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

Transmission of streptococcus mutans from mother to child

Dental caries is the most infectious and communicable dental disease of all age groups, which effects overall health of an individual. Childhood caries is a multifactorial dental disease and if left untreated it leads to discomfort, pain and lack of interest in routine activities and ultimately destroys tooth structure and early loss of tooth. Steptococcus mutans [S.mutans] is the main cariogenic microorganism. S.mutans breaks down sugar for energy and produces acidic environment, which causes demineralization of superficial structures of tooth i.e. enamel and dentin resulting in dental caries. It can be transmitted horizontally and vertically. According to the recent studies vertical mode of transmission is more common in preschool children than horizontal. Mainly the transferred genotypes are responsible for the transmission of caries from mothers to their children. There is genotypic diversity in population to population. No such relevant study has been conducted on local population so there is a need to know the main cariogenic genotypes ofS. mutans and its transmission from mothers to their children in local population

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

Association of alveolar bone loss with obesity: a comparative study

Background: Obesity acts as a risk factor for many diseases like diabetes mellitus, hypertension, and ischemic heart disease. Recently, it has been found that obesity is also associated with periodontal disease especially in adults and urban population

Objective: The objective of the present study was to assess association between obesity and alveolar bone loss caused by periodontal diseases in urban Pakistani population in 30-40 years age group

Subjects and Methods: 100 patients of established periodontal disease were selected based on Community Periodontal Index [CPI]. Patients were divided into obese and non-obese groups of 50 each. The criterion for diagnosis obesity was based on body mass index [BMI]. The selection of all 100 subjects was done according to exclusion and inclusion criteria which possibly excluded all other factors which might enhance alveolar bone loss except obesity. Then panoramic radiographs of all subjects were taken and alveolar bone loss was measured. Then to rule out the effect of age on alveolar bone loss an age-related alveolar bone score was calculated for all subjects of both; obese and non-obese group

Results: In this study there were 43 males and 57 females with the mean age of 35.10+2.24 and mean alveolar bone score 64.51+8.21. Obese patients had higher Alveolar Bone loss sore than non-obese individuals with an odds ratio of 4.33 [2.43 - 6.57]

Conclusion: In middle aged patients of periodontal disease belonging to urban Pakistani population obesity as assessed by body mass index [BMI] is associated with increased alveolar bone loss

Helicobacter pylori in dental plaque; is it related to brushing frequency, plaque load and oral health status?

To determine the relation between presence of H. pylori in supra-gingival dental plaque with oral hygiene habits and oral health status of patients suffering from symptomatic dyspepsia. Descriptive study. The Department of Oral Health Sciences, Shaikh Zayed FPGMI, Lahore, from September 2008 to August 2009. One hundred and fifty dyspeptic subjects with dental plaque were enrolled. After recording brushing frequency, oral health status and plaque load, the supra-gingival dental plaque samples were collected by sterile curettes. Helicobacter pylori were detected in dental plaque samples through PCR assay. Presence of H. pylori in dental plaque was found to be 37.5% in the sample. Most of the subjects brushed once daily, had plaque index score of 1 and had fair to poor oral hygiene status. Approximately 35% of the individuals who brushed once or twice a day harbored the bacterium in their dental plaque. There was no difference between bacterial detection rates among different categories of plaque index and oral health status of the study subjects. Presence of H. pylori in dental plaque was found to be associated with neither brushing frequency nor with the plaque load nor with the oral health status of individuals suffering from symptomatic dyspepsia

Is oral health status of children with beta-Thalassemia worse than that of their normal counterparts?

To determine the association, if any, of patients suffering from beta-Thalassema with dental caries, gingival condition and oral health status and compare it to their normal counterparts. A. total of 90 children suffering from beta-Thalassemia and 60 healthy controls [age range 6-15 years] were selected from similar socio-economic and parental education background. Oral hygiene status and gingival condition were examined using Oral hygiene Index-Simplified and Modified Gingival Index respectively. Dental caries was recorded using DMFT /dmft Index according to the criteria described by the World health Organisation. Dental caries status in both primary and permanent dentition was found similar in both the groups of children [p>0.5]. GI score of thalassemic children was 0.73 +/- 1.08 and of the healthy subjects was 0.85 +/- 0.95 [p>0.5], however oral health status of the two groups was found to be different [p<0.005] with a larger number of healthy group having [good] oral hygiene as compared to their thalassemic counterparts. There was no significant difference in the dental caries status and gingival condition of children with beta-Thalassemia as compared to their normal counterparts; however, oral hygiene status of the healthy children was significantly better than children suffering from beta-Thalassemia

Sensitivity and specificity of saliva in estimation of anti-HCV antibodies

This study was done to assess the efficacy of saliva as a screening tool in Hepatitis C infection when collected in a sterile test tube by simple spitting process. Anti Hepatitis C Virus antibodies [Anti-HCV] were detected in salivary samples of patients and healthy controls without using any special salivary collection device. Paired serum and oral fluid collections were obtained from 50 HCV positive cases and twenty five negative individuals. Saliva samples were collected in a sterile disposable plastic test tube by simple spitting of un-stimulated saliva by the study subjects. A modification of the serum HCV ELISA assay was developed to improve test accuracy for an oral fluid substrate. The presence or absence of anti-HCV antibodies in the blood serum was taken as gold standard against which anti-HCV levels in saliva were comparid. Overall sensitivity of saliva to detect Anti HCV antibodies was found to be 94.2% while specificity was 100%. This simple method of oral fluid collection proved to be an effective alternative to special collection saliva can be used as a cost effective screening tool for initial screening of hepatitis C infection in high risk populations

Causes of dental extractions in a teaching hospital: a retrospective study

Objectives: the aim of the study was to examine the reasons for dental extraction and to determine the pattern of extractions in patients seeking care at the Dr. Ishrat ul Ibad Institute of Oral Health Sciences [DIKIOHS] over a period of 5 months

Methods: a cross-sectional study on 1300 patients aged between 4-80yrs was conducted at the Oral Biology Department of DIKIOHS. Information regarding the patients age, sex, type of tooth extracted and reason for extraction was recorded. Results were compiled and analyzed using SPSS version 15

Results: total 1300 study cases with 1705 extractions were evaluated. Out of the total 594 [45.69%] were females while 706 were males [54.3%] with 780 and 925 extractions respectively. The most common reason for tooth extraction for both genders was caries. The total population was divided into 3 age groups, 4 - 20 yrs, 20 - 40 yrs and 40 - 80 yrs. The number of extractions in each group was 240, 807 and 658 respectively. Hence the age group with the most frequent number of tooth extractions was 20 - 40 years. The most common type of extracted tooth in the study population was tooth number 36 [mandibular permanent left first molar] and the least common was tooth number 81 [mandibular deciduous right central incisor]

Conclusion: the most common reason for extraction in the present study was found to be dental caries. The age group with the most extractions was between 20 - 40 years which indicates that awareness regarding oral hygiene needs to be improved in young adults

Oral health related quality of life individuals with down syndrome

Down syndrome [DS] is the most common cause of mental and physical retardation in the world. Individuals with Ds have skeletal, dental and soft tissue anomalies which along with their mental retardation lead to poor level of oral health as compared to normal population. This in turn has a negative impact on their quality of life. Despite all the problems oral health is reported to be the greatest unattended need of the disabled. The present review highlights the dental and oral problems that are faced by individual with DS so that a strategy can be devised to handle these conditions in the dental office

Removal of large infratemporal fossa schwannoma; case report and review of literature

Schwannomas are encapsulated benign tumors of the Schwann cells. Schwannomas arising in the infratemporal fossa [ITF] are rarely reported. We report a case of ITF schwannoma extending to the skull base and orbital floor, involving posterior ethmoidal cells, retrobulbar region, buccal space part of posterior maxilla and right maxillary sinus. A 35-year old female presented to us with swelling on the right side of the face. Biopsy revealed a schwannoma. The tumor was successfully removed via anterior approach through modified Weber-Ferguson incision. Modified Weber-Ferguson incision is a useful approach for the removal of large benign tumors arising in the infratemporal fossa that involve the maxilla and maxillary sinus

Stopping aspirin and warfarin for dental procedures: time for review

Surgical management of patients on anticoagulants is poorly understood in all fields of medicine and not just dentistry. Dental management of patients receiving oral anticoagulants is still controversial, a decision. must be made whether to continue or interrupt the anticoagulants. The traditional management entails the interruption of anticoagulant therapy for dental surgery to prevent hemorrhage. However, this practice may increase the risk of a potentially life-threatening thromboembolism. The aim of this paper is to review the evidence of this controversial issue and to highlight the areas of major concern. The pertinent literature was reviewed and all available evidence collected from Medline. Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was applied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those in whom oral anticoagulation therapy was stopped before surgery. The existing evidence suggests that many patients can safely undergo routine outpatient oral surgical procedures without alteration of their regular therapeutic anticoagulation regimens and without additional medical intervention