Evaluation and Correction of Dental Disorders in Children and Young Adults with End-Stage Chronic Kidney Disease

Abstract

Introduction. End-stage chronic kidney disease (CKD5) and associated drug therapy have adverse effects on both soft and hard oral tissues. Purpose. To evaluate dental status as well as treatment effectiveness of identified oral pathology in patients with CKD5. Materials and methods. The study included 55 patients under renal replacement therapy (RRT): 3 were on dialysis and 55 were after kidney transplantation; 37 were children with a median age of 13.8 [10.9; 15.5] years and 21 were young adults aged 23.3 [23.0; 23.7]. The dental examination included: assessment of prevalence and intensity of dental caries (indices DMFT, DMFT + dmft, dmft), defects in enamel development (MDDE), oral hygiene (PLI), periodontal condition (GI), bleeding, and the degree of gingival growth. In 26 patients with permanent occlusion therapeutic and prophylactic toothpastes were prescribed, as well as toothbrushes with soft bristles, and changes in dental status were assessed after 2 months of their use. Results. The prevalence of caries was 48.3%, the intensity in primary dentition of dmft=0, in mixed = 1 [1; 5], and in permanent = 4 [2; 7]. Enamel development defects were detected in 62.1% of the examined, the median number of teeth with defects was 12 [6; 18]: with code 1 – 3 [2; 4], with code 2 – 10 [4; 15], and with code 3 – 4 [2; 7]. At the initial examination, the median of oral hygiene index ranged from 1.40 [0.95; 1.85] in primary dentition, being 1.50 [1.30; 1.90] in permanent, to 1.80 [1.30; 1.90] in mixed one. The median of the GI index was 1.35 [1.03; 1.60]. Gum bleeding was diagnosed in 55.2% of examined patients, amlodipine-induced gum hyperplasia – in 53.4%. Re-examination of patients with permanent dentition two months after the use of moisturizing toothpaste and toothbrush revealed that the median PLI, GI and gingival bleeding decreased from 1.50 [1.30; 1.80] to 0.85 [0.30; 1.30] (p<0.001), from 1.30 [1.00; 1.50] to 0.5 [0.30; 1.10] (p<0.001) and from 56.0% to 31.6% (p=0.042) respectively. The proportion of patients with gingival hyperplasia decreased slightly from 57.7% to 50.0% (p=0.78), confirming the leading role in the development of this condition of drug therapy. Conclusion. There is a low intensity of caries, poor oral hygiene and inflammation of the gum tissues of moderate severity, presence of defects in enamel development in patients undergoing RRT. Correction of individual hygiene contributes to improvement of dental status.