Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study

Abstract

Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.

Prevalence of Dental Caries in Patients on Renal Replacement Therapy—A Systematic Review

“…Another prospective cohort study found untreated caries to increase all-cause mortality in HD patients [ 10 ]. A Taiwanese nationwide population-based cohort study in patients with CKD showed that sufficient root canal treatment, which is often needed in case of fairly advanced carious lesions, leads to a lower risk of death during HD therapy [ 55 ]. In the included studies, therapy-related issues (e.g., eGFR) or inflammatory laboratory values (e.g., C-reactive protein [CRP]) were rarely considered across investigations, making a conclusion on this issue impossible.…”

Knowledge, attitudes and performance of Iranian endodontists regarding patients with kidney diseases

“…As a result, timely access to endodontic treatment can considerably impact upon the lives of CKD patients in a positive way. Studies conducted in Taiwan using real-world population-based data have documented improved survival in CKD patients undergoing dialysis when timely root canal treatment was undertaken ( 35 ).…”

Doença renal crônica: influencia sistêmica na odontologia e manifestações bucais

“…Com base nos resultados e nos artigos incluídos no presente trabalho, sobre as manifestações bucais que incluem: cárie, perda de inserção clínica, doença periodontal, fluorose, cálculo dental, placa bacteriana, inflamação perirradicular, infecção microbiana no sistema de canais radiculares, disgeusia, hálito urêmico, xerostomia, hipoplasia de esmalte e distúrbios gustativos (Parkar;Ajithkrishna, 2012;Tiwari et al, 2013;Swapna;Koppolu;Prince, 2017;Nascimento et al, 2018;Misaki et al, 2019;Sharma et al, 2020;Chiu et al, 2021).…”

“…O tratamento para DRC inclui o uso de medicamentos anti-hipertensivos e a baixa ingestão de líquidos, em consequência disso, pode-se ocorrer desidratação e em função desse fato a xerostomia pode se tornar um sintoma frequente e persistente nesses pacientes (Howell;Perry;Patel, 2016;Nascimento et al, 2018;Marinosk et al, 2019;Chiu et al, 2021) 2019) em suas pesquisas notaram que a relação da cárie com o paciente renal crônico é menor que no grupo saudável. Foram sugeridas algumas explicações para esse fato, dentre elas, o alto índice de uréia que afeta o pH bucal, uma maior quantidade de fosfato e uma baixa quantia de cálcio, afetando sua ação no processo de desmineralização e remineralização, consequentemente, aumentando a capacidade tampão exercida pela saliva, assim a doença cárie não terá uma instalação facilitada em comparação aos pacientes saudáveis (Gautam et al, 2014;Tadakamadla et al, 2014;Fregoneze et al, 2015;Swapna;Koppolu;Prince, 2017;Pham;Lee, 2018;Menezes et al, 2019;Silva et al, 2019).…”