Kidney treatment could affect mouth health

By Sarah Guy

Study results indicate a positive association between the type of treatment modality chronic kidney disease (CKD) patients receive and the likelihood for them having periodontitis.

Specifically, CKD patients undergoing predialysis or hemodialysis are significantly more likely to have severe chronic periodontitis than their counterparts treated with continuous ambulatory periodontal dialysis (CAPD) or healthy individuals without CKD.

"The pathogenesis of periodontitis elicits the production of cytokines, prostaglandins, and in some cases, acute phase reagents, such as C-reactive protein; therefore periodontitis may have a systemic negative effect on homeostasis and a negative influence on any ongoing disease," explain Ricardo Fischer and colleagues from Rio de Janeiro State University, Brazil.

Their study included 40 CAPD patients, 40 hemodialysis patients, 51 predialysis patients, and 67 healthy individuals with no clinical signs of ongoing systemic disease.

All study participants underwent oral clinical examinations, and chronic periodontitis was defined as having clinical attachment loss of at least 4 mm in more than 30% of oral sites, while severe chronic periodontitis denoted the presence of at least four sites with clinical attachment loss of at least 6 mm.

Fischer and co-investigators found a significantly higher incidence of generalized chronic periodontitis among predialysis patients compared with CAPD and hemodialysis patients, and healthy individuals, at 56.9% versus 15.0%, 25.0%, and 26.9%, respectively.

They also report significantly higher rates of severe chronic periodontitis in predialysis and hemodialysis patients, compared with CAPD patients and healthy participants, at 62.7% and 55.0% versus 32.5% and 28.0%.

Adjustment for gender and race had no significant effect on these results, Fischer et al note in the Journal of Periodontal Research. However, current smoking significantly increased the higher frequency of generalized chronic periodontitis in the predialysis group compared with not smoking.

This association with smoking could have been influenced by the fact that current smoking was about three times more common among the CKD patients than the healthy individuals, observe the authors.

Finally, the researchers report that predialysis and hemodialysis patients had a significantly higher percentage of oral sites with clinical attachment loss of more than 6 mm, indicating "worse periodontal conditions" overall.

To provide insight into possible causes of their findings, the research team suggests "an appropriate case-control study should be designed to answer the question of whether CKD is associated with periodontitis."

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