Oral Health Status in Children with Renal Disorders

Advances in pediatric nephrology have resulted in increased survival rates of children with renal disorders. Renal disease is characterized by multiple organ involvement, including soft and hard tissues of the oral cavity. Data regarding the oral health status of Indian children with renal disorders is scarce. Thus, the aim of this study was to assess the oral health status of children with renal disorders in Jaipur city, India. Thirty six children in the age-group of 4-14 years, diagnosed with renal disorders were selected. Data pertaining to demographics, medication history, body mass index and blood investigations were obtained from the hospital records. The World Health Organization (WHO) criteria were used to diagnose dental caries. Enamel defects were recorded according to Developmental Defects of Enamel index. Oral hygiene status, salivary pH and buffering capacity were also assessed. The mean blood hemoglobin value was 9.75gm/dl, blood urea nitrogen 43.06 gm/dl and serum creatinine 1.5 mg/dl. Enamel defects were seen in 58.3% of children. Their mean deft and DMFT scores were 1.5 and 0.5, respectively. The mean Oral Hygiene Index-Simplified (OHI-S) score was 1.56. Gingival overgrowth was not present. Mean salivary pH was 6.92 and buffering capacity of stimulated saliva was 9.86. It is necessary for pediatric dentists to follow preventive oral health regimens that are tailored to these patients.

Renal disorder, Enamel Defects, Salivary pH, Dental caries

1. Trivedi HS, Pang MM. Discrepancy in the epidemiology of non dia-betic chronic renal insufficiency and end – stage renal disease in black and  white  Americans:  The  third  National  Health  and  Nutrition Examination  Survey  and  United  States  Renal  Data  System.  Am  J Nephrol, 23: 448–457, 2003.

2. Bagga A, Mantan M. Nephrotic syndrome in children. Ind J Med Res, 122: 13–28, 2005.

3. Eddy AA, Symons JM. Nephrotic syndrome in children. Lancet, 362: 629–639, 2003.

4. Mc Kinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM. Time trends  and  ethnic  patterns  of  childhood  nephrotic  syndrome  in Yorkshire, UK. Pediatr Nephrol, 16:1040–1044, 2001.

5. Riegden S. The management of chronic and end–stage renal failure. In: Webb N, Postlethwaite R. Textbook of Clinical Pediatric Nephrology. 3rd edition: Oxford Medical Publications GB: 427- 445, 2003.

6. Koch MJ, Buhrer R, Pioch T, Scharer K. Enamel hypoplasia of primary teeth in chronic renal failure. Pediatr Nephrol, 13: 68–72, 1999.

7. Guyton & Hall. Textbook of Medical Physiology. Elsevier Publication, 402–418, 2005.

8. Davidovich  E,  Davidovits  M,  Eidelman  E,  Schwarz  Z,  Bimstein  E. Pathophysiology, Therapy, and Oral Implications of Renal Failure in Children and Adolescents: An update. Pediatr Dent, 27: 298–105, 2005. 

9. Nunn JH, Sharp J, Lambert HJ, Plant ND, Coulthard MG. Oral health in children with renal disease. Pediatr Nephrol, 14: 997–1001, 2000.

10. US  DHHS.  National  Centre  for  Health  Statistics  2000  CDC  growth charts for the United States: Methods and development. Vital Health Stat, 11: 41–41, 2002.

11. WHO: Oral health Surveys–Basic methods. Geneva: 4th edition, 1997. 

12. FDI commission on Oral Health, Research and Epidemiology. An epi-demiological index of developmental defects of dental enamel (DDE index). Int Dent J, 32: 159–167, 1982.

13. Greene  JC,  Vermilion  JR.  The  simplified  oral  hygiene  index.  J Am Dent Assoc, 68: 7, 1964.

14. Miglani DC, Beal JF, PMC Beans, Behari SA. The assessment of den-tal cleanliness status of the primary dentition using a modification of the simplified oral hygiene index. (OHIS - M). Journal of Indian Dent Assoc, Dec: 385–388, 1973.

15. Agarwal  KN,  Saxena A,  Bansal AK, Agarwal  DK.  Physical  growth assessment in adolescence. Ind Pediatr, 38: 1215–35, 2001.

16. Banerjee I, Ghia N, Bandopadhyay S, Sayed HN, Mukherjee D. Body mass index in Bengali adolescents. Ind Pediatr, 42: 262–267, 2005.

17. Dowd  FJ:  Saliva  and  dental  caries.  Dent  Clin  North  Am,  43(4): 579–597, 1999.

18. Nikiforuk  G:  Understanding  Dental  Caries.  Karger.  Sydney,  p. 239–247, 1985.

19. Shannon IL, Feller RP, Eknoyan G, Suddick RP. Human parotid saliva in renal failure and during dialysis. Arch Oral Biol, 22: 83–86, 1977.

20. Jaffe EC, Roberts GJ, Chantler C, Carter JE. Dental findings in chronic renal failure. Br Dent J, 160: 18–20, 1986.

21. De Rossi SS, Glick M. Dental considerations for the patient with renal disease receiving hemodialysis. J Am Dent Assoc, 127: 211–19, 1996.

22. Lucas VS, Roberts GJ. Oro-dental health in children with chronic renal failure and after renal transplant: a clinical review. Peadiatr Nephrol,(10): 1388–1394, 2005.

23. Greenberg MS, Glick M. Burket’s oral medicine diagnosis and treat-ment. 10th edition. Philadelphia; p. 417–9, 2003.

24. Leone  CW  and  Oppenheim  FG:  Physical  and  chemical  aspects  of saliva as indicators of risk for dental caries in humans. J Dent Educ, 65(10): 1054–1062, 2001.

25. Alamoudi N, Farsi N, Faris J, Masoud I, Merdad K, Meisha D. Salivary characteristics of children and its relation to oral microorganism and lip mucosa dryness. J Clin Pediatr Dent, 28(3): 239–48, 2004 .

26. Al Nowaiser A, Roberts GJ, Trompeter RS, Wilson M, Lucas VS. Oral health  in  children  with  chronic  renal  failure.  Pediatr  Nephrol,  18: 39–45, 2003.

27. Yahya NB, Ali B. The dental and oral status of children with chronic renal failure. J Indian Soc Pedod Prev Dent, Mar: 7–9, 2007.

28. Spak CJ, Berg U, Ekstrand J. Renal clearance of fluoride in children and adolescents. Pediatrics, 75: 575–79, 1985