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CHRONIC APICAL PERIODONTITIS IN CHRONIC KIDNEY DISEASE PATIENTS

Table 1 . Relations between apical lesions and demographic variables Gender Age Environment Education CKD Etiology

Table 2 . Relationship between chronic apical periodontitis on the one hand , and smoking , diabetes , BMI , cholesterol , serinemia , on the other hand

Smoking Diabetes BMI Cholesterol Albumin

Table 3 . Relations between apical lesions on the one hand , and eRFG , CKD stage , on the other hand

Apical lesions Pearson Correlation Sig .( 2-tailed ) N eRFG

. 034 . 813 50

CKD Stage

. 005 . 972 50

4 . Discussion

The study was performed on a group of 51 patients , the same number used by Buhlin et al , 4 who investigated the oro-facial health of patients with end-stage renal disease , focusing on their periodontal conditions . They showed that a substantial number of patients who suffer from chronic kidney disease have dental problems that required attention . The investigation of infection sources in this study was complemented by panoramic radiographs , which enabled visualization of teeth together with the bone support structures . Studies using radiological analysis for patients with chronic kidney disease are limited in the literature . In the present study , the most common radiological changes observed were deposits of calculus , dental caries and the presence of chronic apical periodontitis . For the latter , periapical radiographs were the only means of identification , approximately 70 % of patients from the group investigated having at least one periapical lesion , characteristic for chronic apical periodontitis . In a similar study , Thorman et al . 5 compared the panoramic radiographs of 93 pre-dialytic and dialytic patients with chronic kidney disease with a control group and found an increased prevalence of periapical infections in patients from the study group .

Epidemiological studies have shown that apical periodontitis is a chronic common disease in the general population . 6 , 7 , 8 However , data on the prevalence of chronic apical periodontitis vary between populations and countries , and depend on differences in the prevalence of dental caries , access to dental services and the methodology used .

Thus , a study conducted in Portugal on a group of 322 individuals resulted in a 27 % prevalence of chronic apical periodontitis 6 and another study in Norway a 16 %. 7 Higher values were reported in research conducted by Jiménez-Pinzón et al . in Spain ( 61.1 %), 8 Loftus et . al in Ireland ( 33.1 %), 9 Tsuneishi et al . 10 in Japan ( 69.8 %), Demo et al . 11 in Belgium ( 63.1 %). The results of this study showed that elevated serum cholesterol levels (> 190 mg / dL ) are associated with an increased number of chronic apical periodontitis . The explanation could be given by the presence of cholesterol crystals , commonly found in biopsies of periapical lesions . It seems these crystals come from disintegrated erythrocytes present in the blood vessels stagnant inside a lesion , lymphocytes , plasma cells and macrophages ( which decay into periapical lesions ) and circulating plasma lipids . Once they have been deposited , cholesterol crystals act as irritants and cause foreign body reactions . Macrophages and giant cells trying to devour cholesterol crystals , but are unable to degrade crystalline cholesterol . Furthermore , macrophages exposed to cholesterol crystals apparently act like a bone lysis and thus a chronic inflammation in the periapical area is supported . 12

Cholesterol is also related to another common