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Background and purpose: Smoking increases the incidence and severity of periodontal disease. Elevation in the level of salivary soluble CD44 is considered as a diagnostic marker in some smoking-induced disorders such as periodontal disease. This study evaluated the salivary soluble CD44 level in smokers and non-smokers with and without moderate chronic periodontitis, before and one month after scaling and root planning (SRP). Materials and methods: This case-control study was done in 50 male aged 30 to 60 years attending Periodontology and Oral Medicine Departments of Babol Faculty of Dentistry, 2011-2012. The patients included 23 with moderate chronic periodontitis, 11 smokers, 12 non-smokers, and 27 patients with healthy periodontium of whom nine were smokers and 18 were non-smokers). The level of salivary soluble CD44 was assessed at baseline for all patients and one month after SRP for patients with moderate chronic periodontitis. Results: The highest and lowest level of salivary soluble CD44 was seen in smokers with moderate chronic periodontitis and non-smokers with healthy periodontium, respectively. The results after SRP treatment in patients with periodontitis showed significant reductions in salivary soluble CD44 levels in both smokers (P=0.001) and non-smokers (P=0.031) and this reduction was found more in smokers (P=0.021). Conclusion: Periodontitis can increase the level of salivary soluble CD44. Also, smoking and periodontal disease have a synergism effect on increasing the level of salivary soluble CD44.

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Background and purpose: Gestational diabetes mellitus is one of the main complications in pregnancy.  Periodontitis associated with increase in inflammatory factors is a risk factor in pregnancy. In this study we investigated the relation between periodontitis and related inflammatory mediators and gestational diabetes mellitus.

Materials and methods: A total of 100 singleton pregnant women with gestational diabetes and 100 singleton pregnant women with normal glucose level (gestational age >20 weeks) were included. The patients underwent dental examinations and those with periodontitis and gingivitis were identified. Blood samples were taken and ESR and hsCRP were measured in all patients. Data was analyzed in SPSS applying independent t-test and qui square.

Results: The prevalence of periodontitis in patients and controls were 36% and 28%, respectively (P= 0.22). All periodontitis were moderate and no severe periodontitis was observed. Gingivitis was seen in both pregnant women with diabetes (74%) and control patients (83%) (P= 0.12). Among the subjects 18% of patients and 22% of the control group had severe gingivitis while others had moderate to mild gingivitis (P= 0.45). Dental plaques were seen in 73% of pregnant women with diabetes and 91% of the control group (P= 0.01). No significant relationship was seen in inflammatory mediators between the individuals with/without periodontitis and gingivitis.

Conclusion: In this study, no relationship was found between gestational diabetes, gingivitis, severity of gingivitis, periodontitis, and inflammatory markers. According to the lower levels of dental plaque in pregnant women with gestational diabetes other reasons rather than poor oral hygiene are believed to be involved. Due to higher false positive estimation of probing depth caused by gingival hypertrophy in pregnancy, more precise criteria are needed to investigate periodontitis in pregnant women.

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Histiocytosis is a term applied to a group of rare disorders of the reticuloendothelial system. Eosinophilic granuloma is the most benign and localized of the three Langerhans cell histiocytosis (LCH) entities that could be solitary or multiple. In 2015, the incidence of the disease was reported to be 1 in 9100000. Eosinophilic granuloma can affect almost any bone, but commonly involves the mandible when the jaws are affected. Conventional treatment of LCH includes surgery, radiotherapy, chemotherapy and steroid injections (alone or in combination). Spontaneous regression of localized disease has also been reported. We report a 30-year-old man with the LCH solitary eosinophilic granuloma in the mandible. The patient had lost all the mandibular teeth because of a misdiagnosis with periodontitis and osteomyelitis.

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Background and purpose: Periodontitis and gingivitis are inflammatory diseases in supporting tissues of tooth. Mast cells are inflammatory cells that can participate in destruction of connective tissue in periodontal diseases. In this study we evaluated mast cells count in gingival tissues in individuals with periodontal diseases and compared that with those in healthy people.

Materials and methods: This case-control study was done in 60 samples obtained from patients with advanced periodontitis (n=15), moderate periodontitis (n=15), gingivitis (n=15), and healthy tissue samples (n=15, control group). Biopsy specimens obtained during flap and crown lengthening surgery were stained with toluidine blue and hematoxylin eosin.

Results: Mast cells count were significantly different between four groups (P<0.001). In fact a significant difference was found in healthy status compared to that in moderate periodontitis, advanced periodontitis and gingivitis (P<0.001) but it did not show any significant difference in advanced and moderate periodontitis compared with that in gingivitis (P>0.05). Also, mast cells count did not reveal any significant difference between advanced periodontitis and moderate periodontitis (P>0.05). Moreover, we found no significant relationship between mast cells count and degree of microscopic inflammation (P=0.09)

Conclusion: Mast cells are believed to play a role in pathogenesis of periodontal diseases, but further studies are suggested to clarify this role.

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Background and purpose: Controlling inflammation is a major approach in periodontal treatments, but scaling and root planing are not always effective enough. Curcumin is anti-inflammatory and can adjust inflammatory reactions and its efficacy and immunity is proven. The present research aimed at evaluating the potential of Curcumin BCM-95 in treatment of patients with chronic periodontitis.
Materials and methods: In a double blind clinical trial, the clinical parameters including, Gingival Sulcus Bleeding Index (GSBI), Loe and Silness Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Level (CAL) were recorded at the beginning of the study, at week 6, and month 4. In case group, patients with moderate chronic periodontitis who had no systemic disease with at least one periodontal pocket with 4-6mm depth in each quadrant and bleeding on probing were chosen. After scaling and root planing, the patients took 2 Curcumin oral capsules per day for 4 weeks. The patients in the control group were given placebos.
Results: The effect of time was found to be significant in PPD, GI, CAL, and GSBI. Moreover, significant differences were seen between PPD average measurements before medication, at first follow up, and second follow-up (P<0.05). But, in GI, GSBI, and CAL the group effect was not significant. In other words, the reduction was seen in these parameters in both groups but they were not significant.
Conclusion: The effect of Biocurcumax ^TM Curcumin (BCM-95) was significant in treatment of moderate chronic periodontitis in PPD between the two groups which reduced this parameter.
 

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 Background and purpose: Psoriasis is a chronic inflammatory genodermatosis, and periodontitis is an inflammatory disease of the protective tissue of the tooth. There is increasing prevalence of psoriasis and periodontitis and some studies indicated a relationship between psoriasis and periodontitis. The purpose of this investigation was to study the frequency and severity of periodontitis in patients with psoriasis.
Materials and methods: In this study, the severity of psoriasis and mouth and teeth examination results of 40 patients were recorded. Tooth looseness, number of missing teeth, bleeding on probing, and clinical attachment loss were measured using periodontal probe. Data analysis was carried out applying t test, Chi square, and correlation coefficient.
Results: The overall prevalence of periodontal diseases was 80%, including loose teeth (10%), missing teeth (47.5%), gingival bleeding (60%), and gingival resorption (62.5%). Periodontal diseases were found to be significantly associated with duration and severity of psoriasis (P = 0.032 and P <0.001, respectively). Also, there was a significant association between severity of periodontal diseases and duration and severity of psoriasis (P = 0.048 and P = 0.023, respectively).
Conclusion: According to this study, periodontal diseases are highly prevalent in patients with psoriasis which are associated with severity and duration of psoriasis. Inflammatory process is involved in both diseases, so, accurate oral examinations for periodontal diseases are strongly suggested in patients with psoriasis.

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Background and purpose: Ascorbic acid is an important antioxidant and its depletion is a risk factor for periodontal diseases. This study aimed to evaluate the effect of 2% atorvastatin dentifrice and ascorbic acid on improving clinical periodontal parameters in patients with chronic periodontitis.
Materials and methods: This clinical trial included 72 patients with moderate and severe chronic periodontitis attending periodontology department in Yazd Dental School, Iran. They were randomly divided into four groups (n=18 per group). Group 1 was the control group that used 0.2% fluoride dentifrice after Scaling and Root Planing (SRP). Group 2 used 0.2% flouride dentifrice + adjunctive use of atorvastatin 2% following SRP. Group 3 used 0.2% fluoride dentifrice and 250mg chewable ascorbic acid tablet after SRP. Group 4 used 0.2% fluoride dentifrice + adjunctive use of atorvastatin 2% and 250mg chewable ascorbic acid after SRP. Periodontal parameters including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and modified gingival index (MGI) were measured at baseline and one month after treatment. Data were analyzed in SPSS V17 applying Chi square, ANOVA, and Tukey test.
Results: After one month, significant decreases were seen in CAL (P= 0.0001) and MGI
(P= 0.029). In groups 2 and 4, the decrease in CAL was significantly higher than the control group
(P= 0.0001) and in comparison between case groups there were significant differences between groups 3 and 4 (P= 0.0001). In group 3, significant decrease was seen in MGI compared to the control group (P<0.05).
Conclusion: Combination treatment with SRP, 2% atorvastatin dentifrice and ascorbic acid is more effective in improving periodontal parameters than SRP alone.
 
(Clinical Trials Registry Number: IRCT20171015036782N5)
 

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Background and purpose: Determining the prevalence of various diseases in different communities is one of the first measures to improve the level of education, prevention and treatment of diseases. Occasionally, first symptoms of some diseases appear in mouth, so, timely diagnosis made by dentists is of particular importance. The aim of this study was to determine the frequency of oral mucosal lesions and some related factors in patients over 12 years of age in Oral Medicine Department affiliated with Semnan Dental School in 2017-2019.
Materials and methods: In this descriptive study, all individuals aged 12 years and older (n=1001) were investigated. Data, including gender, age, oral lesions, smoking, and wearing dentures were recorded in a checklist and analyzed in Chi-square test in SPSS V26.
Results: In this study, 1001 people including 420 men and 581 women were studied. Frequency of oral lesions was 78.5%. The most common lesions were coated tongue (36.5%), gingivitis (34%), and periodontitis (28.4%). There was a significant relationship between age and oral lesions (P< 0.001). Total frequency of lesions was significantly higher in smokers (P= 0.016). Among the patients, 98.8% were unconscious about their oral lesions.
Conclusion: Relatively high frequency of oral lesions and lack of awareness of their presence in people studied indicate the necessity for periodic oral mucosal examinations and dental examinations.

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 Background and purpose: The association between periodontal diseases and endometrial cancer (EC) has been assessed in some studies but the probable role of inflammatory factors such as visfatin is unknown. This study aimed at evaluating the levels of visfatin in gingival crevicular fluid (GCF) in patients with EC and chronic periodontitis (CP) to address this gap.
Materials and methods: In a case-control study with matched age and body mass index controls, 120 female participants were divided into four groups. Case groups included group I (EC-CP [n=20]), group II (EC without CP [n=20]), and controls were group III (without EC but diagnosed with CP [n=40]), and group IV (healthy without EC or CP [n=40]). GCF samples were collected and visfatin was assessed by enzyme-linked immunosorbent assay.
Results: Clinical periodontal parameters such as periodontal pocket depth, clinical attachment loss, and bleeding on probing were significantly higher in EC-CP group than other groups (P<0.001). Mean visfatin level in GCF was found to be significantly different in group I compared with groups II and IV (P<0.001). Also, there was a significant difference in visfatin concentration in GCF between group III and group IV (P<0.001).
Conclusion: According to current study, GCF visfatin concentration is probably associated with EC and CP.
 

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Background and purpose: Systemic conditions, such as diabetes or cardiovascular disease are associated with periodontal disease. Recent studies suggested a link between periodontitis and gastrointestinal cancers. Due to the importance of this issue, this study aimed to evaluate the prevalence of chronic periodontitis in patients suffering from gastric, esophageal, and colorectal cancers attending Sari Imam Khomeini Hospital, 2017-2018.
Materials and methods: In this cross-sectional study, clinical examination of 100 patients was performed by assessing clinical attachment loss (CAL), bleeding on probing (BOP), and tooth loss. After recording the periodontal pockets' depth and gingival recession, the CAL was calculated. Chronic periodontitis was categorized as mild, moderate, and severe based on classification of periodontal disease. Chi-Square and ANOVA were applied for data analysis.
Results: According to findings in patients with gastric cancer (n= 23) mild, moderate and sever periodontitis were seen in 8.7%, 26.1%, and 26.1%, respectively. There were 10 patients with esophageal cancer of whom 40% were healthy, 40% had moderate periodontitis, and 20% had severe periodontitis. Among patients with colorectal cancer (n=67), 7.5% had mild periodontitis, 46.3% had moderate periodontitis, and 1.5% had severe periodontitis.
Conclusion: In patients with moderate to severe chronic periodontitis, due to the loss of periodontal support of the teeth that leads to loosening the teeth, the chances of tooth loss increase which naturally disrupts the patient's eating process and causes digestive problems.

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 Background and purpose: 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.
Materials and methods: 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.
Results: 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.
Conclusion: According to this study, there is no link between osteoporosis and periodontal status in postmenopausal women.
 

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Background and purpose: Diabetes is one of the most common diseases in the world, and blood sugar control and periodontal diseases are mutually related. The aim of this study was to investigate the periodontal status of people with type 2 diabetes referred to Imam Khomeini and Touba Medical Centers in Sari during 2018-2019.
Materials and methods: This descriptive cross-sectional study included 107 randomly selected patients who were diagnosed with type 2 diabetes (controlled and uncontrolled). HbA1C values were evaluated to check the diabetes status of the patients, and Community Periodontal Index (CPI) was evaluated to check the periodontal status. Statistical analysis was performed using SPSS V24.
Results: All the 107 patients were females, with an average age of 49.7±11.2. Diabetes was controlled in 46.7% of the patients, while 37.4% of the patients had uncontrolled diabetes. In the examination of periodontal condition, 40.2% were healthy, 30.8% had gingivitis, and 29% had periodontitis. The value of CPI was 1.8 ± 0.5, and code 3 (envelope 4-5 mm) was the most frequent index.
Conclusion: Since the highest frequency of Community Periodontal Index of Treatment Needs (CPITN) was related to code 3 (4-5 mm packet depth), it is recommended that diabetic patients fulfill their oral hygiene and make regular visits to the dentist for follow up examinations.
 

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Background and Purpose: Diabetes Mellitus is a group of complex, multi-system metabolic disorders that alter many functions of the immune system and are associated with delayed recovery and a reduced immune response. Apical periodontitis is the inflammation and destruction of the periodontium in the apical region of the root, originating from the pulp, and as a result, an inflammatory response creates a radiolucent area at the root apex. In this study, we aimed to investigate the relationship between the presence of pulp and periapical lesions and controlled type 2 diabetes in the radiographic images of patients.
Materials and Methods: In this cross-sectional study, 45 patients were included in the case group (patients with controlled diabetes) and 45 in the control group (healthy individuals). Periapical and endodontic status was evaluated based on examinations using panoramic and periapical images. In the dental examinations (excluding third molars), the following were recorded for each patient: the number of teeth in the mouth, the number and location of teeth without root canal treatment with a periapical lesion, the number and location of teeth with root canal treatment, and the number and location of teeth with root canal treatment with a periapical lesion. The periodontal condition was assessed using the periapical index (PAI), with scores greater than 3 considered indicative of periapical pathology. For inferential analysis, chi-square tests and independent t-tests were used.
Results: Among the 90 participants, 53 were women and 37 were men. The average age of the participants was 43.6 years, and the average age was higher in the diabetic group. In total, 52.2% of patients had periapical lesions and 63.3% had pulpal lesions, with these two lesions being significantly more common in diabetic individuals(P<0.05). Among all patients, there was a significant relationship between gender and periapical lesions (P=0.022), with women having a higher prevalence of these lesions. In non-diabetic individuals, unlike diabetic individuals, the relationship between gender and periapical lesions was significant, with women having more lesions(P=0.03). Across all patients, there was a significant relationship between age and periapical lesions (P=0.001), with the average age being higher in patients with periapical lesions. In diabetic individuals, unlike non-diabetic individuals, no significant relationship was observed between these two variables (P=0.828).
Conclusion: The study results demonstrated a significant relationship between the prevalence of pulp and periapical lesions and factors such as sex, age, and type 2 diabetes. The findings revealed that the prevalence of pulp and periapical lesions is higher in patients with type 2 diabetes compared to those without diabetes. The likelihood of developing these lesions increases with age and is generally higher in women. Additionally, no correlation was found between the prevalence of pulp and periapical lesions in men without type 2 diabetes and increasing age in individuals with type 2 diabetes.