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Elhusseiny GA, Saleh W. Oral Health in Children with Chronic Kidney Disease, Hemodialysis, and Renal Transplantation: A Comprehensive Narrative Review of the Oral Manifestations and Dental Implications. Clin Med Insights Pediatr 2024; 18:11795565241271689. [PMID: 39206206 PMCID: PMC11350538 DOI: 10.1177/11795565241271689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 09/04/2024] Open
Abstract
Chronic kidney disease (CKD) in children presents multifaceted challenges, impacting various aspects of health, including oral health. This narrative review provides a comprehensive synthesis of literature focusing on the oral health status of pediatric CKD patients, encompassing oral manifestations, dental considerations, and management challenges associated with hemodialysis and kidney transplantation. A comprehensive search strategy was employed, utilizing databases such as PubMed, Scopus, Web of Science, and Google Scholar, to identify relevant literature on oral manifestations in children with CKD, including those undergoing hemodialysis or renal transplantation. Search terms were carefully selected to capture studies examining enamel hypoplasia, dental caries, delayed tooth eruption, gingival diseases, periodontal diseases, radiographic alterations, craniofacial development, dry mouth, and changes in the oral mucosa. Our narrative review meticulously selected articles through a systematic process. Ultimately, 12 studies meeting the inclusion criteria were included in the review. Relevant data from each included study were independently extracted and synthesized, focusing on oral manifestations and their implications in pediatric CKD patients. The synthesized findings were organized and presented in a structured manner within the review article, considering their clinical implications and informing recommendations for dental management of children with CKD. This article highlights the importance of a coordinated effort between nephrologists, dentists, and other healthcare professionals in providing holistic care for pediatric CKD patients. A comprehensive understanding of the oral health status of these children, along with proactive dental management strategies, contributes to improved overall health outcomes and a better quality of life. This review aims to serve as a valuable resource for the oral healthcare providers involved in the care of pediatric CKD patients.
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Affiliation(s)
- Ghada A Elhusseiny
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Wafaa Saleh
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Wallace CK, Vernazza CR, Emmet V, Singhal N, Sathyanarayana V, Tse Y, Taylor GD. Evaluation of UK paediatric nephrology teams' understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study. Pediatr Nephrol 2024; 39:2131-2138. [PMID: 38300268 PMCID: PMC11147922 DOI: 10.1007/s00467-024-06292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Oral health conditions are common in children and young people (CYP) with kidney disorders. There is currently limited literature on how confident paediatric nephrology teams feel to identify and manage oral health concerns for their patients. METHOD An exploratory mixed-method survey was distributed across all 13 UK specialist paediatric nephrology centres with responses received from consultants, registrars, specialist nurses and special interest (SPIN) paediatricians. RESULTS Responses received from 109 multidisciplinary team members of 13/13 (100%) UK tertiary units. Ninety-two percent (n = 100) of respondents reported they had never received any training in oral health and 87% (n = 95) felt that further training would be beneficial to optimise care for patients and improve communication between medical and dental teams. Most respondents reported that they did not regularly examine, or enquire about, their patients' oral health. Only 16% (n = 17) reported that all their paediatric kidney transplant recipients underwent routine dental assessment prior to transplant listing. Severe adverse oral health outcomes were rarely reported and only 11% (n = 12) of respondents recalled having a patient who had a kidney transplant delayed or refused due to concerns about oral infection. Seventy-eight percent (n = 85) felt that joint working with a dental team would benefit patients at their unit; however, 17% (n = 18) felt that current infrastructure does not currently support effective joint working. CONCLUSIONS Across the UK, paediatric kidney health professionals report lack of confidence and training in oral health. Upskilling subspecialty teams and creating dental referral pathways are recommended to maximise oral health outcomes for CYP with kidney diseases.
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Affiliation(s)
| | | | - Victoria Emmet
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Nidhi Singhal
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Greig D Taylor
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Gu R, Wang Q, Shi P, Zhang Y, Ying D, Zhi Y, Zhang J. The association between dental caries and steroid-sensitive nephrotic syndrome in children. Pediatr Nephrol 2024; 39:1125-1133. [PMID: 37783894 DOI: 10.1007/s00467-023-06167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Pathogenesis and relapse of steroid-sensitive nephrotic syndrome (SSNS) are primarily associated with infection. Dental caries is the most common chronic progressive oral infection in children. However, clinical studies of SSNS combined with dental caries in children are rare. METHODS In our retrospective cohort study from January 2021 to June 2022, 145 children with SSNS were included in the baseline analysis and 105 in the follow-up analysis. The follow-up period was 1 year. The primary study endpoints were the relapse-free period and frequently relapsing nephrotic syndrome (FRNS). Secondary endpoints included the number and triggers of relapses and concomitant medications. RESULTS The median age was 5.5 years, with a caries rate of 60.7%, the mean DMFT/dmft was 3.86, and the caries filling rate was 1.6%. Except for the lower proportion of high household income and high parental education observed in the caries group, no statistical differences were found when comparing the other baseline data with the non-caries group. The caries group had a shorter relapse-free period and a lower 1-year cumulative relapse-free survival rate (HR = 1.90, 95% CI 1.17-3.09, P = 0.009). Univariate regression analysis showed caries associated with FRNS (OR = 2.714, 95% CI 1.021-7.219, P = 0.045), but the correlation no longer remained in the multivariate analysis. Additionally, seven cases of caries-derived pulpal periapical inflammation triggered SSNS relapses. The caries group had more infection triggers and concomitant medication use. CONCLUSION Dental caries and relapse of SSNS are potentially associated, but careful evaluation is needed.
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Affiliation(s)
- Rui Gu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Qin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Peipei Shi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yingying Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Daojing Ying
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yuanzhao Zhi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jianjiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Mohamed FF, de Oliveira FA, Kinoshita Y, Yalamanchili RR, Eltilib LA, Andras NL, Narisawa S, Tani T, Chu EY, Millán JL, Foster BL. Dentoalveolar Alterations in an Adenine-Induced Chronic Kidney Disease Mouse Model. J Bone Miner Res 2023; 38:1192-1207. [PMID: 37191192 PMCID: PMC10524958 DOI: 10.1002/jbmr.4829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
Chronic kidney disease (CKD) is characterized by kidney damage and loss of renal function. CKD mineral and bone disorder (CKD-MBD) describes the dysregulation of mineral homeostasis, including hyperphosphatemia and elevated parathyroid hormone (PTH) secretion, skeletal abnormalities, and vascular calcification. CKD-MBD impacts the oral cavity, with effects including salivary gland dysfunction, enamel hypoplasia and damage, increased dentin formation, decreased pulp volume, pulp calcifications, and altered jaw bones, contributing to clinical manifestations of periodontal disease and tooth loss. Underlying mechanisms are not fully understood, and CKD mouse models commonly require invasive procedures with high rates of infection and mortality. We aimed to characterize the dentoalveolar effects of an adenine diet (AD)-induced CKD (AD-CKD) mouse model. Eight-week-old C57BL/6J mice were provided either a normal phosphorus diet control (CTR) or adenine and high-phosphorus diet CKD to induce kidney failure. Mice were euthanized at 15 weeks old, and mandibles were collected for micro-computed tomography and histology. CKD mice exhibited kidney failure, hyperphosphatemia, and hyperparathyroidism in association with porous cortical bone in femurs. CKD mice showed a 30% decrease in molar enamel volume compared to CTR mice. Enamel wear was associated with reduced ductal components, ectopic calcifications, and altered osteopontin (OPN) deposition in submandibular salivary glands of CKD mice. Molar cusps in CKD mice were flattened, exposing dentin. Molar dentin/cementum volume increased 7% in CKD mice and pulp volume decreased. Histology revealed excessive reactionary dentin and altered pulp-dentin extracellular matrix proteins, including increased OPN. Mandibular bone volume fraction decreased 12% and bone mineral density decreased 9% in CKD versus CTR mice. Alveolar bone in CKD mice exhibited increased tissue-nonspecific alkaline phosphatase localization, OPN deposition, and greater osteoclast numbers. AD-CKD recapitulated key aspects reported in CKD patients and revealed new insights into CKD-associated oral defects. This model has potential for studying mechanisms of dentoalveolar defects or therapeutic interventions. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Fatma F. Mohamed
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Flavia Amadeu de Oliveira
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Yuka Kinoshita
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Riti R. Yalamanchili
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Leena A. Eltilib
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Natalie L. Andras
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Sonoko Narisawa
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Takashi Tani
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Emily Y. Chu
- Department of General Dentistry, Operative Division, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - José Luis Millán
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Brian L. Foster
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Sezer B, Kodaman Dokumacıgil N, Kaya R, Güven S, Türkkan ÖN, Çiçek N, Alpay H, Kargül B. Association between serum biomarkers and oral health status in children with chronic kidney disease: A cross-sectional study. Clin Oral Investig 2023:10.1007/s00784-023-04989-1. [PMID: 37014503 DOI: 10.1007/s00784-023-04989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the association between serum biomarkers and oral health parameters in children with chronic kidney disease (CKD). MATERIALS AND METHODS Serum hemoglobin, blood urea nitrogen, serum creatinine, calcium, parathormone, magnesium, and phosphorus levels were measured in 62 children with CKD aged between 4 and 17 years. Intraoral examinations of the patients were performed by two different pediatric dentists. Dental caries was assessed using the decayed-missing-filled-teeth (DMFT/dmft) indexes, and oral hygiene was assessed using the debris (DI), calculus (CI), and simplified oral hygiene (OHI-S) indexes. Spearman's rho coefficient and generalized linear modeling were used to examine the association between serum biomarkers and oral health parameters. RESULTS The results of the study showed that there were negative and statistically significant correlations between serum hemoglobin and creatinine levels and dmft scores in pediatric patients with CKD (p = 0.021 and p = 0.019, respectively). Furthermore, blood urea nitrogen levels and DI and OHI-S scores (p = 0.047 and p = 0.050, respectively); serum creatinine levels and DI, CI, and OHI-S scores (p = 0.005, p = 0.047, p = 0.043, respectively); and parathormone levels and CI and OHI-S scores (p = 0.001 and p = 0.017, respectively) were found to be positively and statistically significantly related. CONCLUSIONS There are associations between various serum biomarker levels and dental caries and oral hygiene parameters in pediatric patients with CKD. CLINICAL RELEVANCE The impact of changes in serum biomarkers on oral and dental health is important for dentists' and medical professionals' approaches to patients' oral and systemic health.
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Affiliation(s)
- Berkant Sezer
- Department of Pediatric Dentistry, School of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye.
| | - Nur Kodaman Dokumacıgil
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Remziye Kaya
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Serçin Güven
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Özde Nisa Türkkan
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Betül Kargül
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
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