ORAL HEALTH ASSESSMENT IN CHRONIC KIDNEY DISEASE (CKD) PATIENTS ON MAINTENANCE HEMODIALYSIS

Introduction:

CKD is disease of global health concern with multisystem manifestations. One lesser talked about aspect is the oral health issue in CKD patients which stems from the uremic milieu, imbalances in calcium and mineral metabolism, endocrine and immune dysfunction, all of which can contribute to inadequate oral health but the data regarding this aspect of CKD is limited. This study was designed to better understand the effects CKD and hemodialysis therapy on oral health of patients in the context of Indian population.

Methods:

It was a cross-sectional, prospective, observational study spanning 12 months conducted at a single tertiary care center in adult patients on maintenance hemodialysis enrolled from OPD and admitted patients. Sample Size of 96 was decided based on prevalence of Oral health problems among CKD patients as reported in earlier studies assuming 95% Confidence level and 10% absolute precision. Eligible patients were enrolled after getting ethical clearance and informed consent. The selected patients were administered a WHO questionnaire and were also subjected to oral health examination by a single dental surgeon in oral health sciences wing. 

1. WHO oral health questionnaire: The oral health symptoms were judged in five categories namely tooth/mouth pain, dry mouth, mastication problems, dysgeusia and body image issues based on the answers given to WHO oral health questionnaire. 

2. WHO oral health assessment form 2013 was used to look at various aspects of oral health such as dentition status, periodontal disease, loss of attachment, gingival bleeding, dental erosion and oral mucosal lesions. Oral health examination was used to assess four parameters: total number of sound teeth; decayed, missing due to caries, fixed tooth (DMFT) score; gingival bleeding and periodontitis. 

The results obtained from above study were also compared with data from similar study from our center in non dialysed patients of CKD to examine the differences between two groups. 

Results:

The mean age of the cohort was 52.5 ± 12.6 years consisting of 55 males and 41 females. All patients were subjected to oral health assessment and it was compared to a previous study (n=125) conducted in our center on CKD-ND patients. Oral health symptoms and examination findings between the index study and historical control are summarized in table 1 and table 2 respectively. 

In addition, we also looked at the effect of educational status, teeth cleaning frequency and CKD-MBD markers on oral health perception and examination findings.  

Level of education and tooth cleaning frequency was found to have a significant correlation with oral health perception, body image issues, masticatory problems, number of sound teeth, DMFT score and Periodontitis. 

The median values of the Ca-P product, iPTH and Vitamin D were not significantly associated with compared to oral perception and examination findings. 

Conclusions:

Our study showed that CKD-5D patients had a high prevalence of oral health problems. A comparison to oral health in CKD patients not on dialysis reveals an association between disease progression, dialysis and increased oral health problems. We suggest including oral health assessment on a periodic basis to look at this neglected aspect of poor oral health in CKD-5D to provide a better quality of life to these patients. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.