| OBJECTIVE: Oral diseases(dental caries and periodontitis)in maintenance hemodialysis(MHD)patients were investigated and analyzed to explore their risk factors.A mouse model of chronic renal failure(CRF)was constructed,and the pathological changes of alveolar bone and gingiva in CRF mice were observed,and the expression levels of tumor necrosis factor(TNF)and interleukin-6(IL-6)were measured by immunohistochemistry.The expression levels of TNF and IL-6 were measured by immunohistochemistry to clarify the presence or absence of periodontal lesions in CRF mice.MATERIALS AND METHODS: Patients in hemodialysis centers of three hospitals in Shanghai(Shanghai Fourth People’s Hospital,Shanghai Sixth People’s Hospital,and Shanghai Eighth People’s Hospital)underwent a comprehensive oral examination to assess the prevalence of dental caries and periodontitis,and to collect relevant clinical data(age,gender,whether combined with diabetes,whether combined with hypertension,duration of dialysis)and laboratory indices(white blood cells,platelets,hemoglobin,basophils,etc.).The prevalence of dental caries and periodontitis in the fourth national oral epidemiological survey sponsored by the Chinese Dental Association in 2015 was selected for comparative analysis.Maintenance hemodialysis patients were divided into caries and non-caries groups and periodontitis and non-periodontitis groups.After screening variables by univariate analysis,logistic regression analysis was included to find independent influencing factors of oral disease.A mouse model of CRF was constructed,and the histopathological changes of gingiva were assessed by HE staining;the bone resorption of osteoclasts in alveolar bone was observed by TRAP staining;the expression levels of TNF-α and IL-6 in gingiva were detected by immunohistochemistry.RESULTS:(1)A total of 351 patients(29 were edentulous)from 3 hemodialysis centers were included,of which 233 patients(66.4%)were male and 118(33.6%)were female.The prevalence of dental caries was 68.32%(220/322),with a mean of 2.42 caries/person,4.12 missing teeth/person,and 0.24 fillings/person;the prevalence of periodontitis was 95.65%(308/322).According to the CDC/AAP criteria,the severity of periodontitis disease was graded in the order of mild 24.35%(75/308),moderate 36.36%(112/308),and severe 39.29%(121/308).(2)According to age stratification,the prevalence of dental caries in MHD patients in the age group 35-44 years was 65.38%(17/26)compared with 62.70%(2765/4410)in the general population(P=0.778),the prevalence of periodontitis in MHD patients was 84.62%(22/26)compared with 52.8%(2328/4410)in the general population(P=0.001)The prevalence of dental caries was 63.53%(54/85)in MHD patients in the age group 55-64 years compared with 72.6%(3356/4623)in the general population(P=0.064),and the prevalence of periodontitis was 95.29%(81/85)in MHD patients compared with 69.3%(3204/4623)in the general population(P<0.001);the prevalence of dental caries in MHD patients in the age group 65-74 years compared with 69.3%(3204/4623)in the general population(P<0.001);and the prevalence of periodontitis in MHD patients in the age group 65-74 years compared with 69.3%(3204/4623).The prevalence of dental caries was 80.0%(84/104)in MHD patients compared with 76.67%(3398/4431)in the general population in the age group of 74 years(P=0.330),and the prevalence of periodontitis was 99.04%(103/104)in MHD patients compared with 64.6%(2862/4431)in the general population(P<0.001).(3)Univariate analysis: statistically significant differences were found between the carious and non-carious groups in age,sex,frequency of brushing and whether flossing was used,Creactive protein,total bilirubin,direct bilirubin,calcium ions,albumin,albumin globule ratio,prealbumin,urea,creatinine,uric acid,potassium ions,phosphorus ions,magnesium ions,and 25-hydroxyvitamin D3 levels(P<0.05 or 0.001).Statistically significant differences were found between the periodontitis and non-periodontitis groups in terms of age,alkaline phosphatase,total bile acids,urea,and bicarbonate and HDL cholesterol levels(P<0.05 or 0.001).(4)Multifactorial logistic regression analysis: age ≥65 years(OR=3.959;95% CI: 1.647,9.707),elevated total bilirubin(OR=1.163;95% CI: 1.021,1.34)were independent risk factors for dental caries in patients with MHD;flossing(OR= 0.255;95% CI: 0.079.0.758),elevated direct bilirubin(OR=0.736;95% CI: 0.554,0.967),elevated uric acid(OR=0.996;95% CI: 0.992,1),and elevated 25 hydroxyvitamin D3(OR=0.939;95% CI: 0.898,0.98)were protective factors for dental caries in MHD patients(P<0.05).Age ≥65 years(OR=5.272;95% CI: 1.025,30.438)and elevated urea levels(OR=1.105;95% CI: 1.016,1.206)were independent risk factors for the development of periodontitis in patients with MHD;elevated HDL cholesterol levels(OR=0.538;95% CI:0.267,1.054)was a protective factor for the development of periodontitis in patients with MHD(P<0.05).(5)HE staining of CRF mice showed significant regression of gingival epithelium and gingival conjugate epithelium,and the attachment point of gingival conjugate epithelium proliferated toward the root;most of the area was displaced to the root tip and formed periodontal pockets;a small amount of chronic inflammatory cells infiltrated under the gingival epithelium was seen;a moderate amount of acute inflammatory cells were seen in the conjugate epithelium.TRAP staining showed a large number of osteoclastic giant cells in the alveolar bone of CRF mice.Compared with the control group,IL-6 was significantly elevated in the CRF mice,and the difference between the two groups was statistically significant;TNF-α was elevated in the CRF mice,but the difference between the two groups was not statistically significant.CONCLUSION: The prevalence of dental caries and periodontitis was high in patients on maintenance hemodialysis,and 3/4 of patients with periodontitis were moderately severe.Age ≥65 years and elevated total bilirubin levels were independent risk factors for the development of dental caries in MHD patients(P<0.05 or 0.001).Age ≥65 years and elevated urea levels were independent risk factors for the development of periodontitis in patients with MHD(P<0.05).Through CRF mice,it was found that after impaired renal function in mice,there were a large number of osteoclastic giant cells in the alveolar bone,gingival epithelium and gingival conjugate epithelium were significantly regressed,and gingival conjugate epithelium attachment sites proliferated toward the root;most of the area was displaced to the root tip and formed periodontal pockets;a small amount of chronic inflammatory cell infiltration was seen under the gingival epithelium;a moderate amount of acute inflammatory cells were seen in the conjugate epithelium,and IL-6 in the gingival tissue of CRF mice was significantly(P<0.01),suggesting the occurrence of periodontitis in mice. |
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