International Journal of Current Research and Review DOI:

Review Article

æ the Expanding Scope of Periodontics

°*V° A Review Article

IJCRR Section: Healthcare Sci. Journal Impact Factor: 6.1 (2018) ICV: 90.90 (2018)

Yash Jain‘, Rathna Valluri?, C Srikanth?, Kranti Kiran Reddy Ealla

‘Intern, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India; “Intern, Malla Reddy Institute of Dental Sciences, Hy- derabad, Telangana, India; *Professor and Head of the Department, Dept. of Periodontics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India; ‘Professor, Department of Oral and Maxillofacial Pathology, Malla Reddy Institute of Dental Sciences,

Hyderabad, Telangana, India.


Periodontology is widely recognized as the dental speciality pertaining to the ailments of the tissues surrounding and supporting the tooth. In the past decade a significant amount of research in periodontology was directed towards applications of advanced fields of studies like genomics, proteomics, nano-technology, bio-photonics, etc. The aim of the present review article is to outline the scope of periodontology, by briefing current practices and emphasizing the more recent and advanced developments.

Key Words: Advances in Periodontology, Biophotonics, Genomics, Nanotechnology, Periodontal Vaccine, Probiotics, Proteom-

ics, Tissue-engineering


Periodontics as a speciality is considered to have begun dur- ing the mid-nineteenth century when John W. Riggs (1811- 1885), now popular for defining the term “Riggs disease”, started confining his practice to treating diseases of the peri- odontium’. Over the centuries, periodontics has come to include under its umbrella, an enormity of scientific disci- plines.


In the present article, periodontology is briefed in terms of its conventional diagnostic aids and therapies, and the more recent and advanced developments are then discussed.

Diagnostic Aids

Periodontics encompasses a plethora of conventional and ad- vanced diagnostic tools including probes, radiographic tech- niques and microbial analyses.

Probes: These are physical devices used to measure the dis- tance from the bottom of the pocket to a reference line (usu-

ally the cemento-enamel junction). An overview of all the periodontal probes developed is shown in Table 1.

Radiographic diagnostic aids include

1. Digital Subtraction Radiography (DSR):This has been used in the post treatment assessment in regen- erative procedures). It is a great tool in conducing longitudinal assessments.

2. Computer-assisted densitometric image analysis sys- tem (CADIA): or advanced than DSR, CADIA has been shown to detect the changes in the density of the crestal even bone before the crestal height reduces“. CADIA can also be employed to evaluate the results of regenerative procedures.

3. Tuned aperture computed tomography (TACT): It has been shown to be more accurate for quantifying osse- ous changes in healing bone defects and has proposed as an alternative for pre-surgical implant planning.

4. Cone-beam computed tomography (CBCT): Studies have been done validating the usefulness and accu- racy of CBCT in visualizing periodontal structures and in regenerative procedures.

5. Micro CT: In a study by Park” et. al., it was demon- strated that Micro CT is reliable approach for quanti-

Corresponding Author:

Phone: +91 9703468477; E-mail: ISSN: 2231-2196 (Print)

Received: 24.10.2019 Revised: 10.11.2019

Dr. Yash Jain, Intern, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India.

ISSN: 0975-5241 (Online)

Accepted: 16.11.2019

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Jain The expanding scope of periodontics a review article

tative assessment of the alveolar bone.

6. Optical coherence tomography (OCT): OCT renders early detection of subgingival calculus possible as dental calculus has been found to have strong scatter- ing properties and can be differentiated from Enam- el®),

7. Magnetic resonance imaging (MRI): In a study, in- cluding 25 patients with dental implants, by Gunz- inger® et. al., it was discussed that MAVRIC (multi- acquisition variable-resonance image combination) reduced the artifacts from dental implants (which is one of the major issues for the use of MRI in oral cav-


Other imaging techniques

1. Ultrasound Imaging: It has been shown that this im- aging modality is highly accurate and repeatable for periodontal evaluation”. Various systems employ- ing ultrasound have been developed for the detection of subgingival calculus, i.e., Detectar®, Keylaser II®, and Dental Endoscope.

2. Photoacoustic Imaging technique: This imaging technique integrates visible and near infrared excita- tion with acoustic detection and its application has been demonstrated in measuring periodontal pocket depths.

Diagnosis through Microbial Analysis: It has been ob- served that microbial analysis of the significant organisms in periodontal diseases helped in the clinical decision making process for the adjunctive use of systemic antibiotics”.

Some of the methods of microbial analysis include:

1. Microscopic assays 2. Culture assays 3. Immunologic assays e direct immunofluorescence e direct immunofluorescence 4. DNA probe assays 5. Enzyme-based assays

Periodontal Therapy

The core of periodontal therapy includes various non-surgi- cal and surgical modalities. Non-surgical therapy is mainly focused at eliminating plaque and plaque retentive features (calculus, overhanging restoration margins etc) through scal- ing, root planning and is always combined with oral hygiene instructions.

Surgical therapy is indicated when there are deep obstinate periodontal pockets despite good plaque control. Other sur- gical procedures include those that correct a variety of natu- ral and pathological aberrations in the periodontium (curet- tage, gingivoplasty, gingivectomy, muco-gingival surgeries, crown lengthening surgery, root resection procedures and periodontal reconstructive procedures). Different approach-

es in surgical periodontology (conventional scalpel and laser surgeries, cryosurgery, electro cauterization, piezosurgeries) provide a diverse treatment options for diverse conditions. These therapies constitute the core of periodontics (Table 2).

Scope of Periodontics The scope of periodontics extends substantially into the oth- er specialities of dentistry.


The significance of the implications of orthodontic therapy in periodontics can not be over-stated as the medium for orthodontic tooth movement is the periodontal ligament, a central component of the periodontium. In a patient with compromised periodontal health, meticulous care must be provided to ensure the orthodontic therapy is carried out in inflammation-free periodontal tissues. Another interesting overlap between the principles of these two specialities is the ‘Periodontally Accelerated Osteogenic Orthodontics’ where orthodontic tooth movement is accelerated by way of inte- grating selective alveolar corticotomy and particulate bone- grafting with orthodontic-therapy'». Temporary anchorage devices or mini-implants are often used for orthodontic an- chorage.


The success of the outcome of any prosthodontic treatment is based on the solid foundation of the periodontium and on restoration designs that are conducive to periodontal health.

Periodontics-Oral Surgery

Many a surgical procedures constitute this interdisciplinary interface such as frenectomy, frenotomy, ridge augmenta- tion procedures, etc. During orthognathic surgeries, there is convincing evidence that suggests, there is significant inci- dence of periodontal injury in the region of segmental osteot- omy), It has been reported that orthognathic surgeries have a marked effect in the development of gingival recessions.

Periodontics-Restorative Dentistry

When planning a restoration, consideration must be given to the margin placement, restoration contours and contacts, embrasure shape, and polish of the restoration, so that it is conducive to periodontal health.


There is an intimate relationship between the periodontium and the endodontium through the apical foramen, lateral ca- nals, accessory canals and dentinal tubules. Such a natural continuum in the anatomy predisposes to a pathological con- tinuum as well.

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Jain The expanding scope of periodontics a review article


The interplay in these departments is appreciated during age estimation using tooth cementum annulations (TCAs) and amino acid racemization (sample taken from gingiva, as it is the most accessible), Gingival epithelium assessment, and using implants (that endure the thermal insults due to the high melting point of titantum) and implant recognition software for identification”.

Periodontology and Geriatrics

Age-related changes are seen in every tissue of the perio- dontium in the elderly (thinning of the epithelium, reduced keratinization, flattening of rete pegs in gingiva; increase in the fibrous component in the connective tissue; increase in the width of cementum; resorption of bone). In this group of patients the treatment protocol must reflect the consideration of any other systemic and psychological diseases, resistance and regenerative potential, state of host immune response. In an article by Ira B. Lamster“!” it is discussed that there is a present-day demographic shift where the count of older adults (>65 years) surpasses the count of young individuals (<5 years) and that by 2050 the number of people of age 65 and older will reach 1.5 billion, hence, dental professionals must boost their knowledge necessary to care for older popu- lation as this will turn out to be an appreciable part of the future of dental profession.

Periodontal Medicine

Periodontics has ramifications in a multitude of systemic conditions. Periodontal disease has been inflicted as hav- ing reverberations in cardiology (Porphyromonas gingivitis secretes an enzyme gingipain“® that is associated with ac- tivation of the thrombin receptor on the platelet leading to platelet aggregation), pulmonology (respiratory pathogens may attach to the excessive plaque in patients with perio- dontitis and act as a source of infection to distal portions of respiratory tracts”; dental plaque has been suggested as a critical reservoir for harboring the micro-organisms respon- sible for hospital acquired pneumonia in institutionalized elderly®”), pregnancy (Periodontitis is notably associated with preeclampsia and is considered a risk factor?), stroke, osteoporosis. Periopathogens also possess the reputation of being capable of causing bacteremia and subsequently focal infections‘), Hence, periodontology should be reflected as an essential part of preventive medicine.

Tissue Engineering

Tissue engineering has gained favor in periodontics due to its potential in periodontal tissue regeneration and is based on three approaches: (i)Protein (proteins affecting the growth, differentiation and maturation are used) (ii) Cell (Mesenchy- mal stem cells are used) and (iii) Gene therapy based meth- ods”. Gene therapy is an encouraging therapeutic modality in periodontics. Depending on the method of introduction

of the gene vector, it can be either in vivo (where they are delivered directly at the target site) or ex vivo (where the target cells are extracted, processed with gene vectors and implanted at the target site).

Host Modulation Host modulation is gaining importance as a periodontal therapy. Here various therapeutic agents (Table 3) are used to down-regulate the biologic function of pro-inflammatory mediators in the host.


A popular stream for current researchers in periodontology is ‘Biophotonics’. It deals with the area overlapped between photonics and biomedical sciences. Various periodontal ap- plications of biophotonics have been listed in table 4.

Photodynamic therapy (PDT) is one such application where when used an as adjunct to SRP has shown improved results. The three elements of photodynamic therapy are oxygen, photosensitizer and light. The triplet state photosensitizer, that forms after excitation of photosensitizer with light can react with biomolecules in two ways: Type I and Type IT®.

Type I: Direct electron/hydrogen transfer Type II: formation of singlet oxygen

Photodynamic anti-microbial chemotherapy (PACT) had been observed to show efficacy against bacteria (including drug-resistant strains), yeasts, and parasites®®,


Concepts of micro-dentistry, in the context of periodontol- ogy engendered a periodontal endoscope (The Perio-Scope) that harbors fibre-optic technology for illumination, mag- nification and video-recording for visualizing sub-gingival tissues”. This allows instrumentation in the most efficient way possible ensuring a thorough debridement. Using the similar technology, endoscopic capillaroscopy systems have been developed for the imaging of periodontal-pocket and gingival crevice micro-vasculature®). This currently aids in understanding the pathological process but in future may prove to be an effective diagnostic aid.

Genomics, Proteomics and Nanotechnology Future of periodontics powered by genomics, proteomics and nanotechnology seems immensely promising. Nutrigenom- ics is a newly unravelling scientific sphere that is believed to have implications in the development of periodontal dis- eases. Epigenetic variations (like DNA methylation, histone modifications, chromatin remodelling) in genes regulating nutrients can increase the probability of micronutrient dis- eases like obesity and type 2 Diabetes Mellitus that have pro- pensity for periodontal manifestations®”.

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Introduced by Kellam and Weiss, Infectogenomics deals with the influence of host genetic variability on microbial colonization and governs the outcome of infection by vari- ous pathogens®”, A variety of genetic factors have been rec- ognized to impact periodontal pathogen invasion. Mutations in the genes expressing a few pattern recognition receptors (TLRs and NLRs) evoke an altered host response to micro- bial invasion”. Polymorphisms in the IL-1 gene have been extensively implicated in the pathogenesis of chronic peri- odontitis°*+», Other gene polymorphisms (in genes express- ing cytokines) associated with periodontitis are of tumour necrosis factor-a (TNF-a), MMP8, nuclear factor kappa B (NF-«B), Vitamin D receptor etc®”.

Genome-Wide Association Studies: These have broad- ened the current knowledge of the genetic implications of Chronic Periodontitis. In a study by Rhodin®® et. al., NIN and ABHD/2B(severe CP), KCNKI(red complex), and DAB2IP(Pg) were identified in loci that have been previous- ly suggested as associated with chronic periodontitis and two novel associations were detected, i.e., WHAMM and AP3B2.

Proteomics, currently a propitious research frontier in perio- dontics, is the study of proteomes and their functions. Haigh BJ et. al. in a study applying quantitative proteomic analysis on saliva from subjects with severe periodontitis reveled al- tered abundance in 15 proteins and of those S 100 proteins showed the most prominent change®». Parotid secretory pro- tein and haptoglobin have the potential to act as biomarkers for detecting and monitoring periodontitis.

Biomarkers for periodontal disease can be classified into (i) Proteomic (ii)Genetic (iii)Microbial (iv)Other°°(Table 5). Proteomics and Genomics, along with salivary diagnostics, when applied to periodontology are vastly promising as they may reveal such biomarkers for diagnosis and targets for dis- ease intervention.

Recent developments in the micro-fabrication technology and MEMS helped develop ‘lab-on-chip’ (LOC) systems which are used as point-of-care (POC) testing devices for periodontal diagnosis. This LOC system executes complex assays within a short period of time and with small sam- plesS”. Some of the commercially available POC systems for use on saliva include: Oral fluid nanosensor test (OF- NASET, University of California, Los Angeles [UCLA] Col- laborative Oral Fluid Diagnostic Research Laboratory, led by Dr. David Wong®®), Electronic taste chips (Rice Univer- sity in Houston, Texas), OraQuick, Integrated microfluidic platform for oral diagnostics. Gingival Crevicular Fluid and Plaque have also been as oral diagnostic substrates for POC tests like Periogard and Perioscan (BANA) respectively®”.

Dentistry is entering the era of ‘Personalized-medicine’ and it is more applicable in periodontology than in any other aspect of dentistry. Personalized medicine disposes the concept of

‘one-size-fits-all’ and precisely tailors a health care regimen for the individual based on the genomic-proteomic profile of the patient and risk factors associated. Personalized-medicine is progressively becoming more practically relevant with the advent of sophisticated diagnostic advances, salivary diag- nostics. In a study by W.V. Giannobile at. al.“®, association of tooth loss with 1 vs.2 annual preventive visits was tested among high-risk patients (>1 of the risk factors: smoking, diabetes or interleukin-1 genotype) and low-risk patients (no risk factors). It was found that in the low-risk group the sec- ond annual preventive visit did not have significant effect on tooth loss outcome whereas in the high-risk group, the subgroup with 2 annual preventive visits showed lower event (tooth loss) rates than the subgroup with 1 annual preventive visit. Hence, it was concluded that stratification of patients based on associated risk factors and gene biomarkers could be beneficial in resource allocation for preventive medicine.

With the advent of nanotechnology new domains opened up for research in periodontology. Nano-materials in the form of nanotubes, hollow spheres, core shell structures are gain- ing importance in the context of controlled drug release. Tri- closan loaded nanoparticles have been tested through emul- sification-diffusion process“ and gained positive response. Scaffold systems have also been constructed at a nanoscale for periodontal tissue regenerations procedures. Applications of nanotechnology in periodontology have been listed in ta- ble 6.

Dermatoglyphics in Periodontics: It has been shown by Vaidya” et. al. that more whorls and less arches in both right and left hands, in the fingerprints, were seen in patients with chronic periodontitis. Dermatoglyphics could potential act as a useful tool for the prompt diagnosis and prevention of those oral diseases that are directly or indirectly influenced genetically.


Applications of probiotics (e.g., lactobacillus acidophilus) are encouraging (Table 7) as they have proven to reduce the pHof the oral cavity and posses an antioxidant property that reduce the formation of plaque and calculus. Dendritic cells up-regulate the expression of Th] (T-helper cell 1: for intra- cellular pathogens) and Th2 (T-helper cell 2: for extracellular pathogens) after being stimulated by Probiotics. Probiotics enhance immunity through “toll like receptors”).

Periodontal Vaccine

A promising avenue for research has opened up after realiza- tion of the prospective applications of periodontal vaccine. Why is the drive for periodontal vaccine compelling? Apart from being the most culpable disease for tooth loss world wide, periodontitis is implicated for having systemic seque- lae like atherosclerosis, diabetes mellitus, respiratory infec-

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tions, pre-term low-weight birth, rheumatoid arthritis, etc. Hence, inventing new prevention methods is compelling. Periodontal vaccination can be active, passive or genetic&® (Table 8).

Stem Cell Therapy

Periodontal ligament stem cells (PDLSCs) are present in the peri-vascular space of the periodontal ligament and are considered to be a sub-population of the Mesenchymal stem cells having resemblance to pericytes®”. In an experi- mental study by Kengo Iwasaki et. al©®, periodontal liga- ment stem cells were transplanted into surgically created periodontal defects in rats and it the results revealed peri- odontal regeneration is induced by transplanting PDLSCs. Although there currently are gaps in making periodontal- regeneration using stem cells practical, the presence of gripping evidence for the potential of its applications is driving a large chunk of research in this avenue to make this a clinical reality.

Extracorporeal Shock Wave Therapy

Exploration for newer and better treatment modalities re- sulted in the introduction of Extracorporeal Shock Wave Therapy (ESWT) into dentistry. ESWT uses shock waves of a certain energy to cause a sudden and transient pres- sure disturbance in the targeted tissue that triggers a re- sponse. In a review by Munivenkatappa Lakshmaiah Ven- katesh Prabhuji® et. al., it is discussed that ESWT has a potential for bone regeneration, rapid periodontal healing, anti-inflammatory properties, etc., and that ESWT can be implemented in periodontal therapy following appropriate modifications.

Artificial Intelligence

Although it is still at a very initial state, a lot of researched is being directed at incorporating Artificial Intelligence (AT) into dentistry. Softwares are being developed that combine more precise CBCT scans with machine learning to detect even the slightest anomalies based on a number of previous scans and provide an appropriate treatment plan. Such a software can be helpful in that the patient is aware of the nature of their problem just a few minutes after the scan and has in mind a probable treatment plan that makes the work of the dentist more convenient. Artificial intel- ligence could be applied in the context of implantology for automatic selection of optimal implant sites and angula- tions for a given patient.

Advancements in the teaching of Periodontics: Virtual Re- ality and Haptics: Two visuo-haptic systems named Periosim and periodontal simulator (University of Illinois at Chicago, USA) simulate three dental instruments, i.e., a periodontal probe, an explorer and a scaler. This is used to train students in different aspects of periodontololgy™.


The scope of periodontology in the past decade has expanded rapidly into various scientific fields of study and the future trends will embrace concepts like:

* biophotonics

e stem cell biology

e periodontal vaccines

e nanotechnology (powered by genomics and proteom- ics)


Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Source of Funding None.

Conflict of Interest The authors declare no conflict of interest.


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Table 1: Periodontal Probes Overview

Periodontal Probes | 1" Generation e William's Probe @ Conventional instruments e CPITN Probe @ No probing-pressure control e UMich O Probe @ UNC-15 Probe @ Naber’s Probe 2" Generation © True pressure Sensitive (TPS) Probe e Pressure sensitive (Not exceeding |e Electronic pressure sensitive probe 0.2N/mm?) @ Yeaple (Jojen Technologies LLC,15 Coach Side Lane Pittsford, NY 14534 USA) 3" Generation @ InterProbe (The Dental Probe, Inc., Glen Allen, VA 23058) © Automated © Foster-Miller (Alabama) Probe e@ Florida Probe System (Florida Probe Corporation 3700 NW oist Street, C-100 Gainesville, FL 32606 USA) @ Florida Probe with PASHA* probe @ Toronto Automated Probe @ Accutek Probe

4™ Generation © 3-D probes 5" Generation e 3-D Probes

@ Non-Invasive

Ultrasonographic Probe (US) Probe

Most Recent Advancement

Non-Invasive periodontal Probing through Fourier-Domain Optical Coherence Tomography

Non-Periodontal Calculus Detection

Detec-Tar (Dentsply Professional, York, PA, USA)

Probes Gingival Temperature

Periotemp Probe (Abiodent Inc, Danvers, MA)

Periodontal Disease Evaluation System

Diamond Probe/Perio 2000 System (Diamond General Devel- opment Corp., 333 Parkland Plaza, Ann Arbor, MI 48103-6202)

Tooth Mobility

*Pressure-controlled, Automated, Standardized Hand-Piece

Periotest (Siemens AG, Bensheim, Germany)

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Table 2: Core of Periodontal Therapy

Delivering Oral Hygiene Instructions

Supra-gingival and Sub-gingival Scaling

Non-Surgical Elimination of other plaque retentive features

Management of risk factors like Smoking

Anti-microbial/Anti-plaque agents/Systemic antibiotics




Mucogingival Surgeries

Soft Tissue Pocket reduction and elimination procedures

Surgical Lip-repositioning




Resective Osseous Surgeries

Hard Tissue

Regenerative Osseous Surgeries

Table 3: Host-Modulation Drugs

Category Class Example Mechanism of Action Ref.

Antiproteinases Tetracyclines Subantimicrobial-dose doxycline | Inhibits collagenase activity (23) (24)

Chemically modified tetracyclines | Inhibition of MMPs, pro-inflam-

(CMT-1,2,3,4,5,6,7,8) matory cytokines, inducible nitric oxide synthase (iNOS) Anti-inflammatory | Salicylates Asprin Down-regulation of prosta- (23)

drugs glandins (among which PGEz is

Indomethacin : : à Propionic acid derivatives | ibuprofen, flurbiprofen, naproxen o Cen et Table 4: Biomedical Sciences + Photonics = Biophotonics Clinical Applications Diagnosis In vitro imaging and spectroscopy (for optical diagnosis) Treatment Thermal Interaction Laser Tissue Welding Photodynamic Therapy Bioimaging Research Applications Photomechanics Spectroscopy Absorption, Fluorescence

Infrared (IR)

Mass Spectroscopy

Nuclear Magnetic Resonance Spectroscopy

Nuclear Quadrupole Resonance Spectroscopy

Ultraviolet-visible spectroscopy or ultraviolet - visible spec- trophotometry (UV/VIS)

Raman Spectroscopy

Fibre Optic Sensors (Biosensors)

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Table 5: Biomarkers in Periodontal Disease (36)

Proteomic alkaline phosphatase







Genetic IL-1 polymorphisms

IL-10 polymorphisms

Tumor necrosis factor Polymorphisms


Aggregatibacter actinomycetemcomitans

Porphyromonas gingivalis

Prevotella intermedia


Campylobacter rectus


Other Calcium


Hydrogen sulfide

Methyl mercaptan


Table 6: Nanotechnology In Periodontology

Diagnosis lab-on-a-chip (LOC) assay system Valuable in detection of diagnostic periodontal biomarkers and in assessment of disease severity Bone Grafting | Nanocrystalline Bone grafts in Bone Regeneration | Nanosized particle bone grafts have improved osteoconductive properties than traditional Hy- droxyapetite. Implants Nanostructured Diamond ultrahigh rigidity Nanostructured Hydroxyapatite Coatings Enhance osteoblastic activity Nanostructured Metallo-Ceramic Coatings Drug Delivery | Nanoparticles triclosan-loaded nanoparticles have been tested (41) for the treatment of periodontal disease Periodontal Nanofibers Nanofiber materials have been reported to have (44) Tissue Engi- been fabricated for three-dimensional cell culture neering and tissue engineering Local Anes- Nanotechnology based anesthetic suspensions Numerous micron size active analgesic moving (45) thesia dental robots suspended in a colloidal suspension Dentifrobots In the form of tooth pastes and mouthwashes Perform continuous calculus debridement (46)

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Table 7: Probiotics in Periodontal Therapy

Ref. Use of L. reuteri lozenges has shown to improve clinical effectiveness in moderate (49) Lactobacillus reuteri and deep pockets f f Has been reported to up-regulate the expression of B-defensins in oral cavity, de- (50) Lactobacillus helveticus creasing the no. of P. gingivlalis Has been observed to decrease the amount of periodontopathic bacteria (51)

Lactobacillus salivaris

Lactobacillus brevis Down-regulates the inflammatory cascade (52) Has been shown to reduce alveolar bone loss and disorganization of periodontal (53) Lactobacillus gasseri ligament Inhibits volatile sulphur compounds (VSCs)Production (54)

Weissella cibaria i Inhibits biofilm formation (55)

Table 8: Periodontal Vaccines

Active Immunization Whole cells

Sub-unit vaccines

Synthetic peptides as antigens

Passive Immunization Monoclonal antibody Plantibodies Genetic Immunization Plasmid vaccines

Live, viral vector vaccines

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