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Olander AE, Helenius-Hietala J, Nordin A, Savikko J, Ruokonen H, Åberg F. Association Between Pre-Transplant Oral Health and Post-Liver Transplant Complications. Transpl Int 2023; 36:11534. [PMID: 37767526 PMCID: PMC10520246 DOI: 10.3389/ti.2023.11534] [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: 05/02/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Oral disease is linked with systemic inflammation and various systemic conditions, including chronic liver disease. Liver transplantation (LT) candidates often need dental infection focus eradication, and after LT, there is high risk of many inflammation-related complications. We studied whether pre-LT dental status is associated with the occurrence of post-LT complications. This study included 225 adult LT recipients whose teeth were examined and treated before LT, and 40 adult LT recipients who did not have pre-LT dental data available. Data on post-LT complications were collected from the national liver transplant registry and followed up until the end of July 2020. Worse pre-LT dental status was associated with a higher risk of acute rejection post-LT compared to patients with good dental status. Worse dental status was also associated with higher 1-year-post-LT ALT levels and lower albumin levels. In conclusion, poor pre-LT oral health seems to associate with an increased risk of post-LT acute rejection and with elevated ALT levels and decreased albumin levels, suggesting an effect on post-LT liver health. Therefore, prevention and treatment of oral and dental diseases should be promoted early in the course of liver disease.
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Affiliation(s)
- Annika Emilia Olander
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jaana Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Savikko
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hellevi Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Fredrik Åberg
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Assessment of the oral health status of children with chronic kidney disease. Pediatr Nephrol 2023; 38:269-277. [PMID: 35499576 DOI: 10.1007/s00467-022-05590-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are various oral symptoms related to the disease and its management in individuals with chronic kidney disease (CKD). The aim of the study was to investigate the oral health status of children with different stages of CKD, kidney transplant recipients (KTR), and healthy children. METHODS A total of seventy-one children diagnosed with CKD and fifty-two healthy children were included in the study. Each patient was examined for dental caries by the decayed-missing-filled-teeth (DMFT/dmft) index and the International Caries Detection and Assessment System (ICDAS-II), developmental defects of enamel (DDE) by the DDE index, and oral hygiene by the debris (DI), calculus (CI), and simplified oral hygiene (OHI-S) indices. RESULTS The median number of DMFT/dmft was 1.00 (interquartile range (IQR):1.00-4.00) in children with stage 1-3 CKD, 0.00 (IQR: 0.00-2.50) in stage 4-5 children, 0.00 (IQR: 1.00-3.00) in KTR, and 8.00 (IQR: 1.00-13.00) in healthy children. According to ICDAS-II categories, the percentage of children with severe caries was 53.8% in healthy children, while it was 44.4% in KTR, 25.9% in stage 1-3, and 11.4% in stage 4-5 children. While the percentage of children with DDE was 88.8% in KTR, 80% in stage 4-5, and 66.7% in stage 1-3 children, this rate was 44.2% in healthy children. The highest mean OHI-S score was observed in stage 4-5 children (2.10 ± 1.08), followed by KTR (1.46 ± 1.19), stage 1-3 (1.27 ± 0.61), and healthy children (0.45 ± 0.44), respectively. CONCLUSIONS Compared to healthy children, children with CKD had more debris accumulation, calculus formation, and more DDE but a lower severity of dental caries. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Evaluation of the correlation between oral infections and systemic complications in kidney transplant patients: a retrospective pilot study. BMC Oral Health 2022; 22:530. [PMID: 36424574 PMCID: PMC9685840 DOI: 10.1186/s12903-022-02590-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Data regarding the efficacy of the dental clearance required prior to kidney transplantation (KT) for preventing post-transplant complications is controversial. The aim of this retrospective study was to investigate a possible correlation between any untreated oral infectious foci and the onset of systemic complications in KT patients. METHODS Patients scheduled for regular check-ups during the post-transplant period were visited at the C.I.R. Dental School in Turin, Italy. Patients were asked to bring orthopantomography (OPT) acquired prior to transplantation to compare the possible presence of untreated infectious foci at the time of transplantation with the time of their post-transplant visit. Patients were then divided, according to the evaluation of the OPT obtained prior to the transplantation, into two groups according to their dental status prior to the transplant. "Group Infected" was comprised of patients with no dental clearance, and "Group Clear" included patients with dental clearance. The medical records were then retrospectively reviewed for the evaluation of any systemic complications that occurred after transplantation. The following medical complications were considered: fever, pneumonia, urinary tract infections, systemic infections, kidney rejection, and death. Complications were divided in two groups: early complications, which occurred within 100 days of transplantation, and late complications, which occurred more than 100 days after transplantation. RESULTS A total of 77 patients were enrolled in the study. Group Infected was composed of 19 subjects (25%), while Group Clear was composed of 58 patients (75%). In Group Infected, 13 (68%) patients developed complications within 100 days of transplantation, and 11 (58%) did so after 100 days. In Group Clear, 31 (53%) patients had complications within 100 days of the transplant, and 23 (40%) did after 100 days. Patients in Group Infected had a statistically significant increase in episodes of fever (p = 0.03), compared to Group Clear, with a higher relative risk (RR) of 3.66 in the first 100 days after transplantation. CONCLUSION Within the limitations of the present retrospective pilot study, and based on the results, a correlation between the absence of dental clearance prior to KT and a higher RR of developing a fever within the first 100 days post transplantation was highlighted. The present results encourage doctors to continue research on the topic, which remains controversial. Further prospective studies are required to confirm the results of the present study.
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Tuma M, Silva Andrade N, Correia Aires R, Cristelli MP, Medina Pestana JO, Gallottini M. Oral findings in kidney transplant children and adolescents. Int J Paediatr Dent 2022; 32:894-902. [PMID: 35316550 DOI: 10.1111/ipd.12965] [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: 03/05/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them. AIM To describe the oral conditions of post-renal transplant children and adolescents. DESIGN Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions. RESULTS A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug-induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience. CONCLUSION Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus.
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Affiliation(s)
- Marina Tuma
- DDS at the Special Care Dentistry Centre, School of Dentistry of the University of São Paulo, São Paulo (SP), Brazil
| | | | - Rosana Correia Aires
- DDS at the Special Care Dentistry Centre, School of Dentistry of the University of São Paulo, São Paulo (SP), Brazil
| | | | | | - Marina Gallottini
- DMD, PhD at the Special Care Dentistry Centre of the University of São Paulo, São Paulo (SP), Brazil
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Moest T, Lutz R, Jahn AE, Heller K, Schiffer M, Adler W, Deschner J, Weber M, Kesting MR. Frequency of the necessity of dentoalveolar surgery or conservative treatment in patients before kidney transplantation depending on the duration of dialysis and causative nephrological disease. Clin Oral Investig 2021; 26:2383-2390. [PMID: 34623508 PMCID: PMC8898213 DOI: 10.1007/s00784-021-04202-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This retrospective study evaluates intraoral surgical and conservative treatment need in patients with a chronic kidney end-stage disease, depending on the duration of dialysis treatment and the causative nephrological disease. MATERIAL AND METHODS This study is based on data of patients referred to the Department of Oral and Maxillofacial Surgery of the University Hospital Erlangen, Germany, prior to kidney transplantation between January 2015 and March 2020. The necessity for oral surgical or dental therapy was determined by clinical and radiological examinations. Data on renal replacement therapy, cause of underlying renal disease, lifestyle, and general health were collected. RESULTS Data of N = 89 patients demonstrated that surgical treatment need depends on dialysis duration (p = 0.042). Patients, who had been dialyzing for 2 to 3 years showed the highest need for surgical intervention (80.0%; p = 0.024), followed by dialysis patients with a dialysis time of more than 3 years (48.1%). Similarly, dialysis patients in the second or third year of dialysis had the highest need for conservative treatment (73.3%; p > 0.05), followed by 55.6% of dialysis patients in the third year of dialysis. CONCLUSIONS Operative and conservative treatment is essential to optimize subsequent kidney transplantation. The greatest necessity could be detected for patients in the second and third years of dialysis. CLINICAL RELEVANCE Oral health addressing surgical and conservative treatment need depends on the duration of dialysis in patients with a chronic kidney end-stage disease.
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Affiliation(s)
- Tobias Moest
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054, Erlangen, Germany.
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054, Erlangen, Germany
| | - Arne Eric Jahn
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054, Erlangen, Germany
| | - Katharina Heller
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen-Nuremberg, Erlangen, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054, Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstraße 11, 91054, Erlangen, Germany
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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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Nomura Y, Ishii Y, Chiba Y, Suzuki S, Suzuki A, Suzuki S, Morita K, Tanabe J, Yamakawa K, Ishiwata Y, Ishikawa M, Sogabe K, Kakuta E, Okada A, Otsuka R, Hanada N. Does Last Year's Cost Predict the Present Cost? An Application of Machine Leaning for the Japanese Area-Basis Public Health Insurance Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020565. [PMID: 33445431 PMCID: PMC7827468 DOI: 10.3390/ijerph18020565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
The increasing healthcare cost imposes a large economic burden for the Japanese government. Predicting the healthcare cost may be a useful tool for policy making. A database of the area-basis public health insurance of one city was analyzed to predict the medical healthcare cost by the dental healthcare cost with a machine learning strategy. The 30,340 subjects who had continued registration of the area-basis public health insurance of Ebina city during April 2017 to September 2018 were analyzed. The sum of the healthcare cost was JPY 13,548,831,930. The per capita healthcare cost was JPY 446,567. The proportion of medical healthcare cost, medication cost, and dental healthcare cost was 78%, 15%, and 7%, respectively. By the results of the neural network model, the medical healthcare cost proportionally depended on the medical healthcare cost of the previous year. The dental healthcare cost of the previous year had a reducing effect on the medical healthcare cost. However, the effect was very small. Oral health may be a risk for chronic diseases. However, when evaluated by the healthcare cost, its effect was very small during the observation period.
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Affiliation(s)
- Yoshiaki Nomura
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
- Correspondence:
| | - Yoshimasa Ishii
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Yota Chiba
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Shunsuke Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Akira Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Senichi Suzuki
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Kenji Morita
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Joji Tanabe
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Koji Yamakawa
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Yasuo Ishiwata
- Ebina Dental Association, Kanagawa 243-0421, Japan; (Y.I.); (Y.C.); (S.S.); (A.S.); (S.S.); (K.M.); (J.T.); (K.Y.); (Y.I.)
| | - Meu Ishikawa
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Kaoru Sogabe
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Erika Kakuta
- Department of Oral Microbiology, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Ayako Okada
- Department of Operative Dentistry, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan;
| | - Ryoko Otsuka
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
| | - Nobuhiro Hanada
- Department of Translational Research, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan; (M.I.); (K.S.); (R.O.); (N.H.)
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