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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2007  |  Volume : 25  |  Issue : 1  |  Page : 7-9

The dental and oral status of children with chronic renal failure

Department of Dentistry, Tehran and Islamic Azad University of Medical Science, Iran

Correspondence Address:
Yahya B Nakhjavani
Pedo Department, Tehran University, Engelab Ave. Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.31981

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The main purpose of this investigation was to evaluate the oral and dental status of chronic renal failure (CRF) patients undergoing hemodialysis at children's Hospitals in Tehran. Fifty-three children with CRF aged 5-18 years recruited from the renal unit of children's medical center, Tehran Hospitals for children, were studied. The decayed, missing, filled dmf, DMF, and MGI scores were recorded. The CRF children had low prevalence of dental caries, although none of the clinical diagnoses displayed the absence of gingival inflammation. Duration of dialysis and Anemia had a significant influence on the gingival condition. Especially anemia leads to severe gingivitis. The CRF children need careful monitoring and all such patient should be given oral hygiene education as topmost priority.

Keywords: Chronic renal failure, dmf, DMF, hemodialysis, MGI

How to cite this article:
Nakhjavani YB, Bayramy A. The dental and oral status of children with chronic renal failure. J Indian Soc Pedod Prev Dent 2007;25:7-9

How to cite this URL:
Nakhjavani YB, Bayramy A. The dental and oral status of children with chronic renal failure. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2023 Jan 29];25:7-9. Available from: http://www.jisppd.com/text.asp?2007/25/1/7/31981

   Introduction Top

Chronic renal failure (CRF) results from the progressive and chronic deterioration of nephrons, which happens over years. [1] Advances in pediatric nephrology during the last two decades have resulted in a marked increase in the number of children [2],[3] surviving with CRF, on renal replacement therapy. Although many complication of chronic renal disease can now be prevented or treated effectively, these therapeutic advances have introduced new problems including concern for oral health. [2],[3]

The oral manifestation of CRF includes ammonia - like smell, dysgeusia, stomatitis, decreased salivary flow, xerostomia, and partitas. Renal osteodystrophy is a common problem in patients with renal failure. [1],[3],[4]

Disturbed calcium and phosphate metabolism may cause enamel opacities, loss of lamina dura, loosening of teeth, bony fracture, and bone tumors from secondary hyper

parathyroidism. Despite altered vitamin D metabolism, radiographic assessments have shown only a slight delay in dental eruption, which was not statistically significant. [2],[5],[6]

Renal failure is associated with the reduction of caries perhaps linked to altered oral pH. Enamel hypoplasia is frequently seen in patients with renal disease, particularly CRF. [2],[7],[8],[9],[10],[11] The purpose of this investigation was to determine the oral health status of children undergoing renal dialysis in Tehran children's Hospitals.

   Materials and Methods Top

In this cross-sectional study, 53 children aged between 5 and 18 years (20 males and 33 females) were studied. They were referred to one of the following hospitals for hemodialysis: children medical center, Bahrami, Ali-Askar, Labbafi Nejad. The data based on clinical examination, patients' medical files and parents' replies were examined for Lobene Gingival Index (MGI) and decayed, missing or filled teeth (DMF) and also factors such as, gender, age, anemia, heart disease and dialysis duration. Immunosuppressive administration was recorded and relation between these factors and DMF and MGI was studied. The Chi-square test was used for statistical analysis. [12],[13]

   Results Top

Significantly greater proportions of the CRF children were caries-free (33%). The mean DMF score was 2.25 (SD=2). None of the children in this study displayed an absence of gingival inflammation. There was no statistically significant relationship between the DMF scores and gender ( P =0.5), age ( P =0.5), anemia ( P =0.4), and heart disease ( P =0.5), dialysis duration ( P =0.4) and immunosuppressive administration ( P =0.3). There was a significant positive relationship between gingivitis and anemia ( P =0.0002) and dialysis duration ( P =0.007) [Table - 1],[Table - 2].

There was no statistically significant relationship between gingivitis and gender ( P =0.1), age ( P =0.3), heart disease ( P =0.7) and immunosuppressive administration ( P =0.3).

The results showed that moderate and severe gingivitis was five times more than mild gingivitis in children who have undergone renal dialysis for more than 1 year. In patients with anemia also moderate and severe, gingivitis were more than the mild gingivitis.

   Discussion Top

The dental disease indices for a group of 53 children with CRF were similar to those recorded by earlier workers. [2],[3] The main difference of this work is focused with particular attention to influence of anemia and other factors on oral and dental conditions.

A significantly greater proportion of children with CRF were caries free. Both the mean dmf and DMF were significantly lower in the CRF children which is in agreement with earlier studies. [2],[3]

Our data confirmed the finding from other studies that these children have a lower prevalence of dental caries. [7],[10],[11] It is likely that the increased pH of the oral cavity also plays a protective role. This occurs because salivary urea is split to form ammonia and carbon di-oxide may raise the pH above the critical level for demineralization of dental enamel. [1],[9],[14]

The values for the gingival index are also in agreement with other, similar studies [14] mild gingival over growth was seen in a significant number of the majority because it did not interfere with regular oral cleaning, was cosmetically acceptable and did not usually prevent the eruption of successor teeth. It is of note that there was no relationship between the use of chemotherapeutic agents to produce overgrowth and prevalence of gingival hyperplasia.

The results obtained in the present study, showed DMF does not change with increasing age. There was also relationship between the children with mixed dentition and who have permanent dentition ( P =0.5) which is in agreement with earlier work significantly [3] in this study there was no significant relation between duration of hemodialysis and DMF, while Alwahdani in his study confirmed higher proportion of DMF in children with increased dialysis duration. We found no relation between administrations of immunosuppressives and DMF, however, Benderli in his study showed the increase in DMF with administration of immunosuppressive. In contrast in the study carried out by Numm et al., children who used immunosuppressive had low incidence of dental caries. [2],[15],[16]

In the current study, there was no significant relation between gingivitis gender and age which in agreement with earlier study. [17] Significant, correlation with gingivitis and gingival index was seen with increasing dialysis duration, Which is in agreement with results from three earlier investigation. [17],[18],[19]

   Conclusion Top

It is suggested that anemia and dialysis duration should be considered specifically and the management of these factors and oral hygiene care in these children reduces their problems.

   References Top

1.Greenberg MS, Glick M. Burket's oral medicine diagnosis and treatment. 10 th ed Philadelphia; 2003. p. 417-9.  Back to cited text no. 1    
2.Numm JH, Sharp J, Lambert HJ, Plant ND, Coulthard MG. Oral health in children with renal disease. Pediatr Nephrol 2000;14:997-1001.  Back to cited text no. 2    
3.Al-Nowaiser A, Roberts GJ, Trompeter RS, Wilson M, Lucas VS. Oral health in children with chronic renal failure. Pediatr Nephrol 2003;18:39-45.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Epstein SR, Mandel I, Scopp IW. Salivary composition and calculus formation inpatients undergoing hemodialysis. J Periodontol 1980;51:336-8.  Back to cited text no. 4  [PUBMED]  
5.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 Periodontal 2002;29:479-83.  Back to cited text no. 5    
6.Gavalda C, Bagan JV, Scully C, Silvester FJ, Milian MA, Jimenez Y. Renal hemodialysis patients: Oral, salivary, dental and periodontal finding in 105 adult cases. Oral Dis 1999;5:299-302.  Back to cited text no. 6    
7.Peterson S, Woodhead J, Crall J. Caries resistance in children with chronic renal failure: Plaque pH, salivary pH and salivary composition. Pediatr Res 1985;19:796-9.  Back to cited text no. 7  [PUBMED]  
8.Ertugrul F, Elbek-Cubukcu C, Sabah E, Mir S. The oral health status of children undergoing hemodialysis treatment. Turk J Pediatr 2003;45:108-13.  Back to cited text no. 8  [PUBMED]  
9.Obry F, belcourt A, Frank RM, Geisrt J, Sommermater J, Fischbach M. Low caries activity and salivary pH in youngsters dialyzed for chronic renal failure. J Bio Buccale 1984;12:181-6.  Back to cited text no. 9    
10.Bublits A, Machat E, Scharer K, Komposch G, Mehls O. Changes in dental development in paediatric patient with chronic kidney disease. Proc Eur Dial Transplant Assoc 1981;18:517-23.  Back to cited text no. 10    
11.Wolff A, Stark H, Binderman I, Eisenstein B, Drukker A. The dental status of children with chronic renal, failure. Int Pediatr Nephrol 1985;6:127-32.  Back to cited text no. 11  [PUBMED]  
12.Sturdevants, Roberson. Operative dentistry. 4 th ed. Mosby: 2002. p. 67-8.  Back to cited text no. 12    
13.Newman M, Carranza F, Takei H. Clinical periodontology. 9 th ed. Philadelphia; 2002. p. 79-90.  Back to cited text no. 13    
14.Joff EC, Chuntler C, Charter JE. Denial findings in chronic renal failure. Br Dent J 1986;160:18-20.  Back to cited text no. 14    
15.Al-Wahadni A, Al-Omari MA. Dental diseases in Jordanian population on renal dialysis. Quintessence Int 2003;34:343-7.  Back to cited text no. 15    
16.Benderli Y, Erdilek D, Koray F, Telci A, Turan N. The relation between salivary IgA and caries in renal transplant patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:588-93.  Back to cited text no. 16    
17.Duran I, Erdemir EO. Periodontal treatment needs of patients with renal disease receivinghemodialysis. Int Dent J 2004;54:247-8.  Back to cited text no. 17    
18.Davidovich E, Schwore Z Davidovitch M, Eidelman E, Bimstein E. Oral findings and periodontal status in children adolusents and young adults suffering from renal failure. J Clin Periodontal 2005;32:1076-82.  Back to cited text no. 18    
19.Naugle K, Darby ML, Bauman DB, Lineberge LT, Powers R. The oral health status of individuals on renal dialysis. Ann Periodontal 1998;3:197-205.  Back to cited text no. 19    


  [Table - 1], [Table - 2]

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