Bidirectional relationship between chronic kidney disease and periodontal disease

Non communicable diseases [NCDs] affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus [DM], cardiovascular diseases [CVD], pulmonary diseases, osteoporosis and chronic kidney diseases [CKD]. About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy

Mixed dentition space analysis: a review

During mixed dentition period discrepancy between spaces available and required in the arch is predicted so that teeth can erupt freely with good alignment. Mixed dentition space analysis is done for this purpose in which size ofunerupted canine andpremolars is predicted. Accurate prediction is very important regarding correct orthodontic diagnosis and treatment planning. Prediction equation and or tables based on size of already erupted permanent teeth are the most widely used methods. Tooth size varies in different racial and ethnic groups and among genders so prediction equation and tables specific to each population for both male and female must be made. Mandibular incisors; combination ofmandibular incisors and mandibular 1[st] molars; and mandibular incisors and maxillary 1[st] molars have been used worldwide. Recent studies have reported that mandibular incisors are not the best predictors and sum ofmandibular incisors and maxillary 1[st] molars are even more accurate predictor for the estimation of size of unerupted teeth. In Pakistani population combination of mandibular incisors and maxillary 1[st] molar have not been employed so study must be conducted to estimate which combination of group of teeth is more accurate for the estimation of size of unerupted canine and premolars in local population