Evaluation of Dental and Periodontal Health of Renal Transplant Patients Under Different Immunosuppressive Medications

Abstract

Objective: Renal transplantation is considered to be most efficient renal replacement therapy option of end-stage renal disease. The numbers of patients who are in need of and whom are already had renal transplantation are increasing. The immunosuppressive medicaments taken by patients after transplantation may have an effect on dental and periodontal health. This study aimed to evaluate the dental and periodontal health status of renal transplant patients taking different immunosuppressive medications.

Materials-Methods: A total of 296 patients; 156 patients with renal transplantation (BN group) and 140 healthy patients (control group) took part in the study. Patients in BN group also evaluated in subgroups depending on the immunosuppressive medicaments taken; cyclosporine A (CSA, n=44), tacrolimus (TAC, n=27) and sirolimus (SRO, n=85). Dental status of patients assessed by decayed, missing, filled teeth (DMFT) index. Probing depth (CD), gingival index (GI) and plaque index (PI) were used to evaluate the periodontal status of patients. The demographic details and patients’ oral hygiene habits were questioned. Statistical analysis of data was performed using ANOVA, Mann-Whitney U and Kruskal Wallis tests.

Results: The mean transplant age of the participants was 7,32±5,70 years. All periodontal parameters were significantly higher in BN group compared to healthy controls (p<0,05). Missing teeth were significantly higher and the filled teeth were significantly lower in BN group (p<0,05). Probing depth and Gİ scores were higher in CSA group (p<0,05). Plaque scores were significantly lower in control group (p<0,05). Restored teeth were significantly lower in control group compared to CSA and SRO groups. Tooth brushing and interdental cleaning frequency was lower in BN group.

Conclusion: Impaired dental and periodontal health was observed in BN group, substantially concomitant result of the inadequate removal of dental plaque. The awareness of dental/ periodontal health and the importance of oral hygiene procedures should be stated to decrease treatment needs, and to achieve and maintain optimum oral health after renal transplantation.

Keywords

• renal transplantation,immunosuppressive agents,oral health,periodontal disease

Farklı İmmünsupresiflerin Böbrek Nakilli Hastaların Dental ve Periodontal Sağlığına Etkisi

Abstract

Amaç: Böbrek nakli, son dönem böbrek hastalığının renal replasman tedavisinde en etkili tedavi seçeneği olarak kabul edilmektedir. Böbrek nakline ihtiyacı olan ve böbrek nakli geçirmiş olan bireylerin sayısı günümüzde artmaktadır. Transplantasyon sonrası hastalar tarafından kullanılmakta olan immünsupresif ilaçlar, dental ve periodontal sağlığı etkileyebilir. Bu çalışmanın amacı böbrek nakli olan ve farklı immünsupresif ilaç kullanan hastaların dental ve periodontal sağlık durumlarının karşılaştırılarak değerlendirilmesidir.

Materyal-Metot: Yüz elli altı böbrek nakilli hasta (BN grubu) ve 140 sistemik olarak sağlıklı hasta (kontrol grubu) olmak üzere toplam 296 birey çalışmaya dahil edildi. Böbrek nakli grubundaki hastalar ayrıca kullanmakta oldukları immünsupresif ilaç türüne göre de alt gruplara ayrılarak değerlendirildi; siklosporin A (CSA, n=44), takrolimus (TAC, n=27) ve sirolimus (SRO, n=85). Bireylerin dental sağlık düzeyi çürük, eksik ve dolgulu diş (DMFT) sayılarına bağlı olarak değerlendirildi. Bireylerin periodontal sağlık düzeyini belirlemek için sondalanabilir cep derinliği (PD), gingival indeks (Gİ) ve plak indeksi (Pİ) kullanıldı. Demografik veriler ve hastaların oral hijyen alışkanlıkları sorgulanarak kaydedildi. Verilerin istatistiksel analizi ANOVA, Mann-Whitney U ve Kruskal Wallis testleri kullanılarak yapıldı.

Bulgular: Böbrek nakli olan bireylerin nakil yaşı ortalaması 7,32±5,70 yıl olarak belirlendi. Kontrol grubu ile karşılaştırıldığında BN grubundaki bireylerin periodontal parametrelerinin anlamlı olarak yüksek olduğu gözlendi (p<0,05). BN grubunda kontrol grubuna göre eksik diş sayısının anlamlı olarak yüksek, restore edilmiş diş sayılarının ise anlamlı olarak düşük olduğu belirlendi (p<0,05). Kontrol grubu ile karşılaştırıldığında CSA grubunda PD ve Gİ skorlarının anlamlı düzeyde yüksek olduğu gözlendi (p<0,05). Plak indeksinin ise kontrol grubunda anlamlı olarak düşük olduğu saptandı (p<0,05). Dolgulu diş sayısının CSA ve SRO gruplarında kontrol grubuna göre anlamlı düzeyde düşük olduğu izlendi (p<0,05). Böbrek nakli olan hastaların diş fırçalama sıklığının ve ara-yüz temizliği sıklığının kontrol grubuna göre düşük olduğu belirlendi.

Sonuç: Yeterli olmayan plak uzaklaştırma sıklığının bir sonucu olarak, BN grubundaki bireylerde dental ve periodontal sağlığın bozulduğu izlenmiştir. Böbrek nakli öncesinde oral hijyen prosedürlerinin önemi ve dental/periodontal sağlığın farkındalığı vurgulanarak tedavi gereksinimlerinin azaltılmalı ve optimum ağız sağlığı elde edilmeli ve korunmalıdır.

Keywords

• renal transplantasyon,immünsupresif ajanlar,oral sağlık,periodontal hastalık

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