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

The Oral Health Condition of Patients on Hemodialysis at a Tertiary Healthcare Facility in Eastern Nepal

Objectives

This study was done to compare the oral health of chronic kidney disease (CKD) patients on hemodialysis to healthy individuals and to assess the effect of the duration of dialysis on oral health.

Materials and Methods

A comparative cross-sectional study was conducted among purposively selected 54 cases undergoing dialysis and 54 apparently healthy controls. Caries experience and periodontal status were recorded under similar examination conditions and compared between cases and controls. The correlation between oral health and the duration of dialysis was assessed. A p value of <0.05 was considered significant.

Results

The mean age of the participants was 47.09 ± 12.23 years. Median caries experience among cases and controls was two (0-26) and three (0-15), respectively (p=0.013). Periodontitis among the two groups was found to be significantly different with a greater number of cases showing increased severity (p  < 0.001). The severe form of periodontitis was associated with a greater mean duration of dialysis.

Conclusion

Significant differences exist between the periodontal health of patients undergoing dialysis compared to healthy controls. Longitudinal studies are required to check the causal effect of CKD on periodontitis.

Oral health challenges in patients with chronic kidney disease: A comprehensive clinical assessment

Loss of kidney function causes oral manifestations and multiple complications that have implications for dental treatment and patients' systemic conditions. We aimed to determine the clinical condition, epidemiological profile, and incidence of dental caries in patients with chronic kidney disease (CKD). This was an observational, cross-sectional, field study using a quantitative and epidemiological approach. The sample consisted of 45 randomly selected patients with CKD from a total of 114 patients. Data were collected through oral clinical examination, anamnesis, and medical records compiled in a clinical file specially developed for this research. Clinical evaluation was performed, including a Decayed, Missing, and Filled Teeth (DMFT) index examination. Data were analyzed using the Shapiro-Wilk test, Mann-Whitney test, and Spearman's rho coefficient. All analyses were performed using IBM SPSS Statistics software version 20.0, with a confidence interval of 95 % and significance level of 5 % (p < 0.05). The results indicated that CKD is more prevalent in the 5th decade of life, with a slight predilection for men. Oral cavity alterations were observed in 77.8 % of patients. The study population had a very high DMFT index, with a high number of missing teeth and a low number of decayed and filled teeth. Poor oral health in patients with CKD indicates a lack of care that supports the necessity of installing a preventive and therapeutic oral program and a regular follow-up aimed at this group of patients.

Assessment of the oral health status of children with chronic kidney disease

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.

Oral health-related quality of life in chronic kidney disease patients

BACKGROUND

Chronic kidney disease (CKD) is a systemic disease with a major burden on several life aspects, including oral health. As life expectancy has improved in CKD patients, oral health status has become important regarding their quality of life. The aim of this study was to investigate oral health and oral health-related quality of life (OHRQoL) in CKD patients.

MATERIALS AND METHODS

This was a cross-sectional study. Patients' age, gender, and estimated glomerular filtration rate (eGFR) stage were recorded. Oral Health Impact Profile-14 (OHIP-14) was used to evaluate OHRQoL. Decayed, missing, and filled teeth (DMFT) index was utilized to record oral health status. SPSS software was used to analyze data. One-way ANOVA, t-test and Pearson/Spearman correlations were used. P < 0.05 was considered statistically significant.

RESULTS

One hundred and four patients participated; 60.6% male versus 39.4% female. Mean age was 52.1 ± 18.1 years. The most frequent eGFR stage was 5 (41.2%). Mean DMFT score was 18.7 ± 8.5. Mean OHIP-14 score was 14.82 ± 5.86. DMFT score was significantly correlated with OHIP-14 total score as well as its physical domains (P < 0.05). The correlation between eGFR stage and OHIP-14/DMFT score was both statistically significant (P = 0.03/P = 0.02, respectively).

CONCLUSION

DMFT score was significantly correlated with OHRQoL in CKD patients, especially regarding its physical domains. Paying attention to fulfill dental treatment needs seems mandatory to improve OHRQoL and overall quality of life in these patients.

Severity of Periodontal Disease in Chronic Kidney Disease Patients: A Hospital-Based Study

Background

Periodontal disease is a chronic inflammatory condition of multifactorial origin. The inflammatory mediators released during the progression of disease may affect all the organs of the body. Renal disease is a chronic systemic disease which may influence the progression of periodontal disease. Therefore, this study was conducted to evaluate and compare the prevalence of periodontal disease among individuals with chronic kidney disease undergoing maintenance hemodialysis with healthy individuals.

Methodology

In this cross-sectional study including 150 participants, 75 patients with different renal diseases undergoing hemodialysis (Group I) and 75 healthy controls (Group II) were included. The general examination of the patients was done. Blood pressure, pulse, and body mass index were recorded, followed by biochemical investigations, in which serum urea, serum creatinine, and random blood sugar were evaluated for each participant. Plaque Index (PI) and Gingival Index (GI) scores were recorded. Probing pocket depth (PPD) and gingival recession GR were measured, and clinical attachment level (CAL) was calculated based on the obtained values. The subjects were then categorized into three groups, namely, no/mild, moderate, and severe periodontitis.

Results

Out of the total study participants, 68% were men and 32% were women, with a mean age of 47 years. Serum markers were significantly elevated in Group I compared to Group II. Poor oral hygiene and periodontitis were observed to be much higher in dialysis patients compared to the control group. The two groups also significantly differed in PI, GI, PPD, GR, and CAL, all of which were higher in Group I.

Conclusions

The results suggest that patients with renal disease must be screened for periodontal disease.

Associations between dental caries and systemic diseases: a scoping review

BACKGROUND

The objective of this study was to evaluate and present evidence from animal and human clinical studies on associations between dental caries and systemic diseases, and to suggest potential mechanisms that might explain such associations.

METHODS

An electronic search was conducted of PubMed, Embase and Cochrane Central Register of Controlled Trials for articles published from 2010 to 2020 in the English language. From the initial search, 404 full-text studies were assessed for eligibility. After excluding studies for technical and study limitations, a total of 67 studies were included in the summary tables and additional studies were included in the review to support evidence.

RESULTS

Few systemic disease and conditions were found to be clinically meaningfully associated with caries experience. Best evidence from human and animal studies described association between metabolic diseases and dental caries. Several interesting animal studies were noted that could generate clinical hypotheses and further investigations in rodent models for cardiovascular injury and hyperglycemia. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CONCLUSIONS

Limited clinical evidence was found connecting several systemic diseases and dental caries. Inadequate data was found to suggest any modifications to current clinical practice or prevention guidelines.

CLINICAL SIGNIFICANCE

Understanding of associations between dental caries and systemic diseases play a crucial role in the treatment planning and education of the dental patient.