DOI: https://doi.org/10.53350/pjmhs22163974 ORIGINAL ARTICLE 974 P J M H S Vol. 16, No. 03, MAR 2022 Comparative Evaluation of General Oral and Periodontal Health Status of Chronic Kidney Disease (CKD) patients in Various Stages admitted to Sharif Medical and Dental College, Lahore, and Healthy Controls HIRA BUTT 1 , NAUMAN RAUF KHAN 2 , MUHAMMAD AMAN 3 , SYEDA MARYAM FATIMA 4 , MARIA JABBAR 5 , FAROOQ MAQSOOD 6 1 Demonstrator, Department of Oral Pathology, College of Dentistry, Sharif Medical & Dental College, Lahore 2 Professor, Department of Oral Pathology, College of Dentistry, Sharif Medical & Dental College, Lahore 3 General Dental practitioner, Irfan Dental Clinic Jhelum 4 House Officer, College of Dentistry, Sharif Medical and Dental College, Lahore 5 General dental practitioner, Gujranwala 6 Training medical officer, Department of Periodontology, Rehman College of Dentistry, Peshawar Correspondence to: Hira Butt, Email: hira.ah.butt@gmail.com Phone: 0336-7160357 ABSTRACT Objective: To assess the general oral and periodontal health status of chronic kidney disease patients in various stages and compare it to healthy controls. Methodology: A Cross-sectional comparative study was conducted in Sharif Medical and Dental College, Lahore on 50 patients with chronic kidney disease and 58 controls for the time duration of one year. Data collection was based on the Community Periodontal Index of Treatment Needs and Decayed Missing and Filled index. Results: There was a significant association between stage of kidney disease and periodontal health (p= ≤0.001) and general oral health as determined by the DMFT index (≤0.001). There was a significant difference in the scores of decayed teeth between the controls and stage 3 (0.042), stage 5 (≤0.001) and stage 4 (p= 0.001). The difference in the scores of missing teeth was significant between controls and stage 5 (p=≤0.001) and stage 4 (p=0.001). Similar was the case for decayed missing and filled teeth index scores for controls and stage 3 (p=0.013), stage 5 (≤0.001) and stage 4 (≤0.001). Conclusion: Bleeding gums were most common in stage 3 while pocket depths of 4-5mm were highest in stage 4 and 5 patients. Pocket depth of 4 to 5mm was the most prevalent periodontal problem in controls. In the controls, more individuals had a high DMFT score in comparison to low scores. The scores of decayed teeth and decayed missing filled index were significantly different among the controls and stages 3, 5 and 4 while for missing teeth score, the difference was significant between controls and stages 4 and 5. Keywords: Periodontal health, Community periodontal index for treatment needs (CPITN), Decayed missing and filled teeth (DMFT) index, chronic kidney disease. INTRODUCTION Periodontal health is defined as a state free of any periodontal disease both clinically and histologically 1 . It is characterized by the absence of inflammation in periodontal tissues. Periodontal disease is a complex oral health issue of that is precipitated by alteration in host immunity, oral microflora and environmental factors 2 . Host determinants of clinical periodontal health are categorized into local and systemic factors. Local predisposing factors include: periodontal pockets, dental restorations and root anatomy while systemic factors include host immune function, systemic health and genetic makeup of host 2, 3 . Environmental determinants including smoking, medications, stress and nutrition also predispose to periodontal disease. A relationship between oral health and general well being and health of individuals has been reported in the past. Among the systemic diseases, renal disease has been shown to affect not only the general health of the patient but also oral and periodontal health 4 . Multiple causes have been proposed to explain this correlation one of which is reduced immune response to microbial organisms. In addition to this these patients have difficulty in maintaining good oral hygiene because of the intense psychological burden and time-consuming treatment sessions. Additional variables are age, associated systemic disease, dialysis vintage and lack of access to dental care services. Renal disease is classified into five sages on the basis of their functional efficiency determined by Glomerular Filtration Rate (GFR). Stage 1 renal disease has normal function with GFR >90, stage 2 has mildly decreased function with GFR 60-89%, stage 3 has moderately decreased function with GFR 30-59%, stage 4 has severely decreased function with GFR 15-29% and stage 5 renal disease is kidney failure with GFR <15% 5 . Studies have reported a strong association between periodontitis and renal disease 6, 7 . However such study has not been conducted in our region. It will help the clinicians and patient to understand the effect of renal disease on general oral and periodontal health and will improve the quality of life of such patients. The aim of this study was to assess the general oral and periodontal health status of chronic kidney disease (CKD) patients in various stages and compare it to healthy controls. METHODOLOGY A Cross sectional comparative study was conducted in Sharif Medical and Dental College, Lahore on 50 patients with chronic kidney disease and 58 healthy controls from August 2019 to August 2020. The study was conducted after ethical approval certificate No. SMDC/SMRC/100-19 from Sharif Medical Research Centre (SMRC). The sampling technique employed was convenient sampling. The sample size was calculated to be 58, keeping the precision at 15% and prevalence of chronic kidney disease 3.5% 8 and confidence level 95%, the same size was calculated to be 50. Informed consent was taken from patients prior to data collection. Chronic kidney disease patients irrespective of their gender and stage of disease who were 18 years of age were included in the study. The patients who had any other systemic illness and those undergoing renal dialysis for any reason besides chronic kidney disease were excluded from the study. Controls were included irrespective of their gender, were free of chronic kidney disease and were above 18 years of age. The controls who had any other systemic illness, those who had a past medical history or family history of of chronic kidney disease were excluded from the study. The collected data was recorded in a specialized proforma. Community Periodontal Index of Treatment Needs (CPITN) and Decayed Missing and Filled index (DMFT) were used for assessing the periodontal and general oral health respectively of patients and controls. The data was analyzed using IBM SPSS Statistics 23. P value ≤ 0.05was considered significant. Numeric data was presented as mean and its respective standard deviation. Nominal data was presented as frequency and percentages. Fisher exact test was used to find the association between periodontal and general oral health of participants with and without chronic kidney