Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial

AIM

The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM.

MATERIALS AND METHODS

The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H₂ O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01.

RESULTS

Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H₂ O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups.

CONCLUSION

After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Peri-implant clinicoradiographic status among betel-quid chewers and controls

The aim of the present case-control observational study was to evaluate the peri-implant clinicoradiographic status among betel-quid chewers and controls. Self-reported betel-quid chewers and controls were included. Participants were categorized into 3 groups: Group-1: Individuals chewing betel-quid with tobacco; Group-2: Individuals chewing betel-quid without tobacco; and Group-3: Controls (individuals not using tobacco in any form). Demographic data was collected using a questionnaire. Periodontal and peri-implant clinicoradiologic parameters (plaque and gingival indices [PI and GI], probing depth [PD] and crestal bone loss/marginal bone loss [CBL/MBL]) were assessed. Clinical attachment loss (AL) around teeth was also assessed. Group comparisons were done using the one-way analysis of variance and Bonferroni Post-hoc adjustment tests. Correlation of periodontal and peri-implant inflammatory parameters with the duration of betel-quid chewing habit and duration of placement in the mouth were assessed using logistic regression analysis. P<0.05 was considered statistically significant. Thirty, 30 and 30 patients were included in groups 1, 2 and 3, respectively. Full-mouth PI (P<0.01), GI (P<0.01), clinical AL (P<0.01), PD (P<0.01) and mesial and distal MBL (P<0.01) were higher in groups 1 and 2 than Group-3. Peri-implant mPI (P<0.01), mGI (P<0.01), PD (P<0.01) and MBL/CBL (P<0.01) were significantly higher in groups 1 and 2 than Group-3 with no significant difference in groups 1 and 2. Betel-quid chewing habit either with or without tobacco is a risk-factor of peri-implant soft-tissue inflammation and CBL.

Postoperative Analgesic and Anti-inflammatory Effectiveness of Ginger (Zingiber officinale) and NSAIDs as Adjuncts to Nonsurgical Periodontal Therapy for the Management of Periodontitis

PURPOSE

The authors hypothesize that ginger (Zingiber officinale) tablets and non-steroidal anti-inflammatory drugs (NSAIDs) are effective in reducing postoperative self-rated pain and periodontal parameters (plaque index [PI], gingival index [GI], and probing depth [PD], clinical attachment loss [AL] and marginal bone loss) following non-surgical periodontal therapy (NSPT) in patients with periodontitis. The aim was to compare the postoperative analgesic and anti-inflammatory effectiveness of ginger tablets and NSAIDs as adjuncts to nonsurgical periodontal therapy for the management of periodontitis. Materials and Methods: Patients with periodontitis were included. All patients underwent NSPT. In groups 1 and 2, patients received postoperative ginger (400 mg) and non-steroidal anti-inflammatory drugs (400 mg), respectively. Demographic data were collected, and full-mouth periodontal parameters (PI, GI, PD and CAL) were evaluated at baseline and at 7, 14 and 21 days. Self-rated pain scores were assessed at baseline, and at 24 h, 3 and 7 days of follow-up. In both groups, self-rated pain was assessed pre- and postoperatively using the numeric rating scale (NRS). Power analysis was performed on data from a pilot investigation and group comparisons were done. Statistical significance was set at p < 0.01.

RESULTS

Baseline mean NRS scores in groups 1 and 2 were 4.19 ± 0.12 and 4.13 ± 0.08, respectively. All participants had stage II/grade B periodontitis. At baseline, self-rated pain scores were significantly higher among patients in groups 1 and 2 at 24 h (p < 0.01) and 3 days (p < 0.01) of follow-up. In groups 1 (p < 0.01) and 2 (p < 0.01), self-rated pain scores were significantly higher at 24 h compared with 3 days of follow-up. In both groups, there was a significant reduction in PI (p < 0.01), GI (p < 0.01) and PD (p < 0.01) at 7, 14 and 21 days of follow-up compared with baseline.

CONCLUSION

Ginger and traditional NSAIDs are effective in reducing postoperative pain and inflammation following NSPT in patients with moderate periodontitis.

Whole Salivary Cotinine Levels and Interleukin 1-β Levels among Young Adults Involuntarily Exposed to Vapor from Electronic Nicotine Delivery Systems

PURPOSE

To the assess whole salivary cotinine and interleukin 1β (IL-1β) levels among individuals involuntarily exposed to vapor from electronic nicotine delivery systems (ENDS) (test group) and unexposed individuals (control group).

MATERIALS AND METHODS

Demographic data and information related to ENDS vapor exposure were collected using a questionnaire. Unstimulated whole saliva samples were collected, unstimulated whole-saliva flow rate (UWSFR) was calculated, and cotinine and IL-1β levels were determined using enzyme-linked immunosorbent assay. Sample-size estimation and statistical analysis were performed. Regression analysis was performed to determine the correlation between whole salivary cotinine and IL-1β levels. Statistical significance was set at p < 0.05.

RESULTS

Forty-eight individuals (24 and 24 in test and control groups, respectively) were included. Mean ages of individuals in the test and control groups were comparable. In the test group, the mean duration for which the individuals inhaled vapor from ENDS in each session was 22.3 ± 9.5 min and they were exposed to ENDS vapor 12.2 ± 2.4 times daily. There was no difference in the UWSFR between patients in the test (0.21 ± 0.02 ml/min) and control (0.22 ± 0.04 ml/min) groups. Whole salivary cotinine (p < 0.001) and IL-1β (p < 0.001) levels were significantly higher in the test than control group.

CONCLUSION

Young adults involuntarily exposed to vapor from ENDS express elevated whole salivary cotinine and IL-1β levels. Long-term exposure to ENDS vapor may potentially predispose vulnerable populations to oral and systemic inflammatory diseases.

Peri-implant parameters and cytokine profile among Peri-implant disease patients treated with Er Cr YSGG laser and PDT

AIM

To assess the effect of Er,Cr:YSGG (ECL) laser-assisted non-surgical treatment and Photodynamic therapy (PDT) as an adjunct to mechanical debridement (MD) on clinical and radiographic peri‑implant inflammatory parameters in patients with peri‑implant disease MATERIAL AND METHODS: A total of 95 patients with the peri‑implant disease were divided into 3 groups. Patients in group 1 were treated with MD only, patients in group 2 recieved MD+ECL and patients in group 3 were treated with MD+PDT. Perimplant parameters CBL: Crestal bone loss; PD: Probing depth; BI: Bleeding index; PI: Plaque index were measured from baseline to 3 month and 6 months follow up. The means and standard deviation (SD) of the aforementioned parameters were calculated using multiple comparison tests Post hoc Tukey test. Power analysis and sample size (PASS) was used for calculating sample size. The power was estimated at 85% along with a minimum of 30 participants in each group with a two-sided significance level of 0.05 was to be achieved RESULTS: At baseline mean scores of peri‑implant PI, BI and PD were comparable among patients in group 1 (control), 2 (ECL), and 3 (PDT). At 3 months follow up, mean scores of peri‑implant PI (P <0.05), BI (P <0.05) and PD (P <0.05) in group 1 (control) were significantly higher compared to group 2 (ECL) and 3 (PDT). At 6 months follow-up, PI and BI mean scores among groups 1, 2, and 3 were comparable (P>0.05). However, PD was significantly higher in control than groups 2 and 3 (P<0.05) CONCLUSION: MD with adjunct ECL and adjunct PDT are more efficient in reducing peri‑implant soft tissue inflammatory parameters for short-term use than MD alone.

An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers

OBJECTIVES

The aim of this study was to assess the impact of smoking on the whole salivary flow rate (SFR), IgA levels and clinical oral dryness (COD) among active and passive smokers.

MATERIAL AND METHODS

The participants were categorized as active smokers (N = 54) or passive smokers (N = 163). Saliva was collected in tubes and placed in ice storage at -70°C. Salivary IgA levels were assessed in duplication using the enzyme linked immunosorbent assay (ELISA) method. Following the saliva sample collection, the subjects were assessed for COD using the COD score, SFR and caries. Chi-square test, the t-test and ANOVA were employed to compare the clinical impact of the smoking status associated with specific variables (smoking status, number of cigarettes, active caries, gender, age, COD score, IgA level and SFR). A p-value of <0.05 was considered significant.

RESULTS

Two hundred and seventeen subjects with the mean age of 32.86±6.30 years, with 145 males (66.8%) and 72 females (33.2%), were included in the study. Among the active smokers, 88.8% were males compared to 11.2% females. The active smokers had the mean age of 32.52 years, a COD score of 1.43, an IgA level of 1.39 g/l, and a SFR of 0.37 ml/min. Among the passive smokers, 59.5% were males and 40.5% were females, with the mean age of 32.97 years, a COD score of 0.87 g/l, an IgA level of 1.47, and a SFR of 0.42 ml/min. Active caries showed a positive correlation with the number of cigarettes, with significance in the >35 years age group (p < 0.05).

CONCLUSIONS

The study demonstrated significant differences in SFR, IgA and COD scores among the active and passive smokers. The number of cigarettes had a negative impact on saliva production, IgA levels, the oral health status, and the progression of caries with respect to age and gender. Smoking potentially leads to xerostomia associated with active caries. Int J Occup Med Environ Health. 2022;35(1):39-51.

Analgesic Efficacy of Curcuma longa (Curcumin) after Surgical Periodontal Therapy

PURPOSE

To compare the analgesic efficacy of orally administered Curcuma longa (curcumin) and mefenamic acid (MA) after surgical periodontal therapy (SPT).

MATERIALS AND METHODS

Seventy-six periodontitis patients were randomly divided into two groups. In the test group, patients received curcumin capsules (200 mg), and in the control group, patients received MA (500 mg). All patients underwent post-operative antibiotic therapy using 500 mg amoxicillin and 400 mg metronidazole for 7 days. Post-operative pain and discomfort were evaluated using the numerical rating scale (NRS) and verbal rating scale (VRS), respectively. Evaluation were performed after 24 (T1), 48 (T2), and 72 h (T3). Group comparisons were done using Student's t-test and the Mann-Whitney U-test. The level of statistical significance was established at p < 0.05.

RESULTS

All patients had stage 3/grade C periodontitis. The mean age of individuals in the test and control groups were 58.4 ± 7.3 and 57.2 ± 5.2 years, respectively. A family history of periodontal diseases was reported by 37.5% and 47.4% individuals in the test and control groups, respectively. In the test and control groups, the total mean duration of periodontal surgery was 168.2 ± 12.2 and 173.4 ± 10.7 min, respectively. There was no statistically significant difference in the mean NRS and VRS scores among patients in the test and control groups. In both groups, there was no statistically significant difference in the change in NRS scores at any time point.

CONCLUSIONS

Compared with MA, curcumin is ineffective for pain and discomfort management after SPT. The possibility of the results being biased due to lack of operator blinding cannot be overlooked.

The effect of 805 nm near-infrared photobiomodulation on proliferation and differentiation of bone marrow stem cells in murine rats

OBJECTIVE

To evaluate the effect of near infra-red gallium-aluminium-arsenide (GaAlAs) diode laser (805 nm) irradiation on proliferation and differentiation of rat femoral bone marrow-derived mesenchymal stem cells (BMSCs) cultured in osteogenic medium.

MATERIALS AND METHODS

BMSCs were obtained from femurs of 60 Sprague Dawley rats (200 gm). The control group comprised isolated BMSCs supplemented with an osteogenic differentiation medium. On the other hand, in the experimental group, the BMSCs were irradiated with a near-infrared laser in addition to an osteogenic differentiation medium. The experimental group was irradiated with a soft tissue laser comprising of allium-aluminium-arsenic (Ga-Al-Ar) Diode at a near-infrared wavelength of 805 nm in continuous mode. The different output powers applied were 0.5 W, 1.0 W, 1.5 W and 2.0 W respectively. Various energy levels of 1, 4, 7 and 10 J were used for irradiation. Alkaline phosphatase (ALP) assay and Alizarin staining were performed to confirm osteogenic differentiation. Statistical analysis was done using a one-way ANOVA and a p-value of <0.05 was considered significant.

RESULTS

According to our findings, 1.27 J/cm2 was the optimal energy density value that significantly increased the BMSC proliferation at the output of 1.5 W with the power density of 1.27 W/cm2. On 1.27 J/cm2, there was a significant difference compared to the control group on the first day, and the osteogenic differentiation increased significantly on the 4th day compared to the 1st day.

CONCLUSIONS

According to our findings, 1.27 J/cm2 was the optimal energy density value that significantly increased the BMSC proliferation at the output of 1.5 W with the power density of 1.27 W/cm2.

Evaluation of serum neuron specific enolase levels among patients with primary and secondary burning mouth syndrome

INTRODUCTION

Burning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited.

AIM

This study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome.

METHODS

One hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala's criteria for the diagnosis of burning mouth syndrome, including "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test.

RESULTS

The mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren's syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients.Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.

Association of Self-Perceived Psychological Stress with the Periodontal Health of Socially Deprived Women in Shelter Homes

The present study aimed to assess the effect of self-perceived psychological stress on the periodontal health of socially deprived women. The study included three hundred and eighty-five socially deprived women residing in shelter homes. The presence of stress and its severity was assessed by using Sheldon Cohen's 10-item perceived stress scale (PSS), and periodontal health status was assessed utilizing the community periodontal index. Statistical analyses were performed using an independent sample t-test, a one-way ANOVA, the Pearson chi-Square test, and binary logistic regression. Results: A total of 385 samples were included, the majority of whom (n = 297; 72.5%) belonged to the age group of 15-30 years. There were 34 (8.8%) participants who were educated up to graduate level. A total of 47.8% of the women were found with healthy periodontal status, and 52.5% of the samples were diagnosed with major psychological stress. Half of the samples (201-52.2%) had a periodontal problem. The mean PSS was found statistically significant concerning age group, education, and psychological stress level. In the univariate logistic regression analysis, a significant association of periodontal status was observed with the age group 31-45 years [(OR = 1.76; 95% C.I (1.11-2.78)] and with a major psychological stress level [(OR = 2.60; 95% C.I (1.72-3.93)]. Psychosocial stress among socially deprived women was found to be a risk factor for periodontal disease.

Comparison between Allogenic and Xenogenic Bone Blocks on the Osteogenic Potential of Cultured Human Periodontal Ligament Stem Cells: Confocal Laser and Scanning Electron Microscopy Study

Aim:

The aim of this study was to compare between equine and human bone blocks in the osteogenic differentiation of cultured human periodontal ligament stem cells (hPDLSCs) at 14 and 21 days of culture, using confocal laser microscopy and scanning electron microscopy.

Materials and Methods:

In vitro cultures of commercially obtained hPDLSCs were seeded onto equine and human bone blocks. At 14 days and 21 days of culture, confocal laser microscope images were obtained to assess cellular differentiation and adhesion, and scanning electron microscope images were obtained to validate the osteogenic differentiation by showing the morphological characteristics of the new bone cells.

Results:

Both equine and human bone blocks showed positive staining for newly formed bone cells through the confocal laser microscope analysis, however, a higher signal intensity was expressed at 21 days of culture. These findings indicate the biocompatibility of hPDLSC with both types of bone blocks, cellular differentiation, and adhesion. Scanning electron microscopy images validated the osteogenic differentiation by showing the common characteristics of bone cells as flattened, polygonal morphology with multiple extending cytoplasmic processes.

Conclusion:

Both equine and human bone blocks were able to confirm the osteogenic capability of seeded human PDLSC. There was no significant difference between equine and human bone blocks on the human PDLSC differentiation. Superior osteogenic differentiation of cultured hPDLSCs was evident at 21 days in comparison to 14 days.

Peri-implant Sulcular Fluid Galectin-1, Soluble Urokinase Plasminogen Activator Receptor and IL-1β Levels under Peri-implant Inflammatory Conditions

PURPOSE

Soluble urokinase plasminogen activator receptor (suPAR) and interleukin 1-beta (IL-1β) are inflammatory biomarkers, whereas galectin-1 is an anti-inflammatory cytokine. The relationship between suPAR, galactin-1 and IL-1β levels in peri-implant sulcular fluid (PISF) in relation to dental implants remains unaddressed. The aim was to assess suPAR, galectin-1, and IL-1β levels in PISF under peri-implant inflammatory conditions.

MATERIALS AND METHODS

Demographic data and information related to jaw location and duration of implants in function as well as systemic health was retrieved from patients' dental records. Peri-implant plaque and gingival indices (PI and GI, respectively), probing depth (PD) and crestal bone loss (CBL) were recorded. The PISF was collected and levels of suPAR, galectin-1 and IL-1β were determined using standard techniques. Sample-size estimation and statistical analyses were done. Correlation of suPAR and galectin-1 with IL-1β were assessed via logistic regression. p-values < 0.05 were considered statistically significant.

RESULTS

Seventy-two patients (45 males and 27 females) with peri-implant diseases were included. Thirty-six patients (22 males and 14 females) had peri-implant mucositis; 36 (23 males and 13 females) had healthy peri-implant tissues. The PISF volume was statistically significantly higher among patients with (0.52 ± 0.05 µl) than without peri-implant diseases (0.06 ± 0.01 µl) (p < 0.001). The PISF levels of suPAR (p < 0.01), galectin-1 (p < 0.01) and IL-1β (p < 0.01) were statistically significantly higher among patients with than without peri-implant diseases. In patients with peri-implant mucositis, PISF suPAR (p < 0.001) and galectin-1 (p < 0.001) levels correlated with PISF IL-1β levels. In patients with peri-implant mucositis, increasing peri-implant PD and IL-1β levels directly correlated with increased PISF suPAR (p < 0.001) and galectin-1 (p < 0.05) levels.

CONCLUSION

Increased PISF levels of suPAR, galectin and IL-1β suggest that these proteins possibly contribute towards the pathogenesis of peri-implant inflammation, and are potential biomarkers of peri-implant diseases.

Osteogenic Potential of Periodontal Ligament Stem Cells Cultured in Osteogenic and Regular Growth Media: Confocal and Scanning Electron Microscope Study

AIM

To evaluate the ability of osteogenic culture media in comparison with regular growth culture media in enhancing the osteoblastic cell differentiation of human periodontal ligament stem cells (hPDLSCs).

MATERIALS AND METHODS

In vitro cultures of commercially obtained hPDLSCs were seeded onto xenograft bone blocks in both regular and osteogenic media. Confocal laser microscope images were obtained for cellular differentiation and adhesion, and scanning electron microscopy (SEM) images were obtained to validate the osteogenic differentiation by showing the morphological characteristics of the newly formed cells.

RESULTS

Confocal laser microscope analysis showed positive staining for new bone cells with an increased signal intensity when samples were cultured in osteogenic culture media compared with regular culture media. These findings indicate the effect of the active ingredients of the osteogenic culture media in enhancing the osteogenic differentiation hPDLSC. Scanning electron microscopy images validated the osteogenic differentiation showing a flattened, polygonal morphology with multiple extending cytoplasmic processes of new cells.

CONCLUSION

Xenograft bone blocks are biocompatible scaffold for the osteogenic differentiation of seeded hPDLSCs. Osteogenic culture media enhances and increases the osteogenic differentiation of hPDLSCs into new bone cells more than regular growth culture media. Periodontal ligament stem cells are a predictable biological input as a cell-based tissue-engineered construct and biologically acceptable when it is cultured in a suitable growth media that mimics the intended environment.

CLINICAL SIGNIFICANCE

Consideration of the clinical use of equine bone blocks and periodontal ligament stem cells in a suitable biological environment as a potential new option for bone regeneration techniques.