Cutaneous sinus tract of dental origin is the commonest of the many types of sinus tracts that are formed on the face and neck. Cutaneous sinus tracts may originate from local chronic osteomyelitis (Garre's osteomyelitis). Although the etiological factor is usually periapical infection, they are seldom of periodontal origin. Conventional periapical and panoramic roentgenograms are generally insufficient for diagnosis and treatment planning of cutaneous sinus tracts of periodontal origin. In the present case, computed tomography was used for diagnosis, and osteomyelitis was managed by periodontal treatment.

Gingival recession is the one of the commonest clinical features of chronic periodontitis and poses a great esthetic and functional problem to the patient. Several treatment modalities have been described in the dental literature to treat the localized gingival recession. In the present study, the efficacy of subepithelial connective tissue graft (SCTG) and the acellular dermal matrix allograft (ADMA) was evaluated and compared in the treatment of localized gingival recession. Nine patients with bilateral identical Miller's class I or II were selected and randomly assigned to treatment with either SCTG or the ADMA. Six months follow-up result showed significant clinical outcome in both the treatment groups in terms of improvement in recession depth, root coverage percentage, probing depth, clinical attachment level and the width of keratinized tissue. However on comparison between the two groups, no significant difference was found in relation to any of the parameters. Hence, it can be concluded that both the techniques (SCTG & ADMA) are equally effective in the treatment of localized gingival recession and restoring the esthetic and function.

Femoral veins have been used for decades to position temporary hemodialysis catheters. Few reports, however, describe its use for permanent vascular access. This study describes the use of tunneled femoral vein catheters as permanent vascular accesses. Fourteen chronic hemodialysis patients (nine males and five females) had tunneled central venous catheters placed in the femoral vein from November 2004 to July 2005. The age of the patients ranged from 21 to 68 years with a mean of 49.8 ± 5.9 years. Placement of a catheter via the internal jugular veins was impossible in 10 patients whose course was complicated by thrombosis or strictures of the superior vena cava. The remaining four patients had exhausted conventional access sites. The insertion of the femoral catheters involved a subcutaneous tunnel that was created by retrograde passage of the catheter through the cannula to the point of exit at a preselected site in the epsilateral thigh away from the groin. The life span of the tunneled femoral catheter ranged between 32-240 days; median time in place was 182 days. There were four incidences of tunnel infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis, which were treated successfully without the need for catheter removal. Other complications such as bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas were not observed. We conclude that tunneled femoral catheters are suitable alternatives for long-term hemodialysis access. Additional studies with a greater sample size are needed to confirm this conclusion.

The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin (Neosporin), and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys to restoring vision and avoiding the subsequent need for penetrating keratoplasty.

Hereditary gingival fibromatosis is a rare disorder characterized by various degrees of attached gingival overgrowth. Gingival fibromatosis usually develops as an isolated disorder but can be one feature of a syndrome. A case of a 17-year-old female who presented with a generalized severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost the whole dentition. Excess gingival tissue was removed by conventional gingivectomy under local anesthesia. The postoperative course was uneventful and the patient's appearance improved considerably. Good esthetic result was achieved without recurrence of the gingival overgrowth. After treatment, regular recall visits are necessary in order to evaluate oral hygiene, and the stability of the periodontal treatment.

Even though dentistry was not a specialized branch of Ayurveda, it is included in its Shalakya Tantra (system of surgery). Problems such as deformities of the oral cavity, plaques and infections were managed in ancient India. Traditional medicine can treat various infectious and chronic conditions. Research has shown that all kinds of chewing sticks described in ancient Ayurveda texts have medicinal and anti-cariogenic properties. Its oil pulling (Kaval, Gandush) practice is claimed to cure about 30 systemic diseases. Amla (Emblic myrobalan), is a general rebuilder of oral health. Bilberry fruit (Vaccinium myrtillus) and hawthorn berry (Crateagus oxycanthus) stabilize collagen, strengthening the gum tissue. Liquorice root (Glycyrrhiza glabral) promotes anti-cavity action, reduces plaque, and has an antibacterial effect. Use of safe, quality products and practices should be ensured based on available evidence if traditional medicine is to be acknowledged as part of primary health care. Scientific validations of the Ayurveda dental health practices could justify their incorporation into modern dental care. Publicity of these techniques using appropriate media would benefit the general population by giving more confidence in the ancient practices, thus preventing tooth decay and loss.

Aggressive periodontitis, although not rare, is a fairly unknown condition. Little is known about its optimal management. While majority of patients with common forms of periodontal disease respond predictably well to conventional therapy (oral hygiene instructions (OHI), non-surgical debridement, surgery, and Supportive Periodontal therapy (SPT)), patients diagnosed with aggressive form of periodontal disease often do not respond predictably/favorably to conventional therapy owing to its complex multi-factorial etiology. Protocols for treating aggressive periodontitis are largely empirical. There is compelling evidence that adjunctive antibiotic treatment frequently results in more favorable clinical response than conventional therapy alone. This article mainly focuses on the role of adjunct use of pharmacological agents in improving the prognosis and treatment outcome of aggressive periodontitis patients.

Background: Periodontitis is inflammation of the supporting tissues of the teeth caused by specific microorganisms. Intra-periodontal pocket, mucoadhesive drug delivery systems have been shown to be clinically effective in the treatment of periodontitis. The aim of this study was to formulate a mucoadhesive gel from the seed hull of Quercus brantii and fruits of Coriandrum sativum for the treatment of periodontitis. Materials and Methods: The semisolid concentrated extracts were incorporated in gel base. Mucoadhesive gels were prepared using carbopol 940‚ sodium carboxymethylcellulose (sodium CMC) and hydroxypropyl methylcellulose K4M (HPMC) as bioadhesive polymers. Physicochemical tests‚ mucoadhesive strength measurement and in vitro drug release study were carried out on two formulations containing carbopol 940 and sodium CMC polymers (Formulations F ₄ and F ₅ ). We investigated the antibacterial activity of formulation F ₅ against Porphyromonas gingivalis using the disk diffusion method on supplemented Brucella agar. Results: Eight gel formulations were prepared. Physical appearance, homogeneity and consistency of F ₄ and F ₅ were good. Mucoadhesion and viscosity of F ₅ (1% carbopol 940 and 3% sodium CMC) was more than F ₄ (0.5% carbopol 940 and 3% sodium CMC). Drug release from F ₅ was slower. Both of formulations were syringeable through 21 G needle. In the disk diffusion method, F ₅ produced significant growth inhibition zones against P. gingivalis. Conclusion: The ideal formulation for the treatment of periodontitis should exhibit high value of mucoadhesion, show controlled release of drug and be easily delivered into the periodontal pocket preferably using a syringe. Based on in vitro release and mucoadhesion studies‚ F ₅ was selected as the best formulation.

Background: Nicotine replacement therapy (NRT) can help smokers to quit smoking. Nicotine chewing gum has attracted the attention from pharmaceutical industries to offer it to consumers as an easily accessible NRT product. However, the bitter taste of such gums may compromise their acceptability by patients. This study was, therefore, designed to develop 2 and 4 mg nicotine chewing gums of pleasant taste, which satisfy the consumers the most. Materials and Methods: Nicotine, sugar, liquid glucose, glycerin, different sweetening and taste-masking agents, and a flavoring agent were added to the gum bases at appropriate temperature. The medicated gums were cut into pieces of suitable size and coated by acacia aqueous solution (2% w/v), sugar dusting, followed by acacia-sugar-calcium carbonate until a smooth surface was produced. The gums' weight variation and content uniformity were determined. The release of nicotine was studied in pH 6.8 phosphate buffer using a mastication device which simulated the mastication of chewing gum in human. The Latin Square design was used for the evaluation of organoleptic characteristics of the formulations at different stages of development. Results: Most formulations released 79-83% of their nicotine content within 20 min. Nicotine-containing sugar-coated gums in which aspartame as sweetener and cherry and eucalyptus as flavoring agents were incorporated (i.e. formulations F _19-SC and F _20-SC , respectively) had optimal chewing hardness, adhering to teeth, and plumpness characteristics, as well as the most pleasant taste and highest acceptability to smokers. Conclusion: Taste enhancement of nicotine gums was achieved where formulations comprised aspartame as the sweetener and cherry and eucalyptus as the flavoring agents. Nicotine gums of pleasant taste may, therefore, be used as NRT to assist smokers quit smoking.