Gold Standards in Periodontics: A Review

The field of dentistry has evolved where people expect the best oral health care from specialists. Periodontics is that specialty of dentistry which deals with prevention, diagnosis, and treatment of diseases of the supporting tissues of the teeth. Almost half of the world's population is suffering from periodontal diseases. Periodontitis is the sixth most common chronic diseases in the world and along with dental caries, the most common cause of tooth loss. Through the effort of various professional organisations and research, various reliable products and treatment modalities have been developed. A gold standard is a benchmark which has been thoroughly tested and has reputation as a reliable modality. Some of established gold standards in periodontics include: periodontal probing, measurement of clinical attachment loss, bone loss, cone beam computed tomography, quantitative polymerase chain reaction tests, biopsies as investigative techniques; periodontal debridement, subepithelial connective tissue graft for recession coverage, lasers, autogenous bone in alveolar ridge augmentation prior to oral implantation, dental implant as reconstruction of missing dentition, and chlorhexidine mouth wash as treatment options. The objective of the review is to provide critical evaluation of the data available from existing studies in Periodontics which can help identify potential research areas to explore.

The Impact of Dental Neglect on Oral Health Among 16-30-Year-Olds in Dhulikhel, Kavrepalanchok, Nepal

Introduction: Oral health status is linked to oral health behaviour and dental neglect can be an important parameter for assessment of oral health status. Such evaluation will help in providing and planning appropriate health promotion activities to target population. Objective: To assess socio-demographic variations in Dental Neglect (DN) and to determine the association between DN and oral health. Methods: Analytical cross-sectional study done at dental hospital in Dhulikhel from September-November 2020. A sample of 327 aged 16-30 years were selected by convenience sampling technique. Demographic details along with DN were collected through the DN questionnaire. Both self-reported oral health and oral health status were assessed. Oral health status was determined by using the Oral Hygiene Index-simplified (OHI-S) and the Decayed Missing Filled index (DMFT). Results: Majority 170 (52%) of the sample were from high DN group. A total of 187 (57.2%) of the participants rated their oral health status as all right. Higher number of participants were seen in the fair group of oral hygiene status. Significant correlations were found between education and OHI-S scores. Mean DMFT score was 3.6±1.6 which had higher mean Decayed (D) component as compared to the Missing (M) and Filled (F) components in the index. Conclusion: Dental neglect is present among the study population and is associated with self-reported oral health status. Disparities were observed between the socio-demographic variables and DN. The DN Scale can be used in dental health promotion and also in evaluation of health promotion interventions.

Relationship Between Body Mass Index and Chronic Periodontitis

Introduction: Obesity is regarded as unnecessary body fat in ratio to lean body mass. Besides being an established risk factor for cardiovascular and other systemic diseases, obesity has been suggested to be a potential threat for periodontitis as well. Objective: The objective of the study was to learn relationship between body mass index (BMI) and periodontal disease. Methods: This analytical cross-sectional study was conducted at People’s Dental College from February 16 to April 15, 2021 after ethical approval. Seventy-two participants were selected conveniently who, on the basis of calculation of weight and height were allocated into two groups: Group A: participants with normal BMI, Group B: Obese/ overweight individuals. Plaque index, gingival index, periodontal pocket, and clinical attachment loss were recorded in both the groups to assess the periodontal disease status. On basis of findings, the two groups were statistically compared. Results: The result showed clinical attachment loss was significantly higher (P <0.001) in overweight/obese group than in normal BMI group (P =0 .001). Conclusion: The findings of this study suggest that obesity and overweight can be a possible predisposing factor for periodontal disease.

Prevalence of Gingival Pigmentation and its Association with Gingival Biotype and Skin Colour

Introduction: The facial appearance depends on several oral and extraoral factors including colour of facial skin and pigmentation of gingival epithelium. The colour of the gingiva varies among individuals and is thought to be associated with cutaneous pigmentation which ranges from light to dark brown or black colour. Objective: To assess the prevalence of physiological gingival pigmentation, gingival biotype and their association with skin colur in Nepalese subjects visiting Kantipur Dental College and Hospital (KDCH). Methods: This was an analytical cross-sectional study which was carried out from February 2020 to June 2020 in all patients of age-group 16 to 80 years visiting the Department of Periodontics at KDCH after ethical approval. Patients were recruited by convenience sampling and examined thoroughly to find out gingival biotype and extent of gingival pigmentation intraorally as well as skin colour extraorally. Results: In this study, 210 patients were examined among which, 105 (50%) were males and 105 (50%) were females. Out of 210, 33 (15.7%) had pink tissue without pigmentation, 84 (40%) had pigmentation only in attached gingiva, 58 (27.6%) in attached gingiva and interdental papilla, 32 (15.2%) had diffuse pigmentation involving all parts of gingiva, 2 (1%) had in marginal gingiva only, and 1 (0.5%) in marginal gingiva and interdental papilla. Conclusion: A strong association was found between gingival pigmentation and facial skin colour in present study (P <0.001). Establishing the pattern of gingival pigmentation in Nepalese population will help to choose a specific depigmentation therapy that will harmonise with skin colour.

Assessment of Labial Alveolar Bone Thickness in Maxillary Central Incisor using Cone Beam Computed Tomography

Introduction: The maxillary anterior region is becoming a major concern due to its aesthetic relevance. The buccal bone thickness is important for implant placement, orthodontic treatment and restorative treatment. Objective: To assess the thickness of alveolar bone in the maxillary central incisor using cone beam computed tomography (CBCT). Methods: A cross-sectional observational study was conducted at Department of Dental Surgery, Bir Hospital where CBCT of 53 samples from July 2019 till December 2019, the archived CBCT images was assessed retrospectively. The thickness of the labial bone in a direction perpendicular to the outer surface of the tooth root was measured at a distance of 2 mm from the cementoenamel junction (CEJ). The measurement was taken thrice and the mean measurement was considered. Results: The labial alveolar bone thickness in maxillary central incisor was found to be 0.55±0.27 mm at a distance of 2 mm from the CEJ. Only 2 (3.8%) of the samples had an alveolar thickness of >1 mm. No statistically significant difference was found with respect to gender and age. Conclusion: The average thickness of the labial alveolar bone in maxillary central incisor using cone beam computed tomography was found to be thin.

Microinvasive Oral Squamous Cell Carcinoma of Gingiva: An Enigma

Microinvasive oral squamous cell carcinoma (MIOSCC) of gingiva is an early stage relatively ‘thin’ tumour without invasion of deep tissues. A 55-year old male reported with the chief complaint of gum swelling in lower right back jaw region for one month. On examination, diffuse, unscrappable, white homogenous plaque extending from 35 to 48 was present with a firm, sessile gingival growth approximately eight millimetre in diameter. A provisional diagnosis of verrucous leukoplakia was made. Hence, biopsy was performed which confirmed MIOSCC and mild dysplasia for different sites. The patient is on regular follow-up and with no signs of recurrence.

Occurrence of Extra Roots in Permanent Mandibular Molars: A Cone Beam Computed Topography Study

Introduction: Permanent mandibular first and second molars may display extra roots namely radix entomolaris and radix paramolaris which may have implications in endodontic treatment outcome, if missed. Objective: To evaluate the occurrence of extra roots in permanent mandibular first and second molars in a sample of Nepalese population. Methods: This analytical cross-sectional study was done at Dhulikhel hospital. Convenience sampling technique was utilised for data collection of 773 CBCT images. Images from June 2018 to June 2020 were retrospectively screened for presence of fully erupted bilateral mandibular first and second molars. Presence of extra roots were recorded and laterality, gender, and racial variations were analysed by Fisher’s exact test and Chi-square test using SPSS v.20. Results: For mandibular first molars, out of 517 patients, 65 (11.38%) had radix entomolaris: 38 (13.2%) female and 27 (9.54%) male. Among 38 females; occurrence was 21 (7.3%) bilateral, 16 (5.56%) unilateral right and 1 (0.34%) unilateral left side. Likewise, among 27 males, the occurrence was 15 (5.3%) bilateral, 6 (2.1%) unilateral right and 6 (2.1%) unilateral left side. Regarding races, 50 (14.6%) were Mongoloids and 15 (6.6%) were Aryans. No radix paramolaris was found in mandibular first molars. For mandibular second molars, out of 623 patients, radix entomolaris and paramolaris were observed in 0.8% and 0.48% respectively. Conclusion: The overall occurrence of radix entomolaris in mandibular first and second molars was found to be 11.38% and 0.8%, respectively. Practitioners should be aware of these unusual variations to avoid iatrogenic mishap due to missed canal.

Pattern of Malocclusion in Patients undergoing Orthodontic Treatment at a Tertiary Care Teaching Hospital

Introduction: Malocclusion can cause dental caries, periodontal disease and aesthetic problems. Malocclusion is most common dentofacial abnormality found in human population. However, the awareness for orthodontic treatment is increasing. Objective: The aim of this research was to evaluate pattern of malocclusion in patients undergoing orthodontic treatment at Nobel Medical College Teaching Hospital of Biratnagar, Nepal. Methods: Two hundred and eighty preoperative study casts (2018 Jun to 2020 Jun) of orthodontic patients aged from 12-55 years were selected from 680 patient’s records of department of orthodontics of Nobel medical college teaching hospital, Biratnagar. Standard protocol of Angle’s classification of malocclusion was used to classify malocclusion and its traits were recorded. Data were entered in Microsoft Excel and descriptive statistics were calculated. Results: The prevalence of malocclusion were 59.65% (167) of Angle’s class I, 35.71% (100) of Angle’s class II and 4.64% (13) of Angle’s class III malocclusion. Among various attributes of malocclusion, deep bite was the most common trait (188, 67.14%). Increased overjet was found in 169 (60.35%) subjects. Crowding and spacing were found in 164 (58.57%), and 109 (38.92%) respectively. Conclusion: Angle’s class I malocclusion is most prevalent malocclusion seen followed by Angle’s class II and Angle’s class III.

Bicuspidisation: Two is Better than None - A Case Report

A periodontally compromised tooth with severe furcation involvement may as well be retained of their roots rather than its removal in toto. Bicuspidisation (Premolarisation) is a surgical technique of sectioning mandibular molar roots with their respective crown portions followed by rehabilitation with fixed prosthesis in the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. The present case report demonstrates the successful management of grade III furcation involved mandibular molar by bicuspidisation followed by subsequent prosthodontic rehabilitation. It gives a better alternative to salvage a periodontally compromised tooth rather than opting for extraction.

Congenital Maxillary Double Lip: A Case Report

A double lip is an infrequent anomaly that may either be congenital or acquired. It commonly effects the upper lip with more predilection in males. Double lip may require surgical correction for aesthetic or masticatory reasons. Treatment includes excision of the mucosa and submucosal tissue that gives good result. A 19-year-old male presented with bulge under central portion of upper lip with no constriction. Surgical correction was done using an elliptical incision to remove excess mucosal tissues. Satisfactory aesthetic result was obtained with an uneventful healing.