Medicinal plants and antimicrobial activity.

Reactive oxygen species

A classification scheme for periodontal and peri-implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The workshop was co-sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Planning for the conference, which was held in Chicago on November 9 to 11, 2017, began in early 2015. An organizing committee from the AAP and EFP commissioned 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry. The authors were charged with updating the 1999 classification of periodontal diseases and conditions and developing a similar scheme for peri-implant diseases and conditions. Reviewers and workgroups were also asked to establish pertinent case definitions and to provide diagnostic criteria to aid clinicians in the use of the new classification. All findings and recommendations of the workshop were agreed to by consensus. This introductory paper presents an overview for the new classification of periodontal and peri-implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. Changes to the 1999 classification are highlighted and discussed. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. The scope of this workshop was to align and update the classification scheme to the current understanding of periodontal and peri-implant diseases and conditions. This introductory overview presents the schematic tables for the new classification of periodontal and peri-implant diseases and conditions and briefly highlights changes made to the 1999 classification. It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1).

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A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification.

Bisphosphonates: The first 40 years

1. The interpretation of epidemiological data of periodontal disease is difficult, due to inconsistencies in the methodology used. It is not possible, therefore, to accurately assess if the prevalence of the periodontal diseases shows a world-wide decline. As long as the disease is assessed through accumulated clinical attachment loss, retention of the natural dentition in older ages entails increased prevalence in these cohorts. Contemporary epidemiological studies should ideally employ full-mouth examination of the periodontal tissues. Partial recording estimates are generally biased, especially when the prevalence of the disease is low. 2. Early-onset periodontitis is infrequent in all populations. Adult periodontitis is rather prevalent; however, advanced disease affects limited subfractions of the population (probably less than 10 to 15%). Although prevalence figures vary with race and geographic region, in most cases, the progression pattern of the disease seems compatible with the retention of a functional dentition throughout life. 3. Of a plethora of behavioral and environmental risk markers identified by multi-variate analysis, smoking and presence of certain subgingival microorganisms have been proven to be true risk factors. The same holds true for diabetes mellitus, a systemic condition that confers a risk for periodontal disease which is independent of the effect of other significant factors. 4. In certain cases, periodontal infections appear to have a systemic impact on the host. Most recent data indicate that periodontal disease may confer risk for coronary heart disease and pre-term low birth weight.

Periodontal Diseases: Epidemiology

Background. Periodontal disease is a public health problem and is strongly associated with systemic diseases; however, its worldwide distribution is not fully understood. Objective. To evaluate global data of periodontal disease: (1) among adolescents, adults, and older population and (2) in low-, middle-, and high-income countries. Methods. This ecological study included data of periodontal disease from the World Health Organization’s data bank which are based on the Community Periodontal Index of Treatment Needs (CPITN code: 0 = no disease; 1 = bleeding on probing; 2 = calculus; 3 = periodontal pocket (PD) 4-5 mm; 4 = PD (6+ mm). Age- and income-related periodontal disease inequalities were evaluated across the globe. Results. Compared with 9.3% of adults and 9.7% of older persons, 21.2% of adolescents had no periodontal disease ( ). Nearly 18.8% of adolescents compared with 8.9% of adults and 5% of older persons had bleeding on probing ( ). Similarly, 50.3% of adolescents, 44.6% of adults, and 31.9% older persons demonstrated the occurrence of calculus ( ). On the other hand, older persons had the highest prevalence of PD 4-5 mm and PD 6+ mm than adults and adolescents ( ). The distribution of periodontitis (CPITN code 3 + 4) in adults differed significantly in low- (28.7%), lower-middle- (10%), upper-middle- (42.5%), and high-income countries (43.7%) ( ). However, no significant differences in periodontitis (CPITN code 3 + 4) were observed in adolescents and older persons in low- to high-income countries. Conclusions. Within the limitations of data, this study found that the distribution of periodontal disease increases with age. Periodontitis was the most common in older persons and in population from high-income countries.

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Global Prevalence of Periodontal Disease and Lack of Its Surveillance.

Chewing sticks (Miswak) is most commonly used int he Middle East and Indian Subcontinent Salvadora persica (Arak) and Azadirachta indica (Neem) are commonly used as oral hygiene tools in different parts of the world, Several studies have demonstrated the anti-plaque anticarious and antibacterial effect of these sticks. The aim of this study was to compare the effectiveness of antimicrobial activity of Neem and Arak chewing stick's aqueous extracts at various concentrations. The microbial inhibition was measured using blood agar and ditch plate method up to 48 hous. The pH of Neem extract was 6.1 and of Arak was 4.9 Data suggested that both chewing stick extracts are effective at 50% concentration on strept mutans and Strept faecalis. Arak extract was more effective at lower concentrations for Strept faecalis. The effect may be due to the difference of their chemical composition and variability in their PH. Further research is needed to extrapolate other plants used for oral hygiene. Chewing sticks are recommended as oral hygiene tools for health promotion in developing countries.

The antimicrobial effects of extracts of Azadirachta indica (Neem) and Salvadora persica (Arak) chewing sticks.

In the practice of dentistry, stress, tension, and postural practices can contribute to back and neck problems. Two hundred and four dentists and dental auxiliary (87 males and 117 females) in Riyadh city, Saudi Arabia were surveyed to determine the prevalence of postural problems. The candidates were interviewed and observed during practice. The data obtained showed that 111 (54.4%) of the subjects complained of neck pain and 150 (73.5%) complained of back pain. Only 37% of those complaining of back pain sought medical help. Within the limitations of this study, it might be concluded that neck and back pain among dental personnel are not of a severe nature.

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Back & neck problems among dentists and dental auxiliaries.

The aim of this study was to assess the antimicrobial activity of the miswak chewing stick (Salvadora persica) in vivo, especially on streptococcus mutans and lactobacilli. The study was conducted clinically using patients' saliva and measuring the effect of miswak (chewing stick), miswak extract, toothbrush, and normal saline on mutans and lactobacilli. Forty male subjects aged 20-45 years were included in the study; there were four groups of ten subjects each. For the study, 50% of miswak extract (solution) was used. The levels of mutans streptococci and lactobacilli were measured using commercially available Vivacare line CRT (Caries Risk Test) bacteria 2 in 1 kit. The results showed there was a marked reduction of streptococcus mutans among all groups. When the groups were compared, the reduction of streptococcus mutans was significantly greater using miswak in comparison to toothbrushing (p = 0.013), and there was no significant difference for lactobacilli reduction (p = 0.147). It may be concluded miswak has an immediate antimicrobial effect. Streptococcus mutans were more susceptible to miswak antimicrobial activity than lactobacilli. Dietary intake of sugar and oral health status may be considered for controlled clinical trials with special emphasis on the antibacterial activity of miswak on cariogenic bacteria for a longer period of time. A toothbrush with and without toothpaste should be compared with miswak alone. Further research is needed with a larger sample size.

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The immediate antimicrobial effect of a toothbrush and miswak on cariogenic bacteria: a clinical study.

Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed.

Khalid Almas

Papers

Global Prevalence of Periodontal Disease and Lack of Its Surveillance.

The antimicrobial effects of extracts of Azadirachta indica (Neem) and Salvadora persica (Arak) chewing sticks.

Back & neck problems among dentists and dental auxiliaries.

The immediate antimicrobial effect of a toothbrush and miswak on cariogenic bacteria: a clinical study.

The Role of Nutrition in Periodontal Health: An Update.