We thank Dr. Varon (1) for his interest in the relationship between periodontitis and kidney disease in type 2 diabetes, but we disagree with most of his statements and conclusions.

First, although our analysis (2) excluded individuals with kidney disease (macroalbuminuria or low glomerular filtration rate) at baseline, we did not exclude individuals with known risk factors for …

https://care.diabetesjournals.org/content/diacare/30/12/e139.full.pdf

Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes Response to Varon

Opinions on the interdependence between diabetes mellitus and oral periodontal disease are controversial. Experimental and clinical investigations carried out so far have not brought unique results. General objective of our research is to investigate on the strictly defined group of subjects aged 35-44 with diabetes mellitus type I the influence of metabolic control HbA1C on changes of periodontium and other organs. According to duration of diabetes mellitus the patients are divided into subdecade and postdecade groups. This group consists of 56 patients out of which 33 patients are with subdecade and 23 with postdecade insulin-dependent diabetes mellitus. In this group periodontal pocket depths, gingival index, number of extracted teeth and the volume of nonstimulated saliva are measured in comparison with a control group. The incidence of oral diseases and complications in other organs of insulin-dependent patients in subdecade and postdecade period are also examined and recorded. Periodontal diabetic disease is verified by pathohistological findings. Values of HbA1C in either subdecade or postdecade group with diabetes mellitus are above normal values. Values of periodontal pocket depths as well as the values of gingival index are substantially greater at insulin-dependent diabetes mellitus patients compared to the control group.

Diabetes mellitus and periodontal diseases

Bacteremia Associated with Toothbrushing and Dental Extraction

Background: Platelet-rich fibrin (PRF) promotes tissue regeneration by releasing various growth factors. The palatal donor site of the epithelialized connective tissue (CT) graft significantly influences the patient’s morbidity. The aim of this study is to compare the effects of PRF and gelatin sponge on the healing of palatal donor sites and the patient’s morbidity.Methods: Forty patients with at least one site of Miller Class I or II gingival recession were treated by a coronally advanced flap with CT graft resulting from the de-epithelialization of a free gingival graft. In the test group (20 patients), a PRF membrane was placed over the palatal wounds; conversely, the 20 control group patients were treated with an absorbable gelatin sponge. Patients were monitored at 1, 2, 3, and 4 weeks after surgery for the complete re-epithelialization of the palatal wound (CWE), the alteration of sensitivity around the wound area, postoperative discomfort, and changes in feeding habits (CFH). Furthermore, the cons...

Clinical Comparison of Platelet-Rich Fibrin and a Gelatin Sponge in the Management of Palatal Wounds After Epithelialized Free Gingival Graft Harvest: A Randomized Clinical Trial.

Platelet-rich fibrin is a blood concentrate system used for soft tissue and bone tissue regeneration. In the last decade, platelet rich fibrin (PRF) has been widely used in different indication fields, particularly in oral and maxillofacial surgery. This review investigates the level of scientific evidence of published articles related to the use of PRF for bone and soft tissue regeneration in dentistry and maxillofacial surgery. An electronic literature research using the biomedical search engine “National Library of Medicine” (PubMed-MEDLINE) was performed in May 2017. A total of 392 articles were found, 72 of which were classified for each indication field. When comparing PRF with biomaterials vs biomaterial alone in sinus lift (5 studies; IIa), no statistically significant differences were detected. Socket preservation and ridge augmentation using PRF significantly enhanced new bone formation compared to healing without PRF (7 studies Ib, IIa, IIb). Reepithelialization and bone regeneration was achiev...

Fifteen Years of Platelet Rich Fibrin in Dentistry and Oromaxillofacial Surgery: How High is the Level of Scientific Evidence?

Background: IL-1 cytokines have central roles in the pathogenesis of periodontal disease Polymorphism in the locus +3954 (C/T) of the human IL-1B gene has been shown to affect the levels of this cytokine Aim: The aim of the present study was to investigate the association between the IL-1 B (+3954) gene polymorphism and the occurrence of different clinical forms of periodontitis Materials and Methods : Genomic DNA was obtained from 90 individuals and amplified using the PCR with specific primers flanking the locus +3954 of IL-1B PCR products were submitted to restriction endonuclease digestion and analyzed by gel electrophoresis, allowing for the determination of the genotypes and detection of the polymorphism Statistical Analysis: Fisher's exact test was used for comparing the frequency of genotype distributions between groups Results: The chronic periodontitis group displayed a higher percentage of T alleles (38%) when compared to the aggressive periodontitis group (20%) and to the control group (19%) Conclusion: Our study data states that polymorphism in the locus +3954 of IL-1B gene could be a risk factor for chronic periodontitis in a sample of Indian population of Karnataka state

Evaluation of interleukin -1B (+3954) gene polymorphism in patients with chronic and aggressive periodontitis: A genetic association study.

Background: The width of attached gingiva varies from tooth to tooth and also among individuals with mixed opinions regarding an adequate or sufficient dimension of the gingiva. Although the need for a so-called adequate amount of keratinized tissue for maintenance of periodontal health is questionable, the mucogingival junction serves as an important clinical landmark in periodontal evaluation. There are various methods of locating the mucogingival junction namely the functional method and the visual method with and without histochemical staining, which aid in the measurement of the width of attached gingiva. Materials and Methods: This study was carried out to assess the full mouth mid-buccal width of attached gingiva in individuals of four different age groups. This study also evaluated the difference in visual and histochemical methods in identification of the mucogingival junction to calculate the width of attached gingiva. Results: It was seen that the width of attached gingiva increases with age, and there was no significant difference in the width of attached gingiva by both the methods. Conclusion: Width of attached gingival varies in different areas of the mouth and also increases with age with no significant difference in the method of its assessment.

Assessment of the width of attached gingiva using different methods in various age groups: A clinical study

Dentistry, an art in science and tranquilizer in medicine, has seen a lot of changing concepts over a decade and one such novel innovation is piezosurgery. Piezosurgery is a true revolution in bone surgery as it fulfils both biological and technical criteria.

It has a variety of applications ranging from minor surgical procedures to complex implantology, plastic and reconstructive surgeries. Piezosurgery uses a low frequency modulated ultrasonic insert which produces microvibrations in the range of 60-200micro meter/sec and leads to safe and precise bony incision without damaging underlying vital structures like nerves, mucosa and vessels. It overcomes technical difficulties such as visibility by producing bloodless field during surgery and removes debris simultaneously through internal irrigation mechanism. The soft tissues remain safe and biological factors like release of certain cytokines promote bone healing and enhance patients recovery.

This critical review outweighs piezosurgery over traditional tools and emphasizes on its clinical and biological aspects contributing to beneficial dental health.

Escalating role of piezosurgery in dental therapeutics.

Throughout history, there has been the belief that diseases that affect the mouth, such as periodontal disease, can have an effect on the rest of the body It is only very recently that scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes, and preterm low birth weight Birth weight is affected by multiple factors and is considered as an outcome of a complex multifactorial system Periodontitis is a remote gram-negative infection that may play a role in low birth weight Periodontopathic microorganisms and their products have a wide range of effects mediated through host cytokine production in target cells Many combined animal studies and data supporting plausible biologic mechanisms suggest that periodontal infection has a negative impact on pregnancy outcome in some women

Relationship between maternal periodontal status and preterm low birth weight

The general dental practitioner and paediatric dentist are in a unique position to identify and distinguish between a seemingly innocuous condition that may be a normal physiological aberration or an early sign of severe destructive periodontal disease. Although severe destructive periodontal conditions are uncommon in children, it is essential that children receive a periodontal screening as part of their regular dental examination. Early diagnosis ensures a high likelihood of a successful therapeutic outcome, primarily by reduction of aetiologic factors, remedial therapy and development of an effective maintenance protocol. This prevents the recurrence and progression of disease and reduces the incidence of tooth loss. In the first article, we discussed the classification, plaque-induced and non plaque-induced gingival diseases, localized and generalized forms of chronic as well as aggressive periodontitis. In this second article, we discuss periodontitis as a manifestation of systemic disease, necrotiz...

Ashish Kumar

Papers

Evaluation of interleukin -1B (+3954) gene polymorphism in patients with chronic and aggressive periodontitis: A genetic association study.

Assessment of the width of attached gingiva using different methods in various age groups: A clinical study

Escalating role of piezosurgery in dental therapeutics.

Relationship between maternal periodontal status and preterm low birth weight

Periodontal diseases in children and adolescents: a clinician's perspective part 2.