Search

Purpose: Earlier in vitro models have aimed to study the barrier function against the bacterial penetration across the GTR membranes. No such study is present in the literature which is aimed to quantify bacterial adhesion over the surface of the membrane irrespective of surface being examined. Method: Sterile Resorbable PLA/PGA copolymer and Non resorbable Microporous eptfe based GTR membrane were used in the study. Both groups were subdivided into two subgroup (n=10) based on incubation period of 24 and 48 hours. Incubated in Todd Hewitt broth with streptococcus mutans, at each incubation time period the samples were vortexed and analysed for bacterial count (CFU) and also by scanning electron microscopy. Result: Between PLA/PGA and ePTFE GTR membrane at 24 hrs incubation time period , there was a significant difference in terms of Colony forming units (W = 100.000, p = Conclusion: Our findings depicts that ePTFE based GTR membrane showed significantly lesser bacterial adhesion on its surface as compared to PLA/PGA at both the incubation periods i.e. 24hrs and 48 hrs as shown by both spot test and SEM .

Background. Tobacco smoke is an established risk factor for periodontitis. However, few studies have evaluated the periodontal status of smokeless tobacco (SLT) users, while that of individuals with dual habits has largely been unexplored. Therefore, the current study aimed to find if the periodontal status in individuals with dual habits of smoking and SLT use is different from those with any single habit.Methods. Four groups (A: exclusive smokers, B: exclusive tobacco chewers, C: individuals with dual habits, and D: non-users of tobacco), each comprising 75 males in the age group of 20 to 35 years, were selected. Along with the history of tobacco use, a modified oral hygiene index (OHI), gingival index (GI), probing depth (PD), and the number of teeth with gingival recession (GR) were recorded. The data were assessed using the Chi-squared test, one-way ANOVA, and logistic regression. Statistical significance was set at P3.0). The prevalence of severe gingivitis (GI>2.0) was significantly lower among exclusive smokers (group A) and those with dual habits (group C) compared to the other two groups. As much as 60% of group C participants had average PD in the range of 4-6 mm, while deeper average PD (>6 mm) was most common among smokers. The highest risk of having a tooth with GR was also associated with the dual habit (OR = 4.33, 95% CI = 3.24 - 5.76) compared with the non-users.Conclusion. While both forms of tobacco were associated with poor periodontal status, the additive effect of smoking and SLT use was evident in almost all the parameters, more so with poor oral hygiene and the prevalence of gingival recession. These findings emphasize that individuals with dual habits have an additional risk for periodontal destruction.

Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods. A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r). Results. The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479). Conclusions: Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters.

Introduction: Dental health workers are always at a risk of communicable diseases. With the increasing number of infected patients and blood borne pathogens, it becomes very important to have proper knowledge and attitude towards communicable diseases. As hepatitis B infection is a major health hazard throughout the world, healthcare students should have through knowledge about this disease. The present study was conducted to assess the level of knowledge, attitude, and behavior about hepatitis B infection among healthcare interns as they indulge in more clinical work. Materials and Methods: A cross-sectional survey was conducted of the interns of MBBS, BDS, and nursing at Rohilkhand Medical College, Institute of Dental Sciences and Rohilkhand college of nursing. The questions were obtained from a study performed in Turkey in 2010 and were modied by an infection control expert. Ethical clearance for the study was obtained from the institutional ethical committee, Institute Of Dental Sciences. Students who voluntarily wanted to participate were included in the study. Questionnaire containing 20 questions to assess the level of knowledge, attitude, and behavior about hepatitis B was distributed among the students. Data were compiled and statistical analysis was done. Results: The response rate was 90% (N = 360). In our study, majority of interns had knowledge of HBV transmission. The level of knowledge was more in MBBS interns. Similarly attitude was also higher in MBBS interns but behavior was higher in dental graduates as compared to MBBS and nursing. Conclusion: With the measure of knowledge, attitude and behaviour the students should be encourage more to acquire knowledge, practice proper infection control and use of protective measures to control the spread of infection.

Giant cell fibroma (GCF) is a relatively rare lesion in the oral cavity. Despite having unique microscopic features, it can be easily misdiagnosed clinically as any common hyperplastic lesion. This report presents a case of a 21-year old male with a lesion involving the papilla between the mandibular central incisors. The lesion was excised completely under topical anesthesia using a 980 nm diode laser. On histopathological examination of the excised tissue, no thermal damage or any other alteration was observed, while the features were suggestive of GCF. Healing of the gingiva was uneventful and without any signs of recurrence. Apart from the widely known advantages of the diode laser, it also appears to maintain the integrity of biopsy specimens, if used with appropriate settings. This advantage may play a vital role in the biopsy of rare lesions where the diagnosis is entirely based on accurate histopathological examination.

The goal of periodontal therapy includes management of bacterial pathogens to control the destruction of the periodontal tissue. A number of different nonsurgical and surgical therapies have been used in achieving this goal. Objective: To evaluate the effectiveness of doxycycline compared with nonsurgical therapy alone or in combination with nonsurgical therapy on gingival crevicular fluid β-Glucuronidase levels (ßG) and clinical parameters over a 20-week period in patients with chronic periodontitis. Methods: An interventional study comprising 60 patients with chronic periodontitis. They were divided into three groups of different treatment approach. The plaque index, gingival index, probing depth, and clinical attachment levels were recorded, and gingival crevicular fluid (GCF) samples were collected at 2, 6, 10, and 20 weeks, after treatment. Results: The levels of GCF βG and clinical parameters were higher when the treatment was initiated, and the levels decreased after treatment. No significant difference was found in the βG level when nonsurgical therapy and doxycycline were used alone. In comparison, when doxycyline and nonsurgical therapy were combined, the level of βG decreased significantly. Conclusion: The present study indicated the usefulness of doxycycline as an adjunct to nonsurgical periodontal therapy in lowering GFC βG levels and clinical parameters.

Aim: The aim of this study was to determine the utility of plasma total antioxidant capacity (TAC) as marker of periodontal disease by estimating TAC of periodontally healthy and chronic periodontitis patients and the impact of scaling and root planning on total antioxidant status of periodontitis patients. Materials and Methods: Blood plasma samples were collected from randomly selected eighty individuals (40 periodontally healthy controls and 40 chronic periodontitis patients), with an age range of 20–45 years and were analyzed for TAC by ferric reducing antioxidant power assay. Scaling and root planing was performed in periodontitis patients, and TAC level was measured again after 3 weeks. Data were analyzed with t-test, using SPSS software (PSAW, Windows version 18.0). Results: The mean plasma TAC was significantly lower (792.33 ± 124.33 μmol/L, P < 0.001) in chronic periodontitis patients compared to healthy control (1076.08 ± 193.82 μmol/L). Plasma TAC level increased significantly (989.75 ± 96.80, P < 0.001) after scaling and root planing. Conclusions: An inverse relationship exists between plasma TAC and severity of chronic periodontitis suggesting disturbed oxidant-antioxidant balance in chronic periodontitis. Scaling and root planing resulted in the restoration of TAC to normal levels. These results are important from the perspective of including antioxidants in periodontal therapy regime to boost up body's antioxidant defense system and to reduce oxidative stress-mediated periodontal tissue damage. We concluded that TAC can be used as a biomarker to evaluate the health of periodontium.

Background: Various medications are used in the treatment of chronic systemic diseases that affect the periodontium. Antidepressants in mentally depressed patients are prescribed for a long term, but their effect on the periodontium has not been studied adequately. A case–control study was conducted to know the effect of two commonly prescribed antidepressants – venlafaxine (serotonin–norepinephrine reuptake inhibitor [SNRI]) and fluoxetine (selective serotonin reuptake inhibitor [SSRI]). These drugs have been shown to possess anti-inflammatory properties but do not protect the periodontium from insults caused by these medications, which are significantly associated with the presence of destruction of the periodontium. The aim of this study was to clinically evaluate the effect of antidepressants on various periodontal parameters. Materials and Methods: The study sample consisted of 182 depressed patients divided into three study groups: Group I – the control group diagnosed as depressed on the first visit, Group II – depressed patients taking fluoxetine 20 mg/day, and Group III – patients taking venlafaxine 75 mg/day. Patients in Groups II and III were on isolated antidepressant medication at least for a period of 3 or more months. Mental depression in patients was assessed with the Patient Health Questionnaire-based Hamilton Depression Rating Scale with scoring of ≤16. All the depressed patients were assessed for periodontal health on the basis of the clinical periodontal parameters. Results: The commonly prescribed antidepressants such as fluoxetine and venlafaxine do not protect the periodontium from destruction in spite of possessing anti-inflammatory properties; therefore, these drugs may be considered as a risk factor for periodontal health. The comparative periodontal indices on nonusers of antidepressants or control group (Group I), users of SSRI (fluoxetine) (Group II), and users of antidepressants-SNRI (venlafaxine) (Group III) showed increased periodontal parameters, especially debris index (DI), calculus index (CI), gingival index (GI), periodontal pocket depth (PD), and loss in clinical attachment level. There was no significant difference for CI and GI, probing PD, and clinical attachment levels except DI which was significantly different (P ≤ 0.001). Conclusion: The depressed patients receiving fluoxetine or venlafaxine should be regularly evaluated for periodontal health status as these drugs are risk factors for normal periodontal tissues. Further, these medications did not protect the periodontium from periodontal inflammation, although possessing anti-inflammatory properties.

Aim: Periodontal disease is an immune-inflammatory response of tooth supporting structures to microbial dental plaque. It is influenced by various factors such as poor oral hygiene, smoking, systemic diseases, and psychological factors such as stress. This case-control study was performed to consider mental depression as a risk factor for periodontal disease. Materials and Methods: A total of 170 subjects were selected. All the subjects were assessed for the presence of depression by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and severity of depression was measured by Hamilton depression rating scale. For assessment of periodontal disease, clinical periodontal parameters oral hygiene index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. Results: Univariate logistic regression analysis demonstrated that subjects with depression had significantly higher values of debris index, calculus index, gingival index, PPD, and CAL (P < 0.001). Periodontal status was poor in patients with severe and very severe grade depression patients (P = 0.049). For all the indices/parameters, mean values of patients with > 6 months of illness were higher (P < 0.05). Conclusion: Within the limits of this study, it is concluded that mental depression significantly affects the periodontium. It may be considered as risk factor for periodontal disease.

Necrotizing periodontitis is a distinct and specific disease characterized by rapidly progressing ulceration of the interdental gingiva and then spreading along the gingival margins and leading to acute destruction of periodontal tissues. Necrotizing ulcerative gingival lesions are common in developing countries because of poor nutritional status, poor oral hygiene and debilitating conditions. In the developed world it is mostly seen in patients with the HIV infections and other immune system dysfunctions. The exact etiology of the necrotizing lesions is still unknown; however a fuso-spirochaetal infection along with weakened host immune system seems to play a major role in the pathogenesis of these diseases. Presented is the case of acute necrotizing periodontitis in a 21 year old male patient with no systemic disease but a history of tobacco use (chewing and smoking) since 7 years. The patient was managed by conservative treatment followed by surgery for the correction of gingival defects.

Background The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Methods Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

Gingival enlargement is a common periodontal pathology seen in medically compromised patients. Although it is not the disease itself, certain medications used to treat these chronic diseases are known to precipitate the gingival enlargement. Periodontitis (PD) and gingival enlargement have been reported increasingly in patients with chronic renal failure. Severe enlargement is detrimental to esthetics and function while having a negative impact on the overall oral health-related quality of life. Treatment of such cases requires comprehensive periodontal management by a specialist, keeping in mind the medically compromised state of the patient. This report presents a case of severe PD with generalized gingival enlargement in a 45-year-old male who was a known case of Stage 4 chronic kidney disease, obstructive uropathy, and hypertension. Gingival enlargement was managed by gingivectomy and gingivoplasty. Six months' follow-up showed no sign of recurrence.

Host modulation, includes inhibition of matrix metalloproteinases, blocking production of proinflammatory cytokines and inhibition of osteoclastic activity, has therapeutic value as adjunctive therapy in treating chronic periodontitis. This case series presented three patients with chief complaint of teeth mobility where endo perio involvement was diagnosed. The endo perio combined lesions generally shows the communication between pulp and periodontal tissues with the same origin of dental infection. Diagnosis in such cases is difficult and generally raising problem in the management. All of the cases were managed by non surgical endodontic therapy combined with host modulation. All local factors causing the lesion were removed. Clinical outcome after six and nine months were quite satisfactory. Combined endo perio cases are challenging to the dentists and involve multidisciplinary involvement. To manage such cases, dentists have to rely on the unconventional techniques.DOI: 10.14693/jdi.v22i1.378

Aims and Objectives: (1) To evaluate the effect of type 2 diabetes mellitus on salivary TNF-α level in chronic periodontitis. (2) To evaluate the effect of smoking on salivary TNF-α level in chronic periodontitis. (3) To compare and correlate TNF-α level with the healthy individuals. Materials and Methods: Subjects aged 30-35 years were included for the study and divided into four groups as a group of 20 systemically and periodontally healthy individuals (group I), a group of 20 subjects with pocket probing depth (PPD) ≥5 mm and clinical attachment loss (CAL) of ≥2 mm (group II), a group of 20 diabetic subjects (of more than 5 years) with periodontal parameters as of group II as (group III) and a group of 20 subjects smoking (≥10 cigarettes a day) with periodontal parameters of group II as (group IV). Periodontal parameters of PPD, CAL, gingival index (GI), and plaque index (PI) were measured using standard indices and criteria. Three milliliter of unstimulated saliva was taken and salivary TNF-α determined by using ELISA technique (Quantikine Human total TNF-A immunoassay kit). Results: Data revealed highest mean TNF-α in group III followed by group IV, group II, and group I. Mean TNF-α of both group III (76.1%) and group IV (48.8%) was significantly higher as compared to group I (P < 0.001). Mean TNF-α of group III was also found to be significantly different and higher (68.1%) as compared to group II (P < 0.001). Although higher mean TNF-α (31.5%) was found in group IV in comparison to group II, the difference was not statistically significant. Besides above, TNF-α also showed a direct positive correlation with PPD in group II (r = 0.30, P > 0.05) and a significant negative correlation was observed between CAL and TNF-α in group IV. Conclusion: Our study clearly underlines a profound impact of diabetes and smoking on salivary TNF-α in chronic periodontitis subjects in comparison to healthy subjects. Moreover, diabetes status increased TNF-α significantly in comparison to smoking in chronic periodontitis patients.

Objective: C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. Materials and Methods: A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. Results: Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. Conclusion: The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.

In its pursuit of understanding the wonders of human body, mankind has stumbled upon yet another discovery which not only is a key to chest of unanswered queries but also opens a plethora of new possibilities. Till recently the osteocytes were considered latent cells merely entrapped in the matrix of bone. With the discovery of beta-catenin pathway and sclerostin molecule, these cells are now being recognized to perform a multitude of physiological functions which are important to bone function and turnover. Mechanosensor function of osteocytes via sclerostin molecule offers new possibilities in alveolar bone preservation. Sclerostin and its inhibitors have potential in prosthetic, regenerative and preventive therapy in dentistry. Osteocytic pathway of sclerostin release and mechanism of its interaction with occlusion is discussed in this article.

Introduction Acute gingival bleeding can occasionally be the only sign of systemic bleeding problems. The diagnosis and management of such conditions may challenge the skills of the dentist. Case report The present report describes a case of severe, prolonged gingival bleeding in a 54-year-old woman as a consequence of Plasmodium falciparum malaria infection. Specific highlights are focused on the management of the patient with emphasis on early diagnosis of the disease so as to improve the prognosis. This case report also stresses that medical intervention to correct the underlying aberration of hemostasis is necessary for local dental measures to successfully stop bleeding. Conclusions Acute gingival bleeding as a complication of systemic disease can be challenging to manage unless the underlying systemic cause is diagnosed. Therefore, the dentist must be aware of various systemic conditions that can lead to gingival bleeding. The present case report describes a patient with acute gingival bleeding secondary to Plasmodium falciparum infection.

Esthetic rehabilitation of edentulous site with horizontal ridge deficiency presents as one of the most challenging situations in implant practice. With the increase in popularity of dental implants, augmentation of the alveolar ridge and soft tissue has also become a routine procedure in most of the cases. Although hard-tissue augmentation is performed by other specialists also, a periodontist needs to master the skills of soft-tissue management to deliver esthetic and functional results in implant-supported prostheses. This case report presents a single-staged ridge split approach using piezoelectric surgery with simultaneous implant placement followed by connective tissue grafting at second-stage surgery. Single-staged segmental ridge split technique not only reduces the total treatment duration but also the surgical morbidity for the patient. A subepithelial connective tissue graft is strongly advocated around implants as it is highly predictable while ensuring better esthetic results in terms of tissue color, texture, and long-term stability of the surrounding mucosa.

Congenital macrostomia or transverse facial cleft is a rare congenital craniofacial anomaly, which affects the esthetics and functions of oral cavity. It is usually associated with deformities of other structures developed from the first and second branchial arches. Bilateral transverse cleft, occurring alone is uncommon. Since the deformity is rare, its treatment has not been commonly described in the literature. We report a case of congenital bilateral macrostomia as an isolated, asyndromic deformity to add one more case in the literature and surgical technique has been discussed here.

BackgroundInstrumentation of the root surface, results in formation of a smear layer of organic and mineralized debris which serves as a physical barrier, inhibiting new connective tissue attachment to the root surface. The present study advocates the use of an endodontic irrigant MTAD (mixture of tetracycline, citric acid and detergent) as a root conditioning agent.The main aim of the study was to compare the root conditioning ability of an endodontic irrigant MTAD (mixture of tetracycline, acid and detergent) with 17% EDTA (ethylenediaminetetraacetic acid).Materials and methodsSixty freshly extracted human single rooted teeth with confirmed periodontal involvement were selected for this study and decoronated. The apical third of each root was removed and the remaining root was sectioned longitudinally to produce a 6mm to 8mm long tooth section. The root surface was then instrumented by hand using a sharp Gracey 1–2 periodontal curette with 6–8 strokes per area to achieve a smooth glass-like surface. A total of 60 specimens were prepared which were randomly divided into three groups (n=20). Each group received the root conditioning treatments as follows:Group A: Control Group: only saline rinsing.Group B: root conditioning treatment with 17% EDTA for 5min.Group C: root conditioning treatment with BioPure MTAD for 5min.All specimens were prepared for SEM and scored according to the presence of smear layer.Results and conclusionsMTAD removed the smear layer successfully from the root surfaces. The mean smear score for samples treated with Biopure MTAD was lower than those treated with EDTA, (p=0.04). MTAD can be used as a root conditioning agent with efficient smear layer removal ability and known antimicrobial and anticollagenase activity.

This article presents a case of giant cell granuloma in a 24-year-old man. Clinical, histopathological, and radiographic findings are discussed and a differential diagnosis and treatment plan are suggested. Clinical behavior among lesions may vary between nonaggressive and aggressive forms, and even radiographic appearances are not identical. The present case resembled a variety of conditions clinically but was diagnosed histopathologically as giant cell granuloma. This case is presented to emphasize the importance of histopathologic examination to ensure proper diagnosis and treatment.

PURPOSE Cigarette smoking is a major risk factor in periodontal diseases. The pathogenesis of periodontal diseases may be affected by alterations of the inflammatory response by smoke. Nitric oxide (NO) is a gaseous, colorless, highly reactive, short-lived free radical with a pivotal role in the regulation of various physiological and pathological mechanisms in the body. It is important in host defense and homeostasis, on the one hand, whereas, on the other hand, it modulates the inflammatory response in periodontitis, leading to harmful effects. The aim of this study was to assess the levels of NO in both the serum and saliva of smokers and nonsmokers having chronic periodontitis and to compare them with periodontally healthy controls. METHODS SIXTY SUBJECTS PARTICIPATED IN THE STUDY AND WERE DIVIDED INTO THREE GROUPS: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of twenty subjects. The biochemical estimation of NO in the collected serum and in the saliva was performed using the Griess colorimetric reaction. RESULTS The results showed that the mean value of the salivary and serum NO was greater in group II than in group I, and also greater in group III than in group II. CONCLUSIONS NO appears to play an important and rather complex role in the immuno-inflammatory process and in the remodeling and maintenance of osseous structures. It is therefore logical that modulation of this mediator has potential for the treatment of a number of inflammatory conditions including periodontal disease.

With the scientific advancements in the management of malignant diseases, the treatment is expensive and bears high morbidity in term of oral mucositis. It is a debilitating condition and has been researched extensively for its pathogenesis and treatment. Various treatment options include barrier forming, mucosal protectants, mouth rinses, growth factors, lasers and midline-sparing procedures. Some agents are used locally while others are administered systemically. Despite the availability of a wide range of treatment options for mucositis, a cost-effective treatment is yet to be evolved.

Dental fluorosis is a condition which is said to be present when the morphologic features of a tooth are altered clinically, in the form of discoloration or anatomic malformation which is attributed to the developmental changes induced by excess fluoride levels in plasma at the time of tooth formation. In India, an estimated 60 million people are at risk and 6 million people are disabled due to fluorosis. Lack of understanding into the effects of fluorosis on periodontium has left a blind spot in the vision of management of periodontitis in such patient groups. This article suggests the important connection these two conditions can have and emphasize research in this study field.

Oral myiasis is a disease caused by larvae of housefly and associated with poor oral hygiene, mouth breathing and incompetent lips. The disease is characterized by presence of maggots in affected parts of the body and is usually seen in tropical countries, although cases have been reported from other parts of the world. There are various methods for treating this disease. In this case report, a combination of treatment modalities has been favored.