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Tuesday, August 9, 2011

Essay on Kidney Disease and Risk of Periodontal Disease

Kidney disease is any disease or disorder the affects the normal functioning of the kidneys.  One of the more common kidney diseases is the renal failure which is the condition where the kidneys fail to function adequately and properly.  Renal failure is classified into acute, subacute, chronic and terminal renal failure (Marinho et al, 2007, p. 305). 

The association between renal failure and periodontal disease was discovered when researchers found that there was an increased risk of periodontal disease in patients with reduced glomerular filtration rates.  Recent studies now has established that patients who are suffering from renal failure and those who are undergoing dialysis are more prone to periodontal disease and other oral health problems.  These studies also found that the severity of oral diseases is directly related to stage of the renal failure as those patients who are in the end stage of renal failure have more severe periodontal disease.  In other words, those who are in the latter stage of renal failure or those who are in the latter stage of their dialysis have greater degree of periodontal destruction (Cengiz et al, 2009, p.2). 

It must however be emphasized that periodontal disease may also be caused by other factors.  Studies have shown that diet has an effect on the development of periodontal disease.  For instance, sugar creates acidic conditions in the mouth which are ideal for the formation of bacteria.  Alcohol is also a reason for the development of gum disease and that alcoholics are more prone to having periodontal diseases.  Studies also show that lack of vitamin C and vitamin D may lead to bleeding, destruction of the ligaments and tooth loss
There are several reasons why patients who are suffering from end stage renal failure and those receiving dialysis are more prone to periodontal disease and other oral health problem. 

One reason is that these patients often have a bad taste in their mouth because of the urea which stays from the blood which eventually breaks down to form ammonia.  This often leads to halitosis. Other research says that this is due to the changes it the chemistry of the saliva where levels of creatinine, urea, sodium, potassium, chloride and alpha-amylase were significantly higher in patients receiving dialysis that those who are not.  The most practical reason is that those who have kidney disease often consider dental hygiene and dental treatment as less important considering that the patients are already getting treatment for kidney disease. 

In a study conducted by Marinho et al, they found that patients with chronic renal failure have a lower prevalence of caries, more supragingival plaque, more teeth with a loss of insertion and more missing teeth than those patients who have no kidney diseases.  RG Craig, on the other hand, states that chronic renal failure leads to xerostomia, delayed too eruption, calcification, enamel hypoplasia and altered salivary pH levels (RG Craig, 2008, p.2). However, researchers have also found that periodontal diseases when left untreated may increase the risk of heart attack.  Compared to patients with chronic renal failure, the cases of carries were lower in the patients with terminal renal failure.  This could indicate that the severity of the renal failure may be a protective factor against caries.  Other researchers also suggest that the patient suffering from periodontal disease should see a dental hygienist before and after the kidney transplant as studies show that dental diseases that are left untreated may lead to viral infection inside the gum tissue which may promote the growth of bacteria.  The growth of bacteria causes severe complications which may damage the organ.  The chronic inflammation that may be caused by a dental disease may also trigger a heart disease. 
In the same manner, periodontal treatment is now considered to have a key role in the success of organ transplant patients and in improving the patient’s quality of life.  Periodontal treatment which involves therapy of non surgical scaling and root planning, oral hygiene promotion, antimicrobial therapy and getting education on dental care help in preventing the presence of viral infection and growth of bacteria. 

In a National Health and Nutrition Examination Surveys, out of a total of 15,488 Americans examined from 1988 to 1994 and out of 13,233 Americans examined from 1999 to 2004, the results showed that 10% of Americans had chronic kidney disease between 1998 and 1994 and 13% of Americans had chronic kidney disease between 1999 to 2004 (Daniel J. DeNoon, 2007, p.1). 

As of this time, availability of studies on the number of Americans who have kidney disease and periodontal disease at the same time is scarce.  There is as yet no data on the estimated number of Americans who have kidney disease and periodontal disease.  However, in a recent study conducted by Joseph et al (2009), the results showed that out of a total of 77 patients who have kidney disease 71 have moderate to severe periodontitis.  Based on this study, 7.8% of patients have mild or no periodontal disease while 44.2% have moderate periodontal disease and 48% has severe periodontal disease.

There are many risk factors associated with periodontal disease.  The first step in avoiding periodontal disease or in preventing it from getting worse is to know what causes it.  Smoking and drinking are habits that should be avoided.  Proper nutrition will also help make the gums and teeth stronger and prevent it from weakening and having infection.  Another risk factor is kidney Disease.  Taking into account the increasing number of patients with kidney disease, it is likely that there will be an increase in the number of patients with periodontal disease.  Patients who are being treated for kidney disease and undergoing dialysis or have undergone transplant need to seek expert help to ensure that they are protected against the growth of virus and bacteria which may affect the dialysis or the success of the transplant

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