Effectiveness of Topical Oxygen Therapy in Gingivitis and Periodontitis: Clinical Case Reports and Review of the Literature

Gingivitis and periodontitis are common oral pathological conditions. Several optional adjunctive local therapies are used clinically. While antibiotics and chlorhexidine are the most common agents of choice, their long-term use is associated with several adverse effects. Some of these include staining of teeth and restorations, cellular cytotoxicity and hypersensitivity. Topical oxygen therapy has been recently introduced and could be clinically capable of inhibiting plaque bacterial biofilm growth. Available as a mouthwash, toothpaste and oral gel, this formulation comprises cellulose, glycerol and sodium peroxoborate, and releases topical oxygen in a controlled manner. Moreover, it releases topical oxygen, in a controlled manner, and lactoferrin, which are capable of antibacterial action and stimulation of bone cells, respectively. The aim of this paper is to report a case of gingivitis and another case of periodontitis, both of which were successfully treated clinically with adjunctive local oxygen therapy (blue®m). Additionally, this paper aims to review the relevant literature in terms of adjunct topical or local therapies used in the treatment of gingivitis and periodontitis, in order to understand how local therapies are helpful and to know if local oxygen therapy is a suitable clinical alternative.

Correlation between whole salivary prostaglandin E2 and hemoglobin A1c levels among type-2 diabetic and non-diabetic patients with periodontal inflammation

BACKGROUND

It is hypothesized that whole salivary prostaglandin E2 (PgE2) levels are higher in patients with type-2 diabetes mellitus (type-2 DM) than non-diabetic individuals with periodontal inflammation; and that whole salivary expression of PgE2 is correlated with hemoglobin A1C (HbA1c) levels. The aim of the present study was to compare whole salivary PgE2 levels among patients with type-2 DM and non-diabetic individuals with periodontal inflammation.

METHODS

Sociodemographic data, duration since the diagnosis and management of type-2 DM, most recent hemoglobin A1C (HbA1c level), and any familial history of DM was retrieved from patient's healthcare records. Participants were divided into four groups: Group-1: type-2 diabetics with periodontal inflammation; Group-2: type-2 diabetics without periodontal inflammation; Group-3: non-diabetics with periodontal inflammation; and Group-4: non-diabetics without periodontal inflammation. Plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL) and marginal bone loss (MBL) were measured. Unstimulated whole saliva samples were collected and PgE2 levels were measured. Group-comparisons were done and P < 0.05 were considered statistically significant.

RESULTS

One-hundred-sixty individuals were included. Mean HbA1c levels were higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05). The PI (P < 0.05), GI (P < 0.05) and PD (P < 0.05) were higher in Group-1 than groups 2 and 4. The CAL was higher in Group-1 than groups 2 (P < 0.05) and 3 (P < 0.05). The PD (P < 0.05), PI (P < 0.05) and GI (P < 0.05) were higher in Group-3 than Group-4. The MBL was higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05). The PgE2 levels were higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05).

CONCLUSION

Hyperglycemia in patients with type-2 DM is associated with increased expression of whole salivary PgE2 levels and worsened periodontal inflammation compared with individuals with well-controlled type-2 DM and non-diabetic individuals.

Dental Students' Perceptions Towards E-learning in Comparison With Traditional Classroom Learning

INTRODUCTION

Electronic learning (e-learning) has evolved into a popular educational approach since the coronavirus disease 2019 (COVID-19) pandemic. While this represents an additional model for teaching, traditional classroom learning fosters the development of interpersonal skills and enables students to share and discuss specific topics. However, existing research on the comparison of both these modes of learning in the field of dental education is inadequate. This study aimed to evaluate the perceptions of dental students towards both electronic and classroom learning.

METHODS

A cross-sectional questionnaire-based survey was conducted between November 2022 and January 2023 among dental students in Saudi Arabia. Students were questioned on their comparative perceptions of e-learning and classroom learning before, during, and after the COVID-19 pandemic. Questionnaire responses, including demographic data, were collected and tabulated, using electronic data management software. The tabulated data were analyzed to provide descriptive statistics and compare electronic and classroom learning with demographic variables and previous experience with e-learning.

RESULTS

Most respondents reported possessing average information technology (IT) skills and prior experience with e-learning. Blackboard Learning Management System (LMS) (Reston, VA: Blackboard Inc.), Zoom (San Jose, CA: Zoom Video Communications Inc.), and Microsoft Teams (Redmond, WA: Microsoft Corporation) were the most commonly used and advantageous e-learning platforms. While the majority of participants found both methods acceptable for problem-based learning sessions and theoretical lectures, they reported e-learning to be less effective than classroom learning for clinical and practical sessions. Regarding e-learning as a preferred method over classroom learning, most responses were "neutral" or "uncertain." Comparing the mean ranks of the ordinal responses for the different teaching methodologies and the nominal responses for e-learning as the preferred method, no statistically significant interactions were observed for demographic characteristics, IT-skill levels, or prior experience with e-learning.

CONCLUSION

Although enhanced performance and learning capacity are enabled through e-learning, the advantages of personal interactions and the feasibility of practical and clinical dental sessions are achieved only through classroom learning.

Efficacy of 0.12% Chlorhexidine and Salvadora persica-based Mouthwash in Reducing Oral Candida Carriage and Periodontal Inflammation in Cigarette Smokers and Non-smokers after Non-surgical Periodontal Therapy

PURPOSE

The present study assessed the efficacy of 0.12% chlorhexidine (CHX) and Salvadora persica-based mouthwashes (SPM) in reducing oral Candida carriage (OCC) and periodontal inflammation in cigarette smokers and non-smokers after non-surgical periodontal treatment (NSPT).

MATERIALS AND METHODS

Self-reported cigarette smokers and non-smokers with periodontal inflammation as well as non-smokers with a healthy periodontal status were included. NSPT was performed in all participants. Based on the type of mouthwash, participants were randomly divided into three groups as follows: group 1: CHX; group 2: SPM; and group 3: distilled water (ddH2O) with mint flavour (control group). Clinical attachment loss (CAL), plaque index (PI), gingival index (GI), probing depth (PD), and marginal bone loss (MBL) were measured. Clinical periodontal parameters were re-assessed at a 6-week follow-up. Oral yeast samples were collected and identified using a concentrated oral-rinse culture technique and PCR, respectively. Clinical and laboratory-based investigations were done at baseline and after six weeks. Statistical significance was set at p < 0.05.

RESULTS

At baseline, PI, MBL, PD and CAL were comparable in all participants. None of the patients had periodontitis at baseline. Post-operatively, CHX and SPM were more effective in reducing PI (p < 0.01), GI (p < 0.01) and PD (p < 0.01) in non-smokers than in the control group. The OCC was statistically significantly higher among smokers compared with non-smokers at baseline. At the 6-month follow-up, CHX was more effective than SPM in reducing OCC in non-smokers (p < 0.01). At the 6-week follow-up, there was no difference in OCC among cigarette smokers regardless of the type of mouthwash prescribed postoperatively.

CONCLUSION

In cigarette smokers and non-smokers, CHX and SPM are effective in reducing periodontal soft-tissue inflammation after NSPT. Post-operative use of CHX is more effective than SPM in reducing OCC.

Role of Chlorhexidine and Herbal Oral Rinses in Managing Periodontitis

OBJECTIVE

The aim of this research was to assess the effect of 0.12% chlorhexidine (CHX) and a Salvadora persica-based mouthwash on whole salivary tumour necrosis factor-alpha (TNF-α) levels and periodontal inflammation in patients with type 2 diabetes mellitus (T2DM).

METHODS

Patients with and without medically diagnosed T2DM were included. Patients' medical records were evaluated to confirm the diagnosis of T2DM. All patients underwent nonsurgical periodontal therapy (NSPT). Patients were divided into 2 subgroups. In the test and control group, patients were advised to rinse with an S persica-based mouthwash and a non-alcoholic 0.12% CHX after NSPT twice daily for 2 weeks, respectively. Demographic data were collected. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were measured, and whole salivary TNF-α levels were gauged at baseline and at 3-month follow-up. Haemoglobin A1c (HbA1c) levels were measured in all patients at baseline and at 3-month follow-up. Sample size estimation was done, and group comparison was performed. Level of significance was set at P < .01.

RESULTS

Twenty-one nondiabetic individuals and 21 patients with T2DM were included. At baseline, there was no significant difference in clinical and radiographic periodontal parameters amongst in patients with and without T2DM. At 3-month follow-up, HbA1c, TNF-α, PI, PD, and clinical AL were comparable with their respective baseline values in the test and control groups amongst patients with T2DM. In nondiabetic individuals, there was a significant reduction in PI (P < .01), GI (P < .01), and PD (P < .01), and TNF-α (P < .01) at 3-month follow-up in the test and control groups compared with their respective baseline scores.

CONCLUSIONS

In the short term, NSPT with 0.12% CHX or S persica-based mouthwashes is more effective in reducing periodontal inflammation and whole salivary TNF-α levels in nondiabetic individuals than in patients with T2DM with periodontal inflammation.

Nanocrystalline hydroxyapatite in periodontal bone regeneration: A systematic review

Background

Periodontal diseases when persistent, results in periodontal pockets, attachment loss and progressive destruction of the alveolar bone. Grafting periodontal bone defects with bone substitute biomaterials has proven clinical success for accomplishing reconstruction of lost attachment apparatus, especially in deep intra-bony defects. Nanoparticles (NPs) have been considered indispensable in the future of health sciences and NP based alloplastic graft materials such as nanocrystalline hydroxyapatite (NCHA) hold great promise for regeneration of periodontal defects. Therefore the aim of this review is to evaluate the role of NCHA as an effective substitute for periodontal bone regeneration.

Material & methods

Popular scientific databases such as PubMed (Medline), Cochrane database of clinical trials, Scopus (Elsevier), Web of science (Clarivate Analytics) and Google Scholar, were searched. The literature search was restricted to published reports in English, between January 2000 and December 2021. Database search returned 1227 results which were screened based on title, author names and publication dates.

Results

Data from the 14 included studies were reviewed and tabulated. In the present review, all the studies reported using commercially available NCHA for periodontal bone regeneration.

Conclusion

NCHA is a suitable bone substitute material for periodontal bone regeneration, with outcomes comparable to that of conventionally used graft materials such as bovine xenograft and other synthetic alloplastic materials. While grafting with NCHA in intrabony periodontal defects, after any form of periodontal flap surgery or debridement, significantly improves bone regeneration by 6 months, addition of adjuncts like EMD and PRF further enhance the outcomes.

Effectiveness of 0.12% chlorhexidine and a Salvadora persica-based mouthwash in reducing periodontal inflammation and whole salivary IL-1β levels after non-surgical periodontal therapy in young light cigarette-smokers

OBJECTIVE

The aim was to assess the effectiveness of 0.12% chlorhexidine (CHX) and a Salvadora persica (SP)-based mouthwash in reducing periodontal inflammation and whole salivary interleukin (IL)-1β levels after non-surgical periodontal therapy in young light cigarette-smokers.

PATIENTS AND METHODS

Self-reported current cigarette-smokers and never-smokers with periodontal inflammation were included. All patients underwent non-surgical periodontal therapy. Patients were divided into 2 subgroups. In the test- and control-group, patients were advised to rinse with a Salvadora persica-based mouthwash and a non-alcoholic 0.12% CHX twice daily for 2-weeks, respectively. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment loss (AL) and whole salivary IL-1β were measured at baseline and at 3-months' follow-up. Significance was set at p<0.01.

RESULTS

34 cigarette-smokers and 34 never-smokers were included. At 3-months of follow-up, PI, PD, and clinical AL were comparable with their respective baseline values among cigarette-smokers. In never-smokers, there was a significant reduction in scores of PI (p<0.01), GI (p<0.01) and PD (p<0.01) at 3-months of follow-up compared with baseline. At 3-months of follow-up, there was no significant difference in PI, GI, PD, and clinical AL among never-smokers in the test- and control-groups. Among never-smokers, there was a significant reduction in whole salivary IL-1β levels at 3-months' follow-up (p<0.01).

CONCLUSIONS

Usage of 0.12% CHX or a S. persica-based mouthwash following NSPT is ineffective in controlling periodontal inflammation and reducing whole salivary IL-1β in young light cigarette-smokers compared with never-smokers.

Assessment of salivary alpha amylase and mucin-4 before and after non-surgical treatment of peri-implant mucositis

BACKGROUND

The present study was based on the null hypothesis that there is no difference in clinicoradiographic parameters and whole salivary alpha amylase (AA) and mucin-4 levels before and after non-surgical mechanical debridement (NSMD) of patients with peri-implant mucositis (PM). The aim was to assess whole salivary AA and mucin-4 levels before and after treatment of PM.

METHODS

Patients with PM (Group-1) and individuals without peri-implant diseases (Group-2) were included. Demographic data was collected and peri-implant modified plaque and bleeding indices (mPI and mBI, respectively), probing depth (PD) and crestal bone loss were measured at baseline. Levels of AA and mucin-4 were assessed in unstimulated whole saliva samples. All patients underwent full-mouth non-surgical periodontal therapy (NSPT) and NSMD; and clinical parameters and salivary biomarkers were re-assessed after 3 months. Level of significance was set at P < 0.01.

RESULTS

Twenty-six and 32 individuals were included in groups 1 and 2, respectively. None of the participants had periodontitis. At baseline clinical periodontal parameters (PI [P < 0.001], GI [P < 0.001], clinical AL [P < 0.001] and PD [P < 0.001]) were significantly high in Group-1 than Group-2. At 3-month follow-up, there was a statistically significant reduction in clinical periodontal and peri-implant parameters (PI [P < 0.01], GI [P < 0.01], and PD [P < 0.01]) in Group-1 compared with their baseline values. At baseline, salivary AA levels were significantly high in Group-1 than Group-2 (P < 0.01). At 3-month follow-up, there was no significant difference in whole salivary AA levels among patients in groups 1 and 2.

CONCLUSIONS

The AA and mucin-4 levels are potential biomarkers for evaluation of peri-implant diseases including PM. Mechanical instrumentation continues to be the most predictable treatment option for the management of peri-implant diseases.

Postoperative anti-inflammatory efficacy of 2% saline rinses and a herbal- mouthwash after non-surgical periodontal therapy for the management of periodontal inflammation in young adults with chlorhexidine allergy: A randomized controlled trial

AIM

The present randomized controlled trial assessed the postoperative anti-inflammatory efficacy of 2% saline rinses (SR) and a herbal- mouthwash (HMW) after non-surgical periodontal therapy (NSPT) for the management of periodontal inflammation in patients with chlorhexidine (CHX) allergy.

MATERIALS AND METHODS

Patients with periodontal inflammation with and without self-reported CHX-allergy were included. All patients underwent non-surgical periodontal therapy (NSPT). Patients were randomly divided into three groups. In the SR and HMW groups, 2% SR, and a HMW, respectively were prescribed. In Group-3 (CHX-group), patients without CHX allergy were included and were prescribed 0.12% CHX. In all groups, plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL) and marginal bone loss were measured at baseline. Clinical periodontal parameters were re-assessed at 6-weeks' follow-up. P<0.01 were considered statistically significant.

RESULTS

Thirteen, 12 and 12 patients were included in the SR, HMW and CHX groups, respectively. At baseline clinical and radiographic periodontal parameters were comparable in all groups. In all groups, PI (P<0.01), GI (P<0.01) and PD (P<0.01) were significantly higher at baseline compared with their respective values at 6-weeks of follow-up. There was no significant difference in clinical AL at all time intervals in all groups. There was no significant correlation between periodontal parameters and age, gender and daily toothbrushing/flossing in all groups.

CONCLUSION

In young adults with self-reported CHX-allergy, herbal-mouthwashes and/or 2% SR are suitable postoperative prescriptions after NSPT.

Histological and Histomorphometric Analyses of Bone Regeneration in Osteoporotic Rats Using a Xenograft Material

We evaluated the effect of osteoporotic induction after eight weeks of initial healing of bone defects grafted with a xenograft material in a rat model. Bone defects were created in the femoral condyles of 16 female Wistar rats (one defect per rat). The defects were filled with bovine bone (Inter-Oss) granules. After eight weeks of bone healing, rats were randomly ovariectomized (OVX) or sham-operated (SHAM). At 14 weeks of bone healing, all animals were euthanized. Bone specimens were harvested and processed for histological and histomorphometric analyses to assess new bone formation (N-BF%), remaining bone graft (RBG%) and trabecular bone space (Tb.Sp%) within the defect area. After 14 weeks of bone healing, histological evaluation revealed a significant alteration in trabecular bone in OVX rats compared to SHAM rats. There was lower N-BF% in OVX rats (22.5% ± 3.0%) compared to SHAM rats (37.7% ± 7.9%; p < 0.05). Additionally, the RBG% was significantly lower in OVX (23.7% ± 5.8%) compared to SHAM (34.8% ± 9.6%; p < 0.05) rats. Finally, the Tb.Sp% was higher in OVX (53.8% ± 7.7%) compared to SHAM (27.5% ± 14.3%; p < 0.05) rats. In conclusion, within the limitations of this study, inducing an osteoporotic condition in a rat model negatively influenced bone regeneration in the created bone defect and grafted with a xenograft material.

Histomorphometric Evaluation of Peri-Implant Bone Response to Intravenous Administration of Zoledronate (Zometa®) in an Osteoporotic Rat Model

We evaluated the response to peri-implant bone placed in the femoral condyle of osteoporotic rats, following intravenous zoledronate (ZOL) treatment in three settings: pre-implantation (ZOL-Pre), post-implantation (ZOL-Post), and pre- + post-implantation (ZOL-Pre+Post). Twenty-four female Wistar rats were ovariectomized (OVX). After 12 weeks, the rats received titanium implants in the right femoral condyle. ZOL (0.04 mg/kg, weekly) was administered to six rats 4 weeks pre-implantation and was stopped at implant placement. To another six rats, ZOL was given post-implantation and continued for 6 weeks. Additional six rats received ZOL treatment pre- and post-implantation. Control animals received weekly saline intravenous injections. At 6 weeks post-implantation, samples were retrieved for histological evaluation of the percentage of bone area (%BA) and of the percentage of bone-to-implant contact (%BIC). BA% for ZOL-Pre (29.6% ± 9.0%) and ZOL-Post (27.9% ± 5.6%) rats were significantly increased compared to that of the controls (17.3% ± 3.9%, p < 0.05). In contrast, ZOL-Pre+Post rats (20.4% ± 5.0%) showed similar BA% compared to Saline controls (p = 0.731). BIC% revealed a significant increase for ZOL-Post (65.8% ± 16.9%) and ZOL-Pre+Post (68.3% ± 10.0%) rats compared with that of Saline controls (43.3% ± 9.6%, p < 0.05), while ZOL-Pre rats (55.6% ± 19%) showed a BIC% comparable to that of Saline controls (p = 0.408). Our results suggest that receiving intravenous ZOL treatment before or after implant placement enhances peri-implant bone responses in terms of bone area. However, the effect of different ZOL treatment regimens on BIC% was found to be inconclusive.

Impact of Single or Combined Drug Therapy on Bone Regeneration in Healthy and Osteoporotic Rats

Complications in bone regeneration in patients with systemic impaired bone metabolism (e.g., osteoporosis) represent a rapidly increasing clinical challenge. Alendronate and simvastatin are drugs commonly used to promote bone metabolism in osteoporotic conditions. The aim of this study was to evaluate initial bone regeneration within osseous defects grafted with beta-tricalcium phosphate (β-TCP) in adjunction with systemic coadministrations of alendronate and simvastatin (i.e., daily subcutaneous injection for 3 weeks) in healthy and osteoporotic rats. Eighty Wistar female rats were ovariectomized (OVX; n = 40) or sham operated (n = 40). Six weeks later, osseous defects (a 3-mm critical-sized defect) were created in the left femoral condyles and then grafted with β-TCP. From the day following graft installation, OVX and sham animals received for 3 weeks a daily subcutaneous injection of alendronate (50 μg/kg of body weight) and simvastatin (5 mg/kg of body weight), alone or in combination. A control group was included, which received subcutaneous saline administration. At the end of the 3 weeks, rats were euthanized and specimens (femoral condyles) were retrieved for histological evaluation and histomorphometric measurements, that is, bone area (BA%) and remaining bone graft (RBG%). In osteoporotic rats, 3 weeks of daily subcutaneous injection of combined therapy (alendronate plus simvastatin) led to a significant (p < 0.05) increase in BA% and a significant decrease in RBG% compared to healthy controls in osseous defects grafted with β-TCP (BA%: 28.6 ± 12.0 vs. 18.2 ± 7.6, RBG% 61.3 ± 11.1 vs. 70.7 ± 7.3). No significant differences in BA% and RBG% were found in the OVX rats for single treatments. Furthermore, healthy controls showed similar BA% and RBG% upon single or combined therapy compared to nontreated control rats. Daily coinjections (for 3 weeks) of alendronate plus simvastatin result in a significant enhancement of bone regeneration within osseous defects grafted with β-TCP in osteoporotic rats. Despite the expected effects on osteoporotic bone, our study did not confirm the hypothesized benefit of alendronate and simvastatin on bone regeneration in osseous defects in healthy conditions. The efficacy of the combination drug therapy on bone regeneration demands further investigation to elucidate molecular and cellular aspects underlying this therapy.

Bone Regeneration Using Antiosteoporotic Drugs in Adjunction with Bone Grafting: A Meta-Analysis

The aim of this review was to systematically assess bone regeneration by using antiosteoporotic drugs in adjunction with bone grafting compared with controls (bone grafting without the administration of antiosteoporotic drugs). The review also evaluated statistical differences in the effect between systemic and local routes of drugs. Also, the effect of type of drugs (anticatabolic vs. anabolic) was subevaluated. PubMed and EMBASE (via OvidSP) resulted in inclusion of 60 animal studies. The studies were assessed for reporting quality and risk of bias. Outcome data from selected studies were categorized as either experimental (bone grafting with the administration of antiosteoporotic drugs) or control. Meta-analysis of selected studies was done for these outcomes: histomorphometrical bone area (BA%) and micro-CT bone volume (BV%). In this review, several animal models (52 healthy, 6 osteoporotic, and 2 both conditions) were subjected to examine the effect of antiosteoporotic drugs on bone grafting, with a predominant use of rodent species. Assessment indicates poor reporting quality and unclear risk of bias in the majority of studies. Random-effects meta-analysis revealed a significant increase in overall BA% (mean difference [MD]: 2.6, confidence interval [CI]: 2.25 to 2.92) and BV% (MD: 0.12, CI: 0.05 to 0.19) due to osteoporotic drug treatment compared with controls. For subgroups, both routes of antiosteoporotic drug administration showed similar effects on BA%. In contrast, systemic antiosteoporotic drug administration led to significantly higher BV% (MD: 6.75, CI: 5.30 to 8.19) compared with local administration (MD: 0.02, CI: -0.03 to 0.08). Further, administration of anabolic drugs significantly increased BA% (MD: 5.75, CI: 4.62 to 6.87) compared with anticatabolic drugs (MD: 1.86, CI: 1.47 to 2.26). In conclusion, both histomorphometrical and micro-CT scan analysis indicated an overall effect of using the antiosteoporotic drugs toward bone regeneration in adjunction with grafting. However, not all studies showed a positive effect and the present results need to be applied with care, as the included papers showed experimental heterogeneity for animal models. Further (pre)clinical research is warranted to explore whether drug-based strategies can be an effective adjunctive with bone grafting. Impact Statement The aim of this meta-analysis was to assess whether antiosteoporotic drugs can promote bone regeneration in adjunction with bone grafting by using preclinical animal models. Although the majority of included studies indicated poor reporting quality and unclear risk of bias, an overall positive effect of the antiosteoporotic drugs toward bone regeneration related to bone grafts can be highlighted.

Antiosteoporotic Drugs to Promote Bone Regeneration Related to Titanium Implants: A Systematic Review and Meta-Analysis

IMPACT STATEMENT

This meta-analysis was to investigate literature on the administration of antiosteoporotic drugs as an effective adjunct therapy for implant osseointegration using in vivo animal models.