Periodontal Problems Research Articles

Assessment of Alveolar Bone and Periodontal Status in Peritoneal Dialysis Patients.

Chronic kidney disease (CKD) affects 8–13% of the global population and has become one of the largest burdens on healthcare systems around the world. Peritoneal dialysis is one of the ultimate treatments for patients with severe CKD. Recently, increasing severe periodontal problems have been found in CKD patients. Periodontitis has been identified as a new variable risk factor for CKD. The aim of this study was to investigate the periodontal status and severity of alveolar bone loss in CKD patients with peritoneal dialysis (PD). One hundred and six patients undergoing PD (PD group) and 97 systemically healthy periodontitis patients (control group) were enrolled. The differences in the dimensions of the alveolar bone between two groups were compared, and the distribution of alveolar bone defects was analyzed by cone-beam computed tomography (CBCT). Gingival index (GI), plaque index (PLI), periodontal probing depth (PPD), and attachment loss (AL) were recorded. The levels of inflammatory factors in gingival crevicular fluid were assessed by ELISA. Compared to control group, there was a higher degree of alveolar bone loss in maxillary premolars, maxillary 2nd molar and mandibular 1st molar in patients with PD (p < 0.05). A comparison of bone loss in different sites revealed that the area with the highest degree of bone loss were on the mesial-buccal, mid-buccal, distal-buccal, and mesial-lingual site in PD patients. The expression levels of inflammatory factors were higher in PD group (p < 0.01). In conclusion, PD patients presented more severe periodontal and inflammatory status than systemically healthy periodontitis patients. The loss of the alveolar bone differed between the two groups. Different sites and teeth exhibited a diverse degree of bone loss. This study highlights that clinicians should pay close attention to periodontal status of peritoneal dialysis patients and provides a new thinking to improve healthcare for CKD.

Effect of glucose mediated oxidative stress on apoptotic gene expression in gingival mesenchymal stem cells

BackgroundDiabetes is a common disease that causes gingival and periodontal problems. Stem cells isolated from dental sources are an emerging area of research with a potential to facilitate regenerative medicine. The stem cells retain the property of self-renewal and the ones isolated from dental sources are mainly multipotent mesenchymal stem cells that have the ability to self-renew as well as differentiation towards multiple lineages.ObjectivesWe aimed to isolate and characterize gingival mesenchymal stem cells by pluripotency markers and investigated the effect of oxidative stress on growth kinetics and apoptotic gene expression of gingival cells exposed to glucose mediated oxidative stress.MethodsIn this study, we isolated gingival mesenchymal stem cells from gingiva. This was followed by morphologic analysis using inverted phase contrast microscopy and molecular profiling of these cells for the mRNA expression of specific genes. The isolated cells were cultured till passage 3 and then exposed to oxidative stress (high glucose concentration). We measured the apoptotic gene expression and compared their growth kinetics.ResultsThe results showed that oxidative stress produced by glucose reduced growth kinetics and increased apoptotic gene expression in gingival mesenchymal stem cells. According to the genetic results, glucose activated TNF family to initiate apoptosis.ConclusionIn conclusion, the present study demonstrated that high glucose obliterated cellular proliferation testified by evaluating growth kinetics and induced apoptotic gene expression in gingival mesenchymal stem cells. This initiated extrinsic apoptotic pathway mediated by TNF family. Therefore, in diabetes oral health condition is compromised and periodontal disease is common.

Immunological parameters examination of the oral fluid in normal and pathological conditions: sensitivity analysis of microorganisms in modern therapeutic practice in vitro

Inflammation of the mucosal immune system is a common occurrence (saliva). The masticatory process and salivary enzymes destroy antigenic material that enters the mouth cavity, yet it can still activate immunological responses. Many soluble components are secreted by epithelial cells or incorporated into oral cavity fluids. Defensins, histatins, lysozyme, and lactoferrin all have antibacterial action. They appear to work synergistically with secretory IgA. The objectives of this study is to examine the immunological parameters (concentration of total IgA and secretory IgA) of the oral fluid of the examined individuals in normal and pathological conditions; and to identify the sensitivity/resistance of microorganisms-the main representatives of the oral microflora to antimicrobial drugs widely used in modern therapeutic practice (antibiotics) in vitro. To achieve the study's goals, 65 individuals aged 18 to 50 were evaluated. To measure secretory IgA in oral fluid, we used a solid-phase immunoassay and a ZAO Vector Best sIgA ELISA BEST strip. The "secretory IgA-ELISA" reagent collection is designed to quantify secretory IgA in body fluids using enzyme-linked immunosorbent assay. The enzyme-linked immunosorbent assay measures secretory IgA. The t-test was used to assess the significance of differences across indicator groups. Results indicated that amount of total IgA in oral fluid is significantly lower in people with dental and periodontal problems than in people who are healthy. This indicates a decrease in oral cavity resistance and an increase in carious/periodontal processes. Caries and/or periodontal disease have been linked to lgA deficiency. The results showed that staphylococci and streptococci dominated the oral cavity microbiota in the comparison groups. In addition to this, Neisseria and Veillonella were found. Streptococci accounted for 57 percent of all microorganisms planted in this biotope. Enterobacteria accounted for up to 15%, whereas Neisseria accounted for about 4% and 2%. The decrease in sIgA levels in periodontitis patients' saliva indicates a lack of local mucous membrane protection, increasing the risk of caries and periodontitis. The lower sIgA levels in the mouth make tooth tissue more susceptible to caries-causing microbe adherence than in healthy people.

Gummy Smile Treatment by Aesthetic Crown Lengthening on Altered Passive Eruption Case

An attractive smile enhances the appearance and acceptance of an individual in society. Gum exposure more than 3 mm is generally considered unattractive and known as a gummy smile, which is usually considered an aesthetic problem. At present, patients have a greater desire for more aesthetic results that may influence the planning of dental treatments. This case report aimed to describe the surgical sequence of aesthetic crown lengthening to improve smile profile and eliminate gummy smile. We reported a 21-year-old non-smoking woman with no pertinent medical history who presented with a chief complaint of an unattractive smile due to excessive gingival display. The gingival display in the smile was 5 mm, and the width to height ratio of the central incisor was 121%. Neither periodontal problems nor teeth mobility was detected. Assessment for the condition was excessive gingival display due to altered passive eruption. The overall prognosis for this case was good. The primary treatment plan proposed to the patient was an aesthetic crown lengthening. Altered passive eruption class I subtype A was a case conclusion, and aesthetic crown lengthening with gingivectomy without osseous reduction was the selected treatment. In conclusion, aesthetic crown lengthening should be considered as a surgical component of aesthetic therapy to improve smile profile and eliminate gummy smile.

Predictability of Root Movements Using Virtual Root Setup in a Patient With Periodontal Disease Treated With Clear Aligners

Aims: The aim of the study was to show a case with a midline diastema in a patient with high periodontal risks and gingival recessions treated with clear aligners. The objective was to predict and quantify root movements using a dedicated software that extrapolates data from the Cone Beam Computed Tomography (CBCT). Case Presentation: A 31-year-old female with a mandibular midline diastema asked for an aesthetic treatment. She had vertical bone loss on the lower central incisors, so a CBCT was necessary in order to plan the root movements. The purpose of the treatment was to avoid an uncontrolled tipping of the incisors and, therefore, a vestibular movement of the roots, which could cause serious periodontal problems. Conclusion: At the end of the treatment, the complete closure of the diastema and the radiographic healing of the vertical bone loss between mandibular central incisors were achieved. The superimpositions with the virtual setup demonstrated predictability of root movements of 76%.

The Role of Information in Dental Traumatology in Patients during Developmental Age: A Cognitive Investigation.

Objectives The gestation period involves a series of changes in all maternal organs and systems, due to hormonal fluctuations that also affect the oral cavity, leading to possible development of diseases such as gingivitis, oral pregnancy tumor, or periodontitis. Over the years, the positive correlation between poor oral health and adverse outcomes in pregnancy, such as fetal changes, low birth weight, preterm birth, or preeclampsia, has also been highlighted. The aim of this study is to analyze and understand the levels of knowledge and information of pregnant women about the possible repercussions that they may have on the oral cavity, caused by hormonal alterations. Materials and Methods A questionnaire of 17 multiple choice questions was formulated and published online from 01/02/2020 to 31/08/2020, aimed at pregnant women and new mothers. The Google Forms platform was used to collect the data that were then statistically analyzed by creating crosstabs with multiple dependency variables. Results The study cohort was represented by 1,191 women, whose responses first showed that about half were unaware of the predisposition to develop infections and periodontal problems during the gestation period. The same noticed bleeding and gum swelling during brushing and despite this, only 21% visited their dentist to resolve the situation. Furthermore, 88.2% of all women did not know that problems in the oral cavity can lead to adverse pregnancy outcomes. Conclusion Primary prevention is essential and must be implemented with the collaboration of the various professional figures who follow the woman during gestation.

Perception of orthodontists & post graduates regarding techniques to reduce orthodontic treatment duration: A prospective questionnaire study

Prolonged orthodontic treatment timing might cause pathologic changes like root resorptions, periodontal problems & psychological impact on patients. By shortening of treatment duration it helps to prevent undesired sequelae & increased motivation towards treatment. Recently a number of techniques with the potential to reduce treatment time had been administered. The major categories were: - Biological through local or systemic administration of drugs, Mechanical or physical stimulation such as vibrators & low energy lasers, surgically facilitated accelerated orthodontic treatment like corticotomy and piezocision. Therefore the aim of this study is to help in evaluating the knowledge & utilization of techniques used by an orthodontists & Post-graduates in their practice. Keywords: Accelerated orthodontic treatment, Orthodontic treatment time, Prospective questionnaire study, Reduction in treatment time

Proximal contact tightness for Class II direct composite resin restorations: a literature review

This article reviews the literature regarding factors that affect proximal contact tightness (PCT) when restoring Class II cavities with direct composite resin. The PCT between two adjacent teeth is an important factor in maintaining oral health by ensuring that tooth positions remain stable, food is deflected away during mastication, dental papillae are maintained and to facilitate hygienic cleaning. If open contacts are created, there is a greater chance that the patient will experience periodontal problems or caries. Using sectional matrix systems with separation rings, and using materials with less polymerization shrinkage are effective methods to increase PCT and create significantly tighter contacts compared with using circumferential matrix systems. CPD/Clinical Relevance: Understating the clinical factors that affect proximal contact tightness between adjacent teeth is important to achieve optimal contacts in direct composite resin restorations to maintain oral health.

Vitamin D Deficiency and Diseases

Objective: Vitamin D deficiency is claimed to be associated with many diseases in the world population. Many studies reported that vitamin D deficiency is quite prevalent in Pakistan. The aim of this review is to describe the current status of vitamin D deficiency in healthy individuals and in different disease conditions in this country. Materials and Methods: Search engines such as “Google Scholar,” “Medline,” and “PubMed” were used by applying key words such as vitamin D deficiency and different disease conditions in the Pakistani population. In this study, people with vitamin D levels less than 30 ng/mL were reported as being vitamin D deficient. Results: A total of 82 studies were included: Among these, 12 studies showed vitamin levels less than 30 ng/mL in healthy individuals (male and female) and 70 studies in different disease conditions. It was found that about 64.6% of healthy subjects had vitamin D levels less than 30 ng/ml. Moreover, 70 studies showed vitamin D deficiency in some diseases, such as musculoskeletal, bone, and periodontal problems, nursing mothers and children, tuberculosis (TB), diabetes, cardiovascular problems, and some type of cancers. Conclusion: The current status of vitamin D deficiency in the healthy population and in several diseases and conditions is thoroughly discussed in this review. This review could be helpful in understanding the status of vitamin D and the different aspects of vitamin D research in this population.

Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report

Aim: Some immunological changes occurring in mothers during pregnancy increase their susceptibility to infections, including periodontal infections. Sheehan syndrome (SS) is a disease that occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. The presence of multiple hormonal deficiencies leads to the impairment of bone microarchitecture, which can cause osteopenia and even osteoporosis. Osteoporosis and periodontitis are both chronic diseases characterized by bone loss. Moreover, recent studies have shown that there is a relationship between menopause, osteoporosis, alveolar bone resorption, and tooth loss. This case report aims to evaluate the oral and periodontal status of a patient with SS and to raise awareness about dental and periodontal problems that may occur in such patients.&#x0D; Methodology: A 63-year-old female patient diagnosed with SS in the endocrinology clinic was referred to the periodontology clinic with complaints of multiple tooth loss, mobility in her teeth, and gingival bleeding. In the clinical and radiographic examination of the patient, it was determined that all teeth had horizontal bone resorption; moreover, there was mobility in the mandibular anterior teeth and hemorrhage in the gums. When the patient’s laboratory results were examined, it was seen that the basal plasma levels of free triiodothyronine (T3) and thyroxine (T4), growth hormone (GH), prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, and total testosterone values were significantly lower, and the anterior pituitary elevation was significantly decreased in pituitary magnetic resonance (MR) imaging.&#x0D; Conclusion: The periodontium is the target tissue of sex and other hormones. Hormonal changes may affect the inflammatory–immune tissue responses of periodontal tissues. Many studies have shown that thyroid and sex hormones affect oral and especially periodontal tissues. The degradation of hormonal hemostasis may induce a series of pathological events in the oral environment, resulting in inflammatory changes in gingival tissues, periodontal attachment losses, and destruction of the alveolar bone. Systemic diseases that affect hormonal conditions, such as SS, must be considered in the evaluation of oral health. Medical physicians should refer their patients to the dentist for consultation when evaluating patients’ hormonal status and planning their treatment.&#x0D; &#x0D; How to cite this article: Şen SC, Saygun NI, Or Koca A, Özcan E. Evaluation of the periodontal status of a patient diagnosed with Sheehan syndrome: A case report. Int Dent Res 2021;11(Suppl.1):308-11. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.46&#x0D; &#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.&#x0D;

Salivary Oxidative Stress Markers' Relation to Oral Diseases in Children and Adolescents.

Current evidence suggests that salivary markers of oxidative stress are indicative of clinical disease indices such as the papillary bleeding index (PBI) and the caries index (CI). The aim of this study was to assess the relation of oxidative stress markers with oral dental caries and periodontal problems in a pediatric population. In our case-control study, unstimulated whole saliva was collected from individuals aged 3–18 years (n = 177); 14 individuals were excluded. Study subjects were divided into those with caries (CI = 2, n = 78) and those who were caries-free (n = 85). These groups were then divided into another subset consisting of children (mean age 7.3 years, n = 121) and adolescents (mean age 16.1 years, n = 42). The PBI was determined in all groups. We then assessed salivary levels of oxidative stress markers. Our results showed that, the total antioxidant capacity (TAC) level increased in patients with more gingival bleeding (p < 0.05) in the study group aged 3–18 years. In addition, TAC showed a significant decrease in samples with caries when compared to the caries-free group in adolescents (p = 0.008). In conclusion, TAC levels may be a marker of both gingival bleeding and dental caries in young adult populations. We hope that in the near future, prophylaxis, control, follow up and even possible therapeutic use of oxidative stress markers in a chairside way will become possible as antioxidants have been shown to be effective against oral diseases.

The Potential of Aloe vera as an Active Ingredient in Toothpaste Formulations: A Narrative Review

Context: Tooth brushing is a primary method to prevent the onset of oral diseases. Aloe vera is commonly used in dentistry as an herbal alternative due to its anti-inflammatory and anti-microbial actions; recently, it has been used in toothpaste formulations as an active agent. This review aimed to investigate the clinical effects of A. vera as an active ingredient in toothpaste formulations. Evidence Acquisition:: The data used in this review was extracted from articles published until 2020. We searched official databases, including Scopus, PubMed, Google Scholar, Embase, and Science Direct, using the “Aloe vera”, “dentifrice”, and “toothpaste” keywords. After screening titles and abstracts, relevant studies were used for full-text review. Results: Although conflicting results have been reported on the usage of A. vera toothpaste in different studies, the majority of findings suggest that A. vera effectively reduces periodontal indices and removes different organisms, including Streptococcus mutans. However, the overall effects of this herbal toothpaste were found to be equal to those of other commercial toothpaste. Conclusions: Aloe vera toothpaste is as beneficial as other kinds of toothpaste. Therefore, it can be used as an adjunct agent in toothpaste due to its established effects on improving periodontal problems and reducing different oral cavity micro-organisms.

Effect of teledentistry on the oral health status of patients undergoing fixed orthodontic treatment at the first three follow-up visits.

As the prevalence of such oral diseases as dental caries and periodontal problems increases during fixed orthodontic treatment, patient education is an essential aspect of any such treatment. Two methods have been proposed for this purpose: direct education in a clinic (the conventional method); and education using social media, such as the Telegram application (a type of teledentistry). The aim of this study was to evaluate the effect of teledentistry as an educational tool on the oral health status of patients undergoing fixed orthodontic treatment at the first 3 follow-up visits. Sixty participants were enrolled from patients whose fixed orthodontic treatment was to begin at a dental clinic in Tehran, Iran. They were randomly assigned to one of 2 trial arms. At the end of the 1st appointment, one of the groups was educated in person about maintaining oral hygiene during treatment, and an educational clip was sent to the members of the other group via the Telegram application. During the next 3 follow-up appointments, plaque index (PI), bleeding on probing (BOP), and gingival color and consistency were analyzed for each patient to assess their oral hygiene compliance during treatment. There was a statistically significant difference in PI and BOP between the 2 groups at the 3rd and 4th appointments; however, gingival color and consistency did not differ significantly with regard to the manner of education (p > 0.05). Patient age did not have a considerable effect on the oral health status in either group (p > 0.05). Teledentistry is an effective and efficient method to improve oral hygiene in patients undergoing fixed orthodontic treatment.

Effectiveness of a Dental Intervention to Improve Oral Health among Home Care Recipients: A Randomized Controlled Trial.

We quantified the effectiveness of an oral health intervention among home care recipients. Seven German insurance funds invited home care recipients to participate in a two-arm randomized controlled trial. At t0, the treatment group (TG) received an intervention comprising an oral health assessment, dental treatment recommendations and oral health education. The control group (CG) received usual care. At t1, blinded observers assessed objective (Oral Health Assessment Tool (OHAT)) and subjective (Oral Health Impact Profile (OHIP)) oral health and the objective periodontal situation (Periodontal Screening Index (PSI)). Of 9656 invited individuals, 527 (5.5%) participated. In the TG, 164 of 259 (63.3%) participants received the intervention and 112 (43.2%) received an outcome assessment. In the CG, 137 of 268 (51.1%) participants received an outcome assessment. The OHAT mean score (2.83 vs. 3.31, p = 0.0665) and the OHIP mean score (8.92 vs. 7.99, p = 0.1884) did not differ significantly. The prevalence of any periodontal problems (77.1% vs. 92.0%, p = 0.0027) was significantly lower in the TG than in the CG, but the prevalence of periodontitis was not (35.4% vs. 44.6%, p = 0.1764). Future studies should investigate whether other recruitment strategies and a more comprehensive intervention might be more successful in improving oral health among home care recipients.

Coronally Repositioned Semilunar Flap for Root Coverage: A Case Report

Gingival recession is one of the most commonly encountered periodontal problem. It is one of the most difficult to treat periodontal issue since it requires great amount of clinical skills and patient co-operation. There are plethora of techniques and their modifications available with different levels of predictability for root coverage. One of the highlighted technique amongst many is the coronally repositioned semilunar flap. It has various advantages like tension free flap during healing (without sutures), better predictability and minimal clinical skills required. This case report describes in detail a case treated with semilunar flap and discusses further about it.

Understanding patient perspectives of relationship between periodontal and systemic health: a hospital-based cross-sectional study

Background: Patient awareness regarding the interrelationship between periodontitis and systemic diseases is an essential consideration in the periodontal management of medically compromised patients Aims: The present study envisages understanding the patient perspective on periodontal diseases and periodontal-systemic disease interrelationship. Settings and Design: Hospital-based cross-sectional questionnaire study Methods and Material: Data was collected through a questionnaire consisting of 21 self-administered, structured, close ended questions that was distributed among 302 subjects presenting to the department of Periodontology. Statistical analysis used:The frequency of each response was expressed as percentage and correlations between responses to related questions were performed. Results: A reasonably acceptable level of awareness was noted regarding independent understanding of periodontal diseases and common systemic diseases. However, many of the subjects failed to appreciate the relationship between them Conclusions: According to the findings of the survey, there exist the need of educating patients regarding the interrelationship between periodontal diseases and systemic health. Key-words: Interrelationships, Patient awareness, Periodontal diseases, Questionnaire, Systemic diseases Key Messages: Awareness and cooperation on the part of the patients are essential in managing periodontal diseases in patients with systemic diseases. Patients need to be educated regarding the perio-systemic interrelationships for the successful management of periodontal and systemic problems, the onus of which is equally upon both medical and dental fraternities.

Effect of Helichrysum Oil on Toothache

Introduction: Toothache is the pain or inflammation in the tooth. A symptom of toothache includessensitivity, gum bleeding, cavities etc. Toothache can occur due to improper an dental care and oral hygienepractice which is one of the commonest reasons. The genus Helichrysum consists of about 600 specieswhich are flowering in the family of sunflower. The other names are Italian strawflower and Immortelle.It grows on dry, rocky and sandy regions in the Mediterranean. It has anti-inflammatory, antispasmodicand analgesic properties. The aim of the study is to determine the effect of helichrysum oil on toothache.Materials and Methods: The sample size of the study was 15 individuals with toothache who visited thedental clinics. Participants having periodontal problems, cardiovascular problems were excluded from thestudy. To every 2 drops of helichrysum oil, 1 ml of coconut oil was added. The intensity of the pain wasmeasured by using the pain scale. The participants were given to apply it on the gingival area of the painfultooth. The patients were followed to know the intensity of pain after a few hours. The results were tabulatedand then statistically analysed. Results and Discussion: 27% of the participants have moderate pain after afew hours of application of oil. 26% of them have less pain. 13% of participants have very little pain. 27%of them do not feel any change in the intensity of pain. 7% have high pain. Conclusion: From this studyit was evident that helichrysum oil had an effect in reducing the tooth ache as helichrysum possess antiinflammatoryproperties.

Evaluation of Oral Manifestations of Patients with Parkinson’s Disease–An Observational Study

Background: Parkinson’s disease is the second most common neurodegenerative disorder which affectsaround four million people globally.Many of the signs of Parkinson’s disease are found in the head andneck. The typical “masklike” facial appearance with infrequent blinking and lack of expression is causedby bradykinesis.. Abnormalities in oral behaviour, such as purposeless chewing, grinding, and suckingmovements, are also well recognized in patients with Parkinson’s disease.Aim and Objectives: The aim of this study is to assess the overall oral health status of the patients withParkinson’s disease and to analyze the impact of Parkinson’s disease on the oral cavity of the individualssurviving with the disease.Materials and Methods: The study sample included 50 Parkinson’s disease patients. The patients of all agegroups and both genders were included.Results: Out of fifty patients. majority of the patient s were above 60 yrs. 6% of the patients reported withPositive family history of Parkinson’s diseases.14% of the patients had gross facial asymmetry, 68% of thepatients showed dryness of mouth.8% of the patients suffered loss of taste.14% of the patients showed hypersalivation. 54% of the patients showed gingivitis. And 76% of the patients were found having periodontitis.Conclusion: Treatment for oral and dental problems of Parkinson’s disease affected patients is mandatory.Treatment can be done by supplementing artificial saliva for dryness of mouth, dental fillings for dentalcaries, periodic scaling for periodontal problems, oral rehabilitation measures and regular dental check up

English

BACKGROUND Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It has a significant impact on the world’s health systems. Due to a rapid increase in disease burden globally, there arises the need for newer methods of early detection of DR to prevent various complications including total blindness. The association between periodontal problems and diabetes has been studied widely and a positive correlation has been found. Literature search revealed that no studies have been done so far comparing the oral hygiene status among type 2 diabetics with and without retinopathy, thus the purpose of the study was to compare oral hygiene status among type 2 diabetics with and without progressing diabetic retinopathy and thus look for any association between existing oral hygiene status and severity of diabetic retinopathy. METHODS Study was conducted on type 2 diabetic patients with and without progressing diabetic retinopathy visiting the Department of Opthalmology at the University Medical College. A thorough evaluation of oral hygiene status of patients participating in the study was done using OHI - S and Gingival Index. RESULTS There was no statistically significant difference between the OHI - S and diabetic retinopathy, P value (0.522). The gingival index showed statistically significant relation with severity of diabetic retinopathy with P - value of 0.027. The intergroup comparison of the association between the mean OHI - S and GI scores and severity of diabetic retinopathy was found to be statistically insignificant P &lt; 0.269 and P &lt; 0.125. CONCLUSIONS There could be a plausible relationship between diabetic retinopathy and oral hygiene condition. Because of the regional variation in the oral hygiene condition further prospective studies on a large population are required to ascertain whether the existing oral hygiene status has a direct impact on the progression and severity of diabetic retinopathy. KEY WORDS Diabetic Retinopathy, Oral Hygiene, Periodontitis, Type 2 Diabetes Mellitus, Oral Hygiene Index Simplified, Gingival Index

Endo-perio lesions

The interrelationship between periodontal and endodontic disease has aroused confusion, queries and controversy. Differentiating between periodontal and endodontic problems can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may create periodontal involvement. In others, periodontal pathology may create pulpal pathology. This review article discusses the various clinical aspects to be considered for accurately diagnosing and treating endo-perio lesions.