**5. Discussion and summary**

The present chapter highlights the fact that oral health status is debilitated and compromised among the hemodialysis patients and gets worsened with increasing

**33**

*Hemodialysis and Oral Health*

patient care approach.

needs of this special group.

more than twice a week.

compromised medical status.

and increasing salivary buffer capacity [23].

of dialysis therapy on dental health.

optimum patient care.

*DOI: http://dx.doi.org/10.5772/intechopen.87085*

duration and hemodialysis and underlying kidney disease which might contribute significantly to morbidity and potential mortality among these patients. This further emphasizes the concept of common risk factor approach with multidisciplinary

The dental health is compromised in patients undergoing hemodialysis therapy,

This warrants the need for intensified preventive oral health-care modalities in these patients, so as to improve their dental health which can have a significant impact on their overall health. The dialysis team should be encouraged to make the dental referral as early as possible, if needed, and regular monthly dental checkups should be advocated. Further emphasis on the effective implementation of oral health promotion program for medically compromised patients is recommended. Oral health education and counseling regarding oral health-care-seeking behavior during the hemodialysis appointment can motivate and educate patients along with their family members. At the same time, dental fraternity should receive appropriate training for treatment of these medically compromised patients to cater to the

Analysis of the effect of duration of dialysis on the periodontal tissues did not show confirmatory relationship. However the frequency of hemodialysis has a significant influence on the periodontal status of the patients with a deteriorated CPI scores with the increased frequency of hemodialysis from once to twice and

Also, there is a significant existence of higher prosthetic needs concerning to mouth among the patients undergoing hemodialysis. Hence, oral health-care delivery system may be strengthened to cater to the prosthetic needs of these patients as well. Increased prosthetic needs of the patients with the duration of dialysis might be attributed to the dental care denial by the dental practitioners owing to their

The hemodialysis patients usually report poor oral hygiene. These patients exhibit immunocompromised state although they are not completely immune deficient and are still able to deal with bacterial challenge. The patients with chronic kidney disease showed poor oral hygiene which could probably be due to longstanding disease duration leading to a debilitated oral hygiene. Further there is high deposit of calculus on teeth due to uremic salivary pH in hemodialysis patients.

Majority of the hemodialysis patients suffer from diabetic nephropathy and have strict dietary pattern. Further, increased alkalinity of the oral cavity is reported in the uremic patients as a result of high urea level in saliva inhibiting bacterial growth

Further studies are required to correlate the dental findings with the biochemical serum markers over a duration of time so as to validate the influence of duration

The current chapter highlights the relation between oral health and hemodialysis. This further necessitates more interdisciplinary research on this topic. Medical and dental health-care professionals need to join hands and work together ensuring

and with the increasing duration of hemodialysis, various clinical oral healthrelated parameters get worsened with increasing duration of hemodialysis. The chronic disease condition and time-taking treatment (hemodialysis) affect the oral health-care habits resulting in poor periodontal condition among the patients. The psychological effect of long-standing kidney diseases resulting in high stress level and depression in hemodialysis patients compromises the periodontal health further. Hence, oral health promotive and preventive intervention early in the

hemodialysis patients can influence the oral health status positively.

#### *Hemodialysis and Oral Health DOI: http://dx.doi.org/10.5772/intechopen.87085*

*Renal Diseases*

to their treatment modality.

treatment among these patients.

tive dental treatment.

**5. Discussion and summary**

14.**Kaushik et al.** [21] assessed the changing oral and salivary environment in patients suffering from end-stage renal disease (ESRD) and undergoing hemodialysis. A cross-sectional study was conducted on 100 ESRD patients over a period of 15 months out of which 25 patients were randomly selected to assess the salivary changes and compared with 25 controls. The study showed that most common oral manifestations in these patients were oral malodor, dry mouth, taste change, increased caries incidence, calculus formation, and gingival bleeding. The salivary findings revealed that the rates of both unstimulated and stimulated whole saliva decreased in patients; however, pH and buffer capacity of unstimulated whole saliva increased. The authors have suggested that ESRD patients undergoing hemodialysis require special considerations during dental treatment as they have varied oral manifestations primarily due

15.**Xie et al.** [22] evaluated oral health status and oral hygiene behavior among hemodialysis patients in China. Caries status was examined and recorded along with the sociodemographic information of 306 patients, aged 24–88 (58.09 ± 14.06). It was interesting to note that that majority of the patients followed good oral hygiene practices and brushed their teeth twice daily. However, limited use of other oral hygiene aids like floss or mouth wash was reported. The oral health treatment seeking behavior was compromised since the commencement of hemodialysis therapy. The mean DMFT scores of the patient were 9.63 ± 7.54. It was concluded that hemodialysis therapy seemed to prevent patients from visiting a dentist and there was a great need for dental

16.**Jain et al.** [23] conducted a study to assess the effect of duration of hemodialysis and the underlying kidney disease on the dental health status of patients undergoing hemodialysis and to compare their dental health status with that of healthy controls. A cross-sectional study was conducted on 400 patients and 400 controls selected through stratified random sampling method from five zones of Delhi. Based on the duration of hemodialysis, the patient group was divided into subgroups ranging from less than 3 months to more than 12 months. The complete oral health status was recorded using the WHO dentition status and treatment need, community periodontal index, oral hygiene index, and prosthetic status and prosthetic needs. It was observed that with increasing duration of hemodialysis, periodontal status worsened as per maximum CPI scores (p value = 0.018). Majority of patients (81.25%) reported the presence of calculus. It was interesting to observe that the severity of periodontal disease was higher among the patient group (p value 0.035). Oral hygiene status was also compromised among patients (mean OHI scores 5.15 ± 1.975). No significant difference was observed regarding caries status among patients and controls. Prosthetic needs were higher among patients. It was thus concluded that the duration of hemodialysis had a significant influence on oral hygiene status and prosthetic needs signifying the need of preven-

The present chapter highlights the fact that oral health status is debilitated and compromised among the hemodialysis patients and gets worsened with increasing

**32**

duration and hemodialysis and underlying kidney disease which might contribute significantly to morbidity and potential mortality among these patients. This further emphasizes the concept of common risk factor approach with multidisciplinary patient care approach.

The dental health is compromised in patients undergoing hemodialysis therapy, and with the increasing duration of hemodialysis, various clinical oral healthrelated parameters get worsened with increasing duration of hemodialysis. The chronic disease condition and time-taking treatment (hemodialysis) affect the oral health-care habits resulting in poor periodontal condition among the patients. The psychological effect of long-standing kidney diseases resulting in high stress level and depression in hemodialysis patients compromises the periodontal health further. Hence, oral health promotive and preventive intervention early in the hemodialysis patients can influence the oral health status positively.

This warrants the need for intensified preventive oral health-care modalities in these patients, so as to improve their dental health which can have a significant impact on their overall health. The dialysis team should be encouraged to make the dental referral as early as possible, if needed, and regular monthly dental checkups should be advocated. Further emphasis on the effective implementation of oral health promotion program for medically compromised patients is recommended. Oral health education and counseling regarding oral health-care-seeking behavior during the hemodialysis appointment can motivate and educate patients along with their family members. At the same time, dental fraternity should receive appropriate training for treatment of these medically compromised patients to cater to the needs of this special group.

Analysis of the effect of duration of dialysis on the periodontal tissues did not show confirmatory relationship. However the frequency of hemodialysis has a significant influence on the periodontal status of the patients with a deteriorated CPI scores with the increased frequency of hemodialysis from once to twice and more than twice a week.

Also, there is a significant existence of higher prosthetic needs concerning to mouth among the patients undergoing hemodialysis. Hence, oral health-care delivery system may be strengthened to cater to the prosthetic needs of these patients as well. Increased prosthetic needs of the patients with the duration of dialysis might be attributed to the dental care denial by the dental practitioners owing to their compromised medical status.

The hemodialysis patients usually report poor oral hygiene. These patients exhibit immunocompromised state although they are not completely immune deficient and are still able to deal with bacterial challenge. The patients with chronic kidney disease showed poor oral hygiene which could probably be due to longstanding disease duration leading to a debilitated oral hygiene. Further there is high deposit of calculus on teeth due to uremic salivary pH in hemodialysis patients.

Majority of the hemodialysis patients suffer from diabetic nephropathy and have strict dietary pattern. Further, increased alkalinity of the oral cavity is reported in the uremic patients as a result of high urea level in saliva inhibiting bacterial growth and increasing salivary buffer capacity [23].

Further studies are required to correlate the dental findings with the biochemical serum markers over a duration of time so as to validate the influence of duration of dialysis therapy on dental health.

The current chapter highlights the relation between oral health and hemodialysis. This further necessitates more interdisciplinary research on this topic. Medical and dental health-care professionals need to join hands and work together ensuring optimum patient care.

*Renal Diseases*
