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Kreher D, Ernst BLV, Ziebolz D, Haak R, de Fallois J, Ebert T, Schmalz G. Prevalence of Dental Caries in Patients on Renal Replacement Therapy-A Systematic Review. J Clin Med 2023; 12:jcm12041507. [PMID: 36836050 PMCID: PMC9967680 DOI: 10.3390/jcm12041507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Patients under renal replacement therapy (RRT) often show oral problems, including dry mouth, periodontal and dental diseases. This systematic review aimed to evaluate the caries burden in patients on RRT. Therefore, a systematic literature search based on the databases PubMed, Web of Science and Scopus was performed by two independent individuals in August 2022. Search terms were: "caries" AND "dialysis", "caries" AND "renal replacement therapy", "caries" AND "kidney". The systematic process was complemented by manual search. Studies on adult patients (age ≥ 18 years), treated by any form of RRT and explicitly reporting caries prevalence or incidence were checked for their eligibility and subsequently analyzed qualitatively. For all included studies, a quality appraisal was applied. From the systematic search, 653 studies were identified, of which 33 clinical investigations were included in the qualitative analysis. The majority (31 studies) of all included patients underwent hemodialysis (HD), with a sample size between 28 and 512 participants. Eleven studies investigated a healthy control group. Oral examinations were heterogeneous across studies; the caries burden was primarily assessed by decayed-(D-T), missing- and filled-teeth index (DMF-T). The number of decayed teeth ranged between 0.7 and 3.87 across studies. Only six out of these 11 studies found significant differences in caries prevalence/incidence between RRT and controls, whereby only four studies confirmed worse caries burden in RRT individuals. No information was provided on caries stadium (initial caries, advanced caries, invasive treatment need), caries activity or location (e.g., root caries) across studies. Most of the included studies were assessed to be of moderate quality. In conclusion, patients on RRT suffer from a high prevalence of dental caries. Alongside a need for further research in the field, improved, multidisciplinary, patient-centered dental care concepts are required to support dental and overall oral health in individuals on RRT.
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Affiliation(s)
- Deborah Kreher
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Bero Luke Vincent Ernst
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
| | - Jonathan de Fallois
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig, 04109 Leipzig, Germany
| | - Thomas Ebert
- Medical Department III—Endocrinology, Nephrology, Rheumatology, University of Leipzig, 04109 Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04109 Leipzig, Germany
- Correspondence:
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Lin R, Li H, Chen L, He J. Prevalence of and risk factors for thirst in the intensive care unit: An observational study. J Clin Nurs 2023; 32:465-476. [PMID: 35199411 PMCID: PMC10078651 DOI: 10.1111/jocn.16257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/13/2022] [Accepted: 02/08/2022] [Indexed: 01/17/2023]
Abstract
AIM AND OBJECTIVES This study investigated the incidence of thirst and contributing factors in intensive care unit (ICU) patients by analysing differences in physiologic, psychological, and disease- and environment-related parameters in ICU patients with vs without thirst. BACKGROUND Little is known about the factors that influence thirst, and there are no standardised methods for identifying at-risk patients in the ICU. Previous studies generalised the risk of thirst in ICU patients because of a lack of data on relevant variables. Here, we examined the factors contributing to thirst based on symptom management theory. DESIGN Prospective descriptive design. METHODS Physiologic, psychological, disease-related and environment-related data were collected for 301 patients from 4 ICUs (medical, surgical, cardiac and emergency ICUs) of a hospital from 15 December 2017-10 July 2019 through a screening interview, questionnaires and from electronic medical records. The data were analysed with descriptive statistics, the t-test and chi-squared test, and by logistic regression. Binary stepwise logistic regression was used to identify thirst-associated factors. The findings are reported according to the STROBE checklist for cross-sectional studies. RESULTS In total, 210/301 (69.8%) ICU patients experienced thirst. Risk factors were nil per os order (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.44-11.69), surgery (OR = 2.96, 95% CI: 1.11-7.93), high glucose (OR = 3.36, 95% CI: 1.01-11.17) and greater disease severity (OR = 1.13, 95% CI: 1.02-1.24). CONCLUSION Thirst is common in ICU patients. Timely detection of patients' thirst and identification of those at high risk by ICU nurses can ensure the implementation of effective and safe interventions. RELEVANCE TO CLINICAL PRACTICE The results of this study highlight the need to evaluate thirst symptoms in patients with severe disease and develop relief strategies for fasting, perioperative, and hyperglycaemic patients and others who are at high risk of thirst.
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Affiliation(s)
- Rong Lin
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China.,Department of Nursing, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hong Li
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China.,Department of Nursing, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lili Chen
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou, China.,The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jinyi He
- Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China
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3
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Dembowska E, Jaroń A, Gabrysz-Trybek E, Bladowska J, Trybek G. Oral Mucosa Status in Patients with End-Stage Chronic Kidney Disease Undergoing Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:835. [PMID: 36613157 PMCID: PMC9819349 DOI: 10.3390/ijerph20010835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
There are reports in the literature of interrelationships between chronic kidney disease and periodontitis pathophysiology; similar risk factors play a role in these conditions. Due to chronic kidney disease (CKD), patients on hemodialysis (HD) are more susceptible to developing pathological processes in the gingiva, periodontium, and oral mucosa. This study aimed to evaluate the condition of the oral cavity, with particular attention to lesions of the oral mucosa of patients with end-stage renal disease in Poland, West Pomeranian Voivodship. A case-control study assessed oral health in 200 Polish subjects, including 100 dialysis-station patients who constituted the study group (HD) and 100 healthy patients who formed the control group (K). The physical examination consisted of a general medical and dental history. Evaluation of the oral mucosa included detailed noting of the type of lesions, nature of complaints, and their location. The results showed a higher prevalence of oral lesions highlighting oral mucosal pathology in patients with HD than in group K. Most common symptoms reported by patients with CKD (HD) were xerostomia, taste disorders, and burning mouth. These findings highlight the need to implement comprehensive multispecialty care in patients with chronic systemic diseases.
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Affiliation(s)
- Elżbieta Dembowska
- Specialized Center of Dentistry-Elzbieta Dembowska, al. Bohaterow Warszawy 11b/5, 70-370 Szczecin, Poland
| | - Aleksandra Jaroń
- 4th Military Clinical Hospital in Wroclaw, ul. Rudolfa Weigla 5, 50-981 Wroclaw, Poland
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Ewa Gabrysz-Trybek
- Individual Specialist Medical Practice Ewa Gabrysz-Trybek, 70-111 Szczecin, Poland
| | - Joanna Bladowska
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, M. Curie-Skłodowskiej 68, 50-369 Wrocław, Poland
| | - Grzegorz Trybek
- 4th Military Clinical Hospital in Wroclaw, ul. Rudolfa Weigla 5, 50-981 Wroclaw, Poland
- Department of Oral Surgery, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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4
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Anil K, Vadakkekuttical RJ, Radhakrishnan C, Parambath FC. Correlation of periodontal inflamed surface area with glycemic status in controlled and uncontrolled type 2 diabetes mellitus. World J Clin Cases 2021; 9:11300-11310. [PMID: 35071560 PMCID: PMC8717502 DOI: 10.12998/wjcc.v9.i36.11300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The bidirectional link between periodontitis and diabetes mellitus (DM) has been established. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently utilized tools [clinical attachment loss (CAL) and probing pocket depth (PPD)] are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal inflamed surface area (PISA) quantifies the surface area of bleeding pocket epithelium and estimates the inflammatory burden. Studies relating to the periodontal status of diabetic patients with and without microvascular complications are scarce. This study assessed the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 DM (T2DM) with and without microvascular complications.
AIM To assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, and uncontrolled T2DM with and without microvascular complications.
METHODS This study comprised 180 T2DM patients. Based on glycated hemoglobin (HbA1c) levels, they were grouped into: (1) Controlled T2DMgroup: (HbA1c ≤ 7%); (2) Uncontrolled T2DM group: (HbA1c > 7%) without microvascular complications; and (3) Uncontrolled T2DM group: (HbA1c > 7%) with microvascular complications. Each group comprised 60 patients. All patients were assessed for periodontal parameters (Bleeding on Probing, PPD, CAL, Oral hygiene index simplified and PISA), and systemic parameters (HbA1c, fasting plasma glucose and post prandial plasma glucose).
RESULTS The proportion of periodontitis among controlled T2DM group, uncontrolled T2DM group without microvascular complications, uncontrolled T2DM group with microvascular complications was 75%, 93.4% and 96.6% respectively. Extent and severity of periodontitis were high in the uncontrolled T2DM group. A significant positive correlation was found between PISA and HbA1c among all patients (r = 0.393, P < 0.001). The dose–response relationship between PISA and HbA1c was observed. An increase of PISA with 168 mm2 was associated with a 1.0% increase of HbA1c.
CONCLUSION High proportion and severity of periodontitis, and increased inflamed surface area in uncontrolled T2DM may have contributed to the poor glycemic control and microvascular complications.
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Affiliation(s)
- Krishna Anil
- Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
| | - Rosamma Joseph Vadakkekuttical
- Department of Periodontics, Government Dental College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
| | - Chandni Radhakrishnan
- Department of Medicine, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
| | - Fairoz Cheriyalingal Parambath
- Department of Microbiology, Government Medical College (Affiliated to Kerala University of Health Sciences), Calicut 673008, Kerala, India
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5
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Mirzaei A, Shahrestanaki E, Daneshzad E, Heshmati J, Djalalinia S, Asayesh H, Mahdavi-Gorabi A, Heshmat R, Qorbani M. Association of hyperglycaemia and periodontitis: an updated systematic review and meta-analysis. J Diabetes Metab Disord 2021; 20:1327-1336. [PMID: 34900784 DOI: 10.1007/s40200-021-00861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Purpose The aim of this updated systematic review and meta-analysis was the association between hyperglycemia and periodontitis. Methods We searched PubMed/MEDLINE, Web of Science, and Scopus until March 2021. The key search words were based on "periodontitis" and "hyperglycemia." We included cohort, case-control, and cross-sectional studies, restricted to publications in English. The quality assessment of included studies and data extraction were done by two independent reviewers. Meta-analysis was performed for cross-sectional studies using the random-effects model. Results The literature search yielded 340 studies, and finally, 19 and 11 studies were included in systematic review and meta-analysis, respectively. The total sample size of the eligible studies in the meta-analysis was 38,896 participants, of whom 33% were male with a mean age of 51.20 ± 14.0 years. According to a random-effect meta-analysis in cross-sectional studies, the pooled odds ratio (OR) for the association between hyperglycemia and periodontal indices was statistically significant (OR: 1.50, 95%CI: 1.11, 1.90). There was evidence of publication bias (coefficient: - 3.53, p-value = 0.014) which, after imputing missing studies, the pooled OR of the association between hyperglycemia and periodontitis change to 1.55 (95%CI: 1.20, 1.90). Conclusion Results of the present study show that hyperglycemia was positively associated with periodontitis. However, more cohort and prospective longitudinal studies should be conducted to find the exact association. Overall, it seems the management of hyperglycemia could be considered as a preventive strategy for periodontitis. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-021-00861-9.
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Affiliation(s)
- Ahmadreza Mirzaei
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Ehsan Shahrestanaki
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Daneshzad
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Javad Heshmati
- Songhor Healthcare Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shirin Djalalinia
- Development of Research & Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Armita Mahdavi-Gorabi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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6
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Mori T, Nagata T, Nagata M, Fujimoto K, Fujino Y, Mori K. Diabetes severity measured by treatment control status and number of anti-diabetic drugs affects presenteeism among workers with type 2 diabetes. BMC Public Health 2021; 21:1865. [PMID: 34654398 PMCID: PMC8520264 DOI: 10.1186/s12889-021-11913-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The number of people with diabetes is increasing and resulting in major economic losses. Presenteeism accounts for the majority of economic losses, so measures against presenteeism are important. This study investigated the relationship between severity of type 2 diabetes and presenteeism. METHODS A cross-sectional study was conducted among workers over 40 years of age. Participants were classified as normal group or diabetic treatment group using their medical examination results and health insurance claims data. Diabetic treatment groups were described by degree of treatment control: Good (HbA1c < 7%), Intermediate (7% ≤ HbA1c < 8%), and Poor (8% ≤ HbA1c). Therapy type was also divided into monotherapy and combination therapy. Logistic regression analysis was performed to predict presenteeism loss using the Quantity and Quality method. RESULTS Data on 13,271 workers were analyzed. Presenteeism loss was significantly higher in all treatment control groups compared with the normal group, particularly for the intermediate and poor control groups. The monotherapy group did not differ from the normal group, but presenteeism loss was significantly higher in the combination therapy group than the normal group. CONCLUSIONS Presenteeism loss in workers with diabetes may be affected by diabetes severity, and even if treatment control were good, presenteeism loss could occur when the number of anti-diabetic drugs was high. Therefore, it is important to provide early intervention and continuous support as a preventive measure against not only diabetes and diabetes-related complications but also presenteeism.
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Affiliation(s)
- Takahiro Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan.
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Masako Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
- Data Science Center for Occupational Health, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Kenji Fujimoto
- Data Science Center for Occupational Health, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Koji Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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7
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Mahajan S, Bhaskar N, Kaur RK, Jain A. A comparison of oral health status in diabetic and non-diabetic patients receiving hemodialysis - A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102256. [PMID: 34488058 DOI: 10.1016/j.dsx.2021.102256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/18/2022]
Abstract
AIM(S) To assess and compare the impact of diabetes on the overall oral health status of hemodialytic patients. MATERIALS AND METHODS Four databases were searched with a manual search for relevant studies. This review compared periodontal health status, dental status, salivary changes, objective and subjective manifestations between diabetic and non-diabetic patients undergoing hemodialysis. Results were reported according to the PRISMA guidelines. RESULTS AND CONCLUSION (s): Despite few constraints, this review showed that diabetic patients on hemodialysis therapy are at greater risk of developing periodontal disease, and other oral manifestations. Therefore, it has been observed that concomitant diabetes increases oral health problems in a patient undergoing hemodialysis.
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Affiliation(s)
- Shifali Mahajan
- Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Nandini Bhaskar
- Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Rose Kanwaljeet Kaur
- Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Ashish Jain
- Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India.
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8
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Laheij A, Rooijers W, Bidar L, Haidari L, Neradova A, de Vries R, Rozema F. Oral health in patients with end-stage renal disease: A scoping review. Clin Exp Dent Res 2021; 8:54-67. [PMID: 34459147 PMCID: PMC8874082 DOI: 10.1002/cre2.479] [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: 03/23/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In patients with end stage, renal disease a high rate of morbidity and mortality is present. Studies suggest that end stage renal disease may affect oral health. Therefore, the aim of this study was to perform a scoping review on periodontal disease, dental caries, xerostomia, and hyposalivation in end stage renal disease patients. MATERIALS AND METHODS A literature search (in PubMed and Embase.com) was performed up to September 29, 2020, in collaboration with a medical information specialist. Included outcome variables were the community periodontal index, probing pocket depth, gingival index, bleeding on probing, decayed-missing-filled-teeth, carious-absent-obturated index, Xerostomia Inventory and the (un)stimulated whole salivary flow rate. RESULTS Forty three out of 1293 studies were included in the final review comprising 7757 end stage renal disease patients. The average age was 58.3 ± 29.4 years. 28.2%-78.8% of patients reported xerostomia and the (un)stimulated salivary flow rates were significantly lower. Higher community periodontal index scores were measured in end stage renal disease patients. More decayed-missing-filled-teeth were recorded, but no differences were found between groups. CONCLUSIONS Xerostomia and hyposalivation were highly prevalent in end stage renal disease patients. Patients have more deepened pockets, but an equal number of carious teeth compared to healthy controls.
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Affiliation(s)
- Alexa Laheij
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Wietse Rooijers
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Lela Bidar
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Lema Haidari
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands
| | - Aegida Neradova
- Department of Nephrology, Dianet Amsterdam, and Amsterdam UMC, Netherlands
| | | | - Frederik Rozema
- Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, location AMC, Netherlands
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9
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Ezzatt OM, Hamed MG, Gamil Y. Oropharyngeal and otorhinological changes in end stage renal patients undergoing hemodialysis. J Clin Exp Dent 2021; 13:e701-e708. [PMID: 34306534 PMCID: PMC8291163 DOI: 10.4317/jced.58292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/16/2021] [Indexed: 11/03/2022] Open
Abstract
Background The study aimed to assess oropharyngeal and otorhinolaryngological changes in end stage renal disease (ESRD) patients undergoing hemodialysis and correlate the findings to renal functions. Material and Methods This case-control study compared oral and otorhinolaryngological findings in 85 patients with (ESRD) on maintenance hemodialysis to age and sex matched 85 healthy controls. Frequencies of findings were calculated and compared and correlation between biochemical and the oral health parameters in case group was determined using T-test, chi-square and Pearson correlation test (significance were set at P<0.05). Results The frequency of oral signs and mucosal symptoms were significantly higher among ESRD compared to healthy controls. Dry mouth (34.12%), bad odour (32.94%), increased tongue coating (50.59%) and pale mucosa (45.88%) were the most commonly reported. Otorhinolaryngological findings was higher in cases than in controls, with otomycosis (10.59%) and allergic rhinitis (5.88%) being the most frequent findings. Serum creatinine and blood urea mean levels were higher in ESRD patients with oral and otorhinolaryngological findings compared to those without findings. Conclusions Oral and nasal manifestations in patients with ESRD on maintenance hemodialysis were significantly higher in comparison to healthy individuals and were related to their serum creatinine and blood urea mean levels. Key words:Chronic kidney disease, renal dialysis, Oral manifestation, nasal, case control, Egypt.
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Affiliation(s)
- Ola M Ezzatt
- Associate professor in department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Mohamed G Hamed
- Assistant professor in department of Otorhinolaryngology, Faculty of Medicine, Helwan University and ENT consultant in Arayah Hospital in Maadi, Cairo, Egypt
| | - Yasmine Gamil
- Lecturer in department of Oral Medicine, Periodontology and Oral Diagnosis. Faculty of Dentistry, Modern University of Information and Technology (MTI). Cairo, Egypt
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10
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M NK, K N RS, H M T, Kamath G, D D. Prevalence of xerostomia in patients on haemodialysis: A systematic review and meta-analysis. Gerodontology 2021; 38:235-241. [PMID: 33432660 DOI: 10.1111/ger.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/04/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Haemodialysis is the most popular procedure of treating end-stage renal disease. But patients on haemodialysis report various symptoms including xerostomia that add to the physical as well as the psychological stress. Xerostomia is also considered to be one of the factors for interdialytic weight gain. This systematic review aims to find out the prevalence of xerostomia in patients on haemodialysis. The results would help the nephrologists to consider xerostomia, treat it appropriately and minimise the risks during haemodialysis. METHODS The search strategy was in line with the PRISMA guidelines. An online literature search of databases like PUBMED, SCOPUS, Wiley Online Library and the Cochrane library along with journal hand searches and scanning of references was done. The relevant articles were identified based on the inclusion and exclusion criteria. Full-text articles were obtained and scrutinised. Risk of bias assessment was carried out for the included articles. RESULTS Four articles satisfying the inclusion criteria were finalised. The pooled prevalence of xerostomia in patients on haemodialysis was 52.3%. The assessment of risk bias placed the articles at low risk. CONCLUSION With the limited number and variations of studies, the prevalence of xerostomia in haemodialysis patients was high. Ideal management approaches could be proposed if many more accurate estimates of prevalence of xerostomia in patients on haemodialysis are recorded in future.
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Affiliation(s)
- Nanditha Kumar M
- Department of Prosthodontics, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Raghavendra Swamy K N
- Department of Prosthodontics, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Thippeswamy H M
- Department of Public Health Dentistry, JSS Dental College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
| | - Giridhar Kamath
- Department of Prosthodontics, Sharavathi Dental College & Hospital, Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | - Devananda D
- Department of Biochemistry, JSS Medical College & Hospital, JSS Academy of Higher Education & Research, Mysuru, India
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11
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Kumar S, Vineetha R, Pai KM, Prabhu R, Patil V, Smriti K. Oral manifestations in chronic kidney disease patients undergoing hemodialysis: a hospital-based study. MINERVA STOMATOLOGICA 2020; 69:302-308. [PMID: 32407059 DOI: 10.23736/s0026-4970.20.04300-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD-HD) patients undergoing routine hemodialysis have been reported to have oral signs and symptoms due to disease process or various comorbidities like diabetes mellitus (DM). Both CKD and DM can cause oral changes. Hence this study aimed to evaluate the prevalence of oral symptoms and signs in CKD-HD patients and to rule out DM as possible confounding factor for the oral findings. METHODS Oral manifestations were assessed in 102 CKD-HD patients, and compared with 100 DM patients and 101 non-diabetic patients with no renal impairment. RESULTS Most common symptom reported by patients with CKD-HD were xerostomia, altered taste. The most prevalent objective findings were oral dryness. There was statistically significant difference in symptoms and signs between CKD-HD and non-CKD patients. However, no significant difference between CKD-HD with and without DM. CONCLUSIONS This study showed increased prevalence of oral findings in CKD patients. It also revealed that Diabetes mellitus cannot be a contributing factor for increased prevalence of oral manifestations in CKD patients.
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Affiliation(s)
- Swati Kumar
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindranath Vineetha
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India -
| | - Keerthilatha M Pai
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindra Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vathsala Patil
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Komal Smriti
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Keles M, Tozoglu U, Uyanik A, Eltas A, Bayindir YZ, Cetinkaya R, Bilge OM. Does Peritoneal Dialysis Affect Halitosis in Patients with End-Stage Renal Disease? Perit Dial Int 2020; 31:168-72. [DOI: 10.3747/pdi.2009.00089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective There are various causes of halitosis, one of which is chronic renal failure. The objective of this study was to investigate halitosis levels in end-stage renal disease (ESRD) patients before and after peritoneal dialysis (PD) therapy. Methods 42 subjects with ESRD were included in this study. The presence of halitosis was assessed using an organoleptic measurement and compared with blood urea nitrogen (BUN) levels and salivary flow rates. Decayed, missing, and filled teeth (DMFT) index and Community Periodontal Index (CPI) were calculated. All measurements were done before and after patients had received 3 months of PD therapy. Results Mean serum BUN level was found to be lower (46.05 ± 13.30 vs 91.24 ± 31.28 mg/dL), salivary flow rate higher (0.34 ± 0.07 vs 0.26 ± 0.04 mL/minute), and halitosis level lower (2.39 ± 0.60 vs 3.90 ± 0.37) at the end of 3 months of PD therapy than at the beginning of PD therapy. There was no significant difference in CPI or DMFT index before and after PD therapy (p > 0.05). There was statistically significant positive correlation between the presence of halitosis and BUN levels ( r = 0.702, p = 0.001 before PD; r = 0.45, p = 0.002 after PD) and a negative correlation between the presence of halitosis and salivary flow rates ( r = -0.69, p = 0.000 before PD; r = -0.37, p = 0.01 after PD). Conclusion High BUN levels and low salivary flow rates were found to be associated with halitosis. PD may play an important role in decreasing the level of halitosis in ESRD patients.
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Affiliation(s)
- Mustafa Keles
- Department of Nephrology, Faculty of Medicine, Erzurum, Turkey
| | - Ummuhan Tozoglu
- Departments of Oral Diagnosis and Radiology, Erzurum, Turkey
| | - Abdullah Uyanik
- Department of Nephrology, Faculty of Medicine, Erzurum, Turkey
| | | | - Yusuf Ziya Bayindir
- Operative Dentistry, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
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Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study. Int J Dent 2019; 2019:1608329. [PMID: 31662758 PMCID: PMC6778863 DOI: 10.1155/2019/1608329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine and compare OHRQoL (oral-health-related quality of life) using the Geriatric Oral Health Assessment Index (GOHAI-12) and Oral Health Impact Profile (OHIP-14) among patients receiving hemodialysis (HD). Methods Face-to-face interviews and intraoral examinations were conducted among 70 patients. Mann-Whitney U test and Kruskal-Wallis test were used to compare each item score with demographics and dental and overall health status. Results The mean number of years on dialysis was 4.7 ± 7.5 yrs; the mean number of teeth present was 19.7 ± 11.04; median values of OHRQoL using GOHAI-12 and OHIP-14 were 52 and 64. Within GOHAI-12, limiting food (p 0.043), uncomfortable eating in front of people (p 0.045), limiting contact with people (p 0.046), and eating without discomfort (p 0.011) were significantly associated with females. Being worried (p 0.040) and self-conscious (p 0.048) were significant for age groups ≤65 years. Prevented from speaking was associated with >20 teeth (p 0.016). Being worried about oral health was associated with number of years on dialysis (p 0.042). Within OHIP-14, speech was associated with number of teeth present (p 0.024). Total inability to function was significantly associated with race (p 0.018), number of teeth (p 0.028), and edentulousness (p 0.031). Conclusions GOHAI-12 was more effective than OHIP-14 in assessing OHRQoL. However, most subjective experiences did not correlate with clinical findings. Systemic health issue like end-stage renal disease affecting QoL might have taken precedence over dental problems. Clinical assessments should be inherent in oral-health evaluation and there should be cooperation between nephrologists and dentists in promoting oral health and treating systemic conditions among HD patients.
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Periodontal Disease in Patients Receiving Dialysis. Int J Mol Sci 2019; 20:ijms20153805. [PMID: 31382656 PMCID: PMC6695931 DOI: 10.3390/ijms20153805] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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15
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Marinoski J, Bokor-Bratic M, Mitic I, Cankovic M. Oral mucosa and salivary findings in non-diabetic patients with chronic kidney disease. Arch Oral Biol 2019; 102:205-211. [DOI: 10.1016/j.archoralbio.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi Università Cattolica del Sacro Cuore Roma Italia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
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Bruzda-Zwiech A, Szczepańska J, Zwiech R. Xerostomia, thirst, sodium gradient and inter-dialytic weight gain in hemodialysis diabetic vs. non-diabetic patients. Med Oral Patol Oral Cir Bucal 2018; 23:e406-e412. [PMID: 29924756 PMCID: PMC6051689 DOI: 10.4317/medoral.22294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/23/2018] [Indexed: 11/22/2022] Open
Abstract
Background In hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients. Material and Methods The study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured. Results Significantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient. Conclusions Concomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. Key words:Diabetes mellitus, hemodialysis, hyposalivation, inter-dialytic weight gain, sodium gradient.
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Affiliation(s)
- A Bruzda-Zwiech
- Department of Pediatric Dentistry Medical University of Lodz, Poland 92-213 Lodz, Pomorska 251,
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Huang Y, Shi X, Mao Q, Zhang Y, Cong X, Zhang X, Zhang Z, Wu L, Xiang R, Yu G. Aquaporin 5 is degraded by autophagy in diabetic submandibular gland. SCIENCE CHINA-LIFE SCIENCES 2018; 61:1049-1059. [PMID: 29951954 DOI: 10.1007/s11427-018-9318-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/16/2018] [Indexed: 01/08/2023]
Abstract
Autophagy is a catabolic process which is involved in the development of many diseases including diabetes mellitus and its complications. Hyposalivation is a common complication of diabetes mellitus, whereas its mechanism remains unclear. Here, we observed that the stimulated salivary flow rate of SMG was significantly decreased in db/db mice, a diabetic mice model. The expressions of aquaporin 5 (AQP5), a water channel protein, were decreased, whereas the mRNA level of AQP5 was increased in SMGs of both diabetic patients and mice. Under transmission electron microcope, more autophagosomes were detected in diabetic SMGs. Expressions of autophagy related proteins LC3II, Beclin-1 and ATG5 were increased, meanwhile autophagy substrate p62 was decreased in SMGs of diabetic patients and mice, indicating that autophagy was activated in diabetic SMG. Double immunofluorescence staining showed that the colocalization of AQP5 and LC3 was increased in SMGs of diabetic mice. In cultured SMG-C6 cells, high glucose (HG), but not high osmotic pressure, reduced AQP5 protein expression and induced autophagy. Moreover, inhibition of autophagy by 3-methyladenin, an autophagy inhibitor, or by autophagy-related gene 5 siRNA, decreased HG-induced AQP5 reduction in SMG-C6 cells. Additionally, the expression of p-p85, p-Akt and p-mTOR were decreased in HG-treated SMG-C6 cells. Pretreatment with 740Y-P, a PI3K agonist, significantly suppressed HG-induced autophagy and AQP5 degradation. Taken together, these results indicate that autophagy plays a crucial role in AQP5 degradation in diabetic SMG via PI3K/Akt/mTOR signaling pathway, which contributes to the dysfunction of diabetic SMG. Our study provides a novel mechanism of diabetic hyposalivation.
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Affiliation(s)
- Yan Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Xijin Shi
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Qianying Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Yan Zhang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Xin Cong
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Xueming Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Zhejing Zhang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Liling Wu
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Ruolan Xiang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China.
| | - Guangyan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
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Zhao D, Khawaja AT, Jin L, Li KY, Tonetti M, Pelekos G. The directional and non-directional associations of periodontitis with chronic kidney disease: A systematic review and meta-analysis of observational studies. J Periodontal Res 2018; 53:682-704. [PMID: 29777531 DOI: 10.1111/jre.12565] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 12/11/2022]
Abstract
This systematic review aimed to assess the current evidence on the directional and non-directional associations of periodontitis with chronic kidney disease (CKD). Electronic search for observational studies on the association of periodontitis with CKD was performed in MEDLINE, EMBASE, PubMed, Open GREY and Cochrane library up to June 5, 2017. Two reviewers conducted study selection, data collection and assessment of methodological quality using the original and modified Newcastle-Ottawa Scale. Cohort, case-control and cross-sectional studies were included, which clearly defined periodontitis and CKD or reported acceptable clinical parameters of these 2 diseases in adults. Meta-analysis was employed to estimate the pooled odds ratio on the non-directional association and the incidence rate ratio (IRR) for the directional association. Among 2530 potential eligible articles, 47 were finally included. Most of them investigated a non-directional association of periodontitis with CKD, including 7 case-control studies and 38 cross-sectional studies; 24 studies had statistical analysis on the non-directional association and 75% of them reported significant results, which were supported further by the meta-analysis (random: odds ratio = 2.12, P < .001; χ2 = 25.74, I2 = 88.3%). None of the studies focused on the directional association of CKD (as the exposure) with periodontitis (as the outcome), whereas 2 retrospective cohort studies explored a directional association of periodontitis (as the exposure) with CKD (as the outcome) (random: IRR=2.10, P > .05; fixed: IRR=1.76, P < .05; χ2 = 4.65, I2 = 78.3%). Overall, the high heterogeneity of studies limits the significance of these results. There is substantial evidence on the non-directional association of periodontitis with CKD, while there are limited studies on the directional association. Well-designed prospective studies with longer follow-ups in representative communities are needed to clarify the directional association and enhance the quality of the evidence on this topic.
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Affiliation(s)
- D Zhao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - A T Khawaja
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - L Jin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - K-Y Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - M Tonetti
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - G Pelekos
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Rodakowska E, Wilczyńska-Borawska M, Fryc J, Baginska J, Naumnik B. Oral health-related quality of life in patients undergoing chronic hemodialysis. Patient Prefer Adherence 2018; 12:955-961. [PMID: 29910608 PMCID: PMC5987751 DOI: 10.2147/ppa.s161638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS The aims of the study were to determine oral health-related quality of life (OHRQoL) in chronic hemodialysis (HD) patients and to estimate which scale describing OHRQoL, Oral Health Impact Profile (OHIP-14) or Geriatric/General Oral Health Assessment Index (GOHAI), was more useful in this particular group. METHODS This was a cross-sectional study conducted by means of a census survey. The Polish versions of OHIP-14 and GOHAI were used to assess OHRQoL. The oral examination included decayed, missing and filled teeth (DMF-T) Index; Oral Hygiene Index simplified; Plaque Index and Gingival Index. In the statistical analysis, the Kruskal-Wallis test, Mann-Whitney U test, Pearson's χ2 test and Spearman's rank correlation coefficients were used as appropriate. RESULTS The final sample consisted of 72 patients (mean age 63.2±15.2 years). The mean duration of HD treatment was 43.8 months. The mean number of teeth was 10.9. The majority of participants (81.9%) were dentate; only 22.2% of the respondents had >20 teeth. Among the dentate subjects, 44.1% wore removable dental prostheses (60.7% women). The most prevalent items for GOHAI (mean 14.71; SD 7.21) were uncomfortable to swallow, discomfort when eating and unhappy with appearance. The most prevalent items for OHIP-14 (mean 8.87; SD 10.95) were uncomfortable to eat foods, and diet has been unsatisfactory. The internal reliability (Cronbach's alpha) was 0.637 for GOHAI and 0.918 for OHIP-14. Chewing problems were significantly related to GOHAI (p=0.001) and OHIP-14 (p<0.001) scales. Higher OHIP-14 scores were significantly associated with dental treatment needs (p=0.029) and poor self-rated oral status (p=0.001). CONCLUSION The HD patients had an unsatisfactory oral status, but using only OHRQoL scale was insufficient to capture all their oral health problems. The scales did not fully reflect poor oral health in HD patients. The oral problems were not a major concern for this group of patients, which could indicate the adaptation to impaired oral health or a change in health priorities. Regular dental examinations together with the assessment of OHRQoL in HD patients are required for a comprehensive patients' state. In our study, more variables were significantly related to the OHIP-14 scale than to the GOHAI scale. Thus, the OHIP-14 scale may be more useful in assessing OHRQoL in HD patients.
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Affiliation(s)
- Ewa Rodakowska
- Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland
- Correspondence: Ewa Rodakowska, Department of Restorative Dentistry, Medical University of Bialystok, ul Marii Skłodowskiej-Curie 24 A, 15-276 Bialystok, Poland, Tel +48 85 7468 5760, Email
| | | | - Justyna Fryc
- Faculty of Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Baginska
- Department of Dentistry Propaedeutics, Medical University of Bialystok, Bialystok, Poland
| | - Beata Naumnik
- I Department of Nephrology and Transplantation with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
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Altamimi AG, AlBakr SA, Alanazi TA, Alshahrani FA, Chalisserry EP, Anil S. Prevalence of Periodontitis in Patients Undergoing Hemodialysis: a Case Control Study. Mater Sociomed 2018; 30:58-61. [PMID: 29670479 PMCID: PMC5857055 DOI: 10.5455/msm.2018.30.58-61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives: To assess the prevalence of periodontal disease among patients undergoing renal dialysis. Methods: Sixty hemodialysis patients (30 males, 30 females) with a mean age of 44.4±9.5 years comprised the study group. Periodontal parameters such as plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment level (CAL) were measured in these patients and 60 age and sex-matched control subjects. The data was tabulated and analyzed. Results: The mean duration of dialysis was 5.50±3.02 years. The plaque index (PI) bleeding on probing (BOP), Periodontal probing depth (PPD) and clinical attachment level (CAL) were significantly higher in patients undergoing hemodialysis than in control subjects. The mean clinical attachment level was significantly higher among the dialysis patients (2.78±0.83 mm) than the control subjects (1.97±0.53 mm). The plaque index and bleeding on probing also showed a similar pattern in patients undergoing hemodialysis compared to control patients. The prevalence and severity of periodontal disease seems to be higher in patients undergoing dialysis. Conclusion: From the observations of this study, it can be concluded that patients undergoing hemodialysis are more prone to periodontal diseases. Further studies with a larger population and a comparison with the duration of dialysis may further substantiate the current findings.
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Affiliation(s)
| | | | | | - Faleh A Alshahrani
- Department of Oral and Maxillofacial Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Elna Paul Chalisserry
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Sukumaran Anil
- Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha University, Poonamallee High Road, Chennai, India
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Zhang J, Jiang H, Sun M, Chen J. Association between periodontal disease and mortality in people with CKD: a meta-analysis of cohort studies. BMC Nephrol 2017; 18:269. [PMID: 28814274 PMCID: PMC5558661 DOI: 10.1186/s12882-017-0680-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Periodontal disease occurs relatively prevalently in people with chronic kidney disease (CKD), but it remains indeterminate whether periodontal disease is an independent risk factor for premature death in this population. Interventions to reduce mortality in CKD population consistently yield to unsatisfactory results and new targets are necessitated. So this meta-analysis aimed to evaluate the association between periodontal disease and mortality in the CKD population. METHODS Pubmed, Embase, Web of Science, Scopus and abstracts from recent relevant meeting were searched by two authors independently. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for overall and subgroup meta-analyses. Statistical heterogeneity was explored by chi-square test and quantified by the I2 statistic. RESULTS Eight cohort studies comprising 5477 individuals with CKD were incorporated. The overall pooled data demonstrated that periodontal disease was associated with all-cause death in CKD population (RR, 1.254; 95% CI 1.046-1.503; P = 0.005), with a moderate heterogeneity, I2 = 52.2%. However, no evident association was observed between periodontal disease and cardiovascular mortality (RR, 1.30, 95% CI, 0.82-2.06; P = 0.259). Besides, statistical heterogeneity was substantial (I2 = 72.5%; P = 0.012). Associations for mortality were similar between subgroups, such as the different stages of CKD, adjustment for confounding factors. Specific to all-cause death, sensitivity and cumulative analyses both suggested that our results were robust. As for cardiovascular mortality, the association with periodontal disease needs to be further strengthened. CONCLUSIONS We demonstrated that periodontal disease was associated with an increased risk of all-cause death in CKD people. Yet no adequate evidence suggested periodontal disease was also at elevated risk for cardiovascular death.
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Affiliation(s)
- Jian Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hong Jiang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China.
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China.
| | - Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.
- Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, People's Republic of China.
- Key Laboratory of Multiple Organ Transplantation, Ministry of Health, Key Laboratory of Nephropathy, Hangzhou, Zhejiang Province, People's Republic of China.
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Hastings JF, Vasquez E. Diabetes and Tooth Loss among Working-Age African Americans: A National Perspective. SOCIAL WORK IN PUBLIC HEALTH 2017; 32:443-451. [PMID: 28796580 PMCID: PMC5881378 DOI: 10.1080/19371918.2017.1358126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Natural teeth are still lost in adults despite improvements in dental care and access to treatment across the life span. The study examined whether tooth loss can be mitigated in adults experiencing diabetes. National online survey data from the Service Utilization among African Americans with Co-morbid Depression and Diabetes (n = 275) were analyzed using logistic regression analyses. Diabetes was most prevalent among men (73.5%) and least prevalent among women (40.6%). In general and among the women, those without diabetes have approximately 50% fewer missing teeth than those with diabetes (odds ratio = .50; 95% confidence interval: 0.30, 0.83). Tooth loss is a traumatic experience and a serious life event that requires professional attention.
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Affiliation(s)
- Julia F. Hastings
- Health Policy, Management, & Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Elizabeth Vasquez
- Epidemiology, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
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López-Pintor RM, López-Pintor L, Casañas E, de Arriba L, Hernández G. Risk factors associated with xerostomia in haemodialysis patients. Med Oral Patol Oral Cir Bucal 2017; 22:e185-e192. [PMID: 28160594 PMCID: PMC5359703 DOI: 10.4317/medoral.21612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To determine the prevalence of xerostomia and hyposalivation in Haemodialysis (HD) patients, to clarify risk factors, assess patient's quality of life, and to establish a possible correlation among interdialytic weight gain (IDWG) and xerostomia. MATERIAL AND METHODS This study was performed on a group of 50 HD patients. Data were collected using a questionnaire containing demographic and clinical variables, a visual analogue scale (VAS) for xerostomia, IDWG, and an oral health impact profile questionnaire (OHIP-14). Unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. RESULTS A total of 28 HD patients (56%) suffered xerostomia. Dry mouth was associated with hypertension (OR, 5.24; 95% CI, 1.11-24.89) and benzodiazepine consumption (OR, 5.96; 95% CI, 1.05-33.99). The mean xerostomia VAS and OHIP-14 scores were 31.74±14.88 and 24.38±11.98, respectively. No significant correlation was observed between IDWG% and VAS and OHIP total score. Nonetheless, a positive correlation between VAS level of thirst and IDWG% was found (r=0.48 p=0.0001). UWS and SWS means (determined in 30 patients) were 0.16±0.17 and 1.12±0.64, respectively. Decreased values of UWS and SWS were reported in 53.33% and 36.66% of HD patients. CONCLUSIONS Xerostomia in HD has a multifactorial aetiology due to accumulative risks as advanced age, systemic disorders, drugs, fluid intake restriction, and salivary parenchymal fibrosis and atrophy. Therefore, it is important to detect possible xerostomia risk factors to treat correctly dry mouth in HD patients and avoid systemic complications.
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Affiliation(s)
- R-M López-Pintor
- Departamento Estomatología III, Facultad de Odontología, Plaza Ramón y Cajal s/n, 28040 Madrid Spain,
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Schmalz G, Schiffers N, Schwabe S, Vasko R, Müller GA, Haak R, Mausberg RF, Ziebolz D. Dental and periodontal health, and microbiological and salivary conditions in patients with or without diabetes undergoing haemodialysis. Int Dent J 2017; 67:186-193. [PMID: 28547773 DOI: 10.1111/idj.12282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this cross-sectional study was to evaluate the dental and periodontal health, as well as the microbiological and salivary conditions, of patients with and without diabetes mellitus (DM) who are receiving haemodialysis. METHODS One-hundred and fifty-nine haemodialysis patients were included and divided into groups according to the pre-existing diabetes status: DM or no DM. The oral examination included dental findings and assessment of the periodontal situation. The periodontal condition was classified as healthy/mild, moderate or severe periodontitis. Subgingival biofilm samples were analysed using the polymerase chain reaction. The salivary diagnostics included measurement of unstimulated and stimulated salivary flow, pH and buffer capacity. Statistical analyses used Fisher's test, the t-test and the Mann-Whitney U-test (α = 5%). RESULTS The dental findings showed no significant difference between patients with and without DM (P = 0.44). The prevalence of periodontitis was high (96% in patients with DM and 97% in patients who did not have DM) and there was no significant difference between the groups (P = 0.71). There was a higher prevalence of Porphyromonas gingivalis, Parvimonas micros, Eubacterium nucleatum and Capnocytophaga spp. in patients without DM (P < 0.05). The salivary pH was significantly higher in patients without DM (P < 0.01). CONCLUSION While differences in the prevalence of periodontal pathogenic bacteria and in the salivary pH were detected between the groups, the dental and periodontal status was comparable between patients with and without DM. Accordingly, DM appears to have no decisive influence on the oral health in patients treated with haemodialysis who have well-controlled diabetes.
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Affiliation(s)
- Gerhard Schmalz
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Nora Schiffers
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany.,Department of Preventive Dentistry, Periodontology, and Cariology, University Medical Center Goettingen, Goettingen, Germany
| | - Sandra Schwabe
- Department of Preventive Dentistry, Periodontology, and Cariology, University Medical Center Goettingen, Goettingen, Germany
| | - Radovan Vasko
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Gerhard A Müller
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer F Mausberg
- Department of Preventive Dentistry, Periodontology, and Cariology, University Medical Center Goettingen, Goettingen, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology, and Periodontology, University of Leipzig, Leipzig, Germany
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Chen W, Laiho S, Vaittinen O, Halonen L, Ortiz F, Forsblom C, Groop PH, Lehto M, Metsälä M. Biochemical pathways of breath ammonia (NH
3
) generation in patients with end-stage renal disease undergoing hemodialysis. J Breath Res 2016; 10:036011. [DOI: 10.1088/1752-7155/10/3/036011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ausavarungnirun R, Wisetsin S, Rongkiettechakorn N, Chaichalermsak S, Udompol U, Rattanasompattikul M. Association of dental and periodontal disease with chronic kidney disease in patients of a single, tertiary care centre in Thailand. BMJ Open 2016; 6:e011836. [PMID: 27466240 PMCID: PMC4964184 DOI: 10.1136/bmjopen-2016-011836] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Several studies have shown an association between oral diseases and chronic kidney disease (CKD), and regular oral care may be an important strategy for reducing the burden of CKD. The objective of this study was therefore to evaluate the association between dental and periodontal diseases in Thai patients with various stages of CKD. METHODS This was designed as a cross-sectional study and was performed between 2011 and 2012. The inclusion criteria were age >20 years and a diagnosis of CKD for at least 90 days. Data from medical records were collected, clinical oral examination was performed, and data were statistically analysed. RESULTS A total of 129 patients with different stages of CKD were included. Ninety-eight (76%) were men. The age range was 30-86 years. The Decay, Missing and Filling Tooth Index and the number of missing teeth were higher in the group with moderate CKD than in the control group (21 vs 17.5, p=0.045, 13 vs 8 p=0.01, respectively). Serum albumin levels decreased when estimated glomerular filtration rate (eGFR) was in decline (γ=0.33; p=0.002). Severe periodontitis was significantly higher in the 'more severe CKD group' (eGFR <60 mL/min/1.73 m(2)) than in the 'less severe CKD group' (eGFR 60-90 mL/min/1.73 m(2); 24% vs 9%, p=0.03). Severe periodontitis, eGFR <30 mL/min/1.73 m(2) and brushing teeth more than once a day were associated with hypoalbuminaemia (defined as <3.8 g/dL) (OR (95% CI) 5.88 (1.64 to 21.11), 5.80 (1.58 to 21.35) and 0.16 (0.05 to 0.60), respectively). CONCLUSIONS Severe periodontal diseases were more prevalent in patients with more severe CKD than in those with less severe CKD. The novel association of serum albumin levels with periodontal status was demonstrated in progressive stages of CKD. Dental intervention may be beneficial from the early stages of CKD.
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Affiliation(s)
- R Ausavarungnirun
- Medicine Division, Medical Department, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand
| | - S Wisetsin
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - N Rongkiettechakorn
- Medicine Division, Medical Department, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand
| | - S Chaichalermsak
- Department of Oral Medicine and Periodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - U Udompol
- Medicine Department, Saraburi Hospital, Muang, Saraburi, Thailand
| | - M Rattanasompattikul
- Medicine Division, Medical Department, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand
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Lasisi TJ, Raji YR, Salako BL. Salivary creatinine and urea analysis in patients with chronic kidney disease: a case control study. BMC Nephrol 2016; 17:10. [PMID: 26775026 PMCID: PMC4715295 DOI: 10.1186/s12882-016-0222-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Many metabolic changes develop in patients with chronic kidney disease which often necessitate frequent biochemical analysis of blood. Saliva analysis as an alternative to blood has many advantages. The aims of this study were to evaluate levels of salivary creatinine and urea in patients with chronic kidney disease in comparison to healthy individuals; to determine correlation between salivary creatinine/urea and blood creatinine/urea and to evaluate the diagnostic potential of saliva. Methods A case control study, involving 50 patients with late stage chronic kidney disease and 49 healthy individuals as control. Blood and saliva samples were analyzed for urea and creatinine levels. Data are presented as median with interquartile range and compared using Independent Samples Mann Whitney U test. Correlation between plasma and salivary creatinine as well as urea was determined using Spearman’s correlation test. Receiver operating characteristics (ROC) analysis was done to determine the diagnostic ability of salivary creatinine and urea and cut-off values were established. Results Median salivary creatinine levels were 2.60 mg/dl and 0.20 mg/dl while median salivary urea levels were 92.00 mg/dl and 20.50 mg/dl in patients with chronic kidney disease and controls respectively. Salivary levels of creatinine and urea were significantly elevated in chronic kidney disease patients (p < 0.001). In addition, there was positive correlation between blood and salivary creatinine as well as urea levels. Total areas under the curve for salivary creatinine and urea were 0.97 and 0.89 respectively. Cut-off values for salivary creatinine and urea were 0.55 mg/dl and 27.50 mg/dl respectively which gave sensitivity and specificity of 94 % and 85 % for creatinine; as well as 86 % and 93 % for urea. Conclusions Findings of this study suggest that analysis of salivary creatinine and urea in patients with chronic kidney disease reflects their levels in blood. Hence, salivary creatinine and urea could be used as diagnostic biomarkers of chronic kidney disease.
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Affiliation(s)
- Taye Jemilat Lasisi
- Department of Physiology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria. .,2Department of Oral Pathology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.
| | - Yemi Raheem Raji
- 3Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Babatunde Lawal Salako
- 3Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Kowall B, Holtfreter B, Völzke H, Schipf S, Mundt T, Rathmann W, Kocher T. Pre-diabetes and well-controlled diabetes are not associated with periodontal disease: the SHIP Trend Study. J Clin Periodontol 2015; 42:422-30. [DOI: 10.1111/jcpe.12391] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Bernd Kowall
- German Diabetes Center; Institute of Biometrics and Epidemiology; Düsseldorf Germany
- Center of Clinical Epidemiology; c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE); University Hospital; Essen Germany
| | - Birte Holtfreter
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, and Endodontology; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Henry Völzke
- Institute for Community Medicine; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Sabine Schipf
- Institute for Community Medicine; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Torsten Mundt
- Department of Prosthodontics, Gerodontology and Biomaterials; Dental School; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
| | - Wolfgang Rathmann
- German Diabetes Center; Institute of Biometrics and Epidemiology; Düsseldorf Germany
| | - Thomas Kocher
- Unit of Periodontology; Department of Restorative Dentistry, Periodontology, and Endodontology; University Medicine; Ernst-Moritz-Arndt-University; Greifswald Germany
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Hajian-Tilaki A, Oliae F, Jenabian N, Hajian-Tilaki K, Motallebnejad M. Oral health-related quality of life and periodontal and dental health status in Iranian hemodialysis patients. J Contemp Dent Pract 2014; 15:482-90. [PMID: 25576117 DOI: 10.5005/jp-journals-10024-1566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to evaluate oral health status and oral health related quality of life (OHRQoL) in Iranian patients undergoing hemodialysis. MATERIALS AND METHODS In this cross-sectional study 145 (95 dentate and 50 edentulous) patients undergoing hemodialysis participated. Demographic information, laboratory findings and dental health status was recorded by a standard form. Oral hygiene status was obtained by simplifed oral hygiene index (OHI-S) and oral health was evaluated by decay missing flling teeth (DMFT) index, plaque index (PLI) and periodontal disease index. Oral health related quality of life was determined by means of short form oral health impact profle (OHIP-14) and general oral health assessment index (GOHAI). RESULTS The mean (± SD) DMFT, PLI and PDI were 15.47 ± 7.85, 2.03 ± 0.95, 4.09 ± 1.31 respectively. OHI-S was good in 7 (7.4%), fair 25 (26.6%) and poor in 38 (26.6%) of patients. The mean OHIP-14 and GOHAI scores were 31.32 ± 12.53 and 29.07 ± 8.5 respectively. The self-perceived oral health of 58 (40%) was good, 49(33.8%) was fair and 38 (26.2%) was poor. Patients with higher scores for the questionnaires had significantly worst self-rated oral health. Besides, there was a significant positive correlation between dental and periodontal variables with OHIP-14 and GOHAI scores. CONCLUSION Hemodialysis patients had a poor oral hygiene and periodontal status, weak attitudes and negligence toward oral health but they were satisfed of their oral health condition and their OHRQoL was approximately good. Therefor it should be communications between nephrologists and oral health care professionals for promoting the oral health status of the patients. CLINICAL SIGNIFICANCE The findings high light the need of comprehensive oral examinations including periodontal therapy, restorative treatment, preventive dental treatment and follow-up care in the hemodialysis patients.
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Affiliation(s)
- Arefe Hajian-Tilaki
- Dental Student, Department of Oral Medicine, Babol University of Medical Sciences, Mazandaran, Iran
| | - Farshid Oliae
- Assistant Professor, Department of Nephrology, Shahid Behashti Hospital, Babol University of Medical Sciences, Mazandaran, Iran
| | - Niloofar Jenabian
- Associate Professor, Department of Periodontology and Implantology, Babol University of Medical Sciences, Mazandaran, Iran
| | - Karimollah Hajian-Tilaki
- Professor, Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Mazandaran, Iran
| | - Mina Motallebnejad
- Associate Professor, Department of Oral Medicine, Babol University of Medical Sciences, Mazandaran, Iran, e-mail:
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Popławska-Kita A, Siewko K, Szpak P, Król B, Telejko B, Klimiuk PA, Stokowska W, Górska M, Szelachowska M. Association between type 1 diabetes and periodontal health. Adv Med Sci 2014; 59:126-31. [PMID: 24797988 DOI: 10.1016/j.advms.2014.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE We assessed periodontal status in patients with type 1 diabetes and healthy individuals in relation to their glycemic control, smoking and inflammatory biomarkers. MATERIAL/METHODS Periodontal status was examined in 107 patients with diabetes and 40 controls, using Oral Hygiene Index (OHI), Community Periodontal Index (CPI) and tooth number. CPI values of 0-2 and 3-4 were classified as non-periodontitis and periodontitis, respectively. Blood samples were analyzed for glucose, HbA1c, CRP, fibrinogen, interleukin-1 and tumor necrosis factor-alpha (TNF-α). RESULTS Periodontitis was found in 15.0% of the controls and 57.9% of diabetic patients, including 40.0% of these with good metabolic control (GMC) and 59.5% of those with poor metabolic control (PMC). Severe periodontitis was more frequent in the PMC than in the GMC group and in the controls (26.0% vs. 20.0% vs. 5.0%). The PMC patients had lower number of sextants with CPI 0 and higher number of sextants with CPI 3 and CPI 4 as well as lower tooth number in comparison with the controls. The patients with periodontitis had higher TNF-α (p<0.001) and OHI (p<0.001) than the patients without periodontitis. The number of sextants with CPI 0 correlated negatively with fibrinogen and TNF-α levels, whereas the number of sextants with CPI 3 correlated positively with TNF-α and fasting glucose level. CONCLUSIONS There is good evidence that type 1 diabetes increases the risk of periodontal disease. Our results suggest that poor metabolic control of diabetes together with smoking and inadequate oral hygiene increase the risk of severe periodontal destruction in patients with type 1 diabetes.
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Affiliation(s)
- Anna Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland.
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Szpak
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Beata Król
- Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland
| | - Beata Telejko
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Adrian Klimiuk
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Wanda Stokowska
- Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Szelachowska
- Department of Endocrinology, Diabetology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
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Chhokra M, Manocha S, Dodwad V, Gupta U, Vaish S. Establishing an Association between Renal Failure and Periodontal Health: A Cross Sectional Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2013; 7:2348-50. [PMID: 24298526 DOI: 10.7860/jcdr/2013/5937.3521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 08/08/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED Periodontal infections can act as focus of infection, aggravating the immunocompromised state of End Stage Renal Disease patients (ESRD). AIM Evaluation of the periodontal health status of ESRD patients undergoing haemodialysis and establishing the underlying association between renal failure and periodontal disease. MATERIAL AND METHODS Eighty control and test subjects were included in the study, after matching age and sex. Creatinine and GFR were measured in each patient. Oral hygiene index- Simplified (OHI-S), Gingival Index (GI), Pocket Depth (PD) and Clinical Attachment Level (CAL) were recorded as periodontal parameters to assess the correlation between the subjects of the two groups. Further, the test group was divided into three sub-groups, on basis of duration, as less than 6 months, from 6 months to one year and more than one year. STATISTICAL ANALYSIS Student's t - test and ANOVA were used to analyze the inter-group and intragroup comparisons. RESULTS Statistical significant difference was observed for all periodontal parameters between the test and control group. However, difference amongst periodontal parameters on basis of duration of haemodialysis was seen between the subgroups of test subjects, it was not found to be statistically significant. CONCLUSION Severity of periodontal diseases in ESRD patients undergoing haemodialysis majorly affected due to debilitating condition of the subjects. Dialysis vintage has only a small role to play in worsening of the condition. Further research is needed to potentiate the establishment of two-way relationship between renal disease and periodontal condition.
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Tiwari V, Saxena V, Bhambhal A, Tiwari U, Singh A, Goud S. THE ORAL HEALTH STATUS OF PATIENTS WITH RENAL DISEASE IN CENTRAL INDIA: A PRELIMINARY STUDY. J Ren Care 2013; 39:208-13. [DOI: 10.1111/j.1755-6686.2013.12040.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vidhatri Tiwari
- Department of Public Health Dentistry; R.K.D.F. Dental College and Research Centre; Bhopal Madhya Pradesh India
| | - Vrinda Saxena
- Department of Public Health Dentistry; People's College of Dental Sciences and Research Centre; Bhopal Madhya Pradesh India
| | - Ajay Bhambhal
- Department of Public Health Dentistry; People's College of Dental Sciences and Research Centre; Bhopal Madhya Pradesh India
| | - Utkarsh Tiwari
- Department of Pedodontics; People's College of Dental Sciences and Research Centre; Bhopal Madhya Pradesh India
| | - Aishwarya Singh
- Department of Public Health Dentistry; People's College of Dental Sciences and Research Centre; Bhopal Madhya Pradesh India
| | - Siddana Goud
- Department of Public Health Dentistry; R.K.D.F. Dental College and Research Centre; Bhopal Madhya Pradesh India
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Malathi L, Masthan KMK, Balachander N, Babu NA, Rajesh E. Estimation of salivary amylase in diabetic patients and saliva as a diagnostic tool in early diabetic patients. J Clin Diagn Res 2013; 7:2634-6. [PMID: 24392426 DOI: 10.7860/jcdr/2013/7574.3634] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/15/2013] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to estimate the salivary amylase levels in non-insulin dependent diabetes mellitus patients and to correlate these findings with those in normal individuals, in order to provide salivary amylase level as a bio-chemical indicator for diagnosing and monitoring the glucose levels. MATERIAL AND METHODS The study samples consisted of 60 individuals. Both males and females participated in the study. Thirty non-insulin dependent diabetes mellitus patients of age group of 30 to 60 years and healthy individuals of same number and age group were included in this study. The data obtained in this study were statistically analyzed by using Student's t-test. RESULTS In estimation of salivary amylase levels, the comparison of mean and standard deviation showed the highest mean score (2739.48 +1525.20) among the diabetic patients and lowest mean score (1740.38 + 638.51) among the non-diabetic patients. The p-value obtained was less than 0.01. Hence, a highly significant difference in the mean scores regarding salivary amylase (u/l) was found among the two groups. CONCLUSION The mean scores of age, fasting blood sugar, post prandial blood sugar, HbA1c and salivary amylase levels were greater in diabetic patients than in non-diabetic patients.
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Affiliation(s)
- L Malathi
- Senior Lecturer, Department of Oral Pathology and Microbiology, Sree Balaji Dental College & Hospital , BharathUniversity, Chennai, India
| | - K M K Masthan
- Professor and Head, Department of Oral Pathology and Microbiology, Sree Balaji Dental College & Hospital , Bharath University, Chennai, India
| | - N Balachander
- Associate Professor, Department of Oral Pathology and Microbiology, Sree Balaji Dental College & Hospital , Bharath University, Chennai, India
| | - N Aravindha Babu
- Professor, Department of Oral Pathology and Microbiology, Sree Balaji Dental College & Hospital , Bharath University, Chennai, India
| | - E Rajesh
- Senior Lecturer, Department of Oral Pathology and Microbiology, Sree Balaji Dental College & Hospital , Bharath University, Chennai, India
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Bossola M, Di Stasio E, Giungi S, Vulpio C, Papa V, Rosa F, Tortorelli A, Tazza L. Xerostomia is Associated With Old Age and Poor Appetite in Patients on Chronic Hemodialysis. J Ren Nutr 2013; 23:432-7. [DOI: 10.1053/j.jrn.2013.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/11/2022] Open
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Ruospo M, Palmer SC, Craig JC, Gentile G, Johnson DW, Ford PJ, Tonelli M, Petruzzi M, De Benedittis M, Strippoli GFM. Prevalence and severity of oral disease in adults with chronic kidney disease: a systematic review of observational studies. Nephrol Dial Transplant 2013; 29:364-75. [PMID: 24081863 DOI: 10.1093/ndt/gft401] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oral disease may be increased in people with chronic kidney disease (CKD) and, due to associations with inflammation and malnutrition, represents a potential modifiable risk factor for cardiovascular disease and mortality. We summarized the prevalence of oral disease in adults with CKD and explored any association between oral disease and mortality. METHODS We used systematic review of observational studies evaluating oral health in adults with CKD identified in MEDLINE (through September 2012) without language restriction. We summarized prevalence and associations with all-cause and cardiovascular mortality using random-effects meta-analysis. We explored for sources of heterogeneity between studies using meta-regression. RESULTS Eighty-eight studies in 125 populations comprising 11 340 adults were eligible. Edentulism affected one in five adults with CKD Stage 5D (dialysis) {20.6% [95% confidence interval (CI), 16.4-25.6]}. Periodontitis was more common in CKD Stage 5D [56.8% (CI, 39.3-72.8)] than less severe CKD [31.6% (CI, 19.0-47.6)], although data linking periodontitis with premature death were scant. One-quarter of patients with CKD Stage 5D reported never brushing their teeth [25.6% (CI, 10.2-51.1)] and a minority used dental floss [11.4% (CI, 6.2-19.8)]; oral pain was reported by one-sixth [18.7% (CI, 8.8-35.4)], while half of patients experienced a dry mouth [48.4% (CI, 37.5-59.5)]. Data for kidney transplant recipients and CKD Stages 1-5 were limited. CONCLUSIONS Oral disease is common in adults with CKD, potentially reflects low use of preventative dental services, and may be an important determinant of health in this clinical setting.
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Swapna LA, Reddy RS, Ramesh T, Reddy RL, Vijayalaxmi N, Karmakar P, Pradeep K. Oral health status in haemodialysis patients. J Clin Diagn Res 2013; 7:2047-50. [PMID: 24179940 DOI: 10.7860/jcdr/2013/5813.3402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/13/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the oral and dental manifestations in non- diabetic and diabetic uraemic patients who were undergoing haemodialysis and to estimate and compare the salivary pH in these two groups. MATERIAL AND METHODS Ninety Seven uraemic patients who were undergoing maintenance haemodialysis were included in the study. Subjective and objective findings were evaluated and recorded in a specially designed proforma. Predialytic unstimulated whole salivary pH was recorded by using pH-measuring strips. Dental health assessment consisted of DMFT and CPITN indices. RESULTS A subjective oral manifestation of dysguesia was found to be more significant in non-diabetic patients (p<0.008). Statistically, a high significance was observed with mucosal petechiae in 31.9% patients of diabetic group .The overall DMFT score was significantly higher in diabetic group. A moderate significance was found with a CPI score of 5 (p<0.015). The pH of saliva was significantly higher among diabetic patients. CONCLUSION The diabetic subjects who were on haemodialysis were at a high risk for developing periodontal disease and they exhibited a potential threat for dental decay and xerostomia. A lower salivary pH and a poor glycaemic control may affect their oral health. Further research is required to clarify the combined influence of diabetic nephropathy on oral health.
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Affiliation(s)
- Lingam Amara Swapna
- Assistant Professor, Sri Sai College of Dental Surgery , Vikarabad, Andhra Pradesh, India
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Ariyamuthu VK, Nolph KD, Ringdahl BE. Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review. Cardiorenal Med 2013; 3:71-78. [PMID: 23802000 DOI: 10.1159/000350046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.: Circulation 2012;125:2520-2544] claims that, even though evidence exists to believe that periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction, there is little evidence that those interventions prevent atherosclerotic vascular disease or modify the outcomes. In this review, we discuss the periodontal findings and their association with an increased prevalence of inflammatory markers and cardiovascular mortality in ESRD patients and CKD.
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Bhattacharyya I, Kramer JM. Clinical pathologic conference case 5: Unusual severe glossitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e46-9. [PMID: 23738346 DOI: 10.1016/j.oooo.2013.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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NEGRATO CA, TARZIA O, JOVANOVIČ L, CHINELLATO LEM. Periodontal disease and diabetes mellitus. J Appl Oral Sci 2013; 21:1-12. [PMID: 23559105 PMCID: PMC3881811 DOI: 10.1590/1678-7757201302106] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 09/05/2012] [Accepted: 12/11/2012] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Periodontal disease (PD) is one of the most commonly known human chronic disorders. The relationship between PD and several systemic diseases such as diabetes mellitus (DM) has been increasingly recognized over the past decades. OBJECTIVE The purpose of this review is to provide the reader with knowledge concerning the relationship between PD and DM. Many articles have been published in the English and Portuguese literature over the last 50 years examining the relationship between these two chronic diseases. Data interpretation is often confounded by varying definitions of DM, PD and different clinical criteria were applied to determine the prevalence, extent and severity of PD, levels of glycemic control and diabetes-related complications. METHODS This paper provides a broad overview of the predominant findings from research conducted using the BBO (Bibliografia Brasileira de Odontologia), MEDLINE, LILACS and PubMed for Controlled Trials databases, in English and Portuguese languages published from 1960 to October 2012. Primary research reports on investigations of relationships between DM/DM control, PD/periodontal treatment and PD/DM/diabetes-related complications identified relevant papers and meta-analyses published in this period. RESULTS This paper describes the relationship between PD and DM and answers the following questions: 1- The effect of DM on PD, 2- The effects of glycemic control on PD and 3- The effects of PD on glycemic control and on diabetes-related complications. CONCLUSIONS The scientific evidence reviewed supports diabetes having an adverse effect on periodontal health and PD having an adverse effect on glycemic control and on diabetes-related complications. Further research is needed to clarify these relationships and larger, prospective, controlled trials with ethnically diverse populations are warranted to establish that treating PD can positively influence glycemic control and possibly reduce the burden of diabetes-related complications.
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Affiliation(s)
- Carlos Antonio NEGRATO
- PhD in Medical Sciences, Research Support Center, Diabetics Association
of Bauru, São Paulo, Brazil
| | - Olinda TARZIA
- PhD in Oral Biochemistry, Bauru School of Dentistry, University of São
Paulo, Bauru, SP, Brazil
| | - Lois JOVANOVIČ
- MD, CEO & Chief Scientific Officer - Sansum Diabetes Research
Institute, Santa Barbara, USA
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Murali P, Narasimhan M, Periasamy S, Harikrishnan TC. A comparison of oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis. J Oral Maxillofac Pathol 2012; 16:374-9. [PMID: 23248470 PMCID: PMC3519213 DOI: 10.4103/0973-029x.102490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the oral and dental findings of uremic patients receiving hemodialysis and to compare the Results between diabetic and non-diabetic groups. MATERIALS AND METHODS A total of 100 patients undergoing hemodialysis were classified into diabetic and non-diabetic groups and examined for uremic oral manifestations, dental caries (DMFT), and periodontal status (CPITN). Mann-Whitney test of significance has been applied for analyzing DMFT score and chi-square test is used for analyzing CPITN score. RESULTS Of the study group, 46% were diabetic and only 11% of them did not have any oral manifestation. Oral manifestations observed were xerostomia and uremic odor, which contributed to 47 (23%) and 37 (17%), respectively. Hyperpigmentation was present in 26 (12%), macroglossia in 23 (11%), and uremic tongue coating in 24 (11%). Mucosal petechiae were seen in 17 patients contributing to 8% of total patients. Eleven patients had tongue pallor (5%), 9 patients had glossitis with depapillation (4%), and 7 patients had dysgeusia (3%). Angular cheilitis and gingival swelling were seen in 5 patients (2%). CONCLUSION The oral and dental manifestations were higher in prevalence in the study group. However, there was no significant difference between the two groups.
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Affiliation(s)
- Preethi Murali
- Department of Oral Pathology, Meenakshi Ammal dental college, Alappakam, Chennai, India
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Abstract
The aim of the study was to assess the periodontal status of patients among group of patients receiving hemodialysis in two super specialty renal institutes in the state of Gujarat. A cross-sectional study of 304 subjects, 152 subjects each in dialysis, and control group was conducted. Oral hygiene status was assessed using a Simplified Oral Hygiene Index, and periodontal status was assessed using the Community Periodontal Index (CPI) and Loss of Attachment (LOA) as per WHO methodology 1997. The dialysis group had poor oral hygiene than the control group (P<0.001). There was high severity of periodontitis in the dialysis group as compared with the control group (P<0.001). None of the subjects had healthy periodontium. There was high severity of periodontitis (for both in terms of CPI and LOA) in the dialysis group as compared with control group that was found to be statistically highly significant (P<0.001). However, no statistically significant difference was observed (P>0.05) when the intergroup comparison for CPI and LOA were made among the subgroups according to the duration of dialysis. Periodontal disease is prevalent in chronic renal failure patients who showed the unacceptable level of oral hygiene and hence there is need for oral health promotion and preventive programs among the patients receiving dialysis.
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Affiliation(s)
- S. M. Parkar
- Department of Public Health Dentistry, Ahmedabad Dental College and Hospital, Gandhinagar, Gujarat, India
- Address for correspondence: Dr. Parkar Sujal M, B-25 Krishna Bunglows, Gandhinagar Highway, Motera, Ahmedabad- 380 005, Gujarat, India. E-mail:
| | - C. G. Ajithkrishnan
- Department of Public Health Dentistry, K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India
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Bhatsange A, Patil SR. Assessment of periodontal health status in patients undergoing renal dialysis: A descriptive, cross-sectional study. J Indian Soc Periodontol 2012; 16:37-42. [PMID: 22628961 PMCID: PMC3357032 DOI: 10.4103/0972-124x.94602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 11/19/2011] [Indexed: 11/25/2022] Open
Abstract
Objective: An inter-relationship between periodontal disease and systemic health has been suspected for centuries, but evidence to explain the connection has only been elucidated in the past few decades. Among the systemic diseases, end stage renal disease has been shown to affect not only the general health of the patient but also oral and periodontal health. This study was undertaken to gain an insight into whether duration of dialysis therapy influences the oral and periodontal health of these patients and also to see if these parameters reflect their biochemical values. Materials and Methods: The study was conducted on 75 patients undergoing dialysis and a control group of 25 subjects. The study group was divided into three subgroups depending upon the duration of dialysis. Oral hygiene and periodontal disease status were measured by Simplified Oral Hygiene Index by Greene and Vermillion and Periodontal Disease Index by Ram-fjord. Biochemical parameters measured were blood urea nitrogen and salivary urea levels. Comparison of these parameters was made between the study and control groups through analysis of variance (ANOVA) and student's t-test. Results: Prevalence of periodontal disease was evident in the dialysis group. Oral hygiene status was poor in comparison with the control group. Clinical and biochemical parameters showed statistically significant difference between the groups rather than within the groups. Conclusion: Oral and periodontal health appeared to be compromised. Their deteriorating general health is anticipated to cause negligence towards oral health care. This population needs comprehensive oral and periodontal care right from the diagnosis of chronic renal failure. There exists a need for communication between nephrologists and oral health care professionals. Longitudinal studies warranted in this regard.
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Affiliation(s)
- Anuradha Bhatsange
- Department of Periodontics, JMF'S ACPM Dental Collage and Hospital, Sakri Road, Dhule, Maharastra, India
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Teratani G, Awano S, Soh I, Yoshida A, Kinoshita N, Hamasaki T, Takata Y, Sonoki K, Nakamura H, Ansai T. Oral health in patients on haemodialysis for diabetic nephropathy and chronic glomerulonephritis. Clin Oral Investig 2012; 17:483-9. [PMID: 22552594 DOI: 10.1007/s00784-012-0741-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/16/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to clarify differences in oral health status between patients who needed haemodialysis (HD) owing to diabetic nephropathy (DN) and chronic glomerulonephritis (CGN). MATERIALS AND METHODS Ninety-eight HD patients who were 50-70 years old were selected as the study subjects [DN group (29 subjects) and CGN group (69 subjects)] to compare with 106 control subjects (control group) not undergoing HD. All HD subjects underwent oral- and systemic-related examination just before HD therapy. RESULTS The mean number of teeth present in the DN group was significantly less than in the CGN and control groups. The mean percentage of sites with bleeding on probing in the DN group was greater than in the CGN and control groups. The mean salivary flow rate in the DN and CGN groups was significantly lower compared with the control group. CONCLUSION The patients undergoing HD for DN were found to have fewer teeth and worse periodontal health compared with those undergoing HD for CGN and with the control subjects not undergoing HD. Furthermore, the dental and periodontal health of the patients undergoing HD for CGN was comparable to that of the controls. CLINICAL RELEVANCE For effective measures of prevention and improvement of oral health in HD patients, clinicians should be aware of the differences in the characteristics of the oral health between patients undergoing HD for DN and CGN.
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Affiliation(s)
- Gou Teratani
- Division of Community Oral Health Science, Department of Health Promotion, School of Dentistry, Kyushu Dental College, 2-6-1 Manazuru, Kokurakita-ku, Kitakyushu 803-8580, Japan
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Messier MD, Emde K, Stern L, Radhakrishnan J, Vernocchi L, Cheng B, Angelopoulos C, Papapanou PN. Radiographic periodontal bone loss in chronic kidney disease. J Periodontol 2011; 83:602-11. [PMID: 22060047 DOI: 10.1902/jop.2011.110306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We examined the extent and severity of radiographic periodontal bone loss in patients with different stages of chronic kidney disease (CKD) and explored a potential dose-response relationship between bone loss and CKD-related biomarkers. METHODS Panoramic radiographs were obtained from 129 CKD patients (78 males and 51 females; mean age: 63.5 years, range: 24 to 91 years), including 63 patients undergoing dialysis for an average of 3.3 years (range: 0.5 to 14 years). Glomerular filtration rate (GFR), dialysis dose, and levels of serum biomarkers were obtained through a hospital database. Interproximal bone loss was assessed as a percentage of root length. RESULTS Twenty-nine participants were edentulous (23.8% of those on dialysis versus 21.2% of those with residual kidney function; χ(2) test, P = 0.724). The extent of bone loss was higher among dialysis patients (analysis of variance [ANOVA], P = 0.007), but no clear dose-response association between CKD stage and extent was evident. GFR, dialysis dose, and levels of serum biomarkers did not differ between edentulous and dentate individuals, and only serum albumin was lower in patients with extensive bone loss (ANOVA, P = 0.030). After adjusting for dialysis status, the severity of bone loss was positively associated with glucose levels (multiple regression, P = 0.019) and white blood cell count (P = 0.032), whereas the number of teeth present was positively associated with plasma phosphorus (P = 0.008) and negatively with glucose levels (P = 0.011). CONCLUSION Despite a higher extent of bone loss in dialysis patients, the lack of a dose-response association between bone loss and CKD stage or the levels of CKD-related serum biomarkers underscores the complex relationship between the two conditions.
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Malekmakan L, Haghpanah S, Pakfetrat M, Ebrahimic Z, Hasanlic E. Oral health status in Iranian hemodialysis patients. Indian J Nephrol 2011; 21:235-8. [PMID: 22022082 PMCID: PMC3193665 DOI: 10.4103/0971-4065.82634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Due to increased survival among hemodialysis (HD) patients, new problems including concerns of oral health have appeared. In this study, we aimed to evaluate the oral health status and related risk factors in Iranian HD patients. Demographic information, medical history, laboratory findings, and dental health status were gathered. The decayed, missing and filled teeth (DMFT) index in accordance with the World Health Organization (WHO) criteria was obtained. Kt/V was calculated for patients. A P-value of <0.05 was considered statistically significant. Seventy-two patients were evaluated, with a mean age and HD time of 53.4±15.3 years and 36.9±33.8 months, respectively. Thirty-five (48.6%) complained of dry mouth, 33 (49.3%) of taste change, 22 (31%) of malodor mouth, and 30 (46.9%) had dental calculus. The overall mean DMFT score was 18.6±9.9. DMFT score had a negative significant correlation with Kt/V (r=–0.4, P=0.004). Women and singles as well as patients with a low educational level and/or lesser dialysis time had a significantly higher DMFT score (P<0.05). Kt/V was significantly lower in patients suffering from dry mouth and dental calculus (P<0.05). Interestingly DMFT score was significantly lower in patients with dental calculus compared to patients without it (P=0.001). It seems that our patients have a poor dental hygiene level and high DMFT score especially women, singles, patients with low Kt/V and a low education level. The oral health maintenance program for a patient receiving dialysis should be reinforced in our centers.
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Affiliation(s)
- L Malekmakan
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Eltas A, Tozoğlu U, Keleş M, Canakci V. Assessment of oral health in peritoneal dialysis patients with and without diabetes mellitus. Perit Dial Int 2011; 32:81-5. [PMID: 21632442 DOI: 10.3747/pdi.2010.00113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The incidence of chronic renal failure continues to rise worldwide, and although the oral and dental changes in individuals with this condition have been examined, investigations with diabetic peritoneal dialysis (PD) patients are limited. We therefore examined salivary pH, dry mouth, taste change, and mucosal ulceration in diabetic and nondiabetic uremic patients receiving PD. A total of 49 patients undergoing PD therapy were allocated to either the diabetic or the nondiabetic group. Salivary pH, dry mouth, taste change, and mucosal ulceration were determined for both groups. Salivary flow rate and pH were both lower in the diabetic group. Buffer capacity, dry mouth, taste change, and mucosal ulceration were all increased in that group. These findings were associated with level of glycosylated hemoglobin A1c. Our observations indicate that, compared with nondiabetic PD patients, patients with diabetes exhibit more severe oral uremic symptoms, including dry mouth, burning mouth syndrome, taste change, and mucosal ulcerations. The oral health in these patients should be followed.
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Affiliation(s)
- Abubekir Eltas
- Department of Periodontology, Inonu University, Malatya, Turkey.
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Effect of 16% carbamide peroxide bleaching gel on enamel and dentin surface micromorphology and roughness of uremic patients: an atomic force microscopic study. Eur J Dent 2010; 4:175-82. [PMID: 20396450 PMCID: PMC2853833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To investigate the effect of 16% carbamide peroxide bleaching gel on surface micromorphology and roughness of enamel and root dentin of uremic patients receiving hemodialysis using atomic force microscopy (AFM). Methods: A total of 20 sound molars were collected from healthy individuals (n=10) and uremic patients (n=10). The roots were separated from their crowns at the cemento-enamel junction. Dental slabs (3 mm x 2 mm x 2 mm) were obtained from the buccal surface for enamel slabs and the cervical third of the root surface for dentin slabs. Dental slabs were then flattened and serially polished up to #2500-grit roughness using silicon carbide abrasive papers. Half of the slabs obtained from healthy individuals and uremic patients were stored in artificial saliva and left without bleaching for control and comparison. The remaining half was subjected to a bleaching treatment using 16% carbamide peroxide gel (Polanight, SDI Limited) 8 h/day for 14 days and stored in artificial saliva until AFM analysis was performed. Statistical analysis of the roughness average (Ra) results was performed using one-way ANOVA and Bonferroni post hoc multiple comparisons test. Results: The micromorphological observation of bleached, healthy enamel showed exaggerated prism irregularities more than non-bleached specimens, and this observation was less pronounced in bleached uremic enamel specimens with the lowest Ra. Bleached healthy dentin specimens showed protruded peritubular dentin and eroded intertubular dentin with the highest Ra compared to bleached uremic dentin. Conclusions: The negative effects of the bleaching gel on uremic tooth substrates are less dramatic and non-destructive compared to healthy substrates because uremia confers different micromorphological surface changes.
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