SPECTRUM OF ORAL AND DENTAL MANIFESTATIONS IN CHRONIC KIDNEY DISEASE PATIENTS – A SINGLE CENTER EXPERIENCE
Background: Increased survival among Chronic Kidney Disease (CKD) patients have led to new problems including concerns for oral health. Periodontitis is a potential proinflammatory state associated with protein energy malnutrition and accelerated atherosclerosis. As supported by literature, patients with periodontitis have higher odds and risks of developing cardiovascular diseases. In our work, we aimed to look into the spectrum of oral and dental manifestations in CKD patients and compare the prevalence of periodontal disease with that of age and gender matched controls.
Study design & population: This was an observational, case control cross sectional study where 100 patients with CKD and 100 age and sex matched controls were involved. Patients were asked about symptoms of unpleasant taste, dry mouth and burning tongue and were examined for oral lesions such as pale mucosa, dry fissured lips, Saburral tongue, Candidiasis, petechiae, ecchymosis, smooth tongue, ulcerative stomatitis and angular cheilitis by a trained dental surgeon with appropriate armamentarium. The Periodontal disease index using the plaque component, calculus component, gingival and periodontal components were scored for each patient.
Statistical analysis: Student t-test & Chi-square test were used to determine the difference in clinical parameters between the patients and controls. SPSS version 16.0 was used for data analysis.
Results: Most common symptoms in CKD patients were xerostomia (45%) and unpleasant taste (42%) while the most common signs were pale mucosa and smooth tongue (28%). Prevalence of uremic fetor, xerostomia, pale mucosa, dry fissured lips, suboral tongue, smooth tongue in diabetic CKD patients was higher than in non-diabetic CKD patients. Periodontal disease index scoring revealed a significantly higher plaque index, calculus index and gingival and periodontal index in CKD patients compared to controls.
Conclusions: Periodontitis is an ignored source of systemic inflammation in patients with CKD. Our study highlights the rampant prevalence of oral lesions and periodontitis in CKD particularly in diabetic CKD and End stage renal disease (ESRD) patients. Recognising and managing periodontitis at an early stage may help in decreasing the pro inflammatory state and increasing the nutritional status of CKD patients. Periodic oral cavity and periodontal assessment should be made a part of routine standard of care in CKD patients.
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