نیلوفر جنابیان

Osteoporosis and periodontitis are two diseases associated with bone loss and are common among postmenopausal women. There are many contradictory results on the effect of osteoporosis on periodontal tissue. This study aimed to determine the association between osteoporosis and periodontal status in postmenopausal women.

This cross-sectional study was part of the second phase of the Amir kola Health and Aging Project (AHAP), in which 210 postmenopausal women were randomly divided into three groups (n=70 per group); normal bone density group,  osteopenic group, and osteoporotic group. Periodontal status was measured using Periodontal Disease Index (PDI), Plaque Index (PI), and Simplified Oral Hygiene Index (OHI-S). Bone mineral density (BMD) was measured by Dual-energy X-ray absorptiometry (DEXA). Data were analyzed in SPSS V17 applying ANOVA, Kruskal-Wallis, and Pearson correlation coefficient.

The average age of the participants was 65.24±4.36 years. There were no statistically significant differences between the mean OHI (2.26±1.40), PDI (2.76±1.42), and PI (1.23±0.87) in the osteoporotic group, and the mean OHI (2.01±1.62), PDI (2.56±1.61), and PI (1.35±0.91) in the osteopenia group, and mean OHI (1.73±1.37), PDI (2.47±1.43), and PI (1.23±0.87) in the normal group (P>0.05). The OHI, PDI, and PI had a slight but insignificant negative correlation with BMD.

According to this study, there is no link between osteoporosis and periodontal status in postmenopausal women.

Nifedipine (NF) is a calcium channel blocker that accelerates wound healing and subsequently relieves pain and discomfort. The aim of the present study was to investigate the local effect of this drug on the wound-healing process of the palate.

In this triple-blind clinical trial study, 31 patients who were referred to the Periodontology Department of Babol Dental School (14 in the experimental group and 17 in the control group) were examined. They were candidates for gingival surgery and needed a palate transplant. Mucotom was used to create identical wounds in the palate (transplant donor). After a free gingival grafting, the active ingredient of 0.3% NF was applied as a mucosal adhesive (made of chitosan) in the area of the graft (palate). Patients were examined and recorded on days 2, 4, 7, 14, and 30 after surgery for wound closure and healing criteria (Landry & Manchester scar scale) and pain (VAS). Sutures were removed on day 7 of the study. Data were analyzed with SPSS 20 and chi-square, Kruskal-Wallis and Mann-Whitney tests. The significance level was set at 0.05.

Based on Landry and Manchester criteria, the wound healing process in the two groups was not significant (p=0.125). There was no significant difference between mean wound size reduction and VAS in both treatment and control groups (p=0.253).

Topical NF has no effect on the natural process of healing oral mucosal ulcers and reducing pain.

Considering that nutrition plays a prominent role in the health of the elderly, oral health and the associated quality of life are very important for a healthy diet. The aim of this study was to investigate the association between the frequency of fruit and vegetable consumption and oral health-related quality of life (OHRQoL) among the elderly in Amirkola.

 This study was part of the second phase of the Amirkola elderly cohort study conducted on 750 older people who underwent a special oral and dental examination in 2016-2020 using the Oral Health Questionnaire. The frequency of fruit and vegetable consumption was assessed with the  Semi-Quantitative Food Frequency  Questionnaire (SQFFQ), OHRQoL was assessed with the  General Oral Health Assessment Index (GOHAI), and information on age, sex, history of systemic diseases, and the number of teeth was extracted from the full data set completed by specialists for each patient. Data were analyzed with SPSS 20 using the chi-square statistical test, ANOVA, and Pearson correlation coefficient. A value of p<0.05 was considered significant.

 Non-smokers and people with a higher level of education had a better OHRQoL (P=0.022 and P=0.036, respectively). There was no significant relationship between the frequency of fruit and vegetable consumption and OHRQoL, but a significant relationship was found between the frequency of fresh herb consumption and OHRQoL (p=0.005). In men, there was a significant relationship between the number of teeth and frequency of vegetable consumption as well as between OHRQoL and frequency of fresh herb consumption in men (P=0.048, r=0.096).In women, a significant relationship was observed between the frequency of total vegetable consumption and OHRQoL (p=0.021, r=0.129).

According to the results of the present study, it was found that the amount of fruit and vegetable consumption has no effect on improving the OHRQoL among the elderly of Amirkola city.

Periodontal disease is one of the most common chronic oral diseases worldwide. A variety of foods may affect periodontal health. Due to the importance of periodontal health in the old age, this study was designed to investigate the association between carbohydrate intake and periodontal health in the elderly in Amirkola, northern Iran.

This cross-sectional study is part of the second phase of the Amirkola Health and Ageing Project (AHAP). The evaluated participants included 400 elderly people (200 men and 200 women). Socio-demographic data of all subjects were recorded in the information form. Periodontal status, including plaque index (PI), periodontal disease index (PDI) and Oral Hygiene Index (OHI) were evaluated. Then, the Semi-Quantitative Food Frequency Questionnaire (SQFFQ) was completed in order to receive daily carbohydrates in grams per day for all Participants. Then, the relationship between carbohydrate intake and periodontal health was evaluated.

The participants consumed an average of 316±102.4 gr/day carbohydrates. The mean range of PI, OHI, PDI and in the high carbohydrate intake (>300 gr) group were 2.18±1.39, 2.84±1.51 and 1.51±0.86, respectively, and this rate was lower than the group with low carbohydrate intake (<300 gr) (1.96±1.52, 2.56±1.53 and 1.37±0.91), but the difference between the two groups was not significant.

In the present study, there was no relationship between periodontal health indices and carbohydrate intake.

Chronic periodontitis is a slow-growing inflammatory disease that often occurs in adults. In the elderly, periodontal indices may also change due to a number of psychological factors, such as depression and consequent changes in cortisol levels. Therefore, this study was performed to investigate the relationship between depression and periodontal indices in the elderly in Amirkola, Northern Iran.

This case-control study, which is part of the second phase of the Amirkola Health and Ageing Project (AHAP) to investigate the health status of the elderly in this city, was performed on 300 elderly people. After examination, subjects were divided into two groups: periodontitis (n=100) and control (n=200). In both groups, the presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS), in which a score of 5 or higher is a sign of depression, and periodontal indices including OHIS and PDI were examined based on PDI≥4 periodontitis criterion. Then, the two groups were compared in terms of the association between periodontal indices and depression.

In this study, 133 were female (44.3%) and 167 were male (55.7%). 35 patients (35%) in the case group and 61 patients (30.5%) in the control group had symptoms of depression. The mean GDS score in patients with periodontitis (3.70±3.68) was slightly higher than healthy individuals (3.49±3.40), but no significant correlation was observed between GDS and PDI. Old age, male gender, lower level of education and smoking were higher in patients with periodontitis, which was statistically significant only in smoking and level of education (p=0.042 and p=0.009, respectively). In this study, a positive and weak relationship was observed between age and PDI (r=0.19 and p=0.001).

The results showed that there is a relationship between periodontal indices and depression. Although it was not statistically significant, it is clinically noteworthy.

Ability to reconstruct the papilla in anterior maxilla is important aspect of perio-plastic surgery. In most articles, connective tissue is used with different designs of incisions. The aim of this study was to use sub-epithelial connective tissue graft (SCTG) with two types of incisions called papilla preservation and semilunar.
This basic randomized clinical study was performed on 10 sites in two patients. The patients were selected through inclusion and exclusion criteria. Papilla preservation and semilunar techniques were performed on four and six sites, respectively in the anterior maxilla. In both techniques SCTG was gained from palate .The apico-coronal and mesiodistal changes of the dark triangles were measured after 3 and 6 months. Landry(Healing) index was measured after 14 days and one month,Visual Analogue Scale (Esthetic) index was estimated in 3 and 6 month after surgery and Visual Analogue Scale (VAS ) index was analysed as well . Data were analysed using SPSS. Mann- Whitney, Wilcoxon and Paired t- Test were measured.
Mean±SD of mesiodistal distance in the time of surgery was 2.00±0.000 in semilunar and 2.1±0.629 in papilla preservation technique whereas after 3 months, it was 1.33±0.016 and 1.37±0.478 for semilunar and papilla preservation, respectively and after 6 month was 1.00±0.000 for semilunar and 1.25±0.500 for papilla preservation. Mean±SD of apicocornal changes by semilunar incision in the time of surgery ,3 month after and 6 months later was 2.67±0.516 ,2.25±0.612and1.91±0.204 whereas by papilla preservation was 2.50±0.577,2.25±0.500 and 2±0.000, respectively.
Both techniques had positive effect on papilla reconstruction and the outcome was the same in both groups.

The aim of periodontal treatment is to regenerate periodontium. Regenerative treatments include the use of plasma that is rich in growth factors (PRGF).
In a randomized clinical trial, 20 three-walled intrabony defects from five patients with moderate periodontitis were randomly assigned to three groups. Patients in the control group underwent debridement of lesions. In the first treatment group, the defects were debrided and cenomembrane was applied. The third group was treated with debridement, PRGF and cenomembrane. Measures of vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival index (GI; Sinless and Loe) and radiographic index (by digital subtraction) were made preoperatively and 6 months post-surgery. Wilcoxon signed-ranks and Chi-square tests were used for analyzing quantitative and qualitative variables, respectively.
All three groups showed improvements in all measures except GI. Intra-group comparison for clinical attachment level (CAL) indicated significant difference in all groups before and after surgery (P The use of PRGF was associated with improvements in all parameters but not for GI.

Antioxidant agents such as cocoa could have some benefits in treatment of inflammation including periodontitis. The aim of this study was to investigate the effects of cocoa consumption on moderate chronic periodontitis. This single-blind randomized clinical trial study was performed on 40 subjects who were randomly divided into two groups. Treatment group received 30 gr dark chocolate (78% cocoa) and control group received 22. 5 gr white chocolate three times a day for 4 weeks. Saliva samples were collected from patients at baseline and t wenty-eight days after eating chocolate. Probing pocket depth (PPD)، Gingival index (GI، Silness and Loe)، Modified papillary bleeding index (MPBI، Barnett)، Clinical attachment loss (CAL) were recorded at baseline and 2nd، 4th، 6th، 8th weeks later in ramfjord teeth. Total antioxidant capacity (TAC) and lipid peroxidation of saliva were estimated by Ferric reducing antioxidant power (FRAP) and Tiuborbituric acid reactive substances (TBARS) methods. Data of clinical parameters were analyzed using t-test and repeated measures test. Biochemical parameters were analyzed using t-test. Intra-group comparison of clinical parameters demonstrated significant decrease in both groups (p<0. 0001) and inter-group comparison showed significant decrease of MPBI in treatment group، (p<0. 03). MPBI and GI were significantly decreased in treatment group compared to the control in the weeks of 4th، 6th and 8th، according t-test (GI4، P=0. 008-GI6، P=0. 008-GI8، P=0. 009)، (MPBI4، MPBI6، MPBI8، P<0. 0001). Treatment group showed the increase in FRAP، (p<0. 00001) and decrease in TBARS، (P<0. 015) which were statically significant in compare with control group. Consuming dark chocolate could increase TAC and decrease lipid peroxidation، gingival bleeding and inflammation.

Of all the different techniques used to reconstruct local bone defects guided bone regeneration (GBR) has proved the best choice. Angiogenesis and blood products are important for GBR and are usually derived from blood vessels in the bone. Animal studies have not shown consistent effects of decortication on improving the results of GBR. The aim of this preliminary study was to assess the success rate of bone augmentation with and without bone decortication.

In this quasi-experimental preliminary study, 8 edentulous areas of the mandible were selected in 30-50-year-old patients, with adequate height but inadequate buccolingual width, for augmentation before implant surgery. In the first surgery buccolingual width of the ridge was measured at a height of 2-5 mm from the crest. Augmentation with GBR was performed without decortication of the buccal cortical bone, except in three cases. Seven months later, measurements of the buccolingual width were repeated and biopsies were taken, followed by evaluation of histopathological and histomorphometrical parameters. Descriptive variables were studied and reported.

In areas without decortication, at 2- and 5-mm distances from the crest the mean buccolingual width increases were 0.2 ± 0.05 and 0.6 ± 0.03 mm, respectively. The mean increases in width for decortication areas were 0.33 ± 0.24 and 2.5 ± 0.50 mm, respectively. In all the cases, contact of the newly formed bone with the xenograft was the dominant view.

Under the limitations of the present study, decortication before lateral augmentation of mandibular ridges by using GBR yielded better results in terms of bone reconstruction.

Passive cigarette smoking or environmental tobacco smoke (ETS) exposure is a major public health concern. Children are the most vulnerable group to ETS exposure. The aim of this study was to evaluate the relationship between passive smoking and Total Antioxidant Capacity (TAC) and salivary lipid peroxidation in adolescents. In this historical cohort study sixty adolescents aged 12 to 15 years old were selected. The subjects were assigned into two groups of healthy non-smokers (control) and passive smokers (case) and they were matched for age and sex. Unstimulated saliva was collected with spiting method، and then TAC and salivary lipid peroxidation were measured with FRAP and TBARS methods respectively. Statistical analysis was done using independent t-test. TAC was significantly lower in passive smokers (1218. 8±511. 5 µmol) than in nonsmokers (1490. 5±379. 2 µmol) (p=0. 023). Salivary lipid peroxidation level was higher in passive smokers (14. 6±0. 6 µmol) than in nonsmokers (14. 4±0. 8 µmol) but it the difference was not statistically significant (p=0. 176). The exposure to cigarette smoke can cause a reduction in the salivary Total Antioxidant Capacity.

Vascular endothelial growth factor (VEGF) induces proliferation of endothelial cells، stimulates angiogenesis، and increases vascular permeability and it is an important factor in inflammation and wound healing. The aim of this study was to compare the VEGF level of human gingival crevicular fluid (GCF) in periodontal health and disease. In this case-control study، forty-five subjects from periodontics department of Babol dental school were evaluated in three groups; periodontitis (group 1; n=15)، gingivitis (group 2; n=15)، without periodontal disease (group 3; n=15). Periodontal status was evaluated by measuring probing depth، clinical attachment loss، plaque and bleeding on probing. Samples obtained from GCF of patients after isolation by paper cone. VEGF was assessed by using an ELISA and compared. In periodontitis patients، the mean and standard deviation of VEGF collected from diseased sites were 61. 38±90. 63 pg/ml، in gingivitis patients، concentration of VEGF was 31. 53±63. 64 pg/ml and also concentration of VEGF in healthy patients was 14. 50±6. 17 pg/ml. There was no statistical difference between the mean concentrations of VEGF in studied groups. The results of this study showed that there is no correlation between concentration of VEGF and periodontal situation.

Passive smokers are those who are exposed to cigarette smoke at home or outside of the home. Children are the most vulnerable group of passive smokers. Cigarette smoke in passive smokers is as harmful as in smokers. The aim of this study was to assess the cotinine level in children aged 12-15 years old in Babol, Iran. In this cross-sectional study, samples of saliva were collected from 200 school children aged 12-15 years, in Babol, Iran and cotinine level has been measured with ELIZA. Of 49 (24.5%) passive smokers, 20 were girls and 29 were boys. There was no significant correlation between sex and cotinine level. There was a correlation between cotinine level and smoking in parents or the other family members. (p<0.05) The results of this study showed that a quarter of school children aged 12-15 years in Babol were passive smokers. So, health authorities are recommended to implement public training program to train the families not to smoke around children.

As an important achievement in industrialization and urbanization، depression can be much related to the oral hygiene especially periodontal indexes which are a symbol of tooth and oral hygiene and their surrounding tissues. The purpose of this study was to compare the periodontal indexes in individuals with and without depression disorders.

The present study was carried out in the form of a questionnaire، examination، and recording in the information form. The subjects were divided into two groups of 50; a group included the patients suffering from depression who hospitalized in Neuropsychology ward of Panje Azar hospital in Gorgan، Iran and the control group included either the patients who referred to department of oral medicine and diagnosis of Babol dental school or the people accompanying the patients who had claimed to have no history of depression. The periodontal indexes of the study included: Silness and Loe plaque index، Loe gingival index، pocket depth analysis، as well as bleeding on probing. The information related to each patient was recorded in the form and then two groups were compared.

In the present study، the pocket probing were 2. 7692±0. 5991 and 2. 2917±0. 4643 in the control and case groups، respectively (p= 0. 009). The Plaque Index means were 1. 5385±0. 1 and 7763. 2593±0. 5257 in the control and case groups، respectively. Furthermore، the GI and BOP difference between the two groups were not significant. Moreover، there was no significant relationship between the mean of all the analyzed indexes and the increase of depression.

The results of the present study indicate a vivid relationship between the depth of pocket probing and depression. Nevertheless، none of the periodontal indexes were obviously related to the degree of depression.

Administration of amoxicillin and metronidazole along with scaling and root planning (SRP) is an effective adjunctive therapy for chronic periodontitis. Studies have shown that administration of azithromycin is also effective for treatment of chronic periodontitis. This study aimed to compare the effect of short-term and long-term azithromycin regimen with amoxicillin and metronidazole for treatment of moderate chronic periodontitis in adults.

This experimental study was carried out on 75 patients with moderate chronic periodontitis aged 35-50 yrs. with at least one pocket with a probing depth of 4-6 mm and attachment loss of 3-4 mm in each quadrant. Loe and Silness Gingival Index (GI), Modified Papillary Bleeding Index (MPBI) of Barnett, Loe and Silness Plaque Index (PLI), Probing Pocket Depth (PPD) and Attachment Loss (AL) were calculated at 0, 2 and 4 days, 6 weeks and 2 and 3 months after therapy. The patients underwent SRP and assigned to three groups. Group one received 250 mg metronidazole plus 250 mg amoxicillin 3 times a day for 7 days. Group 2 received 500 mg azithromycin twice daily for 7 days and group 3 received 250 mg azithromycin once a day for one month. Data were analyzed using ANOVA and Repeated Measures ANOVA.

PLI, MPBI, GI, PPD and AL parameters showed a significant reduction in all groups at all understudy time points (P<0.05). The reduction in BI, GI and PLI parameters was greater in group 3 compared to groups 1 and 2 (P<0.05); but, no significant difference was observed between groups 1 and 2 in this respect. A greater reduction in PPD was noted in groups 2 and 3 compared to group 1 (P<0.05). AL showed a significant reduction in group 3 compared to groups 1 and 2 only in the final follow-up session (P=0.042).

Antibiotic therapy regimens were all effective for treatment of chronic periodontitis but the magnitude of improvement was greater in long-term azithromycin group compared to others.

Statement of Problems: Amoxicillin–Metronidazole in conjunction with mechanical therapy such as scaling and root planning (SRP) is an effective adjunctive method for treatment of chronic periodontitis. The use of Co–Amoxiclave as a single medical therapy has been of interest because of its similar therapeutic effects as compared with the compounds mentioned above. The aim of this study was to compare the effects of Amoxicillin-Metronidazole and Farmentin (a new compound of Co- Amoxiclave) in treatment of Moderate Chronic Periodontitis. Methods and Material: In this experimental single blind study, 60 patients (30 females and 30 males) with choronic moderate perdontitis and with an average age of 30-50 years old were evaluated. Scalling and root planning (SRP) and oral health instruction (OHI) were done for all the patients. They were divided into three groups. Group one received Farmentin and group two received Amoxicillin–Metronidazole for one week. Group three didnt receive any antibiotic.Periodontical Disease Index (PDI), Gingival Index (GI), Modified Papillary Bleeding Index (MPBI), Plaque index (PLI), and probing packet Depth (PPD) were measured in their first visits, one week after scaling and before taking medicine, 1,3,6 weeks after taking medicine and 2, 3 months later. Finally, all the data were statistically analyzed by Anova and Tukey test. None of the parameters under the study showed a statistically significant difference between groups 1 and 2 (P 0.05). During the treatment GI showed a significant difference between the test and control groups (p <0.05). MPBI in the test and control groups was significantly different one week after scaling and follow ups. There were significant differences between the two test groups and control in PLI, one week after taking medicine. Also, there were significant differences between groups 1 and 3 (p=0.049, p=0.007) and groups 2 and 3 (p =0.044, p =0.028) in the 4 latest follow up for PPD and PDI. Both Farmentin and Amoxicillin-Metronidazole in conjunction with mechanical therapy (SRP) have similar effects in treatment of chronic moderate periodontitis; however, they are more effective than SRP alone.

Chemotherapeutic agents are adjunctive substances for treatment of periodontitis through modulation of host response. Sodium alendronate is one of the medicaments which are used for this purpose. Since alkaline phosphates (ALP) level is an indicator for evaluation of bone metabolism changes, in this study the effect of sodium alendronate on periodontitis is investigated by measuring gingival crevicular fluid alkaline phosphates (GCF ALP) levels. In this double–blind experimental study, 24 patients (12 males and 12 females between the agen of 35 to 50 years) with moderate chronic periodontitis have been evaluated. All patients received scaling and root planning. Sodium alendronate and placebo capsules were used weekly in a period of six months for case and control groups respectively samples were collected in first visit, 3 months, and 6 month later and analyzed with spectrophotometry. Periodontal assessments were probing pocket depth, gingival index (loe and silness) and plaque index (silness and loe). Data were analyzed by t-test, repeated measurement paired t-test. Mean changes of GCF ALP optical absorbtion were significant in case group through the period of 6 months, and in control group through the period of 3 months, however after 6 months in control group there is no significant changes in comparison with base line evaluations. During the study GCF ALP changes between two group were not significant statically. Mean changes of plaque index and gingival index were statically significant in both groups through 6 months period. Plaque index variations were significantly different between two groups. But duration of gingival index changes between 2 groups was insignificant. The use of sodium alendronate for 6 months improves periodontal parameters and decrease GCF ALP level, but these results are not so significant during this period of time.

Periodontal disease is a chronic inflammatory condition characterized by loss of connective tissue attachment and alveolar bone. The prevention of bone loss may be enhanced by modulating the host response. So, methods which are able to change the host response can be used as adjunction in treatment of periodontitis. One of the medicaments used for this purpose is sodium alendronate(ALN). The aim of this study was to evaluate the effect of alendronate on alveolar bone loss in treatment of periodontitis In this double blind clinical trial, 22 patients (11female, 11male)with moderate periodontitis and average age of 35-50 were selected and divided into two groups. Group I received one capsule of sodium alendronate once a week for 6 month. Group II received placebo during the study period. All the patients received phase I treatment. In order to evaluate alveolar bone height, a periapical radiograph was taken in parallel method at first visit and after 6 months, in the same position. The radiographs were obtained from mandibular second premolar and first molar area and were evaluated with adobe photoshop CS version. The periodontal parameters of the same area(probing pocket depth, clinical attachment level)were measured in initial visit and after 6 months. Data were analysed using Independent Sample t-test, Paired t-test and Mann-Withney U test. Probing pocket depth in groups I and II showed significant reduction after 6 months(P=0.043,0.003 respectively), but clinical attachment level decreased significantly only in groupI(P=0.013). Alveolar bone height did not show significant differences in both groups after 6 months(P>O.05). Using sodium alendronate for six months was more effective than scaling and root planning (SRP) alone, but this effect was not significant.

Aspartate aminotransferase is present in gingivial Crevicular fluid, and there is preliminary evidence that its activity may correlate with the extent of gingival inflammation and tissue destruction. Method & Mateial: This work describes a study in which AST was monitored over a one year in 96 Patients with moderate adult periodontitis. Values for plaque index, gingival index and probing attachment level were recorded, and 30- second 3min samples of gingival fluid harvested. As partate aminotransferase activity was determined by a standar method. Our results showed that Aspartate aminotransferase activity in control group was 432.7526.82 and in patient group was 763.4253.27 unit/min/ ml of GCF. Aspartate aminotransferase activities of 500 units in min in ml of GCF or higher appeared to be associate with active disease. Aspartate aminotransferase activity in GCF is strongly related to human periodontal disease. Our results showed that Ast, as a direct measure of tissue damage, will prove to be useful odjunct in the diagnosis of active periodontitis and ultimately aid in the design of more effective therapy.