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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
Apical Lesions Pearson Correlation Sig.( 2-tailed) N
. 199. 162 51
-. 038. 791 51
. 083. 562 51
-. 141. 322 51
-. 095. 509 51
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
Apical lesions Pearson Correlation Sig.( 2-tailed) N
. 119. 404 51
-. 199. 162 51
-. 010. 948 48
. 411 **. 004 48
-. 440 **. 002 48
**. The association is significant at p < 0.01
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

30 STOMA. EDUJ( 2016) 3( 1)