Oral health-related quality of life and periodontal and dental health status in Iranian hemodialysis patients

Patient-Reported Outcomes Following Systemic Antibiotic Adjunct to Nonsurgical Treatment of Periodontitis: A Randomized Controlled Clinical Trial

OBJECTIVES

Considering the importance of patient-centered care, we aimed to evaluate the impact of systemic antibiotics on oral health-related quality of life during nonsurgical periodontal treatment. This controlled trial addresses a gap in understanding how systemic antibiotics influence patient-reported outcomes, focusing on Stage III periodontitis.

MATERIALS AND METHODS

Sixty-one adults participated in a double-blind, randomized clinical trial, with participants divided into two groups: the test group, which received antibiotics, and the control group. All the participants received nonsurgical periodontal treatment. We conducted follow-up assessments at one and 3 months posttreatment, including recording clinical parameters and administering the Oral Health Impact Profile-14 (OHIP-14) questionnaire.

RESULTS

The results showed a notable improvement in the quality of life for patients in the test group compared to the control group at 1 month (p value = 0.012) and 3 months (p value = 0.014) after treatment. While there were improvements in pocket probing depth, gingival index, and clinical attachment loss in both groups, it is worth noting that only bleeding on probing exhibited a significant improvement in the test group after 3 months compared to the control group (p value = 0.008).

CONCLUSIONS

In summary, incorporating systemic antibiotics alongside nonsurgical periodontal treatments appears to bring about positive outcomes for individuals dealing with Stage III periodontitis during nonsurgical treatment, ultimately enhancing their oral health-related quality of life.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT Id): IRCT20201221049786N1.

Assessment of periodontal status in patients undergoing renal dialysis - A hospital-based study

Background

The World Health Organization (WHO) recognized chronic kidney disease as the 12th and 17th leading cause of death and disability in the world, respectively. End-stage renal disease (ESRD) patients undergoing dialysis are also often prone to gingival and periodontal tissue inflammation.

Aim

The aim of this study was to assess and compare periodontal status among dialysis patients with age- and gender-matched controls in Hyderabad City, India.

Materials and Methods

Cases (n = 165) included people who had been diagnosed with ESRD, while controls (n = 165) were subjects accompanying cases who were matched for age and gender. The oral hygiene behavior (OHB) was assessed using the OHB Index developed by Buunk et al. Periodontal status was assessed using the Community Periodontal Index modified and loss of attachment (LOA) based on the modified WHO criteria 2013.

Results

Significantly higher means of OHB were seen among cases. Higher means of bleeding, pocket depth (PD), and LOA were seen with increasing age among males, low level of education, and presence of systemic condition among both cases and controls. The mean number of teeth with pocket depth (PD) >4 mm and the mean number of sextants with LOA >3 mm were significantly higher among cases than controls. At the same time, the gingival bleeding was significantly higher among controls. Regression analysis revealed that subjects who underwent dialysis (cases) and the presence of the systemic condition were only the significant predictors for the presence of periodontal disease.

Conclusion

The study concludes that patients undergoing hemodialysis are more prone to periodontal diseases, which are again influenced by systemic conditions.

Comparison of oral health-related quality of life and its association with the periodontal status among the adults: A questionnaire-based study

Background

Oral health-related quality of life (OHRQoL) is used for evaluating needs of people, their health problems, their level of satisfaction, and various effects of any intervention which have been provided for recording of various nonclinical aspects of oral health.

Aim

The objective of the study was to compare OHRQoL and its association with periodontal health among adult population.

Materials and Methods

This prospective and cross-sectional study was conducted on 300 respondents who were diagnosed with periodontitis. 14-item containing Oral Health Impact Profile 14 (OHIP-14) questionnaire was used for study analysis. A single observer made clinical examinations. Mann-Whitney "U" and Kruskal-Wallis statistical tests were used for comparing the OHIP-14 scores. Statistically significance was set at P < 0.05.

Results

Majority of study participants were of female gender (62.0%). A significant association was observed between loss of attachment and OHIP14 scores (P = 0.003).

Conclusion

Poor periodontal health may affect the OHRQoL.

Oral Hygiene practices and Oral Health Related Quality of Life observed in patients reporting to Dental Institution in North India during COVID-19 Pandemic

OBJECTIVE

The purpose of the study was to ascertain Oral Health Related Quality of Life (OHRQOL) and evaluate oralhygiene practices in patients visiting a dental institution during COVID-19 time.

MATERIALS AND METHODS

Face-to face interviews were conducted using a semi-structured close-ended questionnaire,assessing oral hygiene practices and self-reported oral problems perceived in last 6 months, using both Hindi and English version of Oral Health Impact Profile (OHIP-14) Questionnaire. Frequency distribution of oral hygiene practices were obtained, and Descriptive statistics computed the scores of OHIP-14. Kruskal-wallis test and Independent t-test were used to match the association of OHIP-14 with demographic variables. Multiple linear regression analysis was utilized to compute the association of OHIP-14 with independent variables, age and gender.

RESULTS

Subjective evaluation of OHRQOL (Oral Health Related Quality of Life) using OHIP-14 Porforma resulted in high score for physical pain and psychological discomfort but subjects expressed less discomfort in connection to functional limitation, physical disability, psychological discomfort, social disability and handicap domains of OHIP-14. With progressive increase in age OHRQOL worsened. Females had poor OHRQOL, with significant difference as compared to males. Gender and marital status observed variance in OHIP-14 with statistically significant difference (P <0.000).

CONCLUSION

More than two-third subjects preferred cleaning their teeth using toothbrush and toothpaste. Therefore, COVID-19 consequently impacted OHRQOL of the general population.

A comparison of oral health status in diabetic and non-diabetic patients receiving hemodialysis - A systematic review and meta-analysis

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.

Volatile sulphur compounds in people with chronic kidney disease and the impact on quality of life

The objectives are to identify volatile sulphur compounds (VSCs) in individuals with Chronic Kidney Disease (CKD) and to relate quality of life and oral health. A case-control study with 32 individuals with CKD in haemodialysis in the study group (SG) and 32 healthy individuals in the control group (CG) was performed. The VSCs were identified by gas chromatograph before (BC) and after cysteine (AC) mouthwash and an organoleptic test. For oral health assessment, oral health index was used. For quality of life, the Oral Health Impact Profile (OHIP-14) and Medical Outcomes Study 36-Item Short Form Health Survery (SF-36) were used. The hydrogen sulphide AC, methyl mercaptan AC, tongue coating, dry mouth, plaque index, and DMFT were significantly higher in the SG. VSCs did not negatively affected the impact of oral health on the quality of life in the SG but did in the CG. As for the impact of general health on quality of life, methyl mercaptan BC and AC worsened overall health in vitality and mental health, respectively. Individuals with CKD have more halitosis than healthy individuals, and it is more related to methyl mercaptan. The halitosis worsened the general quality of life of individuals with CKD. The diagnosis and identification of the origin of halitosis is important to prevent one more factor that it worsened the global quality of life of patients with CKD.

Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy - a systematic review

Background

The oral health of patients undergoing renal replacement therapy (RRT) is insufficient. Poor oral health and its components can affect the oral health-related quality of life (OHRQoL) of these patients. The aim of this systematic review was to assess the OHRQoL of adult patients under RRT.

Methods

A systematic literature search was performed using the terms: dialysis OR “renal disease” OR kidney OR “renal failure” OR “kidney transplantation” OR hemodialysis OR “peritoneal dialysis” OR “renal replacement therapy” AND “oral health-related quality of life”, complemented by manual search. Clinical studies including adults (age ≥ 18 years) that were published between 2009 and 2019 were included in qualitative analysis.

Results

Twelve out of 20 studies were included in the qualitative analysis. The majority (11/12 studies) included patients undergoing haemodialysis (HD), with a sample size between 47 and 512 participants. Two studies included patients after kidney transplantation. Only one-quarter of the investigations included a healthy control group. The overall OHRQoL was found to be reduced. The majority of studies found relationships between OHRQoL and different oral health parameters. Furthermore, several relationships between OHRQoL and general quality of life as well as disease related parameters including age, gender, diabetes, blood parameters and dialysis duration were found. OHRQoL subscales psychological/psychosocial impairment and pain were predominantly affected.

Conclusions

Patients under RRT suffer from a reduced OHRQoL, which is potentially influenced by oral health and disease related parameters. Interdisciplinary dental care is needed and should consider both physical and psychosocial issues.

Dentist-Patient Communication of Treatment Outcomes in Periodontal Practice: A Need for Dental Patient-Reported Outcomes

Periodontal practice has made tremendous progress toward evidence-based treatment over the past decade. Importantly, a new classification scheme for periodontal and peri-implant treatments has recently been devised that is incorporating current evidence and enabling patient-specific periodontal care. However, this important progress can be further accelerated with the availability of patient-perceived outcomes of periodontal and implant interventions. The majority of existing clinical studies assess treatment effects based on clinician-measured surrogate outcomes, such as probing depth and attachment levels which are easily communicated to or perceived by dental patients. As dental patient-reported outcomes (dPROs) gain momentum in dental practice, our understanding of the true outcome of dental therapies is vastly increasing. In periodontal research in particular, the utilization of dPROs has clearly demonstrated that periodontal disease contributes to an individual's burden of disease in a substantial manner. Correspondingly, disease treatment interventions seem to lead to varying levels of patient-perceived improvements. The present editorial aims to highlight the importance of patient communication of treatment outcomes in periodontal and implant research and to review the information on available measures for capturing dPROs.

Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study

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.

Dialysis vintage time has the strongest correlation to psychosocial pattern of oral health-related quality of life - a multicentre cross-sectional study

Background

Aim of this cross-sectional, multicentre study was to investigate associations of dialysis vintage time in haemodialysis (CKD5D) patients with oral health-related quality of life (OHRQoL) and dental and periodontal treatment need.

Material and Methods

CKD5D patients were divided into subgroups according to dialysis vintage time in different dialysis centres in Germany. OHRQoL was assessed with oral health impact profile (OHIP-G14). Dental treatment need was classified as presence of carious lesions. Periodontal treatment need was defined as periodontal screening index score (PSI) 3-4.

Results

In total, 190 participants were divided into the subgroups according to the time on CKD5D: 0 - 2 (n = 29), 3 - 5 (n = 35), 6 - 8 (n = 34), 9 - 12 (n = 29), 13 - 20 (n = 34) and >20 years (n = 29). The overall treatment need in the total cohort was 92% (dental 56%, periodontal 88%) with a total OHIP-G14 sum score of 4.17 [2; 0-5] without a significant correlation. Time on CKD5D was inversely correlated with the OHIP G14 score (p<0.01, R = -0.201). The pattern psychosocial impact was significantly associated with the dialysis duration (p<0.01) and showed a negative correlation to the OHIP-G14 (R = -0.283, Spearman´s rho test p<0.01). For oral function also a negative correlation with OHIP-G14 was detected (Spearman´s rho: -0.183).

Conclusions

Patients with a prolonged dialysis vintage time show an improved OHRQoL, which might be mainly caused by the positive development of psychosocial pattern of OHRQoL. The oral health situation of HD patients seems unsatisfying, independently of dialysis vintage time and OHRQoL. Accordingly, an improvement in oral health situation of CKD5D patients is mandatory necessary. Thereby, consideration of psychosocial aspects especially at the beginning of CKD5D therapy and a sensitization regarding oral health issues with increasing vintage time might be recommendable.

Key words:Dental care, oral health, oral related quality of life, haemodialysis, chronic kidney disease.

Oral health-related quality of life in patients on chronic haemodialysis and after kidney transplantation

OBJECTIVES

The objective of the study was to evaluate oral health-related quality of life (OHRQoL) depending on dental and periodontal situation in patients on haemodialysis (HD) and after kidney transplantation (KTx) compared to healthy controls (HC).

SUBJECTS AND METHODS

OHRQoL was assessed using the German short form of Oral Health Impact Profile (OHIP G14). Dental health was estimated using the decayed, missing and filled teeth index (DMF-T). Periodontal health was classified as healthy/mild or moderate/severe periodontitis.

STATISTICAL ANALYSIS

Mann-Whitney U-test, Kruskal-Wallis test, chi-square test and Fisher's test.

RESULTS

Eighty-seven HD patients, 39 KTx patients and 91 HC were included. Significant differences in DMF-T, D-T, M-T and F-T scores were identified between groups (P < 0.001). The prevalence of moderate/severe periodontitis was significantly higher in the HD and KTx group compared to HC (P = 0.002). Differences in OHIP G14 between groups were neither clinical relevant nor statistically significant (P = 0.199). A significant effect of DMF-T (P = 0.012), M-T (P < 0.001) and periodontitis (P = 0.023) on the OHIP G14 scores was identified only in HC.

CONCLUSIONS

Improvement in dental care of HD and KTx patients is required. OHIP G14 values provide a subjectively considered low importance of oral health in HD and KTx patients, leading to need of motivation and sensitisation of these patients.