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1.  The Effect of Intensive Oral Hygiene Care on Gingivitis and Periodontal Destruction in Type 2 Diabetic Patients 
Yonsei Medical Journal  2009;50(4):529-536.
This study aimed to investigate the effects of oral hygiene care by oral professionals on periodontal health in type 2 diabetes mellitus patients.
Materials and Methods
Diabetic participants were recruited at a university hospital and matched at a 1:1 ratio by age and gender, and randomly allocated into intervention (40 people) and control groups (35 people). Tooth brushing instruction, oral health education, and supra-gingival scaling were implemented in all patients at baseline. This program was repeatedly conducted in intervention patients every month for 6 months, and twice at baseline and the sixth month in the control. Oral health was measured by decayed, missing, and filled teeth (DMFT), plaque index, calculus index, bleeding index, patient hygiene performance (PHP) index, tooth mobility, Russel's periodontal index, and community periodontal index (CPI). Diabetes-related factors, oral and general health behaviors, and sociodemographic factors were interviewed as other confounding factors. An analysis of covariance (ANCOVA) was used with SPSS for Windows 14.0.
At baseline, there were no significant differences between the two groups in average of periodontal health (calculus index, bleeding index, Russel's periodontal index, CPI, and tooth mobility), diabetes-related factors (fasting blood glucose, postprandial blood glucose, and HbA1c), and in distribution of sociodemographic factors and health behaviors. In intervention group, plaque index, dental calculus index, bleeding index, and PHP index were reduced fairly and steadily from the baseline. There were significant differences in plaque index, dental calculus index, bleeding index, PHP index, and Russel's periodontal index between the two groups at sixth month after adjusted for baseline status.
Intensive oral hygiene care can persistently improve oral inflammation status and could slow periodontal deterioration.
PMCID: PMC2730616  PMID: 19718402
Dental prophylaxis; oral hygiene; periodontal diseases; type 2 diabetes mellitus
2.  Periodontal conditions in patients with Marfan syndrome – a multicenter case control study 
BMC Oral Health  2013;13:59.
Marfan syndrome (MFS) is a disorder of the connective tissues. Alterations of the elastic fibers may manifest in different tissues especially in the skeletal, cardiovascular and ocular system. Oral manifestations like orthodontic or skeletal anomalies and fragility of the temporomandibular joint have been well described by various authors. However, no data are available regarding a possible periodontal involvement of MFS. Hence, the aim of the present study was to investigate for the first time if MFS may increase the susceptibility to periodontitis.
A comprehensive periodontal examination including documentation of probing pocket depth, gingival recession, clinical attachment level, and bleeding on probing was conducted in all patients. In addition, dental conditions were assessed by determining the Index for Decayed, Missing and Filled Teeth (DMFT) and a self-administered questionnaire was filled out by patients. For statistical analysis, the unpaired t-Test was applied (level of significance: p < 0.05). Both groups were matched concerning well known periodontal risk factors like age, gender and smoking habits.
82 participants, 51 patients with MFS (30 female and 21 male, mean age: 40.20 ± 15.35 years) and 31 sound controls (17 female and 14 male, mean age: 40.29 ± 13.94 years), were examined. All assessed periodontal and dental parameters were not significantly different between groups.
Based on our data, patients with MFS did not reveal a higher prevalence of periodontitis compared to the control group. However, Marfan patients showed a tendency to more inflammation signs, which can be explained by the crowded teeth. Therefore, a regular professional cleaning of the teeth is recommendable (i.e., 6 months intervals) in order to reduce the bacterial biofilm in the oral cavity and thus resulting in a decreased risk of systemic diseases, specifically endocarditis.
PMCID: PMC3816571  PMID: 24165013
Marfan syndrome; Periodontal conditions; Periodontitis; Inflammation signs; Attachment-loss; Dental conditions; Oral manifestations
3.  Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjögren's syndrome 
the classification criteria for primary Sjögren's syndrome (pSS) include a number of oral components. In this study we evaluated if salivary flow and composition as well as dental caries are oral markers of disease severity in pSS.
in 20 patients fulfilling the American-European Consensus criteria for pSS and 20 age-matched healthy controls whole and parotid saliva flow rates and composition, measures of oral dryness, scores of decayed, missing and filled tooth surfaces (DMFS), periodontal indices, oral hygiene, and dietary habits were examined.
in pSS, salivary flow rates, pH, and buffer capacities were lower, and DMFS, salivary sodium and chloride concentrations higher than in the healthy controls. DMFS also correlated inversely to salivary flow rates and positively to oral dryness. Apart from slightly increased gingival index, and more frequent dental visits in pSS, the periodontal condition, oral hygiene or sugar intake did not differ between these two groups. In pSS, findings were correlated to labial salivary gland focus score (FS) and presence of serum-autoantibodies to SSA/SSB (AB). The patients having both presence of AB and the highest FS (>2) also had the highest salivary sodium and chloride concentrations, the lowest salivary phosphate concentrations, lowest salivary flow rates, and highest DMFS compared to those with normal salivary concentrations of sodium and chloride at a given flow rate.
the salivary changes observed in some pSS patients reflect impaired ductal salt reabsorption, but unaffected acinar transport mechanisms, despite low salivary secretion. Our results suggest that changes in salivary flow and composition as well as dental caries may serve as potential markers of the extent of autoimmune-mediated salivary gland dysfunction in pSS. The study also indicates that the ductal epithelium is functionally affected in some pSS patients, which calls for future pathophysiological studies on the mechanisms underlying this impaired salt reabsorption.
PMCID: PMC554998  PMID: 15740617
4.  A comparison of the efficacy of powered and manual toothbrushes in controlling plaque and gingivitis: a clinical study 
Plaque is intimately related to the production and progress of dental caries and inflammatory gingival and periodontal diseases. Good plaque control facilitates the return to health for patients with gingival and periodontal diseases. Daily use of a toothbrush and other oral hygiene aids is the most dependable way to achieve oral health benefits for all patients.
A randomized clinical trial was conducted to compare the efficacy of a powered toothbrush with a manual toothbrush in controlling plaque and gingivitis over a 6-week period. The sample consisted of 60 dental students of both sexes, with ages ranging from 18 to 28 years. The samples were stratified and randomly divided into two groups of 30 by a second examiner using the coin toss method; one group used a manual toothbrush and the other group used a powered toothbrush. Each participant’s gingival index, plaque index and oral hygiene index were assessed on the seventh, 14th, and 45th days on the basis of the assigned toothbrush. Collected data were analyzed and different subgroups were compared using Student’s t-test.
A paired t-test revealed a highly significant reduction in the gingival, plaque, and oral hygiene index scores of the manual and powered groups at the first, second, and sixth weeks (P-value < 0.0001). An unpaired t-test revealed a significant reduction between the plaque index scores of the manual and powered groups at the second week (P-value < 0.05). Another unpaired t-test revealed a highly significant reduction between the plaque index scores of the manual and powered groups at the sixth week (P-value < 0.0001).
The subject group using the powered toothbrush demonstrated clinical and statistical improvement in overall plaque scores. Powered toothbrushes offer an individual the ability to brush the teeth in a way that is optimal in terms of removing plaque and improving gingival health, conferring good brushing technique on all who use them, irrespective of manual dexterity or training.
PMCID: PMC3652371  PMID: 23674927
plaque control; oral hygiene; powered toothbrush
5.  Dental caries experience, oral health status and treatment needs of dental patients with autism 
Journal of Applied Oral Science  2011;19(3):212-217.
Autism is a lifelong neurodevelopmental disorder. The aims of this study were to investigate whether children with autism have higher caries prevalence, higher periodontal problems, or more treatment needs than children of a control group of non-autistic patients, and to provide baseline data to enable comparison and future planning of dental services to autistic children.
Material and Methods
61 patients with autism aged 6-16 years (45 males and 16 females) attending Dubai and Sharjah Autism Centers were selected for the study. The control group consisted of 61 non-autistic patients chosen from relatives or friends of autistic patients in an attempt to have matched age, sex and socioeconomic status. Each patient received a complete oral and periodontal examination, assessment of caries prevalence, and caries severity. Other conditions assessed were dental plaque, gingivitis, restorations and treatment needs. Chi-square and Fisher's exact test of significance were used to compare groups.
The autism group had a male-tofemale ratio of 2.8:1. Compared to controls, children with autism had significantly higher decayed, missing or filled teeth than unaffected patients and significantly needed more restorative dental treatment. The restorative index (RI) and Met Need Index (MNI) for the autistic children were 0.02 and 0.3, respectively. The majority of the autistic children either having poor 59.0% (36/61) or fair 37.8% (23/61) oral hygiene compared with healthy control subjects. Likewise, 97.0% (59/61) of the autistic children had gingivitis.
Children with autism exhibited a higher caries prevalence, poor oral hygiene and extensive unmet needs for dental treatment than non-autistic healthy control group. Thus oral health program that emphasizes prevention should be considered of particular importance for children and young people with autism.
PMCID: PMC4234331  PMID: 21625735
Autism; Autistic disorder; Dental caries; Dental care for disabled; Dental care for children; Oral health
6.  Oral health and liver function in children and adolescents with cirrhosis of the liver 
People with cirrhosis of the liver are predisposed to developing oral lesions. The occurrence and type of lesion depend on the degree of liver function impairment and its type, and on the severity and duration of systemic diseases. In children, the age at which the early symptoms of liver disease are experienced is also of great importance.
To assess the prevalence of oral pathological lesions in children and adolescents with cirrhosis of the liver, and their correlation with the degree of liver function impairment.
Material and methods
Clinical and laboratory results of liver function tests (Model of End-Stage Liver Disease/Score of Paediatric End-Stage Liver Disease, Child-Pugh score) were assessed in 35 patients with cirrhosis of the liver. The average age of the patients was 10.7 ±4.74 years. All patients also had their oral cavities examined (mucosa, gingiva – GI, hygiene – PLI, teeth – dmft/dmfs and DMFt/DMFs, DDE Index and Candida spp. presence) and this was then correlated to the degree of liver function impairment.
According to the Child-Pugh scale, 16 patients were class A and 19 were class B/C. Jaundice during the first 3 years of life occurred in 9 patients. Mucosal lesions were found in 26 out of 35 patients (74%), including 10 out of 16 (63%) in Child-Pugh group A, and 16 out of 19 (84%) in group B/C (NS – non significant). Oral candidiasis occurred more often in class B/C than in class A (47.4% vs. 12.5%; p < 0.05). The GI index (Gingival Index) and PLI index (Dental Plaque Index) did not differ between the groups (A vs. B/C) but correlated in the whole group (R = 0.58) as well as in subgroups A (R = 0.65) and B/C (R = 0.59). Dmft/dmfs and DMFt/DMFs indexes did not differ between groups A and B/C, and neither did the DMFt/DMFs in patients with/without enamel defects.
Oral mucosal lesions are commonly found in children with cirrhosis of the liver. Advanced liver disease promotes oral candidiasis. Severity of gingivitis correlates with the presence of dental plaque.
PMCID: PMC4027847  PMID: 24868295
mucosal lesions; enamel defects; gingivitis; cirrhosis of the liver; children
7.  The Influence of Type-1 Diabetes Mellitus on Dentition and Oral Health in Children and Adolescents 
Yonsei Medical Journal  2008;49(3):357-365.
The present study is to investigate the effects of type 1 diabetes mellitus on dentition and oral health for children and adolescents.
Materials and Methods
The investigation was carried out on 100 subjects. The first group consisted of 50 subjects with type 1 diabetes mellitus (21 females, 29 males), age 9 ± 0.14 years; In the second group, there were 50 healthy subjects who did not suffer from any systemic disease (25 females, 25 males), age 9 ± 0.11 years. The subjects were evaluated and divided into two groups of 5 - 9 years old, and 10 - 14 years old. The dentition of all participants was examined. Besides, the DFS/dfs index, oral hygiene conditions were evaluated, as well as the plaque index (PI), gingival index (GI) and calculus index (CI). The data obtained from each group were compared statistically.
When compared to the non-diabetic group, we observed that dental development was accelerated until the age of 10 in the diabetic group, and there was a delay after the age of 10. The edentulous interval was longer in the group with type 1 diabetes mellitus. This was accompanied by a high ratio of gingival inflammation. Gingival inflammation was 69.7% in the group of 5 - 9 year-old, and 83.7% in the group of 10 - 14 year-old with type 1 diabetes mellitus. Though there was a greater loss of teeth in the group with type 1 diabetes mellitus, there were more caries in the control group. The PI, GI and CI values showed an increase with aging in favor of the group with type 1 diabetes mellitus. There was statistically significant difference in PI, GI and CI between the control and type 1 diabetes mellitus groups for 10 - 14 year-old patients (p < 0.001).
The findings we obtained showed that type 1 diabetes mellitus plays an important part in the dentition and oral health of children and adolescents.
PMCID: PMC2615350  PMID: 18581583
Type 1 diabetes mellitus; dentition; oral health
8.  Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study 
To evaluate and compare the oral health status and the impact of supervised toothbrushing and oral health education among school children of urban and rural areas of Maharashtra, India.
Materials and Methods:
A total of 200 school children in the age group 12-15 years were selected by stratified random sampling technique from two schools and were further divided into two groups: Group A (urban school) and Group B (rural school). Both the groups were again subdivided into control group and study group. Supervised toothbrushing was recommended for both the groups. The toothbrushing teaching program included session on oral health education, individual toothbrushing instructions, and supervised toothbrushing. Dental caries increment, plaque scores, and gingival status were assessed as per the World Health Organization (WHO) criteria (1997), Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index, and Loe-Silness Gingival Index (1963), respectively. Cronbach's alpha, Chi-square test, paired t-test, and unpaired t-test were utilized for data analysis.
The mean plaque and gingival score reduction was significantly higher in the study groups as compared to the control groups. An increase in the mean of Decayed, missing, filled teeth (DMFT) and Decayed, missing, filled teeth and surfaces (DMFS) scores throughout the study period was seen in children who participated in study.
Oral health education was effective in establishing good oral health habits among school children and also in enhancing the knowledge of their parents about good oral health.
PMCID: PMC4209617  PMID: 25374836
Dental caries; dental health education; oral hygiene status; school children; toothbrushing
9.  Is periodontal health a predictor of drug-induced gingival overgrowth? A cross-sectional study 
Dental Research Journal  2014;11(5):579-584.
Gingival overgrowth is a common side-effect of amlodipine regimen on the oral cavity. There is controversy regarding the cause and effect relationship of periodontal health and drug induced gingival overgrowth. Therefore, this study was conducted to investigate and to assess the relationship between the periodontal health and the onset and severity of gingival overgrowth in hypertensive patients receiving amlodipine.
Materials and Methods:
A total of 99 known hypertensive patients on amlodipine regimen were included in this study. Probing pocket depth (PPD) and clinical attachment loss (CAL) were noted on four sites of maxillary and mandibular anterior teeth. Gingival enlargement scores were assessed for each patient by employing the hyperplastic index. Oral hygiene status was evaluated using the calculus index (CI). Patients were divided into H, E and L groups based on their periodontal status and responders and non-responders based on their hyperplastic index scores. Differences in means of different periodontal variables in different groups were tested for significance by using ANOVA and unpaired Student t-test. Pearson's correlation coefficient was calculated to assess the correlation between different variables. For all analyses, P < 0.05 was considered to be significant.
All the periodontal parameters were statistically highly significant (P = 0.00) amongst H, E and L groups and between responders and non-responders. Statistically highly significant Pearson correlation coefficients were found between mean PPD and mean hyperplastic score, mean CAL and mean hyperplastic score and mean calculus and mean hyperplastic score.
The results of this study indicated a definite association between periodontal health and development and severity of amlodipine-induced gingival overgrowth
PMCID: PMC4241612  PMID: 25426150
Amlodipine; drug-induced gingival overgrowth; oral hygiene; periodontal disease
10.  Comparative evaluation of oral hygiene practices and oral health status in autistic and normal individuals 
The present study attempts to explore the oral hygiene practices and oral health status in autistic patients as compared to nonaffected, same aged healthy individuals.
Materials and Methods:
The oral hygiene practices, prevalence of caries and periodontal status were evaluated in 117 autistic patients and 126 healthy individuals. The test and control groups were divided into three categories, based on the type of dentition as Primary dentition (Category 1), Mixed dentition (Category 2) and Permanent dentition (Category 3). Plaque and gingival status was recorded by plaque index (Loe, 1967) and gingival index (Loe, 1967), periodontal status by community periodontal index of treatment needs and dental caries by DMFT/DEF index. Statistical analysis was done using descriptive statistics, independent sample t-test, contingency coefficient test and one-way ANOVA test by SPSS 14 software.
There was no statistically significant difference in the brushing habits between autistics and controls (P = 0.573); however, Autistics required assistance in brushing. Prevalence of caries was significantly lower in autistic patients (P = 0.000). Plaque and gingival scores were significantly higher in autistic patients (P = 0.000) and prevalence of periodontal disease was significantly higher in autistic patients (P = 0.000). Greater number of autistic patients required professional scaling and root planing (P = 0.000).
The present study suggests that autistic patients have a higher rate of periodontal disease and lower caries compared to controls. Attempts should be made by parents, general dentists and periodontists to teach oral hygiene methods to these patients by constant repetition and patience, as autistic individuals can develop skills over a period of time and lead a more productive and independent life.
PMCID: PMC3894080  PMID: 24478969
Autism; dental caries; oral hygiene; periodontal status
11.  The Effect of Non-surgical Periodontal Therapy on Hemoglobin A1c Levels in Persons with Type 2 Diabetes and Chronic Periodontitis: A Randomized Clinical Trial 
Chronic periodontitis, a destructive inflammatory disorder of the supporting structures of the teeth, is prevalent in patients with diabetes. Limited evidence suggests that periodontal therapy may improve glycemic control.
To determine if non-surgical periodontal treatment reduces hemoglobin A1c (HbA1c) in persons with type 2 diabetes (DM) and moderate to advanced chronic periodontitis.
Design, Setting and Participants
The Diabetes and Periodontal Therapy Trial (DPTT) is a 6-month, single-masked, randomized, multi-center clinical trial. Participants had DM, were taking stable doses of medications, had HbA1c ≥7% and <9%, and untreated periodontitis. Five hundred fourteen participants were enrolled between November 2009 and March 2012 from diabetes and dental clinics and communities affiliated with five academic medical centers.
The treatment group (n=257) received scaling and root planing plus chlorhexidine oral rinse at baseline, and supportive periodontal therapy at three and six months. The control group (n=257) received no treatment for six months.
Main Outcome Measure
Difference in HbA1c change from baseline between groups at six months. Secondary outcomes included changes in probing pocket depths, clinical attachment loss, bleeding on probing, gingival index, fasting glucose, and the Homeostasis Model Assessment (HOMA2).
Enrollment was stopped early due to futility. At 6 months, the periodontal therapy group increased HbA1c 0.17% (1.0) (mean (SD)) compared to 0.11% (1.0) in the control group, with no significant difference between groups based on a linear regression model adjusting for clinical site (mean difference = -0.05%; 95% Confidence Interval (CI): -0.23%, 0.12%; p=0.55). Probing depth, clinical attachment loss, bleeding on probing and gingival index measures improved in the treatment group compared to the control group at six months with adjusted between-group differences of 0.33mm (95% CI: 0.26, 0.39), 0.31mm (95% CI: 0.23, 0.39), 16.5% (95% CI: 12.9, 20.0) and 0.28 (95% CI: 0.21, 0.35), respectively; all p values <0.0001).
Conclusions and Relevance
Non-surgical periodontal therapy did not improve glycemic control in patients with DM and moderate to advanced chronic periodontitis. These findings do not support the use of nonsurgical periodontal treatment in patients with diabetes for the purpose of lowering HbA1c.
PMCID: PMC4089989  PMID: 24346989
Diabetes; Diabetes Mellitus; Type 2; Periodontal Disease; Periodontitis; Glycated Hemoglobin; HbA1c
12.  C - Reactive Protein Levels in Patients with Periodontal Disease and Normal Subjects 
Although periodontitis is a chronic inflammatory disease but some factors of acute inflammation phase are involved in this disease among which is the C-Reactive protein (CRP). To minimize its effects, anti-inflammatory drugs or non-pharmacological approaches such as oral hygiene is recommended. CRP can also be used for the prediction and early detection of periodontal disease. The aim of the present study was the comparison of the amount of salivary C-Reactive protein (CRP) in healthy subjects and patients with periodontal disease. This case-control study was done on 90 patients referred to the Department of Periodontology of Babol Dentistry School. These subjects were divided into three groups of healthy (n = 30), gingivitis (n = 30), and chronic periodontitis (n = 30), based on Gingival Index (GI) and Clinical Attachment Loss (CAL) indices. 2ml saliva samples were collected from these people and clinical indicators including GI, CAL, Periodontal Pocket Depth (PPD), and Bleeding Index (BI) were assessed. ELISA method was used to evaluate the salivary CRP levels. Collected data were analyzed using SPSS statistical software by non-Parametric Kruskal-Wallis and Mann-Whitney test and Spearman correlation coefficient and P<0.05 was considered significant. The mean salivary CRP levels were 5332.62±5051.63pg/ml in periodontitis patients, 3545.41±3061.38pg/ml in gingivitis group and 3108.51±3574.47pg/ml in healthy subjects. The statistic analysis showed a significant difference in salivary CRP concentrations between the periodontitis patients and healthy subjects (P=0.045). The results indicate that there is a significant association between periodontitis and salivary CRP concentrations.
PMCID: PMC3920533  PMID: 24551806
CRP; periodontitis; gingivitis; saliva
13.  Dental and Periodontal Health Status of Beta Thalassemia Major and Sickle Cell Anemic Patients: A Comparative Study 
Background: This study aimed to assess the dental and periodontal health status of beta thalassemia major and sickle cell anemic patients in Bilaspur, Chattishgarh, India.
Materials & Methods: A total of 750 patients were included in the study. The patients were randomly divided into three groups I (n=250), II (n=250) and III (n=250), ranging from 3-15 years. After performing a thourough general examination, including their demographic data, intraoral examination was done using Decayed-Missing-Filled Teeth Index (DMFT Index), Plaque index (PI) and Gingival index (GI). Statistical analysis was done using statistical software SPSS 17.5 version. Chi square test & student t test was used for the comparison of study and control groups. The level of significance was set at P<0.05.
Results: In the present study, it was found that, prevalence of dental caries and periodontal diseases was significantly more in beta thalassemic patients followed by sickle cell anemic patients than control group. However, when group I (beta thalassemia) was compared with group II (sickle cell anemia), results were found to highly significant (P<0.001) only for decayed missing filled tooth.
Conclusion: Appropriate dental and periodontal care improves a patient's quality of life. Preventive dental care is must for thalassemic and Sickle cell disease patients.
How to cite this article: Singh J, Singh N, Kumar A, Kedia NB, Agarwal A. Dental and Periodontal Health Status of Beta Thalassemia Major and Sickle Cell Anemic Patients: A Comparative Study. J Int Oral Health 2013; 5(5):53-8.
PMCID: PMC3845285  PMID: 24324305
beta thalassemia; dental caries; periodontal disease; sickle cell anemia
14.  Dental Caries Prevalence in Human Immunodeficiency Virus Infected Patients Receiving Highly Active Anti-Retroviral Therapy in Kermanshah, Iran 
Cell Journal (Yakhteh)  2014;16(1):73-78.
Introduction of new approaches for the treatment of human immunodefi- ciency virus (HIV) infection such as anti-retroviral medicines has resulted in an in- crease in the life expectancy of HIV patient. Evaluating the dental health status as a part of their general health care is needed in order to improve the quality of life in these patients. The aim of this study was to compare the root and crown caries rate in HIV patients receiving highly active antiretroviral therapy (HAART) with that rate in HIV patients without treatment option.
Materials and Methods
This cross sectional study consisting of 100 individuals of both genders with human immunodeficiency virus were divided into two groups: i. group 1 (treat- ment group) including 50 patients with acquired immunodeficiency syndrome (AIDS) receiving HAART and ii. group 2 (control group) including 50 HIV infected patients not receiving HAART. Dental examinations were done by a dentist under suitable light using periodontal probe. For each participant, numbers of decay (D), missed (M), filled (F), Decayed missed and filled teeth (DMFT), decay surface (Ds), missed surface (Ms), filled surface (Fs), Decayed missed and filled surfaces (DMFS), and tooth and root caries were recorded. Data were analyzed using Chi-square test and independent t test using SPSS 13.0, while p-value of <0.05 was considered statistically significant in all analysis.
The mean and standard deviation (SD) of decayed, missed and filled teeth of those who were on highly active antiretroviral therapy was 6.86 ± 3.57, 6.39 ± 6.06 and 1.89 ± 1.93, respectively. There was no significant difference between these values regarding to the treat- ment of patients. The mean and standard deviation of DMFT, DMFS and the number of de- cayed root surfaces were 15.14 ± 6.09, 56.79 ± 28.56, and 4.96 ± 2.89 in patients treated by anti-retroviral medicine which were not significantly different compared to those without this treatment.
According to the results of the present study, highly active antiretroviral ther- apy could not be considered as a single factor for dental caries prevalence in HIV-infected patients. However, more research is recommended to evaluate the cariogenic potential of these medicines.
PMCID: PMC3933441  PMID: 24518976
Dental Caries; HIV Infection; Anti-Retroviral Agents; Root Caries; Iran
15.  IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care 
BMC Oral Health  2013;13:58.
Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care.
This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI.
Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases.
The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits.
IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making.
Trial registration
Protocol ID: ISRCTN56465715
PMCID: PMC4015981  PMID: 24160246
Oral hygiene advice; Scale and polish; Prevention; Toothbrushing advice; Periodontal instrumentation; RCT; Primary care
16.  Gingival crevicular fluid MMP-8-concentrations in patients after acute myocardial infarction 
The aim of this study was to determine the presence of matrix metalloproteinase-8 in the gingival crevicular fluid (GCF) of patients after acute myocardial infarction (AMI).
A total of 48 GCF samples from 20 AMI patients, hospitalized at the Department of Cardiology and Angiology of the Johannes Gutenberg University Mainz, were investigated. Besides the myocardial infarction all patients suffered from chronic periodontal disease. Fifty-one GCF samples from 20 healthy age matched individuals with similar periodontal conditions served as controls. The dental examination included the assessment of oral hygiene, gingival inflammation, probing pocket depth, clinical attachment level and X-ray examination. The study was only carried out after the positive consent of the regional ethic commission. A quantitative assessment of aMMP-8 levels in the gingival crevicular fluid was performed with the help of the DentoAnalyzer (Dentognostics GmbH, Jena, Germany), utilising an immunological procedure.
The aMMP-8 concentrations found in the gingival crevicular fluid of the AMI patients significantly differed (p = 0.001; mean value 30.33 ± 41.99 ng/ml aMMP-8) from the control group (mean value 10.0 ± 10.7 ng/ml aMMP-8). These findings suggest that periodontal inflammation in AMI patients might be associated with higher MMP-8-values compared to the healthy controls.
The acute myocardial infarction seems to influence the degree of periodontal inflammation, thus the measurement of the gingival crevicular fluid MMP8 levels seems to be a helpful biochemical test to obtain information about the severity of the periodontal disease.
PMCID: PMC3022744  PMID: 21219642
17.  Oral health in a group of patients with Rett syndrome in the regions of Valencia and Murcia (Spain): A case-control study 
Objectives: Rett syndrome (RS) is a rare disease with oral manifestations that have not been described in detail or in a standardized manner in the literature. The present study describes the oral health of the population with RS in two Spanish regions, following the protocol of the World Health Organization for conducting common oral health surveys. Study Design: A prospective, observational case-control study was carried out, involving a group of patients with RS (n1=41) and a mean age of 13.37±3.19 years, and an age- and gender-matched control group without RS (n0=82). The data referred to oral health and habits were recorded by means of a questionnaire and oral examination was used to document caries indicators (prevalence of caries, df(t), df(s), DMF(T), DMF(S) and indices referred to dental loss, morbidity, restoration), the Community Periodontal Index (CPI), and the most characteristic oral manifestations. Results: The most frequent oral habit in the patients with RS was diurnal bruxism, followed by stereotyped tongue movements and oral breathing. The caries scores were lower in the RS population than in the control group, but patients with RS showed greater periodontal alterations and a greater prevalence of drooling, dental wear, high-arched palate and anterior open bite. Conclusions: The population with RS exhibits characteristic and early oral habits and alterations, and periodontal problems that are more notorious than caries disease, so that our efforts should focus on the diagnosis and early correction of the parafunctional habits, promoting restorative treatment, and providing instructions on correct oral hygiene.
Key words:Rett syndrome, oral habits, bruxism, caries.
PMCID: PMC4259377  PMID: 25350594
18.  Evaluation of Calendula officinalis as an anti-plaque and anti-gingivitis agent 
Calendula officinalis (C. officinalis), commonly known as pot marigold, is a medicinal herb with excellent antimicrobial, wound healing, and anti-inflammatory activity.
To evaluate the efficacy of C. officinalis in reducing dental plaque and gingival inflammation.
Materials and Methods:
Two hundred and forty patients within the age group of 20-40 years were enrolled in this study with their informed consent. Patients having gingivitis (probing depth (PD) ≤3 mm), with a complaint of bleeding gums were included in this study. Patients with periodontitis PD ≥ 4 mm, desquamative gingivitis, acute necrotizing ulcerative gingivitis (ANUG), smokers under antibiotic coverage, and any other history of systemic diseases or conditions, including pregnancy, were excluded from the study. The subjects were randomly assigned into two groups – test group (n = 120) and control group (n = 120). All the test group patients were advised to dilute 2 ml of tincture of calendula with 6 ml of distilled water and rinse their mouths once in the morning and once in the evening for six months. Similarly, the control group patients were advised to use 8 ml distilled water (placebo) as control mouthwash and rinse mouth twice daily for six months. Clinical parameters like the plaque index (PI), gingival index (GI), sulcus bleeding index (SBI), and oral hygiene index-simplified (OHI-S) were recorded at baseline (first visit), third month (second visit), and sixth month (third visit) by the same operator, to rule out variable results. During the second visit, after recording the clinical parameters, each patient was subjected to undergo a thorough scaling procedure. Patients were instructed to carry out regular routine oral hygiene maintenance without any reinforcement in it.
In the absence of scaling (that is, between the first and second visit), the test group showed a statistically significant reduction in the scores of PI, GI, SBI (except OHI-S) (P < 0.05), whereas, the control group showed no reduction in scores when the baseline scores were compared with the third month scores. Also, when scaling was performed during the third month (second visit), there was statistically significant reduction in the scores of all parameters, when the third month scores were compared with the sixth month scores in both groups (P < 0.05), but the test group showed a significantly greater reduction in the PI, GI, SBI, and OHI-S scores compared to those of the control group.
Within the limits of this study, it can be concluded that calendula mouthwash is effective in reducing dental plaque and gingivitis adjunctive to scaling.
PMCID: PMC3917203  PMID: 24554883
Anti-gingivitis; anti-inflammatory; anti-plaque; Calendula officinalis
19.  Association of dental and periodontal status with bisphosphonate-related osteonecrosis of the jaws. A retrospective case controlled study 
Archives of Medical Science : AMS  2014;10(1):117-123.
To assess the association of oral hygiene, dental caries, and periodontal status with bisphosphonate-related osteonecrosis of the jaws.
Material and methods
A retrospective case-control study on 81 patients treated for neoplasms with bone metastases. Twenty-nine patients with bone necrosis and 52 controls treated with bisphosphonates were compared using the Oral Hygiene Index, Decay, Missing, Filled Teeth, Community Periodontal Index of Treatment Needs, and Residual Periodontal Bone. The null hypothesis stated that there was no difference in parameters of oral health between patients with and without bone necrosis. Differences of means of above-mentioned variables were compared between the groups with Student's t-test or Mann-Whitney rank sum test and χ2 test. Value of p ≤ 0.05 was considered significant.
Poorer oral hygiene (OHIs 1.94 vs. 1.32; p = 0.065), more advanced dental caries (DMFT 26.85 vs. 22.87; p = 0.05), and more advanced periodontal disease (CPITN: = 0: 21.05% vs. 42.51%; = 1 13.16% vs. 7.29%; = 2: 0% vs. 15.38%; = 3: 65.79% vs. 28.34%; = 4: 0% vs. 6.48%, Residual periodontal bone 73.1% vs. 80.51%; p = 0,001) were characteristic of patients with bisphosphonate related jaw necrosis when compared with control group. An advanced dental caries or periodontal disease required surgical intervention which directly contributed to the development of the bone necrosis.
Dental and periodontal disease can lead to bisphosphonate-related osteonecrosis of the jaw. Oncologic patients treated with bisphosphonates should be offered preventive care to reduce dental plaque, calculus, dental caries, and periodontal disease.
PMCID: PMC3953981  PMID: 24701224
necrosis; jaw; dental status; periodontal status; oral health
20.  Poor periodontal health as a risk factor for development of pre-eclampsia in pregnant women 
Periodontal disease has been considered a systemic exposure implicated in a higher risk of adverse pregnancy outcomes. The aim of the present study was to determine whether maternal oral health is associated with an increased risk of pre-eclampsia.
Subjects and Methods:
A case-control study was conducted which included 40 pregnant women patients admitted to the Department of Obstetrics and Gynecology, J.N. Medical College, A.M.U, Aligarh. Pre-eclampsia was defined as classic triad of hypertension, proteinuria and symptoms such as swelling/edema esp. in hands and face, headache, visual changes etc., A periodontal examination was done during 48 h after child delivery. Maternal oral status was evaluated using gingival index by Loe and Silness, oral hygiene index (simplified) by greene and vermillion and periodontal pockets and clinical attachment level (CAL).
Statistical Analysis:
Null hypothesis that no difference exist between the two groups (pre-eclamptic and non-pre-eclamptic Group) was calculated using paired t-test, Chi-square and Mann-Whitney U statistical tests using SPSS 11.5 (Statistical Package for Social sciences, Chicago). P < 0.05 was considered to be statistically significant.
The amount of gingival inflammation, oral hygiene levels, pocket depth and CALs as measured by their respective indices were higher in the pre-eclamptic group when compared to non-pre-eclamptic group. Furthermore CAL was significantly increased in the test group. This study showed that pre-eclamptic cases were more likely to develop periodontal disease (P < 0.05). 30% of the test group and 65% of the case group had periodontal disease (P < 0.05) which had shown that pre-eclamptic cases were 4.33 times more likely to have periodontal disease (odds ratio = 4.33).
Maternal oral status was determined to be associated with an increased risk of pre-eclampsia.
PMCID: PMC4095624  PMID: 25024545
Case-control study; periodontal disease; pre-eclampsia; pregnancy; risk factor
21.  Association between Periodontopathogens and CRP Levels in Patients with Periodontitis in Serbia 
Background and aims
Recent epidemiological studies have shown that individuals with periodontitis have a significantly higher risk of developing coronary heart disease, which might be attributed to the complex microbiota in the dental plaque. Periodontopathogens have been reported as risk factors for cardiovascular disease. This study evaluated association of chronic periodontitis and periodontopathogens with CRP in systemically healthy Serbian adults.
Materials and methods
Serum C-reactive protein levels were measured in 24 patients with moderate periodontitis, 26 patients with severe periodontitis, and 25 periodontally healthy subjects. Periodontal health indicators included gingival bleeding on probing and periodontal disease status. Patients with moderate periodontitis had low attachment loss and pocket depths of <4 mm. Patients with severe periodontitis had high AL and pocket depth of >5 mm. The control group with healthy gingiva had gingival sulcus of <2 mm and no attachment loss. Presence of periodontopathogens in subgingival plaque samples was analyzed by polymerase chain reaction.
The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had both severe and moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated CRP leves of >5 mol/L was greater in the higher clinical AL group compared to the group with less attachment loss. Presence of periodontopathogens was also associated with elevated CRP levels and poor periodontal status.
PD and subgingival periodontopathogens are associated with increased CRP levels. These findings suggest that periodontal infection may contribute to systemic inflammatory burden in otherwise healthy individuals.
PMCID: PMC3429984  PMID: 23019501
A. actinomycetemcomitans; C-reactive protein; P. gingivalis; periodontitis
22.  Periodontal status of HIV-infected patients undergoing antiretroviral therapy compared to HIV-therapy naive patients: a case control study 
Although severe oral opportunistic infections decreased with the implementation of highly active antiretroviral therapy, periodontitis is still a commonly described problem in patients infected with human immunodeficiency virus (HIV). The objective of the present investigation was to determine possible differences in periodontal parameters between antiretroviral treated and untreated patients.
The study population comprised 80 patients infected with HIV divided into two groups. The first group was receiving antiretroviral therapy while the second group was therapy naive. The following parameters were examined: probing pocket depth, gingival recession, clinical attachment level, papilla bleeding score, periodontal screening index and the index for decayed, missed and filled teeth. A questionnaire concerning oral hygiene, dental care and smoking habits was filled out by the patients.
There were no significant differences regarding the periodontal parameters between the groups except in the clinical marker for inflammation, the papilla bleeding score, which was twice as high (P < 0.0001) in the antiretroviral untreated group (0.58 ± 0.40 versus 1.02 ± 0.59). The participants of this investigation generally showed a prevalence of periodontitis comparable to that in healthy subjects. The results of the questionnaire were comparable between the two groups.
There is no indication for advanced periodontal damage in HIV-infected versus non-infected patients in comparable age groups. Due to their immunodeficiency, HIV-infected patients should be monitored closely to prevent irreversible periodontal damage. Periodontal monitoring and early therapy is recommended independent of an indication for highly active antiretroviral therapy.
PMCID: PMC3337541  PMID: 22472296
HIV; HAART; PBS; periodontitis; PSI
23.  Nothing to smile about 
Several studies have demonstrated the high incidence of periodontal disorders among patients suffering from mental illnesses, probably because of self-care impairment, the difficult financial conditions, and the lack of motivation. The primary aim of this study was to evaluate the impact of depression and alexithymia on periodontal status. Due to the influence of personality traits on behavior in general, the secondary aim of our study was to investigate the possible impact of personality disorders on dental status.
Patients with major depression (DP) referred to our psychiatry unit and healthy individuals (controls) were consecutively enrolled during the period April 2012–September 2012. All the participants to the study underwent a psychiatric evaluation (through questionnaires investigating the presence of depression, anxiety, personality disorders, and alexithymia) and a dental examination through the following indexes: plaque index, gingival index, simplified oral hygiene index, periodontal index.
Fifty DP (aged 56.7±15.2 years) and 40 controls (aged 56.1±15.9 years) were enrolled in the study. DP showed a worse oral hygiene status. In particular, statistically significant differences were found when comparing DP and controls in terms of plaque index, simplified oral hygiene index, gingival index, periodontal index, and oral health impact profile. In addition, periodontal health was found to be negatively related to the severity of depression and the presence of alexithymia. The strength of association between depression and dental indexes was reduced after adjusting for the other psychiatric variables (alexithymia and personality disorders) and was confirmed only for oral health impact profile.
Psychiatric variables seem to affect the patients’ periodontal status; due to the high frequency of dental problems, patients suffering from mental illnesses should be referred to the oral health services for evaluation.
PMCID: PMC4211900  PMID: 25364254
depression; alexithymia; oral health; dental health; oral health-related quality of life; dental indexes
24.  Plasma 25-hydroxyvitamin D concentrations and periodontal disease in postmenopausal women 
Journal of periodontology  2012;84(9):1243-1256.
Vitamin D has anti-inflammatory and anti-microbial properties that, together with its influence on bone health, may confer periodontal benefit.
We investigated cross-sectional associations (1997–2000) between plasma 25-hydroxyvitamin D concentrations [25(OH)D] and periodontal measure among 920 postmenopausal women. Chronic measures of disease were defined based on: 1) alveolar crestal height (ACH) measures from intraoral radiographs and tooth loss, and the 2) Center for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) criteria using measures of clinical attachment level (CAL) and probing pocket depth (PD). Acute oral inflammation was assessed by the % of gingival sites that bled upon assessment with a probe. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) for periodontal disease among participants with adequate ([25(OH)D]≥50 nmol/L) compared to deficient/inadequate ([25(OH)D]<50 nmol/L) vitamin D status adjusted for age, dental visit frequency, and body mass index.
No association was observed between vitamin D status and periodontal disease defined by ACH and tooth loss (adjusted OR=0.96, 95% CI: 0.68–1.35). In contrast, women with adequate compared to deficient/inadequate vitamin D status had a 33% lower odds (95% CI: 5%–53%) of periodontal disease defined using the CDC/AAP definition and a 42% lower odds (95% CI: 21%-58%) of having ≥50% of gingival sites that bled.
Vitamin D status was inversely associated with gingival bleeding, an acute measure of oral health and inflammation and inversely associated with clinical categories of chronic periodontal disease that incorporated PD, an indicator of oral inflammation. However, vitamin D was not associated with chronic periodontal disease based on measures of ACH in combination with tooth loss.
PMCID: PMC3745794  PMID: 23259413
vitamin D; 25-hydroxyvitamin D; periodontal diseases; postmenopausal period; epidemiology; women
25.  Periodontal status among patients with diabetes in Nuuk, Greenland 
International Journal of Circumpolar Health  2014;73:10.3402/ijch.v73.26093.
Diabetes is becoming more common in the Greenlandic population. Patients with diabetes are more prone to periodontal disease. Periodontal status may have an effect on metabolic control.
The aim of this study was to estimate the prevalence of periodontitis amongst patients with diabetes in Nuuk, Greenland, and secondly, to observe if dental care was associated with improved periodontal status and metabolic control.
Study design
Observational cross-sectional study and a pilot study of a dental care intervention.
Sixty-two Greenlandic patients with diabetes were included in the study. Data were collected from the Electronic Medical Records (EMR), in addition to a telephone interview. Patients were offered 3 dental examinations with a 3-month interval. The dental examinations consisted of a full-mouth assessment of number of remaining teeth and assessment of periodontal status. Patients received scaling and root planing, together with information and instructions on oral hygiene. Information on glycated haemoglobin (HbA1C) values was collected from the EMR at each dental examination.
In this study, 21.0% (13/62) of patients with diabetes had periodontitis. About 42% had less than 20 teeth. The association between diabetes and periodontitis was known by 20 out of the 62 patients. Over half of the patients had been to a dental examination within the last year. The prevalence of periodontitis decreased significantly from 21.0 to 0% (p<0.001) after 3 dental examinations. No change in HbA1C levels was observed (p=0.440).
Periodontitis was common among patients with diabetes in Nuuk. Dental health status based on Periodontal Screening Index (PSI) and bleeding on probing (BOP) seemed to improve after dental health care, indicating a need for increased awareness among patients and health care professionals. HbA1C levels were not improved among the patients.
PMCID: PMC4265130  PMID: 25498562
diabetes; periodontitis; Greenland; Inuit

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