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Beyer A, Ebach F, Reutter H, Sauerstein K, Hilger AC, Krickau T, Tzschoppe A, Woelfe J, Galiano M, Schaefer JT. Oral health status in children with chronic kidney disease, kidney transplantation, and nephrotic syndrome: a cross-sectional study. Pediatr Nephrol 2025; 40:2287-2293. [PMID: 39904895 PMCID: PMC12117002 DOI: 10.1007/s00467-025-06698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/15/2025] [Accepted: 01/16/2025] [Indexed: 02/06/2025]
Abstract
INTRODUCTION Chronic kidney disease (CKD) has been previously associated with a decline in oral health. This study aimed to examine the oral health of children with CKD, nephrotic syndrome (NS), and children that received kidney transplantation (KTR). METHODS A case-control study was conducted involving children with CKD stages 1-3, children with CKD stages 4-5, pediatric kidney transplant recipients, and children with NS. Developmental Defects of Enamel (DDE) were evaluated using the DDE Index, while dental caries was assessed with the Decayed Missing Filled Teeth Index (DMFT). Plaque and debris were measured utilizing the Simplified Oral Hygiene Index (OHI-S), which includes the two subindices Simplified Calculus Index (CI-S) and Simplified Debris Index (DI-S). RESULTS Children with CKD 1-3, CKD 4-5, and KTR presented with significantly higher DI-S and CI-S scores and significantly more DDE. There was no difference in the DMFT score in children with CKD 4-5 and KTR. For children with CKD 1-3, a significantly lower DMFT score was observed compared to the control group. Children with NS did not show any differences for DI-S, CI-S, DMFT, and DDE compared to healthy peers. CONCLUSION Oral health status is not affected in children with NS. Children with CKD 1-3, CKD 4-5, and KTR have more plaque, debris, and DDE and should be surveyed regularly by their dentists.
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Affiliation(s)
- Anna Beyer
- Friedrich-Alexander Erlangen-Universität, Schloßplatz 4, 91054, Erlangen, Germany.
| | - Fabian Ebach
- Department of Neonatology and Pediatric Intensive, Care University Hospital Bonn, Bonn, Germany
| | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, University Hospital Erlangen, Erlangen, Germany
| | - Katja Sauerstein
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Alina Christine Hilger
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Krickau
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Anja Tzschoppe
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Joachim Woelfe
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
| | - Jan Thomas Schaefer
- Department of Pediatrics and Adolescent Medicine, Department of Pediatric Nephrology, University Hospital Erlangen, Erlangen, Germany
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Morozova NS, Elovskaya AA, Maslikova EA, Sevbitov AV, Timoshina MD, Amkhadova MA, Maltseva LD, Velichko EV, Danilova EY, Morozova OL. Perspectives on Matrix Metalloproteinase-8 and Salivary Osteoprotegerin in Orthodontic Strategy in Children with Chronic Kidney Disease. J Clin Med 2025; 14:2951. [PMID: 40363983 PMCID: PMC12072570 DOI: 10.3390/jcm14092951] [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: 03/27/2025] [Revised: 04/22/2025] [Accepted: 04/22/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: This study aimed to establish the regularities of changes in the content of matrix metalloproteinase 8 (MMP-8) and osteoprotegerin (OPG), the most well-known indicators of bone metabolism disorders, in the saliva of children with different severities of chronic kidney disease (CKD) who need orthodontic treatment. Methods: The study of MMP-8 and OPG content in saliva was carried out in 76 children in need of orthodontic treatment, who were divided into equal groups (G) of 19 people: G1-children with congenital malformations of the urinary tract, acquired renal pathology, and CKD stage 1 and 2, receiving medical therapy, as well as more having a deep distal bite formed by mandibular micrognathia; G2-children with a terminal stage of CKD, receiving renal replacement therapy in the volume of hemodialysis, with a characteristic distal bite of different etiology; G3-children one year after kidney transplantation, with a tendency to form an open distal bite, associated to a greater extent with maxillary macrognathia. G4-practically healthy children without renal pathology stratified by sex and age. Results: It was found that the content of MMP-8 and OPG in the saliva of children with different CKD stages who needed orthodontic treatment was significantly higher than the G4. The maximum values of MMP-8 were registered in G2. An increase in OPG content in saliva was observed in the G1 and G3. Conclusions: The identified changes in markers of mineral and bone disorders in the saliva of children with different stages of CKD show the possibility of their use as non-invasive predictive and prognostic markers for the diagnosis of preclinical stages of bone metabolic disorders.
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Affiliation(s)
- Natalia Sergeevna Morozova
- Department of Dental Diseases Propaedeutics, E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 117418 Moscow, Russia (A.V.S.); (M.D.T.)
| | - Alina Alekseevna Elovskaya
- Department of Pediatric, Preventive Dentistry and Orthodontics, E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 121059 Moscow, Russia; (A.A.E.); (E.A.M.)
| | - Ekaterina Andreevna Maslikova
- Department of Pediatric, Preventive Dentistry and Orthodontics, E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 121059 Moscow, Russia; (A.A.E.); (E.A.M.)
| | - Andrey Vladimirovich Sevbitov
- Department of Dental Diseases Propaedeutics, E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 117418 Moscow, Russia (A.V.S.); (M.D.T.)
| | - Maria Dmitrievna Timoshina
- Department of Dental Diseases Propaedeutics, E.V. Borovsky Institute of Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), 117418 Moscow, Russia (A.V.S.); (M.D.T.)
| | - Malkan Abdrashidovna Amkhadova
- Department of Surgical Dentistry and Implantology of the Faculty of Advanced Medical Studies Moscow Regional Research and Clinical Institute (“MONIKI”), 129110 Moscow, Russia;
| | - Larisa Dmitrievna Maltseva
- Department of Pathophysiology, Institute of Digital Biodesign and Modeling of Living System, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119019 Moscow, Russia; (L.D.M.); (E.V.V.); (O.L.M.)
| | - Ellina Valerievna Velichko
- Department of Pathophysiology, Institute of Digital Biodesign and Modeling of Living System, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119019 Moscow, Russia; (L.D.M.); (E.V.V.); (O.L.M.)
| | - Elena Yur’evna Danilova
- Molecular Theranostics Institute, Biomedical Science and Technology Park, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Department of Chemistry, M.V. Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Olga Leonidovna Morozova
- Department of Pathophysiology, Institute of Digital Biodesign and Modeling of Living System, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119019 Moscow, Russia; (L.D.M.); (E.V.V.); (O.L.M.)
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Chapple ILC, Hirschfeld J, Cockwell P, Dietrich T, Sharma P. Interplay between periodontitis and chronic kidney disease. Nat Rev Nephrol 2025; 21:226-240. [PMID: 39658571 DOI: 10.1038/s41581-024-00910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2024] [Indexed: 12/12/2024]
Abstract
Periodontitis is a ubiquitous chronic inflammatory disease affecting the supporting tissues of the teeth and is a major cause of multiple tooth loss. Despite being preventable, periodontitis and dental caries are responsible for more years lost to disability than any other human condition. The most severe form of periodontitis affects 1 billion individuals, and its prevalence is increasing globally. Periodontitis arises from a dysregulated and hyperactive inflammatory response to dysbiosis in the periodontal microbiome. This response has systemic effects associated with premature mortality and elevated risk of several systemic non-communicable diseases (NCDs), including atheromatous cardiovascular disease, type 2 diabetes and chronic kidney disease (CKD). This risk association between periodontitis and NCDs is independent of their shared common risk factors, suggesting that periodontitis is a non-traditional risk factor for NCDs such as CKD. As periodontitis progresses, the immune cells and mediators underpinning its pathophysiology leak into the systemic circulation through the ulcerated oral mucosal lining, inducing in a systemic inflammatory profile that closely mirrors that observed in patients with CKD. The relationship between periodontitis and CKD seems to be bi-directional, but large-scale intervention studies are required to clarify causality and could lead to new care pathways for managing each condition as an exposure for the other.
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Affiliation(s)
- Iain L C Chapple
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre in Inflammation, Birmingham, UK.
| | - Josefine Hirschfeld
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre in Inflammation, Birmingham, UK
| | - Paul Cockwell
- Department of Nephrology, University Hospital Birmingham, Birmingham, UK
| | - Thomas Dietrich
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre in Inflammation, Birmingham, UK
| | - Praveen Sharma
- Periodontal Research Group, Institute of Clinical Sciences, University of Birmingham and Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre in Inflammation, Birmingham, UK
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Kodaman Dokumacıgil N, Sezer B, Oktay Ş, Alpay H, Kargül B. Dental caries, oral hygiene and salivary characteristics in children with chronic kidney disease: a case-control study. Pediatr Nephrol 2025:10.1007/s00467-025-06730-4. [PMID: 40105933 DOI: 10.1007/s00467-025-06730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 01/28/2025] [Accepted: 02/18/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND The aim of this study was to compare the oral health findings and salivary parameters of children with different stages of chronic kidney disease (CKD) with those of healthy peers. METHODS Intraoral examinations were performed on 43 children aged 8-17 years with CKD and 40 healthy controls from the same pediatric nephrology clinic. Oral health was assessed using the DMFT/dft indices (decayed-missing-filled-teeth), debris index (DI), calculus index (CI), and simplified oral hygiene index (OHI-S). Saliva samples from the children were analyzed for salivary flow rate (SFR), pH, buffering capacity (BC), total oxidant status (TOS), total antioxidant capacity (TAOC), urea, creatinine (Cr), calcium (Ca), potassium (K), phosphorus (P), and salivary α-amylase (SAA). Spearman's rho coefficient was used to examine the relationship between salivary and serum biomarkers levels and oral health findings. RESULTS While the DMFT/dft scores were lower in children with CKD (p = 0.001), DI, CI, and OHI-S scores were higher in healthy peers (p < 0.001). Children with CKD had lower SFR, Ca, and TAOC levels, and higher BC, pH, urea, Cr, K, P, TOS, and SAA levels (p < 0.001) compared to healthy controls. Later stages of CKD was associated with the lower dft ( r s = - 0.35; p = 0.022). CONCLUSIONS Children with CKD exhibit fewer caries and poorer oral hygiene compared to their healthy peers, and their saliva characteristics differ significantly from those of the healthy group. Disease-related changes in serum and salivary characteristics affect the oral health of children with CKD, necessitating collaboration between pediatric nephrologists and dentists. TRIAL REGISTRATION ClinicalTrials.gov (NCT06578832).
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Affiliation(s)
- Nur Kodaman Dokumacıgil
- Department of Pediatric Dentistry, Faculty of Dentistry, Institute of Health Science, Marmara University, Istanbul, Türkiye.
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye.
| | - Berkant Sezer
- Department of Pediatric Dentistry, School of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye
| | - Şehkar Oktay
- Department of Biochemistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Betül Kargül
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
- School of Dentistry, Queen Mary University of London, London, UK
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Hoefer KC, Weber LT, Jazmati N, Noack MJ, Barbe AG, Graf I. Chronic Kidney Disease With Related Oral Health Problems and Alterations in the Tongue Microbiome Illustrated by a 15-Year-Old Girl: A Case Report. Case Rep Pediatr 2025; 2025:1018472. [PMID: 40007817 PMCID: PMC11858826 DOI: 10.1155/crpe/1018472] [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: 08/27/2024] [Accepted: 01/18/2025] [Indexed: 02/27/2025] Open
Abstract
Chronic kidney disease (CKD) is characterised by a gradual loss of kidney function over time and is often linked to oral health issues. This case illustrates typical conditions in young CKD patients based on a 15-year-old girl with CKD stage 4 and methylmalonic aciduria, severe gingivitis and hyperplasia of the gingiva, and a need for orthodontic treatment. Oral hygiene interventions, homecare instructions and deep cleaning under antibiotic shielding were necessary to improve the patient's oral health. The immediate worsening of oral health status after extending the interval between regular prophylaxis appointments highlights the need for intensive prevention in young CKD patients to control oral health disorders. This report aims to demonstrate burden-of-care-reducing oral prophylaxis options for patients suffering from severe CKD with oral manifestations. Trial Registration: German Registry of Clinical Trials: DRKS00010580.
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Affiliation(s)
- Karolin C. Hoefer
- Department of Operative Dentistry and Periodontology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Lutz T. Weber
- Department of Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nathalie Jazmati
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Michael J. Noack
- Department of Operative Dentistry and Periodontology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Isabelle Graf
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Gupta S, Ardeshna A, Rossouw PE, Valiathan M. Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis - Part 1. Dent Clin North Am 2024; 68:693-706. [PMID: 39244251 DOI: 10.1016/j.cden.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
This article explores the intersection of various systemic conditions with orthodontic treatment. Renal diseases, including chronic kidney disease and renal transplant, present challenges such as delayed tooth eruption and gingival overgrowth, necessitating careful orthodontic planning and collaboration with physicians. Liver diseases, particularly hepatitis, heighten the risk of periodontal disease and mandate strict infection control measures during orthodontic procedures. Ehlers-Danlos syndrome poses challenges related to collagen fragility, rapid tooth movement, and orthodontic relapse. Autoimmune diseases like diabetes mellitus and juvenile idiopathic arthritis require tailored orthodontic approaches considering oral complications and joint involvement.
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Affiliation(s)
- Sumit Gupta
- Diplomate, American Board of Orofacial Pain, Private Practice, Rak Dental Care & Implant Centre, Ras Al Khaimah, United Arab Emirates.
| | - Anil Ardeshna
- Diplomate American Board of Orthodontics, Department of Orthodontics, Rutgers School of Dental medicine, 110 Bergen Street, Newark, NJ 07101, USA
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, University of Rochester Eastman Institute of Oral Health, 625 Elmwood Avenue, Box 683, Rochester, NY 14620, USA
| | - Manish Valiathan
- Department of Orthodontics, Case Western Reserve University, 9601 Chester Avenue, Cleveland, OH 44106, USA
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Elhusseiny GA, Saleh W. Oral Health in Children with Chronic Kidney Disease, Hemodialysis, and Renal Transplantation: A Comprehensive Narrative Review of the Oral Manifestations and Dental Implications. Clin Med Insights Pediatr 2024; 18:11795565241271689. [PMID: 39206206 PMCID: PMC11350538 DOI: 10.1177/11795565241271689] [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: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 09/04/2024] Open
Abstract
Chronic kidney disease (CKD) in children presents multifaceted challenges, impacting various aspects of health, including oral health. This narrative review provides a comprehensive synthesis of literature focusing on the oral health status of pediatric CKD patients, encompassing oral manifestations, dental considerations, and management challenges associated with hemodialysis and kidney transplantation. A comprehensive search strategy was employed, utilizing databases such as PubMed, Scopus, Web of Science, and Google Scholar, to identify relevant literature on oral manifestations in children with CKD, including those undergoing hemodialysis or renal transplantation. Search terms were carefully selected to capture studies examining enamel hypoplasia, dental caries, delayed tooth eruption, gingival diseases, periodontal diseases, radiographic alterations, craniofacial development, dry mouth, and changes in the oral mucosa. Our narrative review meticulously selected articles through a systematic process. Ultimately, 12 studies meeting the inclusion criteria were included in the review. Relevant data from each included study were independently extracted and synthesized, focusing on oral manifestations and their implications in pediatric CKD patients. The synthesized findings were organized and presented in a structured manner within the review article, considering their clinical implications and informing recommendations for dental management of children with CKD. This article highlights the importance of a coordinated effort between nephrologists, dentists, and other healthcare professionals in providing holistic care for pediatric CKD patients. A comprehensive understanding of the oral health status of these children, along with proactive dental management strategies, contributes to improved overall health outcomes and a better quality of life. This review aims to serve as a valuable resource for the oral healthcare providers involved in the care of pediatric CKD patients.
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Affiliation(s)
- Ghada A Elhusseiny
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Wafaa Saleh
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Hoefer KC, Weber LT, Barbe AG, Graf I, Thom S, Ehren R, Nowag A, Wisplinghoff H, Noack MJ, Scholz CJ, Jazmati N. Intensive oral prophylaxis does not alter the tongue microbiome in young patients with chronic kidney disease: longitudinal, randomized, controlled study. Front Immunol 2024; 15:1430655. [PMID: 39224583 PMCID: PMC11366650 DOI: 10.3389/fimmu.2024.1430655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Gingivitis is a common intraoral disease in patients with chronic kidney disease (CKD), which poses a particular interdisciplinary challenge. We aimed to determine the influence of an intensive oral prophylaxis program (OPP) compared to standard prevention measures on the tongue microbiome of young patients with CKD. Methods Thirty patients with CKD (mean age 14.2 ± 5.2 years) and generalized gingivitis were included. The effects of the intensive OPP were compared with standard prophylaxis according to statutory health insurance (treatment as usual, TAU) as a control. Tongue swabs were taken from the patients at baseline (t1) and after 3 (t2) and 6 (t3) months. Next-generation sequencing of 16S rDNA genes was used to quantitatively characterize microbial communities. Results There were no differences in the abundance, richness, or diversity of the observed genera and species between the two study groups at baseline or after 3 or 6 months. Furthermore, no change in predefined gingivitis and oral health bacterial clusters were found. At the phylum level, Firmicutes were decreased after intervention in the TAU group (t2TAU 42.9 ± 7.1 to t3TAU 34.8 ± 4.7 (npairs=14), p=0.003; false discovery rate 0.02). The decrease of Firmicutes was not significant in the OPP group. Conclusions Despite the intensity of dental prophylaxis and decreasing clinical signs of inflammation and decreasing plaque amount, no clinically relevant changes in the tongue microbiome were observed. Our results confirm the conserved and stable nature of the tongue microbiome, even in children with CKD.
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Affiliation(s)
- Karolin C. Hoefer
- Faculty of Medicine and University Hospital of Cologne, Polyclinic of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Lutz T. Weber
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, Children’s and Adolescents Hospital, Pediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | - Anna Greta Barbe
- Faculty of Medicine and University Hospital of Cologne, Polyclinic of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | - Isabelle Graf
- Department of Orthodontics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Rasmus Ehren
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, Children’s and Adolescents Hospital, Pediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | | | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Virology and Microbiology, Witten/Herdecke University, Witten, Germany
| | - Michael J. Noack
- Faculty of Medicine and University Hospital of Cologne, Polyclinic of Operative Dentistry and Periodontology, University of Cologne, Cologne, Germany
| | | | - Nathalie Jazmati
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
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Wallace CK, Vernazza CR, Emmet V, Singhal N, Sathyanarayana V, Tse Y, Taylor GD. Evaluation of UK paediatric nephrology teams' understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study. Pediatr Nephrol 2024; 39:2131-2138. [PMID: 38300268 PMCID: PMC11147922 DOI: 10.1007/s00467-024-06292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Oral health conditions are common in children and young people (CYP) with kidney disorders. There is currently limited literature on how confident paediatric nephrology teams feel to identify and manage oral health concerns for their patients. METHOD An exploratory mixed-method survey was distributed across all 13 UK specialist paediatric nephrology centres with responses received from consultants, registrars, specialist nurses and special interest (SPIN) paediatricians. RESULTS Responses received from 109 multidisciplinary team members of 13/13 (100%) UK tertiary units. Ninety-two percent (n = 100) of respondents reported they had never received any training in oral health and 87% (n = 95) felt that further training would be beneficial to optimise care for patients and improve communication between medical and dental teams. Most respondents reported that they did not regularly examine, or enquire about, their patients' oral health. Only 16% (n = 17) reported that all their paediatric kidney transplant recipients underwent routine dental assessment prior to transplant listing. Severe adverse oral health outcomes were rarely reported and only 11% (n = 12) of respondents recalled having a patient who had a kidney transplant delayed or refused due to concerns about oral infection. Seventy-eight percent (n = 85) felt that joint working with a dental team would benefit patients at their unit; however, 17% (n = 18) felt that current infrastructure does not currently support effective joint working. CONCLUSIONS Across the UK, paediatric kidney health professionals report lack of confidence and training in oral health. Upskilling subspecialty teams and creating dental referral pathways are recommended to maximise oral health outcomes for CYP with kidney diseases.
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Affiliation(s)
| | | | - Victoria Emmet
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Nidhi Singhal
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Greig D Taylor
- School of Dental Sciences, Newcastle University, Newcastle Upon Tyne, UK
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Gu R, Wang Q, Shi P, Zhang Y, Ying D, Zhi Y, Zhang J. The association between dental caries and steroid-sensitive nephrotic syndrome in children. Pediatr Nephrol 2024; 39:1125-1133. [PMID: 37783894 DOI: 10.1007/s00467-023-06167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Pathogenesis and relapse of steroid-sensitive nephrotic syndrome (SSNS) are primarily associated with infection. Dental caries is the most common chronic progressive oral infection in children. However, clinical studies of SSNS combined with dental caries in children are rare. METHODS In our retrospective cohort study from January 2021 to June 2022, 145 children with SSNS were included in the baseline analysis and 105 in the follow-up analysis. The follow-up period was 1 year. The primary study endpoints were the relapse-free period and frequently relapsing nephrotic syndrome (FRNS). Secondary endpoints included the number and triggers of relapses and concomitant medications. RESULTS The median age was 5.5 years, with a caries rate of 60.7%, the mean DMFT/dmft was 3.86, and the caries filling rate was 1.6%. Except for the lower proportion of high household income and high parental education observed in the caries group, no statistical differences were found when comparing the other baseline data with the non-caries group. The caries group had a shorter relapse-free period and a lower 1-year cumulative relapse-free survival rate (HR = 1.90, 95% CI 1.17-3.09, P = 0.009). Univariate regression analysis showed caries associated with FRNS (OR = 2.714, 95% CI 1.021-7.219, P = 0.045), but the correlation no longer remained in the multivariate analysis. Additionally, seven cases of caries-derived pulpal periapical inflammation triggered SSNS relapses. The caries group had more infection triggers and concomitant medication use. CONCLUSION Dental caries and relapse of SSNS are potentially associated, but careful evaluation is needed.
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Affiliation(s)
- Rui Gu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Qin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Peipei Shi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yingying Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Daojing Ying
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yuanzhao Zhi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jianjiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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11
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Hoefer KC, Weber LT, Barbe AG, Graf I, Thom S, Nowag A, Scholz CJ, Wisplinghoff H, Noack MJ, Jazmati N. The tongue microbiome of young patients with chronic kidney disease and their healthy mothers. Clin Oral Investig 2024; 28:110. [PMID: 38265670 PMCID: PMC10808353 DOI: 10.1007/s00784-024-05492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Oral microbiome plays a crucial role in the incidence and development of oral diseases. An altered intestinal microbiome has been reported in adults with chronic kidney disease (CKD). This study aimed to characterize the tongue microbiome of young patients with CKD compared to their healthy mothers to identify the influence of CKD-associated factors on resilient tongue ecosystem. MATERIAL AND METHODS Thirty patients with CKD (mean age, 14.2 years; 16 males and 14 females) and generalized gingivitis were included in the study. Swabs of the posterior tongue were collected from the patients and 21 mothers (mean age 40.8 years). Next-generation sequencing of 16S rDNA genes was employed to quantitatively characterize microbial communities. RESULTS The bacterial communities were similar in terms of richness and diversity between patients and mothers (p > 0.05). In patients with CKD, 5 core phyla, 20 core genera, and 12 core species were identified. CONCLUSIONS The tongue microbiome of the study participants showed no relevant CKD-associated differences compared to their mothers and appears to be a highly preserved niche in the oral cavity. Differences observed in the abundance of individual species in this study could be attributed to the age rather than CKD, even after a mean disease duration of 11 years. CLINICAL RELEVANCE CKD and its associated metabolic changes appear to have no detectable impact on the resilient tongue microbiome observed in young patients.
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Affiliation(s)
- Karolin C Hoefer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, Cologne, Germany.
| | - Lutz T Weber
- Children´s and Adolescents Hospital, Pediatric Nephrology, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anna Greta Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, Cologne, Germany
| | - Isabelle Graf
- Department of Orthodontics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | | | | | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Virology and Microbiology, Witten/Herdecke University, Witten, Germany
| | - Michael J Noack
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, Cologne, Germany
| | - Nathalie Jazmati
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
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12
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Mohamed FF, de Oliveira FA, Kinoshita Y, Yalamanchili RR, Eltilib LA, Andras NL, Narisawa S, Tani T, Chu EY, Millán JL, Foster BL. Dentoalveolar Alterations in an Adenine-Induced Chronic Kidney Disease Mouse Model. J Bone Miner Res 2023; 38:1192-1207. [PMID: 37191192 PMCID: PMC10524958 DOI: 10.1002/jbmr.4829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
Chronic kidney disease (CKD) is characterized by kidney damage and loss of renal function. CKD mineral and bone disorder (CKD-MBD) describes the dysregulation of mineral homeostasis, including hyperphosphatemia and elevated parathyroid hormone (PTH) secretion, skeletal abnormalities, and vascular calcification. CKD-MBD impacts the oral cavity, with effects including salivary gland dysfunction, enamel hypoplasia and damage, increased dentin formation, decreased pulp volume, pulp calcifications, and altered jaw bones, contributing to clinical manifestations of periodontal disease and tooth loss. Underlying mechanisms are not fully understood, and CKD mouse models commonly require invasive procedures with high rates of infection and mortality. We aimed to characterize the dentoalveolar effects of an adenine diet (AD)-induced CKD (AD-CKD) mouse model. Eight-week-old C57BL/6J mice were provided either a normal phosphorus diet control (CTR) or adenine and high-phosphorus diet CKD to induce kidney failure. Mice were euthanized at 15 weeks old, and mandibles were collected for micro-computed tomography and histology. CKD mice exhibited kidney failure, hyperphosphatemia, and hyperparathyroidism in association with porous cortical bone in femurs. CKD mice showed a 30% decrease in molar enamel volume compared to CTR mice. Enamel wear was associated with reduced ductal components, ectopic calcifications, and altered osteopontin (OPN) deposition in submandibular salivary glands of CKD mice. Molar cusps in CKD mice were flattened, exposing dentin. Molar dentin/cementum volume increased 7% in CKD mice and pulp volume decreased. Histology revealed excessive reactionary dentin and altered pulp-dentin extracellular matrix proteins, including increased OPN. Mandibular bone volume fraction decreased 12% and bone mineral density decreased 9% in CKD versus CTR mice. Alveolar bone in CKD mice exhibited increased tissue-nonspecific alkaline phosphatase localization, OPN deposition, and greater osteoclast numbers. AD-CKD recapitulated key aspects reported in CKD patients and revealed new insights into CKD-associated oral defects. This model has potential for studying mechanisms of dentoalveolar defects or therapeutic interventions. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Fatma F. Mohamed
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Flavia Amadeu de Oliveira
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Yuka Kinoshita
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Riti R. Yalamanchili
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Leena A. Eltilib
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Natalie L. Andras
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Sonoko Narisawa
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Takashi Tani
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Emily Y. Chu
- Department of General Dentistry, Operative Division, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - José Luis Millán
- Sanford Children’s Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Brian L. Foster
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
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13
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Therssen L, Lambrecht L, Vansteenkiste G, Knops N. Abnormal teeth and renal calcifications: Answers. Pediatr Nephrol 2023; 38:2603-2610. [PMID: 36917292 DOI: 10.1007/s00467-023-05908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Lore Therssen
- Pediatrics, UZ Leuven, Katholieke Universiteit Leuven Universitaire Ziekenhuizen, Leuven, Belgium.
| | - Loes Lambrecht
- Pediatrics, Pediatric Nephrology, AZ Herentals, Herentals, Belgium
| | | | - Noël Knops
- Pediatrics, Groene Hart Ziekenhuis, Gouda, Netherlands
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14
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Sezer B, Kodaman Dokumacıgil N, Kaya R, Güven S, Türkkan ÖN, Çiçek N, Alpay H, Kargül B. Association between serum biomarkers and oral health status in children with chronic kidney disease: A cross-sectional study. Clin Oral Investig 2023:10.1007/s00784-023-04989-1. [PMID: 37014503 DOI: 10.1007/s00784-023-04989-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the association between serum biomarkers and oral health parameters in children with chronic kidney disease (CKD). MATERIALS AND METHODS Serum hemoglobin, blood urea nitrogen, serum creatinine, calcium, parathormone, magnesium, and phosphorus levels were measured in 62 children with CKD aged between 4 and 17 years. Intraoral examinations of the patients were performed by two different pediatric dentists. Dental caries was assessed using the decayed-missing-filled-teeth (DMFT/dmft) indexes, and oral hygiene was assessed using the debris (DI), calculus (CI), and simplified oral hygiene (OHI-S) indexes. Spearman's rho coefficient and generalized linear modeling were used to examine the association between serum biomarkers and oral health parameters. RESULTS The results of the study showed that there were negative and statistically significant correlations between serum hemoglobin and creatinine levels and dmft scores in pediatric patients with CKD (p = 0.021 and p = 0.019, respectively). Furthermore, blood urea nitrogen levels and DI and OHI-S scores (p = 0.047 and p = 0.050, respectively); serum creatinine levels and DI, CI, and OHI-S scores (p = 0.005, p = 0.047, p = 0.043, respectively); and parathormone levels and CI and OHI-S scores (p = 0.001 and p = 0.017, respectively) were found to be positively and statistically significantly related. CONCLUSIONS There are associations between various serum biomarker levels and dental caries and oral hygiene parameters in pediatric patients with CKD. CLINICAL RELEVANCE The impact of changes in serum biomarkers on oral and dental health is important for dentists' and medical professionals' approaches to patients' oral and systemic health.
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Affiliation(s)
- Berkant Sezer
- Department of Pediatric Dentistry, School of Dentistry, Çanakkale Onsekiz Mart University, Çanakkale, Türkiye.
| | - Nur Kodaman Dokumacıgil
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Remziye Kaya
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
| | - Serçin Güven
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Özde Nisa Türkkan
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Neslihan Çiçek
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Harika Alpay
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Betül Kargül
- Department of Pediatric Dentistry, School of Dentistry, Marmara University, Istanbul, Türkiye
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15
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Szulimowska J, Zalewska A, Taranta-Janusz K, Marczuk-Kolada G, Żendzian-Piotrowska M, Maciejczyk M. Association Between Salivary Cytokines, Chemokines and Growth Factors and Salivary Gland Function in Children with Chronic Kidney Disease. J Inflamm Res 2023; 16:1103-1120. [PMID: 36941986 PMCID: PMC10024471 DOI: 10.2147/jir.s399786] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/25/2023] [Indexed: 03/15/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) is a systemic inflammatory disease that leads to multiple organ complications not only in the kidneys and the cardiovascular system, but also in the oral cavity. CKD children experience reduced saliva secretion (hyposalivation), which leads to increased incidence of dental caries and significant impairment of patients' quality of life. However, the causes of salivary gland dysfunction in children with CKD are unknown. The present study is the first to evaluate the inflammatory and anti-inflammatory profile in the saliva of children with CKD at different stages of renal failure with normal and reduced salivary gland function. Methods Thirty children with CKD (age 9-16) and thirty age- and gender-matched healthy children were classified for the study. Salivary inflammatory and anti-inflammatory profile were assayed using the multiplex ELISA assay. Results We demonstrated statistically significant changes in salivary pro-inflammatory (↑TNF-α, ↓IL-7), anti-inflammatory (↑IL-10), Th1 (↑INF-γ, ↑IL-15), Th2 (↑IL-4, ↑IL-5, ↑IL-6, ↑IL-9) and Th17 (IL-17) cytokines as well as chemokines (↑MCP-1/CCL-2, ↑MIP-1α/CCL3, ↓MIP-1β/CCL4, ↓EOTAXIN/CCL11) and growth factors (↑G-CSF, ↑FGF) in unstimulated saliva of children with CKD compared to the controls. Although the evaluation of the salivary inflammatory profile does not indicate a particular dominance of any of the branches of the immune system, we observed a statistically significant increase in the concentration of all Th2 cytokines assayed. The multivariate regression analysis showed that the content of salivary cytokines, chemokines and growth factors depends on the secretory function of the salivary glands, ie, salivary flow, total protein concentration and amylase activity in the saliva. Salivary MIP-1α/CCL3 was the most effective to differentiate children with CKD and hyposalivation from patients with normal saliva secretion. Discussion Inflammation is involved in salivary gland dysfunction in children with CKD, although further studies on in vitro and in vivo models are necessary to confirm this hypothesis.
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Affiliation(s)
- Julita Szulimowska
- Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland
| | - Anna Zalewska
- Department of Restorative Dentistry, Medical University of Bialystok, Bialystok, Poland
| | | | | | | | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
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16
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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: 10] [Impact Index Per Article: 5.0] [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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17
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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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18
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Höfer K, Turnowsky A, Ehren R, Taylan C, Plum G, Witte H, Noack MJ, Weber LT. The impact of a needs-oriented dental prophylaxis program on bacteremia after toothbrushing and systemic inflammation in children, adolescents, and young adults with chronic kidney disease. Pediatr Nephrol 2022; 37:403-414. [PMID: 34297188 PMCID: PMC8816805 DOI: 10.1007/s00467-021-05153-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing. METHODS To examine whether intensive dental prophylaxis can restore oral health, reduce the prevalence of bacteremia and degree of systemic inflammation indicated by CRP levels, we conducted this pilot study examining 30 CKD patients aged 6-26 years, 15 receiving intensive prophylaxis (IP), 15 receiving treatment as usual (TAU) serving as control group. There were three appointments for examination, each 10 ± 1 weeks apart (at baseline, after intervention periods one and two, when TAU also received IP, and the IP group stopped prophylaxis). RESULTS The gingival index (GI) in the IP group decreased by 90% (GI 0.09; p=0.001), resulting in almost healthy gingiva. There was no significant change in CRP or prevalence of bacteremia. General prevalence of bacteremia after toothbrushing was 9.5% affecting 7 (26%) of the participants. In three participants, bacteremia dissolved after IP, in one after TAU. Two patients developed bacteremia ≥ 10 weeks after ending IP. We identified eight different bacterial species. CONCLUSIONS We were able to show that IP can effectively treat gingivitis. It might be a promising approach to reduce systemic inflammation and subsequently lower premature cardiovascular disease, despite the lack of statistical significance. Future research requires a larger patient cohort to enable matched treatment groups with long-term follow-up and molecular detection methods for bacteremia. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Karolin Höfer
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Strasse 32, D-50931, Cologne, Germany.
| | - Anna Turnowsky
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rasmus Ehren
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Taylan
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Hanna Witte
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Strasse 32, D-50931 Cologne, Germany
| | - Michael J. Noack
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Cologne, Kerpener Strasse 32, D-50931 Cologne, Germany
| | - Lutz T. Weber
- Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, and University Hospital Cologne, University of Cologne, Cologne, Germany
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