Abstract
BackgroundChronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing.MethodsTo examine whether intensive dental prophylaxis can restore oral health, reduce the prevalence of bacteremia and degree of systemic inflammation indicated by CRP levels, we conducted this pilot study examining 30 CKD patients aged 6–26 years, 15 receiving intensive prophylaxis (IP), 15 receiving treatment as usual (TAU) serving as control group. There were three appointments for examination, each 10 ± 1 weeks apart (at baseline, after intervention periods one and two, when TAU also received IP, and the IP group stopped prophylaxis).ResultsThe gingival index (GI) in the IP group decreased by 90% (GI 0.09; p=0.001), resulting in almost healthy gingiva. There was no significant change in CRP or prevalence of bacteremia. General prevalence of bacteremia after toothbrushing was 9.5% affecting 7 (26%) of the participants. In three participants, bacteremia dissolved after IP, in one after TAU. Two patients developed bacteremia ≥ 10 weeks after ending IP. We identified eight different bacterial species.ConclusionsWe were able to show that IP can effectively treat gingivitis. It might be a promising approach to reduce systemic inflammation and subsequently lower premature cardiovascular disease, despite the lack of statistical significance. Future research requires a larger patient cohort to enable matched treatment groups with long-term follow-up and molecular detection methods for bacteremia.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information
Highlights
Despite extensive progress in the treatment of patients affected by chronic kidney disease (CKD), morbidity and mortality still remain unacceptably high [1]
Poor oral health in patients suffering from Chronic kidney disease (CKD) is one important, yet often underestimated, source of chronic inflammation [7, 8]
Four participants decided to leave before randomization for personal reasons and three patients had to be excluded as they received antibiotic treatment at baseline examination
Summary
Despite extensive progress in the treatment of patients affected by chronic kidney disease (CKD), morbidity and mortality still remain unacceptably high [1]. In past research concerning the most reliable biomarkers to predict cardiovascular outcome and mortality in CKD patients, the best evidence has been found for C-reactive protein (CRP) and interleukin-6 (IL-6) [5]. Poor oral health in patients suffering from CKD is one important, yet often underestimated, source of chronic inflammation [7, 8]. Examining the oral condition in patients with CKD, studies demonstrate there is a much higher prevalence of gingivitis, plaque accumulation, attachment loss, enamel hypoplasia, and gingival bleeding or gingival hyperplasia compared to systemically healthy controls whereas caries prevalence remains low, even when kidney function decreases [9, 10]. Chronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing
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