Context: Patient-reported outcomes (PROs) have become primary or secondary outcome measure in clinical trials and epidemiological studies in Medicine and Dentistry in general and Periodontology in particular. PROs are patients' self-perceptions about consequences of a disease or its treatment. They can be used to measure the impact of the disease or the effect of its treatment. There are insufficient data in Periodontology related to scale development methodology although, recently, there is an increase in the number of published studies utilizing such tools in major journals. Aim: This paper is an overview of the development methodology of new PRO tools to study the impact of periodontal disease. Materials and Methods: The iterative process begins with a research question. A well-constructed a priori hypothesis enables validity assessment by hypothesis testing. The qualitative steps in item generation include literature review, focus group discussion, and key informant interviews. Expert paneling, content validity index, and pretesting are done to refine and sequence the items. Test–retest reliability, inter-rater reliability, and internal consistency reliability are assessed. The tool is administered in a representative sample to test construct validity by factor analysis. Conclusion: The steps involved in developing a subjective perception scale are complicated and should be followed to establish the essential psychometric properties. The use of existing tool, if it fulfills the research objective, is recommended after cross-cultural adaptation and psychometric testing.

Background: Platelet concentrates are used in various medical procedures to promote soft- and hard-tissue regeneration. In recent times, their antimicrobial efficacy is also explored. However, various platelet concentrates have evolved which differ in the centrifugation protocols. One such recently introduced platelet concentrate is injectable platelet-rich fibrin (i-PRF) concentrate. Hence, the aim was to evaluate the antimicrobial property, and platelet count of i-PRF in comparison to other platelet concentrates, i.e., PRF, platelet-rich plasma (PRP), and control (whole blood). Materials and Methods: Blood samples were obtained from 10 chronic generalized marginal gingivitis patients. Platelet concentrates were prepared using standardized centrifugation protocol. Platelet count was evaluated by manual counting method using smear preparation of each sample. Subsequently, antimicrobial activity against oral bacteria was examined on blood agar using disc diffusion method to quantify the inhibitory effects. Results: Statistical significance was analyzed by one-way analysis of variance (ANOVA). P <0.05 was considered statistically significant. Mean zone of inhibition around i-PRF (P < 0.01) and PRF (P < 0.05) showed statistical significance. Although a distinct zone of inhibition was seen with PRP, it was not statistically significant (P > 0.05). i-PRF showed statistically significant difference (P < 0.001) in platelet count when compared to control. It was also significant when compared to PRP (P < 0.01), PRF (P < 0.001). Conclusion: i-PRF has maximum antimicrobial efficacy and higher platelet count in comparison to other platelet concentrates, thereby indicating to have a better regenerative potential then others.

Background: The present study aims to evaluate the efficacy of diode laser alone and in combination with desensitizing toothpastes in occluding dentinal tubules (both partially occluded and completely occluded tubules) by scanning electron microscope (SEM). Materials and Methods: Fifty human teeth were extracted, cervical cavities were prepared and etched with 17% ethylenediaminetetraacetic acid, and smear layer was removed to expose the tubules. The teeth were divided into five groups: Group I – Application of NovaMin-formulated toothpaste, Group II – Application of Pro-Argin^™-formulated toothpaste, Group III – Application of diode laser in noncontact mode, Group IV – NovaMin-formulated toothpaste followed by laser irradiation, and Group V – Pro-Argin^™-formulated toothpaste followed by laser irradiation. After treatment, quantitative analysis of occluded dentinal tubules was done by SEM analysis. Results: The mean values of percentages of total occlusion of dentinal tubules in Groups I, II, III, IV, and V were 92.73% ± 1.38, 90.67% ± 1.86, 96.57% ± 0.64, 97.3% ± 0.68, and 96.9% ± 6.08, respectively. Addition of diode laser (Groups III, IV, and V) yielded a significant occlusion of the dentinal tubules when compared to desensitizing toothpastes alone (Groups I and II). Conclusion: Diode laser (Group III) has shown more efficacy in occluding dentinal tubules when compared with desensitizing toothpastes which was statistically significant (P < 0.05). Among the five groups, NovaMin + diode laser (Group IV) showed the highest percentage of occluded dentinal tubules.

Context: Chronic periodontitis and osteoporosis are multifactorial diseases which share common risk factors. Interactions between genetic and other factors determine the likely hood of osteoporotic fractures and chronic periodontitis. Calcitonin receptor (CTR) gene polymorphism is one of the important factors which contribute to the development of osteoporosis and chronic periodontitis. Aims: This study highlights the association of CTR gene polymorphisms at codon 447 in patients with osteoporosis and chronic periodontitis and healthy controls in south Indian population. Settings and Design: The study was designed as a case–control retrospective, observational clinical trial which was conducted to assess the role of CTR gene polymorphism in patients with osteoporosis and periodontitis as well as in healthy controls. Materials and Methods: A total of 50 subjects were taken into the study comprising of 20 healthy and 30 osteoporotic subjects with chronic periodontitis between the age group of 30–55 years. Within the limitations of our study, only 50 subjects were taken in the study due to the strict sampling method (Patients who were just diagnosed with osteoporosis and periodontitis and hence not taking any medication). 2 ml of blood sample was collected in ethylenediamine tetra acetic acid containing vials, and polymerase chain reaction was run to identify CTR gene polymorphism. Statistical Analysis Used: Statistical analysis was done by student t-test. Pertaining to C > T allele pattern there was a significant difference between the test and control group. Results: A significant difference was observed between the test and control group in relation to the C > T allele pattern. Patients showing TT genotype distribution had greater periodontal destruction and lower bone-mineral density compared to CT genotype distribution followed by CC genotype distribution indicating TT homozygotes are more prone to the development of osteoporosis with increased risk of fracture and loss of alveolar bone. Males and females showed equal susceptibility to osteoporosis and chronic periodontitis. Conclusions: CTR polymorphism at codon 447 may be associated with osteoporosis and chronic periodontitis

Aim: The aim of the present study is to compare the gingival melanin repigmentation after diode laser application and surgical removal done by scraping with Kirkland knife. Materials and Methods: This study was a randomized split-mouth study where 10 patients presenting with unattractive, diffuse, dark brown to black gingival discoloration on the facial aspect of the maxillary gingiva were treated by diode laser application and surgical removal and followed up for 3-, 6-, and 9-month intervals. Results: The results showed a statistically significant difference in repigmentation between the groups at the interval of 3 months (P = 0.040), but the difference was statistically not significant at 6 months (P = 0.118) and 9 months (P = 0.146). On surgically treated sites, all cases showed repigmentation of the gingiva, but in laser treated, there were two individuals which did not show repigmentation of the gingiva even at the end of 9-month observation time. Conclusion: The incidence of repigmentation was slightly less in laser-treated sites as compared to surgical depigmentation although the difference was statistically significant only up to 3 months.

Background: There have been a very limited number of studies regarding the assessment of bone mineral density (BMD) using dual energy X-ray absorptiometry scan. Hence, the purpose of the study was to assess the relationship between BMD and periodontal health in three different study groups. Materials and Methods: The study comprised of thirty female individuals who were categorized into three groups: ten premenopausal women with healthy periodontium (Group A), ten premenopausal women with generalized chronic periodontitis (Group B), and ten postmenopausal women with generalized chronic periodontitis (Group C). Number of teeth, plaque index, probing depth, clinical attachment level, interproximal alveolar bone loss, T-score for dual femur and posteroanterior (PA) spine, and BMD for dual femur and PA spine of each individual were recorded in all the three groups. Results: The BMD and T-score of dual femur and PA spine were found to be low in Group C when compared to Group A and B which was statistically significant. Conclusion: Postmenopausal women with generalized chronic periodontitis (Group C) exhibited severe periodontal destruction with less BMD. Hence, it is suggested that periodontitis may be a risk indicator for osteoporosis in postmenopausal women and vice versa.

Background: Epilepsy is a gathering of neurological disorders characterized by epileptic seizures. Epileptic children, who are on active treatment with antiepileptic drugs, have a well-recognized side effect of gingival enlargement. Therefore, all efforts should be made, particularly for the population who are diagnosed or affected by the systemic disease. This study was conducted with an aim to determine oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs. Materials and Methods: The cross-sectional observational study was conducted in the department of pedodontics and attached general hospital. A sample size of 120 participants with 60 healthy and 60 epileptic children between age 2 and 14 years were included. Oral health status of participants was examined using oral hygiene simplified index and plaque index. Gingival enlargement was assessed using Miranda–Brunet index. For statistical analysis, one-way ANOVA test, independent t-test, and Pearson's Chi-square test were used. Results: From the total participants included in the study, 49% of participants had good oral hygiene from healthy group, and 28% participants had poor oral hygiene from the epileptic group. Sodium valproate was the most common drug used and was associated with increased gingival enlargement. Conclusion: Conclusion can be drawn that epileptic children under medication had poor oral hygiene and an increased risk for gingival enlargement as compared to their healthy counterparts. It must be stressed that the epileptic patients should be given dental care without conditions and provided with best possible care to restore esthetics and functions.

Aim: The aim of this study was to assess the efficacy of 0.1% curcumin mouthwash and to compare it with 0.2% chlorhexidine gluconate as an antiplaque agent and its effect on gingival inflammation. Materials and Methods: One hundred and fifty subjects, age between 20 and 30 years were recruited. Study population were randomly divided into three groups. In Group A, 50 subjects were advised the experimental mouthwash. Group B subjects used placebo mouthrinse, and chlorhexidine mouth wash was given to Group C. The subjects were advised to use 10 ml of mouthwash for 1 min twice a day 30 min after brushing. Parameters were recorded for plaque, gingival, and sulcus bleeding indices at day 0, 7, 14, and 28 days along with subjective assessment of taste. Results: On intragroup comparison between curcumin, chlorhexidine, and placebo mouthwash, the mean percentage reduction of the plaque index (PI) between 0 and 28 days were 0.58,0.57 and 1.17, respectively (P < 0.01), percentage reduction of gingival index (GI) between 0 and 28 days were 0.65, 0.66, and 1.09, respectively (P < 0.01) and sulcus bleeding index (SBI) showed a percentage reduction of 0.69, 0.66, and 1.13, respectively The intergroup comparison revealed chlorhexidine and curcumin mouthwash were statistically significant with P < 0.001 as compared to placebo. Conclusion: Curcumin mouthwash has shown an antiplaque and antigingivitis properties comparable to chlorhexidine mouthwash. Thus, curcumin mouthwash and chlorhexidine gluconate can be effectively used as an adjunct to scaling and root planning.

Background: Although mechanical plaque removal is an effective method, powered toothbrushes are specially designed to benefit differently abled. Literature comparing plaque removal efficacy between manual and powered toothbrushes among differently abled is sparse. Study Design and Setting: A cross-over, randomized, double-blind study was conducted in differently abled institution. Materials and Methods: Twenty differently abled participants were randomly assigned to two groups of ten participants. Plaque removal efficacy of battery-operated powered toothbrush was compared with manual toothbrush in a single brushing on the 8^th day. After a washout of 1 week, groups were switched. Assessment of plaque scores was done using Turesky's modification of Quigley-Hein plaque index. Statistical Analysis: Difference in plaque score between pre- and post-brushing in each group was compared using paired sample t-test. Results: In the pooled data analysis combining the results of Phase I and II, mean pre- and post-brushing plaque scores with manual toothbrush was 2.26 ± 0.4 and 1.93 ± 0.5, respectively, while with powered toothbrush, it was 2.21 ± 0.4 and 1.96 ± 0.4, respectively. However, difference in mean plaque reduction between manual and powered toothbrushes was not significant. Conclusion: Manual toothbrushes were equally effective compared to powered toothbrushes. Long-term studies precisely documenting cost-effectiveness and participant perception in the ease of use are recommended to validate our results.

Background: Periodontal disease prevalence in children is an indicator of future disease burden in the adult population. Knowledge about the prevalence and risk status of periodontal disease in children can prove instrumental in the initiation of appropriate preventive and therapeutic measures. Aim: This school-based cross-sectional survey estimated the prevalence and severity of periodontal disease among 15–17-year-old children in Kozhikode district and assessed the risk factors. Materials and Methods: Multistage stratified random sampling and randomized cluster sampling were used in the selection of schools and study participants, respectively, in three educational districts of Kozhikode. Periodontal disease was assessed among 2000 school children aged 15–17 years, by community periodontal index. A content validated questionnaire was used to evaluate the sociodemographic characteristics and other risk factors. Results: The prevalence of periodontal disease was estimated as 75% (72% gingivitis and 3% mild periodontitis). The prevalence was higher in urban population (P = 0.049) and males had significantly (P = 0.001) higher prevalence. Lower socioeconomic strata experienced slightly more periodontal disease burden. Satisfactory oral hygiene practices (material and frequency) were observed, but oral hygiene techniques were erroneous. Unhealthy dental treatment-seeking practices and unfavorable attitude toward dental treatment (ATDT) significantly influenced periodontal health status. Overall awareness about dental treatment was poor in this study population. Conclusion: The prevalence of periodontal disease among 15–17-year-old school children in Kozhikode district is 75% and is influenced by sociodemographic characteristics. Other risk factors identified were unhealthy dental treatment-seeking practices and unfavorable ATDT. Implementation of well-formulated oral health education programs is thus mandatory.

Gingival enlargement refers to any increase in the size of normal gingiva. The gingiva may be enlarged in response to various interactions between the host and the environment. It can be of various types including inflammatory, drug induced, associated with systemic disease, neoplastic, false, and idiopathic. Idiopathic gingival enlargement is a rare condition of undetermined etiology. The enlargement can be localized or generalized to entire dentition and is usually associated with the emergence of the teeth into the oral cavity and may regress after extraction. Treatment aims to solve patient's psychological, esthetic, and masticatory needs. This is a case series of four siblings (3 boys and 1 girl) who reported to the Department of Periodontology with a chief complaint of swollen gums and difficulty in eating. After careful clinical examination and histopathological evaluation, a diagnosis of familial gingival fibromatosis was made. Treatment plan included gingivectomy and gingivoplasty and follow-ups.

Tuberculosis (TB) is an inflammatory granulomatous disease that rarely presents as primary lesion in gingiva. Gingival involvement has been reported in only a very limited number of cases. A 13-year-old boy presented with gingival enlargement in the maxillary and mandibular anterior region associated with enlargement of lower lip with no systemic manifestations. He had a history of tuberculous lymphadenitis before 5 years which was inadequately treated. The patient's erythrocyte sedimentation rate was 70 mm/h. Histopathological report of the gingival lesion revealed noncaseating granulomas with nests of epithelioid cells and multinucleated Langhans giant cells. The patient was then referred to a physician for management, who initiated active antitubercular treatment following which the condition resolved. The aim of this article is to emphasize the importance of early diagnosis of primary TB of the gingiva which may be misdiagnosed when oral lesions are not associated with any apparent systemic infection.

Generalized aggressive periodontitis (GAP) is a debilitating form of the disease and it results in deteriorating effects on the esthetic and functional aspects of the oral cavity. This case report describes the comprehensive rehabilitation of GAP patient using dental implants. The treatment planning involved thorough scaling and root planning (SRP) with oral hygiene instructions. The patient was motivated to adhere to a strict oral hygiene regimen following which periodontal flap surgery employing guided tissue regeneration and bone grafts was performed. Bacterial culture for anaerobic microorganisms was done using a gas pack pre- and postperiodontal treatment to confirm the effectiveness of the periodontal treatment regimen and also to proceed with dental implant placement. The rigorous maintenance program ensured the stability of the periodontium following which immediate placement of dental implants in the maxillary and mandibular anterior region was done. The fixed metal-ceramic prosthesis was fabricated in a step-by-step process and the patient was recalled on a periodic basis over a 3-year follow-up duration. This case is a testimonial to the postperiodontal treatment long-term stability with excellent patient cooperation and strict maintenance protocol.

Excessive gingival display (EGD) resulting in a “gummy smile” is a major esthetic concern with ramifications in an individual's personal and social life. Numerous treatment modalities have been used for the correction of EGD. The present case report describes the successful treatment of a young woman with an excess gingival display caused by a hyperactive upper lip and a mild vertical maxillary excess that was treated with a laser-assisted lip repositioning surgical technique accompanied by gingival recontouring. The procedure was accomplished by laser-assisted removal, through scraping a strip of mucosa from the maxillary buccal vestibule and suturing the mucosa of the lip to the mucogingival junction. This technique resulted in shortened vestibule and restricted the muscle pull of the elevator muscles of the lip, thereby reducing gingival display when the patient smiles. Laser-assisted lip repositioning surgery can be a viable, minimally invasive alternative to orthognathic surgery.

Background: Stem cells are unspecialized, multipotent cells which can differentiate into different cell types. The human periodontal ligament encloses subpopulation of Periodontal Ligament Stem Cells (PDLSCs) which are able to regenerate the periodontium by differentiating into various cells of PDL. Literature have shown the promising results of periodontal regeneration by exvivo cultured transplantation of PDLSCs into the osseous defects. Methods: Based on current literature on use of ex vivo culture and associated problems, a novel technique is being presented , Stem cell application in periodontal regeneration (SAI-PRT) which uses autologous PDLSCs along with its niche adhering to extracted tooth root for direct application using gelatin sponge as scaffold in regeneration of intrabony periodontal defect bypassing ex-vivo culture. Results: The cases initiated under SAI-PRT protocol, and have shown excellent clinical and radiographic improvement in intrabony defect using direct transplant of autologous PDLSCs . Conclusions: SAI-PRT can be used for the treatment of periodontal osseous defects at chair side.