Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy – a systematic review

Abstract

Background: The oral health of patients undergoing renal replacement therapy (RRT) is insufficient. Poor oral health and its components can affect the oral health-related quality of life (OHRQoL) of these patients. The aim of this systematic review was to assess the OHRQoL of adult patients under RRT. Methods: A systematic literature search was performed using the terms: dialysis OR "renal disease" OR kidney OR "renal failure" OR "kidney transplantation" OR hemodialysis OR "peritoneal dialysis" OR "renal replacement therapy" AND "oral health-related quality of life", complemented by manual search. Clinical studies including adults (age ≥ 18 years) that were published between 2009 and 2019 were included in qualitative analysis. Results: Twelve out of 20 studies were included in the qualitative analysis. The majority (11/12 studies) included patients undergoing haemodialysis (HD), with a sample size between 47 and 512 participants. Two studies included patients after kidney transplantation. Only one-quarter of the investigations included a healthy control group. The overall OHRQoL was found to be reduced. The majority of studies found relationships between OHRQoL and different oral health parameters. Furthermore, several relationships between OHRQoL and general quality of life as well as disease related parameters including age, gender, diabetes, blood parameters and dialysis duration were found. OHRQoL subscales psychological/psychosocial impairment and pain were predominantly affected. Conclusions: Patients under RRT suffer from a reduced OHRQoL, which is potentially influenced by oral health and disease related parameters. Interdisciplinary dental care is needed and should consider both physical and psychosocial issues.

Oral changes in patients before and after transplantation of solid organs and hematopoietic stem cells

“…Chronic renal diseases are accompanied by frequent clinical manifestations on other organs and systems, or other chronic diseases, among which poorly controlled diabetes and cardiovascular diseases are the most common. In addition, the adverse effects of numerous drugs and therapies have resulted in a wide spectrum of various oral manifestations in about 90% of patients with renal insufficiency [10]. Chronic liver diseases and permanent damage to the functions of this organ often lead to the occurrence of oral diseases affecting oral mucous membrane and salivary glands, gingiva and periodontal tissues, jaw bone and hard dental tissue [8].…”

“…Due to changes in oral mucous membrane and parenchyma of the salivary glands after the application of therapy for hematologic malignancies, as well as stress, in the period prior to the tissue and cell transplantation, reduction in the secretion of stimulated saliva may be observed. Poor oral hygiene and decreased salivary secretion lead to a greater number of diseased teeth and the higher prevalence of periodontal disease [10].…”

Oral Health Status of Children Undergoing Hemodialysis and Kidney Transplantation in Mansoura City, Egypt

“…Nearly 90% of patients suffering from chronic renal failure (CRF) have oral symptoms that affect both hard and soft tissue. These manifestations may be caused by etiologic factors of kidney disease, or the process of dialysis, and kidney transplantation (1)(2)(3)(4) .The oral manifestations of the children suffering from chronic renal failure are mainly depend on the age of the child at the onset of the disease, the type of kidney disease, specific conditions of the host and the administered medication (5) .…”

“…Moreover, the plasma fluoride concentration may be elevated due to renal dysfunction, leading to dental fluorosis. Dental fluorosis was recorded among 77% of the populations with chronic kidney disease (5,12) . Alterations in salivary Ca, P, magnesium and elevated salivary pH were established in Patients with CRF; furthermore, increased salivary urea lead to precipitation of Ca-P and Ca-Ox (11) .…”

Palliative dental care: Ignored dimension of dentistry amidst COVID‐19 pandemic

“…Since the focus is mainly on the management of underlying disease conditions, the oral health in these patients is often neglected. Oral health status has a significant impact on the QoL of patients with complex end‐stage diseases 2 . Oral ulcers, xerostomia, halitosis, dental caries, endodontic or periodontal abscess reduce the efficiency of the stomatognathic system and may result in diminished physical, social and emotional well‐being 3 .…”