CHRONIC APICAL PERIODONTITIS IN CHRONIC KIDNEY DISEASE PATIENTS
condition in the chronic kidney disease, the cardiovascular disease. Atherosclerosis is a multifactorial disease, which occurs at young ages and evolves with age. The presence of cholesterol crystals is also recognized in atherosclerotic plaques in humans. Slutzki-Goldberg et al. 13 conducted a study in which they evaluated the possible link between age and cholesterol deposits in periapical lesions. They have examined the biopsies of lesions identified in a group of teenagers and one of elderly and found that there is a significantly increased incidence of cholesterol deposits in periapical biopsies performed in elderly individuals, where serum cholesterol levels were elevated. The cholesterol crystal formation mechanism is probably similar to the genesis of atherosclerosis. Chronic apical periodontitis is an acute or chronic inflammatory lesion, present around the apex of a tooth and caused by a bacterial infection of the endodontic system. Histologically, it is represented by a periapical inflammatory response that occurs after the resorption of the adjacent support bone and local infiltration of inflammatory cells. 14 Thus, the significant associations, between lower serum albumin values and the high number of periapical lesions, from this study were not statistically surprising given that hypoalbuminemia(< 3.5 mg / dL) can be caused by acute or chronic inflammatory responses.
5. Conclusions This descriptive study showed that chronic apical periodontitis is highly prevalent in patients with chronic kidney disease, but future research is required to determine whether endodontic diseases are worsened by the chronic kidney disease or vice versa. The detection of some abnormal cholesterol and albumin levels during the regular investigations of patients with chronic renal failure, require a mandatory dental visits that will be associated with a radiological examination to detect chronic apical periodontitis. Most often silent from a clinical point of view, chronic apical periodontitis is diagnosed accidentally or following an acute exacerbation. These are powerful outbreaks of infection with diverse microbial flora camped at this level, able to cause amplification of the inflammatory response in the chronic kidney disease. The results obtained in our study emphasize the importance of radiological examinations for all patients, prior to kidney transplantation, since they may have teeth with inflammatory lesions, which cannot be clinically detected. According to the World Health Organization, health is an essential part of the social, economic and personal development of the individual and an important component of the quality of life. Especially in patients with CKD, the health of the oral cavity must be permanently assisted and improved in order to maintain a good overall body condition.
Acknowledgments The authors declare no conflict of interest related to this study. There are no conflicts of interest and no financial interests to be disclosed.
REFERENCES
1. Barnett ML. The oral-systemic disease connection. An update for the practicing dentist. J Am Dent Assoc. 2006; 137 Suppl 2:5S-6S. 2. Ursea N. Insuficienţa renală cronică. In: Esenţialul în nefrologie, Ursea N, editor. Bucureşti: Editura Fundaţiei Române a Rinichiului; 2000:197-226. 3. Gomes MS, Blattner TC, Filho MS, Grecca FS, Hugo FN, Fouad AF, Reynolds MA. Can apical periodontitis modify systemic levels of inflammatory markers? A systematic review and meta-analysis. J Endod. 2013; 39( 10): 1205-1217. 4. Buhlin K, Bárány P, Heimbürger O, Stenvikel P, Gustafsson A. Oral health and pro-inflamatory status in end-stage renal disease patients. Oral Health Prev Dent. 2007; 5( 3): 235- 244. 5. Thorman R, Neovius M, Hylander B. Clinical findings in oral health during progression of chronic kidney disease to end-stage renal disease in a Swedish population. Scand J Urol Nephrol. 2009; 43( 2): 154-159. 6. Marques MD, Moreira B, Eriksen HM. Prevalence of apical periodontitis and results of endodontic treatment in an adult, Portuguese population. Int Endod J. 1998; 31( 3): 161- 165. 7. Skudutyte-Rysstad R, Eriksen HM. Endodontic status amongst 35-year-old Oslo citizens and changes over a 30- year period. Int Endod J. 2006; 39( 8): 637-642. 8. Jiménez-Pinzón A, Segura-Egea JJ, Poyato-Ferrera M,
Velasco-Ortega E, Ríos-Santos JV. Prevalence of apical periodontitis and frequency of root-filled teeth in an adult Spanish population. Int Endod J. 2004; 37( 3): 167-173. 9. Loftus JJ, Keating AP, McCartan BE. Periapical status and quality of endodontic treatment in an adult Irish population. Int Endod J. 2005; 38( 2): 81-86. 10. Tsuneishi M, Yamamoto T, Yamanaka R, Tamaki N, Sakamoto T, Tsuji K, Watanabe T. Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100( 5): 631-635. 11. De Moor RJ, Hommez GM, De Boever JG, Delmé KI, Martens GE. Periapical health related to the quality of root canal treatment in a Belgian population. Int Endod J. 2000; 33( 2): 113-120. 12. Nair PN. On the causes of persistent apical periodontitis: a review. Int Endod J. 2006; 39( 4): 249-281. 13. Slutzky-Goldberg I, Baev V, Volkov A, Zini A, Tsesis I. Incidence of cholesterol in periapical biopsies among adolescent and elderly patients. J Endod. 2013; 39( 12): 1477- 1480. 14. Segura-Egea JJ, Jimenez-Moreno E, Calvo-Monroy C, Ríos-Santos JV, Velasco-Ortega E, Sánchez-Domínguez B, Castellanos-Cosano L, Llamas-Carreras, JM. Hypertension and dental periapical condition. J Endod. 2010; 36( 11): 1800-1804.
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