A patient presented with a recurrent gingival swelling in the upper left anterior region which was localized, erythematous, and involved the interdental papilla. The patient had a history of biopsy from the same site 5 to 6 months prior. The lesion was surgically excised and subjected to histopathological evaluation. The case highlights the importance of histopathology in diagnosing rare gingival lesions with recurrence.
Lymphangiomas are hamartomatous tumors of lymphatic vessels that are benign in nature. This developmental deformity results from sequestration of lymphatic tissue, which is separated from the rest of the lymphatic system. Lymphangiomas most commonly occur in the head and neck region, representing nearly 75% of all cases, with about half of the lesions being present at birth. Lymphangioma of the gingiva presents as asymptomatic gingival growth. Histopathologically, it consists of numerous dilated lymphatics, lined by thin endothelial cells, and the spaces contain proteinaceous fluid, i.e. lymph. Surgical excision is considered the preferred treatment modality. In addition to highlighting the usefulness of immunohistochemical labeling of D2-40, a lymphatic endothelium marker, to distinguish the endothelial lining of lymphatic vessels from that of blood vessels, the authors describe a rare case of gingival lymphangioma in a 74-year-old male patient. Even though lymphangiomas in the oral cavity are uncommon, doctors should take them into consideration in order to start treatment as soon as possible and prevent consequences.
Background:Gingival recession affects approximately 81% of people worldwide and represents one of the most common oral health issues. Increasingly, more people are using digital platforms to find information about their health, with YouTube represented as a popular source for learning about oral health topics. However, studies have not been conducted on the quality or trustworthiness of gingival recession information that is available on YouTube. Objective:To systematically evaluate the content quality, usefulness, and reliability of YouTube™ videos concerning gingival recession and its management using validated assessment tools. Materials and Methods:A cross-sectional analysis was conducted using four search terms: "gingival recession," "gum recession treatment," "receding gums," and "gum graft." Twenty videos that met the inclusion criteria were independently evaluated by two calibrated dental evaluators using the Global Quality Scale (GQS), audiovisual quality assessment, and a customized usefulness index. Videos were classified by source (expert vs. non-expert) and content level (high vs. low). Statistical analysis examined the relationships between quality metrics and video characteristics. Results:Expert-created videos comprised 85% of the sample, significantly higher than previously reported for other dental topics. The mean GQS score was 3.4 ± 0.9, indicating moderate-to-good overall quality. High-content videos accounted for 70% of the sample and expert videos demonstrated significantly superior quality across all metrics (GQS: 3.5 vs. 2.7, P < 0.05; usefulness index: 8.2 vs. 5.3, P < 0.01). Content analysis revealed strong coverage of treatment procedures (80%) but significant gaps in prevention education (35%) and practical considerations (15%). Conclusions:YouTube videos concerning gum recession had better quality in terms of content than did videos pertaining to other dental subjects. Videos found on YouTube were at a high level in terms of professional input and contained a moderate-to-high amount of educational information. There was little or no information provided in YouTube videos related to prevention as well as full patient instruction. Therefore, it appears that while YouTube can be a viable source for providing patients with educational materials, there are some subject matter areas that need greater emphasis by professionals.
The hard palate is one of the frequent sites of local complications after administration of local anesthetics. Hard, recalcitrant palatal tissues associated with forceful or excessive administration of solution, induction of trauma, use of contaminated solutions, or reactivation of latent viruses may represent or exacerbate local complications in the palatal region. Ulceration and necrosis are uncommon, rare complications of local anesthesia. The aim of this case report was to inform dentists about a rare complication after local anesthesia and how to manage it. A rare case of palatal necrotic hematoma in a 35-year-old male patient after periodontal flap surgery is reported. The course of treatment was conservative for 15 days. After a month, the condition heals so no additional care is needed.
Introduction:According to the World Health Organization, periodontitis is the sixth most common disease in humans. Some evidence has pointed out that a relationship exists between periodontal disease and some systemic diseases, such as cardiovascular diseases. Given that cardiovascular events are predicted to be one of the leading causes of death by 2030, we decided to investigate the relationship between the severity of periodontitis and carotid artery calcification (CAC) on panoramic radiographs. Materials and Methods:A total of 132 individuals (66 CAC + and 66 CAC-) were included in this case-control study. Panoramic radiographs of the patients were evaluated. Patients aged 30 years or older, who were dentate, who were suffering from periodontitis, and who did not have any systemic diseases or potential risk factors affecting CAC were included in the study. Clinical and radiographic assessments were used to determine the severity and activity of periodontitis (bleeding on probing, probing depth, clinical attachment loss, tooth loss, and alveolar bone loss). Results:Among CAC + individuals, 20 people had unilateral lesions and 46 had bilateral lesions; comparison of the severity of periodontitis showed no significance between them. The severity of periodontal disease was significantly higher in the CAC + individuals compared to the CAC - individuals (P < 0.05). Furthermore, the body mass index values were considerably higher in CAC - individuals (P = 0.032). There was no significant difference in the distribution of age, sex, smoking, alveolar bone loss, and number of lost teeth between the two groups. Conclusion:The results of the present study showed a significant correlation between the severity of periodontitis and CAC.
Background and Objectives:Nigella sativa, a medicinal plant of the Ranunculaceae family, is widely used for its antimicrobial and anti-inflammatory properties. This study aimed to evaluate the antibacterial activity of N. sativa seed extract against two major periodontal pathogens: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Materials and Methods:In this study, bacterial samples were collected from 30 patients with moderate-to-severe chronic periodontitis. Pure cultures of anaerobic bacteria were used to assess susceptibility to N. sativa extract and to amoxicillin-metronidazole. Antibacterial activity was evaluated using broth microdilution and agar dilution methods. Results:From the previous experiments conducted, it was determined that the extract from the plant has an inhibitory effect at a concentration of mg/mL, but not at concentrations of 4 and 8 mg/mL. Furthermore, from previous experiments, it was determined that the growth inhibition was from 14 mg/mL for A. actinomycetemcomitans and was 52 mg/mL for P. gingivalis. Furthermore, it was determined that at a concentration of 100-210 mg/mL, the growth of both pathogens was inhibited. Assessment of the FIC index for synergistic and antagonistic interactions showed synergism for the combination of N. sativa and metronidazole for the A. actinomycetemcomitans, antagonism for P. gingivalis, and no interaction with amoxicillin. Conclusion:The antibacterial property of N. sativa has positive implications and can probably be used in herbal medicine for periodontal diseases, where it can be used for the formulation of mouthwashes and toothpastes. More studies should be done.
Background:Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that affects the synovial joints and is often associated with multiple comorbidities. Emerging evidence suggests a bidirectional link between RA and periodontal inflammation, wherein shared inflammatory mediators contribute to disease severity and therapeutic outcomes. Objective:The objective of the study was to examine the relationships among demographic and clinical characteristics, comorbidities, periodontal impairment assessed using Russell's Periodontal Index, systemic disease activity measured by Disease Activity Score (DAS28) and C-reactive protein (CRP), and treatment regimens in patients with RA. Materials and Methods:A cross-sectional cohort of 33 patients clinically diagnosed with RA (21 seropositive and 12 seronegative) was analyzed. Demographic, serological, and clinical data were retrieved from medical records and verified during follow-up consultations. Russell's Index was used to quantify periodontal involvement, whereas disease activity was assessed using the DAS28 score, which incorporates CRP levels. Details of comorbidities and prescribed treatments, hydroxychloroquine (HCQ), corticosteroids, or combination therapy, were documented. Descriptive and correlational analyses were performed to evaluate associations between disease activity, oral impairment, and therapeutic approach. Results:The cohort comprised 91% females, with a mean age of 46.5 ± 9.8 years. Seropositive RA was identified in 64% of patients. The mean Russell's Index was 2.42 in the RA+ and 1.92 in the RA- groups, showing greater periodontal impairment in seropositive cases. Hypertension (12%), diabetes (6%), and hypothyroidism (6%) were the most frequent comorbidities. Combination therapy (HCQ + steroids) was most commonly prescribed (36%) and associated with higher DAS28 and Russell's scores. A positive correlation was noted between disease activity and periodontal index values. Conclusion:Both systemic comorbidities and oral inflammatory burden influence RA severity. Integrating periodontal assessment with systemic disease monitoring enables more precise, personalized therapy selection. Russell's Index, in conjunction with DAS28 and CRP, may serve as a useful adjunctive marker for therapeutic stratification in RA.
Background:Dental implants have become a widely accepted solution for the replacement of missing teeth, offering functional and esthetic benefits. The long-term success of dental implants largely depends on the distribution of stresses in the surrounding bone, as excessive stress can lead to bone resorption and implant failure. Finite element analysis (FEA) is a powerful tool that allows for the simulation of mechanical behavior under functional loading, providing insights into stress patterns and implant performance in various anatomical and prosthetic configurations. Aim:The aim of the study was to analyze stress distribution around conventional and basal dental implants placed in the posterior region of the mandible using FEA. Materials and Methods:The finite element model simulated a partially edentulous posterior mandibular segment where the mandibular second premolar and first molar were missing. Two dental implants were placed in the posterior mandible to simulate clinical rehabilitation of this region. Three-dimensional models were developed using cone beam computed tomography scans, and FEA was performed with ANSYS Workbench 18.1. Two models were analyzed: Model 1: conventional implant (4.1 mm × 8 mm) in 10-mm residual bone height and Model 2: basal implant (3.5 mm × 16 mm) in 8-mm residual bone height. Stress distribution was assessed under masticatory loading conditions to evaluate implant stability and stress accumulation in surrounding bone structures. Results:The study was designed as a comparative FEA evaluating stress distribution between conventional and basal implant systems placed in the posterior mandible under identical loading conditions. Model 2 (basal implant) exhibited greater deflection (13 μm), which may compromise implant stability. Model 1 (conventional implant) demonstrated higher stress accumulation in the cortical bone (34.71 MPa). Conclusion:The present FEA demonstrates that although basal implants showed slightly lower crestal bone stress, the increased deformation observed may influence long-term biomechanical stability under functional loading conditions. Hence, Model 1 (conventional implant) is the preferred choice for clinical applications, offering better stability and longevity compared to Model 2.
Background:Specific germs produced periodontitis, a destructive inflammatory disease of the tissues supporting the teeth that destroyed the periodontal ligament and alveolar bone, and the creation of pockets, gingival recession, or both. Adjunctive therapy and mechanical scaling were used to treat periodontitis. Because of its anti-inflammatory, antibacterial, antioxidant, and wound-healing properties, the ethanol extract of snakefruit peel (Salacca zalacca var. pondoh) included phytochemicals that were helpful as an alternate supplementary therapy for periodontitis. Objective:This study aimed to evaluate the effect of snake fruit peel ethanol extract on probing depth and gingival recession in Wistar rats with experimentally induced periodontitis. Materials and Methods:A posttest-only control group design was used in a real experimental laboratory investigation. Twenty-four Wistar rats were used as research subjects and divided into six groups. On days 1, 7, and 14, the treatment group received the ethanol extract of snake fruit peel, while the positive control group received chlorhexidine gluconate. The One-way Analysis of Variance (ANOVA) and Post hoc least significant difference tests were used for data analysis. Results:One-way ANOVA showed significant differences in probing depth and gingival recession among the groups (P < 0.05). The treatment groups showed lower probing depth and gingival recession scores than the positive control groups across all observation periods. Conclusion:Snake fruit peel ethanol extract was associated with lower probing depth and gingival recession scores in Wistar rats with experimentally induced periodontitis. Further studies are required to confirm its biological mechanisms and therapeutic potential as an adjunctive periodontal therapy.
Background:Dental caries and periodontitis are among the most prevalent oral diseases globally, ranking first and sixth, respectively, in terms of prevalence. Despite sharing common risk factors such as genetic predisposition, lifestyle habits, and socioeconomic influences, these diseases are often considered independent due to differences in microbial etiology. However, research on their potential correlation has yielded conflicting results, warranting further investigation. Aim:The study aimed to assess the severity of periodontal disease using Russell's Periodontal Index (PI) and to evaluate its correlation with decayed, missing, and filled teeth (DMFT) scores in adults. Materials and Methods:A cross-sectional study was conducted over 2 months. A total of 200 adult patients (aged 30-55 years) visiting the outpatient department were included based on predefined inclusion and exclusion criteria. DMFT scores were recorded according to the World Health Organization criteria (1987), and periodontal status was assessed using Russell's PI. Additional covariates such as oral hygiene habits, sugar consumption, family history of gum disease, and prior dental visits were also evaluated. Data analysis was performed using SPSS 20.0, applying Chi-square and analysis of variance tests. Results:A significant positive correlation was found between DMFT scores and periodontal disease severity. Patients with a DMFT score <5 exhibited a healthy periodontium, while those with scores between 5 and 10 had gingivitis, and those with DMFT >10 showed periodontitis. Type A caries (coronal caries) was not significantly associated with periodontitis, whereas type B caries (root caries) demonstrated a strong correlation. Among covariates, education level and age were significantly associated with periodontal health, while gender, sugar consumption, frequency of brushing, and dental visits showed no significant impact. Conclusion:The findings suggest a positive correlation between the severity of periodontal disease and DMFT scores, indicating that dental caries and periodontitis may coexist more frequently than previously assumed. However, their distinct microbial environments present challenges in establishing a direct causal relationship. Further longitudinal studies are needed to explore the underlying mechanisms linking these two conditions.
Background:Diagnosing periodontitis using traditional methods can reflect past tissue destruction and not indicate the active disease. This highlights the need for accurate and specific diagnostic methods that assess the current disease activity more accurately. Thus, the present study aimed to evaluate the diagnostic performance and association of salivary matrix metalloproteinase-9 (MMP-9) and S100A8 levels with periodontitis among reverse smokers, smokers, and nonsmokers. Materials and Methods:Thirteen milliliters of saliva sample were collected from 100 participants, 25 each of reverse smokers with periodontitis (RS + P), smokers with periodontitis (S + P), nonsmokers with periodontitis (NS + P) and systemically and periodontally healthy individuals (HI). Probing pocket depth and clinical attachment loss were measured and correlated with the levels of MMP-9 and S100A8, which were tested by the Enzyme-linked immunosorbent assay method. Results:The levels of both biomarkers were significantly higher (P < 0.05) in reverse smokers with periodontitis than in other groups. Both MMP-9 and S100A8 had a sensitivity of 91.7% for detecting periodontitis, demonstrating equal sensitivity. The specificity was slightly higher for MMP-9 (41.7%) when compared to S100A8 (38.9%). These markers increased with the severity of periodontal disease; however, a significant (P = 0.001) increase was observed only with salivary S100A8. Conclusions:Within limitations, salivary MMP-9 and S100A8 may be possible biomarkers for smokers (especially reverse smokers) with periodontitis and have a good screening potential for periodontitis. However, more studies are essential to understand the prognostic value of salivary MMP-9 and S100A8 for periodontitis.
Background:Gingival hyperpigmentation is a significant esthetic concern, particularly in individuals with high smile lines. Traditional surgical methods for depigmentation often face the challenge of recurrence. Vitamin C, due to its antioxidant properties and role in melanin inhibition, has emerged as a promising adjunctive agent for gingival depigmentation. Aim:This systematic review and meta-analysis aimed to evaluate the effectiveness of Vitamin C in managing gingival hyperpigmentation, either as a standalone treatment or in combination with other modalities. Materials and Methods:The protocol of this systematic review was registered in PROSPERO (CRD42024613787), and it was in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, Cochrane Library, and Google Scholar, for studies published between 2018 and 2024. The review included randomized controlled trials (RCTs) and clinical trials comparing Vitamin C interventions to conventional depigmentation techniques, and a meta-analysis was conducted using the standardised mean difference (SMD) as the effect measure. Results:Eight studies were included for qualitative synthesis and three RCTs for quantitative analysis. The meta-analysis revealed a statistically significant improvement in depigmentation scores at 1-month follow-up (SMD: 1.93; 95% confidence interval: 1.37-2.48). However, no significant differences were observed at baseline or at the 3-month follow-up, where high heterogeneity was present. Conclusion:Vitamin C demonstrates promising short-term efficacy in the treatment of gingival hyperpigmentation, especially when used as an adjunct to conventional therapy. However, variability in protocols and long-term outcomes highlights the need for further standardized trials.
Aim:This in vitro study was conducted to evaluate the effects of photobiomodulation (PBM) with 940 nm diode LASER on diabetic human gingival fibroblasts (DHGF) and diabetic human periodontal ligament fibroblasts (DPDLF) obtained from patients with poorly controlled diabetes mellitus. Materials and Methods:DHGF and DPDLF were isolated and harvested from patients with poorly controlled Type 2 diabetes mellitus (HbA1c > 8). The cells were seeded separately in cell-culture plates and exposed to 940 nm diode LASER at 0.1 W power and 2 J or 4 J energy. The cells were exposed once, twice or thrice at 24 h intervals. Cell viability, proliferation, and migration were assessed in test and control groups via Trypan Blue Assay, MTS Assay, and Scratch Test Assay. The experiment was performed in the form of triplicate. Results:Overall, the DHGF and DPDLF, which were exposed to PBM, exhibited better viability, proliferation, and migration than their corresponding controls. Cell viability was significantly higher in DHGF exposed thrice to 4 J energy at 24-h intervals (P < 0.05). As per the MTS assay analysis, PBM at 2 J energy accelerated cellular proliferation in DHGF and DPDLF (P < 0.05). The scratch test assay revealed significantly smaller wounds at 12 h and 24 h in all irradiated groups than in controls, suggesting faster cell migration. Conclusion:PBM using 940 nm diode at 0.1 W power and delivering 2 J energy could be a valuable tool for enhancing periodontal healing in patients with poorly controlled diabetes.
Background:Identifying the cementoenamel junction (CEJ) in patients with altered passive eruption (APE) can be challenging during esthetic crown lengthening. The free gingival groove (FGG) may serve as a useful landmark for estimating CEJ position. This study evaluated the agreement between FGG and surgically identified CEJ, and explored additional photographic variables for CEJ prediction when FGG was not clearly identifiable. Materials and Methods:This retrospective study analyzed presurgical and flap-reflected intraoral photographs of teeth 13-23 from 48 patients with APE who underwent esthetic crown lengthening at a university periodontal clinic. Proportion-based measurements were obtained in ImageJ by a calibrated examiner. The percentage of crown width to the distance from the incisal edge to the FGG (%WIFR) was measured on presurgical photographs, and the percentage of crown width to anatomical crown length (%WALR) was measured on flap-reflected photographs as the reference for CEJ position. Results:%WIFR showed strong agreement with %WALR across all teeth (R 2 = 0.941, P < 0.001). The association was weakest in lateral incisors compared with central incisors and canines. Type I subgroup B showed evidence of effect modification of the %WIFR-%WALR relationship. When FGG was not clearly identifiable, a stepwise regression model incorporating other photographic variables provided a prediction of %WALR (R 2 = 0.824, P < 0.001). Conclusions:Standardized intraoral photographs can support clinically applicable CEJ estimation in APE, using the FGG as the primary landmark and a proportion-based prediction model as an alternative approach.
Background:Dickkopf-1 (DKK-1) is a Wnt signaling pathway inhibitor that plays a crucial role in bone metabolism and inflammation. Its level is influenced by systemic conditions such as diabetes and smoking, which are known risk factors for periodontitis. The study aims to estimate and compare the levels of DKK-1 in gingival crevicular fluid (GCF) before and after nonsurgical periodontal therapy (NSPT) in individuals with chronic periodontitis, type 2 diabetes mellitus (T2DM), and smoking habits. Materials and Methods:A total of eighty participants were divided into four groups (n = 20 each): Group I (healthy controls), Group II (chronic periodontitis), Group III (chronic periodontitis with T2DM), and Group IV (chronic periodontitis with smoking). Clinical parameters including Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth, and clinical attachment level were recorded at baseline and 1 month after NSPT. GCF samples were collected using periopaper strips and analyzed for DKK-1 levels using the enzyme-linked immunosorbent assay. Results:Baseline DKK-1 levels were significantly higher in periodontitis patients compared to controls (P < 0.001), with the highest levels observed in the diabetes and smoking groups. After NSPT, all groups demonstrated significant reductions in DKK-1 levels and clinical parameters (P < 0.001), although DKK-1 levels remained elevated in all groups after NSPT compared to controls. Conclusion:Elevated GCF DKK-1 levels in chronic periodontitis, particularly among smokers and diabetics, indicate its potential as a biomarker of disease severity and therapeutic response.
Introduction:Microbial dysbiosis and chronic infection are linked to peri-implantitis, a complex inflammatory disease. Staphylococcus aureus, capable of stress adaptation, immune evasion, and antibiotic resistance, is increasingly recognized as a major cause of implant infections. These traits are regulated by small RNA (sRNA), but the regulatory environment in oral settings remains poorly understood. This study employs empirical sRNA-messenger RNA (mRNA) interaction data and a graph-based method to analyze these regulatory circuits. Materials and Methods:Using a curated cross-linking, ligation, and sequencing of hybrids dataset of sRNA-mRNA interactions in S. aureus, we implemented a hybrid graph attention autoencoder (GAT-AE). Interaction scores were encoded as edge weights to construct a bipartite graph. The model used a feedforward decoder to reconstruct interaction scores and graph attention layers to learn 64-dimensional node embeddings. Mean squared error, mean absolute error, and coefficient of determination (R 2) were used to assess the model's performance. Results:The model identified SprX and RsaE as key regulatory sRNAs that govern antibiotic resistance, stress responses, and metabolic adaptation. Because of its role in immune evasion, the spa mRNA has become a major regulatory target. The model identified co-regulated clusters, reconstructed the overall network structure, and captured biologically significant patterns, despite modest predictive accuracy (R 2 = 0.01). Conclusion:This study demonstrates the utility of GAT-AE models for investigating posttranscriptional regulation in S. aureus, particularly in the context of peri-implantitis. Identifying sRNA hubs involved in survival and virulence lays the groundwork for future diagnostic and therapeutic approaches targeting sRNA-mediated pathways in oral infections.
Background:Chronic periodontitis (CP) and type 2 diabetes mellitus (DM) are linked through shared inflammatory pathways. This systematic review and meta-analysis assessed the effect of nonsurgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) adipocytokines and periodontal clinical outcomes in patients with CP and controlled type 2 DM (T2DM). Materials and Methods:PubMed, Scopus, and EBSCOhost were searched from 1980 to 2023 in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, with a priori registration in PROSPERO (CRD42023450510). Eligible randomized, controlled, and observational studies evaluated GCF adipocytokines by enzyme-linked immunosorbent assay (ELISA) before and after NSPT. Risk of bias (RoB) was assessed using RoB 2 and Risk of Bias in Nonrandomized Studies of Interventions, and certainty of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation. Seven studies were included in the quantitative synthesis, and pooled effects were estimated using random-effects models (Restricted Maximum Likelihood) with standardized mean change and 95% confidence intervals. Results:NSPT significantly reduced GCF adipocytokine levels in CP patients with T2DM and significantly improved periodontal clinical parameters. No significant change in adipocytokines was observed in patients with CP without diabetes, for whom comparator data were available. Although the direction of effect was consistently favorable, the evidence base was limited by small sample sizes and methodological weaknesses. Conclusions:NSPT may improve both inflammatory biomarker profiles and periodontal status in patients with CP and controlled T2DM. Adipocytokines may serve as useful biomarkers of periodontal treatment response, but the current evidence is of low certainty and should be interpreted cautiously. Clinical Significance:Reduction of GCF adipocytokines after NSPT, together with improved periodontal indices, may provide a quantitative biomarker-based approach for monitoring treatment response. The observed adipocytokine shifts also suggest a potential pathway through which periodontal care may contribute to improved glycemic control, underscoring systemic benefits of periodontal therapy.
