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Oral health in children with chronic renal failure
Abeer Al-Nowaiser1, Graham J Roberts, Richard S Trompeter
1Department of Paediatric Dentistry, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK.
Insights
Children with chronic renal failure (CRF) show reduced dental caries but increased plaque and enamel defects. Higher salivary urea and buffering capacity were noted, with fewer oral Streptococcus mutans in CRF patients.
Area of Science:
- Pediatric Nephrology
- Oral Health
- Biochemistry
Background:
- Chronic renal failure (CRF) impacts multiple bodily systems, including oral health.
- Limited research exists on the specific oral health profile of pediatric CRF patients.
Purpose of the Study:
- To investigate dental caries, plaque, gingival health, enamel defects, and salivary parameters in children with CRF.
- To compare oral health indices between children with CRF and healthy controls.
Main Methods:
- Cross-sectional study involving 70 children with CRF (aged 4-13.6 years) and controls.
- Assessment of dental caries, plaque, gingival inflammation/enlargement, and enamel defects.
- Analysis of salivary urea, buffering capacity, and oral streptococcal flora in a subset of patients.
Main Results:
- CRF children had significantly higher caries-free rates (40% vs 8.5%) but increased plaque scores.
- Higher prevalence of enamel defects (57%) and gingival enlargement (8 CRF children) observed in the CRF group.
- CRF group exhibited greater salivary buffering capacity and significantly higher salivary urea levels, with reduced Streptococcus mutans.
Conclusions:
- Pediatric CRF is associated with a unique oral health profile, including caries protection but increased plaque and enamel defects.
- Elevated salivary urea and buffering capacity in CRF may influence oral microflora and disease prevalence.
- Integrated dental care focusing on oral hygiene is crucial for managing potential complications like gingival hyperplasia and periodontal disease in pediatric CRF patients.
Abstract:
Seventy children with chronic renal failure (CRF) aged 4-13.6 years were recruited from the Renal Unit of the Great Ormond Street Hospital for Children. Indices were recorded for dental caries, dental plaque, gingival inflammation, gingival enlargement, and enamel defects. Salivary urea, buffering capacity, and the oral streptococcal flora were determined for 25 of the children. A significantly greater proportion of the CRF children was caries free, 40% compared with 8.5% of the controls. The mean plaque score was significantly greater in the CRF group for both the primary 12.7 (16) and permanent dentition 22.0 (18.2) compared with the controls, 5.3 (7.6) and 15.5 (13.3), respectively. Eight CRF children had gingival enlargement. Enamel defects affecting the permanent teeth were observed in 57% of the CRF children compared with 33% of the controls. The buffering capacity was significantly greater in the CRF group, pH 6.4 (0.5) compared with the controls pH 5.6 (0.8). The mean salivary urea level (mmol/l) was significantly greater in the CRF children, 11.6 (5.9) compared with 3.6 (1.4) for the controls. The isolation frequency of Streptococcus mutans was significantly greater from controls compared with the CRF children ( P=0.002). An integrated dental service needs to be developed with emphasis on tooth brushing to prevent gingival hyperplasia and periodontal disease after puberty.