Decrease in oral health may be associated with length of time since beginning dialysis

The aim of this study was to evaluate how oral health is affected by the length of time a patient has been receiving hemodialysis (HD) treatment. Ninety‐four subjects participated in this study. Demographic, periodontal parameters, and decayed missing and filled teeth (DMFT) index were recorded by a trained and calibrated examiner. The subjects were divided into two groups: Group L (subjects who had been on HD for less than 36 months), and Group M (those who had been on HD for more than 37 months). In Group M, the mean probing depth was deeper (p= 0.01) and clinical attachment loss was significantly higher (p= 0.02) than subjects in Group L. The DMFT index score was also significantly higher in Group M (p= 0.03). A moderate correlation between length of time on HD and DMFT index, probing depth, and clinical attachment loss was observed. The group of subjects who had been on HD for more than 37 months had more periodontal disease and higher DMFT index scores, suggesting that the length of time on HD could negatively impact oral health.     

Extent and severity of chronic periodontitis in chronic kidney disease patients

Brito F, Almeida S, Figueredo CMS, Bregman R, Suassuna JHR, Fischer RG. Extent and severity of chronic periodontitis in chronic kidney disease patients. J Periodont Res 2012; 47: 426–430. © 2011 John Wiley & Sons A/S Background and Objectve: Chronic inflammatory diseases have been investigated as a possible source of inflammation in chronic kidney disease patients; however, there is a shortage of information about the prevalence of periodontitis in such individuals. Therefore, the aim of this cross‐sectional study was to determine the extent and severity of periodontitis in chronic kidney disease patients undergoing the following three different treatment modalities: predialysis; continuous ambulatory peritoneal dialysis (CAPD); and hemodialysis (HD); and to compare the findings with those from systemically healthy individuals. Material and Methods: Forty CAPD patients (mean age 52 ± 12 years), 40 HD patients (mean age 50 ± 10 years), 51 predialysis patients (mean age 54 ± 11 years) and 67 healthy individuals (mean age 50 ± 7 years) were examined. The periodontal examination included probing pocket depth, clinical attachment loss, bleeding on probing and presence of plaque. Patients with at least four sites with clinical attachment loss ≥ 6 mm were considered to have severe chronic periodontitis, and those with at least 30% of sites with clinical attachment loss ≥ 4 mm were considered to have generalized chronic periodontitis. Results: Predialysis and HD patients had significantly more sites with clinical attachment loss ≥ 6 mm than healthy individuals. The CAPD patients had similar periodontal condition to healthy subjects. There were significantly more cases of severe chronic periodontitis in predialysis and HD patients. Conclusion: Predialysis and HD are associated with a higher prevalence of severe periodontitis compared with healthy individuals and CAPD patients.     

Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis

OBJECTIVE: To analyze and compare periodontal parameters in chronic renal failure (CRF) patients undergoing peritoneal dialysis (PD) therapy with a group of patients on hemodialysis (HD) treatment and healthy controls (C). Participants: Seventy-five PD patients (mean age: 44 +/- 12 years) were matched with 41 HD patients (mean age: 46 +/- 15 years) and 61 C (mean age: 46 +/- 18 years). METHODS: Plaque (PI) and calculus (CSI) accumulation and gingival bleeding (GI) were recorded with the appropriate indices. Periodontal condition was assessed using the probing pocket depth (PPD). One-way anova test, Pearson chi-squared test, Mann-Whitney U-test and Kruskal-Wallis test were performed to compare PD patients with HD patients and healthy C. RESULTS: Plaque Index values were significantly higher (P < 0.001) in the PD and HD groups than the C group. GI values were significantly higher (P < 0.01) in the HD group than the PD group. Finally, CSI values in the PD and HD groups were also significantly higher (P < 0.001) than the C group. CONCLUSIONS: Chronic renal failure patients on PD treatment are more susceptible to periodontal diseases like HD patients. Thus, it is very important to maintain an optimal oral hygiene level. Further studies on periodontal parameters of only PD patients are needed to get more information on the oral health status of this patient group.     

牙周病与慢性阻塞性肺病的联系

牙周病作为一种慢性感染性疾病与许多全身性疾病有着密切的联系。对于慢性阻塞性肺病（chronic obstractive pulmonarg discases，COPD），牙周病作为局部病灶可以促进其发生与发展。本文就牙周病对COPD的影响途径、两者间的流行病学调查，以及一些细胞因子对两者的作用机制做一综述。     

Epidemiologic associations between periodontal disease and chronic obstructive pulmonary disease

The nature of the relationship of periodontal disease to a number of systemic health outcomes, including chronic obstructive pulmonary disease (COPD), remains unclear. Various causal mechanisms have been proposed to explain the observed epidemiologic associations between periodontal diseases and respiratory diseases. We have reviewed the epidemiologic and clinical evidence for this association. The methodologic approach we have taken is based on a structured systematic review of the indexed biomedical literature on these subjects. The primary focus of this review was on the analysis of periodontal health status measures and their association with COPD, which includes chronic bronchitis and emphysema. We found that a paucity of published results exist on this specific relationship and those which do exist typically represent secondary analyses of existing data sets. Nevertheless, the epidemiologic evidence identified in this systematic review indicates that worse periodontal health status is associated with an increased risk of COPD, with odds ratios ranging from 1.45 to 4.50 (significant at the 95% confidence interval). However, it is possible that residual confounding by tobacco smoking may account in part for the observations. A causal association between periodontal health status and risk of COPD, although biologically plausible, remains speculative. Randomized controlled trials will be required in order to address the question of causality and to better understand the biological basis of these epidemiologic associations.     

The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy

OBJECTIVE: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population. DESIGN: Cross-sectional study. SUBJECTS: Forty-two dentate CRF patients--aged 25-52 years old--were matched with a reference group of 808 dentate subjects. METHODS: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self-reported dental problems. Student t-tests and chi-square tests were performed to compare the CRF patients with the controls. RESULTS: All index-scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 +/- 2.6) than in controls (3.0 +/- 2.9). The self-reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08). CONCLUSIONS: For most dental aspects, the oral health of CRF patients is comparable with controls.     

Diagnosis and classification of periodontal disease

Periodontal diseases have been recognized and treated for at least 5000 years. Clinicians have recognized for many years that there are apparent differences in the presentation of periodontal diseases and have attempted to classify these diseases. Systems of classifications of disease have arisen allowing clinicians to develop structures which can be used to identify diseases in relation to aetiology, pathogenesis and treatment. It allows us to organize effective treatment of our patients' diseases. Once a disease has been diagnosed and classified, the aetiology of the condition and appropriate evidence-based treatment is suggested to the clinician. Common systems of classification also allow effective communication between health care professionals using a common language. Early attempts at classification were made on the basis of the clinical characteristics of the diseases or on theories of their aetiology. These attempts were unsupported by any evidence base. As scientific knowledge expanded, conventional pathology formed the basis of classification. More recently, this has been followed by systems of classification based upon our knowledge of the various periodontal infections and the host response to them. Classification of periodontal diseases has, however, proved problematic. Over much of the last century clinicians and researchers have grappled with the problem and have assembled periodically to review or develop the classification of the various forms of periodontal disease as research has expanded our knowledge of these diseases. This has resulted in frequent revisions and changes. A classification, however, should not be regarded as a permanent structure. It must be adaptable to change and evolve with the development of new knowledge. It is expected that systems of classification will change over time. This review examines the past and present classifications of the periodontal diseases.     

血液透析时间对终末期肾脏病患者口腔状况的影响

目的：探讨血液透析时间对终末期肾脏病患者口腔状况的影响。方法：对纳入的130名患者进行龋病和牙周病状况调查,并根据透析时间进行分组,比较组间的口腔健康状况,同时分析口腔临床指标与透析时间之间的关系。结果：3组间的基本资料均衡,龋病状况无显著差异,菌斑指数、牙龈指数和牙周病指数值随透析时间逐渐增加,组间存在显著差异,牙周病指标与透析时间存在显著正相关。结论：血液透析时间对终末期。肾脏病患者的牙周状况产生影响,透析时间是这类患者牙周病的一个危险因素。     

慢性牙周炎和慢性肾病相关关系的 研究进展

慢性牙周炎不仅可以导致牙周支持组织的破坏和丧失,还与多种全身系统性疾病如高血压、糖尿病等有关.慢性肾病是一种破坏肾功能的威胁人类健康的常见的全身性疾病.近年来大量研究显示,慢性牙周炎与慢性肾病可能具有相关关系,通过治疗牙周炎有可能改善肾功能.本文就慢性牙周炎与慢性肾病相关性的流行病学调查研究、牙周治疗对慢性肾病的影响以...     

慢性牙周炎与慢性肾病相关性研究进展

慢性牙周炎是发生在牙周支持组织的一种慢性炎症性破坏性疾病,牙周炎不仅影响口腔健康,也与全身健康密切相关。慢性肾病被认为是一种严重危害生命健康的非传染性慢性疾病。近年来有研究发现慢性牙周炎与慢性肾病之间有密切联系。本文就慢性牙周炎与慢性肾病相关性研究进展作一综述。     

Smoking and periodontal disease

Periodontal disease is considered to be an opportunistic infection as a result of interactions between the causative agents (dental plaque) and the host responses which may be modulated by genetic, environmental and acquired risk factors. Besides being a well-confirmed risk factor in a number of systemic diseases, tobacco smoking has also been associated with periodontal disease. Over the past 10–15 years, more and more scientific data on the impact of smoking on various aspects of periodontal disease and the underlying mechanisms has been published. The purpose of this review was to provide an overview of the available data in order to give practitioners a better understanding of the relationship between smoking and periodontal disease. Subsequently, they can use some of the information in treatment decisions and give advice to patients who are smokers suffering from periodontal disease.     

Relationships among bone turnover, renal function and periodontal disease in elderly Japanese

Yoshihara A, Hayashi Y, Miyazaki H. Relationships among bone turnover, renal function and periodontal disease in elderly Japanese. J Periodont Res 2011; 46: 491–496. © 2011 John Wiley & Sons A/S Background and Objective: We hypothesized that renal function is associated with the relationship between periodontal disease and bone metabolism. The present study evaluated the relationship of bone formation and resorption markers to periodontal disease, taking renal function into consideration, in elderly Japanese subjects. Material and Methods: We selected 148 subjects aged 77 years. The periodontal examination included the assessment of clinical attachment level (CAL). We measured two bone formation markers (serum bone‐specific alkaline phosphatase and serum osteocalcin) and two bone resorption markers (urinary deoxypyridinoline and urinary cross‐linked N‐telopeptide of type I collagen). Creatinine clearance per 24 h, as a measure of renal function, was also determined. The correlations between mean CAL or percentage of sites with ≥6 mm CAL (6+mm CAL) and bone turnover markers, and between bone turnover markers and creatinine clearance levels, were performed by multiple linear regression analysis. Results: There were significant negative relationships between mean CAL or 6+mm CAL and serum osteocalcin levels adjusted for gender, smoking habits and oral care habits (β = ?0.25, p = 0.014 and β = ?0.35, p = 0.001, respectively). In addition, there was a negative relationship between serum osteocalcin and creatinine clearance levels adjusted for gender and smoking habits (β = ?0.45, p < 0.0001). Conclusion: Results from the present study suggest that serum osteocalcin was significantly associated with renal function and periodontal disease. The low systemic bone metabolism, which might be caused by low renal function, is associated with periodontal disease.     

叶酸与牙周病的关系

叶酸在维持机体健康中起着重要作用,研究已证实叶酸的不足是许多慢性疾病的危险因素。牙周病是多因素(包括叶酸缺乏)介导的口腔最常见的两种疾病之一。本文将对二者的关系作一综述。     

Relationship between periodontal disease and lung cancer: A systematic review and meta-analysis

Periodontal disease (PD), as a chronic bacterial infection, might cause cardiovascular and some other systemic diseases, with recent studies reporting that it exhibits some connection with lung cancer. While studies have shown that poor oral health might increase the risk of lung cancer, the veracity of these reports is questionable. Therefore, this meta-analysis was undertaken to investigate the association between PD and the risk of lung cancer. A search was run in PubMed, EMBASE, MEDLINE, CENTRAL, and ClinicalTrials.gov databases up to January 1, 2020. Cohort and case-control studies investigating the correlation between PD and lung cancer were included. Eligibility assessment and data extraction were conducted independently, and a meta-analysis was performed to synthesize the data. The association between PD, edentulism, and lung cancer was measured by the adjusted hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs) provided in articles. We employed appropriate effect model in terms of I² (a fixed-effect model for PD and a random-effect model for edentulism) to obtain summary effect estimates. Statistical heterogeneity was investigated by chi-square test and I² statistics. Newcastle-Ottawa Scale (NOS) was used to assess the quality of their method. Six cohort studies (eight references) and two case-control studies, assessed as high-quality, involving 167 256 participants, were included in the review. The summary estimates based on adjusted data showed an association between PD and a significant risk of lung cancer both in cohort studies (HR = 1.40, 95% CI = 1.25-1.58; I² = 8.7%) and case-control studies (OR = 1.51, 95% CI = 1.16-1.98; I² = 36.5%). Similar features were found in the sensitivity analysis and subgroups for six cohort studies, of male only (HR = 1.36, 95% CI = 1.15-2.60), setting the lung cancer incidence as endpoint (HR = 1.39, 95% CI = 1.24-1.57; I² = 23.9%), and adjusting alcohol for multifactorial HR (HR = 1.38, 95% CI = 1.21-1.57; I² = 39.9%). The summary HR for edentulism was 1.93 (95% CI = 1.05-3.57; I² = 55.3%). No obvious publication bias was detected. This systematic review and meta-analysis demonstrated a significant association between PD and the incidence of lung cancer. Further observational studies are required by using standardized measurements to assess the periodontal status and by eliminating confounding factors, such as alcohol and diabetes, to verify such a relationship.