Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the “tip of the iceberg” of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.

Introduction: Pigmentation of the gingiva is a negative factor in an otherwise acceptable "smile window." Recently, cryosurgery and laser techniques have gained popularity for depigmentation and seem to be the most reliable and satisfactory procedures. To our knowledge, this case series is unique and is the first reporting comparison of cryosurgery and lasers in the literature. Case Series:The study included 20 patients who presented with a chief complaint of "black gums" and requested cosmetic therapy. They were randomly divided into group A and group B of 10 patients each. Patients in group A were treated using a diode laser. The laser beam was set at 0.70 W power, 200 J energy, in continuous mode. Patients in group B were treated using tetrafluoroethane cryosurgery. Patients were followed for 3, 6, 12, and 18 months. Gingival depigmentation was assessed using a new index system, gingival pigmentation index, on the day of first depigmentation and at the end of 18 months. Patient satisfaction was evaluated by using a simple questionnaire. Both procedures were equally effective in depigmentation. At the 18-month follow-up, spotted repigmentation was found in one case in each group. Although there was initial healing discomfort and mild pain with cryosurgery, all the patients were satisfied with the esthetic outcomes.Conclusion: During the 18-month follow-up, the depigmentation achieved using both the techniques was found equivalent and satisfactory. Clin Adv Periodontics 2012;2:129-134.

Objective: A comparative evaluation of the gingival depigmentation by using Tetrafluoroethane cryosurgery and the gingival abrasion technique -2 years of follow up. Material and Methods:Ten systemically healthy patients who were aged 18 to 36 years were selected for the study. Tetrafluoroethane was used for the cryosurgical depigmentation and the gingival abrasion technique used a coarse flame shaped bur. The presence or absence of pigmentation was tabulated, based on the GPI (Gingival Pigmentation Index). For the statistical analysis, Freidman's test was used. Results:The keratinization was completed within a week after the application of the cryogen and about 10 days after the gingival abrasion technique was done. The statistical analysis which was done after 90th, 180th days and 2 years. The p-value which was obtained (p<.001) showed the superiority of cryosurgery over the gingival abrasion. During the follow up period, no side effects were seen for both the techniques and the improved aesthetics was maintained upto 2 years. Conclusion:The use of cryogen Tetrafluoroethane is easy, practical and inexpensive as compared to gingival abrasion, due to its high rate of recurrence. Hence, it is more acceptable to the patients and the operator. Further studies are needed to assess the long term effectiveness of the cryosurgical method of depigmentation.

CHX mouthrinse was most effective in controlling plaque and gingivitis but caused greatest deposition of extrinsic stains. Supragingival calculus deposition was least in triclosan + NaF group followed by CHX + triclosan + NaF + ZnCl(2) and CHX. More than half of the subjects reported adverse events during the experimental phase.