Clinical and radiographic periodontal parameters and release of collagen degradation biomarkers in naswar dippers

Comparison of severity of periodontal clinical parameters among naswar/snuff users: Cross sectional study

Background

Naswar is a moist, non-chewable, and smokeless tobacco product ensconced in the buccal vestibule or floor of the mouth. Consumption of naswar is very popular in South Asia, especially Pakistan. This cross-sectional study compared the periodontal clinical parameters amongst mild, moderate, and severe naswar users.

Methods

318 naswar users, categorized into three equal groups (n = 106) severe naswar users, moderate naswar users, and mild naswar users were drawn for this study. Bleeding on probing, pocking depth, gingival recession, and attachment loss were assessed using the UNC-15 probe and compared among the three groups of naswar users. Data analysis was done with the help of SPSS. Statistical significance was deliberated at p value ≤0.05.

Results

28.9 ± 7.6 years was the mean age presentation. The mean % of bleeding on probing score was 61.95% in severe naswar users, 56.62% in moderate naswar users, and 51.23% in mild naswar users with a p-value of 0.001*. In severe, moderate, and mild naswar users the probing pocket depth (4-6mm) were 35.14%, 30.95%, and 23.21% respectively. 26.78% severe naswar users were having mean percentage for probing pocket depth (>6m) followed by moderate naswar users (17.26%) and mild naswar users (17.26%) with a significant p-value (0.001*). Clinical attachment loss (CAL) was 2.50 percent in light naswar users, 3.0 percent in moderate naswar users, and 4.25 percent in severe naswar users. Clinical attachment loss (CAL) was 2.50 percent in light naswar users, 3.0 percent in moderate naswar users, and 4.25 percent in severe naswar users. Severe naswar users had a high mean percentage of gingival recession (23.21%), whereas light 13.67 percent and moderate 14.88 percent naswar users had a smaller difference.

Conclusions

Clinical periodontal parameters were more worsen in heavy naswar users compared to moderate and light naswar users.

Raman Spectroscopy: A Potential Diagnostic Tool for Oral Diseases

Oral diseases impose a major health burden worldwide and have a profound effect on general health. Dental caries, periodontal diseases, and oral cancers are the most common oral health conditions. Their occurrence and development are related to oral microbes, and effective measures for their prevention and the promotion of oral health are urgently needed. Raman spectroscopy detects molecular vibration information by collecting inelastic scattering light, allowing a “fingerprint” of a sample to be acquired. It provides the advantages of rapid, sensitive, accurate, and minimally invasive detection as well as minimal interference from water in the “fingerprint region.” Owing to these characteristics, Raman spectroscopy has been used in medical detection in various fields to assist diagnosis and evaluate prognosis, such as detecting and differentiating between bacteria or between neoplastic and normal brain tissues. Many oral diseases are related to oral microbial dysbiosis, and their lesions differ from normal tissues in essential components. The colonization of keystone pathogens, such as Porphyromonas gingivalis, resulting in microbial dysbiosis in subgingival plaque, is the main cause of periodontitis. Moreover, the components in gingival crevicular fluid, such as infiltrating inflammatory cells and tissue degradation products, are markedly different between individuals with and without periodontitis. Regarding dental caries, the compositions of decayed teeth are transformed, accompanied by an increase in acid-producing bacteria. In oral cancers, the compositions and structures of lesions and normal tissues are different. Thus, the changes in bacteria and the components of saliva and tissue can be used in examinations as special markers for these oral diseases, and Raman spectroscopy has been acknowledged as a promising measure for detecting these markers. This review summarizes and discusses key research and remaining problems in this area. Based on this, suggestions for further study are proposed.

Longitudinal evaluation of clinical, spectral and tissue degradation biomarkers in progression of periodontitis among cigarette and electronic cigarette smokers

OBJECTIVES

To longitudinally evaluate the periodontal parameters and MMP-8 and CTX (C-terminal crosslinked telopeptide of type I collagen) levels from diseased and healthy sites from cigarette and electronic cigarette (e-cig) smokers and characterize the gingival crevicular fluid (GCF) samples using Raman spectroscopy In addition, to longitudinally determine if MMP-8 and CTX are predictive factors for attachment loss in periodontitis sites.

METHODS

Sixty periodontally healthy and 60 periodontitis/diseased sites from 30 e-cig and 30 cigarette smokers were monitored at baseline, 3 months, and 6-months. GCF was sampled to study the MMP-8 and CTX concentrations using enzyme-linked immunosorbent assay. Infra-red absorption spectra of GCF were acquired at all time points and processed to identify key functional groups.

RESULTS

A significantly increased attachment loss was observed at 6 months for both smokers when compared with baseline (p < 0.01). This difference was significantly high for cigarette smokers compared with e-cig users (p < 0.01). MMP-8, CTX, smoking pack-years were significantly correlated with probing depth and clinical attachment loss among both e-cig and cigarette smokers. For MMP-8 and CTX, the periodontitis sites showed a statistically significant difference between e-cig and cigarette smokers at both 3- and 6 months follow-up. From baseline to 6 months follow-up, periodontitis sites from both groups showed higher spectral band intensities with deconvulations and Raman shifts for Amide I and Amide II peaks.

CONCLUSION

Cigarette smokers showed higher periodontal worsening than e-cig smokers. Smoking, MMP-8, CTX are prognostic factors for clinical attachment loss in cigarette and e-cig smokers.

CLINICAL SIGNIFICANCE

Data for Raman scattering and spectral information identifying collagen degradation among e-cig and cigarette smokers have been analyzed. This type of analysis proves a robust diagnostic and prognostic tool for periodontal diseases. Smoking, MMP-8, and CTX are prognostic factors for clinical attachment loss in cigarette and e-cig smokers.

Interventions to prevent periodontal disease in tobacco-, alcohol-, and drug-dependent individuals

Substance abuse affects more than one sixth of the world's population. More importantly, the nature of the abuse and the type of addictive substances available to individuals is increasing exponentially. All substances with abusive potential impact both the human immuno-inflammatory system and oral microbial communities, and therefore play a critical role in the etiopathogenesis of periodontal diseases. Evidence strongly supports the efficacy of professionally delivered cessation counseling. Dentists, dental therapists, and hygienists are ideally placed to deliver this therapy, and to spearhead efforts to provide behavioral and pharmacologic support for cessation. The purpose of this review is to examine the biologic mechanisms underlying their role in disease causation, to understand the pharmacologic and behavioral basis for their habituation, and to investigate the efficacy of population-based and personalized interventions in prevention of periodontal disease.

Clinical periodontal, bacterial, and immunological outcomes of antimicrobial photodynamic therapy in orthodontic treatment-induced gingival enlargement

AIM

The aim of the present clinical trial is to evaluate the clinical, bacterial, and immunological outcomes of photodynamic therapy (PDT) in adolescent patients with orthodontic treatment-induced gingival enlargement (OTGE).

MATERIALS AND METHODS

A total of 26 adolescent patients, 16 girls and 10 boys, of mean age 16.8 years, undergoing fixed orthodontic treatment for at least 6 months (mean duration in months, 8.3 ± 1.9) and presenting with GE were included in the clinical trial. All patients undergoing fixed orthodontic treatment with clinical diagnosis of OTGE were divided into two groups: Patients receiving full-mouth periodontal debridement (FMPD) 'Group-FMPD' and 'Group-PDT' included participants receiving methylene blue-assisted PDT in the selected area along with FMPD. Clinical periodontal assessments included the evaluation of plaque scores (PS), bleeding on probing (BOP), probing depth (PD) and hyperplastic index (HI). The total bacterial counts of Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and Tannerella forsythia (T. forsythia) were estimated and expressed as log CFU/mL of each bacteria. Cytokines including interleukin (IL)-1β and IL-6 were analyzed using enzyme-linked immunosorbent assay (ELISA) kit.

RESULTS

The mean percentage of PS and BOP statistically significantly reduced with both FMPD and PDT from baseline to 4 weeks (p < 0.05). Although mean PD significantly reduced in both the groups at all time points, there was significantly higher reduction with PDT as compared to FMPD at 2 weeks post treatment (p < 0.05). Inter-group comparison showed PDT demonstrated significantly higher HI at 2- and 4-weeks post treatment (p < 0.05). The mean log CFU/mL of P. gingivalis and T. forsythia showed statistically significantly higher reduction with PDT than FMPD (p < 0.05) at both 2-and 4-weeks follow-up. T. denticola reported significantly reduced levels at 2 weeks follow-up period only with PDT (p < 0.05). No statistically significant difference appeared when both treatment modalities were compared with one another (p > 0.05). Four weeks after periodontal treatment, IL-6 significantly reduced with PDT compared to FMPD (p < 0.05).

CONCLUSION

PDT assisted in reducing bacterial counts and improving hyperplastic index in OTGE.

Application of photodynamic therapy against periodontal bacteria in established gingivitis lesions in adolescent patients undergoing fixed orthodontic treatment

BACKGROUND

The aim of this 4 week follow up randomized controlled clinical trial is to evaluate the effectiveness of photodynamic therapy (PDT) as an adjunct to ultrasonic scaling (US) in the reduction of gingival inflammatory parameters and periodontal pathogens in established gingival inflammation in adolescent patients undergoing fixed orthodontic treatment.

MATERIALS AND METHODS

A total of 22 adolescent patients (mean age: 17.5 years) undergoing fixed orthodontic treatment and presenting with persistent local gingival inflammation were randomized into two groups: Group-US: patients receiving ultrasonic scaling (US) with usual oral hygiene instructions and Group-PDT: in which patients received adjunctive PDT with US. Dichotomous recording for plaque scores (PS) and bleeding on probing (BOP) was used to assess the clinical inflammatory status. The total bacterial counts of P. gingivalis and T. forsythia were estimated and were expressed as log CFU/mL. All assessments were performed at baseline, 1 week and 4 weeks. For intergroup comparisons, student's t-test was computed along with Bonferroni correction for post hoc multiple comparisons. To identify differences between repeated follow-ups, ANOVA multiple rank test was used.

RESULTS

Both treatment modalities reported statistically significant reduction in PS and BOP in patients undergoing fixed orthodontic treatment (p < 0.05). However, there was no significant difference in PS and BOP when US was compared with PDT (p > 0.05). Group-US showed statistically significant reduction in T. forsythia at 1 week only (p < 0.05). Group-PDT showed statistically significant reduction in P. gingivalis and T. forsythia from baseline to 1 week and 4 weeks (p < 0.05). This was also significant when compared with US on both the time points (p < 0.05).

CONCLUSION

PDT was effective in significantly reducing periodontal pathogens in established gingivitis lesions in adolescent patients undergoing fixed orthodontic treatment in short term.

Salivary Interleukin 1-beta levels and clinical periodontal parameters in habitual naswar users and non-users

Objectives:

Aim of our study was to assess the expression of salivary Interleukin 1-beta (IL-1β) and clinical periodontal parameters in naswar users and non-users (controls).

Methods:

Eighty four individuals (forty-two naswar users and forty-two controls) were included in the study which was conducted between August 2017 and May 2018. Salivary IL-1β levels, plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL) was assessed in all the participants.

Results:

PD of 4mm (p<0.05), PD of 5-6mm (p<0.05), CAL (p<0.001) and levels of salivary IL-1β (p<0.05) were significantly higher among naswar users as compared to controls while PI, BOP and number of missing teeth showed no significant difference among the two groups (p>0.05).

Conclusion:

Periodontal inflammatory conditions were worse and salivary IL-1β levels were elevated in naswar users as compared to controls.