Fluid dynamics of gingiva and gingival health in children with end stage renal failure

Tooth loss and risk of end-stage renal disease: A nationwide cohort study

BACKGROUND

The association between renal disease and oral health has been studied in previous researches. The purpose of this study is to evaluate whether oral health, depicted by number of natural teeth was associated with an increased risk of kidney diseases.

METHODS

The present study analysed data from the Korean National Health Insurance from 2007 to 2008. Database of 4,544,610 individuals who received routine health checkups and dental examinations were included in this study.

RESULTS

There was an increase in end-stage renal disease with lower number of natural teeth and longer follow-up periods. Hazard ratios and their 95% confidence intervals for end-stage renal disease in participants with a number of natural teeth of 28, 24 to 27, 20 to 23, and <20 were one (reference), 1.066(0.997,1.139), 1.285(1.161,1.422), and 1.285(1.155,1.429), respectively. The association was significantly noted with age and body mass index (P < 0.05). In general, the substantial increase in hazard ratios is seen with loss of teeth and smoking. Hazard ratios and their 95% confidence intervals for end-stage renal disease in male smoking participants with a number of natural teeth <28 is 1.631(1.339,1.988). However, this association was not noted in female group.

CONCLUSIONS

The association between number of natural teeth and end-stage renal disease was suggested after adjusting for confounding factors by using multiple logistic regression analyses from the entire South Korean population. Oral health, depicted by the number of tooth loss showed strong and dose-dependent association with end-stage renal disease in a large population-based cohort.

Periodontal Disease in Patients Receiving Dialysis

Chronic kidney disease (CKD) is characterized by kidney damage with proteinuria, hematuria, and progressive loss of kidney function. The final stage of CKD is known as end-stage renal disease, which usually indicates that approximately 90% of normal renal function is lost, and necessitates renal replacement therapy for survival. The most widespread renal replacement therapy is dialysis, which includes peritoneal dialysis (PD) and hemodialysis (HD). However, despite the development of novel medical instruments and agents, both dialysis procedures have complications and disadvantages, such as cardiovascular disease due to excessive blood fluid and infections caused by impaired immunity. Periodontal disease is chronic inflammation induced by various pathogens and its frequency and severity in patients undergoing dialysis are higher compared to those in healthy individuals. Therefore, several investigators have paid special attention to the impact of periodontal disease on inflammation-, nutrient-, and bone metabolism-related markers; the immune system; and complications in patients undergoing dialysis. Furthermore, the influence of diabetes on the prevalence and severity of manifestations of periodontal disease, and the properties of saliva in HD patients with periodontitis have been reported. Conversely, there are few reviews discussing periodontal disease in patients with dialysis. In this review, we discuss the available studies and review the pathological roles and clinical significance of periodontal disease in patients receiving PD or HD. In addition, this review underlines the importance of oral health and adequate periodontal treatment to maintain quality of life and prolong survival in these patients.

Medical and Periodontal Clinical Parameters in Patients at Different Levels of Chronic Renal Failure

Aim. To assess the clinical periodontal and medical parameters in patients with chronic renal failure (CRF) at different levels of renal disease. Background. CRF is a progressive and irreversible loss of renal function associated with a decline in the glomerular filtration rate. Periodontal disease is a destructive inflammatory disease affecting periodontal tissues that shows high prevalence in patients with CRF. Materials and Methods. 102 CRF patients were included and divided into an early stage group (EG), predialysis group (PDG), and hemodialysis group (HDG). The medical parameters were taken from the patients' records. Results. Periodontal clinical condition differed among the CRF groups. Clinical attachment loss was greater in the HDG and PDG group compared to the EG (p = 0.0364); the same was observed in the Plaque Index (p = 0.0296); the others periodontal parameters did not show any differences. Ferritin levels were significantly higher in the HDG when compared to the EG and PGD (p < 0.0001), and fibrinogen was higher in PDG compared with the others (p < 0.0001); the triglycerides also showed higher values in the HDG compared with the other groups (p < 0.0001). Conclusion. The patients with renal involvement should have a multidisciplinary approach to an improvement in their oral and systemic health.

[Oral health status of patients undergoing hemodialysis: a Meta-analysis]

OBJECTIVE

This study aimed to systematically evaluate the oral health status of patients suffering from chronic renal failure and undergoing hemodialysis (HD).

METHODS

Electronic databases, namely, China National Knowledge Infrastructure, Wanfang Data base, PubMed, Web of Science, and Cochrane Library, were searched until May 2016 for cross-sectional and case-control studies that investigated the oral health status of patients suffering from chronic renal failure and undergoing HD. Two reviewers independently screened the trials, extracted the data, assessed the quality, and conducted a Meta-analysis with RevMan 5.3 in accordance with the inclusion and exclusion criteria.

RESULTS

Sixteen studies satisfied the eligibility criteria. Meta-analysis revealed that plaque index (MD=0.62, 95%CI: 0.51-0.72), calculus index (MD=1.09, 95%CI: 0.56-1.63), probing depth (MD=0.63, 95%CI: 0.29-0.98), and attachment loss (MD=0.63, 95%CI: 0.56-0.69) were significantly higher in the patients undergoing HD than in the healthy control group (P<0.01). No significant differences in decayed missing filled teeth (MD=1.12, 95%CI: -1.08-3.32) were observed between the patients undergoing HD and the healthy control group (P=0.32).

CONCLUSIONS

The prevalence of caries in patients undergoing HD is similar to that in the healthy control group. However, these patients are at a higher risk of acquiring periodontal diseases than the healthy control group. Thus, the oral health status of these patients should be further evaluated in clinical treatments.

Assessment of oral hygiene and periodontal health around posterior primary molars after their restoration with various crown types

OBJECTIVE

To compare the time-dependent changes in oral hygiene and periodontal health after restoring primary posterior molars with a traditional stainless steel crown (SSC) or an aesthetic crown using various measures of periodontal health and oral hygiene.

DESIGN

This investigation was a randomized, non-blinded prospective controlled clinical trial in which 264 crowns of different types were fitted onto the first and/or second primary molars of 76 children. The oral hygiene and the gingival health of the restored teeth and the antagonistic teeth were evaluated clinically and radiographically at 3- and 6-month intervals for 18 months after fitting the crowns.

RESULTS

The periodontal health of the control teeth was better than that of the remaining 215 restored teeth. The oral hygiene, as measured by the simplified oral hygiene index, and gingival health, as measured by the gingival index and the volume of gingival crevicular fluid, of the restored teeth, irrespective of crown type, progressively increased during the 18-month study period.

CONCLUSIONS

Oral hygiene and gingival health around a restored primary tooth deteriorate with time. Our results suggest that SSC, an open-faced SSC, or a NuSmile(®) pediatric crown should be the preferred crown type for restoring posterior primary teeth.

Osmotic pressure of periimplant sulcular and gingival crevicular fluids: a split-mouth, randomized study of its measurement and clinical significance

OBJECTIVES

This study comparatively investigated periimplant sulcular fluid (PISF) and gingival crevicular fluid (GCF) by means of the osmotic pressure (OP) levels of PISF (PISFOP) and GCF (GCFOP). It was a preliminary research that aimed to quantify PISFOP and GCFOP as well as to evaluate their clinical significances around implants and teeth.

MATERIAL AND METHODS

Partially edentulous implant patients treated by the same clinicians and using the same implant system were randomized in a split-mouth trial design. Fifty-four implants and teeth from these patients were selected in the same mouth and jaw as matched pairs of samples, i.e. as symmetrical or corresponding implant and tooth. PISFOP/GCFOP measurement was performed by an osmometer following PISF/GCF sampling procedures. Clinical significance was evaluated by the correlations between PISFOP/GCFOP and some clinical examination parameters of periimplant/periodontal soft tissues. These parameters included Silness-Löe plaque index (PI), Löe-Silness gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL).

RESULTS

PISFOP was higher than GCFOP, and GI, BOP, PPD and PAL were higher in the implant group than in the tooth group (P<0.05). PISFOP positively correlated with the clinical parameters of implants (P<0.01 for PI, GI and BOP; P<0.05 for PPD and PAL), and GCFOP positively correlated with the clinical parameters of teeth (P<0.01 for PPD; P<0.05 for PI, GI, BOP and PAL).

CONCLUSIONS

The results reveal that PISFOP and GCFOP may be measured by osmometer, and their levels may be related with the clinical conditions of periimplant/periodontal soft tissues.

Significance of elevated gingival crevicular fluid tumor necrosis factor-alpha and interleukin-8 levels in chronic hemodialysis patients with periodontal disease

BACKGROUND AND OBJECTIVE

The prevalence of chronic renal disease in industrialized countries is increasing, and chronic renal disease and periodontitis can have significant, reciprocal effects. The aim of this study was to evaluate the associations between specific clinical parameters and the levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in the gingival crevicular fluid of hemodialysis (HD) patients with periodontal disease.

MATERIAL AND METHODS

Forty-three HD patients and 43 systemically healthy subjects were enrolled in this study. Plaque index (PI), gingival index (GI) and pocket depth were used to determine periodontal status. Venous blood samples were obtained from each patient in the morning before the dialysis session and analyzed to determine the levels of inflammatory, biochemical and hematological parameters. Gingival crevicular fluid was collected from all subjects, and the levels of TNF-alpha and IL-8 were determined in the gingival crevicular fluid samples.

RESULTS

The following results were obtained from HD patients and controls: TNF-alpha (pg/mL), 31.40 +/- 1.46 and 3.06 +/- 0.15 (p < 0.001); IL-8 (pg/mL), 90.98 +/- 94.03 and 35.05 +/- 16.86 (p < 0.001); PI, 1.69 +/- 1.02 and 0.04 +/- 0.02 (p < 0.001); GI, 0.82 +/- 0.06 and 0.04 +/- 0.02 (p < 0.001); and pocket depth, 2.23 +/- 0.63 and 1.51 +/- 0.05 (p < 0.001), respectively. In addition, there were positive correlations between TNF-alpha and PI (r = 0.642, p < 0.001), between TNF-alpha and GI (r = 0.565, p < 0.001), between TNF-alpha and pocket depth (r = 0.522, p < 0.001), between IL-8 and PI (r = 0.402, p = 0.002), between IL-8 and GI (r = 0.396, p = 0.002), and between IL-8 and pocket depth (r = 0.326, p = 0.012). There were negative correlations between albumin and PI (r = -0.491, p < 0.001), albumin and GI (r = -0.406, p < 0.001), albumin and pocket depth (r = -0.464, p < 0.001) and albumin and CRP (r = -0.467, p = 0.002) and between the gingival crevicular fluid levels of TNF-alpha and IL-8, TNF-alpha and hemoglobin (r = -0.745, p < 0.001; r = -0.285, p < 0.05) (respectively).

CONCLUSION

The levels of TNF-alpha and IL-8 in gingival crevicular fluid were significantly higher in HD patients than in controls. There were strong, positive correlations between clinical periodontal parameters and the levels of inflammatory cytokines in gingival crevicular fluid from the HD patients.