|Year : 2021 | Volume
| Issue : 2 | Page : 47-51
Assessment of oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka, India
Arun Kumar Acharya1, Sudarshan Kumar Chinna2, Rashmi Bankur3, Shanthi Margabandhu4, B Anil Babu5, Nasi Ismail5
1 Professor and Head, Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
2 Assistant Professor, Department of Public Health Dentistry, KLE Institute of Dental Sciences, Bengaluru, Karnataka, India
3 Dental Health Officer, Department of Service Clinic, Government Dental College and Research Institute, Bengaluru, Karnataka, India
4 Practitioner, Public Health Dentist, Devi Dental Clinic, Bengaluru, Karnataka, India
5 Postgraduate Students, Department of Public Health Dentistry, Navodaya Dental College and Hospital, Raichur, Karnataka, India
|Date of Submission||18-Apr-2021|
|Date of Acceptance||28-Apr-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Sudarshan Kumar Chinna
Department of Public Health Dentistry, KLE Institute of Dental Sciences, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: According to the World Health Organization (WHO) global burden of disease project, chronic kidney disease is the 12th leading cause of death and 17th leading cause of disability in the world. Statistics show that 90% of the patients suffering from chronic renal failure face oral health-related problems. The objective of the study was to assess the oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka.
Materials and Methods: A cross-sectional study was carried out on 110 patients undergoing hemodialysis at Raichur district, Karnataka. Oral health status was assessed using the WHO assessment form 1997. Oral Hygiene Index – Simplified (1964) was used to assess the Oral Hygiene Status.
Results: The mean age of the patients was 43.99 ± 12.80 years and the mean Decayed Teeth, Missing Teeth, Filled Teeth (FT), and Decayed Missing FT was 2.53 ± 2.39, 4.39 ± 7.57, 0.08 ± 0.30, and 7.00 ± 7.01, respectively. The prevalence of dental caries was 94.5%. Calculus was seen in 60.9% of the patients. Oral hygiene status was poor in 49.5% of the patients. The mean number of teeth required treatment was 4.4.
Conclusion: This special population has high prevalence of dental caries and poor oral hygiene which needed periodic health education and intervention.
Keywords: Chronic kidney disease, hemodialysis, oral health status, oral hygiene
|How to cite this article:|
Acharya AK, Chinna SK, Bankur R, Margabandhu S, Babu B A, Ismail N. Assessment of oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka, India. Int J Prev Clin Dent Res 2021;8:47-51
|How to cite this URL:|
Acharya AK, Chinna SK, Bankur R, Margabandhu S, Babu B A, Ismail N. Assessment of oral health status and treatment needs in hemodialysis patients at Raichur district, Karnataka, India. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Jul 29];8:47-51. Available from: https://www.ijpcdr.org/text.asp?2021/8/2/47/320053
| Introduction|| |
Chronic diseases have become a major public health problem. They are a leading cause of morbidity and mortality in India and other low- and middle-income countries. The chronic diseases account for 60% of all deaths worldwide. Eighty percentage of chronic disease deaths worldwide occur in low- and middle-income countries. In India, the projected number of deaths due to chronic diseases was around 5.21 million in 2008 and is expected to rise to 7.63 million in 2020 (66.7% of all deaths).
The most common cause of chronic renal failure is hypertension, diabetes mellitus, chronic glomerulonephritis, uropathy, and others. Patients with chronic renal failure undergoing hemodialysis are affected by many systemic diseases due to their lack of ability to control water and electrolyte balance and filtrate waste products. Obviously, there would be some manifestations in the oral cavity, especially the gingiva. Like the patients with other systemic diseases, in patients with chronic renal failure frequent recall examinations as preventive measures should be emphasized in order to minimize the need for extensive dental treatment. Close consultation between the dentist and the physician is essential for safe dental management of these patients. Periodontitis is a bacteria-driven chronic inflammatory disease that destroys the connective tissue and bone that supports the teeth and represents a potential source of episodes of bacteremia, especially in immune-compromised patients.
In general, oral health is influenced by many factors such as diet, level of oral hygiene, presence of microorganisms, genetic factors, aging, and systemic diseases. Statistics show that 90% of the patients suffering from chronic renal failure face oral health-related problems because it affects the bone- and soft-tissue structures. As renal failure develops, one of the early symptoms may be bad taste and odor in the mouth, particularly in the morning, this uremic fetor, an ammoniacal odor, is typical of any uremic patient and is caused by the high concentration of urea in the saliva and its subsequent breakdown to ammonia.
Oral manifestations are seen in hemodialysis patients such as enlarged salivary glands, decreased salivary flow, dry mouth, increased calculus formation, low caries rate, enamel hypoplasia, dental malocclusion, petechiae and ecchymosis, bleeding from gingiva, prolonged bleeding, candidal infection, burning and tenderness of mucosa, erosive glossitis, tooth erosion, pale mucosa with diminished color demarcation between attached gingiva and alveolar mucosa; and gingival hyperplasia due to chronic renal failure and can be induced by cyclosporine.
There are no studies that have been conducted on Oral Health Status and Treatment Needs in Hemodialysis patients at Raichur district, Karnataka; hence, the study was conducted to assess the “Oral Health Status and Treatment Needs in Haemodialysis patients at Raichur district, Karnataka, India.”
| Materials and Methods|| |
The study protocol was approved by the Institutional Ethical Committee, Navodaya Dental College and Hospital, Raichur. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. A written informed consent was obtained from each participant. A prior permission was obtained from Medical Director of each Hospital. The sample comprised 110 subjects who were undergoing hemodialysis during the duration of 1 month (August 16, 2014–September 15, 2014) were selected from three major dialysis centers of Raichur district (Bhandari Hospital – 68 cases, Balanku Hospital – 24 cases, and Navodaya Hospital and Research Centre Raichur – 18 cases). The purpose of the study was explained to the patients. All the subjects who were undergoing hemodialysis and who gave written consent were included in the study The patients were divided into three subgroups of those on renal dialysis for (1) <1 year; (2) 1–3 years; and (3) more than 3 years. Those who were refusing consent and patients under the age of 18 years were excluded from the study. All the questions were explained in their local language and the answers were recorded by the examiner. Oral health status and treatment need were recorded according to the World Health Organization, Oral health survey-basic methods (1997). Oral hygiene status was assessed according to Oral Hygiene Index-Simplified (1964). Examination of the hemodialysis patients was done by single examiner using sterilized instruments.
Data were analyzed using SPSS, Version 16.0, (SPSS Inc. Chicago, Illinois, USA). Cohen's Kappa statistics were used to assess the examiner reliability (0.96). Descriptive statistics such as mean, standard deviation (SD), and percentage were used. Association was evaluated using Chi-square test and P < 0.05 was considered statistically significant.
| Results|| |
Among 110 patients, 32.7% of subjects belonged to 35–44 years of age group, followed by 25–34 years of age group (23.6%) and mean age was 43.99 ± 12.80 years. The study group comprised 60.9% males and 39.1% females. In the present study, 70.9% of subjects were from urban area and 29.1% subjects from rural area. Socioeconomic status was assessed using Kuppuswamy scale – 2012, 54.6% of subjects belonged to upper lower class, followed by lower middle class (34.5%), 10.9% middle class, and no one in upper class. Majority of subjects who had undergone hemodialysis had systemic disease such as diabetes (35.5%), followed by hypertension (27.2%) and with both hypertension and diabetes (13.7%). Only 14.6% of dialysis patients were without systemic diseases. In the study, 60.9% of subjects had calculus followed by shallow pockets of 4–5 mm (34.6%), deep pockets (0.9%), healthy (0.9%), and excluded sextants (2.7%). In the present study, 52.7% of patients required one surface filling, followed by pulp care (50.9%), need for other care such as replacement of teeth (49.1%), extraction (21.8%), two surface filling (12.7%), and only 5.4% not required any dental treatment. A total 38.2% of subjects had undergone hemodialysis procedure for <1 year, 40.0% subjects had undergone hemodialysis procedure for 1–3 years of duration, and 21.8% of subjects had undergone hemodialysis since more than 3 years of duration. A total of 2.7% of subjects had the habit of pan chewing, 33.6% had habit of smoking, and 24.5% had habit of drinking alcohol. A total of 81.8% of subjects were free from oral mucosal condition, 5.5% of subjects had traumatic ulceration, 7.2% of subjects had abscess, and 5.5% of subjects had other condition such as pigmentation. Out of twenty patients, 35.0% of subjects had abscess on gingiva, followed by ulceration on lips and palate (10.0%) [Table 1]. A total of 27.3% subjects had loss of attachment 0–3 mm, 43.6% of patients had a loss of attachment 4–5 mm, 26.4% of subjects had a loss of attachment 6–8 mm, and 2.7% of subjects had not recorded due to their complete edentulousness. The prevalence of dental caries among the hemodialysis patients was 94.5%, and 5.5% of patients were caries free. The mean number of decayed teeth, missing teeth, filled teeth (FT), and decayed missing FT (DMFT) per person (±SD) in the present study were 2.53 (±2.39), 4.39 (±7.57), 0.08 (±0.30), and 7.00 (±7.01), respectively. The mean number of teeth required treatment was 4.4. The oral hygiene status in the present study was assessed using Oral Hygiene Index-Simplified. Three hemodialysis patients were completely edentulous and not recorded for Oral Hygiene Index-Simplified. Among 107 patients, 3.8% of patients had good oral hygiene, 46.7% of patients had fair oral hygiene, and 49.5% of patients had poor oral hygiene. All the patients belonged to the age group of 55–64 and 65–74 had dental caries compared to the other age groups. The association between dental caries and age group was found to be statistically significant (P = 0.01) [Table 2]. The percentage of patients with loss of attachment measuring about 4–5 mm was higher in females. The association between periodontal loss of attachment and gender was found to be statistically significant (P = 0.003) [Table 3].
|Table 1: Distribution of haemodialysis patients according to oral mucosal condition by location|
Click here to view
|Table 2: Number and percentage of subjects with and without caries according to age group|
Click here to view
|Table 3: Number and percentage of subjects with loss of attachment according to gender|
Click here to view
| Discussion|| |
In the present study, mean age of the hemodialysis patients was 43.99 (±12.80) years and majority of the subjects were seen between the age group of 35–44 years followed by 25–34 years. This was higher than the study conducted in Amsterdam, Netherland (42.6 ± 9.2), Catolica do Parana, Brazil (42 ± 13), Kerala, India (40.63 ± 7.92), Gujarat, India (37.33 ± 11.86), Lahore, Pakistan (41.37 ± 12.47), and lesser than the study conducted in Saskatchewan (51.1 ± 18.8), Riyadh, Saudi Arabia (45.63 ± 16.77), Bangalore, Karnataka, India (49.38 ± 15.47), Kerman, Iran (53.12 ± 16.73), Shiraz, Iran (53.4 ± 15.3), and North Karnataka, India (48.02 ± 15.15). There is an age-related decline in glomerular filtration rate, so the prevalence of chronic kidney disease increases with age. The present study showed that there were more males (60.9%) than females (39.1%). This was in contrast to the other studies conducted in Riyadh, Saudi Arabia had more females (58.9%) than males (41.1%), Sofia, Bulgaria (females – 57.8% and males – 42.2%), Kerala, India (females – 48.1%), and Kerman, Iran, (females – 62.0%, males – 38%). The percentage of males was more than females in Shiraz, Iran (66.7%), Gujarat, India (75.0%), Babol, Iran (54.8%), Mangalore, Karnataka, India (60.0%), Jordan (63.5%), Iasi, Romania (57.97%), and Lahore, Pakistan (62.5%). Socioeconomic status was calculated according to Kuppuswamy's scale – 2012. Most of the subjects belonged to the upper lower class (54.6%) followed by lower middle class (34.5%) because of lack of literature data, comparison with other studies cannot be done. In the present study, 35.7% of subjects had hypertension and 46.4% of subjects had diabetes; these may be considered as causative agent for renal failure. This was in contrast to the other studies conducted in Kerman, Iran (26.4% – diabetes and 30.8% – hypertension), Mangalore, Karnataka, India (82.5% – hypertension and 57.3% – diabetes), and Lahore, Pakistan (79.0%) – hypertension). In the present study, 38.2% of subjects had undergone hemodialysis procedure since <1 year, 40.0% of subjects had undergone hemodialysis procedure since 1–3 years of duration, and 21.8% of subjects had undergone hemodialysis since more than 3 years of duration This was in contrast to the other study conducted in Guntur, Andhra Pradesh, India, showed 69.4% of subjects had undergone <1 year of duration, 14.1% of subjects had undergone 1–3 years of duration, and 16.5% of subjects had undergone more than 3 years of duration. In the present study, 33.6% of subjects had habit of smoking cigarettes which was similar to other study conducted in Shiraz, Iran (33.6%). Another study conducted in Lahore, Pakistan (5.0%) which had a lesser percentage of smokers than the present study. This may be due to heavy cigarette smoking which increases the risk of chronic renal failure for both men and women. In the present study, 81.8% of subjects were free from oral mucosal condition and 5.5% of subjects had traumatic ulceration which was higher than the study conducted in Guntur, Andhra Pradesh, India (80.6% – free from oral mucosal lesion and 1.9% – ulcer). Other studies conducted in North Karnataka, India (6.0% ulcer) and Amsterdam, Netherland (21.0% ulcer) which was higher than the present study. These lesions may be due to the side effects and characteristics of the treatment they receive. In the present study, 0.9% of subjects had healthy periodontium, 60.9% of them had calculus, 34.6% of them had shallow pocket of 4–5 mm, 0.9% had deep pocket of 6 mm or more, and 2.7% of them were excluded sextant. This was contrast to the other study done in Bialystok, Poland showed that 6.2% bleeding, 24.0% of subjects had calculus, 25.8% of subjects had pockets of 4–5 mm, 12.0% of subjects had pockets of 6 mm or more, and 38.0% of subjects were excluded. Another study conducted in Sofia, Bulgaria showed that 29.0% of subjects had calculus, 29.0% of subjects had 4–5 mm of pockets and 27.0% of subjects had 6 mm or more pockets. Another study conducted in Gujarat, India showed that 2.6% of subjects had bleeding, 43.42% of them had calculus, 51.97% of subjects had 4–5 mm of pockets, and 1.97% of subjects had pockets of 6 mm or more. Another study conducted in Guntur, Andhra Pradesh, India showed that 13.1% of subjects had calculus, 44.2% of subjects had pocket of 4–5 mm, 39.32% of subjects had pocket of 6 mm or more, and 3.4% of subjects were excluded from the study. Study conducted in Oporto Portugal showed that 50.0% had calculus which was lesser than the present study. The higher periodontal disease could be due to a lack of awareness and poor oral hygiene because of the presence of this chronic debilitating illness. In the present study, 27.3% of subjects had loss of attachment 0–3 mm, 43.6% subjects had loss of attachment 4–5 mm, 26.4% of subjects had loss of attachment 6–8 mm and 2.7% of subjects were not recorded due to edentulous condition. This was in contrast to the other studies conducted in Guntur, Andhra Pradesh, India (12.6% – 0–3 mm, 44.2% – 4–5 mm, 33.0% – 6–8 mm, and 5.3% – 9–11 mm loss) and Gujarat, India (59.21% – 0–3 mm and 36.18% – 4–5 mm loss). The prevalence of dental caries in the present study was 94.5% which was much higher than that of the study conducted in Guntur, Andhra Pradesh, India (56.3%). The higher dental caries could be due to a lack of awareness and poor oral hygiene because of the presence of this chronic debilitating illness. The mean number of DMFT per person in the present study was 7.0 ± 7.01 which was much higher than the study conducted in Mathura, Uttar Pradesh, India (6.19 ± 6.40). Other studies conducted in Oporto Portugal (17.14 ± 7.01), Istanbul, Turkey (11.79 ± 7.62), Kerman, Iran (11.33 ± 8.44), Shiraz, Iran (18.6 ± 9.9), Bucharest (17.0 ± 8.3) which was higher than the present study. In the present study, 52.7% of subjects required one surface filling, 50.9% of subjects required pulp care and restoration followed by 49.1% of subjects required need for other care. Because of lack of literature data comparison cannot be done. The oral hygiene status in the present study was assessedusing Oral Hygiene Index-Simplified. A total of 3.8% patients had good oral hygiene, 46.7% of patients had fair oral hygiene, and 49.5% of patients had poor oral hygiene. This was in contrast to other studies conducted in Gujarat, India (9.2% had good oral hygiene, 73.68% had fair oral hygiene, and 17.11% had poor oral hygiene) and Bagalkot, Karnataka, India (37.0% – fair and 63.0% – poor oral hygiene). Significantly higher caries prevalence was seen among hemodialysis patients who were in the age group of 55–64 and 65–74 years (P < 0.01). A significant association was observed between the periodontal loss of attachment and age group of hemodialysis patients (P = 0.02) and also there is a significant association between periodontal loss of attachment and gender of hemodialysis patients (P = 0.003).
| Conclusion|| |
The result of the present study showed that dental caries and periodontal diseases are more prevalent among hemodialysis patients of Raichur district. Those with poor oral hygiene status, inadequate knowledge of dental health care, and poor oral hygiene practices were more likely to develop dental diseases. The step could be to enhance the awareness of the paramedical staff, nephrologists, and dentists about dental infections and the ways to prevent them. Prioritize the mobilization and sensitization of the medical staff and nephrologists regarding the importance of oral health among this special group of patients. Prevention is the most important factor playing a pivotal role in achieving an optimum oral health for all and stressing the importance of regular dental checkup to improve the oral health problems of these patients.
We would like to acknowledge Mr. Ramesh. S. Patil for the statistical assistance and also thank the medical staffs and patients for their kind cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Preventing Chronic Diseases: A Vital Investment. Geneva: World Health Organization; 2005. p. 1-33.
DeRossi SS, Cohen DL. Renal disease. In: Greenberg MS, Glick M, Ship JA, editors. Burket's Oral Medicine. 11th
ed. Hamilton, Ontario: BC Decker Inc; 2008. p. 363-83.
Torkzaban P, Arabi R, Kadkhodazadeh M, Moradi J, Khoshhal M. Periodontal status in patients undergoing hemodialysis. DJH 2009;1:7-10.
Nandini M, Sahana, Pallavi N. Prevalence of periodontitis in hemodialysis patients. IOSR JDMS 2013;6:1-5.
World Health Organization. Oral Health Surveys – Basic Methods. 4th
ed. Geneva: World Health Organization; 1997. p. 1-66.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Bots CP, Poorterman JH, Brand HS, Kalsbeek H, van Amerongen BM, Veerman EC, et al.
The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy. Oral Dis 2006;12:176-80.
Souza CM, Braosi AP, Luczyszyn SM, Casagrande RW, Pecoits-Filho R, Riella MC, et al.
Oral health in Brazilian patients with chronic renal disease. Rev Med Chil 2008;136:741-6.
Joseph R, Krishnan R, Narayan V. Higher prevalence of periodontal disease among patients with predialytic renal disease. Braz J Oral Sci 2009;8:14-8.
Parkar SM, Ajithkrishnan CG. Periodontal status in patients undergoing hemodialysis. Indian J Nephrol 2012;22:246-50.
] [Full text]
Wahid A, Chaudhry S, Badar MA, Khan A, Wahid A. Assessment of periodontal health status of chronic kidney disease patients undergoing hemodialysis; A cross-sectional descriptive study. JUMDC 2014;5:13-9.
Klassen JT, Krasko BM. The dental health status of dialysis patients. J Can Dent Assoc 2002;68:34-8.
Atassi F, Almas K. Oral hygiene profile of subjects on renal dialysis. Indian J Dent Res 2001;12:71-6.
Murthy AK, Hiremath SS. Assessment of oral health status and treatment needs of patients undergoing renal dialysis in a Hospital at Bangalore city. J Indian Assoc Public Health Dent 2005;5:35-8. [Full text]
Chamani G, Zarei MR, Radvar M, Rashidfarrokhi F, Razazpour F. Oral health status of dialysis patients based on their renal dialysis history in Kerman, Iran. Oral Health Prev Dent 2009;7:269-75.
Malekmakan L, Haghpanah S, Pakfetrat M, Ebrahimic Z, Hasanlic E. Oral health status in Iranian hemodialysis patients. Indian J Nephrol 2011;21:235-8.
] [Full text]
Patil S, Khaandelwal S, Doni B, Rahuman F, Kaswan S. Oral manifestations in chronic renal failure patients attending two hospitals in North Karnataka, India. Oral Health Dent Manag 2012;11:100-6.
Chuang SF, Sung JM, Kuo SC, Huang JJ, Lee SY. Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:689-95.
Jenabian N, Ghazi Mirsaeed AM, Ehsani H, Kiakojori A. Periodontal status of patient's underwent hemodialysis therapy. Caspian J Intern Med 2013;4:658-61.
AL-Sebaie DM, AL-Hamory E, Almomanie MQ, Bsoul TM. Periodontal conditions in a Jordanian population on renal dialysis. PODJ 2013;33:513-7.
Solomon S, Forna N, Ursarescu I, Segal L, Nistor I, Veisa G. The oral cavity status in patients with end stage kidney disease and hemodialysis, in correlation to the history of renal impairment and C-reactive protein levels (pilot study). Rom J Oral Rehabil 2014;6:9-13.
Gautam NR, Rao DS, Gautam NS, Rajasekhar V, Radha Rani CH, Tanuja P. Oral health burden of chronic renal failure patients in Guntur City. J Res Adv Dent 2014;3:1:108-16.
Borawski J, Wilczyńska-Borawska M, Stokowska W, Myśliwiec M. The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients. Nephrol Dial Transplant 2007;22:457-64.
Dencheva M. Research of periodontal status and treatment needs by CPITN in patients on haemodialysis and renal transplanted patients. J IMAB 2009;15:3-5.
Sobrado Marinho JS, Tomás Carmona I, Loureiro A, Limeres Posse J, García Caballero L, Diz Dios P. Oral health status in patients with moderate-severe and terminal renal failure. Med Oral Patol Oral Cir Bucal 2007;12:E305-10.
Mohan V, Gupta S. Dental health of patients undergoing hemodialysis (A Study). J Indian Acad Oral Med Radiol 2011;23:208-10. [Full text]
Bayraktar G, Kurtulus I, Kazancioglu R, Bayramgurler I, Cintan S, Bural C, et al.
Oral health and inflammation in patients with end-stage renal failure. Perit Dial Int 2009;29:472-9.
Slusanschi1 O, Badea V, Garneata L, Cuculescu M, Preoteasa E. Aspects regarding oral health and oral hygiene habits in hemodialysis patients. Med Evolution 2012;17:704-11.
Bhatsange A, Patil SR. Assessment of periodontal health status in patients undergoing renal dialysis: A descriptive, cross-sectional study. J Indian Soc Periodontol 2012;16:37-42.
] [Full text]
[Table 1], [Table 2], [Table 3]