This study tested a newly-developed clinical pathway (CP) to manage periodontitis patients against patients managed using usual care. This study was a multi-center quasi-experimental involving newly-diagnosed chronic periodontitis patients. Five dental schools at Malaysian public universities participated in the study. A total of 36 patients participated as a test group and received non-surgical periodontal treatment based on the CP and reviewed at 6, 12 and 24 weeks. Treatment outcomes at each review were compared with data of 36 patients who had been treated without CP and matched as historical controls. Outcome variables were clinical parameters namely probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index and visible plaque index. Improvements in these parameters for both groups were compared using independent t-test for normally distributed data and Mann–Whitney U test for non-normally distributed data. Both groups showed statistically significant post-treatment improvements for all clinical parameters. The CP group had significantly reduced number of sites for PPD ≥ 7mm and CAL gain compared to control group at 12th week (p=0.040) and 24th week (p=0.041), as well as between baseline to 24 weeks (p=0.039) with Cohen’s effect size 0.87, respectively. The use of a CP could lead to significant clinical improvement for patients with chronic periodontitis. Its use could be recommended in dental settings involving multiple operators to ensure best outcomes based on standardized optimal care and shared guidelines for clinical decision-making.

Drug-influenced gingival enlargement (DIGE) among hypertensive patients is commonly associated with antihypertensive drugs such as calcium channel blockers (CCBs). Immune response alteration is one of the proposed mechanisms for DIGE. Immunoglobulin A (IgA) in saliva which involves in defense mechanism was shown to be affected in patients with DIGE. Objective: This study aimed to determine the association of salivary IgA level with DIGE. Methods: This cross-sectional study comprised 47 hypertensive patients who had consumed antihypertensive drugs for at least 3 months. Twenty-one (44.7%) males and 26 (55.3%) females had participated in this study. Data was analyzed using SPSS version 26.0. The p-value of less than 0.05 at a 95% confidence interval is considered statistically significant. Results: Eighty-three percent and 17.0% of hypertensive patients were on CCBs and non- CCBs respectively. Amlodipine was found to be the most common (55.3%) antihypertensive drug consumed. Twenty- one (44.7%) patients presented with DIGE. The salivary IgA level was significantly decreased (p=0.03) among hypertensive patients with DIGE [Median 4.9 ng/mL (IQR 5.268)] compared to those without DIGE [median 15.03 ng/mL (IQR 32.246)]. Conclusion: This data indicates the level of salivary IgA was significantly affected in patients with DIGE which may compromise the defense mechanism of saliva.