both endo and perio treatment. The first two cases involve mandibular first molar and maxillary first molar, respectively. The third case involves maxillary central incisor. In all the cases, first, endodontic treatment was initiated, then open flap curettage along with alloplastic bone substitutes was done. Platelet-rich fibrin and platelet-rich plasma were used along with. Three of the treated cases showed significant improvement radiographically and clinically. There was gain in clinical attachment, reduction in probing depth, and radiographic bone fill. Autologous platelet-rich derivative can be used in combination with alloplastic bone substitute for the management of endo-perio cases. Further long-term studies are needed to explore the clinical effectiveness of platelet-rich derivatives and predicting the probability of success of periodontal therapy.
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