progression. The presence of bleeding on probing (BOP) is widely accepted as an objective sign of inflammation in gingival and periodontal tissues. Although bleeding is caused by hyperaemic inflammatory events, other variables such as defective platelets function can also cause BOP. In this scenario, acquired platelets disorder is commonly caused by the use of aspirin and inflammatory drugs. Beginning in 1988, Food and Drug Administration has repeatedly expanded the indication of aspirin used beyond pain relief to induce risk reduction for various cerebrovascular and cardiovascular diseases, rheumatoid arthritis, osteoarthritis, rheumatoid fever, and other inflammatory joint diseases. These benefits are derived from aspirin’s antithrombotic and anti‑inflammatory activity. Aspirin via cyclo‑oxygenase pathway inhibits thromboxane, which are responsible for platelet aggregation for a period of 7‑10 days. This change in platelet aggregation could increase the chance of bleeding and BOP for that period of time. Thus, aspirin ingestion is considered as factor that has a potential to alter the appearance of bleeding in various bleeding indices. Schrodi et al. investigated the antithrombotic effect of aspirin on BOP in patients with healthy periodontium. Their results demonstrated that 81 mg (low dose) and 325 mg (regular dose) aspirin did not effect on BOP of healthy individuals. However, aspirin intake of 325 mg daily for 7 days moderately increased the appearance of BOP in a population that had 20% BOP sites. Royzman et al. observed that in naturally occurring gingivitis, low dose 81 mg and regular dose 325 mg aspirin showed statistically significant increase in the percentage of BOP. Thus, increase in BOP following aspirin ingestion would challenge the notion that bleeding is a necessary sign of inflammation.[2,5] Failure of the clinicians to take into account aspirin use in patients undergoing periodontal treatment could lead to false positive results, which would lead to an improper diagnosis, treatment choice, and assessment of disease activity and progression. So aspirin intake is an important factor to be considered in the clinical trials as an inclusion/exclusion criterion for potential patient when the outcome of interest will be measured by BOP. This is especially pertinent since the daily use of aspirin now plays a major role in the prevention of myocardial infarction with long term use of low dose of it.
Department of Periodontology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India E‑mail: [email protected]
References 1. 2.
Armitage GC, Research, Science and Therapy Committee of the American Academy of Periodontology. Diagnosis of periodontal diseases. J Periodontol 2003;74:1237‑47. Sundram E, Kharaharilal P, Ilavarasu S, Devi R, Nalini E, Karunamoorthy V. Evaluative comparison of systemic aspirin therapy effects on gingival bleeding in post non‑surgical periodontal therapy individuals. J Pharm Bioallied Sci 2012;4:S221‑5. Capone ML, Tacconelli S, Sciulli MG, Grana M, Ricciotti E, Minuz P, et al. Clinical pharmacology of platelet, monocyte, and vascular cyclooxygenase inhibition by naproxen and low‑dose aspirin in healthy subjects. Circulation 2004;109:1468‑71. Schrodi J, Recio L, Fiorellini J, Howell H, Goodson M, Karimbux N. The effect of aspirin on the periodontal parameter bleeding on probing.
Journal of Pharmacy and Bioallied Sciences October-December 2013 Vol 5 Issue 4
J Periodontol 2002;73:871‑6. Royzman D, Recio L, Badovinac RL, Fiorellini J, Goodson M, Howell H, et al. The effect of aspirin intake on bleeding on probing in patients with gingivitis. J Periodontol 2004;75:679‑84.
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Platelet concentrates: Regenerating the lost tissues Sir, One of the recent promising innovations in dentistry is the use of platelet concentrates for the accelerated repair and regeneration of the soft and hard tissues. The use of platelet concentrates enhances the body’s natural wound healing mechanisms. There has been considerable interest among the medical practitioners to develop some type of biologic glue that could achieve hemostasis and help in wound sealing. In the recent times, several new approaches have been developed to prepare them. They are based on autologous whole blood obtained immediate pre‑operatively, which is then processed immediately into autologous concentrated platelet‑rich plasma (PRP) or platelet rich fibrin (PRF). PRP is an autologous modification of fibrin glue and is an autologous concentrate of human platelets in a small volume of plasma. This is achieved by the use of differential centrifugation in a conventional auto‑transfusion machine. When this PRP is combined with thrombin and calcium chloride, platelet gel is created. This product is a rich source of growth factors and is effective in accelerating significant tissue repair and regeneration. PRP works through the degranulation of the granules in platelets, which contain the synthesized and pre‑packed growth factors. The two most important growth factors are platelet‑derived growth factor, and transforming growth factor‑β. Because PRP enhances osteoprogenitor cells in the host bone and in bone grafts, it has found clinical applications in bone defects, sinus lift augmentation, horizontal and vertical ridge augmentations, ridge preservation, periodontal/peri‑implant defects, cyst enucleations/periapical surgeries, healing of extraction wounds, endodontic surgeries, ablative surgeries of the maxillo‑facial region and blepharoplasty. PRF was first developed in France by Choukroun et al. and is a second generation platelet concentrate. This technique requires neither anticoagulant nor bovine thrombin. PRF occurs in the form of platelet gel and promotes bone growth and maturation, promotes healing of wound and can be used in conjunction with the bone graft materials and can accelerate regeneration of tissues. PRF is considered a useful biomaterial and a number of authors have shown its importance in the treatment of periodontal defects, furcation and gingival recession.[4,5] Though, the material is 329
widely used by the clinicians all over the world because of its ease of preparation and cost effectiveness, more future long‑term clinical trials are required to establish and understand its role completely.
Such papers deserved to be cited when their contents were used. This might have occurred not by any intention, but probably since it was originally a conference presentation, and that the authors might have paid less attention to the drafted report.
Kriti Agarwal, Kanika Agarwal1, Nishant Kumar2
Moreover, stating a scientific claim without substantiating it using proper references renders the statement unreliable. Scientists should use validated material in their reports. If there are no relevant references, they should allude that the assertion is their own deduction, not a scientific finding. Unsubstantiated scientific allegations might blur the distinct lines between scientific facts / theories and unproven ideas / theorems.
Department of Periodontology, D. J. Dental College, Modinagar, 1Department of Periodontology, Sardar Patel Institute of Dental and Medical Sciences, Lucknow, 2 Department of Oral and Maxillofacial Surgery, I. T. S. Dental College, Greater Noida, Uttar Pradesh, India E‑mail: [email protected]
References 1. 2. 3.
Whitman DH, Berry RL, Green DM. Platelet gel: An autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg 1997;55:1294‑9. Oz MC, Jeevanandam V, Smith CR, Williams MR, Kaynar AM, Frank RA, et al. Autologous fibrin glue from intraoperatively collected platelet‑rich plasma. Ann Thorac Surg 1992;53:530‑1. Choukroun J, Diss A, Simonpieri A, Girard MO, Schoeffler C, Dohan SL, et al. Platelet‑rich fibrin (PRF): A second‑generation platelet concentrate. Part V: Histologic evaluations of PRF effects on bone allograft maturation in sinus lift. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:299‑303. Sharma A, Pradeep AR. Autologous platelet‑rich fibrin in the treatment of mandibular degree II furcation defects: A randomized clinical trial. J Periodontol 2011;82:1396‑403. Jankovic S, Aleksic Z, Klokkevold P, Lekovic V, Dimitrijevic B, Kenney EB, et al. Use of platelet‑rich fibrin membrane following treatment of gingival recession: A randomized clinical trial. Int J Periodontics Restorative Dent 2012;32:e41‑50.
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A sound, well-discussed report might be as necessary as a proper research design, if not more important. A high-quality original study needs a good deal of interpretation and discussion, something almost missing in this paper (again perhaps since it was a conference presentation). Even some sentences are repeated throughout the text. These issues might compromise the originality of the content, despite the fact that the methods and results were genuine. This properly designed study could seem more valuable with a better article.
Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran E-mail: [email protected]
References 1. 2. 3.
A well-substantiated report is as vital to science as is a well-designed study Sir, I read with interest the Journal of Pharmacy and Bioallied Sciences conference supplement article of Pillai et al. (Volume 5 | Issue 6 [Supplement]) as conference proceedings on behalf of “Indian academy of dental specialists.” The methods were quite intriguing and well-designed and the results were of scientific merit. Nevertheless, the report was poorly written and also bordering on accidental plagiarism. Many sentences in the introduction and discussion lacked references. Such statements had been reported previously in various articles (including but not limited to these four).[2-5]
Pillai AR, Gangadharan A, Gangadharan J, Kumar NV. Cytotoxic effects of the nickel release from the stainless steel brackets: An in vitro study. J Pharm Bioallied Sci 2013;5:S1-4. Mikulewicz M, Chojnacka K. Cytocompatibility of medical biomaterials containing nickel by osteoblasts: A systematic literature review. Biol Trace Elem Res 2011;142:865-89. Mikulewicz M, Chojnacka K. Release of metal ions from orthodontic appliances by in vitro studies: A systematic literature review. Biol Trace Elem Res 2011;139:241-56. Amini F, Rakhshan V, Mesgarzadeh N. Effects of long-term fixed orthodontic treatment on salivary nickel and chromium levels: A 1-year prospective cohort study. Biol Trace Elem Res 2012;150:15-20. Amini F, Rakhshan V, Sadeghi P. Effect of fixed orthodontic therapy on urinary nickel levels: A long-term retrospective cohort study. Biol Trace Elem Res 2012;150:31-6.
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Website: www.jpbsonline.org DOI: 10.4103/0975-7406.120075
Response from Editor Dear Dr. Vahid, Thank you for your efforts in bringing this issue in front of us. Supplements are published in Journal of Pharmacy and Bioallied Sciences in way it was received from conference organizers. Journal of Pharmacy and Bioallied Sciences October-December 2013 Vol 5 Issue 4
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