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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effect of Non surgical Periodontal Therapy on Gingival Parameters of Diabetic and Non Diabetic Periodontitis Patients: A Prospective Clinical Study
Correspondence Address :
Dr. Mrunmayee Gaydhani,
Postgraduate Student, Department of Periodontology, Pravara Institute of Medical Sciences, Loni, Ahmednagar-413736, Maharashtra, India.
E-mail: mrunmayeeg95@gmail.com
Introduction: Non Surgical Periodontal Therapy (NSPT) has been an effective treatment for suppression of gingival inflammation and improvement of periodontal health in patients. Periodontitis and diabetes have an inter-relationship with each other. Surgical intervention is not always advisable for periodontitis patients with diabetes. Hence, assessing the response of non surgical periodontal treatment in diabetic patients can lead to better and non invasive treatment options.
Aim: To evaluate the effect of NSPT by observing changes in Gingival Index (GI), Plaque Index (PI), Clinical Attachment Loss (CAL), and volume of Gingival Crevicular Fluid (GCF) in diabetic and systemically healthy periodontitis patients.
Materials and Methods: This was a prospective clinical study conducted in the Department of Periodontology, Rural Dental College, Loni, Maharashtra from January 2021 until June 2022. Total of 90 patients were assessed and were divided into three groups. Group A (n=30) included the patients with healthy periodontium and without any systemic disease. Group B (n=30) included the patients with controlled diabetes, with CAL in ranges of 3-4 mm (stage II periodontitis). Group C (n=30) included the patients who are systemically healthy, with CAL in ranges of 3-4 mm (Stage II periodontitis). Clinical parameters including GI, PI, Periodontal Probing Depth (PPD), CAL and volume of GCF were evaluated at baseline. NSPT was performed and parameters were evaluated after three months and then compared with baseline. Statistical analysis was done by descriptive statistics as mean, SD, percentage etc.
Results: A total of 90 patients were included, of which 44 were male patients and 46 were female patients, within the age range of 18-60 years. Patients were grouped 30 each in all three groups A, B, and C with mean age 39.60±7.89, 45.70±10.02 and 43.90±9.64 respectively. The sites of group B showed statistically significant improvement in PPD at three months (1.80±0.76) compared to group C. Sites of group B also showed significant improvement in GI (1.46±0.45). There was no significant difference in the improvements of PI, Volume of GCF and CAL between group B and C at three months.
Conclusion: The present study demonstrated marked improvements in the clinical parameters and their outcomes when the systemically healthy periodontitis patients and diabetic patients are treated with NSPT.
Diabetes, Periodontal pocket, Periotron
Periodontitis is defined as an inflammatory disease of supporting tissues of teeth caused by specific microorganisms or groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession or both (1).
Periodontal disorders are now considered as multifactorial, complicated disorders that involve a complex interaction between the host immune system, inflammatory responses, and environmental modifying factors in the subgingival microbiota (2). Therefore, periodontal health must encompass a holistic review of all aspects involved in the emergence of disease as well as the restoration and maintenance of health.
Diabetes and periodontitis are two complicated chronic diseases that are interrelated. People with diabetes have two to three times higher risk of developing periodontitis than people without the disease, and the degree of glycaemic control is a critical factor in predicting risk. Periodontitis is linked to higher glycated haemoglobin and fasting blood glucose levels in adults without diabetes, and severe periodontitis is linked to an increased risk of developing diabetes (3).
It is essential to determine these significant factors of periodontal health and illness for each patient in order to achieve and maintain oral health. Diabetes Mellitus (DM) has for many years, been recognised as an important risk factor for periodontal diseases and associated with significantly higher prevalence and severity of periodontitis (4).
The present study was to evaluate the effect of NSPT in diabetic and systemically healthy periodontitis patients. Previous studies [5-9] have evaluated the effect of non surgical treatment in periodontitis patients. These studies have not taken into consideration the new staging of periodontitis and its response to NSPT. The present study evaluated patients on the basis of new staging of periodontitis given by American Academy of Periodontology (2017) (10). In this study, we assessed the patients with stage II Periodontitis as stage III and IV periodontitis would include patients with increased bone loss, increased CAL, furcation involvement and loss of teeth. This would not allow accurate evaluation of effect of NSPT. Dentists must inform their patients and their physicians about the connections between glycaemic control and periodontal health, emphasising the inflammatory nature of periodontal disorders and possible systemic complications of periodontal infection.
Hence, our present study aims to evaluate the effect of NSPT in diabetic and non diabetic patients so that a proper treatment plan with significant outcome would be implemented for both the groups leading to a good periodontal health in future.
This prospective clinical study was conducted in the Deparment of Periodontology, Rural Dental College, Loni, Maharashtra, from January 2021 until June 2022. The protocol was approved by institutional ethical committee. (Ethical committee approval number: PIMS/RDC/IEC-UG-PG/2020/09-2020). The sample population included 90 patients out of which 44 were male patients and 46 were female patients, within the age range of 18-60 years.
The patients were scrutinised following the undermentioned inclusion and exclusion criteria.
Inclusion criteria:
1. Age group 18 to 60 years of either sex.
2. Controlled group: Patients with healthy periodontium and no systemic disease.
Cases group: Patients with periodontitis with CAL between 3-4 mm (stage II Periodontitis).
3. The presence of Blood Sugar Level (BSL) fasting in ranges of 70-100 mg/dL and BSL Postprandial (PP) in ranges of 100-180 mg/dL in diabetic patients (11).
4. The patients should be above 18-year-old with an ability to maintain good oral hygiene.
5. The patients giving informed consent for the study were included.
Exclusion criteria:
1. Any systemic illness other than diabetes known to affect the outcome of periodontal therapy.
2. Allergic to medications.
3. Pregnant and lactating women.
4. Use of tobacco/smoking in any form.
5. Patients under anticoagulation treatment or bleeding disorder.
6. Patients with caries or restorations in the area to be treated.
7. Patients with orthodontic malformed teeth.
8. Patients who had undergone any periodontal treatment.
Procedure
Detailed case history of the patients was recorded. In order to have systematic and methodical recording of all observations and information required for the study special case history proforma was designed. Informed consent was obtained from all participants. Treatment procedures were completely explained to all patients before the study. The subjects were assigned into three groups by checking their CAL and BSLs as follows:
Group A: The patients with healthy periodontium and without any systemic disease.
Group B: The patients with controlled diabetes i.e., with BSL fasting and PP in ranges of 70-100 mg/dL and 100-180 mg/dL respectively and periodontitis with CAL in ranges of 3-4 mm (stage II Periodontitis).
Group C: The patients who are systemically healthy with periodontitis with CAL in ranges of 3-4 mm (stage-II Periodontitis).
Both the groups will be studied for the following variables given in (Table/Fig 1) (12),(13),(14).
Method of assessment (Table/Fig 2),(Table/Fig 3),(Table/Fig 4),(Table/Fig 5): All clinical parameters were recorded along with age and gender of patient. GCF quantification was done using Periotron-8000 and periopaper. To record the volume of GCF the 16, 26, 31, 41 teeth were dried using cotton rolls. The paper strips were inserted 1 mm intracrevicularly for 30s and then the values of Periotron-8000 were converted using Periotron Professional 3.0 software. Scaling and root planing therapy was performed for patients with supragingival, subgingival, ultrasonic scalers and root planing was performed with a set of gracey curettes. Oral hygiene instructions and method of tooth brushing was demonstrated to each patient. Patients were recalled after three months to evaluate the same parameters again i.e., GI, PI, PPD, CAL, and volume of GCF.
Statistical Analysis
Statistical analysis was done by descriptive statistics as mean, Standard Deviation (SD), percentage etc. The comparison of mean values of PI, GI, PPD, CAL and volume of GCF after NSPT in group A, B and C from baseline to after three months was done by applying Student’s Paired t-test at 5% (p-value=0.05) and 1% (p-value=0.01) level of significance. Also, comparison of mean values of PI, GI, PPD/sulcular depth, CAL and volume of GCF after three months NSPT in group A, B and C was done by applying Student’s Unpaired t-test at 5% (p-value=0.05) and 1% (p-value=0.01) level of significance. The statistical analysis software namely SYSTAT version 12 (made by Crane’s software, Bangalore) a licensed copy was used for analysis of data.
The distribution of different groups of age and gender has been depicted in the (Table/Fig 6). Group A constituted of 15 males and 15 females, group B constituted of 14 males and 15 females, group C constituted of 15 males and 15 females.
Intragroup comparison between group A: The mean and SD of variables PI, GI, sulcular depth, CAL, volume of GCF were compared within group A from baseline to three months and are depicted in (Table/Fig 7) where intragroup comparison had been done for group A. There was no significant difference between mean values of PI, GI, sulcular depth, CAL and volume of GCF after NSPT (baseline to three months) in group A (p-value >0.005).
Intragroup comparison between group B: The mean and SD of variables PI, GI, PPD, CAL, volume of GCF were compared within group B from baseline to three months which are depicted in (Table/Fig 8), where intragroup comparison had been done for group B. There was significant difference between mean values of PI, GI, PPD, CAL and volume of GCF after NSPT (baseline to 3 months) in group B (p-value=0.0001).
Intragroup comparison between group C: The mean and SD of variables PI, GI, PPD, CAL, volume of GCF were compared within group C from baseline to three months which are depicted in (Table/Fig 9), where intragroup comparison had been done for group C. There was significant difference between mean values of PI, GI, PPD, CAL and volume of GCF after NSPT (baseline to three months) in group C (p-value=0.0001).
Intergroup comparison: On intergroup comparison between group A and B and between group A and C at baseline, significant difference was found between all the parameters (Table/Fig 10),(Table/Fig 11). However, no significant difference was found between all the parameters between group B and C (Table/Fig 12). Comparison of percentage (%) decrease from baseline to three months of all the ginginval parameters for all the groups has been depicted in (Table/Fig 13).
Intergroup comparison between group A and group B: The mean and SD of variables PI, GI, PPD, CAL, volume of GCF were compared between group A and group B after three months which are depicted in (Table/Fig 14) where intergroup comparison had been done for group A and group B. There was a significant difference between mean values of PI, GI, PPD/Sulcular depth, CAL and volume of GCF after three months of NSPT when group A was compared with group B (p-value=0.0001).
Intergroup comparison between group A and C: The mean and SD of variables PI, GI, PPD, CAL, volume of GCF were compared between group A and C after three months which are depicted in (Table/Fig 15), where intergroup comparison has been done for group A and group C. There was a significant difference between mean values of PI, GI, PPD/sulcular depth, CAL and volume of GCF after three months of NSPT when group A was compared with group C (p-value=0.0001).
Intergroup comparison between group B and group C: The mean and SD of variables PI, GI, PPD, CAL, volume of GCF were compared between group B and C after three months which are depicted in (Table/Fig 16) where intergroup comparison had been done for group B and group C. There was a significant difference between mean values of GI, probing pocket depth after three months of NSPT when group B was compared with group C. While PI, CAL and volume of GCF showed no significant difference after three months of NSPT when group B was compared with group C.
The present study demonstrated marked improvements in the clinical parameters and their outcomes when the systemically healthy periodontitis patients and diabetic patients were treated with NSPT.
Mealey BL and Oates TW concluded that diabetic patients had a three-fold higher risk of periodontal disease compared with non diabetic patients after controlling for age, sex, and other confounding factors (15). In a study by Preferansow E et al., it was concluded that uncontrolled diabetes was the crucial cause of periodontal changes and, to a large extent, influenced the function of the masticatory organ in patients (16). Hence, patients with controlled diabetes were assessed in the study so as to avoid inaccurate results and also to correctly evaluate outcome of periodontal therapy. Thus, it is of utmost important for diabetic patients to maintain a good periodontal environment that is less conducive to bacterial plaque retention.
A study by Cruz GA et al., examined the clinical and biochemical changes in patients with and without Diabetes Mellitus (DM) three months following full-mouth scaling and root planning (5). It was concluded that there was no significant difference in non surgical periodontal treatment using full-mouth root planing in clinical and laboratory responses between DM and Non Diabetes Mellitus (NDM) groups after three months of follow-up. This accords with our study in which there was significant reduction from baseline to three months in PI in both group B and group C. Also, there was no significant difference found between both group B and group C at three months, in PI. On intergroup analysis the mean PI of group B and group C after three months did not show significant difference. Bridges RB et al., discovered a higher level of plaque and gingival bleeding in people with diabetes, while Kawamura M et al., observed no correlation between plaque accumulation and the presence of periodontal disease because patients maintained a good level of oral hygiene (6),(7).
In study by Cruz GA et al., there was significant difference in GI from baseline to three months of NSPT (5). This is in accordance with current study where significant difference was found in intragroup analysis from baseline to three months in GI. On intergroup analysis the mean GI of group A and group B after three months showed significant difference. On intergroup analysis the mean GI of group A and group C after three months showed significant difference. The mean GI of group B and group C after three months showed significant difference this was in contrary to study by Cruz GA et al., (5).
On intergroup analysis the mean PPD/sulcular depth of group A and group B after three months showed significant difference. On intergroup analysis the mean PPD/sulcular depth of group A and group C after three months showed significant difference. On intergroup analysis the mean PPD of group B and group C after three months showed significant difference. This is in accordance with study done by Faria-Almeida R et al., where on assessing patients with diabetes after NSPT statistically significant differences in probing depths were observed between the control and diabetic groups at all times (8).
On intergroup analysis, the mean CAL of group A and group B after three months showed significant difference. On intergroup analysis the mean CAL of group A and group C after three months showed significant difference. On intergroup analysis the mean CAL of group B and group C after three months did not show significant difference. This is in accordance with study done by Cruz GA et al., no differences were observed between the DM and NDM groups when evaluated after periodontal therapy performed in a single session using full-mouth SRP (5). The intragroup evaluation showed CAL gains in both groups.
In a longitudinal study done by Rossi V et al., showed reduction in volume of GCF after NSPT (9), this accords with current study where significant reduction in volume of GCF was found after NSPT. On intergroup analysis the mean volume of GCF of group A and group B after three months showed significant difference. On intergroup analysis the mean volume of GCF of group A and group C after three months showed significant difference. On intergroup analysis the mean volume of GCF of group B and group C after three months did not show significant difference.
Thus, the results of present study favour NSPT as one of the treatment modalities in periodontitis with or without diabetes. The results show that significant improvement in clinical parameters can be seen in non diabetic as well as diabetic patients.
Limitation(s)
Limitation of our study included selection bias as study was confined to specific rural area only. The sample size for our study was small and long term follow-up was required. For evaluation of volume of GCF the samples were collected only once but, for appropriate results could be collected in intervals. Some confounding bias could also be present as it is a cross-sectional study. In the present study UNC-15, and Williams probe were used, which could be replaced by advanced diagnostic aids to avoid observational errors.
NSPT could lead to significant improvement in periodontal health of diabetic and non diabetic patients. Parameters like volume of GCF, PI, GI, CAL and probing depth help in assessment of periodontal health and amount of improvement in periodontal health after treatment in diabetic patients. There was significant improvement in all parameters, in all the three groups post therapy. However, there was no significant difference in the outcome of NSPT in diabetic and non diabetic periodontitis patients except for GI and PPD in group B and group C. Thus, NSPT can be an effective measure in assessment and improvement of the periodontal health in diabetic patients. Future perspective includes conducting longitudinal studies with a large sample size for better outcomes. Also, randomised blinded clinical trials can be conducted.
DOI: 10.7860/JCDR/2023/62528.17986
Date of Submission: Dec 28, 2022
Date of Peer Review: Jan 21, 2023
Date of Acceptance: Apr 01, 2023
Date of Publishing: May 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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