Kronik Böbrek Hastalığı Olan Çocuklarda Ağız Diş Sağlığı Durumunun Değerlendirilmesi
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Evaluation of the Oral and Dental Health Status in Children with Chronic Kidney Disease. Hacettepe University, Faculty of Dentistry, Department of Pediatric Dentistry, Thesis, Ankara, 2019. Chronic kidney disease (CKD); is a chronic disorder condition in renal functions characterized by a decrease in glomerular filtration rate due to progressive and irreversible loss of nephrons depending on various etiological factors. CKD or treatment of this disease may adversely affect the oral and dental health of the individual. The effects of the disease on oral and dental health vary depending on the severity, stage and duration of the disease. The aim of this study was to evaluate the oral hygiene and diet habits, oral health status, halitosis, salivary parameters of children with and without CKD and some serum parameters related to oral health in children with CKD. The study was approved by Hacettepe University Non-Invasive Research Ethics Committee. Children with CKD followed in Hacettepe University, Faculty of Medicine, Department of Pediatrics, Department of Pediatric Nephrology and healthy children who had referred to Hacettepe University, Faculty of Dentistry with various complaints were included in the study. After written informed consent was obtained from parents, some sociodemographic attributes of children and their parents, oral hygiene and diet habits of children and parents were obtained by a questionnaire. Dental caries-related records were obtained by using dmft / dmfs, DMFT / DMFS and ICDAS II indices; and the records related to gingival health were obtained by using plaque index (PI), gingival index (GI), OHI-debris and OHI-calculus. Halitosis was assessed by sulfur monitoring method. In addition, saliva flow rate (ml/min), pH and buffering capacity of unstimulated saliva were the evaluated parameters associated with saliva. In CKD group, type of renal replacement therapy, drugs used for treatment and serum hemoglobin levels were evaluated. The children participated in the study aged were between 4-20 years old. The mean age of the 63 children (35 boys, 28 girls) was 13.76±3.97 years and the mean age of the 72 children (31 boys, 41 girls) without CKD was 12.14±2.98 years. The mean dmft, dmfs, DMFT and DMFS indices of children with CKD were 1.41±2.43; 3.94±8.17; 1.07±1.93 and 1.77±3.78 respectively. The mean dmft, dmfs, DMFT and DMFS indices of the children without CKD were 4.16±2.42; 10.03±7.21; 2.23±3.19 and 4.64±9.13 respectively. The mean dmft / dmfs and DMFT / DMFS indices were lower in children with CKD compared with healthy children and it was statistically significant. The highest percentage of children with CKD (30.2%) had ICDAS-2 score and the highest percentage (40.3%) ICDAS-5 score in children without CKD. There was a statistically significant difference in the distribution of ICDAS index scores between children with and without CKD (p<0.05). The mean OHI-debris and OHI- x calculus indices of children with CKD were 1.74±1.10 and 0.41±0.52 respectively; these values are 1.04±0.62 and 0.09±0.21 respectively in without CKD group. The mean plaque and gingival indices of children with CKD (PI and GI) were 1.46±0.64 and 0.65±0.50, respectively; these values are 1.13±0.50 and 0.78±0.39 respectively in without CKD. Accordingly the mean of OHI-debris, OHI-calculus, PI and GI were statistically significantly higher in children with CKD (p<0.05). Halitosis was seen in 36.4% of children with chronic kidney disease and in 47.6% of children without CKD. The flow rate (ml/min), pH and buffering capacity of unstimulated saliva was 0.43±0.22; 7.89±0.46 and 5.94±1.11 respectively in children with CKD and 0.45±0.23; 7.52±0.30 and 4.77±0.67 respectively in without CKD. The mean of unstimulated saliva pH and buffering capacity were significantly higher in children with CKD (p<0.05). As a result, many metabolic and physiological changes associated with chronic kidney disease, the treatments applied, the drugs used may affect the development and mineralization of the teeth, the structure and composition of the saliva and consequently presence of the tooth decay, gingival health and presence of halitosis. Pediatric dentists should be aware of potential oral health problems in children with chronic kidney disease. The importance of oral health, oral hygiene habits and regular dentist visits should be emphasized for children with chronic kidney disease and their parents.