Search Results (230)

Background: Halitosis is a common condition often rooted in periodontal disease and exacerbated by systemic disorders such as obesity. This short-term clinical evaluation investigates the relationship between halitosis, obesity, and periodontitis, and assesses the efficacy of a natural essential oil mouthwash as an adjunctive oral hygiene intervention. Methods: In this randomized, placebo-controlled clinical trial, 45 obese patients with diagnosed periodontitis and self-reported halitosis were randomly assigned to either a test group (n = 30), receiving an essential oil-based mouthwash, or a control group (n = 15), receiving a placebo. Over 28 days, participants were evaluated using plaque index (PI), bleeding on probing (BOP), organoleptic scoring, and BANA test results. Both subjective and objective halitosis assessments were performed. Results: The test group showed marked improvements in all parameters compared to controls. PI decreased by 31.5% in the test group versus 9.25% in controls; BOP reduced by 34.5% versus 6.0%; BANA test positivity dropped by 38.1% in the test group. Organoleptic scores improved by 45.9% (examiner-rated) and 36.8% (self-assessed) in the test group. Conclusions: This 28-day clinical evaluation demonstrates the potential of an essential oil-based mouthwash to significantly reduce halitosis and periodontal inflammation in obese individuals with periodontitis. The necessity of future randomized trials is evident to substantiate the sustained benefits and safety of the intervention. Full article

Objectives: This study aims to evaluate the clinical and microbiological efficacy of a novel Activated Ozonated Extra-Virgin Olive Oil (AOEOO) gel as a topical adjunct in the treatment of periodontal pockets. Methods: In this double-blind, randomized clinical trial, patients diagnosed with stage II–IV periodontitis received either scaling and root planing (SRP) and placebo gel or SRP combined with subgingival AOEOO gel application (test group). Periodontal indices—probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP)—were measured at baseline, 3, and 6 months. Microbiological analysis using real-time PCR quantified six key periodontal pathogens at baseline and after 6 months. Results: AOEOO-treated patients showed significantly greater improvements in PPD, CAL, PI, and BOP at both 3 and 6 months compared to the placebo group (p < 0.05). Also, microbiologically, the AOEOO group exhibited a significant reduction in total bacterial load and in all target pathogens, with reductions ranging from 63.8% to 98.7% (p < 0.05). No adverse effects were reported. Conclusions: The adjunctive use of AOEOO gel significantly improved periodontal outcomes and reduced pathogenic bacterial load, supporting its potential role as a safe and effective supportive treatment in periodontitis management. Full article

Periodontitis is a chronic, multifactorial inflammatory disease characterized by the progressive destruction of the periodontal supporting tissues, including alveolar bone, potentially resulting in tooth loss. Etiopathogenesis involves a dysbiotic shift in the subgingival microbiota where the presence of pathogenic species such as Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Treponema denticola has been documented. This disbalance is combined with an inadequate host immune response, often exacerbated by other systemic comorbidities including diabetes mellitus and cardiovascular diseases. Conventional therapy typically comprises mechanical debridement and adjunctive local or systemic antimicrobials, but emerging antibiotic resistance highlights a need for alternative adjuvant therapeutic strategies. The present descriptive analysis of microbiome and clinical trends study evaluated the adjuvant effects of a clinoptilolite-based zeolite material, namely PMA-zeolite, with professional prophylaxis on clinical and microbiological parameters in patients with chronic periodontitis over a 10-week period. Clinical assessment revealed significant reductions in bleeding on probing (BoP) and periodontal pocket depth (PD), indicating improved inflammatory status. Microbiome profiling demonstrated a marked decrease in key periodontal pathogens, suggesting that PMA-zeolite can help rebalance the oral microbiome. These findings suggest that the combined therapy exhibits promising anti-inflammatory and antimicrobial properties, indicating its role in promoting microbial homeostasis and reducing periodontal inflammation. However, further investigation through larger, controlled clinical trials is needed to validate the efficacy of the therapy. Full article

Objectives: We aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) in promoting wound healing after the surgical removal of inferior third molars. Methods: Patients in need of unilateral mandibular third molar extraction were randomly assigned to either a test or control group before surgery. During the test, a photoactive substance activated with laser light (20 mW, 660 nm) was applied to the post-extraction site for 60 s before suturing to promote healing and disinfection. The control group did not receive any laser applications after tooth removal. The probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and levels of clinical attachment loss (CAL) before surgery (T0), 14 days after surgery (T1), and after 3 months after surgery (T2) were evaluated for the adjacent second molar. Post-operative swelling, pain (VAS index), the number of painkillers taken, alveolar probing, and Landry’s healing index were recorded at T1. Results: Sixty-five patients, aged between 14 and 39 years, were assigned randomly to test (n = 32) or control (n = 33) groups. Five dropouts occurred. Post-operative swelling and the VAS index were significantly lower in the test group compared to the control (p = 0.002 and p = 0.04, respectively). All periodontal indexes except recession significantly worsened at T1 in both groups. After three months, a significant improvement for PPD, CAL, and PI was recorded in the test group compared to the control (p = 0.001). Conclusions: According to the results of this study, the use of aPDT seems to have a beneficial effect on post-operative swelling and pain, as well as the plaque index, in the short-term follow-up. Full article

Background: This systematic review aimed to assess the outcomes related to the use of antimicrobial photodynamic therapy (aPDT) as an adjunct to non-surgical periodontal treatment (NSPT) of patients affected by periodontitis and with type 2 diabetes mellitus (T2DM). Methods: PubMed, Cochrane Library, Scopus, and Web of Science (core collection) were queried up to January 2025. The PICO question investigated the comparison between T2DM patients undergoing NSPT with or without aPDT, in terms of improvement of clinical parameters. Two independent operators performed the study selection, data extraction, and risk of bias assessment (RoB-2 tool). The meta-analysis examined the reduction in bleeding on probing (BoP) and probing pocket depth (PPD) in sites > 4 mm, reporting mean difference (MD) and 95% confidence intervals (CIs). Results: Among 502 studies retrieved, 15 were finally included in the systematic review and meta-analysis. In T2DM individuals, the adjunct of aPDT to NSPT demonstrated a substantial reduction in BoP and PPD after 3 and 6 months compared to the use of NSPT alone. Conclusions: The outcomes of this systematic review suggest that adjunctive aPDT may provide additional benefit to NSPT in reducing inflammation in T2DM patients with periodontitis, indicating that this combined therapy could represent a potentially useful approach for individuals with T2DM. Review registration: registration in PROSPERO (International prospective register of systematic reviews) with ID CRD42024506295 on 6 February 2024. Full article

Background: Periodontitis is linked to sleep-disordered breathing (SDB), including snoring, with 50–75% of cases involving mouth breathing (MB). Standard treatment includes scaling and root planing (SRP). Oral appliance therapy (OAT) is used to treat snoring and SDB. OAT plus a mouth shield (OAT+) worn during sleep may reduce MB to enhance periodontal health. This study evaluated whether OAT+, as an adjunct to SRP, improves periodontal health by reducing periodontal pathogens and facilitating upper airway patency. Methods: Fourteen participants with mild–moderate periodontitis were randomized to receive SRP on one side of the mouth at baseline (T0). Pocket depth (PD), bleeding on probing (BOP), and plaque index (PI) were recorded, and bacterial DNA from periodontal pockets were analyzed via PCR at baseline (T0) and 12 weeks (T3). At 4 weeks (T1), all participants received a self-titrated myTAP^® OA, followed by a mouth shield at 8 weeks (T2). Sleep metrics, including respiratory disturbance index (RDI), were recorded using the NOX T3 at T0–T3. Results: BOP and deep PD levels exhibited slight improvements from the baseline for both SRP and non-SRP (OAT+ only) treated sites but did not achieve significance. BOP decreased significantly more from the baseline in the SRP than in the non-SRP group at T3 (p = 0.028); P. gingivalis’ presence declined on both sides (p = 0.0135). Other periodontal and bacterial parameters showed no significant differences between or within groups. Snoring (p = 0.011), MB (p = 0.025), and RDI (p = 0.019) significantly decreased with OAT+ at T3. Conclusions: In mild–moderate periodontitis patients who snore, OAT+ reduces snoring, MB, and obstructive events, serving as an adjunct to SRP with no negative clinical effects over the short term. The combined therapy yielded similar results to OAT+ alone, likely due to minimization of MB. Its capacity to improve the oral environment is worthy of further investigation. Full article

Background: Topical application within peri-implant pockets ensures high drug concentrations at the infection site while minimizing systemic exposure. However, the comparative effectiveness of non-surgical causal therapy alone versus its combination with doxycycline remains unclear. This retrospective observational clinical study aimed to evaluate the impact of adjunctive doxycycline on peri-implant parameters, considering smoking, systemic conditions, and implant–prosthetic rehabilitation (single implant, implant-supported bridge, or full-arch). Methods: Patients were retrospectively assigned to a control group (CG), receiving non-surgical causal therapy alone, or a test group (TG), which is also treated with topical doxycycline. Peri-implant parameters, including Peri-implant Probing Depht (PPD), Bleeding on Probing (BoP), Plaque Index (PI), and suppuration, were assessed at baseline (T0) and follow-up (T1). Multivariate logistic regression and stratified subgroup analyses were conducted to adjust for confounders such as smoking, systemic conditions, and implant–prosthetic rehabilitation types. Results: Two hundred nine patients were included in the study, of whom 97 were in the CG and 112 were in the TG. At T1, the TG exhibited a statistically significant reduction in PPD, BoP, PI, and suppuration compared to the CG (p < 0.05). Conclusions: The adjunctive use of topical doxycycline significantly enhances clinical outcomes in non-surgical peri-implantitis treatment. Further longitudinal studies are needed to confirm these findings and assess long-term stability. Full article

Aim: This systematic review and meta-analysis evaluated the adjunctive use of hyaluronic acid (HA) in non-surgical periodontal therapy to improve clinical outcomes in patients with moderate-to-severe chronic periodontitis. The aim was to assess its effectiveness in reducing probing pocket depth (PPD), improving clinical attachment level (CAL), and decreasing bleeding on probing (BOP). Methods: Four electronic databases were searched (PubMed, Cochrane Library, Scopus, Web of Science, Grey Literature) for randomized controlled trials (RCTs) published until January 2025 and involving otherwise healthy patients treated with scaling and root planing (SRP) plus HA after at least 12 weeks of follow-up. Risk of bias was assessed using RoB 2.0; data were collected on clinical assessment, microbiological, and biochemical analysis and then analyzed using a fixed-effects or random-effects model considering the high heterogeneity of the included studies, which calls for caution when interpreting the results. Results: Fourteen of the 21 RCTs reviewed underwent a meta-analysis. Compared with SRP alone, the addition of adjunctive HA ≥ 0.8% led to an improvement in PPD, but the reduction in BOP was less consistent. Biochemical markers indicated less inflammation, oxidative stress, and selective antimicrobial activity. Although studies on 0.2% HA are still limited, improvements have been observed in clinical parameters, along with better biochemical and microbiological outcomes in the experimental group compared to the control group. Conclusions: Despite moderate heterogeneity and methodological limitations, the evidence supports the use of HA combined with SRP in periodontal treatment. Full article

Background: Peri-implant diseases, including mucositis and peri-implantitis, pose a challenge to implant dentistry and require effective maintenance protocols. Professional biofilm removal is essential for peri-implant health, but the optimal decontamination method remains controversial. Methods: This randomized clinical trial compared erythritol-based air polishing and ultrasonic instruments with PEEK (polyetheretherketone) inserts in peri-implant maintenance, also regarding the different prosthetic materials. A total of 120 patients with implant-supported feldspar ceramic, zirconia, or lithium disilicate prosthetic crowns were randomly assigned to one of the two decontamination methods. Clinical parameters, including probing pocket depth (PPD), bleeding on probing (BOP), and plaque index (PI), were evaluated at baseline (T0), six months (T1), and twelve months (T2). Statistical analysis was performed using Friedman’s test for repeated measures, followed by Dunn’s post hoc test. Subgroup analysis was conducted based on the prosthetic material. Results: Both treatment modalities led to statistically significant reductions in clinical parameters over 12 months. In the erythritol group, PPD decreased by 21.62%, BOP by 86.62%, and PI by 90.74%. In the ultrasonic group, PPD decreased by 14.86%, BOP by 78.69%, and PI by 64.86% (p < 0.05 for all). No statistically significant differences were observed between groups (p > 0.05). Subgroup analysis revealed similar clinical improvements across all crown materials, suggesting that treatment efficacy was not influenced by the type of prosthetic material. Conclusions: Both erythritol-based air polishing and ultrasonic instrumentation with PEEK inserts are effective and comparable in the maintenance of peri-implant health. As treatment outcomes were independent of crown composition, the choice between modalities should be tailored to patient-specific needs and clinical conditions. Future studies with a longer follow-up are recommended to evaluate the long-term impact on peri-implant tissue stability and to explore the role of prosthetic materials more comprehensively. Full article

Purpose: This study explored the relationship between matrix metalloproteinase−8 (MMP−8) gene polymorphisms (−799C/T, −381A/G, and +17C/G) and peri-implantitis, examining clinical parameters including the probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Methods: This cross-sectional study involved 120 participants categorized into peri-implantitis and healthy implant groups according to the 2018 classification criteria for periodontal and peri-implant diseases. Saliva samples were analyzed for MMP−8 polymorphisms using polymerase chain reaction (PCR) and Sanger sequencing. Statistical analyses were conducted to evaluate genotype- and allele-specific risks and their associations with clinical parameters. Results: Among the 95 samples analyzed, the −799C/T polymorphism was significantly associated with peri-implantitis, with T allele carriers having a higher diagnosis rate (odds ratio: 3.04, p = 0.010). Although T allele carriers exhibited higher mean values for the probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), these differences were not statistically significant across genotypes. No associations were found between the −381A/G and +17C/G polymorphisms and peri-implantitis clinical parameters. Conclusions: The −799C/T polymorphism, specifically the T allele, is strongly linked to peri-implantitis, indicating its potential as a genetic marker for disease susceptibility. Further research is required to investigate the role of MMP-8 polymorphisms in peri-implant diseases and to advance the development of personalized diagnostic tools. Full article

Polycystic ovary syndrome (PCOS) is a complex condition associated with chronic inflammation and oxidative stress and is often linked to periodontal diseases. This study aimed to determine whether gingivitis modulates the NLRP3 inflammasome in peripheral blood mononuclear cells (PBMCs) from women with PCOS. Following a case-control design, 104 women were divided into three groups: controls (n = 36), PCOS without gingivitis (PCOS, n = 44) and PCOS with gingivitis (PCOS+, n = 24). Periodontal parameters, proinflammatory regulators (NFκB p65, JNK), NLRP3 components (NLRP3, ASC, procaspase-1, caspase-1) and oxidative stress markers (superoxide, NRF2, GCLC and GSR) were determined. The PCOS+ group presented elevated values for bleeding on probing (BOP) and plaque and calculus indices, both of which were associated with increased protein levels of NFκB p65 and JNK, thus indicating NLRP3 inflammasome priming. Higher protein levels of NLRP3, ASC, procaspase-1 and caspase-1 in the PCOS+ group confirmed that priming had occurred, suggesting an engagement in assembly. When potential assembly signals of inflammasome were evaluated, the patients with PCOS generally presented enhanced total superoxide and an impaired antioxidant response (NRF2, GCLC and GSR). Moreover, BOP was independently associated with JNK, ASC and procaspase-1. These findings suggest that gingival inflammation modulates the innate immune response in leukocytes of women with PCOS via the NLRP3 inflammasome pathway, which is regulated by proinflammatory factors and oxidative damage. Full article

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients’ awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes–periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations. Full article

Background: Periodontitis is a prevalent inflammatory condition that destroys periodontal tissues. Scaling and root planing (SRP) is the gold standard for non-surgical treatment; however, its efficacy may be limited in cases with complex dental issues. This umbrella review aims to evaluate the effectiveness of hyaluronic acid (HA) as an adjunct to scaling and root planing (SRP) in enhancing clinical outcomes for periodontitis management. Methods: A comprehensive review of five systematic reviews, including meta-analyses where available, was conducted to synthesize evidence on the adjunctive use of HA with SRP. The studies were evaluated using the AMSTAR-2 quality assessment tool to determine methodological rigor. Data on clinical parameters such as probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were extracted and analyzed. Results: The findings indicate that HA supplementation leads to moderate improvements in PD, CAL, BOP, GI, and PI compared to SRP alone. Notable reductions in PD and gains in CAL were observed, with some meta-analyses showing statistically significant benefits. However, the heterogeneity in HA concentrations (0.2–1.4%), application methods, treatment frequencies, and follow-up durations (1 week to 12 months) limits definitive conclusions. Additionally, HA did not significantly affect the reduction in P. gingivalis prevalence. Conclusions: The use of HA in conjunction with SRP shows promise in enhancing the efficacy of non-surgical periodontal therapy. However, the heterogeneity in the quality and methodologies of the studies indicates the necessity for high-quality, standardized randomized controlled trials to establish clear clinical guidelines for the application of HA in the treatment of periodontitis. Full article

Objectives: The aim of this double-blind, clinical trial study was to evaluate the clinical and antibacterial effects of a herbal toothpaste containing white mustard Sinapis alba extract in comparison to a placebo toothpaste. Methods: One hundred and thirteen participants with gingivitis were randomly assigned to the test group (experimental herbal toothpaste) or the control group (placebo toothpaste). The plaque index (PI), approximal plaque index (API), gingival index (GI), and bleeding on probing (BoP) were evaluated, and salivary samples for microbial evaluation of the loads of Streptococcus mutans and Lactobacillus spp. were collected at baseline (T₀) and after 4 weeks (T₁). Comparisons were performed between and within groups. Results: A reduction in all periodontal parameters (PI, API, GI, and BoP) was observed. The experimental toothpaste reduced the PI by 2.43, compared to a 1.95 reduction for the placebo (p = 0.041), and BoP by 30.6%, compared to a 26.8% reduction for the placebo (p = 0.037). Statistically significant reductions in salivary S. mutans and Lactobacillus spp. counts were found in the test group. Among patients who used the experimental toothpaste, 19.2% and 9.6% showed counts of S. mutans and Lactobacillus spp., respectively, below 10⁵ CFU/mL, compared to 44.2% and 40.4% in the placebo group. Conclusions: Toothpaste enhanced with white mustard extract was more effective in reducing the PI and BoP indices and decreasing S. mutans and Lactobacillus spp. counts compared to placebo toothpaste. Full article

Objectives: This study aimed to assess the systemic and local inflammatory responses in patients with periimplantitis, focusing on key immune markers and clinical parameters. The study further explores the relationship between inflammatory markers, clinical indices, and immune dysregulation, particularly regarding T-cell exhaustion and systemic inflammation. Methods: A cohort of patients with periimplantitis, classified into moderate and advanced stages, was compared to a control group of healthy individuals with dental implants. Clinical parameters, including plaque index (API), bleeding on probing (BoP), probing pocket depth (PPD), and peri-implant sulcus depth (PSI), were recorded. Hematological, immunological, and biochemical analyses were performed, with a focus on immune cell populations (NK cells, T-cells, and their exhaustion markers PD-1 and PD-L1). Results: Patients with periimplantitis exhibited significantly higher clinical indices (API, BoP, PSI, and PPD) than the control group, with the most pronounced differences in the advanced periimplantitis group. Hematological analysis revealed increased leukocyte and neutrophil counts, whereas NK cell levels were significantly reduced. Immunological profiling indicated elevated PD-1 and PD-L1 expression on T-cells, suggesting T-cell exhaustion and immune dysregulation. Furthermore, strong correlations were found between increased PPD values and elevated inflammatory marker levels, highlighting the relationship between peri-implant pocket depth and systemic inflammation. Conclusions: The findings confirm that immune dysregulation plays a central role in periimplantitis progression. The association between increased inflammatory markers, immune alterations, and clinical indices emphasizes the need for a multifactorial diagnostic and treatment approach. Integrating immune modulation strategies, clinical assessments, and lifestyle modifications, such as improved oral hygiene and smoking cessation, could improve disease management and reduce recurrence. Full article