Oral health-related quality of life in patients undergoing chronic hemodialysis.

AIMS: The aims of the study were to determine oral health-related quality of life (OHRQoL) in chronic hemodialysis (HD) patients and to estimate which scale describing OHRQoL, Oral Health Impact Profile (OHIP-14) or Geriatric/General Oral Health Assessment Index (GOHAI), was more useful in this particular group. METHODS: This was a cross-sectional study conducted by means of a census survey. The Polish versions of OHIP-14 and GOHAI were used to assess OHRQoL. The oral examination included decayed, missing and filled teeth (DMF-T) Index; Oral Hygiene Index simplified; Plaque Index and Gingival Index. In the statistical analysis, the Kruskal-Wallis test, Mann-Whitney U test, Pearson's χ2 test and Spearman's rank correlation coefficients were used as appropriate. RESULTS: The final sample consisted of 72 patients (mean age 63.2±15.2 years). The mean duration of HD treatment was 43.8 months. The mean number of teeth was 10.9. The majority of participants (81.9%) were dentate; only 22.2% of the respondents had >20 teeth. Among the dentate subjects, 44.1% wore removable dental prostheses (60.7% women). The most prevalent items for GOHAI (mean 14.71; SD 7.21) were uncomfortable to swallow, discomfort when eating and unhappy with appearance. The most prevalent items for OHIP-14 (mean 8.87; SD 10.95) were uncomfortable to eat foods, and diet has been unsatisfactory. The internal reliability (Cronbach's alpha) was 0.637 for GOHAI and 0.918 for OHIP-14. Chewing problems were significantly related to GOHAI (p=0.001) and OHIP-14 (p<0.001) scales. Higher OHIP-14 scores were significantly associated with dental treatment needs (p=0.029) and poor self-rated oral status (p=0.001). CONCLUSION: The HD patients had an unsatisfactory oral status, but using only OHRQoL scale was insufficient to capture all their oral health problems. The scales did not fully reflect poor oral health in HD patients. The oral problems were not a major concern for this group of patients, which could indicate the adaptation to impaired oral health or a change in health priorities. Regular dental examinations together with the assessment of OHRQoL in HD patients are required for a comprehensive patients' state. In our study, more variables were significantly related to the OHIP-14 scale than to the GOHAI scale. Thus, the OHIP-14 scale may be more useful in assessing OHRQoL in HD patients.

Interdisciplinary nature of oral diseases--clinical implications.

Due to the progress in medicine and healthcare as well as the socioeconomic development in industrialised countries we have to deal with the flood of lifestyle diseases. The treatment of such diseases and in particular of complications thereof is the greatest economic burden on contemporary healthcare funding systems. Numerous studies prove the existence of interrelationships and cause-and-effect relationships among oral diseases and systemic illnesses. An analysis of risk factors for the occurrence of numerous systemic illnesses with a society-wide range has shown that the maintenance of oral health is one of essential elements which may considerably influence the modification of treatment outcomes for other general diseases.

Polish school nurses' knowledge of the first-aid in tooth avulsion of permanent teeth.

BACKGROUND: The frequency of dental trauma in schools is secondary only to accidents at home. The aim of this study was to evaluate the knowledge of first aid in the avulsion of permanent teeth presented by Polish school nurses from different areas. METHODS: A cross-sectional study with the use of a structured self-administrative questionnaire was conducted in 2014 on school nurses working in randomly selected Polish provinces. The instrument consisted of demographic questions, questions referring to nurses' experience and training in dental trauma and questions checking knowledge of first-aid in the avulsion of permanent teeth. The maximum number of points to be scored was eight. Data were analyzed with the Kruskal-Wallis, the Mann-Whitney U and Chi(2) tests with the level of statistical significance at p < 0.05. RESULTS: The final sample consisted of 164 nurses of which 70.1 % had experience with dental injuries and 45.7 % witnessed a tooth avulsion in pupils. 10.4 % nurses participated in training courses concerning tooth avulsion and 67.1 % of them independently broadened their knowledge. The knowledge of the first-aid management of an avulsed tooth was moderate (4.72 ± 1.95 points). 78.1 % of nurses chose a correct definition of the term of 'tooth avulsion'. Only 7.3 % of them were aware that the replantation could be conducted by any witness of an accident. Saline was most often chosen as a proper transport medium for an avulsed tooth (57.9 %), whereas 16.1 % of nurses indicated milk. 13.4 % of evaluated nurses showed readiness to conduct an immediate replantation. Most respondents preferred calling child's parents and advising them to bring the child to a dentist (63.4 %). The main factor influencing nurses' level of knowledge was self-education (p < 0.001). Being a witness to dental trauma (p = 0.0032) and working in schools with sports classes (p = 0.0423) were positive determinants of improved knowledge. Nurses from large agglomerations had significantly lower knowledge (p = 0.005). The main source of information for self-education was the Internet. CONCLUSIONS: The evaluated nurses were in need of education with regard to the management of dental trauma cases. The Internet should be used to deliver evidence-based knowledge to medical staff working at schools.

Epidemiological analysis of dental caries in 12-year-old children residing in urban and rural settings in the Podlaskie region of north-eastern Poland.

INTRODUCTION: Dental caries is still a social problem in many countries, including Poland. Through epidemiological studies conducted in index groups among children and adults, it is possible to monitor its progress and take appropriate action. The Podlaskie region is an area where the severity of dental caries in children has been the highest in the country for a few years, both in urban and rural settings. OBJECTIVE: Evaluation and comparison of indicators of the progress of caries--Decayed Missing Filled Teeth (DMFT)--in 12-year-olds from the urban and rural areas of north-eastern Poland, measured between 2003-2010. MATERIALS AND METHOD: In 2003 and 2010, respectively, 445 children were examined: in 2003--188: 101 boys, 87 girls; 98 from urban areas, 90 from rural areas, and in 2010--257 adolescents: 134 boys, 123 girls; 157 from urban areas and 70 from rural areas. The study protocol was strictly subordinated to the WHO study monitor guidelines. DMFT indices were evaluated in particular years. The distribution of their individual components was then compared and analyzed. The outcomes resulting from the place of residence and gender of the adolescents were taken into account. In the statistical analysis, Shapiro-Wilk test and Mann-Whitney U test were used. RESULTS: In 2003, the mean value of DMFT was 4.76, and in 2010 it decreased to 3.36 (p<0.0001). In 2003, DMFT was 4.42 in the rural areas, and after 7 years it has risen to 4.77. There was a significant decrease in the value of the index (from 5.08 to 2.82, p<0.0001) in the urban areas. No significant differences based on gender were observed between these years. CONCLUSIONS: The values of caries intensity among 12-year-olds from the Podlaskie region, both in rural and urban areas, are still high. Among children from the rural areas, dental caries progression is more visible and has not improved during the years 2003-2010. These findings should lead to the development of programmes for the inhabitants of rural areas.

Hepatocyte growth factor in saliva of patients with renal failure and periodontal disease.

BACKGROUND: Hepatocyte growth factor (HGF), endogenous cytokine with pleiotropic repairing and regeneration properties in relation to most tissues and organs, contributes to the progression of periodontal disease (PD). Furthermore, PD is a significant health problem in patients with chronic renal failure (CRF). The role of HGF in the development of PD in this specific population was not a subject of research so far. MATERIAL AND METHODS: The following groups were enrolled in the study: (1) 26 chronic hemodialysis (HD) subjects, (2) 26 patients treated by continuous ambulatory peritoneal dialysis (CAPD), (3) 28 predialysis CRF patients, (4) 26 subjects with advanced PD (without coexisting diseases), and (5) 20 healthy subjects without PDs. HGF level in saliva was measured using the immunoenzymatic method. Gingival index, papillary bleeding index, plaque index, and the loss of clinical attachment level were evaluated. RESULTS: The HGF level in saliva of HD patients was twice higher than in that of subjects with healthy periodontium. Direct relationships between proper HGF level in saliva and the indices GI, PBI, and PI in CAPD-treated patients and with more severe PD were shown. It was found that PD is most advanced in HD patients, moderately in CAPD-treated patients and to the smallest extent in predialysis CRF patients. CONCLUSIONS: The HGF level in mixed saliva is the index of PD progression in subjects without renal failure and in CAPD-treated patients. PD is common in renal failure patients and is a significant problem concerning general health status.

Prosthetic status and treatment needs for lost masticatory function in haemodialysis patients.

INTRODUCTION: Premature loss of permanent teeth leads to stomatognathic system disability. It is a very serious but underrated problem for patients with chronic renal failure. The aim of study was analyse the degree of loss of masticatory function and number of teeth present for haemodialysis patients, and to define patients' needs for prosthetic treatment, which could restore correct occlusal condition. MATERIAL AND METHODS: Sixty-nine haemodialysis patients treated at the Nephrology and Transplantology Clinic with the Dialysis Centre at the Medical University of Bialystok, Poland. We checked: 1) the total number of teeth and number of teeth separately for upper and lower jaws, 2) the existing prosthetic restorations and 3) the preserved masticatory function. RESULTS: More male than female patients were in possession of full dentition.All patients with at least 28 natural teeth with retained occlusal contacts whilst chewing were males (4; 10% males; 5.7% of the whole group). There were 15 edentulous patients: 7 males (10%) and 8 females (11.5%). Hundered percent of female patients presented with various degrees of tooth loss and needed prosthetic treatment. Nearly 70% of tested haemodialysis patients did not have a reconstructed masticatory function. CONCLUSIONS: The population of haemodialysis patients from the North East part of Poland are patients with severe stomatognathic system dysfunctions. It is of importance for dentists, as well as nephrologists, to understand the essence of the problem, as the general health of a patient cannot be improved without ensuring functional comfort of such as important system as the masticatory one.

First-aid algorithms in dental avulsion.

Almost one fourth of traumatic dental injuries occur at schools or in their surroundings. Prevalence of tooth avulsion varies from 0.5% to 16% of all cases of dental trauma. Children with dental avulsion may seek help from school nurses so they should be able to provide first-aid treatment. However, many studies showed that the general level of knowledge of medical staff concerning tooth avulsion is unsatisfactory and that it could be improved by educational activities. This article attempts to give short algorithms of first-aid management of avulsed tooth.

Knowledge of nurses working at schools in Bialystok, Poland, of tooth avulsion and its management.

AIM: The purpose of this study was to evaluate the knowledge of first aid in tooth avulsion among nurses working at schools in Bialystok, Poland. A part of this population attended a lecture on the management of dental trauma 2 years before. METHODS: The survey was conducted in September 2010 and covered 50 (96.15%) school nurses from Bialystok. Thirty-eight of them attended the dental trauma lecture conducted 2 years before the survey. They were asked to fill in an anonymous questionnaire consisting of 20 closed questions referring to demographic data, previous dental trauma experience, and training. Seven questions referred directly to the knowledge of management of dental avulsion and on that basis, the level of nurses' knowledge was evaluated. The data were analyzed statistically using the Mann-Withney U-test with P < 0.05 to find factors influencing the level of knowledge. RESULTS: The study showed that nurses' knowledge about tooth avulsion was at an appropriate level. 86% of the participants chose the correct definition of the term of replantation, 92% understood that the time is crucial for the result of a replantation, 94% knew that an avulsed tooth should be held by the crown, and 96% pointed the proper transport medium. A half of the surveyed nurses declared that they would provide tooth replantation and another 16% would consult the procedures by calling a dentist. One statistically significant correlation between the level of knowledge and previous dental trauma training was revealed (P < 0.01). CONCLUSIONS: The lay knowledge of tooth avulsion in the population of nurses working at schools in Bialystok, Poland, was at an appropriate level. There was a strong correlation between this level and the participation in the lecture on the management of dental trauma conducted 2 years before.

Experience and attitudes of paramedics with regard to first aid in dental avulsion.

INTRODUCTION: The objective of this study was to assess the experience and attitudes of paramedics with regard to first aid in dental avulsion. MATERIAL AND METHODS: An anonymous, voluntary, 11-item survey was conducted in three randomly selected emergency medical service (EMS) stations in the Province of Podlasie. We analyzed what the respondents know about procedures in dental avulsion. We were also interested in the impact of professional and personal experience on the ability to take proper action in the case of avulsed/injured teeth. The use of teeth protectors during intubation was another aspect of our study. Data were statistically analyzed with the chi2 test. RESULTS: The study revealed that paramedics in EMS stations are not trained to provide first aid in dental avulsion. Avulsed teeth were usually not taken from the scene of the accident. We also found that previous experience with dental avulsion did not necessarily help to undertake proper action. However, we found that more than 95% of the respondents would act properly when not on duty. Paramedics do not use any teeth protectors to avoid accidental tooth injuries during intubation. CONCLUSION: We found that paramedics in the Province of Podlasie, Poland, need specialist training courses introducing them to principles of first aid in dental avulsion. Ambulances should carry equipment for the transport of avulsed teeth.

Ozone in dentistry: microbiological effects of gas action depending on the method and the time of application using the ozonytron device. Experimental study.

INTRODUCTION: Bactericidal, virucidal, and fungicidal activity of ozone is generally known and has been exploited for years in industry and medicine. Ozone therapy became an inherent element of the treatment of infection in such fields as surgery, dermatology, cosmetics, and dentistry. Ozone is a gas, so it penetrates very well even into such tissues and spaces that are not easily accessible. Thanks to the property of deep penetration and long ozone presence in tissues after treatment, a long-lasting bactericidal effect is achieved. The action of oxygen radicals is, however, not neutral for the human organism, therefore the use of an appropriate procedure and therapy algorithms is essential. MATERIAL AND METHODS: We decided to confirm the effect of antibacterial activity of ozone applied by means of the Ozonytron device (made by Biozonix) on model strains of Streptococcus salivarius, pneumonia, pyogenes, and agalactiae, Enterococcus faecalis, Staphylococcus aureus and epidermidis, using two application patterns developed by us. RESULTS: We found a statistically significant difference in the size of zones of inhibited bacterial growth on all media depending on the time of action of ozone. In the present paper, the bactericidal activity of ozone in relation to bacterial strains that are most frequently isolated from the oral cavity was confirmed. What is more, two models of application of the gas on the infected medium were compared. CONCLUSION: Research on the use of ozone in combatting bacteria typical for dental diseases has shown that the gas has an oxidizing effect on these bacteria and is bactericidal.

[Salivary phosphate-binding chewing gum--an integrative approach to chronic kidney disease and oral diseases]. / Guma do zucia wiazaca fosforany--jednoczesne leczenie przewleklej choroby nerek i chorób jamy ustnej.

The course and treatment of chronic kidney disease (CKD) is adversely affected by numerous metabolic disarrangements, comorbid states and general diseases, i.e. hyperphosphatemia and metabolic bone disease, chronic inflammation, accelerated atherosclerosis (partly of infectious etiology) and devastating cardiovascular disease. Furthermore, CKD patients are usually afflicted by multiple oral abnormalities, including troublesome oral dryness and the very aggressive form of periodontal disease. The use of chitosan-containing chewing gum in CKD subjects seems to offer a novel therapeutic approach of interdisciplinary importance: the chitosan binds salivary phosphates and, when swallowed, likely phosphates in the alimentary tract, thus beneficially lowering blood phosphate levels, while the gum itself increases impaired salivary flow and has a potent oral antimicrobial activity. Thus, it effectively improves general oral hygiene and prevents progression of periodontal disease being (besides of hyperphosphatemia) one of the established causes of atherosclerosis development/progression. The undemanding maneuver of chewing the chitosan-containing, phosphate-binding gum has a potential to diminish excessive morbidity in CKD patients.

Dental problems in a potential kidney transplant recipient: case report and literature review.

INTRODUCTION: Renal failure is associated with many abnormalities in the oral and dental health status. The aim of this study was to describe dental treatment procedures in a patient on the waiting list for kidney transplantation. MATERIAL AND METHODS: We treated a 46-year-old female with ESRD due to reflux nephropathy who was dialyzed peritoneally for 8 years. She received a cadaveric kidney transplant in 2003. Her immunosuppression consisted of prograf, MMF, and steroids. Creatinine after Tx was 1.58 mg/dL rising to 2 mg/dL 6 months later. Transplant biopsy in 2005 (creatinine 3.5 mg/dL) revealed chronic thrombotic microangiopathy. Four years after Tx she entered the PD program to eliminate odontogenic foci of infection. Pantomography and digital radiography disclosed the presence of three teeth classified as potential centers of inflammation. The methods of treatment were: (1) surgical extraction with filling of the bone defect with BioOss bone substitute material and application of Bio-Gide collagen membrane; (2) extirpation of inflamed pulp under anaesthesia; (3) antiseptic endodontic treatment. RESULTS: Clinical and radiologic examination revealed normal bone healing and normal condition of periapical tissues. CONCLUSION: Elimination of odontogenic centers of inflammation in patients before kidney transplantation should be the goal of a precisely planned multi-specialist treatment. Prevention of odontogenic inflammation must be started as soon as possible in the pre-dialysis period since periodontal diseases are a significant cause of generalized inflammation accelerating progression of atherosclerosis and its complications.

[Oral cavity changes in patients after kidney transplantation and preventive-treatment algorithms]. / Zmiany chorobowe w jamie ustnej u pacjentów po transplantacji nerki i algorytmy postepowania profilaktyczno-leczniczego.

Kidney transplantation is the best option of treatment for patients with end-stage renal failure. However, following kidney transplantation many stomatological abnormalities are frequently reported. It is mainly due to immunosuppressive therapy and subsequent impaired immune response. There is an increased risk of infections and malignancies. The most frequent findings in the oral cavity include: aphthae, erosions of bacterial, viral and fungal origin, lichen-like or leukoplakia-like changes. The another type of change is gingival hyperplasia and its periodontologial consequences. In this review etiology, clinical symptoms of periodontological changes are described together with algorithm of pre- and posttransplant management of oral healthy is provided.

The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients.

BACKGROUND: Periodontitis contributes to generalized inflammation and development of systemic diseases, including atherosclerosis and cardiovascular disease. Its extent in maintenance haemodialysis (HD) patients is disputable and not known in continuous ambulatory peritoneal dialysis (CAPD) and pre-dialysis chronic kidney disease (CKD) patients. METHODS: One hundred and six patients (35 on HD, mean age, 56 years; 33 on CAPD, mean age 51 years; and 38 pre-dialysis CKD stage 2-5, mean age 51 years) from north-eastern Poland were enrolled. Dialysis subjects were recruited from a cohort of 141 HD and 61 CAPD patients. Two control groups comprised 26 generally healthy individuals with advanced periodontitis requiring specialized treatment, and 30 subjects from general population. Gingival index (GI), papillary bleeding index (PBI), plaque index (PI), loss of clinical attachment level (CAL) and community periodontal index of treatment needs (CPITN) were determined according to WHO recommendations. RESULTS: Average values of the indices in HD, CAPD, pre-dialysis CKD, advanced periodontitis and general population subjects were as follows: GI-1.37, 0.95, 1, 2 and 1; PBI-1.45, 0, 0, 2.20 and 1; PI-2.05, 1.59, 1, 2 and 1; and CAL loss-5.11, 3.47, 2.50, 4.68 and 1.40 mm, respectively. CPITN, analysed separately as community periodontal index and periodontal treatment needs, further indicated a high severity of periodontitis in all renal failure groups as compared with general population subjects. The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects. CONCLUSIONS: Periodontal disease is prevalent, severe and under recognized in renal failure patients. Prophylaxis and early dental treatment should be intensified in these subjects, and may be of interdisciplinary importance.

Hepatocyte growth factor in saliva is a potential marker of symptomatic periodontal disease.

Evidence has been emerging that hepatocyte growth factor (HGF) - a pluripotential regenerative cytokine - is a key factor in the pathogenesis and progression of periodontal disease, mostly through its over-stimulation of gingival epithelial cell growth and impairment of the regeneration of collagenous structures. We measured the levels of immunoreactive HGF in unstimulated whole mixed saliva from 26 patients referred for treatment of periodontal disease, and from 20 healthy subjects. HGF was detected in all saliva samples from the patients, the concentration ranging from 0.06 to 5.38 ng/ml, with a mean concentration of 1.87 +/- 1.32 ng/ml. In healthy individuals, the median salivary HGF level was 0.68 ng/ml (range: 0 - 7.33 ng/ml), being almost 3-fold lower (P < 0.0001) than that in the patients. Periodontal parameters in the patients were: gingival index (GI) 2.0 (0 - 2.8), papillary bleeding index (PBI) 2.2 (0 - 3.2), plaque index (PI) 2.0 (0 - 3.0), probing depth (PD) 3.0 (1.8 - 5.9) mm, and loss of clinical attachment level (CAL) 4.7 (1.1 - 10.6) mm. We found that the salivary HGF level was positively correlated with GI (P = 0.004), PBI (P = 0.046) and PI (P = 0.001), but not with PD (P = 0.351), CAL loss (P = 0.172), number of teeth (P = 0.279) or patient age (P = 0.362). Our findings suggest that salivary HGF concentration may be a novel marker of symptomatic periodontal disease, and that it warrants further validation.

[Periodontal disease and atherosclerosis: an underestimated link?]. / Choroba przyzebia i miazdzyca: niedoceniany zwiazek?

Periodontal disease is a common bacterial and destructive disorder of oral tissues. We reviewed epidemiological and experimental to data studies demonstrating close associations between chronic periodontitis and development of generalized inflammation, vascular endothelial injury, and atherosclerosis. Periodontal disease has been convincingly emerging as an important independent cardiovascular risk factor. It deserves timely treatment also as a likely part of primary prevention of ischemic heart disease, stroke, and peripheral vascular disease.