Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   Table of Contents - Current issue
Coverpage
May-June 2016
Volume 20 | Issue 3
Page Nos. 231-351

Online since Monday, July 04, 2016

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EDITORIAL  

A recipe for health: The dental health quotient? p. 231
Ashish Sham Nichani
DOI:10.4103/0972-124X.185254  
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PRESIDENT’S MESSAGE Top

Systems medicine – Evolution of a new era in health care p. 232
Praveen Bhasker Kudva
DOI:10.4103/0972-124X.185255  
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SECRETARY’S MESSAGE Top

Climbing higher p. 234
Balaji Manohar
DOI:10.4103/0972-124X.185256  
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REVIEW Top

Accuracy and precision of cone beam computed tomography in periodontal defects measurement (systematic review) p. 235
Enas Anter, Mohammed Khalifa Zayet, Sahar Hosny El-Dessouky
DOI:10.4103/0972-124X.176389  
Systematic review of literature was made to assess the extent of accuracy of cone beam computed tomography (CBCT) as a tool for measurement of alveolar bone loss in periodontal defect. A systematic search of PubMed electronic database and a hand search of open access journals (from 2000 to 2015) yielded abstracts that were potentially relevant. The original articles were then retrieved and their references were hand searched for possible missing articles. Only articles that met the selection criteria were included and criticized. The initial screening revealed 47 potentially relevant articles, of which only 14 have met the selection criteria; their CBCT average measurements error ranged from 0.19 mm to 1.27 mm; however, no valid meta-analysis could be made due to the high heterogeneity between the included studies. Under the limitation of the number and strength of the available studies, we concluded that CBCT provides an assessment of alveolar bone loss in periodontal defect with a minimum reported mean measurements error of 0.19 ± 0.11 mm and a maximum reported mean measurements error of 1.27 ± 1.43 mm, and there is no agreement between the studies regarding the direction of the deviation whether over or underestimation. However, we should emphasize that the evidence to this data is not strong.
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ORIGINAL RESEARCH Top

Effects of scaling and root planing on gingival crevicular fluid vascular endothelial growth factor level in chronic periodontitis patients with and without diabetes mellitus: A clinicobiochemical study p. 244
Jayaraj Jishnu Pannicker, Dhoom Singh Mehta
DOI:10.4103/0972-124X.176395  
Aim: To estimate the gingival crevicular fluid (GCF) level of vascular endothelial growth factor (VEGF) in periodontally healthy controls and chronic periodontitis (CP) patients with and without diabetes mellitus (DM) and also to investigate the effect of scaling and root planing (SRP) on the GCF VEGF level. Materials and Methods: One hundred and five patients were divided into three groups: Healthy (Group 1), CP (Group 2), and CP with DM (Group 3). Group 2 and Group 3 patients underwent SRP planning, and the cases were followed for 6 weeks. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, and clinical attachment level were recorded at baseline and 6-week posttherapy. GCF samples collected from each patient were quantified for VEGF level using enzyme-linked immunosorbent assay. Results: The mean GCF VEGF level was increased in CP patients with and without DM compared to healthy patients and SRP therapy caused a statistically significant (P < 0.001) reduction in GCF VEGF level.Conclusion: VEGF is increased in GCF of CP patients with and without DM and that SRP substantially reduces its level in GCF.
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Comparison of serum erythropoietin levels in smokers and nonsmokers with periodontitis: A biochemical study p. 249
Vatsala Singh, Abhishek Singh Tanwar, Arathi Shital Hungund, Shital Ajit Hungund, Chaitra Nagaraja
DOI:10.4103/0972-124X.181242  
Aims: This study was carried out to compare serum erythropoietin (Epo) levels in smokers and nonsmokers with periodontitis. Materials and Methods: Fifty-one subjects of both sexes (age range: 30–65 years) with chronic periodontitis (CP) participated in this study. Seventeen patients with generalized CP, nonsmokers without anemia were included in Group I (control group), 17 patients with generalized CP, nonsmokers with anemia were included in Group II, and 17 patients who were smokers, having generalized CP were included in Group III. Peripheral blood samples were obtained and assessed for the number of erythrocytes (total red blood cell [TRBC]), hemoglobin (Hb), and Epo levels. Statistical Analysis Used: One-way analysis of variance and Tukey–Kramer multiple comparisons test to assess the statistical difference between groups. Results: Epo levels varied considerably between the 3 groups. Highest values of Epo were seen in Group III with mean Epo value = 42.81 ± 15, followed by Group II Epo value = 35.21 ± 10.9, then Group I Epo value = 22.06 ± 4.19.Smokers in Group III with CP showed more prevalence toward higher values of Hb% (mean Hb = 12.06 ± 0.84) while there was no statistical difference in the values of TRBC values among the 3 groups (Group I TRBC value = 3.87 ± 0.38, Group II TRBC value = 4.01 ± 0.83, and Group III TRBC value = 3.88 ± 0.45). Conclusion: Periodontitis patients were seen to have lower Epo values further strengthening the hypothesis that CP may lead to anemia of chronic disease. In smokers, higher Hb values were seen with higher Epo levels. It indicates that periodontitis individually and along with smoking may affect anemic status of smokers. Thus, Epo levels may be better means to assess anemic status of smokers than relying only on Hb values.
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Correlation of alkaline phosphatase activity to clinical parameters of inflammation in smokers suffering from chronic periodontitis p. 254
Vishakha Grover, Ranjan Malhotra, Anoop Kapoor, Rupika Bither, Sonia Sachdeva
DOI:10.4103/0972-124X.183099  
Context: Current clinical periodontal diagnostic techniques emphasize the assessment of clinical and radiographic signs of periodontal diseases which can provide a measure of history of disease. Hence, new methodologies for early identification and determination of periodontal disease activity need to be explored which will eventually result in expedited treatment. Aim: To evaluate the correlation of alkaline phosphatase (ALP) activity in gingival crevicular fluid (GCF) to clinical parameters of periodontal inflammation in smokers with chronic periodontitis. Materials and Methods: Study population included 15 smoker male patients in the age group of 35–55 years suffering from moderate generalized chronic periodontitis with history of smoking present. Following parameters were evaluated at baseline, 1 month and 3 months after scaling and root planing: plaque index, bleeding index, probing pocket depth (PD), relative attachment level (RAL), and GCF ALP activity. Statistical Analysis Used: Independent variables for measurements over time were analyzed by using Wilcoxon signed rank test. Results: A statistically significant reduction in all the clinical parameters and GCF ALP activity was observed from baseline to 1 month and 3 months. A correlation was observed between change in GCF ALP activity and PD reduction as well as gain in RAL at 3 months. Conclusion: The present study emphasizes that total ALP activity could be used as a marker for periodontal disease activity in smokers. Estimation of changes in the levels of this enzyme has a potential to aid in the detection of progression of periodontal disease and monitoring the response to periodontal therapy.
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Estimation of interleukin-18 in the gingival crevicular fluid and serum of Bengali population with periodontal health and disease p. 260
Vineet Nair, Prasanta Bandyopadhyay, Debabrata Kundu, Satadal Das
DOI:10.4103/0972-124X.183098  
Context: Host's immune response elicits cytokines in response to bacterial challenge. We explore role of one such cytokine interleukin-18 (IL-18) in periodontal health and disease. Aims: IL-18 is a pro-inflammatory and tumor suppressive cytokine. Dental literatures suggest that IL-18 might have a role to play in the progression from oral health to periodontal disease. Therefore, this study was undertaken to elucidate the level and role of IL-18 in the gingival crevicular fluid (GCF) and serum of individuals with healthy gingiva, chronic gingivitis, chronic periodontitis, and aggressive periodontitis before and after periodontal therapy. Settings and Design: Eighty individuals chosen for the study were divided into healthy control group (1A), chronic gingivitis (2A), chronic periodontitis (3A), and aggressive periodontitis (4A) with twenty individuals each. Criteria for the division were the subject's gingival index, probing pocket depth, clinical attachment loss, and radiographic evidence of bone loss. Materials and Methods: The individuals underwent treatment (scaling in case of Groups 1A and 2A and scaling and root planing followed by flap surgery in Groups 3A and 4A) to form posttreatment Groups 1B, 2B, 3B, and 4B, respectively. Thus, a total of 160 GCF and 160 serum samples were collected and tested by ELISA.Statistical Analysis Used: Intergroup comparison was done by post hoc Tukey's test. Results: The mean IL-18 concentration was greatest in Group 3A (GCF 144.61 pg/μl, serum 55.12 pg/ml) followed by Group 4A (GCF 98.55 pg/μl, serum 39.06 pg/ml), Group 2A (GCF 22.27 pg/μl, serum 27.73 pg/ml) and lowest (GCF 17.94 pg/μl, serum 11.49 pg/ml) in Group 1A. Posttreatment groups (1B–4B) showed reduction in the mean IL-18 concentration in both GCF and serum. Conclusions: As the inflammation increased, there was a concomitant increase in the level of IL-18 and vice versa following periodontal therapy.
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Evaluation of the relation between anemia and periodontitis by estimation of blood parameters: A cross-sectional study p. 265
Venkata Naga Sri Harsha Anumolu, Adusumilli Srikanth, Kusumalatha Paidi
DOI:10.4103/0972-124X.176392  
Background: Anemia of chronic disease is defined as anemia occurring in chronic infections, inflammatory conditions, or neoplastic disorders which are not due to marrow deficiencies or other diseases, and occurring despite the presence of adequate iron stores and vitamins Aims: To evaluate the relation between anemia and periodontitis by estimation of blood parameters and to assess whether periodontitis like other inflammatory conditions can lead to anemia. It is a randomized controlled clinical trial. Materials and Methods: A total of 50 healthy controls, 50 chronic generalized gingivitis, and 50 chronic generalized periodontitis patients were selected. Hemoglobin levels (Hb), erythrocyte count red blood cell, erythrocyte sedimentation rate (ESR), mean corpuscular volu e (MCV), mean corpuscular Hb (MCH) and MCH concentration (MCHC), gingival index, plaque index, probing pocket depth, and clinical attachment level were recorded. Intergroup comparison of blood parameters is by one-way ANOVA. Intergroup pair wise comparison of the three groups is by Newman–Keuls multiple post-hoc procedures. Karl Pearsons's correlation coefficient method is used for correlation between different parameters for three groups. Results: The results revealed a decrease in Hb and erythrocyte counts and increase in white blood corpuscles counts in chronic generalized periodontitis when compared to healthy controls and chronic generalized gingivitis group. There was no statistically significant difference in MCV, MCH, MCHC, and ESR among the groups. Conclusions: The treatment of periodontitis can lead to an improvement in hematocrit and other related blood parameters in chronic generalized periodontitis patients with anemia. This provides evidence that periodontitis like other chronic diseases may also cause anemia.
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Microbial contamination of contact lenses after scaling and root planing using ultrasonic scalers with and without protective eyewear: A clinical and microbiological study p. 273
Rooh Afzha, Anirban Chatterjee, Shobha Krishna Subbaiah, Avani Rangaraju Pradeep
DOI:10.4103/0972-124X.182599  
Background: Ultrasonic scaler is a preferential treatment modality among the clinicians. However, the aerosol/splatter generated is a concern for patients and practitioners. Therefore, the purpose of this study was to evaluate contamination of contact lenses of the dentist after scaling and root planing using ultrasonic scalers with and without protective eyewear. Materials and Methods: Thirty patients were randomly selected for scaling and root planing and divided into 2 groups of 15 each. Group A - dentist wearing contact lenses and protective eyewear. Group B - dentist wearing only contact lenses. After scaling and root planing using ultrasonic scalers, the lenses were subjected to culture and 16S rRNA (16S ribosomal RNA) gene sequencing. Results: In Group A – 15 out of thirty samples were contaminated, in Group B – all the thirty samples were contaminated. Most of the samples showed Gram-positive bacteria and 5 samples were contaminated with fungi. 16S rRNA gene sequencing of forty contaminated samples showed that 31 were contaminated with Streptococcus mutans and 9 with Staphylococcus aureus. Conclusion: Keeping in mind the limitation of the study for the absence of negative control, we would like to conclude that dental practitioners should better avoid contact lenses in a dental setup because of the risk of contamination of the contact lenses from the various dental procedures which can produce aerosol/splatter and if worn, it is recommended to wear protective eyewear.
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Prevalence of herpesviruses in gingivitis and chronic periodontitis: relationship to clinical parameters and effect of treatment p. 279
Rucha Shah, Dhoom Singh Mehta
DOI:10.4103/0972-124X.179896  
Background: Assess the prevalence of herpesviruses in healthy subjects, gingivitis, and chronic periodontitis patients, to assess the relationship between the prevalence of herpesviruses and periodontal clinical parameters, and to evaluate the effect of phase-I therapy on the level of viral detection. Materials and Methods: Hundred patients consisting of 20 healthy subjects, 40 gingivitis, and 40 chronic periodontitis were included in the study. Clinical parameters recorded included plaque index, gingival index, sulcus bleeding index, probing depth, and clinical attachment level. The gingivitis and chronic periodontitis patients received phase-I periodontal therapy including oral hygiene instructions, full mouth scaling for gingivitis patients and scaling and root planing for chronic periodontitis patients. Gingival crevicular fluid (GCF) was collected, and the presence of herpes simplex virus-1 (HSV-1), HSV-2, cytomegalovirus, and Epstein–Barr virus (EBV) was analyzed using polymerase chain reaction (PCR). Recording of periodontal parameters as well as GCF collection was performed at baseline and 6 weeks postphase-I therapy. Results: At baseline, the levels of HSV-1 and EBV detection were lower in healthy controls as compared to gingivitis (P < 0.05) and chronic periodontitis cases (P < 0.001). Phase-I therapy led to reduction in the amount of HSV-1 and EBV in gingivitis patients (P < 0.05) and for HSV-1, human cytomegalovirus and EBV in chronic periodontitis patients (P < 0.05) in comparison to baseline. The prevalence of EBV in chronic periodontitis patients was positively associated with increased gingival index, probing depth and loss of clinical attachment (P < 0.05). Conclusions: Higher prevalence of HSV-1 and EBV viruses in GCF of gingivitis and chronic periodontitis suggests a strong association between these viruses and periodontal diseases and periodontal therapy can lead to a reduction in herpesviruses at infected sites.
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Detection and comparison of Selenomonas sputigena in subgingival biofilms in chronic and aggressive periodontitis patients p. 286
Disha Nagpal, Shobha Prakash, Kishore Gajanan Bhat, Gagandeep Singh
DOI:10.4103/0972-124X.181247  
Background: With the advent of DNA-based culture-independent techniques, a constantly growing number of Selenomonas phylotypes have been detected in patients with destructive periodontal diseases. However, the prevalence levels that have been determined in different studies vary considerably. Aim: The present study was undertaken to detect and compare the presence of Selenomonas sputigena in the subgingival plaque samples from generalized aggressive periodontitis (GAP), chronic generalized periodontitis, and periodontally healthy patients using conventional polymerase chain reaction (PCR) technique. Materials and Methods: A total of 90 patients were categorized as periodontally healthy individuals (Group I, n = 30), chronic generalized periodontitis (Group II, n = 30), and GAP (Group III, n = 30). The clinical parameters were recorded and subgingival plaque samples were collected. These were then subjected to conventional PCR analysis.Statistical Analysis Used: Kruskal–Wallis ANOVA test was used for multiple group comparisons followed by Mann–Whitney U-test for pairwise comparison. Results: On comparison between three groups, all the clinical parameters were found to be statistically highly significant. Comparing Groups I-II and I-III, the difference in detection was found to be statistically highly significant whereas in Groups II-III, it was statistically nonsignificant. On comparison of S. sputigena detected and undetected patients to clinical parameters in various study groups, the difference was found to be nonsignificant. Conclusion:S. sputigena was found to be significantly associated with chronic and aggressive periodontitis. Although the difference in its detection frequency in both groups was statistically nonsignificant when compared clinically, S. sputigena was more closely associated with the GAP.
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Histochemical detection and comparison of apoptotic cells in the gingival epithelium using hematoxylin and eosin and methyl green-pyronin: A pilot study p. 294
Aarati Nayak, Anita Raikar, Vijaylaxmi Kotrashetti, Ramakant Nayak, Sumedha Shree, Soumya Kambali
DOI:10.4103/0972-124X.182601  
Background: Apoptosis plays a critical role in the regulation of inflammation and host immune response. It helps in tissue homeostasis and a disturbance in this is often associated with disease. The use of histochemical stains like hematoxylin and eosin (H and E) and methyl green-pyronin (MGP) can provide a simple and cost-effective method for the detection of apoptotic cells. Aim: Study intended to analyze the expression of apoptosis in the gingival epithelium of healthy subjects and in patients with chronic periodontitis, using H and E and MGP. It is also proposed to correlate the apoptotic index (AI) of healthy individuals and those with chronic periodontitis. Materials and Methods: Twenty gingival biopsies were harvested from which ten samples were of healthy subjects and ten subjects who suffered from chronic periodontitis. Apoptotic cells were analyzed using MGP and H and E under light microscopy. Results: Apoptotic cells were identified at ×100 magnification and AI was calculated. Apoptotic cells were easily distinguishable in MGP stained sections when compared to those stained using H and E. Moreover, apoptotic cell count was higher in chronic periodontitis. Statistical analyses were done by Tukey's multiple post hoc procedure. Conclusion: The study reveals that MGP staining can be used in a routine basic laboratory set up as one of the cost-effective methods for the detection of apoptotic cells.
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Comparative evaluation of probing depth and clinical attachment level using a manual probe and Florida probe p. 299
Amandeep Kour, Ashish Kumar, Komal Puri, Manish Khatri, Mansi Bansal, Geeti Gupta
DOI:10.4103/0972-124X.181241  
Background: To compare and evaluate the intra- and inter-examiner efficacy and reproducibility of the first-generation manual (Williams) probe and the third-generation Florida probe in terms of measuring pocket probing depth (PD) and clinical attachment level (CAL). Materials and Methods: Forty subjects/4000 sites were included in this comparative, cross-sectional study. Group- and site-wise categorizations were done. Based on gingival index, PD, and CAL, patients were divided into four groups, i.e., periodontally healthy, gingivitis, mild to moderate periodontitis, and severe periodontitis. Further, based on these parameters, a total of 4000 sites, with 1000 sites in each category randomly selected from these 40 patients, were taken. Full mouth PD and CAL measurements were recorded with two probes, by Examiner 1 and on Ramfjord teeth by Examiner 2. Results: Full mouth and Ramfjord teeth group- and site-wise PD obtained with the manual probe by both the examiners were statistically significantly deeper than that obtained with the Florida probe. The full mouth and Ramfjord teeth mean CAL measurement by Florida probe was higher as compared to manual probe in mild to moderate periodontitis group and sites, whereas in severe periodontitis group and sites, manual probe recorded higher CAL as compared to Florida probe. Conclusion: Mean PD and CAL measurements were deeper with the manual probe as compared to the Florida probe in all the groups and sites, except for the mild-moderate periodontitis group and sites where the CAL measurements with the manual probe were less than the Florida probe. Manual probe was more reproducible and showed less interexaminer variability as compared to the Florida probe.
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A comparative evaluation to assess the efficacy of 5% sodium fluoride varnish and diode laser and their combined application in the treatment of dentin hypersensitivity p. 307
Isha Suri, Poonam Singh, Quaid Johar Shakir, Arvind Shetty, Ranjeet Bapat, Roshani Thakur
DOI:10.4103/0972-124X.181243  
Background: Dentin hypersensitivity (DH) is an age old complaint with a great number of treatment modalities, but none of these are totally effective till date. Lasers being one of the latest treatment options in periodontics, a study was conducted to test the efficacy of diode laser (DL) in DH alone and in comparison with 5% sodium fluoride (NaF) varnish. Aim: The aim of the present study was to compare the effectiveness of 5% topical NaF varnish and 980 nm gallium aluminum arsenide (GaAlAs) DL alone and combination of 5% NaF + 980 nm GaAlAs DL in the management of DH. Materials and Methods: The study was conducted on 120 teeth in thirty patients with DH assessed by tactile and air blast (AB) stimuli measured by visual analog scale (VAS). Teeth were randomly divided into Group 1 (P) placebo-treated control group, Group 2 (NaF) treated by 5% NaF varnish, Group 3 (DL) treated with 980 nm DL, and Group 4 (NaF + DL) treated with both 5% NaF varnish and 980 nm DL (combination group). Results: There was a significant reduction in DH. The VAS reduction percentages were calculated, and there was a significant decrease in DH above all in G4 (NaF + DL) than G3 (DL) and G2 (NaF). Conclusion: Even though all the three groups (2, 3, and 4) showed improvement in terms of DH reduction, 5% NaF varnish with DL showed the best results among all the groups.
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Morphological study of proximal root grooves and their influence on periodontal attachment loss p. 315
Saravpreet Kaur, Rajan Gupta, Parveen Dahiya, Mukesh Kumar
DOI:10.4103/0972-124X.179404  
Background: The etiology of periodontal diseases is multifactorial including both systemic and local causes. Local factors such as grooves on root surfaces contribute a great deal to the causation of periodontal diseases. Materials and Methods: Proximal radicular grooves were studied in 150 extracted maxillary and mandibular anterior teeth. Periodontal attachment loss was measured after staining the root surfaces with 0.1% toluidine blue stain. The relationship of the presence and absence of grooves with periodontal attachment loss was also studied. Results: The prevalence of proximal root grooves was found to be 86.67%. The prevalence of grooves on maxillary teeth was 43.42% and on mandibular teeth was 56.67%. A greater loss of attachment was present on grooved surfaces than on nongrooved surfaces. Conclusion: The proximal radicular grooves present as one of the major etiological factors in periodontal diseases.
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Variations in the frenal morphology in the diverse population: A clinical study p. 320
Vikas Jindal, Rupinder Kaur, Amit Goel, Atika Mahajan, Neha Mahajan, Atin Mahajan
DOI:10.4103/0972-124X.182598  
Background: The upper labial frenum is a normal anatomic structure with inherent morphological variations. Frenum has variations depending upon the attachment of fibers along with the presence of structural variations. Aim: The aim of this study was to evaluate the prevalence of frenal variations in a diverse ethnic population of Sundernagar, Himachal Pradesh. Materials and Methods: This study was conducted on 500 subjects within age group of 16–40 years (285 females, 215 males). Intraoral examination was done to evaluate the variations in frenum and photographs were taken. Results: In this study, depending upon structural variations, normal frenum was most common followed by frenum with nodule while frenum with appendix was found to be least common. However, no significant difference was found between males and females (P > 0.05) with respect to all frenal attachments. Furthermore, other structural variations were found in the diverse population of Sundernagar, Himachal Pradesh. Conclusion: Upper labial frenum is a small anatomical landmark in the oral cavity found to have diverse morphology. The dentist needs to give due importance for frenum assessment during the oral examination.
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Association of chronic periodontitis with metabolic syndrome: A cross-sectional study p. 324
Naresh Kumar, Ashu Bhardwaj, Prakash Chand Negi, Pravesh Kumar Jhingta, Deepak Sharma, Vinay Kumar Bhardwaj
DOI:10.4103/0972-124X.183096  
Background: Prevalence of metabolic syndrome (MeS) is high among Asians, including Indians and is rising, particularly with the adoption of modernized lifestyle. Various studies have reported a significant relationship between periodontal status and MeS. The objective of this study is to investigate the association between periodontitis and MeS. Materials and Methods: The study included 259 subjects (130 cases with chronic periodontitis, 129 controls without chronic periodontitis) who underwent medical and periodontal checkup. Five components (obesity, high blood pressure, low- and high-density lipoproteins, cholesterol, hypertriglyceridemia, and high plasma glucose) of MeS were evaluated, and individuals with ≥3 positive components were defined as having MeS. The periodontal parameter was clinical attachment level (CAL) on the basis of which cases were selected with moderate (CAL loss 3–4 mm) and severe (CAL loss ≥5 mm) generalized chronic periodontitis. The association between chronic periodontitis and MeS components was investigated using odds ratios (ORs) and 95% confidence intervals (CIs). Results: The association of MeS and chronic periodontitis was strong and significant with OR: 2.64, 95% CI: 1.36–5.18, and P< 0.003. Comparison of mean values of components of MeS between cases and controls reveals that the mean waist circumference (mean difference: −4.8 [95% CI: 7.75–−1.84], P< 0.002) and mean triglycerides level (mean difference: −25.75 [95% CI: −49.22–−2.28], P< 0.032) were significantly higher in cases than in control groups. Although mean systolic blood pressure, diastolic blood pressure, and fasting blood sugar level were higher in cases (125.77, 82.99 and 86.38, respectively) compared with control (122.81, 81.3 and 83.68, respectively), it was statistically insignificant. Conclusion: The results of this study suggest that there is a strong association between chronic periodontitis and MeS. The association was independent of the various potential confounding risk factors affecting the chronic periodontitis such as age, sex, residential background, and tobacco consumption.
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The impact of lifestyles on the periodontal health of adults in Udupi district: A cross sectional study p. 330
Nishu Singla, Shashidhar Acharya, Ramprasad Vasthare Prabhakar, Kalyana Chakravarthy, Deepak Singhal, Ritesh Singla
DOI:10.4103/0972-124X.179405  
Objectives: (1) To assess the impact of different lifestyle factors on periodontal health of adults. (2) To assess the impact of overall/combined lifestyle variable (calculated by health practice index [HPI]) on periodontal health of adults. Materials and Methods: A cross-sectional study consisting of a structured questionnaire on HPI, oral health-related behavior, and personal habits as well as sociodemographic variables was conducted on 800 subjects aged 20–50 years attending dental outreach set-ups of Manipal College of Dental Sciences, Manipal. Clinical examination for periodontal status was done by recording loss of attachment scores using community periodontal index (FDI/WHO-1982). Statistical analysis was done by bivariate analysis using Chi-square followed by multivariate analysis to obtain adjusted odds ratio with 95% confidence interval. Results: After adjusting for all the confounding variables in multivariate logistic regression analysis, the variables that showed an independent association with periodontitis were age, location, marital status, smoking, hours of sleep per night, physical activity, and overall poor lifestyles. Conclusion: Our results support studying a combined approach using various lifestyle behaviors for controlling chronic periodontitis. Necessary public health action on conditions which determine unhealthy lifestyle behaviors across population is needed which is possible by patient's involvement in self-care by promoting healthy lifestyles.
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CASE REPORTS/CASE SERIES WITH DISCUSSIONS Top

Management of a rare case of peripheral squamous odontogenic tumor of the gingiva p. 336
Ramamurti Anjana, Nirupama Murali, Narasimhan Malathi, Ranga Rao Suresh
DOI:10.4103/0972-124X.179897  
Odontogenic tumors (OTs) arising from the periodontium are quite rare. Squamous OT (SOT) is one such neoplasm which has an exceedingly rare occurrence. According to the literature, there have been very few reported cases of SOT with a very small percentage involving the gingiva. Most of the times, these tumors are located within the bone, only a very few peripheral cases been noted so far. Although predominantly benign, the possibility of a malignant transformation prevails. Our case describes a rare presentation of a peripheral SOT involving the upper anterior gingiva in a 59-year-old patient, which presented clinically as a firm and fibrotic swelling. An excisional biopsy was performed as a part of surgical management and for microscopic evaluation to confirm the clinical diagnosis. A soft tissue graft was harvested from an edentulous area to cover the deficit at the surgical site. The patient was evaluated at periodic intervals to assess the healing outcome and for any recurrence of the lesion.
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Desquamative gingivitis as only presenting sign of mucous membrane pemphigoid p. 340
Veena Vijayan, Ajish Paul, Kennedy Babu, Balasubramanian Madhan
DOI:10.4103/0972-124X.182602  
Desquamative gingivitis (DG) is a clinical condition in which the gingiva appears reddish, glazed, and friable with loss of superficial epithelium. DG is considered a clinical manifestation of many gingival diseases and hence not identified as a diagnosis itself. Mucous membrane pemphigoid (MMP) is an autoimmune vesiculobullous disorder of mucous membrane characterized by subepithelial bullae formation. MMP can affect the mucous membranes of oral cavity, conjunctiva, nasopharynx, larynx, esophagus, genitourinary tract, and anus and vary in its severity. The most commonly affected sites are oral cavity and conjunctiva. Since DG may be the early sign or only presenting sign of these conditions, most of the times, dental surgeon plays a key role in the diagnosis and prevention of the systemic complications of these diseases. We report a case of a 41-year-old male patient presented with DG. Histopathological examination revealed subepithelial clefting suggestive of MMP. The patient was treated with topical application of triamcinolone acetonide 0.1% 3–4 times a day for 1 month.
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“United Pedicle Flap” for management of multiple gingival recessions p. 344
Aditi Chopra, Karthik Sivaraman, Subraya Giliyar Bhat
DOI:10.4103/0972-124X.183100  
Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.
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SHORT COMMUNICATION Top

Periodontium bestows vision!! p. 349
Minkle Gulati, Sanjeev Kumar Salaria, Vishal Anand, Nikil Jain, Suraj Pandey
DOI:10.4103/0972-124X.170853  
The role of periodontium in supporting the tooth structures is well-known. However, less is known about its contribution to the field of ophthalmology. Corneal diseases are among major causes of blindness affecting millions of people worldwide, for which synthetic keratoprosthesis was considered the last resort to restore vision. Yet, these synthetic keratoprosthesis suffered from serious limitations, especially the foreign body reactions invoked by them resulting in extrusion of the whole prosthesis from the eye. To overcome these shortcomings, an autologous osteo-odonto keratoprosthesis utilizing intraoral entities was introduced that could positively restore vision even in cases of severely damaged eyes. The successful functioning of this prosthesis, however, predominantly depended on the presence of a healthy periodontium for grafting. Therefore, the following short communication aims to acknowledge this lesser-known role of the periodontium and other oral structures in bestowing vision to the blind patients.
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