Periodontics and Oral Pathology

Periodontics and Oral Pathology

  • Hala Hazzaa added an answer:
    What are the most recent host modulation therapies indicated in treatment of aggressive periodontitis?

    What are the most recent host modulation therapies indicated in treatment of aggressive periodontitis? I am working on the anti-oxidant role of host modulation therapy.

    Hala Hazzaa

    Concerning Teriparatide, would you give us more details about the form, dose, duration ... etc ... In addition, does it have a proven clinical relevance? If yes, you can mention the study.

  • Ulrich Kritzler added an answer:
    Are the SedentexCT guidelines for impacted teeth obsolete?

    The current imaging method of choice is conventional dental radiography. Needed information regarding impacted teeth cannot be obtained adequately by lower dose conventional (traditional) radiography. Should the indication to use cbct be emphasized?

    Ulrich Kritzler

    UP TO ALQERBAN CBCT should be  used in cases with more severe symptoms of maxillary canine impaction. The use of CBCT will improve the diagnostic capabilities and the chances of success in more difficult cases to a level similar to that of simpler cases treated on the basis of 2D information.

  • Sixto Garcia added an answer:
    Is there any consensus on peri-implantitis specific bacteria?

    ¿what type of bacteria are there in periimplantitis?

    are they the same as periodontitis?

    is there any protocol with antibitiotics?

    Sixto Garcia

    thanks proffessor Matys

  • Omayma Siddig added an answer:
    Would Oral cancer grow in this faster pace and does the biopsy worsen the condition?

    A 31-year-old male patient with exophytic mass growing out from his left buccal mucosa, measured 3X2 cm. Incisional biopsy was taken from periphery and it was proved as SCC. After the incisional biopsy (after 14 days) the patient came with progressively enlarged tumor mass from the biopsy site. 

    Omayma Siddig

    We have seen a lot of oral cancer cases that exhibit a rapid rate of growth after taking the incisional biopsy. The inflammation that occurs at the insicion site attempts to heal the incision by poolling in growth factors. The latters act on the malignant squamous cells too causing the flare-up in the tumor size. No to forget mentioning that malignant cell have a stronger response to growth factors than do the normal cells.

  • Sahar El Dessouky added an answer:
    Can we consider CBCT as an effective method for detection of TMJ clicking?

    Does Space analysis of TMJ by CBCT is an accurate method for discrimination between patients with clicking and normal patients?

    Sahar El Dessouky

    Clicking is basically a clinical manifestation which may or may not be accompanied by radiograhic changes of the bone. This means that a patient may suffer severe clicking without any bone alteration. You need here to assess the position of the disc at different stages of mouth opening which is not feasable by CBCT but rather MRI especially the dynamic type. Soft tissue evaluation is not recommended by CBCT.

  • Solomon O Nwhator added an answer:
    Is there any kind of academic institution worldwide to collaborate in dental/periodontal research or lecturing/teaching?

    Dear colleagues,

    I look for any kind of academic institution worldwide to collaborate in dental/periodontal research or lecturing/teaching.

    Topics: periodontology / implantology / halitosis / lasers in dentistry.

    Please contact me


    Solomon O Nwhator

    Is Curd still there? I notice you have not responded to any of the answers. Pls respond if you're still in the house.


  • J. Kazimiroff added an answer:
    Can the orthodontic community afford to neglect the evidence from non-RCT`s?

    Evidence based dentistry started 20 years ago (1). Most Cochrane Systematic Reviews still end with the conclusion that recommendations for clinical practice cannot be made based only on the results of these trials and that more randomised controlled trials are needed to elucidate the interventions for treating a certain kind of malocclusion. Turning the Cochrane reviews into a tool that is more relevant in clinical practice will require implementation of a methodology allowing inclusion of non-RCTs while controlling for possible bias.(2)

    1.. Richards D, Lawrence A. Evidence based dentistry. Br Dent J. 1995;179(7):270–3.

    2. Teich ST, Lang LA, Demko CA. Characteristics of the Cochrane Oral Health Gro up Systematic Reviews. J Dent Eduacation. 2015;79(1):5–15.

    J. Kazimiroff

    Question could be, Can dentistry continue to not conduct non-biased,  not manufacturer supported RCTs? There is a dearth of real dental RCTs and non-biased evidence for dentistry and oral health.  Check out guidelines at AHRQ, final conclusions missing evidence for dentistry. We are light years behind medicine.

  • k.a Galil added an answer:
    Biology of the alveolar bone during orthodontic treatment
    I am interested about the biology of the alveolar bone during the interdisciplinary orthodontic treatment of adult patients
    k.a Galil

    hello   Dr Alexandru Ogodescu.

    we have published a paper on orthodontic tooth movement which includes  activities on alveolar bone during orthodontic tooth movement 

    iam enclosing here the conclusion ;  however if you read the paper we published (enclosed here as an attachment )  and it has more details on the interaction between orthodontics tooth movement and alveolar  bone

    The Periodontium undergoes a series of coordinated and regulated
    cellular and molecular events following application of
    orthodontic forces of physiological magnitude. The PL and AB
    actively involved in bone remodeling. Osteocytes, osteoblasts,
    PL fibroblasts, osteoclasts, chondrocytes and immune cells
    are the principal cell types responsible for producing a number
    of cytokines, growth factors, and transcription factors and
    other regulatory molecules which modulate cell proliferation,
    differentiation, gene expression and cell functions. The ECM
    molecules as well as osteocytes, osteoblasts and PL fibroblasts
    show a remarkable response to the orthodontic forces. Recent
    evidence that SOX-9 gene, PTHrP and IHH play a major role
    in orthodontic tooth movement is of particular interest.

    sincerely Prof Galil.

    DDS,D.Oral and Maxillofacila sugery,Ph.D,FAGD.,FADI.,Cert.Periodntist (Royal College)

  • Nirmala S.V.S.G added an answer:
    What syndromes, apart from Gorlin-Goltz, are associated with multiple keratocysts?

    A patient presented to us with multiple keratocysts. Work-up did not show features of Gorlin-Goltz syndrome. Before being diagnosed as nonsyndromic or Gorlin-Goltz with partial expression, I need to rule out other possible syndromes. Do you know such? or an article listing them. I couldn't find in PubMed.

    Nirmala S.V.S.G

    Dear Omayma,

    I have published an article regarding Conservative Management of Multiple Odontogentic Keratocyst in a Young Patient with 2 Years Follow Up - A case report

    follow the citation: Nirmala SVSG,Sandeep C, Sindhuri V,Vimala Devi P. Conservative Management of Multiple Odontogentic Keratocyst in a Young Patient with 2 Years Follow Up. J Dent App. 2015;2(2): 149-152.

  • Abrão Rapoport added an answer:
    What are the standard care practices for managing xerostomia and its sequelae in cancer patients receiving chemotherapy alone?

    Are there any dental consultations required before commencing chemo? 

    Any fluoride treatment during the course of chemo and later? 

    Abrão Rapoport

    Xerostomia is a permanent sequela of mouth cancer, without therapy.We can try the protection of salivary glands  with administration  of protective solutions,advertizing the patients for the limitations of these procedures

  • Ulrich Kritzler added an answer:
    Periodontally accelerated orthodontic and osteogenic techniques - what is your experience?
    As invasive as it is, this technique, with its variants, seems interesting and promising. I would much appreciate learning from your critical opinions and experience.

    I attach one article and list here others, equally easily available on the net.

    Periodontal Accelerated Osteogenic
    Orthodontics: A Description of the
    Surgical Technique
    Kevin G. Murphy, DDS, MS,* M. Thomas Wilcko, DMD,†
    William M. Wilcko, DMD, MS,‡ and
    Donald J. Ferguson, DMD, MSD§

    An Evidence-Based Analysis of Periodontally
    Accelerated Orthodontic and Osteogenic
    Techniques: A Synthesis of Scientific
    M. Thomas Wilcko, William M. Wilcko, and Nabil F. Bissada

    Yener ÖZAT1 Ruhi NALÇACI2

    One-stage Surgical Alveolar Augmentation (PAOO)
    For Rapid Orthodontic Movement. A Case Report.
    1 Ashish Jain, M.D.S
    2 Tarun Das, M.D.S
    3 Rashi Chaturvedi, M.D.S, D.N.B

    Piezocision Assisted Orthodontics: A new approach to
    accelerated orthodontic tooth movement
    Mittal S.K. 1, Sharma R.2, Singla A.3
    Ulrich Kritzler

    Periodontally accelerated orthodontic and osteogenic techniqueswill speed up tooth movement but will always remain additional invasive techniques. Treatment time can be much faster when you are able to avoid round tripping in using sound biomechanics and in improving time schedules.

    1. Beckwith FR, Ackerman RJ, Cobb CM, Tira DE. An evaluation of factors affecting duration of orthodontic treatment. Am J Orthod Dentofac Orthop. 1999;115(4):439–47.

    2. Sanon M, Taylor DC a, Parthan A, Coombs J, Paolantonio M, Sasane M. Effectiveness and duration of orthodontic treatment in adults and adolescents. J Med Econ. 2012 Jul 4;383–6.

    3. Skidmore KJ, Brook KJ, Thomson WM, Harding WJ. Factors influencing treatment time in orthodontic patients. Am J Orthod Dentofacial Orthop. 2006 Mar;129(2):230–8.

  • John Gabrovsek added an answer:
    What is the role of the host in dental caries infection?
    On the web: Dental caries food for thought
    John Gabrovsek

    Neutrophil leukocytes play the role in all infections including in dental caries infection!

  • Hayfaa Hashim Farah added an answer:
    What is the treatment plan for an 11- year- old boy who is suspected to have amelogenesis imperfecta?

    An 11- year- old boy presented to the dental clinic with his father, complaining of poor esthetics and delaying of eruption of teeth. Examination revealed a suspicion of amelogenesis imperfecta ( clinically & radiographically). Teeth present: 11, 21, 31, 16, 26, 36, 46, all primary molars and canines and partially erupted 12,22, 42. Patient  has also angle, class III. Outline the treatment plan for such a case.

    Hayfaa Hashim Farah


    + 2 more attachments

  • Gururaja Rao added an answer:
    Can antioxidant molecules be used through local/topical drug delivery for oral mucosal lesions?

    The systemic antioxidant therapy is one of the therapeutic options for oral mucosal lesions. In Localized delivery of antioxidant molecules to the oral mucosal lesion, will the oral mucosal cells uptake/absorb the antioxidant molecules? Will the antioxidant molecules perform their action when delivered locally? Which route of delivery (systemic/local) of antioxidant molecules can have better activity?

    Gururaja Rao

    Yes.Anti oxidants are very helpful.Most common anti oxidants like vitamin C is well absorbed also through oral mucosa and sub lingually ,since it is water soluble vitamin.

  • Ramachandra SS added an answer:
    Is there any published literature which gives clear guidelines on when resective or regenerative periodontal surgery should be done ?

    Is there any published literature which gives clear guidelines on when resective or regenerative periodontal surgery should be done ?

    Ramachandra SS

    Thank u Prof Paulo but the IJPRD artcles are decision tree for soft tissue grafting

    I was searching for root resection versus periodontal hard tissue regeneration.

  • Nirmala S.V.S.G added an answer:
    Is there any simple chairside method for identification of risk group of aggressive periodontitis at an early age of life?

    Aggressive periodontitis attacks people at early age of life and causes extensive bone loss which might lead to early loss of dentition, early detection of patients at high risk to be attacked by this type of periodontitis will help them a lot to be involved in a strict professional and personal preventive program thus minimize the periodontal damage to a large extent .I wonder if any one has ideas about any chairside methods  for early  detection of risk factors and  those who are at a high risk for developing this kind of periodontitis?

    Nirmala S.V.S.G

    I do agree with Martin and African Americans are more prone for this and risk may vary from individual to individual.

  • Laura González-Garrido added an answer:
    Which method is more accurate in determining periodontitis in archaeological skeletal remains?

    Some investigators have interpreted the increasing distance between the tooth cervical margin and the alveolar crest as an indication of horizontal bone loss due to chronic inflammatory periodontal disease. But ..... What is going on when continuing eruption had occurred in a high frecuency dental wear population? 

    I sincerely appreciate your taking time to provide your comments and feedback.


    Laura González-Garrido

    Hi Sandra,

    You have done me a great favour by sending me the reference of this paper. Thank you! Of course, I´m trying to find the way to distinguished both.

    All the best, Laura

    See u!

  • Syed Wali Peeran added an answer:
    Does any one have information about DAS 21 anxiety scale in relation to periodontal status?

    Looking for association of DAS 21 and periodontal status, also looking in to role of stress in Hbac1c levels, DAS 21 and periodontal status

    Syed Wali Peeran

    May be this article is of help for you

  • Arkadiusz Dziedzic added an answer:
    Does anyone have a paper demonstrating differing tollerances of periodontal and gingival fibroblasts to calcium ions?
    I have noticed gingival and periodontal ligament fibroblasts have differing morphologies when cultured with MTA.
    Arkadiusz Dziedzic

    Balto HA. Attachment and morphological behavior of human periodontal ligament fibroblasts to mineral trioxide aggregate: a scanning electron microscope study. J Endod. 2004 Jan;30(1):25-9.

    If you are interested in our results regarding the simple evaluation of chemical composition of different MTA materials, please feel free to contact me. We assessed MTAs with the use of SEM, EDS and XPS techniques.

  • Nirmala S.V.S.G added an answer:
    Is there any KAP model for oral health related quality of life research?

    I am conducting a research about Oral health related quality of life by using OHIP-14. One of my variable for conceptual framework is Knowledge,attitude and practice. I am having trouble with the literature part to support which model do I base on for the KAP part. Is there any model that support KAP and oral health related quality of life? I need to put something to support my variable for my literature review part. If anyone can help, please do. Thank you

    Nirmala S.V.S.G

    I do agree with Peter G Robinson

  • Mohammed Sultan Al-ak'hali added an answer:
    Are there any limitations when using free connective grafts alone without covering them by flaps in the treatment of recession around lower incisors?

    In the treatment of gingival recession around lower incisors by applying free connective tissue graft along the area of recession, how it is possible to pull the alveolar mucosal flap from the vestibule and inner mucosa of lower lip with the purpose of covering the connective tissue graft over the gingival recession?

    Mohammed Sultan Al-ak'hali

    Solmon O Nwhator   I know that the CTGs are more reliable and more predictable than FGGs. but i mean in the lower anterior recession where it is difficult to cover the connective tissue graft by the flap.

  • Amit Agrawal added an answer:
    Any published literature wherein cases of aggressive periodontitis with positive family history are at more risk for increased periodontal breakdown?

    Is there any scientific data or published article to show that cases of aggressive periodontal disease with positive family history have or are at more risk for increased periodontal breakdown?

    Amit Agrawal

    Oh Ok.


  • Steven E Eckert added an answer:
    Can anyone give me insight on the risk of developing osteonecrosis of the jaw in dental implant patients taking oral bisphosphonates?
    I’m aware that a higher risk is observed in patients receiving bisphosphonates by IV (Gen Dent. 2010 Nov-Dec;58(6):484-92), but am curious to know specifically if recent studies have demonstrated a relationship between oral bisphosphonates, implants and osteonecrosis of the jaw. Is there a risk/relationship? And should implant patients taking oral BPs be informed of this possible additional risk?
    Steven E Eckert

    In general, with ORAL bisphosphonates the risks seem to accumulate FOR TOOTH EXTRACTION with increased length and dosage of bisphosphonate usage.  Three years used to be thought of as a threshold, now that number is being questioned (both ways, too long or too short).  The thing to remember is that tooth extraction is a variable force application, it is relatively uncontrolled.  Not every extraction is the same.  On the contrary, in patients with osteopenia or osteoporosis (situations for which bisphosphonates are often prescribed) implant osteotomy development is a relatively controlled surgery.  Early articles on bisphosphonate usage for implant surgery "suggested" a protective effect but this never seemed to reach statistical significance (p-value was usually > 0.05 but < 0.1.  Those results were not consistently confirmed nor rejected so our "knowledge" is weak.  Dr. Michelinakis' comment on serum CTX is correct, it has been proposed but not universally accepted as a marker of risk for osteonecrosis.  It has become something of a religion, some believe, some reject.

    So this is a rather weak response but a strong response is likely to be wrong, hence the weak response.

  • Rangeeth Bollam Nammalwar added an answer:
    Will diode laser therapy be an effective replacement for periapical surgery in cases of periapical abscess with sinus tract?
    I have been using 910nm diode laser for treating the rct failure cases with periapical abscess forming a sinus tract into the sulcus, and I am seeing a very good prognosis.
    Rangeeth Bollam Nammalwar

    use of diode laser with sodium hypochloride irrigation seems to work well. The fiber should also reach the apical foramen.

  • Caroline Mohamed added an answer:
    In case of apical swelling (with pus): How many day(s) should we keep open the canal to discharge the pus?
    Recently, I have observed in my clinical practice a re-swelling of infected canal after antiseptic dressing. Sometime the tooth become mobile and extruded. Please suggest the possible solution.
    Caroline Mohamed

    Who told you that science can not be fun?

  • Sunethra Rajapakse added an answer:
    What is the consensus on fluoridated toothpaste for patients with endemic fluorosis?
    Endemic fluorosis
    Sunethra Rajapakse

    thanks Prof Gail for the answer and the reference.



  • Chiara Baroni added an answer:
    Why is diode laser irradiation used in intervals with multiple doses of laser?
    In a number of articles, diode laser is used along with scaling and root planing in moderate periodontitis cases. After the first diode laser application, it is used in intervals- on the 4th,7th,9th and 11th day (a total of 4 or 5 applications of diode laser in Periodontal pockets). Is there any standard criteria for using diode laser in intervals with multiple doses of laser?
    Chiara Baroni
    Does any of you have experience in diode laser remineralisation of hypomineralised enamel?May be using fluoride as an intermediate?How many applications would you suggest?
  • Steven E Eckert added an answer:
    Is there any scientific evidence on the success of Laser-assisted new attachment procedure (the LANAP protocol) in periodontal surgical therapy?
    Steven E Eckert
    The American dental Association has provided a statement on the use of lasers and dentistry. If you go to and then search this topic you will find a pretty well thought out response.

    Here is the section related to the LANAP protocol:
    Laser-Assisted New Attachment Procedure

    A 2007 publication compared the probing depth, attachment gain, and type of attachment from traditional mechanical therapy of advanced chronic periodontitis vs. traditional mechanical therapy that included two intrasulcular applications of Nd: YAG; one aimed at removing the sulcular epithelium and another said to “seal” the pocket.2 In this study, histology was performed on 6 pairs of single-rooted teeth at 3 months. Laser-treated pockets tended to show greater probing depth reductions and clinical attachment gains than non-lased pockets. Based on measurements from notches placed in periodontally involved root surfaces before treatment, lased teeth showed evidence of new cementum while 5 of the 6 control teeth showed a long junctional epithelial attachment. This study concluded that the Laser Assisted New Attachment ProcedureTM (LANAP) can be associated with cementum-mediated new connective-tissue attachment and apparent periodontal regeneration of diseased root surfaces in humans.

    Although the Council is optimistic regarding the potential for lasers to enhance effectiveness in treating periodontitis, dentists should note that this study provides no more than pilot validation for this treatment concept. The study was not blinded, and the sample size was small thereby limiting extrapolation of the results to the general population. Further, pre-treatment notches in the teeth were difficult to place, hard to know exactly where they were placed and are difficult to clearly detect on histological specimens. Moreover, the advanced periodontal destruction initially present in these 6 test teeth make it difficult to extrapolate these results to cases of early and moderate chronic periodontitis, where the anatomic environment, laser energy distribution and clinical outcome may differ substantially. It is also unclear what laser-based “sealing” of a treated periodontal sulcus is and, if real, what benefits it might provide. Additional clinical data from properly designed clinical trials with adequate sample sizes are still required before it can be known to what extent LANAP is safe and effective across the spectrum of patients with chronic periodontitis. The Council therefore cautions clinicians to weigh the available evidence for LANAP when considering the options available for treatment of the periodontal diseases.

    So my interpretation, using this statement from the American dental Association is that this procedure may have some potential but there is certainly no definitive hard scientific evidence to show that it is anything more than another way to address a problem.
  • Amit Agrawal added an answer:
    Does anyone have information on drug induced gingival overgrowth in antihypertensive therapy?
    Identification of this problem as early as possible is very important in management. How do I do it?
    There are many new antihypertensive drugs being used. Some of these might have a similar effect? Are there any research papers?
    Amit Agrawal
    Nifidipine, Amlodipine, Cyclosporine all are known to lead gingival overgrowth. But suppose a patient is taking all three drugs simultaneously, then how to proceed.

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Oral pathology, Oral medicine, Dentistry, Periodontology

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