Journal of Indian Society of Periodontology
Journal of Indian Society of Periodontology
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   2020| May-June  | Volume 24 | Issue 3  
    Online since May 4, 2020

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A survey on the awareness of interrelationship of periodontal disease and systemic health among Mahe population
Doraisamy Murugesan Hemalatha, Anil Melath, Mohammed Feroz, Kayakool Subair, Ashitha Mohandas, Nanditha Chandran
May-June 2020, 24(3):271-275
Background: Systemic health is the fundamental right of any individual, and it cannot be attained or maintained without oral health. Oral cavity is the gateway and the mirror of health. This link is often ignored. This lack of understanding of the correlation between oral and systemic health often leads to the poor systemic health because of the poor oral status. Aim: The aim of the study was to assess the awareness among the general public about periodontal diseases and its impact on systemic health. Materials and Methods: A questionnaire with 15 questions including general awareness about periodontitis and its impact on systemic health were given to patients and were asked to select their preferred option of yes, no, and don't know. The awareness of the individuals was categorized based on their educational qualification, age, and gender as well. Results: The results obtained showed increased awareness among females, postgraduates, and 35–50 years group of individuals according to their category of gender, education, and age group, respectively. Conclusion: There is always a strong influence of oral health on systemic well-being. This link among the two is often ignored and overlooked. Oral health upholds the overall well-being of the patient. Further studies need to be conducted on large scale population and camps need to be conducted to increase the awareness among the general public of periodontal diseases and their systemic impact.
  2,774 286 -
Socket shield: An esthetic success?
Farhan Durrani, Himani Painuly, Akanksha Shukla, Samidha Pandey, Rakhshinda Nahid
May-June 2020, 24(3):289-294
Dental implants require adequate bone, three dimensionally, for successful osseointegration. The extraction socket changes in the dimension had been described in several studies. Implant in extraction socket cannot prevent resorption of the surrounding tissues. The bony alterations make oral esthetic implant reconstruction difficult without hard- and soft-tissue augmentation. Placement of bone substitute material and immediate implant were not able to completely establish an esthetic outcome. A novel technique of retaining the buccal aspect of the tooth root during implant placement has shown preservation of esthetics. Hard and soft tissues were preserved in their original form around the replaced tooth. The retained root on the buccal aspect of an oral implant is observed to have formed cementum and to some aspects of osseointegration with the surrounding tissues. It is called socket-shield technique and if completed meticulously can be an alternative for regenerative materials and soft-tissue grafting. In our report, we completed 14 cases of the said technique with 5-year follow-up. The results looked promising as none of the cases required guided bone regeneration procedures. This may become the future noninvasive method for the preservation of hard and soft tissues around an oral implant in esthetic areas.
  2,408 313 -
Biomarkers in biological fluids in adults with periodontitis and/or obesity: A meta-analysis
Renata Scheeren Brum, Poliana Mendes Duarte, Graziela De Luca Canto, Carlos Flores-Mir, César Augusto Magalhães Benfatti, André Luís Porporatti, Gláucia Santos Zimmermann
May-June 2020, 24(3):191-215
Obesity and periodontal diseases have been investigated to be interconnected, but the molecular mechanism underlying this association is still not clear. The aim of this systematic review is to assess the association of serum, salivary and gingival crevicular fluid (GCF) inflammatory markers (IMs), obesity, and periodontitis. Studies that evaluated IM of adults according to obesity status (O) and periodontitis status (P) (O+P+; O-P+; O+P-) were screened on several electronic databases and grey literature up until February 2019. Risk of bias assessment and level of evidence were evaluated through Fowkes and Fulton scale and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses were grouped according to the biological matrix studied (serum/GCF) and groups (O+P+ vs. O−P+/O+P+ vs. O+P−). Out of the 832 studies screened, 21 were considered in qualitative synthesis and 15 in quantitative synthesis (meta-analysis). Although included studies showed mostly “no” or “minor” problems during the quality assessment, GRADE assessment indicated very low to moderate level of evidence based on the question answered. O+P+ adults exhibited significantly higher serum levels of C-reactive protein (CRP), interleukin 6 (IL-6), leptin, and tumor necrosis factor-α (TNF-alpha) and higher resistin GCF levels than O−P+. O+P+ adults showed significantly higher serum levels of IL-6 and leptin and lower adiponectin serum levels than O+P−. Only qualitative information could be obtained of the IM vaspin, omentin-1, chemerin, IL-10, progranulin, MCP-4, IL-1β, and interferon-γ (IFN-γ). Obesity and periodontitis, together or separately, are associated with altered serum and GCF levels of CRP, IL-6, leptin, TNF-alpha, adiponectin, and resistin. It was not possible to evaluate the association between obesity and periodontitis at salivary levels. The role of recently investigated biomarkers as vaspin, omentin-1, chemerin, IL-10, progranulin, MCP-4, IL-1β, and IFN-γ, which can be key points underlying the association between obesity and periodontitis, remains to be further investigated.
  2,441 241 -
Evaluation and comparison of the antimicrobial activity of royal jelly – A holistic healer against periodontopathic bacteria: An in vitro study
Anjali Khosla, Swyeta Jain Gupta, Anshi Jain, Devi Charan Shetty, Nikhil Sharma
May-June 2020, 24(3):221-226
Context: RJ is a natural bee product and is known to have remarkable health benefits. The objective was to evaluate its antimicrobial potential against periodontopathic bacteria and compare the same with chlorhexidine. Aims: The aim was to evaluate and compare the antimicrobial activity of royal jelly (RJ) with chlorhexidine against the periodontopathic bacteria (aerobic and anaerobic) in subgingival plaque. Materials and Methods: Subgingival plaque samples of 15 chronic periodontitis patients were taken, and clinical parameters were evaluated. Inhibitory effect of RJ and chlorhexidine was investigated “in vitro” on the growth of aerobic and anaerobic bacteria by colony count, minimum inhibitory concentration, and minimum bactericidal concentration (MBC) by the method of serial broth dilution. Statistical Analysis Used: ANOVA statistical analysis was used in this study. Results: Subgingival anaerobic bacteria predominate (colony-forming unit). Chlorhexidine is more sensitive in inhibiting aerobic and anaerobic bacteria (at concentration 50 μg/100 μl). A higher concentration of RJ is required to have an inhibitory effect. MBC of chlorhexidine shows no growth on blood agar plates, whereas minimum bacterial growth is seen around the RJ. Conclusions: Chlorhexidine (gold standard) has a higher inhibitory effect in the case of chronic periodontitis; however, RJ can also be used as an alternative but at higher concentration and lesser dilution. Evaluation of the quality, quantity and the biological activity of RJ is a necessity and must be done before its “in vivo” application.
  2,288 286 -
Comparative evaluation of 2% turmeric extract with nanocarrier and 1% chlorhexidine gel as an adjunct to scaling and root planing in patients with chronic periodontitis: A pilot randomized controlled clinical trial
Sanjeela Rakshith Guru, Adithya K Reddy, Ravi J Rao, Shyam Padmanabhan, Rakshith Guru, TS Srinivasa
May-June 2020, 24(3):244-252
Context: Nanoparticles, owing to their smaller size, penetrate regions inaccessible to other delivery systems, such as periodontal pockets. Thus, the present study aimed to comparatively evaluate efficacy of 2% curcumin with nanocarrier and 1% chlorhexidine gel as a local drug delivery (LDD) in the treatment of periodontal pockets. Materials and Methods: Forty-five chronic periodontitis patients with pocket depth 5–7 mm in two or more teeth were selected. Full-mouth scaling and root planing (SRP) was done for all patients followed by random allocation to the three treatment groups, namely SRP group (Group 1), 2% curcumin with nanogel (Group 2), and 1% chlorhexidine gel (Group 3). Clinical parameter assessment and microbiological analysis of subgingival plaque samples for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythia (Tf) was done at baseline, 21st day, and 45th day. Results: The results showed that when the two LDD agents were used as an adjunct to SRP in chronic periodontitis, there was an improvement in all clinical parameters. Evaluation of microbiological parameters also showed a significant reduction in Aa, Pg, and Tf levels. Comparison of 2% turmeric extract with a nanocarrier system with 1% chlorhexidine gel showed that both the agents had a comparable antibacterial effect on the three selected periodontopathic bacteria. Conclusion: The present study showed that both the LDD agents showed an effective improvement of clinical and microbiologic parameters. 2% curcumin delivered with a nanocarrier system showed results comparable to chlorhexidine gel and hence shows promising future as an LDD agent in the treatment of periodontal pockets.
  1,932 279 -
Periodontal management of severe periodontitis and generalized gingival enlargement in a patient with chronic renal failure
Jaiti Uppal, Himanshu Trivedi, Narinder Dev Gupta, Afshan Bey
May-June 2020, 24(3):284-288
Gingival enlargement is a common periodontal pathology seen in medically compromised patients. Although it is not the disease itself, certain medications used to treat these chronic diseases are known to precipitate the gingival enlargement. Periodontitis (PD) and gingival enlargement have been reported increasingly in patients with chronic renal failure. Severe enlargement is detrimental to esthetics and function while having a negative impact on the overall oral health-related quality of life. Treatment of such cases requires comprehensive periodontal management by a specialist, keeping in mind the medically compromised state of the patient. This report presents a case of severe PD with generalized gingival enlargement in a 45-year-old male who was a known case of Stage 4 chronic kidney disease, obstructive uropathy, and hypertension. Gingival enlargement was managed by gingivectomy and gingivoplasty. Six months' follow-up showed no sign of recurrence.
  1,875 327 1
Son of Sevenless-1 genetic status in an Indian family with nonsyndromic hereditary gingival fibromatosis
Nitya Kala, Harikrishnan Prasad, Premalatha Babu, Srinivasan Poovan Kirubanidhi Kennedy Babu
May-June 2020, 24(3):280-283
Hereditary gingival fibromatosis (HGF) is a rare condition affecting the gingiva and may or may not be a clinical feature of other syndromes. It has been classified as a nondental biofilm-induced gingival disease. The pathogenesis of this condition has been poorly understood till date. Although different genetic mutations have been implicated to play a role, there is considerable interest on an addition mutation of Son of Sevenless-1 (SOS-1) gene. We report a case of a 27-year-old male patient who came to us with the complaint of enlarged gums of several years' duration. There were other members in his family who were similarly affected. After the clinical diagnosis of HGF was confirmed, the patient and his available family members were subjected to a genetic analysis for identification of mutation in SOS-1 gene, which turned out to be negative. The patient was treated with nonsurgical periodontal therapy and is under regular follow-up. To the best of our knowledge, this is the first study to assess SOS-1 mutation in an Indian family.
  1,620 124 -
Medline®, PubMed, PubMed Central….Let's try to decipher
Ashish Kumar
May-June 2020, 24(3):187-188
  1,537 179 -
An aggressive pyogenic granuloma masquerading as a vascular neoplasm
Shravya Jaganath Shetty, Kaveri Hallikeri, Venkatesh Anehosur, Anil Desai
May-June 2020, 24(3):276-279
Pyogenic granuloma (PG) is a benign lesion, with a female predilection, commonly associated with local irritation or trauma. We report an unusual, destructive case of PG, displaying excessive loss of blood and destruction of alveolar bone leading to the loss of maxillary anterior teeth in an 18-year-old female, compromising function and esthetics. The incisional and excisional biopsy specimen of this recurrent lesion obtained during a 5-year span was studied, which revealed an increase in vascularity and extensive proliferation of endothelial cells admixed with varying degree of inflammatory cell infiltrate. The clinical, radiographic, and histopathological diagnostic tools enabled to precisely diagnose the lesion as an aggressive variant of PG, distinguishing it from other vascular neoplasms. No recurrence has been noted during a 5-year follow-up. The clinicians should be aware of the aggressive and destructive clinical behavior of PG to avoid the inadvertent treatment of this reactive lesion.
  1,586 122 1
Effectiveness of diode laser and fluoride on dentin hypersensitivity treatment: A randomized single-blinded clinical trial
Érika Soares Pantuzzo, Fabiano Araújo Cunha, Lucas Guimarães Abreu, Rafael Paschoal Esteves Lima
May-June 2020, 24(3):259-263
Background: This randomized single-blinded clinical trial aimed to evaluate the effectiveness of diode laser and fluoride in the treatment of dentin hypersensitivity (DH) due to gingival recession. Materials and Methods: Twenty-eight individuals randomly distributed across three groups participated: 10 individuals who were treated with diode laser, nine who were treated with fluoride, and nine who received placebo. Pain was assessed with the Visual analog scale (VAS). Evaporative stimulus and tactile stimulus were evaluated with the verbal rating scale (VRS). VAS was applied shortly after, 6 h after, 12 h after, and 24 h after the single-session treatment for DH, whereas VRS was applied shortly after, 15 min and 7 days after the treatment. Participants' quality of life was assessed with the validated Brazilian version of the Dentine Hypersensitivity Experience Questionnaire assessing functional limitations, coping behaviors, emotional, and social impacts caused by DH. Descriptive statistics and the ANOVA test were used. Values of P < 0.05 were statistically significant. Results: Diode laser significantly reduced the DH to the evaporative stimulus (P = 0.002). The application of fluoride did not change the degree of DH to evaporative and tactile stimuli (P > 0.05). The group of individuals who were treated with diode laser presented a higher reduction in DH (25.4%) when compared to the group of individuals treated with fluoride (17.1%), and the group of individuals among whom placebo had been used (2.9%). Descriptive analysis indicated that the items measuring the emotional and social impacts of DH were those with a more negative impact on the individuals. Conclusion: Therapy with diode laser was more effective in reducing DH than therapy with fluoride.
  1,406 217 -
Evaluation of diode laser along with 1.23% acidulated phosphate fluoride gel on dentinal tubule occlusion: An in vitro study
Praveen Jayaram, Amita Olivia Coutinho, Abhishek Bhadranna, Anirban Chatterjee, Vinayak Raghunathan, Faizuddin Imran
May-June 2020, 24(3):253-258
Context: Several studies have recommended the use of lasers in treatment of dentinal hypersensitivity. These materials have been used alone or in combination with an active desensitizing agent. Aims: The present study aimed to evaluate the use of 1.23% acidulated phosphate fluoride (APF) gel and 810 nm diode laser when used alone and when used together on exposed dentinal tubules. Settings and Design: Sixty-one extracted teeth were sectioned with a diamond saw and dentin slices were prepared. They were then treated with 37% orthophosphoric acid to remove the smear layer. Materials and Methods: One of the 61 sections was left as an untreated control, whereas the remaining sixty sections were divided into three groups of twenty sections each. The first set of sections (Group 1) was treated with laser alone, whereas the second set (Group 2) was treated with APF alone. A third set of sections (Group 3) was treated with a combination of laser and APF. The sectioned teeth were then evaluated using field emission scanning electron microscopy, and the percentage of dentinal tubule occlusion was observed. Statistical Analysis: The Shapiro–Wilk normality test was performed to check for the normal distribution of data, whereas the Kruskal–Wallis test was used to compare the mean percentage of dentinal tubule occlusion between the three groups. The Chi-square test was used to compare the number of images with complete tubular occlusion between the three groups. Results: A total of 96 images were processed from the sixty sectioned samples. It was seen that the sections in Group 3 showed the highest percentage of dentinal tubule occlusion. Group 3 also showed the highest number of samples with complete dentinal tubule occlusion. Significantly lesser levels of dentinal tubule occlusion were seen in Groups 1 and 2. Conclusions: Diode lasers were effective in occluding dentinal tubules. The addition of 1.23% APF significantly increased the efficacy and thoroughness of dentinal tubule occlusion. Significantly lesser levels of dentinal tubule occlusion were seen in the sections treated with laser alone and APF alone.
  1,388 199 -
Standardized photometric assessment method: A novel approach for the analysis of dental ergonomic posture
Thamil Selvan Muthuraj, Jacob Raja, Johnson Raja James, Jeyaraj Prince Mohan Raj, Divya Subramnian, Abinaya Varatharajan
May-June 2020, 24(3):227-232
Background: Identification and documentation of the proper and improper dental ergonomic postures have gained its importance in the recent years due to the increased prevalence of work-related musculoskeletal disorders (WMSDs) among dentists and dental students who do not practice proper ergonomic procedure. Aim: The aim of the present study is to analysis ergonomic posture among dental students while performing supragingival scaling (SGS) procedure, using the standardized photometric assessment method (SPAM). Materials and Methods: A total number of 90 students from the third year (III year) to final year (IV year) and internship (Intern) (30 each) were included in the study. All the 90 students were asked to perform SGS procedure and were photographed and analyzed using the current technique. Eight dental ergonomic postures were analyzed in this study and grouped according to the classification system developed for scoring dental ergonomic postures by Garbin et al., in 2011. Analysis of variance test with Bonferroni correction was used to statistically analyze the collected data. Results: The mean index value for III year, IV year and Intern were 2.00, 2.03, and 2.13, respectively, which was not statistically significant (P = 0.709). Conclusions: Analysis of the dental students using the current method showed that most of them come under inadequate and regular category which puts them in a high risk for developing WMSDs. The SPAM to analyze the dental ergonomic posture was simple and effective and should be further explored in the future studies for its pros and cons.
  1,396 145 -
Pyogenic granuloma: Clinicopathological and treatment scenario
Ahmed Salah Al-Noaman,
May-June 2020, 24(3):233-236
Background: Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision. Materials and Methods: A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage. Results: Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion. Conclusion: Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.
  1,225 189 -
Prevalence of periodontitis and its correlates among tribal population of Attapady block, Palakkad District, Kerala
Nisha Gopalankutty, Rosamma Joseph Vadakkekuttical, Sivaraman Remadevi, Abhilash Sasidharan Pillai
May-June 2020, 24(3):264-270
Background: Periodontal disease is an immunoinflammatory disease characterized by loss of clinical attachment with subsequent tooth loss. It includes periodontitis and gingivitis. The studies regarding the prevalence of periodontitis among the tribal populations are scarce. The periodontal health status of the tribal population of Attapady has not been reported so far. Objective: The present study was conducted to assess the prevalence of periodontitis and its association with oral hygiene habits, tobacco usage, and oral health beliefs among tribal population of Attapady. Materials and Methods: This population-based cross-sectional survey of periodontal disease consisting of 360 individuals was conducted among the tribal population of three different panchayats of Attapady. A multistage stratified random sampling was used in the selection of hamlets and cluster sampling for selection of study participants. The sociodemographic characteristics, oral hygiene habits, tobacco usage, and oral health beliefs were assessed using a questionnaire, and clinical examination was based on WHO oral health assessment form 2013. Results: The prevalence of periodontal disease among tribal population of Attapady was 87.5% (95% Confidence interval [CI] 78.48, 96.51).73.3% had gingival bleeding and 13.3% had no/mild periodontitis, The proportion of periodontitis was 84.2% (95% CI 75.5, 92.8). Among chronic perioodntitis subjects 22.8% had moderate periodontitis and 61.4% had severe periodontitis. A significant association was observed between tobacco use (Odds ratio [OR] 5.6, CI 2.99, 10.74), bad oral hygiene habits (OR 4.9, CI 2.64, 9.43), unfavorable oral health beliefs (OR 3.21, CI 1.63, 6.32), and periodontitis. Conclusions: The prevalence of periodontal disease and periodontitis are high among tribal population of Attapady. Unfavorable oral health belief, bad oral hygiene habits, and detrimental habits like tobacco use were the modifiable risk factors identified in this group.
  1,287 116 -
Integrated dentistry
Nymphea Pandit
May-June 2020, 24(3):189-189
  1,199 82 -
Immunohistochemical evaluation of CD117 in mast cell of aggressive periodontitis
Siavash Azizi Mazreah, Maryam Shahsavari, Parvin Arbabi Kalati, Homa Azizi Mazreah
May-June 2020, 24(3):216-220
Context: Aggressive periodontitis is a type of inflammatory response in periodontal tissues that is differentiated from chronic by its earlier onset, its high rate of progression, subgingival microbial composition, the difference in the host's immune response, and family history of the disease. Mast cells live in tissues and contribute to the various allergic and inflammatory conditions, including periodontal diseases, through the release of cytokines, chemokines, and proteolytic enzymes. CD117, the receptor of the stem cell factor expressed by the mast cells, is the hallmark of mast cell development. This study aimed to determine the expression level of CD117 in the mast cells of aggressive periodontitis using immunohistochemistry. Aims: This study aimed to determine the expression level of CD117 in the mast cells of aggressive periodontitis using immunohistochemistry. Subjects and Methods: The study was conducted on tissue samples from 15 patients with aggressive periodontitis and 15 patients with healthy gingival tissue. Samples were stained for CD117 markers using immunohistochemistry. After the microscopic examination of samples, all data were entered into SPSS 20 and analyzed. Statistical Analysis Used: Statistical data were analyzed using Kolmogorov–Smirnov test and independent t- test. Results: According to the results, the mean expression levels of CD117 in the aggressive periodontitis and normal gingival groups were 19.08 ± 6.9 and 18.2 ± 8.1, respectively, which were not statistically significant (P = 0.75). The Kolmogorov–Smirnov test verified the normality of distribution of CD117 expression level. Given the normal distribution of the scores, the independent t-test was used to compare the CD117 expression level in the two study groups. Conclusions: There was no significant difference in the level of CD117 expression between the control and aggressive periodontitis groups.
  1,101 128 -
A comparative assessment of clinical parameters, sialic acid, and glycosaminoglycans levels in periodontitis patients with and without dental fluorosis: A clinical and biochemical study
Prasad Sakthidharan Aswin, Kharidi Laxman Vandana
May-June 2020, 24(3):237-243
Aim: This study was aimed to evaluate and compare the clinical parameters and the gingival crevicular fluid (GCF) levels of sialic acid (SA) and chondroitin sulfate (CS) in dental fluorosed and nonfluorosed (NF) gingivitis and periodontitis patients. Materials and Methods: A total of 100 patients were divided into two control (healthy) and four test (diseased) groups of gingivitis and periodontitis patients with and without dental fluorosis. The GCF-SA and chondrotin sulphate levels were measured using the conventional method and enzyme-linked immuno sorbent assay, respectively. Results: The plaque levels (2.9 ± 0.44), gingival bleeding levels (2.75 ± 0.55), and clinical attachment loss (0.44 ± 0.45) between dental fluorosed participants with chronic periodontitis (fluorosed periodontitis [FP]) and NF participants with chronic periodontitis (nonfluorosed periodontitis [NFP]) groups showed no statistically significant difference. Higher probing pocket depth by community periodontal index (CPI) scores of 4 and clinical attachment level CPI score of 1 (75%) was found in FP group when compared to a score of 3 (FP: 24.5% and NFP: 73.5%) of the NFP group. The GCF SA levels (679.05 ± 101.06) were significantly higher in FP group than NFP group (553.80 ± 49.40) (P = 0.048). Similarly, the GCF CS showed highly significant levels in fluorosis periodontitis (48.08 ± 18.13) group than the NFP group (26.95 ± 8.69). Conclusion: Increased pocket depth score, GCF–SA, and CS levels in the dental fluorosed group were observed when compared with NF group. The diagnostic ability of clinical examination is most often supported by the relevant biochemical parameters that are applicable in this study. The newer diagnostic ability of SA is found to be contributory in this study. The diagnostic ability of CS representing tissue destruction served as an important GCF marker along with SA. Clinical Relevance: In dental fluorosis, estimation of SA and CS is recommended in periodontitis patients.
  1,110 110 -
“…Of the people, by the people, for the people”
Harpreet Singh Grover
May-June 2020, 24(3):190-190
  1,094 64 -