THE ORAL HEALTH STATUS OF PATIENTS WITH RENAL DISEASE IN CENTRAL INDIA: A PRELIMINARY STUDY

Prevalence of Dental Caries in Patients on Renal Replacement Therapy-A Systematic Review

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.

Could drug burden be associated with severe periodontitis in patients receiving haemodialysis?

BACKGROUND

Periodontitis increases the risk of cardiovascular disease in the general population by triggering systemic inflammation.

AIM

To investigate the relationship between systemic inflammation and periodontitis, and clarify any association between severe periodontitis and the medications used by patients receiving haemodialysis.

DESIGN

A cross-sectional study.

PARTICIPANTS

The study was undertaken with 56 patients receiving haemodialysis.

MEASUREMENTS

Demographic and laboratory data and prescribed drugs regularly used by patients were recorded from hospital records. During the dialysis session, a validated Xerostomia Inventory score was completed. A complete dental/periodontal examination was also undertaken on all patients by the same periodontist.

RESULTS

In the study population, stage I periodontitis was determined in 41%, stage II periodontitis in 17%, stage III periodontitis in 21%, and stage IV periodontitis in 21%. Male gender, hypertension, coronary artery disease, β antagonists, calcium channel blockers, sodium polystyrene sulphonate, teeth brushing less than twice a day and high sensitive C-reactive protein > 8 mg/l were significantly associated with severe periodontitis.

CONCLUSION

Drugs, including β antagonists, calcium channel blockers, polystyrene sulphonate, co-morbid conditions and poor or insufficient oral care could facilitate an increase in the severity of periodontitis in patients receiving haemodialysis. Severe periodontitis also seems to be associated with cardiovascular disease and inflammation in patients with chronic renal disease.

Periodontal and chronic kidney disease association: A systematic review and meta-analysis

AIM

Chronic kidney disease (CKD) and kidney failure is increasing globally and evidence from observational studies suggest periodontal disease may contribute to kidney functional decline.

METHODS

Electronic searches of the PubMed, EMBASE, Web of Science, Scopus and Cochrane Library databases were conducted for the purposes of conducting a systematic review. Hand searching of reference lists was also performed. Meta-analysis of observational studies involving periodontal disease and chronic kidney disease in adults was performed.

RESULTS

A total of 17 studies was selected from an initial 4055 abstracts. Pooled estimates indicated the odds of having CKD were 60% higher among patients with periodontitis: pooled OR 1.60 (95% CI 1.44-1.79, I² 35.2%, P = 0.11) compared to those without. Conversely, a similar magnitude but non-significant higher odds of having periodontal disease was found among people with CKD 1.69 (95% CI: 0.84, 3.40, I² = 89.8%, P < 0.00) versus non-CKD. Meta-regression revealed study quality based on the Newcastle-Ottawa Scale and statistical adjustment for potential confounders explained almost 35% of the heterogeneity in the studies investigating the association between CKD and periodontitis.

CONCLUSIONS

Moderate evidence for a positive association between periodontitis and CKD exists. Evidence for the opposite direction is extremely weak based on significant heterogeneity between studies.

Is there association between chronic kidney disease and dental caries? A case-controlled study

Background

The purpose of this study was to assess the association between chronic kidney diseases (CKD) and dental caries.

Material and Methods

107 patients with CKD and 107 with no systemic alteration were randomly included. DMFT (decayed, missing, and filled teeth), plaque index, colony-forming units (CFU) of Streptococcus mutans and salivary composition (IgA total, IgA anti- Streptococcus mutans, calcium and urea) were evaluated. McNemar and Wilcoxon tests were used to compare test and control groups. Spearman test was used to correlate time of hemodialysis and variables studied. Associations between variables were evaluated by logistic regression analysis.

Results

The number of filled teeth, the amount of IgA anti-Streptococcus mutans, salivary urea, education level, monthly income and the amount of CFU of Streptococcus mutans were statistically different between groups. There was a positive correlation between the duration of hemodialysis (Hd) and the amount of IgA anti-Streptococcus mutans, urea in saliva, and the number of CFU of Streptococcus mutans. In the adjusted model, a higher incidence of CFU mutans streptococci, elevated salivary urea, smaller number of filled teeth, lower DMFT, and less calcium salivary were associated with CKD.

Conclusions

Programs to prevent and treat oral problems and regular follow-up at the beginning of dialysis are necessary to increase patients’ awareness of their condition.

Key words:Renal disease, chronic, dental caries, renal dialysis.

Dental caries and developmental defects of enamel in individuals with chronic kidney disease: Systematic review and meta-analysis

OBJECTIVE

To evaluate studies assessing the prevalence of dental caries and developmental defects of enamel (DDE) in individuals with chronic kidney disease (CKD) in comparison with individuals without CKD.

MATERIALS AND METHODS

Electronic searches were performed in PubMed, Web of Science, Scopus, Medline via Ovid, and ProQuest databases from their inception date until February 2018. Two review authors independently selected the studies, extracted data, and assessed the methodological quality. Meta-analysis was performed.

RESULTS

Twenty-seven studies were included in this study. For permanent teeth, 14 studies found that individuals without CKD had higher dental caries scores than those with CKD. However, only five studies presented results with a statistically significant difference between groups. Among the studies evaluating primary teeth, five showed that individuals without CKD had higher dental caries scores than those with CKD. Five studies showed that individuals with CKD had a significantly higher prevalence of DDE than individuals without CKD. The meta-analyses showed that individuals without CKD had significantly higher scores of dental caries teeth and surfaces than individuals with CKD. For DDE, no statistical difference between groups was observed.

CONCLUSIONS

Individuals with CKD present lower dental caries scores and a higher prevalence of DDE in comparison with individuals without CKD.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Associations between the number of natural teeth and renal dysfunction

The purpose of the present study was to investigate the association between the number of natural teeth and measures of kidney dysfunction, such as urinary albumin/creatinine ratio (ACR) and estimated glomerular filtration (eGFR) rate, using nationally representative data.The data used were from the Korea National Health and Nutrition Examination Survey with cross-sectional design, which was conducted between 2011 and 2012; the sample analyzed in this study consisted of a total of 10,388 respondents, each of whom was 19 years or older and had no missing outcome variables. The association between the number of natural teeth and kidney function was assessed by multiple logistic regression and model was adjusted for age, sex, waist conference, smoking, drinking, exercise, education, income, frequency of tooth brushing per day, diabetes, metabolic syndrome, urinary ACR, and eGFR.The mean age, body mass index, and waist circumference were significantly higher among those with lower kidney function (urinary ACR ≥30 mg/g and eGFR <60 mL/min/1.73m). Urinary ACR and eGFR were associated with loss of natural teeth. As urinary ACR increased, the number of natural teeth decreased accordingly. Conversely, the number of natural teeth increased with an increase in eGFR.This study showed that the number of natural teeth is inversely associated with the presence of kidney disease. Severity of tooth loss may be considered an independent risk indicator for kidney disease among Koreans. More epidemiological studies are warranted to investigate the role of tooth loss in kidney disease, to confirm this relationship and to test possible underlying mechanisms.