Periodontitis and health-related quality of life in hemodialysis patients

Correlation of the oral health and biochemical profile in hemodialysis patients with end-stage renal diseases

The current study aims to investigate the oral health of end-stage renal diseases (ESRD) patients undergoing hemodialysis and to correlate it with the biochemical profile of the patients. The current study included 43 ESRD patients on regular hemodialysis. The oral hygiene status, dental, and periodontal health were measured by the following indices: decayed, missed, and filled teeth (DMFT) index, visible plaque index (VPI), and Russell periodontal index (RPI). Several biochemical, hormonal, and hematological parameters were evaluated for each patient. The correlation of the oral health status with the biochemical profile of the patients was measured. The mean age of the participants in the current study was (51.67 ± 14.7) years. About 81% of the participants were hypertensive (35), 19% were diabetic (8), and 28% showed HCV positivity (12). VPI showed 30% of patients had fair oral hygiene and 44% had poor oral hygiene. According to RPI, periodontitis was detected in more than 95% of patients. It was significantly correlated with the age and body mass index (BMI) of the patients. DMFT index was significantly positively correlated to RPI and serum transferrin saturation. RPI scores showed a significant correlation between the ages of the patients and their BMI. VPI significantly correlated with serum calcium, but not with other biochemical variables. ESRD patients treated with hemodialysis showed several oral health concerns. Most of these patients had periodontitis, which was more frequent in diabetics and elderly patients. Advanced grades of periodontitis were associated with older age and increased BMI.

Evaluating the Oral Hygiene and Periodontal Status of Patients Undergoing Hemodialysis

Background Periodontal disease is a chronic inflammatory condition affecting the periodontium, which is induced by various pathogenic microorganisms. The severity and frequency of periodontal disease among patients undergoing hemodialysis are higher compared to healthy individuals. This study aimed to evaluate whether oral prophylaxis and proper oral hygiene maintenance help improve the periodontal condition of patients undergoing hemodialysis. Methodology In this study, 30 participants satisfying the inclusion criteria were selected. We assessed the oral hygiene (Oral Hygiene Index Simplified (OHI-S)) and the periodontal status (probing pocket depth (PPD) and clinical attachment level (CAL)) of the included participants. Non-surgical periodontal management comprising oral prophylaxis and oral hygiene maintenance instructions were provided one week before initiating hemodialysis. The patients were then re-examined after one and three months. At each visit, oral hygiene status and clinical periodontal examinations were performed, along with reinforcing oral hygiene instructions to all participants. Results The mean age of the study participants was 44.10 ± 5.02 years. Repeated-measures one-way analysis of variance was used to compare the mean OHI-S, CAL, and PPD at different periods (baseline, after one month, and after three months), followed by multiple comparison using Bonferroni test. There was a statistically significant improvement in oral hygiene status and periodontal parameters (PPD and CAL) after one month and three months (p < 0.001) while the patient continued with hemodialysis. Conclusions This study showed the potential benefits of oral prophylaxis, oral hygiene maintenance, and periodontal care in patients undergoing hemodialysis.

Association between oral frailty and nutritional status among hemodialysis patients aged ≥50 years

AIM

Malnutrition is a prevalent health issue among hemodialysis patients. Oral frailty, a condition characterized by impairments in multiple oral health aspects and functions, has been associated with nutritional status in the general population. We aimed to determine whether oral frailty was associated with nutritional status in hemodialysis patients aged ≥50 years. Our secondary aim was to determine the prevalence of oral frailty in this population.

METHODS

This cross-sectional study included hemodialysis patients who were admitted to a single medical center. According to the Oral Frailty 5-item Checklist, oral frailty is characterized by the presence of two or more of the following criteria: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. Patients' nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI). Multivariable ordinal logistic regression analysis was performed to assess the association between oral frailty and nutritional status (classified into three categories according to the GNRI: >98, 92-98, and <92).

RESULTS

In total, 152 hemodialysis patients (55 women and 97 men) with a mean age of 70.4 years were included. The prevalence of oral frailty was 61.2%. After adjusting for health characteristics and sociodemographic background, oral frailty was associated with poor nutritional status according to the GNRI (odds ratio = 2.04, 95% confidence interval = 1.02-4.09).

CONCLUSIONS

In this study, approximately 60% of hemodialysis patients aged ≥50 years exhibited oral frailty, and hemodialysis patients with oral frailty had poor nutritional status according to the GNRI. Geriatr Gerontol Int 2024; 24: 891-897.

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.

Latest Concepts in the Endodontic Management of Kidney Patients

Doubtlessly, kidney patients present a common challenge in endodontic practice, so specialists in this field should know and follow several key points regarding this group of medically compromised patients. This review paper aims to explain kidney disease and its complications, as well as notify and discuss the latest concepts on anesthesia, pain management, antibiotic prophylaxis/stewardship, and the risk of viral diseases for these patients, and also the oral manifestations of kidney diseases that may guide endodontists to diagnose kidney intervention and prevent hazardous consequences that may happen during or following endodontic practice on these patients. For this purpose, relevant keywords were searched on Scopus, PubMed, Medline, and Web of Science to find published papers from 1980 to July 2023. Based on the quality, validity, and novelty 57 published articles were selected to provide this review to notify the most important concepts and considerations regarding endodontic management of kidney patients. Overall, it is concluded that training and education of general dentists, as well as endodontic specialists with strong technical, scientific, human, and moral knowledge about kidney patients, with emphasis on the philosophy of prevention of common dangerous systemic consequences originating from endodontic treatments, is the responsibility of dental schools in undergraduate as well as post-graduate programs.

Effects of periodontal treatment on the C-reactive protein levels in hemodialysis patients: A systematic review and meta-analysis

AIM

This systematic review provides a summary of the scientific evidence concerning effects of periodontal treatment on the C-reactive protein (CRP) levels in hemodialysis patients.

MATERIAL AND METHODS

Eight databases were accessed until May 2020 for interventional studies which evaluated CRP levels in hemodialysis patients before and after periodontal treatment. Inclusion criteria were studies involving hemodialysis patients with gingivitis or periodontitis, without restriction of year, language, and publication status. Random effects meta-analysis was performed. The risk of bias in eligible studies was assessed using the Joanna Briggs Institute's Critical Appraisal tools for use in systematic reviews. Certainty of evidence was also evaluated using GRADE approach.

RESULTS

The search in the databases resulted in 326 records, from which only seven met the eligibility criteria and therefore were submitted to qualitative evaluation. The meta-analysis revealed that, in general, the reduction in CRP levels had moderate and statistically significant effect size (standardized mean difference [SMD] = 0.45; confidence interval [CI] 95% = 0.25, 0.65; p < .001). Statistical heterogeneity was low (I2  = 0.0%; p = .771). Most studies showed moderate risk of bias.

CONCLUSION

Based on low certainty of evidence, the results suggest that periodontal treatment can significantly contribute to reduce CRP levels among hemodialysis patients. However, more randomized clinical studies, with follow-up longer than 12 months, using standardized diagnostic methods and controlling confounding factors, should be performed to strengthen the evidence.

Chronic Kidney Disease and Periodontitis Interplay-A Narrative Review

Periodontitis (PO), a chronic microbially-induced inflammation of the supporting tissues of the tooth, is linked to various systemic diseases. We analyze its bidirectional relationship to chronic kidney disease (CKD), a major health-care problem with impressive excess mortality. Overwhelming associative relationship between CKD and PO are analyzed. Major pathophysiologic mechanisms that link CKD to PO are then presented: systemic inflammation, endothelial dysfunction, and imbalance of oxidative stress characteristic of CKD have a role in PO development and might influence escape mechanisms of oral microbiota. Subclinical local and systemic inflammation induced by PO might influence in turn CKD outcomes. Homeostatic changes induced by CKD such as mineral bone disorders, acidosis, uremic milieu, or poor salivary flow are also relevant for the occurrence of PO. There is insufficient evidence to recommend a standardized diagnostic and therapeutic approach regarding association of PO to CKD.

Oral Health-Related Quality of Life, A Proxy of Poor Outcomes in Patients on Peritoneal Dialysis

Introduction

We sought to evaluate the associations of poor oral health hygiene with clinical outcomes in patients receiving peritoneal dialysis (PD).

Methods

As part of the multinational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 participating PD centers throughout Thailand were enrolled from May 2016 to December 2019. The data were obtained from questionnaires that formed part of the PDOPPS. Oral health-related quality of life (HRQoL) used in this study was the short form of the oral health impact profile (oral health impact profile [OHIP]-14, including 7 facets and 14 items). Patient outcomes were assessed by Kaplan-Meier analysis. Cox proportional hazards model regression was used to estimate associations between oral HRQoL and clinical outcomes.

Results

Of 5090 PD participants, 675 were randomly selected, provided informed consent, and completely responded to the OHIP-14 questionnaire. The median follow-up time of the study was 3.5 (interquartile range = 2.7–5.1 months) years. Poor oral health was associated with lower educational levels, diabetes, older age, marriage, and worse nutritional indicators (including lower time-averaged serum albumin and phosphate concentrations). After adjusting for age, sex, comorbidities, serum albumin, shared frailty by study sites, and PD vintage, poor oral health was associated with increased risks of peritonitis (adjusted hazard ratio [HR] = 1.45, 95% confidence interval [CI]: 1.06–2.00) and all-cause mortality (adjusted HR = 1.55, 95% CI: 1.04–2.32) but not hemodialysis (HD) transfer (adjusted HR = 1.89, 95% CI: 0.87–4.10) compared to participants with good oral health.

Conclusion

Poor oral health status was present in one-fourth of PD patients and was independently associated with a higher risk of peritonitis and death.

The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases

Several studies have demonstrated a strong relation between periodontal diseases and chronic kidney disease (CKD). The main mechanisms at the base of this link are malnutrition, vitamin dysregulation, especially of B-group vitamins and of C and D vitamins, oxidative stress, metabolic acidosis and low-grade inflammation. In particular, in hemodialysis (HD) adult patients, an impairment of nutritional status has been observed, induced not only by the HD procedures themselves, but also due to numerous CKD-related comorbidities. The alteration of nutritional assessment induces systemic manifestations that have repercussions on oral health, like oral microbiota dysbiosis, slow healing of wounds related to hypovitaminosis C, and an alteration of the supporting bone structures of the oral cavity related to metabolic acidosis and vitamin D deficiency. Low-grade inflammation has been observed to characterize periodontal diseases locally and, in a systemic manner, CKD contributes to the amplification of the pathological process, bidirectionally. Therefore, CKD and oral disease patients should be managed by a multidisciplinary professional team that can evaluate the possible co-presence of these two pathological conditions, that negatively influence each other, and set up therapeutic strategies to treat them. Once these patients have been identified, they should be included in a follow-up program, characterized by periodic checks in order to manage these pathological conditions.

Periodontal Disease in Patients Receiving Dialysis

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.