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Periodontitis is an inflammatory disease caused by bacterial infection. Recent studies have identified extracellular vesicles (EVs) as potential mediators of inflammation. This study aimed to evaluate the pro-inflammatory properties and miRNA content of EVs secreted in response to Porphyromonas gingivalis infection. Oral epithelial cells (ECs) were infected with P. gingivalis (MOI 100) for 24 h. EVs from infected (P.g.-ECs-EVs) and uninfected cells (ECs-EVs) were isolated, characterized, and tested on naive ECs. Cellular activity, inflammatory markers (TNF-α, IL-1β), and miRNA content of the secreted EVs were evaluated. Bioinformatic analysis was subsequently performed to identify potential targets of differentially expressed miRNAs. P. gingivalis infection increased EV production by 10 2 -fold. P.g.-ECs-EVs exhibited distinct properties compared to ECs-EVs, including higher metabolic activity and elevated TNF-α and IL-1β expression and secretion levels in exposed ECs. Several inflammation-related miRNAs were highly upregulated in P.g.-ECs-EVs (11- to 142-fold; p  < 0.001). P. gingivalis promotes the secretion of pro-inflammatory EVs by ECs, suggesting their role as key mediators in P. gingivalis -induced inflammation and periodontal tissue destruction.

Platelet-rich fibrin (PRF) provides a scaffold for cell migration and growth factors for promoting wound healing and tissue regeneration. Here, we report using PRF in periodontal healing after open flap debridement (OFD) in canine periodontitis. A split-mouth design was performed in twenty dogs. Forty periodontitis surgical sites were randomly categorized into 2 groups; OFD alone and OFD with PRF treatment. Clinical parameters of periodontal pocket depth, gingival index, and the cemento-enamel junction-alveolar bone levels/root length ratio were improved in the OFD + PRF group. The OFD + PRF group also demonstrated a dramatically decreased inflammatory score compared with the OFD group. Collagen accumulation was improved in the OFD + PRF group at later time points compared with baseline. PRF application also significantly reduced inflammatory cytokine expression ( TNFA and IL1B ), and promoted the expression of collagen production-related genes ( COL1A1 , COL3A1 , and TIMP1 ) and growth factors ( PDGFB , TGFB1 , and VEGFA ). These findings suggest that PRF combined with OFD provides a new strategy to enhance the overall improvement of canine periodontitis treatment outcomes, especially in terms of inflammation and soft tissue healing. Therefore, PRF use in treating periodontitis could play an important role as a regenerative material to improve canine periodontitis treatment.

The aim of this study is to compile a comprehensive database on color range and color distribution of healthy human gingiva by age, gender and ethnicity. Spectral reflection of keratinized gingiva at upper central incisors was measured by spectroradiometer and converted into CIELAB values. Lightness range (ΔL*) for all groups together was 26.8. Corresponding a* (green-red) and b* (blue-yellow) ranges (Δa* and Δb*) were 18.3 and 13.0. Significant differences (p < 0.05) were recorded by age for L* and a* coordinates, by gender for b* coordinate and by ethnicity for L*, a* and b* coordinates. R 2 -values between color coordinates were 0.01 (L*/a*), 0.03 (L*/b*) and 0.12 (a*/b*). The smallest color differences were recorded between age groups 46–60 and 60 + (ΔE* = 0.9) and between Caucasians and Hispanics (ΔE* = 1.1). Color difference by gender was 1.3. When total L*a*b* ranges were divided into four equal segments, 51.7% of subjects had L* value within the third segment (from lightest to darkest), 47.1% had a* value within the third segment (from less red to redder) and 59.3% had b* value within the second segment (from less yellow to yellower). It was found that ethnicity and age had statistically significant influence on the color of human gingiva.

Objective Adenosine triphosphate (ATP) is an essential nucleotide that is normally present in both intracellular and extracellular compartments. Extracellular ATP (eATP) has a pivotal role in both physiological and pathological processes of periodontal ligament tissues. Here, this review aimed to explore the various functions of eATP that are involved in the control of behaviours and functions of periodontal ligament cells. Methods To identify the included publications for review, the articles were searched in PubMed (MEDLINE) and SCOPUS with the keywords of adenosine triphosphate and periodontal ligament cells. Thirteen publications were used as the main publications for discussion in the present review. Results eATP has been implicated as a potent stimulator for inflammation initiation in periodontal tissues. It also plays a role in proliferation, differentiation, remodelling, and immunosuppressive functions of periodontal ligament cells. Yet, eATP has diverse functions in regulating periodontal tissue homeostasis and regeneration. Conclusion eATP may provide a new prospect for periodontal tissue healing as well as treatment of periodontal disease especially periodontitis. It may be utilized as a useful therapeutic tool for future periodontal regeneration therapy.

Key Points Highlights the increasing UK population being prescribed drugs that might affect the periodontal tissues. Reviews the more common drugs that can cause changes in healthy and inflamed periodontal tissues. Describes the clinical changes that may be observed. Considers the clinical relevance of these issues in general dental practice. This paper reviews the effects that drugs may have on the gingival and periodontal tissues. Drug-induced gingival overgrowth has been recognised for over 70 years but is becoming a more prevalent occurrence with wider use of antihypertensive and immunosuppressant drugs. The anti-inflammatory steroids, non-steroidal drugs and anti-TNF-α agents might all be expected to exert a dampening effect on chronic periodontitis although the evidence is somewhat equivocal and none of these drugs has emerged as potentially valuable adjuncts to treat periodontal disease. Desquamative gingivitis is a clinical appearance of aggressive gingival inflammation with which a number of drugs have been associated and the oral contraceptives have also been implicated in the development of gingival inflammation. Patients who are prescribed bisphosphonates and anti-platelet drugs are at risk of serious side effects following more invasive dental procedures including extractions and surgical treatments although timely, conventional management of periodontal disease may be undertaken to reduce periodontal inflammation, prevent disease progression and ultimately the need for extractions.

Key Points Provides overview of possible aetiology of gingival overgrowth. Discusses history and key clinical features which aid in diagnosis. Discussion of systemic disease which may contribute to gingival overgrowth Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications. However, rare genetic conditions can result in gingival overgrowth with non-plaque-induced aetiology. It is also important to appreciate the potential differential diagnoses of other presentations of enlarged gingival tissues; some may be secondary to localised trauma or non-plaque-induced inflammation and, albeit rarely, others may be manifestations of more sinister diseases or lesions. A definitive diagnosis will then enable an appropriate management strategy. This paper aims to discuss clinical features and diagnoses for conditions presenting with gingival overgrowth and other enlargements of gingival tissues.

Key Points Highlights that a wide variety in the incidence of oral manifestations has been described in patients with Crohn's disease. Demonstrates that Crohn's disease has negative effects on oral health and therefore patients need special attention from dental clinicians. Points out that oral manifestations may precede gastrointestinal symptoms and recognition can lead to early referral to a gastroenterologist, which is important especially in children Widely varying prevalence rates of oral lesions in patients with Crohn's disease have been reported, ranging from 0.5% to 37%. These manifestations may coincide with or precede intestinal symptoms. Oral manifestations can be classified as specific lesions, when macroscopic examination shows similar changes to those observed endoscopically in the intestine, and non-specific lesions including aphthous ulcerations. The most frequently observed oral lesions are oedema, ulcers and hyperplastic lesions on the buccal mucosa. In most patients these lesions are asymptomatic, however, some patients may experience discomfort. In this review we describe the most relevant oro-dental manifestations observed in patients with Crohn's disease and discuss the potential implications for oro-dental management.

Key Points Suggests that gingival overgrowth management requires a structured approach including preventative, non-surgical cause-related therapy and in some cases surgical interventions. Highlights that failure of cause-related treatment to eliminate aesthetic, functional and speech related complications of gingival overgrowth is likely to indicate surgical intervention. Demonstrates that surgical techniques may include a gingivectomy or apically repositioned flap. Suggests that a variety of techniques may be used to perform a gingivectomy including scalpel, electrosurgery and laser methods. The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 ( BDJ 2017; 222: 85–91 ). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.

Key Points Investigates the efficacy and tolerability of alcohol-free and alcohol-containing chlorhexidine mouthrinses. Discusses the pharmacokinetics of alcohol-free and alcohol-containing chlorhexidine mouthrinses after single and repeated use. Objectives Gingival bleeding following twice-daily use of 0.2% w/v chlorhexidine digluconate mouthrinse with and without alcohol (0.2% CHX-alcohol; 0.2% CHX-alcohol-free, respectively) and brushing with a standard fluoride toothpaste was compared to brushing alone. Methods Three hundred and nineteen subjects with mild-to-moderate gingivitis (with ≥16 gradable permanent teeth including four molars, bleeding after brushing and ≥20 bleeding sites) completed this randomised, examiner-blinded, parallel-group study. A prophylaxis was performed at baseline. Gingival Severity Index (GSI; primary objective), Gingival Index (GI) and Plaque Index (PI) were assessed at baseline and after 6 weeks of treatment. Adverse events (AEs) were recorded throughout the study. Results Between treatment differences at week 6 demonstrated significantly lower GSI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (primary endpoint; treatment difference −0.061 [95% CI −0.081, −0.041] and −0.070 [95% CI −0.090, −0.050], respectively; both p <0.0001). There were also significant reductions in GI and PI for the 0.2% CHX-alcohol and 0.2% CHX-alcohol-free groups compared to brushing alone (all p <0.0001). The proportion of subjects reporting ≥1 treatment-related adverse events (TRAEs) was 27.8% (0.2% CHX-alcohol), 24.8% (0.2% CHX-alcohol-free) and 3.7% (brushing alone). Conclusions Chlorhexidine mouthrinse with or without alcohol as an adjunct to brushing with regular fluoride toothpaste significantly reduces bleeding scores, plaque and gingival inflammation compared to brushing alone. TRAEs are characteristic of those associated with the use of chlorhexidine and are similar for both mouthrinses.