The neglect in oral health is associated with the increased risk of clinical complications within first year after kidney transplantation.

PurposeThe aim of the study was to assess whether hyposalivation is linked with increased thirst sensation and weight gain in hemodialysis (HD) patients and whether there is any connection between hyposalivation and sodium balance.MethodsOne hundred and eleven participants (64 males and 47 females) receiving maintenance hemodialysis, mean age 59.1 ± 13.6 years old, were involved in the study. All participants completed a survey evaluating thirst intensity (DTI) and xerostomia inventory (XI). In addition, pre-dialysis sodium concentration and inter-dialytic weight gain (IWG) were assessed. The division into no-hyposalivation and hyposalivation groups was based on an unstimulated whole saliva (UWS) flow rate.ResultsHyposalivation, UWS below 0.1 mL/min, was reported in 28.8 % of HD patients. In these participants, IWG was higher than in patients with UWS > 0.1 mL/min (3.65 ± 1.78 vs 3.0 ± 1.4; p = 0.042), as well as the pre-dialysis sodium gradient (3.22 ± 2.1 vs 1.6 ± 2.8; p = 0.031). The mean XI and DTI scores did not differ between study groups. In the hyposalivation group, pre-dialysis sodium serum gradient negatively correlated with saliva outflow (ρ = −0.61, p = 0.019) and positively with IWG (ρ = 0.49, p = 0.022). IWG correlated with XI (ρ = 0.622, p = 0.016) in hyposalivation group and with DTI in no-hyposalivation group (ρ = 0.386, p = 0.033).ConclusionsHyposalivation significantly correlates with IWG; however, its influence on thirst and self-reported mouth dryness seems to be weaker than expected. Additionally, hyposalivation was found to be associated with an elevated pre-dialysis sodium gradient.

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BackgroundIn hemodialysis (HD) patients, xerostomia and hyposalivation may intensify sensations of thirst, and contribute to the intake of fluids and excessive inter-dialytic weight gain (IWG). Since IWG is regarded to be higher in diabetic patients than in non-diabetics HD enhancing their mortality, it is crucial to define plausible underlying causes. Therefore, the study investigates factors contributing to the increased IWG in diabetic HD patients.Material and MethodsThe study included 97 HD patients (38 diabetics) receiving hemodialysis. All participants completed surveys comprising the Dialysis Thirst Inventory (DTI) and Xerostomia Inventory. Unstimulated whole saliva flow rate (USWFR) was measured, with USWFR below 0.1 mL/min being regarded as hyposalivation. Additionally, pre- and post-dialysis serum sodium concentration, sodium gradient and IWG were assessed. In diabetic HD patients, hemoglobin A1c (HbA1c) level was measured.ResultsSignificantly higher scores were found in diabetic than non-diabetic HD patients with regard to DTI (21.2±7.7 vs. 17.1±6.2: Z=2.44, p=0.03) and xerostomia (40.5±6.1 vs. 29.9±14.4: Z=4.15, p=0.003). Hyposalivation was observed more often in diabetic HD patients (Z=2.23, p=0.04). IGW was significantly higher in participants with diabetes (Z=2.44, p=0.03), as was the pre-dialysis sodium serum (Z=3.4, p=0.008). High levels of HbA1c were associated with lower levels of serum sodium (r=-0.67 p<0.05). HbA1c positively correlated with pre-dialysis sodium gradient (r=0.66 p<0.05). However, multiple regression analysis found that the only predictors of increased IWG (>4.8 IWG%) in diabetic patients remained saliva flow rate and pre-dialysis sodium gradient.ConclusionsConcomitant diabetes in hemodialysis patients appears to intensify subjective xerostomia and thirst sensation. It also leads to excessive IWG by the increase of pre-dialysis serum sodium gradient. Key words:Diabetes mellitus, hemodialysis, hyposalivation, inter-dialytic weight gain, sodium gradient.

PurposeThe study evaluated whether the dual blockade of the renin–angiotensin system may influence the sodium balance in hemodialysis.MethodsThe study involved 148 hemodialysis patients (male 85, female 63), mean age 59.6 ± 12.9 years. Participants were randomly selected to receive either angiotensin-converting enzyme inhibitor (ACEI)—subgroup A—or dual blockade ACEI and angiotensin receptor blocker (ARB)—subgroup AA.ResultsAt baseline, in the A versus AA subgroups, the pre-dialysis sodium concentrations (mmol/l) were 137.7 ± 0.5 versus 137.9 ± 0.8, the sodium gradients 2.6 ± 0.5 versus 2.9 ± 0.4, interdialytic weight gain (IWG) (kg) 3.1 ± 0.2 versus 3.0 ± 0.3, and thirst inventory score (points) 18.1 ± 1.0 versus 19.0 ± 1.7, respectively. After 3 months of therapy, a decrease in sodium concentration to 134.5 ± 0.5 and the increase of its gradient to 5.5 ± 0.5 were noted in the AA subgroup. An elevation of mean interdialytic weight gain to 3.47 ± 0.2 and thirst score to 21.3 ± 2.1 was observed. No significant changes in subgroup A were found. One month of the dialysate sodium concentration being lowered from 140 mmol/l to 138 mmol/l was associated with reduced serum sodium concentration and gradient, decreased IWG and restored moderate thirst score in the AA subgroup (137.5 ± 0.6 and 2.9 ± 0.6, 3.0 ± 0.5 and 19.2 ± 1.3, respectively).ConclusionsThe dual blockade of the renin–angiotensin system affects sodium balance, increasing the sodium gradient, thus elevating thirst sensation and enhancing interdialytic weight gain. In maintenance hemodialysis patients treated with both ACEI and ARB, lowered dialysate sodium levels should be prescribed.

Dental caries and childhood obesity are major problems affecting the health of children and preventing these conditions in children have been recognized as public health priorities (Hong et al. 2008; Odgien et al. 2010). The aim of the present study was to analyze the association between age-specific body mass index (BMI-for age) and dental caries in 3-to 7-year-olds. A cross-sectional study was conducted on 729 children from randomly chosen kindergartens and elementary schools in the urban area of Lodz, Poland. Anthropometric measurements were taken and the BMI-for-age was calculated for each child. Dental examinations were performed according to the WHO criteria. The sum of decayed, missing, filled primary/ permanent teeth and surfaces -dmft/DMFT and dmft/DMFTS, and caries prevalence were computed. The percentage distribution of the BMI categories in the study group was: 72.7% normal weight, 8.92% underweight, 12.89% overweight and 5.49% obese. Caries prevalence in the primary dentition was significantly lower in underweight children than in those who were of normal weight (p=0.004) or were overweight (p=0.039). However, controlling for age and gender, no significant association was noted between BMI and caries prevalence in either dentition group. The Kruskal-Wallis test failed to reveal any significant differences in mean dmft across the four BMI groups in the whole population, nor within particular age groups, nor in DMFT in 5-to 7-year-olds. There was no association between BMI and dental caries either in the primary dentition or permanent teeth in the early period after eruption.

Most frequent trauma to primary dentitions are injures to the supporting tissue i.e. luxations, but root fractures are relatively uncommon. The difference in the trauma pattern favoring luxation rather than fracture has been found to be typical for the primary dentition, since the elasticity of the alveolar bone surrounding the primary teeth is high and primary tooth held in alveolar socket is less strong. Incidence of foot fractures increases at the age of 3-4 years where physiologic root resorption has begun, thereweakening the root. Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. Because of potential sequelae of trauma to primary teeth, a treatment method that minimizes any additional risks of further damage to the permanent successors should be selected. The report presents a case of 3.5 year-old boy after traumatic injury – extrusion of tooth 51, which required surgical treatment, and apical third horizontal root fracture of tooth 61 treated conservatively. Written consent from subject’s parents/subject’s legal guardians was obtained. Root-fractured primary tooth has been followed clinically and radiographically for 3.5 year, till advanced root resorption. Presented case and cases described in cited literature demonstrate that conservative treatment of root-fractured primary teeth is a favorable method of the treatment that allows the teeth to function naturally until the term of physiological resorption and exfoliation.

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