Aim: To assess the prevalence of oral findings in diabetic and nondiabetic chronic renal failure (CRF) patients receiving hemodialysis (HD).
Materials and methods: This study was conducted on 144 CRF patients undergoing HD therapy. They were further classified into diabetic and nondiabetic groups and also according to the duration of CRF. An oral examination was performed, searching for CRF-associated oral findings, along with due considerations to duration of CRF.
Results: The oral manifestations were found to be higher in diabetic CRF patients (97.14%) relative to nondiabetic CRF patients (89.18%). The diabetic group exhibited a significantly higher number of patients with poor oral hygiene index (p = 000), uremic fetor (p = 0.005), unpleasant taste (p = 0.009), dry-fissured lips (p = 0.002), and pale mucosa (p = 0.019) than the nondiabetic group. The oral manifestations were significantly higher in CRF patients of more than 24 months’ duration.
Conclusion: The CRF HD patients with diabetes mellitus exhibited a higher risk of oral uremic manifestations including uremic fetor, unpleasant taste, pale mucosa, and dry-fissured lips than nondiabetics. The oral health status of CRF HD patients becomes worse with the increase in the duration of CRF
Clinical significance: Oral health status is often a neglected aspect in CRF patients. It should be given prime importance for CRF patients receiving HD to improve the quality of life.
Snyder S, Pendergraph B. Detection and evaluation of chronic kidney disease. Am Fam Physician 2005 Nov;72(9):1723-1732.
Sobrado-Marinho JS, Tomas Carmona I, Loureiro A, Limeres Posse J, Garcia Caballero L, Diz Dios P. Oral health status in patients with moderate-severe and terminal renal failure. Med Oral Patol Oral Cir Bucal 2007 Aug;12(4):305-310.
Gudapati A, Ahmed P, Rada R. Dental management of patients with renal failure. Gen Dent 2002 Nov-Dec;50(6):508-510.
Manfredi M, McCullough MJ, Vescovi P, Al-Kaarawi ZM, Porter SR. Update on diabetes mellitus and related oral diseases. Oral Dis 2004 Jul;10(4):187-200.
Arrieta-Blanco JJ, Bartolome-Villar B, Jimenez-Martinez E, Saavedra-Vallejo P, Arrieta-Blanco FJ. Bucco-dental problems in patients with diabetes mellitus (1): index of plaque and dental caries. Med Oral 2003 Mar-Apr;8(2):97-109.
Molina SD, Monroy RE, Arenas R, Fernandez RF, Rubalcaba PJ, Fabian SMG. Frecuencia de candidiasis oral en pacientes diabeticos tipo 2 ambulatorios en el Hospital General Manuel Gea Gonzalez. Estudio clínico micológico. Dermatología Rev Mex 2002;46:3-9.
Proctor R, Kumar N, Stein A, Moles D, Porter S. Oral and dental aspects of chronic renal failure. J Dent Res 2005 Mar;84(3):199-208.
Kumar NN, Panchaksharappa MG, Annigeeri RG. Modified Schirmer test—a screening tool for xerostomia among subjects on antidepressants. Arch Oral Biol 2014 Aug;59(8):829-834.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964 Jan;68:7-13.
Muhlemann HR. Psychological and chemical mediators of gingival health. J Prev Dent 1977 Jul-Aug;4(4):6-16.
Cohen SG. Renal disease. In: MA Lynch, VJ Brightman, MS Greenberg, editors Burket's Oral Medicine. Mexico: McGraw- Hill International; 1996. pp. 492-514.
Bottomley WK, Cioffi RF, Martin AJ. Dental management of the patient treated by renal transplantation: preoperative and postoperative considerations. J Am Dent Assoc 1972 Dec;85(6):1330-1335.
Kalyvas D, Tosios KL, Leventis MD, Tsiklakis K, Angelopoulos AP. Localized jaw enlargement in renal osteodystrophy: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004 Jan;97(1):68-74.
Tadakamadla J, Kumar S, Mamatha GP. Comparative evaluation of oral health status of chronic kidney disease (CKD) patients in various stages and healthy controls. Spec Care Dentist 2014 May-Jun;34(3):122-126.
de Souza CM, Braosi AP, Luczyszyn SM, Olandoski M, Kotanko P, Craig RG, Trevilatto PC, Pecoits-Filho R. Association among oral health parameters, periodontitis, and its treatment and mortality in patients undergoing hemodialysis. J Periodontol 2014 Jun;85(5):e169-e178.
Kho HS, Lee SW, Chung SCh, Kim YK. Oral manifestations and salivary flow rate, pH, and buffer capacity in patients with end-stage renal disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999 Sep;88(3):316-319.
Postorino M, Catalano C, Martorano C, Cutrupi S, Marino C, Cozzupoli P, Scudo P, Zoccali C. Salivary and lacrimal secretion is reduced in patients with ESRD. Am J Kidney Dis 2003 Oct;42(4):722-728.
Oldenburg B, Macdonald GJ, Perkins RJ. Factors influencing excessive thirst and fluid intake in dialysis patients. Dial Transplant 1988;17:21-23.
Charra B, Chazot C. Volume control, blood pressure and cardiovascular function. Lessons from hemodialysis treatment. Nephron Physiol 2003;93(4):94-101.
Kaya M. Cermik TF, Üstun F, Sen S, Berkarda S. Salivary function in patients with chronic renal failure undergoing hemodialysis. Ann Nuclear Med 2002 Apr;16(2):117-120.
Epstein SR, Mandel I, Scopp IW. Salivary composition and calculus formation in patients undergoing hemodialysis. J Periodontol 1980 Jun;51(6):336-338.
Kao ChH, Hsieh JF, Tsai SCh, Ho YJ, Chang HR. Decreased salivary function in patients with end-stage renal disease requiring hemodialysis. Am J Kidney Dis 2000 Dec;36(6): 1110-1114.
Shepherd R, Farleigh CA, Atkinson C, Pryor JS. Effects of haemodialysis on taste and thirst. Appetite 1987 Oct;9(2): 79-88.
Ciechanover M, Peresecenschi G, Aviram A, Steiner JE. Malrecognition of taste in uremia. Nephron 1980;26(1): 20-22.
Skorecki K, Green J, Brenner BM. Chronic renal failure. In: DL Kasper, E Braunwald, AS Fauci, SL Hauser, DL Longo, JL Jameson, editors Harrison's principles of internal medicine. New York: McGraw-Hill; 2005. pp. 1653-1663.
Baney GPE. Oto-laryngeal problems arising during the management of severe renal failure. J Laryngol Otol 1964 May;78:507.
Davidovich E, Davidovits M, Eidelman E, Schwarz Z, Bimstein E. Pathophysiology, therapy, and oral implications of renal failure in children and adolescents: an update. Pediatr Dent 2005 May-Apr;27(2):98-106.
Duran I, Erdemir EO. Periodontal treatment needs of patients with renal disease receiving haemodialysis. Int Dent J 2004 Oct;54(5):274-278.
Chen L-P, Chiang C-K, Chan C-P, Hung K-Y, Huang C-S. Does periodontitis reflect inflammation and malnutrition status in hemodialysis patients? Am J Kidney Dis 2006 May;47(5):815-822.
Cohen G, Haag-Weber M, Horl WH. Immune dysfunction in uremia. Kidney Int 1997 Nov;62:S79-S82.
Naugle K, Darby ML, Bauman DB, Lineberger LT, Powers R. The oral health status of individuals on renal dialysis. Ann Periodontol 1998 Jul;3(1):197-205.
Al-Wahadni A, Al-Omari MA. Dental diseases in a Jordanian population on renal dialysis. Quintessence Int 2003 May;34(5): 343-347.
Marakoglu IK, Gursoy KD, Demirer S, Sezer H. Periodontal status of chronic renal failure patients receiving hemodialysis. Yonsei Med J 2003 Aug;44(4):648-652.
Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, Norderyd OM, Genco RJ. Assessment of risk for periodontal disease. Risk indicators for attachment loss. J Periodontol 1994 Mar;65(3):260-267.
Chuang SF, Sung JM, Kuo SC, Huang JJ, Lee SY. Oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005 Jun;99(6):689-695.