DR HAIDAR KHADEMI ASSISTANT PROFESSOR

AND HEAD OF ORAL MEDICINE DEPARTMENT OF DENTAL SCHOOL OF

ISFAHAN MEDICAL SCIENCES

UNIVERSITY.IRAN

04/19/23 3

Determination of DMFT Determination of DMFT index in patients with index in patients with

ESRD being treated by ESRD being treated by hemodialysis in Ali hemodialysis in Ali

Asghar medical center ofAsghar medical center of

There are 8 million people in the UNITED STATES There are 8 million people in the UNITED STATES today with some form of kidney disease.Of today with some form of kidney disease.Of these,some 60000 die annually as a result of these,some 60000 die annually as a result of

chronic,progressive,irreversible kidney chronic,progressive,irreversible kidney failure(ESRD).failure(ESRD).

Each year approximately 1.3 in 10000 develop Each year approximately 1.3 in 10000 develop ESRD,and this is increasing by about 10% per ESRD,and this is increasing by about 10% per

year ,most rapidly in patients over 65.ESRD is a year ,most rapidly in patients over 65.ESRD is a bilateral,progressive,and chronic deterioration of bilateral,progressive,and chronic deterioration of

nephrons that results in uremia and ultimately leads nephrons that results in uremia and ultimately leads to death.to death.

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ACUTEACUTE CHRONICCHRONIC

Diabetes mellitus 44.4%Diabetes mellitus 44.4% Hypertension26.6%Hypertension26.6% Glomerlunephritis 12.2%Glomerlunephritis 12.2% Interstitial nephritis7.2 %Interstitial nephritis7.2 % Other diseases 9.6% Other diseases 9.6%

Diabetes mellitus 44.4%Diabetes mellitus 44.4% Hypertension26.6%Hypertension26.6% Glomerlunephritis 12.2%Glomerlunephritis 12.2% Interstitial nephritis7.2 %Interstitial nephritis7.2 % Other diseases 9.6% Other diseases 9.6%

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GastrointestinalGastrointestinal NeuromuscularNeuromuscular Hematologic,immunologicHematologic,immunologic Endocrine metabolicEndocrine metabolic CardiovascularCardiovascular Dermatologic Dermatologic

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1.1. Enlarged(asymptomatic salivary glands)Enlarged(asymptomatic salivary glands)2.2. Decreased salivary flowDecreased salivary flow3.3. Dry mouth Dry mouth 4.4. Odor of urea on breath Odor of urea on breath 5.5. Metalic tasteMetalic taste6.6. Increased calcium formationIncreased calcium formation7.7. Low caries rate Low caries rate 8.8. Enamel hypoplasiaEnamel hypoplasia9.9. Dark brown stains on crownsDark brown stains on crowns10.10.Dental malocclusion Dental malocclusion

11.Pale mucosa11.Pale mucosa12.Low grade gingival inflammation12.Low grade gingival inflammation13.Petechea and echymosis13.Petechea and echymosis14.Bleeding from gingiva14.Bleeding from gingiva15.Prolonged bleeding15.Prolonged bleeding16.Candida infections16.Candida infections17.Burninig and tenderness of mucosa 17.Burninig and tenderness of mucosa 18.Erosive glossitis18.Erosive glossitis19.Tooth erosion (secondray to regugitation)19.Tooth erosion (secondray to regugitation)20.Dehiscence of wounds20.Dehiscence of wounds

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o Deminralization of boneo Loss of bony trabeculationo Ground glass appearanceo Loss of lamina durao Giant cell lesions(brown tumors)o Sockets sclerosiso Pulpal narrowing and calcificationo Tooth mobilityo Arterial and oral calcification

REVIEW OF LITRATURESREVIEW OF LITRATURES

19811981 BUBLITEZ ENAMEL HYPOPLASIA IN2 BUBLITEZ ENAMEL HYPOPLASIA IN2 GROUPS OF NEPHROTIC SYN {73} AND CRF (49).GROUPS OF NEPHROTIC SYN {73} AND CRF (49).1982 1982 DEFFEZ FRENCH. DEFFEZ FRENCH. 19841984 ORBY FRENCH LOWER DECAY IN ESRD ORBY FRENCH LOWER DECAY IN ESRD HYPOPLASIA 2 TEETH. HYPOPLASIA 2 TEETH. 19851985 WOLF & PETERSON WOLF & PETERSON ENAMEL EFFECTS IN CHILDREN(60%) ESRD,CRF. ENAMEL EFFECTS IN CHILDREN(60%) ESRD,CRF. 19891989 GERMANY SCHEULTZEL GERMANY SCHEULTZEL 52% ENAMEL HYPOPLASIA. 52% ENAMEL HYPOPLASIA.19911991 ROJAS FRENCH ROJAS FRENCH19981998 U.S.A U.S.A

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OBJECTIVES • Despites these unfavorable factors,the recent Despites these unfavorable factors,the recent

researches indicated relatively lower DMFT index researches indicated relatively lower DMFT index in these patients.Regarding these results ,this study in these patients.Regarding these results ,this study was trying to identify the DMFT index. The study was trying to identify the DMFT index. The study attempted to find out whether there was statistically attempted to find out whether there was statistically meaningful difference between patients with ESRD meaningful difference between patients with ESRD being treated by hemodialysis,and healthy people.In being treated by hemodialysis,and healthy people.In addition ,the effect of factors,sex,the age of the addition ,the effect of factors,sex,the age of the beginning of hemodialysis treatment and duration beginning of hemodialysis treatment and duration of hemodialysis.of hemodialysis.

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METHODS

• In this descriptive-analytic research,22 patients with In this descriptive-analytic research,22 patients with ESRD being treated by hemodialysis were ESRD being treated by hemodialysis were examined.This was the total number of the patients examined.This was the total number of the patients ranging from 17 to 33 years old who had reffered to ranging from 17 to 33 years old who had reffered to ALI ASGHAR MEDICAL CENTER IN ISFAHAN ALI ASGHAR MEDICAL CENTER IN ISFAHAN during 2 months.After examining and indicating the during 2 months.After examining and indicating the DMFT index in these patients,they were compared DMFT index in these patients,they were compared with a healthy control group which were identical to with a healthy control group which were identical to the study group regarding their sex,age and number. the study group regarding their sex,age and number.

Sampling was easy with no Sampling was easy with no systemic disease except ESRD. 22 systemic disease except ESRD. 22 patients 16 were man and 6 women patients 16 were man and 6 women

and divided in 4 groups. Patients and divided in 4 groups. Patients <25 years old (6), between 20 to 25 <25 years old (6), between 20 to 25 (7), between 26 to 30 (7) and over (7), between 26 to 30 (7) and over

30 were 3 patients.30 were 3 patients.

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P=0.493 P>0.05 t-testP=0.493 P>0.05 t-test

DMFT INDEXDMFT INDEX PERCENTPERCENT NUMBERNUMBER SEXSEX

7.77.7 72.772.7 1616 MM

9.19.1 27.327.3 66 FF

TABLE 1TABLE 1 : :COMPARISON OF MEAN DMFT INDEX BETWEEN MAELSCOMPARISON OF MEAN DMFT INDEX BETWEEN MAELS AND FEMAELSAND FEMAELS..

7.79.1

0

2

4

6

8

10

M F SEX

P=0.8 P>0.05P=0.8 P>0.05Tukey – HSD test (Analysis of variance)Tukey – HSD test (Analysis of variance)

DMFTDMFT PERCENTPERCENT NUMBERNUMBER GROUPGROUP

7.57.5 27.327.3 66 11

7.27.2 31.831.8 77 22

99 27.327.3 66 33

9.69.6 13.613.6 33 44

TABLE 2:TABLE 2:RELATION BETWEEN THE AGE OF DIALYSIS BEGINNINGRELATION BETWEEN THE AGE OF DIALYSIS BEGINNINGAND DMFT INDEX.AND DMFT INDEX.

7.5 7.29

9.6

0

2

4

6

8

10

12

<20 20-25 26-30 >30 AGE OFDIALYSISBEGINING

P= 0.73 P> 0.05P= 0.73 P> 0.05Tukey – HSD test (Analysis of variance)Tukey – HSD test (Analysis of variance)

DMFTDMFT PERCENTPERCENT NUMBERNUMBER GROUPGROUP

7.67.6 45.445.4 1010 11

7.87.8 27.227.2 66 22

9.39.3 27.227.2 66 33

TABLE 3:TABLE 3:RELATION BETWEEN THE DURATION OF DIALYSIS AND RELATION BETWEEN THE DURATION OF DIALYSIS AND DMFT.DMFT.

7.6 7.8

9.3

0

2

4

6

8

10

12

1 2 3 THE DURATION OF

DIALYSIS

P=0.027 P<0.05 t-testP=0.027 P<0.05 t-test

ANTERIOR TOOTHANTERIOR TOOTH

(DMFT)(DMFT)NUMBERNUMBER GROUPSGROUPS

0.04530.0453 2222 CASECASE

0.95450.9545 2222 CONTROLCONTROL

TABLE 4:TABLE 4:COMPRISON OF DMFT INDEX IN ANTERIOR TOOTH IN 2 COMPRISON OF DMFT INDEX IN ANTERIOR TOOTH IN 2 GROUPS(CASE-CONTROL).GROUPS(CASE-CONTROL).

0.0453

0.9545

0

0.2

0.4

0.6

0.8

1

1.2

CASE CONTROL

P=0.007 P<0.05 t-testP=0.007 P<0.05 t-test

DMFT IN POSTERIORDMFT IN POSTERIOR

TOOTHTOOTHNUMBERNUMBER GROUPSGROUPS

8.09098.0909 2222 CASECASE

11.454511.4545 2222 CONTROLCONTROL

TABLE 5:TABLE 5:COMPRAISON OF DMFT INDEX IN POSTRIOR TOOTHCOMPRAISON OF DMFT INDEX IN POSTRIOR TOOTHIN 2 GROUPS (CASE-CONTROL).IN 2 GROUPS (CASE-CONTROL).

8.0909

11.4545

0

2

4

6

8

10

12

14

CASE CONTROL

P=0.001 P<0.05 t-testP=0.001 P<0.05 t-test

TOTAL DMFTTOTAL DMFT NUMBERNUMBER GROUPSGROUPS

8.13648.1364 2222 CAESCAES

12.863612.8636 2222 CONTROLCONTROL

TABLE 6:TABLE 6:COMPARISON TOTAL DMFT INDEX IN 2 GROUPSCOMPARISON TOTAL DMFT INDEX IN 2 GROUPS(CASE-CONTROL).(CASE-CONTROL).

8.1364

12.8636

0

2

4

6

8

10

12

14

CASE CONTROL

It was diagnosed that the patients withIt was diagnosed that the patients with ESRD BEING ESRD BEING TREATED BY HEMODIALYSIS HAD A TREATED BY HEMODIALYSIS HAD A NOTICEABLE,LOWER DMFT INDEX COMPARED NOTICEABLE,LOWER DMFT INDEX COMPARED TO THE NORMAL PEOPLE AND THIS TO THE NORMAL PEOPLE AND THIS DIFFERENCE IS MORE DISTINCT IN POSTERIOR DIFFERENCE IS MORE DISTINCT IN POSTERIOR TEETH.Further,despite the fact that no statitically TEETH.Further,despite the fact that no statitically meaningful relation was found between the age of meaningful relation was found between the age of beginning of hemodialysis treatment,the duration of beginning of hemodialysis treatment,the duration of hemodialysis treatment and thehemodialysis treatment and the DMFT DMFT index of patientsindex of patients withwith ESRD ESRD ,but it is probable that a direct relation exist,but it is probable that a direct relation exist between the 2 above mentioned alternatives and thebetween the 2 above mentioned alternatives and the DMFT DMFT index in these patients in greater samples.index in these patients in greater samples.