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Pradeep A.R.,Government Dental College and Research Institute | Kathariya R.,Government Dental College and Research Institute
Archives of Oral Biology | Year: 2011

Objective: Along with conventional non-surgical periodontal therapy (NSPT) systemic antimicrobials may provide more effective treatment for chronic periodontitis by targeting tissue-invasive bacteria. The aim of this randomized, placebo-controlled, double-masked clinical trial was to evaluate the adjunctive effects of oral clarithromycin (CLM) to non-surgical periodontal therapy for chronic periodontitis. Methods: 40 patients were categorized into two groups: test group - scaling and root planing (SRP) plus CLM (500 mg b.i.d. for 3 days) and control group - SRP plus placebo. Clinical parameters were recorded at baseline and at 1, 3, 6, and 9 months. They included gingival index (GI), probing depth (PD), and clinical attachment level (CAL). Also microbial analysis of dental plaque was done at baseline, 3 and 9 months to estimate the levels of periodontopathic organisms using polymerase chain reaction. ANOVA, Chi-square and Bonferroni tests were used for statistical analysis. Results: Thirty-seven subjects completed the study and the results demonstrated that both groups displayed clinical improvements. Using a subject-based analysis, patients treated with SRP + CLM showed enhanced reductions in PD and gains in CAL (p < 0.001) over time, as compared to control group. Also significant reductions in periodontopathic organisms were noticed in the test group compared to control group. However, no statistically significant differences were noted for Tannerella forsythia levels between the groups during the course of the study. Conclusions: The utilisation of CLM in combination with SRP improves the efficacy of NSPT in reducing PD, improving CAL and in lessening microbial loads. Hence, CLM may be beneficial in the non-surgical treatment regimen of chronic periodontitis. © 2011 Elsevier Ltd.


Pradeep A.R.,Government Dental College and Research Institute
Journal of investigative and clinical dentistry | Year: 2013

The purpose of this study is to evaluate the stem cell factor (SCF) and high sensitive C reactive protein (hs-CRP) concentration in gingival crevicular fluid (GCF) and serum of chronic periodontitis subjects with type 2 diabetes, and to evaluate the effect of nonsurgical periodontal therapy on their GCF and serum concentrations. A total of (age and gender matched) 22 subjects were evaluated. Pre- and post-treatment levels of SCF and hs-CRP in GCF and serum were measured and compared using enzyme linked immunosorbant assay. Clinical parameters including probing depth and clinical attachment level were also measured. Paired t-test was used to compare the before- and after-treatment levels of the two molecules. A highly significant difference (P < 0.001) was found in the GCF and serum concentrations of SCF and hs-CRP before and after treatment. Our observations indicated that short-term nonsurgical therapy resulted in a significant improvement in periodontal indices and in a marked decrease of SCF and hs-CRP serum and GCF levels. © 2012 Wiley Publishing Asia Pty Ltd.


The aim of the present study was to clarify whether there is any correlation between the levels of high-sensitivity C reactive protein (hs-CRP) and stem cell factor (SCF) in serum and gingival crevicular fluid (GCF) of patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (DM). A total of 40 subjects were divided into 3 groups: 10 periodontally healthy subjects (Group 1), 15 CP patients (Group 2), and 15 type 2 DM patients with CP (Group 3). Levels of hs-CRP and SCF in GCF and serum were quantified using different techniques. The clinical outcomes evaluated were gingival index (GI), probing depth (PD) and clinical attachment level (CAL), and the correlations of the two inflammatory mediators with clinical parameters were evaluated. The levels of these inflammatory mediators increased continuously from group 1 to group 2, and to group 3. The serum levels of both hs-CRP and SCF were correlated with PD in patients with CP (P < 0.05). SCF levels were correlated with PD in Group 3 (P < 0.05). The fact that the levels of hs-CRP and SCF were highest in DM patients with CP suggests that the presence of a systemic condition has a profound effect on the levels of inflammatory mediators, both locally at sites of periodontal disease, and elsewhere.


Pradeep A.R.,Government Dental College and Research Institute
Journal of the International Academy of Periodontology | Year: 2012

Effective plaque control is essential for prevention of gingivitis and periodontitis. The aim of this 24-week follow-up parallel study was to evaluate the efficacy of three topical gels in the treatment of gingivitis as compared to placebo gel. One hundred twenty subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into four groups: Group 1--placebo gel, Group 2--chlorhexidine (CHX) gel, Group 3--metronidazole (MTZ) gel and Group 4--chlorhexidine-metronidazole (CHX-MTZ) gel. Clinical evaluation was undertaken using the gingival index (GI) of Löe and Silness and the plaque index (PI) at baseline, 6 weeks, 12 weeks and 24 weeks. Microbiological analysis was also done at the same time intervals. A subjective evaluation was also undertaken by questionnaire. Groups treated with all three gels (CHX, MTZ and CHX-MTZ) showed significant clinical and microbiological improvement as compared to the group treated with a placebo gel. The reduction in PI, GI and microbiological count in the group treated with the CHX-MTZ combination gel was significant when compared to those treated with CHX and MTZ gels. Topical application of CHX or MTZ alone or in combination may have a role in the management of gingivitis.


Pradeep A.R.,Government Dental College and Research Institute
Journal of the International Academy of Periodontology | Year: 2012

Antimicrobials are increasingly being used as adjuncts to non-surgical or surgical periodontal therapy. The main purpose of the present analysis was to evaluate the effect of systemic ornidazole (ORN) on total anaerobic microbial counts of subjects with moderate to advanced chronic periodontitis (CP). This was a single-center, double-blinded, placebo-controlled, randomized clinical trial of six months duration. Fifty-eight subjects presenting with at least 12 teeth with probing depth (PD) > or = 4 mm were selected. Thirty subjects received full-mouth scaling and root planing (SRP) + placebo (control group) and 28 subjects received full-mouth SRP + ORN (test group). The total anaerobic counts were analyzed by collecting subgingival plaque from deepest pockets at baseline (B/L), 1 week, 1 month, 3 months and 6 months. Paired and unpaired t-tests were used to determine the inter- and intra-group differences. Fifty subjects were evaluated up to six months. There was a significant difference in the number of anaerobes in the two groups at all the intervals except B/L (p<0.05). The systemic use of ORN very efficiently reduced the microbial load in the group that received antibiotics.


Thorat M.,Government Dental College and Research Institute
International journal of oral science | Year: 2010

The aim of this study was to measure the level of Oncostatin M (OSM) a gp130 cytokine in the gingival crevicular fluid (GCF) and serum of chronic periodontitis patients and to find any correlation between them before and after periodontal therapy (scaling and root planing, SRP). 60 subjects (age 25-50 years) were enrolled into three groups (n=20 per group), group I (healthy), group II (gingivitis) and group III (chronic periodontitis). Group III subjects were followed for 6-8 weeks after the initial periodontal therapy (SRP) as the group IV (after periodontal therapy). Clinical parameters were assessed as gingival index (GI), probing depth (PD), clinical attachment level (CAL), and radiographic evidence of bone loss. GCF and serum levels of OSM were measured by using Enzyme Linked Immunosorbent Assay (ELISA). It was found that mean OSM levels had been elevated in both the GCF and serum of chronic periodontitis subjects (726.65 +/- 283.56 and 65.59 +/- 12.37 pg mL(-1), respectively) and these levels were decreased proportionally after the periodontal therapy (95.50 +/- 38.85 and 39.98 +/- 16.69 pg mL(-1) respectively). However, OSM was detected in GCF of healthy subjects (66.15 +/- 28.10 pg mL(-1)) and gingivitis-suffering subjects (128.33 +/- 22.96 pg mL(-1)) and was found as below the detectable limit (approximately equal 0.0 pg mL(-1)) in the serum of same subjects. Significant correlation has been found between clinical parameters and GCF-serum levels of OSM. Increased OSM level both in the GCF and serum, and the decreased levels after initial periodontal therapy (SRP) may suggest a use as an inflammatory biomarker in the periodontal disease.


Nayyar A.S.,Government Dental College and Research Institute
Acta Medica Iranica | Year: 2012

The role of oxygen free radicals in the initiation, promotion and progression of carcinogenesis and the protective role of anti-oxidant defenses has been the subject of much speculation in the recent past with conflicting reports in the literature. In recent years, increasing experimental and clinical data have provided compelling evidence for the involvement of oxidative stress in a large number of pathological states including cancers. The aim of this study was to measure the concentration of serum total proteins and albumin as potent anti-oxidants in the sera of patients diagnosed with speckled leukoplakia, one of the oral pre-cancerous lesions reported to have significantly high malignant transformation rates and well-differentiated oral squamous cell carcinoma. The study consisted of sera analysis of total protein and albumin levels in patients with speckled leukoplakia and histologically proven, well-differentiated oral squamous cell carcinoma. One way analyses of variance (ANOVA) was used to test the difference between groups. To find out which of the two groups' means were significantly different; post-hoc test of Scheffe was used. The study revealed variations in sera levels of albumin to be statistically significant. The results obtained emphasize the need for more studies with larger sample sizes to be conducted before a conclusive role for sera levels of total protein and albumin could be drawn as markers of transition from the various oral pre-cancerous lesions and conditions to frank oral squamous cell carcinoma. © 2012 Tehran University of Medical Sciences. All rights reserved.


Pradeep A.R.,Government Dental College and Research Institute | Prapulla D.V.,Government Dental College and Research Institute | Sharma A.,Government Dental College and Research Institute | Sujatha P.B.,Government Dental College and Research Institute
Cytokine | Year: 2011

Objectives: The levels of vascular endothelial growth factor (VEGF) in gingival crevicular fluid (GCF) correlate well with clinical parameters of periodontal disease. The present study was designed to assess the relationship between clinical parameters and VEGF levels of the GCF from inflammed gingiva, periodontitis sites and treated periodontitis sites, and to correlate them to the serum VEGF levels. Design: Thirty, gender and age-matched subjects were divided into three groups- health, plaque-induced gingivitis and chronic periodontitis group, based on gingival index score and clinical attachment level. The fourth group consisted of 10 subjects in the periodontitis group, 6-8. weeks after nonsurgical treatment. Total of eighty samples (forty GCF and forty serum samples) were collected and quantified for VEGF using enzyme immunoassay. Results: The highest mean GCF and serum VEGF concentrations were observed in the periodontitis group and lowest in the healthy group. Periodontitis group showed significant reduction in VEGF levels in both GCF and serum samples after treatment. Conclusions: GCF and serum VEGF levels increased progressively with the disease severity and decreased after treatment of periodontal disease. Moreover GCF and serum VEGF levels correlated positively with clinical periodontal parameters. The study indicates the key role of VEGF in periodontal disease as a inflammatory biomarker. © 2011 Elsevier Ltd.


Gautam G.,Government Dental College and Research Institute
Orthodontics : the art and practice of dentofacial enhancement | Year: 2011

A 16-year-old boy presented with a fused permanent maxillary left central incisor with a supplemental tooth and an additional supplemental tooth lingual to the permanent maxillary right central incisor. Following leveling, alignment, and endodontic therapy, the maxillary fused left central incisor was sectioned and the mesial portion extracted as planned. Fixed orthodontic treatment commenced after 10 days to align the maxillary anterior segment. After completion, the midline diastema was closed with veneers. This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.


Thorat M.S.,Government Dental College and Research Institute
Journal of oral science | Year: 2010

Increasing evidence indicates that systemic conditions are risk factors of periodontitis. Pemphigus is a group of bullous diseases affecting the oral cavity. The aim of this study was to assess the periodontal status of pemphigus vulgaris (PV) patients. The periodontal status of 50 PV patients and 50 healthy subjects was assessed by a single examiner. PV patients were assessed based on the Clinical Severity Score (CSS). Periodontal clinical parameters such as plaque score, full mouth gingival bleeding score, probing depth (PD), clinical attachment level (CAL) and radiological bone loss were recorded. Effects of age, gender, daily tooth brushing habit, oral lesions and treatment duration on the periodontal status of PV patients were also determined. A statistically significant difference was found between the PV group and the healthy group with respect to the plaque score, PD and CAL (P < 0.05). Logistic regression analysis confirmed that age, gender, and treatment did not significantly influence clinical severity of the disease (P > 0.05). Increased PD and CAL were found with an increase in the CSS. The poor periodontal status in PV patients suggests that PV may be involved in the initiation or progression of periodontitis.

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