Oral cavity status in patients with end-stage chronic renal failure receiving dialysis therapy

The dissertation is devoted to a comprehensive study of the dental status of patients with end-stage chronic renal failure receiving renal replacement therapy. The study combines clinical and morphofunctional approaches to assess the state of the oral organs and tissues depending on the type of dialysis and the severity of calcium-phosphate metabolism disturbances. The work analyzes the specific features of mineralization and the chemical composition of the hard dental tissues, performs a crystallographic study of saliva, and examines the influence of dental status on patients' quality of life. On the basis of the data obtained, a program for the prevention and treatment of dental pathology in this category of patients has been substantiated.

RELEVANCE OF THE PROBLEM

Over the past decades, improvements in dialysis methods and kidney transplantation have significantly reduced mortality among patients with end-stage chronic renal failure (ESRF) (Klassen J.T., Krasko B.M., 2002). On the other hand, the number of such patients has been continuously increasing. According to the Register of the Russian Dialysis Society, in 1998 in Saint Petersburg 661 persons were receiving renal replacement therapy (RRT) for ESRF. By 2003 their number had risen to 851.

The principal problem in patients with ESRF is the development of various complications, including those of infectious character, the prevention of which requires special attention.

The oral cavity is one of the possible sources of chronic infection (Huber M.A. et al., 2005). Dental diseases such as periodontitis, non-carious lesions, premature tooth loss, and unsatisfactory oral hygiene are frequently encountered in patients with ESRF. In addition, poor-quality dentures, missing teeth, carious lesions, and other dental problems may lead to impaired nutrition and exert a negative influence on patients' quality of life.

In the domestic literature, insufficient attention has been given to the problem of the dental status and the principles of treatment of patients suffering from ESRF. Dental practitioners are reluctant to treat patients on dialysis, which is explained by insufficient knowledge of the specific features of oral pathology.

The need for continuous dental monitoring of patients receiving dialysis therapy requires the determination of adequate methods of prevention and treatment of ESRF patients, which is impossible without understanding the nature of changes in oral tissues and organs developing as a consequence of serious systemic disorders.

In the foreign literature, the questions of the manifestations of dental diseases in patients with ESRF are rather broadly covered. However, in most cases these works are of a descriptive character.

AIM OF THE STUDY

Morphofunctional substantiation of the principles of formation and pathways of correction of dental pathology in patients with ESRF.

OBJECTIVES OF THE STUDY

1. To evaluate the state of the oral organs in patients with ESRF depending on the severity of calcium-phosphate metabolism disturbances and the type of dialysis.

2. To determine the specific features of the morphological structure and chemical composition of the hard dental tissues in patients with ESRF.

3. To establish the influence of dental status on the quality of life of patients with ESRF.

4. To substantiate the content of the program of dental examination and treatment of patients with ESRF.

SCIENTIFIC NOVELTY

The novelty of the study is determined by the results of a comprehensive clinical and morphofunctional investigation of ESRF patients on dialysis treatment. For the first time, a comparison of the somatic status of patients receiving hemodialysis and peritoneal dialysis has been performed. The influence of different methods of modern dialysis treatment on the state of the oral organs and tissues has been established. The state of mineralization of the hard dental tissues of ESRF patients has been revealed. The influence of the duration of dialysis treatment and of mineral metabolism disturbances on the chemical composition and structure of dental tissues has been established.

In ESRF patients, a crystallographic study of saliva has been carried out for the first time and the specific features of the formation of its crystal lattice have been determined. The influence of dental status on the quality of life of ESRF patients has been established.

On the basis of the established facts, the content of the program of prevention and treatment of hard dental tissue diseases in ESRF patients has been determined.

PRACTICAL SIGNIFICANCE OF THE WORK

The results of the work make it possible to substantiate the content of measures aimed at a higher-quality and more rational treatment of ESRF patients.

STATEMENTS DEFENDED

1. In ESRF patients, preconditions are created for the development of caries (poor hygiene, decrease in Ca/P and (Ca+Mg+Na)/P coefficients, increase in enamel electrical conductivity). However, the alkaline environment prevents this process, promoting the development of non-carious lesions.

2. The leading factors determining changes in the mineral composition of the hard dental tissues are increased levels of urea, creatinine, parathyroid hormone, and inorganic phosphorus, and decreased total calcium in the blood serum of ESRF patients.

3. In patients receiving HD treatment, the state of the oral cavity influences the social and emotional components of quality of life. The dental status of patients on PD does not affect quality of life indicators.

APPROBATION OF THE WORK

The materials of the dissertation were approved at a meeting of the Scientific Society of Dentists (Saint Petersburg, 2007), reported at the All-Russian Congress "Education and Science at Dental Faculties in Higher Educational Institutions of Russia. New Technologies in Dentistry" (Yekaterinburg, 2006), at scientific-practical conferences of young scientists "Current Issues in Clinical and Experimental Medicine" (Saint Petersburg, 2007, 2008), the XII International Conference of Maxillofacial Surgeons and Dentists "New Technologies in Dentistry" (Saint Petersburg, 2007), the XI Anniversary International Medical Congress of Students and Young Scientists (Ternopil, 2007), the XVII and XVIII All-Russian Scientific-Practical Conferences and the I All-European Dental Congress (Moscow, 2007), the All-Russian Scientific Conference "Current Issues in Maxillofacial Surgery and Dentistry" (Saint Petersburg, 2007), the Scientific-Practical Conference with International Participation "Dentistry — Yesterday, Today, Tomorrow" (Kharkiv, 2007), the XIII International Conference of Maxillofacial Surgeons and Dentists "New Technologies in Dentistry" (Saint Petersburg, 2008), the Scientific-Practical Conference of Young Scientists "Current Issues in Clinical and Experimental Medicine" (Saint Petersburg, 2008), the XIX and XX All-Russian Scientific-Practical Conferences "Current Problems in Dentistry" and "Dentistry of the XXI Century" (Moscow, 2008), the First International Distance Scientific Conference "Innovations in Medicine" (Kursk, 2008), and the II Scientific-Practical Conference "Dentistry of the Slavic States" (Belgorod, 2008).

PUBLICATIONS

On the topic of the dissertation, 24 printed works have been published, including 3 in journals recommended by the Higher Attestation Commission (VAK).

IMPLEMENTATION INTO PRACTICE

The results of the study have been implemented into the practical work of Dental Polyclinics No. 9 and No. 20 of Saint Petersburg, and are also used in lecture materials and practical classes at the Departments of Orthopedic Dentistry, Nephrology, and Efferent Therapy of the SEI APE SPbMAPO of the Federal Agency for Health Care and Social Development (Roszdrav).