Periodontal disease is a multifactorial disease affecting the supporting tissues of the teeth, resulting in progressive attachment loss and bone loss. Periodontal disease is influenced by various systemic, environmental, and psychologic factors that have the potential to alter periodontal tissues and host immune response, resulting in more severe periodontal destruction. Several studies have documented the relationship between psychosocial stress and chronic forms of periodontal disease. Stress impairs periodontal health through changes in behavior and complex interactions among the nervous, endocrine, and immune systems. The influence of stress on periodontal disease is affected by the emotional coping skills of the individual. Psychologic stress and depression may also influence the outcome of periodontal therapy. Stressful life events and coping skills are factors to consider in the risk of periodontal disease destruction and the potential for successful periodontal therapy. Therefore psychosocial stress is considered as an important risk factor for periodontal disease, and emotional stress in periodontitis patients should be diagnosed and treatment should be administered for the proper management and successful outcome of periodontal disease.

Periodontal diseases are multifactorial, and many etiological agents are suggested to play a role in their etiopathogenesis. Various risk factors are also suggested to influence the progression of periodontal disease. Until recently, specific bacteria were considered the major pathogens for the disease. However, the occurrence of periodontal disease in some patient groups is still poorly understood, and the role of other initiating agents is being investigated. Evidence strongly suggests the presence of many strains of viruses in the periodontal environment, and possible mechanisms have also been suggested. Periodontal disease as a risk factor for other systemic diseases can also be better explained based on this viral etiology. In this review, we critically analyze the role of viruses in different periodontal diseases, and provide a categorical description of the underlying mechanisms. Clinical implications and future directions are also discussed. Evidence of a causal role of herpes viruses in periodontitis might revolutionize existing strategies to diagnose, prevent, and treat the disease.

Periodontal disease has been linked to adverse cardiovascular events by unknown mechanisms. C-reactive protein is a systemic marker released during the acute phase of an inflammatory response and is a prognostic marker for cardiovascular disease, with elevated serum levels being reported during periodontal disease. Studies also reported elevated levels of various other acute-phase reactants in periodontal disease. It has been reported extensively in the literature that treatment of periodontal infections can significantly lower serum levels of C-reactive protein. Therefore, an understanding of the relationship between acute-phase response and the progression of periodontal disease and other systemic health complications would have a profound effect on the periodontal treatment strategies. In view of this fact, the present review highlights an overview of acute-phase reactants and their role in periodontal disease.

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Leukostasis is a pathological condition in which excessive amounts cause coalescence and sludgin leading to thrombosis, hemorrhage, respiratory distress, and renal failure. It is imperative that it is treated urgently and efficiently.We report an eleven year old boy presented to our emergency room with low-grade fever for 3 days. Clinical examination showed pallor and hepatosplenomegaly, and blood test showed low hemoglobin, low platelet count, and increased WBC count of 8,86,960 cells/mm³, which were primarily lymphoblasts. Additionally, patient had dyselectrolytemia with hyperkalemia, hypocalcaemia, hyperphosphatemia, and hyperuricemia. He was treated with hydration, Alkalinization, Allopurinol, exchange transfusions, and Rasburicase. Flow cytometry confirmed the diagnosis of acute T-cell lymphoblastic leukemia. This case emphasizes the importance of swift and effective use of exchange transfusion in the management of hyperleukocytosis as it is more readily available and illustrates that it is almost, if not equally, effective as Leukoapheresis.