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Oral hygiene and health among hemodialysis patients
Anna Kliś1, Tomasz Irzyniec2, Beata Jarczewska-Głośnicka3
1Szpital Wojewódzki, Bielsko-Biała, Poland;
2 Silesian Medical University, Katowice, Poland 3 STOMA-DENT, Bielsko-Biała, Poland
Background
Dental and oral cavity diseases are common problem among patients with chronic kidney disease (CKD).
CKD leads to the fast progress of caries and periodental diseases.
Oral health is also deteriorated by inadequate hygiene.
The consequence is dysfunction of the chewing apparatus and improper nutrition, which impairs the quality of life and leads to malnutrition.
2
Background
In addition, The World Health Organization points to the correlation between obesity and periodontal disease.
Oral status is also important in the transplant qualification process.
3
Background
Patients who require dialysis are predisposed to dental problem such as:
Peridontal disease,
Gingivitis,
Tooth abnormalities,
Premature tooth loss,
Xerostomia.
Sokołowska-Trelka A. and all, Specific Dental Problems of End-Stage Renal Disease Patients, Dnt. Med. Probl. 2005, 42, 351-356.
4
Objectives
The assessment of behaviors related to oral hygiene for hemodialysed patients and clinical evaluation of their oral health.
5
Methods
49 hemodialysis patients from Bielsko-Biała were examined by a dentist.
The oral examination occured in the dialysis unit on the day of dialysis.
We performed oral examination in the dialysis room using a light-emitting diode (LED) headlamp and standard sterile oral examination kit.
6
Methods
The research material was also collected by means of a 16-items author’s questionnaire and blood tests results.
Study was approved by the Research Ethics Committee.
Participation was voluntary and anonymous – consent signed.
7
Results
The mean age of the respondents: 59.76 ± 14.37 years (range 31-83 years).
The mean duration of participants requiring haemodialysis: 50.45 ± 59.04 months (range 1-274 months). The mean Kt/V: 1.21 ± 0.21
The mean BMI: 26.98 ± 6.89 kg/m2
8
34,69%
65,31% Women
Men
Results
9
Women Men All
Frequency of dental office
visits
Once every six months
Once a year
Once every 2 years
Less frequently
35.30%
41.17%
5.88%
17.65%
18.75%
40.62%
9.38%
31.25%
24.49%
40.82%
8.16%
26.53%
Frequency of toothbrush
replacement
Once every three months
Once every six months
Less frequently
More frequently
52,94%
29,41%
11,77%
5,8%
43,75%
28,13%
21,87%
6,25%
46,94%
28,57%
18,37%
6,12%
Frequency of brushing No brushing
Once a day
Twice a day
After each meal
-
23,53%
70,59%
5,88%
12,50%
28,13%
53,12%
6,25%
8,16%
26,53%
59,19%
6,12%
Forgetting about brushing Yes
No
47,06%
52,94%
56,25%
43,75%
53,06%
46,94%
Other hygiene treatments
(flossing, rinsing…)
Yes
No
29,41%
70,59%
28,13%
71,87%
28,57%
71,43%
Movable dentures Yes
No
52,94%
47,06%
46,88%
53,12%
48,98%
51,02%
Results
10
Type of toothbrush N %
Manual, soft 8 16,33
Manual, medium 23 46,94
Manual, hard 7 14,28
Manual but it doesn’t matter what is it’s
hardness
9 18,37
Electrical 2 4,08
Total 49 100
Results
75,51% of patients reported a problems with oral health, which in most cases (81,63%) appeared with dialysis.
Contrary to the assumptions only 18,37% of patients reported bleeding gums during brushing teeth.
11
Dental examination Inssuficient oral hygiene (Oral Hygiene Index – OHI) was found
in 24,49% of patients.
Women Men
OHI:
0 < 1 – Good oral hygiene
1.1 < 2.0 – Sufficient oral hygiene
2.1 < 3.0 – Bad oral hygiene
12
2 2
1
0,6
1,5
2
0,3333
1
1,6
1,1666
0,83333
2
1,5
1
2
1,25
1,8332
2,4
2
1,5
2
0,8333
2,1666 2
3,1666
2,6666
1
1,5
0,3333
2
1,33333 1,1666
0
0,5
1
1,5
2
2,5
3
3,5
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
2,1666
1,6
3,5
2
1,4999
0,1666
1
2 2,3333
1,2 1,433
1,6666
4,4996
2,5 2,33333
0,8333
2,6666
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Dental examination Approximal Plaque Index (API) indicated the average hygiene of
interdental spaces and need improvement (68,27%).
Women Men
API:
70-100% - Bad oral hygiene
40-69% - Sufficient oral hygiene
25-39% - Good oral hygiene
< 25% - Optimal oral hygiene 13
40
82,23
3,57
69,23 61,54
85,71
17,26 21,42
65,21
55
39,28
76,92 68,75
100
33,33
50 55
85
100
60
100
29,62
85,18 91,6
100 100
3,57
80
12,5
100
58
77,77
0
20
40
60
80
100
120
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
61,5
80
100 100
36,84
7,14
100 100 95,65
54,54
70 76
100 100
70
39,13
81,81
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Dental examination
Sulcus Bleeding Index (SBI) – 36,22%.
Women Men
SBI:
50-100% - Generalized heavy bleeding
30-49% - Generalized moderate bleeding
10-29% - Localized mild bleeding
<10% - Clinically healthy gums
14
75
43,75
74,07
100
75
59,25 50
39,28
20
0
20
40
60
80
100
120
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
28
6,66 12
0
38,46
10,71
33
14,29
39,13
81,81
55
20
100 100
50
8,6
68,18
0
20
40
60
80
100
120
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Dental examination
Women Men
The mean amount teeth with caries: 5.7 ± 3.9
15
5 5
7
5 6
5
3
9
4
7
9
5
3
1
6
3 4
9
2
4
1 2
10
5
12
9
7
2
0
4 4
10
0
2
4
6
8
10
12
14
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
7
5
10
0
7
2 3
5
13
6 5
15
19
2
0
4
9
0
2
4
6
8
10
12
14
16
18
20
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Dental examination
The mean amount removed teeth: 12.5 ± 8.5 More than 10 teeth were removed due to caries over a
half of patients.
Women Men
16
17
12
1
18
4
16
1 2
8
3 4
17
3
27
22
13
9 11
24
19
27
4 4
17
9
15
1
21
5
24
18
1 0
5
10
15
20
25
30
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
8
13
1
26
15
0
25
21
9
19 20
6 7
26
23
6
10
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Conclusion
Oral health is getting worse with the start of renal replacement therapy.
Most patient with inadequate oral hygiene and problems in oral health indicates the need for the education.
Larger studies are required.
17
Thank You!
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