Influence of dialysis duration and parathyroid hormone on the clinical and radiographic oral conditions of pre-transplant patients with chronic kidney disease

Queiroz, Stênio Medeiros; Amorim, Adriana Gomes; Andrade, Ana Luiza Dias Leite de; Gordón-Núñez, Manuel Antonio; Freitas, Roseana de Almeida; Galvão, Hébel Cavalcanti

Abstract

AIM: To evaluate the oral conditions of patients with chronic kidney disease undergoing dialysis and to determine the influence of dialysis duration and bone metabolism on the prevalence and severity of the alterations found. METHODS: The simplified oral hygiene index (OHI-S), prevalence of dental caries (decayed, missing filled teeth index, DMFT), and the periodontal screening and recording (PSR) index were evaluated in 154 patients. Parathyroid hormone (PTH), calcium, phosphorus and urea measurements, as well as panoramic radiographs, were obtained from all patients. To evaluate the effect of duration of dialysis treatment on oral health, the patients were divided into two groups: (1) <5 years and (2) > 5 years. Regarding blood levels of PTH, patients were divided into three groups: (1) 0-149 pg/mL, (2) 150-584 pg/mL, and (3) >585 pg/mL. The OHI-S identified the accumulation of biofilm and calculus around the teeth. RESULTS: Gingival inflammation was found in 100% of dentate patients, with 2 being the predominant PSR score (72.3%). The DMFT index was high (17.52). Dental calculus was the most common radiographic finding (70.8%). No significant correlation was observed between dialysis duration, biochemical alterations, and oral health. CONCLUSIONS: Most patients undergoing dialysis presented precarious oral hygiene, periodontal inflammation, and bone alterations. However, these manifestations were not influenced by the duration of dialysis or bone metabolism.

chronic kidney disease; parathyroid hormone; oral health; hemodialysis

References

¹ Marakoglu I, Gursoy UK, Demirer S, Sezer H. Periodontal status of chronic renal failure patients receiving hemodialysis. Yonsei Med J. 2003; 44: 648-52.
² Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res. 2005; 84: 199-208.
³ Souza CRD, Libério SA, Guerra RNM, Monteiro S, Silveira EJD, Pereira ALA. Evaluation of periodontal condition of kidney patients on dialysis. Rev Assoc Med Bras. 2005; 51: 285-9.
⁴ Gürkan A, Köse T, Atilla G. Oral Health Status and Oral Hygiene Habits of an Adult Turkish Population on Dialysis. Oral Health Prev Dent. 2008; 6: 37-43.
⁵ Carvalho AA, Farsura PP, Bastos MG, Vilela EM. Influence of non-surgical periodontal treatment on hematological and biochemical parameters of patients with chronic renal failure in pre-dialysis. Periodontia. 2011; 21: 27-33.
⁶ Bots CP, Poorterman JHG, Brand HS, Kalsbeek H, van Amerongen BM, Veerman EC et al. The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy. Oral Dis. 2006; 12: 176-80.
⁷ Dirschnabel AJ, Martins AS, Dantas SAG, Ribas Mde O, Grégio AM, Alanis LR et al. Clinical oral findings in dialysis and kidney-transplant patients. Quintessence Int. 2011; 42: 127-33.
⁸ Kho H, Lee S, Sung-Chang Chung S, Kim Y. Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 316-9.
⁹ Bayraktar G, Kurtulus I, Duraduryan A, Cintan S, Kazancioglu R, Yildiz A et al. Dental and periodontal findings in hemodialysis patients. Oral Dis. 2007; 13: 393-7.
¹⁰ Bayraktar G, Kurtulus I, Kazancioglu R, Bayramgurler I, Cintan S, Bural C et al. Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis. Oral Dis. 2008; 14: 185-9.
¹¹ Cengiz MI, Sümer P, Cengiz S, Yavuz U. The effect of the duration of the dialysis in hemodialysis patients on dental and periodontal findings. Oral Dis. 2009; 15: 336-41.
¹² Chamani G, Zarei MR, Radvar M, Rashidfarrokhi F, Razazpour F. Oral health status of dialysis patients based on their renal dialysis history in Kerman, Iran. Oral Health Prev Dent. 2009; 7: 269-75.
¹³ Sekiguchi RT, Pannuti CM, Silva Jr HT, Medina-Pestana JO, Romito GA. Decrease in oral health may be associated with length of time since beginning dialysis. Spec Care Dent. 2012; 32: 6-10.
¹⁴ Frankenthal S, Nakhoul F, Machtei EE, Green J, Ardekian L, Laufer D et al. The effect of secondary hyperparathyroidism and hemodialysis therapy on alveolar bone and periodontium. J Clin Periodontol. 2002; 29: 479-83.
¹⁵ Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964; 68: 7-13.
¹⁶ Klassen JT, Krasko BM. The dental health status of dialysis patients. J Can Dent Assoc. 2002; 68: 34-8.
¹⁷ Souza CM, Braosi APR, Luczyszyn SM, Casagrande RW, Pecoits-Filho R, Riella MC et al. Oral health in Brazilian patients with chronic renal disease. Rev Med Chil. 2008; 136: 741-6.
¹⁸ Dias CRS, Sá TCV, Pereira ALA, Alves CMC. Evaluation of oral condition in chronic renal patients undergoing hemodialysis. Rev Assoc Med Bras. 2007; 53: 510-4.
¹⁹ Borawski J, Wilczyñska-Borawska M, Stokowska W, Myœliwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007; 22: 457-64.
²⁰ Thorman R, Neovius M, Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J Urol Nephrol. 2009; 43: 154-9.
²¹ Hamdy NAT. Calcium and Bone Metabolism Pre- and Post-Kidney Transplantation. Endocrinol Metab Clin N Am. 2007; 36: 923-35.

Publication Dates

Publication in this collection
19 July 2013
Date of issue
June 2013

History

Received
11 Mar 2013
Accepted
25 June 2013

This work is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹ Marakoglu I, Gursoy UK, Demirer S, Sezer H. Periodontal status of chronic renal failure patients receiving hemodialysis. Yonsei Med J. 2003; 44: 648-52.

[2] ² Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res. 2005; 84: 199-208.

[3] ³ Souza CRD, Libério SA, Guerra RNM, Monteiro S, Silveira EJD, Pereira ALA. Evaluation of periodontal condition of kidney patients on dialysis. Rev Assoc Med Bras. 2005; 51: 285-9.

[4] ⁴ Gürkan A, Köse T, Atilla G. Oral Health Status and Oral Hygiene Habits of an Adult Turkish Population on Dialysis. Oral Health Prev Dent. 2008; 6: 37-43.

[5] ⁵ Carvalho AA, Farsura PP, Bastos MG, Vilela EM. Influence of non-surgical periodontal treatment on hematological and biochemical parameters of patients with chronic renal failure in pre-dialysis. Periodontia. 2011; 21: 27-33.

[6] ⁶ Bots CP, Poorterman JHG, Brand HS, Kalsbeek H, van Amerongen BM, Veerman EC et al. The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy. Oral Dis. 2006; 12: 176-80.

[7] ⁷ Dirschnabel AJ, Martins AS, Dantas SAG, Ribas Mde O, Grégio AM, Alanis LR et al. Clinical oral findings in dialysis and kidney-transplant patients. Quintessence Int. 2011; 42: 127-33.

[8] ⁸ Kho H, Lee S, Sung-Chang Chung S, Kim Y. Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88: 316-9.

[9] ⁹ Bayraktar G, Kurtulus I, Duraduryan A, Cintan S, Kazancioglu R, Yildiz A et al. Dental and periodontal findings in hemodialysis patients. Oral Dis. 2007; 13: 393-7.

[10] ¹⁰ Bayraktar G, Kurtulus I, Kazancioglu R, Bayramgurler I, Cintan S, Bural C et al. Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis. Oral Dis. 2008; 14: 185-9.

[11] ¹¹ Cengiz MI, Sümer P, Cengiz S, Yavuz U. The effect of the duration of the dialysis in hemodialysis patients on dental and periodontal findings. Oral Dis. 2009; 15: 336-41.

[12] ¹² Chamani G, Zarei MR, Radvar M, Rashidfarrokhi F, Razazpour F. Oral health status of dialysis patients based on their renal dialysis history in Kerman, Iran. Oral Health Prev Dent. 2009; 7: 269-75.

[13] ¹³ Sekiguchi RT, Pannuti CM, Silva Jr HT, Medina-Pestana JO, Romito GA. Decrease in oral health may be associated with length of time since beginning dialysis. Spec Care Dent. 2012; 32: 6-10.

[14] ¹⁴ Frankenthal S, Nakhoul F, Machtei EE, Green J, Ardekian L, Laufer D et al. The effect of secondary hyperparathyroidism and hemodialysis therapy on alveolar bone and periodontium. J Clin Periodontol. 2002; 29: 479-83.

[15] ¹⁵ Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964; 68: 7-13.

[16] ¹⁶ Klassen JT, Krasko BM. The dental health status of dialysis patients. J Can Dent Assoc. 2002; 68: 34-8.

[17] ¹⁷ Souza CM, Braosi APR, Luczyszyn SM, Casagrande RW, Pecoits-Filho R, Riella MC et al. Oral health in Brazilian patients with chronic renal disease. Rev Med Chil. 2008; 136: 741-6.

[18] ¹⁸ Dias CRS, Sá TCV, Pereira ALA, Alves CMC. Evaluation of oral condition in chronic renal patients undergoing hemodialysis. Rev Assoc Med Bras. 2007; 53: 510-4.

[19] ¹⁹ Borawski J, Wilczyñska-Borawska M, Stokowska W, Myœliwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant. 2007; 22: 457-64.

[20] ²⁰ Thorman R, Neovius M, Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J Urol Nephrol. 2009; 43: 154-9.

[21] ²¹ Hamdy NAT. Calcium and Bone Metabolism Pre- and Post-Kidney Transplantation. Endocrinol Metab Clin N Am. 2007; 36: 923-35.