Oral hygiene practices and periodontal conditions among chronic kidney diseases patients attending Muhimbili National Hospital

Abstract

ABSTRACT Background: Periodontal diseases are among the most common infectious diseases seen in humans characterized by gingival inflammation, as well as loss of connective tissue and alveolar bone from around the roots of the teeth, if untreated may eventually lead to tooth loss. Chronic Kidney Disease is a condition which is characterized by either kidney damage or a decrease in kidney function lasting three months or longer. Studies have established a relationship of CKD with periodontal diseases but the relationship yet established is an association and not causation. Poor oral hygiene is linked with periodontal disease, and lack of proper tooth brushing and other measures of oral hygiene can encourage bacterial deposition and build-up of dental plaque on teeth and gums which can set a stage for inflammatory changes in periodontal tissues. There is pronounced relationship between poor oral hygiene and increased accumulation of dental plaque, Calculus, high prevalence and increased severity of periodontal disease. Objective: The aim of this study is to assess oral hygiene practices and periodontal conditions among Chronic Kidney Diseases patients attending the Muhimbili National Hospital. Material and methods: This was hospital based descriptive cross-sectional study conducted at nephrology clinic at Muhimbili National Hospital. A total of 154 CKD patients, 84 (54.4%) male and 70 (45.5%) female aged 22 to 77 years were recruited. Full-mouth examination was performed and all six surfaces of teeth were examined. The subject’s socio-demographic and Oral hygiene practices were gathered through self-administered structured questionnaires followed by full mouth clinical examination carried out by a single examiner for assessing the presence of plaque, calculus, gingival bleeding on gentle probing, periodontal pocket depth, gingival recession and periodontal attachment loss. The gathered information were coded, entered in a computer and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 20. Frequencies and percentages were generated to show the distribution of specific parameters in periodontal patients. Mean scores were calculated for each periodontal parameter scored and the independent sample ‘t’ test was used for comparing the mean number of sites with plaque, bleeding, calculus, pockets, gingival recession and connective tissue attachment loss according to the age groups, education and sex respectively and the level of statistical significance was set at p < 0.05. ANCOVA was used to analyze the effect of confounder .Chi square test were used for comparing proportion. Results: The study population is composed of 154 CKD patients of whom 84 (54.4%) were males and 70 (45.5%) were females providing a male to female ratio of 1:1. Their age ranged from 22 to 77 years (Mean 49.93±13.06). Very few participants (1.3%) had no formal education and (45.5%) had primary education, and majority (53.2%) had secondary or higher level of education. Concerning brushing habits (51.9%) brushed once per day, (48.5%) brushed more than once per day, Regarding the use of brushing device (mswaki) for tooth cleaning (97.4%) reported to be using plastic tooth brush only for brushing and (2.6%) reported to be using both plastic and chewing stick for cleaning their teeth. All studied participants (100%) reported using fluoridated tooth paste for brushing. The mean number of sites with gingival bleeding was 7.27 ± 9.24. The prevalence of dental plaque was (74.7%). The mean number of surfaces with dental plaque was 46.73 ± 36.91. The prevalence of dental calculus was (70.8%). The mean number of surfaces with calculus was 34.31±29.61. The prevalence of periodontal pockets as (36.4%) The mean number of sites with gingival recession was 7.98 ± 10.24. The prevalence of attachment loss was (39%). The mean number of surfaces periodontal pocket was 4.12 ± 6.74. The prevalence of gingival recession was (54.5%). The mean number of surfaces with attachment loss was 7.81±11.79. Conclusion; In conclusion, most of the study population brushes their teeth once per day and visited a dentist less than once annually, oral hygiene status in this study population was poor, majority of the patients presented with plaque, calculus and gingival bleeding on gentle probing in most of the teeth surfaces examined. Periodontal pocket depth and attachment loss were associated with males sex.