ORAL HEALTH AND INFLAMMATION IN END-STAGE RENAL FAILURE

[Anonymous]

Background/Aims: End-stage renal disease (ESRD) patients have an increased risk of atherosclerotic complications. In both hemodialysis (HD) patients and the general population, it has become evident that inflammation plays an important role in the pathogenesis of atherosclerotic complications. Oral and dental problems in ESRD patients could be an important source of inflammation, thus treatment of these problems is important to protect these patients from potential infections. The decayed, missing, and filled teeth (DMFT) index is an indicator of oral and dental health status. Our aim was to analyze and compare salivary flow rate (SFR), salivary pH (SpH), salivary buffering capacity (SBC), and DMFT index and plaque index (PI) values in PD patients to HD patients and healthy controls (C) and establish the relationship between these parameters and C-reactive protein (CRP).

Methods: 76 PD patients, 100 HD patients, and 111 Cs were included in the study. SFR (milliliters/minute) was measured in stimulated whole saliva, SpH was measured using the Merck indicator, and SBC was measured according to the method of Ericsson: 1 mL whole saliva was added to 3 mL 0.005 N HCl and a stream of air was passed through this mixture for 20 minutes. Finally, DMFT index and PI values were calculated.

Results: No statistically significant differences were found in age or gender distribution among PD, HD, and C groups. There was also no significant difference in time on dialysis between PD and HD groups. SFR was significantly lower in the PD and HD groups than in the C group (1.30 ± 0.83 and 0.70 ± 0.32 vs 1.64 ± 0.45 mL/min) and lower in the HD than in the PD group (p < 0.001). SpH (8.35 ± 0.43 and 8.12 ± 0.74 vs 7.16 ± 0.76) and SBC (7.39 ± 0.47 and 6.82 ± 0.70 vs 5.08 ± 0.73) were significantly higher in the PD and HD groups than in the C group and higher in the PD than in the HD group (p < 0.05 and p < 0.001 respectively). The numbers of filled teeth were significantly higher in the PD than in the HD and C groups (p < 0.001). DMFT index was significantly higher in the PD than in the HD group (p < 0.001). Finally, PI values were significantly higher in the PD and HD groups than in the C group (p < 0.001) and higher in the HD than in the PD group, although this was not statistically significant. In the present study, we also found higher CRP values in HD than in PD patients and a positive correlation between CRP and PI values in PD patients.

Conclusions: PD patients have higher SFR, SpH, and SBC values than HD patients; however, higher DMFT index and higher numbers of filled teeth were observed in PD patients. Compared to healthy controls, patients on dialysis had worse dental and periodontal findings, which might have a role in microinflammation in this group of patients.

        

[Anonymous]

Majority of these patients were on anti coagulants, have open AV fistula and decreased platelet count due to iatrogenic damage to platelets during dialysys, so the major considerations in ESRD patients should be towards control of infections, bleeding and other complications of anemia and adjusting the dosages of the drugs. All the dental procedures should be carried on the next day of dialysis.

        

[Drsumitra]

– A protein in saliva that can be used for the early detection of sepsis cases offers new potential for tracking diseases, according to research from Malmö University in Sweden.

The protein suPAR can be used as a marker of sepsis, according to a university press release. Sepsis affects about 0.2% of the Swedish population and can lead to septic shock, one of the most common causes of death at the country’s intensive care units.

Anna Gustafsson, a doctoral candidate at the school, found that the protein correlates with the so-called SOFA (Sequential Organ Failure Assessment) score, a measure of organ failure that is used in cases of blood poisoning. The occurrence of suPAR in saliva is 10 times higher than in the blood, the study found. Blood glucose levels following starch ingestion are influenced by genetically determined differences in salivary amylase, an enzyme that breaks down dietary starches, according to a new study in the Journal of Nutrition (April 4, 2012) by scientists from the Monell Center.

In the study, amylase activity was measured in saliva samples obtained from 48 healthy adults. Based on extremes of salivary amylase activity, two groups of seven were formed: high amylase (HA) and low amylase (LA).

Each subject drank a simplified corn starch solution and blood samples were obtained over a two-hour period afterwards. The samples were analyzed to determine blood glucose levels and insulin concentrations.

After ingesting the starch, individuals in the HA group had lower blood glucose levels relative to those in the LA group. This appears to be related to an early release of insulin by the HA individuals.

"Not all people are the same in their ability to handle starch," said senior author Paul Breslin, PhD, a sensory geneticist at Monell, in a press release. "People with higher levels of salivary amylase are able to maintain more stable blood glucose levels when consuming starch. This might ultimately lessen their risk for insulin resistance and non-insulin-dependent diabetes."

The findings are the first to demonstrate a significant metabolic role for salivary amylase in starch digestion, suggesting that this oral enzyme may contribute significantly to overall metabolic status.

Additional studies will confirm the current findings using more complex starchy foods, such as bread and pasta, the researchers noted.

 

        

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