The Gaseous Ozone Therapy as a Promising Antiseptic Adjuvant of Periodontal Treatment: A Randomized Controlled Clinical Trial

Background: the establishment of periodontitis is regulated by the primary etiological factor and several individual conditions including the immune response mechanism of the host and individual genetic factors. It results when the oral homeostasis is interrupted, and biological reactions favor the development and progression of periodontal tissues damage. Different strategies have been explored for reinforcing the therapeutic effect of non-surgical periodontal treatment of periodontal tissue damage. Gaseous ozone therapy has been recognized as a promising antiseptic adjuvant, because of its immunostimulating, antimicrobial, antihypoxic, and biosynthetic effects. Then, we hypothesized that the adjunct of gaseous ozone therapy to standard periodontal treatment may be leveraged to promote the tissue healing response. Methods: to test this hypothesis, we conducted a prospective randomized study comparing non-surgical periodontal treatment plus gaseous ozone therapy to standard therapy. A total of 90 healthy individuals with moderate or severe generalized periodontitis were involved in the study. The trial was conducted from September 2019 to October 2020. Forty-five patients were randomized to receive scaling and root-planning (SRP) used as conventional non-surgical periodontal therapy plus gaseous ozone therapy (GROUP A); forty-five were allocated to standard treatment (GROUP B). The endpoint was defined as the periodontal response rate after the application of the ozone therapy at 3 months and 6 months, defined as no longer meeting the criteria for active periodontitis. Statistical analysis was performed employing SPSS v.18 Chicago: SPSS Inc. Results: periodontal parameters differed significantly between patients treated with the two distinct procedures at 3 months (p ≤ 0.005); a statistically significant difference between groups was observed from baseline in the CAL (p ≤ 0.0001), PPD (p ≤ 0.0001) and BOP (p ≤ 0.0001) scores. Conclusions: The present study suggests that SRP combined with ozone therapy in the treatment of periodontitis revealed an improved outcome than SRP alone.

Evaluation of NLRP3 and IL-18 Levels after Periodontal Therapy

The progression of periodontitis depends on interactions between the periodontal pathogens and the host immune cytokines, including interleukin (IL)-1β and IL-18. Production of IL-1β is regulated by NOD-like receptors family pyrin domain containing 3 (NLRP3). This study aimed to evaluate the effect of periodontal treatment on the concentrations of IL-18 and NLRP3 in patients with chronic periodontitis. In this experimental study, 18 patients with chronic periodontitis and a mean age of 46.2±8.95 years, were included. The gingival crevicular fluid (GCF) was collected at the beginning of the study, 4 weeks after non-surgical (phase I), and 4 weeks after surgical periodontal treatment. The levels of NLRP3 and IL-18 were measured; using an enzyme-linked immunosorbent assay. Pearson correlation test was used to analyze the concentration of NLRP3 and IL-18 before and after the treatments with CAL and PD. There was a significant association between the level of NLRP3 and the mean values of PD and CAL before treatment. After each treatment phase, a significant decrease was observed in the NLRP3 level. There was no significant relationship between IL-18 and clinical parameters before and after periodontal treatments. Given the possible association between the level of NLRP3 and clinical parameters, we suggest it as a possible indicator of inflammation in chronic periodontitis and an index for evaluating the treatment outcome.

A prospective interventional trial on the effect of periodontal treatment on Fusobacterium nucleatum abundance in patients with colorectal tumours

Fusobacterium nucleatum is associated with the progression of colorectal cancer. Thus, the possibility of preventing colorectal cancer or its progression by targeting F. nucleatum has been explored. As F. nucleatum is associated with periodontitis, we analysed whether treating periodontitis could influence F. nucleatum abundance in the colon. Patients with colorectal tumours who underwent colonoscopy were recruited. Patients diagnosed with periodontitis by a dentist were treated for approximately 3 months. Endoscopic resection of colorectal tumours was performed after periodontitis treatment, and resected tumours were pathologically classified as high-(HGD) or low-grade dysplasia (LGD). Saliva and stool samples were collected before and after the treatment. Of the 58 patients with colorectal tumours, 31 were included in the study, 16 showed improvement in periodontitis, and 11 showed no improvement. Stool F. nucleatum levels before treatment were significantly lower in the LGD group than in the HGD group. A significant decrease in faecal F. nucleatum levels was observed in patients who underwent successful treatment but not in those whose treatment failed. Salivary F. nucleatum levels were not altered in patients despite periodontal treatment. Thus, successful periodontitis treatment reduces stool F. nucleatum levels and may aid research on periodontitis and suppression of colorectal cancer development.

Efficacy of Chamomile Mouthwash on Clinical And Serum Inflammatory Parameters in Relation to Chlorhexidine in Chronic Gingivitis Patients

Background: Oral and systemic infections are closely linked to poor oral hygiene. Chlorhexidine mouthwash, in addition to tooth brushing has been commonly recommended. About the fact that there is a lot of studies on the effectiveness of chamomile as an herbal mouthwash, there isn't much evidence on its competitive effect with chlorhexidine. Objective: To determine the clinical and inflammatory effects of chamomile as mouthwash (MTC) in the treatment of chronic gingivitis and compare its effect with 0.12% chlorhexidine (CHX). Patients and Methods: A total of 45 subjects aged 18-45 years with chronic gingivitis underwent scaling and polishing with oral hygiene instruction; 15 patients received 1% of (MTC) as mouthwash, 15 patients received 0.12% of chlorhexidine mouthwash, and 15 patients received scaling and polishing only (SRP). Mouthwash was twice daily for 14 days. At the start of the study, clinical periodontal parameters (PI, GI, and BOP) and blood samples were taken and after four weeks of treatment to estimate the levels of C-reactive protein (CRP), alkaline phosphatase (ALP) and total protein (TP). Results: After 4 weeks of periodontal treatment, there was a significant decrease in clinical periodontal parameters (P<0.01) and inflammatory markers (P<0.05) in the MTC and CHX and S&P alone groups. From periodontal treatment, there was no significant difference between the MTC and CHX groups with clinical periodontal parameters and inflammatory markers (P<0.05), although there was a significant difference between the MTC, CHX groups, and the S&P alone group in terms of clinical periodontal parameters and inflammatory markers (P<0.05). Conclusion: Chamomile has been shown to be comparable to CHX in terms of reducing gingivitis by decreasing clinical periodontal parameters and inflammatory chemical markers values such as CRP, ALP, and TP. Keywords: Chamomile; mouthwash; chlorhexidine; gingivitis, CRP, ALP, TP, serum